By Yusuf Ishaku Goje
Kaduna State’s health sector faces significant challenges, with an out-of-pocket health expenditure that far exceeds the 30-40% benchmark and is above the national average; and unacceptable child and maternal mortality rates. This is not unconnected with the level of public investment in the sector.
Kaduna State’s 2024 approved budget has been hailed for meeting the 15% recommended allocation for health expenditure. As of the half-year of 2024, the health sector expenditure (23 billion) performance is 13.1% of the total expenditure (N181 bn). On the surface this is commendable, however, a closer examination of the details are unsettling. More so, that it is per capita of N2,538, using a conservative projected (2020 est.) population of 9.4 million.
A breakdown of the performance of the eight MDAs under the health sector reveals that none exceeded 41% performance of the full-year budget as well as met or surpassed the half year benchmark of 50%. Furthermore, by percentage performance as at half-year, the Ministry of Health had the highest, a 40.2%; followed by Barau Dikko Teaching Hospital, Kaduna, 30.1%; and Kaduna State Primary Health Care Board, 22.7% performance.
Interestingly, the above three MDAs gulped 98.5% of the total half-year health sector budget performance. The others were left to manage less than 2%. Compared to the full-year budget, as at half-year, the Kaduna State Contributory Health Management Authority (KADCHMA) had 2.2%; Kaduna State Health Supplies Management Agency (KADHSMA) had performance of 4.4%; Bureau for Substance Abuse Prevention & Treatment (KADBUSA), 4.4%; Kaduna State AIDS Control Agency (KADSACA), 35.7%; and Kaduna State College of Nursing and Midwifery, 18.7%.
Similarly, a deeper look shows not too impressive performance in some of the key health priority areas with very few exceptions. For instance, as at the 2nd quarter the allocation for Purchase of Health/Medical Equipment had 43.9% performance; while Drugs/Laboratory/Medical Supplies had 0% performance.
In addition, HIV Intervention Fund: N752,700.00 had a 19.1% performance; Emergency Medical Services, 2.4%; Public Health Operations, 11.9%; Health Care Financing, 9.2%; Family Planning (FP Programme), 0.1%; Public Health Emergencies, 1.4%; Health Information Management System, 1.0%; Human Resources for Health, 2.6%; with MNCH Week Expenses, Immunization Plus Day Expenses and Rehabilitation/Repairs – Hospital/Health Centers all having 0%.
Of concern is that as at half-year, we have spent more on Welfare package (N649.9 million), Entertainment and Hospitality (427.1mn), Citizens Engagement (N611.8mn), International Transport and Traveling (N400.4mn) compared to KADCHMA (N27,6mn), KADHSMA (N109.5mn), and KADBUSA (N17,2mn) and KADSACA (N26,7mn).
Same can be said of Purchase of Health/Medical Equipment: (N15.1mn), HIV Intervention Fund (N752,700), Emergency Medical Services (N141,000), Public Health Operations: (N1.5mn), Health Care Financing: (N164,000), Family Planning (N40,000), Public Health Emergencies (N3.3mn), Health Information Management System, (N138,500), Human Resources for Health, (N439,080) as well as MNCH Week Expenses, Immunization Plus Day Expenses, Rehabilitation/Repairs – Hospital/Health Centers and Drugs/Laboratory/Medical Supplies all with zero expenditure.
The underperformance in critical areas is alarming and warrants immediate attention. To address the unacceptable child and maternal mortality rates and out-of-pocket health expenditure among other poor performing health outcomes, the state government in the remaining half of the year needs to prioritize timely and adequate budget cash-backed releases as well as value for money, particularly in areas like drug supply, emergency services, health insurance and family planning/child spacing.
Goje is an active citizen, civil society member and OGP enthusiast
