In 2001, AU heads of states committed to allocate 15% of national budget to health development. The leaders have now come together to review progress on the promise made 12 years ago. But Nigeria has not done well and if we must catch up with other African countries who have done very well, this review must propel the intent.
This is a big week for my home capital, Abuja. African leaders are coming to review the promises they made 12 years ago, when they pledged “to set a target of allocating at least 15% of our annual budget to the improvement of the health sector”.The need for this promise to be met couldn't be clearer. Recently as part of my work for MamaYe, I met a midwife, Nomso, from Anambra state, southeastern Nigeria. She had used the fees for the final year of her course to settle the bills of pregnant patients at her clinic – to prevent them from being detained because they couldn’t pay.Nomso’s patients are not alone in buying basic healthcare from their own pockets. 60% of health spending in Nigeria is paid for directly by families who don’t have insurance. Nigeria’s government allocated $11.50 per person on health in 2012, but now allocates just $10.90. This is far less than what WHO recommends - $54 - as the minimum needed.So, Nigerian families, who risk being pushed into catastrophic poverty by a difficult birth, or by a baby that needs extra care, finance the gap. If the government kept its Abuja promise, it could be spending $51 more per person – which might have allowed Nomso’s patients to settle their bills and return home with their babies.Succint, downloadable evidence on health financing in Nigeria is hereMamaYe is a campaign for maternal and newborn survival - and we want to hold our leaders to account for what they have committed to spend on the health of their citizens. The focus of the Abuja summit is HIV/AIDS, Tuberculosis and Malaria, serious challenges for our continent's health - and in particular women and children. Providing proper care for mothers and babies is vital to combating all three diseases.The data suggests that there is a link between government health spending and mothers’ lives saved, with lower maternal mortality ratios for most (large) countries that spend more than $100 per person.A 2011 study found that a 10% increase in government health spending per person reduced under-5 mortality rates by 7.9 deaths per 1,000 live births. Meeting the Abuja target would mean that Nigeria could reach the fourth Millennium Development Goal: reducing the number of children who die before reaching their fifth birthday by two-thirds.African leaders face many challenges in providing health services to growing populations. But they must be accountable for the promises they have already made to their citizens. In 2001, the President of Nigeria, Olusegun Obasanjo, welcomed the leaders of 52 African countries to Abuja and together they made a commitment on HIV/AIDs, Tuberculosis and Malaria – including the 15% target. Now the leaders of Africa are returning to Abuja to review progress, at the invitation of President Goodluck Jonathan. But in 12 years, not enough has been achieved to meet this target.This year, President Jonathan's government is spending just 5.6% of its budget on health services – that's not much more than what Nigeria was spending back at the first Abuja meeting (3%). It compares to 8.7% on education, and 7.3% on defense in 2013. Moreover, it is actually a drop from 2012, when health spending was 6.2% of the budget.It's a question of priorities – a question that some countries have already answered. Ghana allocated 12.5% of its budget in 2013, a rise from 10% in 2001 – but nowhere near the level that some countries have achieved. Rwanda spent 24% in 2011, showing a clear desire to prioritise the health of its citizens. Ethiopia, the next biggest African country after Nigeria in terms of population, has already reached the Abuja target.Even those countries that are meeting the target need to ensure that they do so consistently and reliably. Malawi first met the target in 2003, but spending on health has dropped back down to 12% over the past two years. Sierra Leone is making progress towards its promise, with 10.5% of its budget promised to health this year – but recent data from the Ministry of Finance suggest only one-fifth of the amount promised for 2013, has so far been disbursed.Nigeria has set up three Sovereign Wealth Funds, including a Future Generations Fund to protect against the decline of oil reserves – but shouldn't we also be ensuring our future generation's health and wellbeing, from birth?Just as Nigeria takes the lead in calling together the African countries to discuss these issues, we ask Nigeria to take the lead in making maternal and child health a political priority. Each country has its own challenges, and its own needs, but we all have to go further.We ask the leaders of all African countries to consider their legacy, and above all, what they can do for the mothers and children of Africa.Succint, downloadable evidence on health financing in Nigeria is here