Niger’s budget takes toll on maternal, child health
March 2, 2017This article originally appeared in New Telegraph.
For a nation to be productive and be categorised among world powers, its citizens must be healthy and have access to quality and affordable healthcare services when the need arises. In this report, DAN ATORI writes on the state of health facilities in Niger State, budgetary allocation, citizens’ participation and government’s effort to move things forward
By Dan Atori
Apart from the issue of inadequate funding, untimely release of allocated funds, extremely weak supervision, monitoring and evaluation of programme activities have adversely affected the health sector in the country.
As a result of poor budget allocation, some key activities such as immunisation, family planning, nutrition, among others have been neglected due to input of little or no funding. Little is done to prevent vaccine preventable deaths that occur daily in the state.
This is so because when the citizens, especially children who are the future leaders are immunised through the administration of vaccines, they are protected against infectious diseases.
Surprisingly, immunisation which is a proven tool for preventing life threatening infectious diseases has not been given priority in the state. From the report of the 2015 immunisation checklist, it is clear that none of the 25 local government areas of Niger State received funds for immunisation activities and only 28 per cent of private health facilities offered routine immunisation.
Mahatma Gandhi, in one of his many quotes said that “It is health that is real wealth and not pieces of gold and silver.” This quote, no doubt, speaks for itself as health is the greatest wealth any human being can boost of.
Our leaders know this fact and that is why they spend billions of naira going for medical check-up abroad at the expense of the ordinary man because when and where most of our healthcare facilities are available, services lack expected standard, required number of human resources and internationally acceptable professionalism.
It is common to see a healthcare facility in Nigeria where there is no basic equipment and where equipment exists there are few or no professional workers.
The quality of healthcare services in the country is generally considered as poor due to shortage of manpower, though Nigerians are among the best doctors and nurses in the world.
Based on this background, the call for accountability has become pertinent, as a nongovernmental organisation, the White Ribbon Alliance, Nigeria (WRAN) has remained undaunted in getting stakeholders especially citizens to advocate and hold governments accountable.
However, over the years, the health budget allocated to Niger State has remained low irrespective of calls from many quarters to increase it in order to meet the 2011 Abuja Declaration to earmark 15 per cent of total budget to health.
Looking at the 2016 state budget tagged ‘Budget of Restoration’, out of the total budget of N85,092,122,133.00 approved, N7,573,351,359.00 of the total budget was allocated to health, bringing the percentage to 8.90 per cent. Looking at the budget performance for 2016 as it concerned capital appropriation and capital release (Capital appropriation was N3,067, 084,195.00 while capital release stood at N503,430,975.00).
It is sad to note that out of the total sum of N10,824,632,656.00 proposed by the state Ministry of Health and its parastatals for 2017, only N2.05 billion out of the N108 billion as proposed by the government as capital allocation in the proposed budget, was presented by the Government to the State House of Assembly.
In Niger state, citizens demand for citizen-led accountability and want to be involved in the decision- making process for proper accountability. To this end, several advocacy and Community Dialogue Meetings on Citizen-Led Accountability for Maternal, Newborn and Child Health, MNCH,in Niger state, stakeholders have identified inadequate budgetary allocation and poor implementation of policies in the health sector as obstacles to achieve expected outcomes in these areas.
Recently, WRAN organised a community dialogue on citizen led accountability in Meto village, Wushishsi and in Lapai Local Government Areas of Niger state where healthcare facilities are in dilapidated state. Citizens identified their healthcare challenges and suggested solutions in a way that if the government listened and more importantly act would yield positive results.
Commissioner for Health and Hospital Services, Dr. Mustapha Jibrin at various events disclosed that increasing healthcare centres is very important to the populace because as the population grows, the health care facilities come under pressure and new facilities were needed.
According to him “the Governor has assured that his administration would ensure children and women were adequately taken care of in the state, especially in the area of their health. Jibrin added, “we understand the situation in the sector.
Recently, 40 medical doctors, 10 specialists and 70 nurses were employed and additional medical personnel would be employed to fill the per-sonnel gap in the sector.” The Primary Health Care Centre at Meto has been fully occupied by bats with offensive stench from the faeces of the mammals.
The facility has been under lock and key as government according to the villagers did not send a single health worker ever since it was constructed. An investigation by the New Telegraph confirmed the claims as the facility is situated in an isolated area where the villagers complained was not serving the purpose for which it was constructed.
One of the women in Meto community, Hajia Hassana Mohammed lamented the poor state of health facility in the community, saying, “if there are serious health cases, we usually rush patients to Wushishi, a far distant location and sometimes, the patients die before we get to Wushishi”. According to her “none of us have set eyes on any health worker or seen the facility here opened for a very long time. Bats have taken over the health centre and government seems not to even care about us.”
While calling on stakeholders to participate wholly on issues that affect them, Country Director, WRAN, Tonte Ibraye said, “social and political changes can only be made with their involvement so that they can engage the government to bring about change that will improve delivery of maternal and new born health at all levels of care.”
When the New Telegraph visited Lapai LGA, one of the Midwives, Hajia Amina Monkwo, the Director of Primary Health Care, Lapai Locan Government Council area, (LGA), said that their major challenge was the rate at which health workers were retiring without effort by government to replace them. According to her “there are no workers. Government needs to employ more hands. I will soon retire.
My worry is that most of the pregnant women for fear that they may not get medical attention resort to Traditional Birth Attendants (TBAs). Many of them cannot even afford transport fare to the facility because of the distance.” She also complained that since 2013 they have not received any form of capitation, adding, “since 2011 when we discovered that we were understaffed, we decided to engage the services of adhoc staff. We pay them through the capitation. All our facilities in Lapai are in dilapidated state.
We have notified the local government authority that is in-charge but since then nothing has been done. “We want the State Government to help the LGC because majority of the people with health problems and those who don’t have access to good health facilities are in the rural areas and not in urban areas.
We need referral vehicles that can convey our elderly people to health centres,” she added. Also, the Chairman, Ward Health Development Committee and Village Head of Yamma, in Lapai, Alhaji Ibrahim Tafida said in order to achieve success, there is need for political commitment by the State government to increase health budget allocation and ensure timely release of allocated funds.
“I am a retired nurse, the health facilities in Lapai are in bad shape. We are the ones equipping and maintaining the PHC in Yamma. These politicians have abandoned us. There are no drugs; our communities usually contribute money to buy drugs.
There is only one health worker in a facility. “One nurse is attending to almost fifty to eighty patients in a day; we have retired yet government has not been able to employ new hands to replace us.”
In Nigeria, it is estimated that for every 10,000 people, there are four doctors to attend to them as most of the highly trained ones are leaving the country to where there are better infrastructure and better pay package.
One thing that is certain is that without adequate budget, timely release of allocated funds, citizens’ engagement, accountability and transparency in the health sector which represents the second component of human capital development, the economy of the state would be poor.
However, the state governor, Alhaji Abubakar Sani Bello after assuming office in May 2015, promised to reposition the state especially the health sector which is a key priority of his administration.
“Governments don’t have to wait until there is problem before they take action," according to a worker at the State Ministry of Health who pleaded anonymity. Also, Bello recently said that the state government will complete 74 Primary Health Care Centers across the state before the end of 2017.
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