By Emejuiwe Victor
THE right to health including (Maternal, New Born and Child Health – [MNCH]) is understood as a right to the enjoyment of a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable state of physical and mental health. MNCH is part of the core content of the right to health and a minimum core obligation of the Nigerian state under national and international standards.
In times of grave national crisis and resource constraints as currently experienced in Nigeria’s economic recession, vulnerable members of society are entitled to special protection and care through the adoption of low cost targeted measures.
These measures should be aimed at accessibility of MNCH services – physical and economic accessibility on the basis of non-discrimination to acceptable and qualitative healthcare services.
The total budget for health is N304,190,961,402 and a review of the budget shows that line items allocated for Maternal, Newborn and Child Health in the 2017 proposed budget is N24,797,066,804. This amount is insufficient to meet up with the demands required for improving MNCH in Nigeria.
Using the estimates required for funding MNCH released by the Organization for Economic Cooperation and Development (OECD); there is an accumulated five year funding gap amounting to N20 trillion.
Major components of MNCH which requires financing includes; the sum of $223m annually for vaccines procurement. In the 2017 budget only 21% of the vaccine needs were provided. For nutrition, according to UNICEF report, about 2.5m Nigerian children are malnourished; each child requires $61 for provision of Ready to Use Therapeutic Food which amount to N46bn, however, in the budget just 1.2bn is proposed for nutrition.
The annual costed plan of action for nutrition (NSPAN) assumes that FGN will provide $10m annually for the period 2014-2018 for nutrition related expenditure. The 2017 budget had just N915m for this in the estimates.
For Family Planning, the sum of $122.5 million is required for FP in 2017 because Nigeria has a costed policy document for Family Planning – Nigeria Family Planning Blueprint (Scale-Up Plan 2014 – 2018).
This was developed to address the London Commitment of increasing CYP to 36% by 2018. However, if partners’ contribution to commodities is pegged at $33 million USD, Nigeria has to fund a total of 111 million USD. Even the pledge of providing $11.5m by FGN was not met. Nigeria needs about N37.2billion to finance this item. In the 2017 estimates only N915, 000,000 was proposed.
Another major line item that is proposed for the 2017 budget is the revitalization of PHCs; N3bn was proposed to revitalize 1000 PHCs which translates to N3m per PHC. The requirement for making PHCs functional especially in the current economic climate in Nigeria indicates that the proposed sum will not be sufficient for the project.
Other component of MNCH which requires major funding is the treatment of VVF. The World Health Organization (WHO) report shows that Nigeria has 800,000 cases of VVF epidemic.
To treat a VVF patient, N100, 000.00 is needed per patient for surgery, remediation and rehabilitation which translates to N80bn. The federal government is required to make a provision of N20bn every year to end this scourge.
The shortfall in the funding of most of these major MNCH commodities highlighted above, shows that MNCH in Nigeria is under emergency and also requires emergency solutions. Unfortunately the federal government has not demonstrated the political will to implement the various funding options that will address the problems of MNCH in Nigeria.
The federal government should begin the process of mobilizing resources for MNCH services. The Voluntary Contributory Health Insurance Scheme should be revisited. The scheme as currently practice does not enjoy wide coverage in Nigeria.
It has become pertinent to make the scheme compulsory, especially for women and girls of reproductive age. This will not only address the issue of Inequality in the accessibility of health care services but it will also guarantee availability of funds to handle most of the health challenges facing mothers and children.
Currently, the Voluntary Contributory Health Insurance Scheme is meant for people who are not covered under the NHIS. It allows membership coverage for interested individuals, families, employers of establishments with less than 10 staff and actively self employed persons. According to the NHIS, with the sum of N15, 000 an individual can be covered by the scheme and the amount can be paid monthly.
There is lack of effective policy implementation of the VCHIS in Nigeria, coupled with lack of sensitization. The funding gap on MNCH should be seen as an opportunity to reactivate the VCHIS.
The federal government should conduct a multi-stakeholder consultation to consider a framework that will strengthen the implementation of the scheme for every citizen of Nigeria, especially for women and young girls of reproductive age.
Victor, Program Officer (Good Governance) writes from Centre for Social Justice, Abuja.