4 May 2017
Save the mothers: Change Nigerian budget priorities
Nigeria’s health care system is far from perfect. Whilst it has been praised for its polio prevention strategies and “managing” the outbreak of the ebola system, its maternal health rates are amongst the worst globally. To quote one of my professors who shall remained unnamed: “Health care is sh*t in Nigeria – but when it comes to maternal health care, the country reaches an absolute low”. Sometimes experts use child mortality rates as measures of development. If they would use this to measure development in Nigeria, the country would drop from place #152/168 on the Human Development Index to one of the second worst in the world, because Nigeria accounts for 14% of global maternal deaths [pdf].
Barriers to maternal and child health are wide-ranging and diverse. One barrier is cultural, like the lack of women empowerment, mobility and personal decision making in households, just as religious reasons not to go to a clinic. However, the largest barrier is political. In the past, maternal health was politically contested, also for religious reasons, or money spent on care went to HIV/AIDS instead of maternal health care. With a small increase [pdf] towards the Sustainable Development Goals from 2012 onwards, the budget was still lacking. However, the result of the recent elections seemed promising. The elected president had promised to allocate more budget and improve Nigeria’s health sector. This hope, however, does not seem to come true. The budget for health care is only increased with 0,17% and there do not seem to be large increases in maternal health care budgeted [pdf]. Furthermore, the allocation of the budget does not say that much about what’s actually released. Over the 2016 health care budget, only about 80% of the budget [pdf] was actually released. Added into that is a complicated structure where there is a lot of information asymmetry. The federal government is responsible for tertiary care, but the Local Government Authorities (LGA) for primary care, whereas the budget is drafted nationally. Essentially, it’s a recipe for disaster where the money just does not go to the places it should.
This is a classic case of government officials missing the incentives to allocate more care to the electorate. One way would be to improve the accountability of the national and local governments. However, in rural regions especially, that is not that high on the parents-to-be priority list. An expert I once spoke to when talking about this problem of accountability told me: “My neighbour gave birth on her own. She didn’t have time to leave her farm to go to our local doctor that lived a few houses away, let alone go visit an LGA to talk about setting up more clinics in the region.”
Therefore, allocating more budgets to maternal health care is not something that should happen top-down only, as currently there is not enough budget drafted. In return, the accountability of officials to actually release and spend that money is also something that cannot solely happen bottom-up. To start fostering development in several areas, of which maternal health care is but one example, the incentives for government authorities cannot solely be the electorate. Nigeria has to come up with some way to change their checks and balances for their development to foster.
Bottom Line: Nigeria needs incentivized government authorities and transparent institutions if they want to improve maternal health care.
* Please comment on these posts by students in my growth & development economics course. It really helps if you highlight unclear analysis, alternative perspectives, better data, etc.