Nigeria: Creating a pool of health budget advocates

Health financing is one of the key panaceas to achieving better health for poor communities.

It constitutes one of the key issues that advocacy efforts aim to change or influence.

Empowering people

To achieve a sustainable improvement in funding for maternal, newborn and child health (MNCH), as well as other important components of the health system, Save the Children is working to empower civil society organisations and the media to enable them to lead advocacy in their respective states.

In a workshop organised for representatives of civil society organisations and health journalists in Zamfara State, the participants were shown basic techniques for analysing the state’s health budgets, with the view of comparing allocations meant for health and other social sectors, as well as analysing various components that make up the budget.

Discovering the real funding gaps

Advocacy issues identified from the budget analysis:

• The  MNCH budget always represents about 4-8% of the total health budget, although the MNCH population is about 25%. Considering the vulnerability and weakness of this population, it was discovered that the population is not being provided with the required funding to access the basic health care required.

• For a state that boasts of providing free medical services to women and children, the budgetary provision for this was not clearly captured in the budget documents, making it difficult for the coverage of the free services to be universal.

• The allocated funds for foreign medical trips need to be reduced and there needs to be increased funding for the state’s health training institutions so as to have more qualified indigenous health workers. The state’s investments in health workers, which includes training and retraining both in Nigeria and overseas, are also scanty.

Speaking out out for change

Having understood the importance of civic participation in budget process, the budget advocates observed that their participation in the formulation and execution of state budget has been low, and that the state government has not been organising public hearings to give people a chance to respond.

Advocacy activities have been identified for each of the four stages of the budget cycle in the state:

• At formulation stage: to conduct budget analysis; study the state’s health policy; meet with unit heads and directors to generate more evidence about the existing funding gaps, and conduct advocacy visits to heads of ministries.

• At enactment stage: to influence the leadership of the state house of assembly as well as to participate in public hearing and budget defence sessions.

• At execution stage: to monitor the budget implementation and service delivery.

• Oversight stage: to analyse the state audit report and re-conduct budget analysis.

Messages from the advocates

The participants issued a communiqué at the end of the workshop that advocates for the following:

• More involvement of civil society organisations in fiscal budgetary process in Zamfara State. The state house of assembly needs to organise a public hearing on the state budget before passing it in to law (as enshrined in the 1999 constitution).

• The media needs to reinforce its role as watchdog of the society with regards to proper implementation of budget, as well as in enlightening the public about the need for their active participation in the budget process.

• Public servants need to make public information available so as to promote transparency and accountability in the governing process.