2024: A preview of Nigeria's State Health Budget Landscape
Exploring Nigeria's health budget allocation, this piece unveils disparities in state-by-state health allocations and offers practical insights for policymakers.
As 2023 draws to an end and states submit their preliminary budgets for approval by the State House of Assemblies, this article delves into critical aspects of health budget allocation, revealing initial patterns that shape the nation's healthcare priorities. States that allocate more resources to health generally exhibit better health indicators, including lower maternal and infant mortality rates, higher life expectancy, and improved overall public health. In essence, robust governmental health spending serves as a cornerstone for building healthier and more resilient societies.
Data used in this analysis was sourced from press releases from state governments and, where available, calculations made from draft budgets which were publicly available on state websites (which were less than five. However, seven states - Akwa Ibom,Ebonyi, Ekiti, Imo, Osun,Plateau and Zamfara - had no publicly available information on their health allocations (as at the time of writing). This was then entered and formatted into an Excel Sheet, and then analysed and visualised in Excel and Tableau respectively.
The total Tableau dashboard can be viewed here while individual visualisations can be seen in the captions of the images. Alright, let’s dive in!
Healthcare Budget Share: What percentage goes to Health?
Circa 2001, the African Union pledged to spend about 15% of its budgetary allocations on the Health Sector. This was with the aim of mobilising more resources for the development of the health sector.
23 years down the line, only 7 states in Nigeria - Bayelsa, Abia, Bauchi, Benue, Borno, Kano and Yobe ✅- are currently hitting that target. Commendably, three of these states are in the North Eastern region of Nigeria - areas that have had historically underdeveloped health indices. Contrastingly, no state in South Western Nigeria is spending as much - with Ogun spending 12% and Lagos spending a lowly 7%. Bayelsa has the highest share nationwide, with 17% of its budget going to Health. Abia State also made massive strides, with Governor Otti implementing a massive increase to make sure Abia hit the 15% target. However, Adamawa is spending only 3% of its budget on health. Interestingly, oil-rich states like Rivers and Delta State are only spending 4% of their budgets on health.
State Budgets on Health: What Each State Has to Spend
Lagos has the highest amount committed to health, with 156 billion committed to the health system. This is almost as much as the two successive highest states - Abia and Ogun with 85 and 81 billion respectively, combined. On the other end of the spectrum, Adamawa, as mentioned earlier, is spending only 6 billion on Health. The majority of states are spending between 26 to 42 million on Health.
Healthcare for All, Healthcare for You: How Much is Spent Per Person?
Healthcare expenditure per capita (HEPC) shows the total expenditure on health relative to the beneficiary population. Simply put, it shows how much money the government is spending on each person’s health. When a government attributes proportionately less of its total expenditure on health relative to its population, this may indicate that health is not regarded as a priority.
Abia, Ogun and Lagos lead the way with 22, 14 and 12 thousand Naira being spent as HECP respectively while Adamawa, Anambra and Kebbi are spending the least HECP with approximately 1, 3 and 3 thousand naira respectively. Most states are spending between 5 to 9 thousand Naira per individual.
Is there any relationship between Health Spending and Health Indicators?
In order to assess if there is any relationship between Health spending and health outcome, we can crossmatch and visualise the HECP with the percentage of women (15-49 years) who had live births in the last 2 years and were assisted by Skilled birth attendants. This statistic was chosen because it indirectly indicates the health workforce available per state and is also a good prognosticator of both maternal and infant mortality.
On closer assessment, it is safe to assume that there is a positive correlation (although not very strong) between governmental health spending and health outcomes - states that spend more have better health indicators.. There also seems to be a stronger geographical correlation, as states with lower spending and poorer indicators (North East and North West) are clustered together. However, other confounders like educational status among others must be properly considered before taking this.
In conclusion
States need to prioritise health by increasing health allocations to the 15% target for improved overall healthcare for citizens. While this applies to a vast majority of states in the country, this is particularly important in the Northern parts of Nigeria where health indicators are lagging behind.
In instances where necessary, federal resources may be strategically allocated based on state-specific needs, to meet up deficits in total state health budgets.
States must also explore ways to optimize HEPC, where states with lower spending power prioritise capital projects in order to ensure equitable healthcare access.