Plans by Nigeria’s government to cut healthcare spending risk undermining the country’s coronavirus response and severely impacting already strained services, health and transparency groups have warned.
Funding for local, primary healthcare services will be cut by more than 40% this year in a revised budget expected to be passed into law in the coming weeks.
The proposed cuts could affect immunisations, childcare, maternal healthcare and family planning services.
Nigeria currently spends less than 5% of its federal budget on health. Dwindling oil sales, the crash in global oil prices and the impact of the coronavirus pandemic are understood to be the reason for the cuts.
According to Prof Innocent Ujah, the head of the Nigerian medical association, the proposed cuts have come just as more investment in health is needed.
“Our budget for health is unacceptably low, under 5%. With the Covid-19 pandemic, it becomes even more serious,” he said. “It will have an impact on our response to the virus.”
Ujah said he was shocked at the announcement of the cuts, as it had been assumed health budgets would be ringfenced during the pandemic.
Fuelling criticisms of the healthcare cuts has been the 37bn naira (£75m) set aside for renovations to Nigeria’s National Assembly buildings.
“Whatever renovations they want to do in the National Assembly should be suspended,” Ujah said. “This is a global emergency.”
The legislative body is heavily criticised in Nigeria for the lack of transparency in government spending and for the high salaries of lawmakers.
Oluseun Onigbinde, the director of BudgIT, an organisation which tracks government spending, said that the budget cuts were not distributed fairly.
“The National Assembly budget was cut 10%, but the severe cuts were made to education and healthcare,” he said.
“It’s a bit shameful that Nigeria’s allocation for health and education has not gone above 5% of the total budget provision in the last five years. The government has really underinvested in healthcare.”
Nigerian authorities took early steps to try to contain the outbreak of Covid-19. But cases are steadily rising, doubling in the past three weeks to 12,000 infections.
A number of challenges have undermined its test and trace strategy, including too few test kits. Just 80,000 tests have been administered, far lower than the country’s health officials want.
The Nigerian Centre for Disease Control has said 75% of infections are occurring in communities without an identifiable trace.
Adding to the challenges are issues with morale among some health staff.
Fifty doctors and nurses at a key Covid-19 response centre in Lagos University teaching hospital say they have not been paid the allowances promised to workers caring for coronavirus cases since April. The allowances are paid on top of their usual salaries.
According to staff who spoke on condition of anonymity, the delay in receiving allowances was making it difficult to recruit health professionals to fight the virus.
“We were assured payments for the Covid response. We started in April, but we’re in the third month and we haven’t been compensated,” said one member of staff.
Many had not seen their families in three months to prevent spreading the virus, and were furious that their payments are not being prioritised.
“We’ve put our lives on the line here, now for us not to be paid is inhumane,” the health worker said.
Government officials said they are working to address the payment delays.
“They have assured us they are working on this but such issues are causing much disillusionment,” said Ujah. “No matter what, in a healthcare emergency, motivation is a very important component.”