NIGERIA MISSES HEALTH TARGET, S'AFRICA, RWANDA TOP SPENDING

THE World Health Organisation (WHO) has identified Nigeria as one of the 46 African countries that have failed to meet the Abuja Declaration 10 years on, and one of the 38 that are off track in meeting the health-related Millennium Development Goals (MDGs) by 2015.

A WHO scorecard entitled: 'The Abuja Declaration: Ten Years On' released last week noted that only Rwanda and South Africa have achieved the Abuja Declaration target adopted by the African Union (AU) in April 2001 to increase government funding for health to at least 15 per cent.

The Guardian learnt  that since 2001 the Federal Government has been allocating between five and eight per cent of her yearly national budget to health, and the 2011 budget is no different.

In September 2000, 189 heads of state adopted the Millennium Declaration designed to improve social and economic conditions in the world's poorest countries by 2015.  Subsequently, a set of eight goals were devised, drawing on the Millennium Declaration, as a way of tracking progress.  Three of these relate specifically to health; two more have health components.

In April 2001, heads of state of African Union countries met and pledged to set a target of allocating at least 15 per cent of their annual budget to improve the health sector. At the same time, they urged donor countries to fulfill the yet to be met target of 0.7 per cent of their Gross National Product (GNP) as official Development Assistance (ODA) to developing countries. This drew attention to the shortage of resources necessary to improve health in low-income settings.

A breakdown of the progress since 2001 in the African Union countries for indicators for health and government health expenditures by WHO showed that Nigeria is one of the 17 African countries that spent less than $33 per capita as health share of total spending of government, and are off track on health MDGs. The other countries are: Burkina Faso, Burundi, Cameroun, Chad, Comoros, Congo, Cote d'Ivoire, Djibouti, Ghana, Guinea Bissau, Liberia, Mali, Mozambique, Senegal, Uganda and Zambia. According to the WHO, although Eritrea and Rwanda spent less than $33 per capita in 10 years they are on track to meeting health-related MDGs.

However, the WHO report noted that Nigeria is one of the 27 countries that have increased the proportion of total government expenditures allocated to health (GGHE/GGE) since 2001.

The WHO report reads: 'Only eight countries are on track with respect to the health MDGs.  Most countries are achieving less than 50 per cent of the gains that would be required to reach the goals by 2015, with progress on MDG 5 (maternal health) being particularly slow. Twenty-seven countries have increased the proportion of total government expenditures allocated to health (GGHE/GGE) since 2001. However, only Rwanda and South Africa have achieved the Abuja Declaration target of at least 15 per cent.'

Meanwhile, seven countries reduced their relative contributions of government expenditures to health during the period. In the other 12 countries, there is no obvious trend upwards or downwards.

'The median level of real per capital government spending from domestic resources on health has increased from US$ 10 to US$ 14 over the decade, although the lowest observed level is still very low at US$ 0.47.  Interestingly, the upper level has fallen from US$ 380 to US$ 314.  The governments of 32 countries currently spend less than US$ 33 per capita on health.

'Of the 14 countries that spend more than US$ 33 per capita, 71 per cent are middle-income countries. It is important to consider both the share of government spending devoted to health as well as the overall level of spending when considering the ability of a country to meet the health MDGs.  The issue is less whether the ratio of GGHE/GGE is static, decreasing or increasing, than the fact that as long as per capita health expenditure is low, countries will not achieve the health MDGs.  However, if both the ratio and per capita real spending increase, the financial constraints to reaching the health MDGs will obviously be reduced.'

The WHO concluded: 'Most AU countries are not yet on track to achieve the health MDGs and part of the explanation can be found in the lack of financial resources available to them.  The Abuja Declaration recognised this as a potential problem 10 years ago, highlighting the importance for governments in AU countries of giving greater weight to health in the allocation of government revenues, while at the same time urging donor countries to increase their funding levels.

'In the 10 years that has passed since the Abuja Declaration, there has been progress towards increasing the availability of financial resources for health at least in terms of dollar values.  However, there has not been appreciable progress in terms of the commitments the AU governments make to health, or in terms of the proportion of GNI the rich countries devote to ODA. While it is important to reiterate the need for governments to be committed to improving the health of their populations, something that is increasingly becoming a political issue in countries, it is also important to look for additional ways of moving more rapidly towards the MDGs.

'The World Health Report 2010 provides some ideas in terms of ways of raising new global and domestic funds for health, ways of increasing financial risk protection relating to health, and ways of becoming more efficient in the use of external and domestic resources used for health. Time is short, but solutions do exist.'