20th Anniversary of the Abuja Declaration (2001-2021) Assessing Nigeria’s two-decades spending on the health sector: why poor allocation, releases & utilization persist?

In 2001, Health Ministers of African countries, including Nigeria’s Health Ministry met and signed the Abuja Declaration. In this meeting, African countries pledged to commit 15% of their total annual budgets to the health sector. The 20th April marks the 20th Anniversary of the Abuja Declaration. Unsurprisingly however, an in in-depth review of national and state-level Health budgets between 2001 and 2021 reveals that this pledge was not met. To this date, Nigeria’s highest allocation to the health sector in an annual budget was 6.23% in 2012. Therefore, the annual average budgetary allocation to the Health Sector over the past 20 years stands at a mere 5.05%. These allocations were significantly short of the 15% committed too in the Abuja Declaration. Put plainly, this represents a 9.95% shortfall.

It is in consideration of the preceding that the development Research and Project Centre’s (dRPC) Partnership for Advocacy in Child and Family Health at Scale (PACFah@Scale) project organised a webinar as part of the first in a series of activities intended to mark the Abuja Declaration. Indeed, the DRPC has developed strong partnership with other Gates Foundation guarantees to showcase the significance of this anniversary.

Dr. Stanley Ukpai, the PACFaH@Scale Project Director, in a signed statement remarked on the timeliness and significance of the webinars topic given the current demands on health sector financing to address epidemics while at the same time continuing to provide Essential Health Services. This is the right time to reflect on fundamental questions on 20 years of health financing around – allocation, utilization, and releases.

The webinar held on the 20^th of April 2021 with the theme – 20th Anniversary of the Abuja Declaration (2001-2021): Assessing the Two- Decades of Spending in the Health Sector; Why Allocation, Releases, and Utilization Persist? In attendance was Ms. Ada Ezeokoli, Editor In chief of the Nigeria Health Watch as moderator. The panellists then included Dr. Afolabi Adejumo, Techincal Advisor to the Director-General of the Budget Office, Nigeria, Mr. Stanley Achonu, CSO Adviser, Open Government Partnership, Nigeria; Mr. Abel Akeni, Head, Research and Policy Advocacy, BudgIT, and Esther Faleye, Ex-Coordinator, Open Alliance, Nigeria.

The 10.31% shortfall which was the subject of the stakeholder dialogue begged the question – why are funds returned to the public treasury every year since 2001 despite the low allocations of less than 15%? In addition to the poor releases, the funds were seldom utilized by the Health sector Ministries Departments and Agencies (MDAs). Inadequate absorptive capacity to use health sector funds allocated has led to the return of funds back to the treasury every year in the last 20 years.

In the webinar, the panellists highlighted the efforts of everyday Nigerians trying to access basic health care as they the ones most affected by the lack of proper funding. However, key recommendations were made on how to address the funding shortfall. Worth noting was Dr Afolabi’s suggestion that pressure should also be applied on State Governments to allocate proper funding as the state is closer to the people than even the Federal Government. In addition, Dr Stanley recognised the central role of CSO’s that have worked to track funds and to advocate for more health funding from the Federal Government.