BUDGETING FOR MATERNAL AND CHILD HEALTH

By Martins Eke

According to recent world health statistics released by the World Health Organisation (WHO), more than half of the births in Nigeria are not attended to by skilled health personnel. Maternal mortality ratio (per 100,000 live births) and underfive mortality ratio (per 1000 live births) amounts to 814 and 104.3 respectively, which are far below global standards. Proportion of married or in-union women of reproductive age who have their need for family planning satisfied with modern methods amounts to a paltry 26.3%, while female life expectancy at birth amounts to just 55.7 years. Clearly, Nigeria is very far from attaining Goal 3 of the Sustainable Development Goals (SDGs) which targets a reduction in maternal mortality ratio to less than 70 (per 100,000 live births) and a reduction in under-five mortality ratio to as low as 25 (per 1000 live births). While reforms within the health sector will go a long way to improve our odds, the need to ensure that our national budgets are in line with existing plans and policies cannot be overstated.

The budget is the most potent tool through which good governance and improved maternal and child healthcare services can be bestowed on Nigerians,hence the need for all hands to be on deck to ensure that the annual budgets of the federal ministry of health will translate into improved healthcare for Nigerian women and children. In the 2018 budget of the federal ministry of health, the appropriation of N20,000,000 for “maternal, infant and young child feeding in Nigeria” with budget code ERGP25112221 is commendable. The appropriation of N10,113,187 for “national cervical cancer screening scale up project” with budget code ERGP25112303 is also commendable. While there is need to increase the amounts for these budget line items, it is recommended that the implementation of the above mentioned line items and the implementation of numerous other similar line items in the 2018 budget should be done judiciously.

In the 2018 budget, the National Primary Healthcare Development Agency (NPHCDA) made provisions for construction/ renovation of primary healthcare centres nationwide. NPHCDA also made provisions for supply of drugs, medical outreach, operational vehicles, boreholes and public conveniences, etc; the total capital vote of NPHCDA in the 2018 budget amounts to N23,303,284,603 (Twenty three billion, three hundred and three million, two hundred and eighty four thousand, six hundred and three naira). Clearly, this is not an amount of money that should be lost to frivolities. Women and children are the most direct beneficiaries of budgetary appropriations for primary healthcare, hence mainstreaming value for money in the procurements of NPHCDA will translate to improved healthcare services for Nigerian women and children.

Also, in the 2018 budget of the federal ministry of health, the appropriation of N70,000,000 for “training of nurses and midwives with specialised skills” with budget code ERGP11132980 by the Nursing and Midwifery Council is commendable.The appropriation of N37,000,000 by the Nursing and Midwifery Council for “procurement of personal protective equipment for handling of infectious diseases” with budget code ERGP11132981 is also commendable.

Women and children will be the biggest beneficiaries of the appropriations of the Nursing and Midwifery Council; hence civil society organisations are encouraged to monitor the implementation of the over N284 million capital vote of the Council. The total capital votes of the National Obstetric Fistula Centres in Abakaliki, Bauchi and Katsina amounts to N990,72 5,307, N337,620,364 and N282,380,385, respectively. Since Obstetric Fistula is a purely maternal health challenge, individuals and groups dedicated to the welfare of women are encouraged to monitor the disbursements of these huge sums of money.

In order to improve the quality of Nigeria’s annual budget for maternal and child health in subsequent years, there is need to increase budgetary allocations to family planning in accordance with Nigeria’s commitments at the London Summit and National Family Planning Scale up Plan 2014. The annual allocation to nutrition should be increased in line with Nigeria’s National Food and Nutrition Policy. Construction and rehabilitation of primary healthcare centres by the federal government across the country should be accompanied by commitments from the state and local governments to fund the recurrent expenditures of these healthcare centres. The funding gap in immunisation should be reduced while steps should be taken to enact the Nigerian Immunisation Trust Fund Bill in order to ensure sustainable funding of immunisationprogrammes. Full details of unclear and omnibus line items in the annual budget for maternal and child health should be made available to civil society organisations and independent monitors. Details of disbursements of donor and counterpart funds for maternal and child health should be made public.