Discrepancies in Kano’s Health Budget Raises Accountability Concerns
By Shahida Salihu
A recent review of Kano state’s health budget has sparked concerns about transparency and accountability in the allocation of funds.
Civil Society Organizations (CSOs) are calling for a closer look at the spending plan, while some government officials maintain that the budget is adequate and appropriately allocated.
Malam Hassan, a resident of Kano’s outskirts, shared his experience in accessing healthcare amidst budget allocation concerns, “Last month, my wife needed urgent medication for her asthma, but the clinic said they were out of stock. I had to travel all the way to the city center to find a pharmacy that had it, and it cost twice as much as usual. If the government is allocating funds for these medications, why are they not reaching our local clinic?”
In Kano, the most populated state in Nigeria and home to the second largest city after Lagos, outbreaks of cholera, diphtheria, measles and cerebrospinal meningitis, in addition to COVID-19, highlight the need for policies and funding to address recurring and emerging disease outbreaks.
Discrepancies: The gap between allocation and expenditure – CISLAC
Discrepancies were identified between the Kano State Public Health Expenditure Tracking Report 2023, published by the Civil Society Legislative Advocacy Centre (CISLAC), and the official state budget documents.
“Our analysis of the state budget revealed significant discrepancies between what was allocated and what was actually spent on healthcare.” said Isah Muhammad, Kano Coordinator for CISLAC.
“These discrepancies raise concerns about where the allocated funds are going and how they are being used.”
“Unfortunately, these funding issues can have tragic consequences. Last year, a young boy in Kano lost his life due to complications from malaria because his local clinic lacked essential supplies. Stories like this highlight the urgency of ensuring our health budget is used effectively,” Muhammad said on a somber note.
Discrepancies: An annual “copy and peste” – Commissioner
Recently, the Kano State Commissioner For Health, Abubakar Yusuf, says his ministry’s annual budget is unrealistic as officials always “copy and paste” the previous year’s budget documents.
Mr Yusuf stated this in April while inaugurating a committee to drive the preparation of the budget and track its implementation, the ministry’s spokesperson, Ibrahim Abdullahi, said in a statement.
“The move is very important looking at the unrealistic nature of the budget of the Ministry characterised by repeated copy and paste over the years,” lamenting that what one sees in the budget of the Ministry is just duplication year by year.
“There is the need for timely and early preparedness of the budgeting process for better results upon implementation. That was why the Ministry deems it pertinent to sit together and map out strategies to have focus, aims and objectives in every fiscal year on what needs to be achieved in its budget so that they start planning from the beginning of the year,” Mr Yusuf said.
Discrepancies: Duplication and Weak Donor Cordination Mar 3yrs Budget – KanSLAM
A budget tracking analysis report from 2020 to 2023 by the Kano State Led Accountability Mechanism (KanSLAM) revealed issues of duplication, weak donor cordination and a wide gap between allocation and cost benefit particularly in the areas of child birth spacing (CBS).
A CBS analysis of the report shows a NGN31.29billion health budget and a mere NGN40million CBS allocation in 2020. Similarly in 2021 the health budget allocation stood at NGN30.72billion with the same NGN40million CBS allocation. Also, the 2022 health budget stood at NGN33.40billion with a NGN110million CBS allocation while in 2023, the health budget stood at NGN40.25bilion with a NGN215million CBS allocation.
Meanwhile, only 2022 had a 100% allocation vs spending. 2020 had 0% spending of the 40million allocation while 2021 had 25% spending (NGN10million) and 2023 had 24.35% spending (NGN52.3million) of the NGN215million CBS allocation.
In addition to inadequate budgetary provisions for CBS programs, inefficient tracking system fo donor contribution and expenditure, KanSLAM expressed worry over parallel data collection and reporting system in the state whereby different development partners violate national rule by collecting data without the consent of Ministry of Health and other concerned Ministries Departments and Agencies.
It recommended the need for proper scrutiny of the budget document to avoid duplication of activities before it is published online and the need to strengthen donor coordination related to health sector expenditure by identfying sources and hermonising same into the budget.
Discrepancies worry health workers
Despite efforts to meet the Abuja Declaration’s 15% healthcare budget allocation, Kano State’s healthcare sector continues to face challenges in utilizing funds effectively.
A closer examination of the state’s healthcare budget from 2019 to 2023 reveals a disconnect between allocation and disbursement.
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According to a medical doctor who prefers to remain anonymous for fear of loosing his job, “The previous administration tried hard to conform to the 15% Abuja declaration for almost three years. However, allocating the budget doesn’t guarantee disbursement or spending the money judiciously. Sometimes politicians allocate humongous amounts of money to a sector for a political score, but they end up releasing two-thirds of the previously budgeted amount.”
Budget tracking reports reveal that while the state government allocated significant funds to healthcare, the actual disbursement and utilization of funds remain a concern.
This raises questions about the effectiveness of the healthcare budget and its impact on the state’s healthcare system.
Another medical Doctor who also requested anonymity decried the lack of basic equipment in health facilities and highlighted inconsistent supplies of medication, including essential life-saving drugs, saying, “Many secondary facilities still lack basic, inexpensive gadgets that are indispensable in healthcare delivery such as blood pressure measuring instruments. There’s also an inconsistent supply of drugs and consumables, including life saving drugs. In many cases, those supplied are substandard and ineffective brands.”
He further questioned the adequacy of the current health sector budget, calling for collaboration between policymakers and healthcare stakeholders to ensure adequate funding is allocated, interventions are prioritized, and corruption is fought.
CSOs Demand Transparency
CSOs are urging the Kano State government to provide a clear explanation for the discrepancies.
“The Kano State government has a responsibility to be transparent about how it allocates and spends public funds.” said Aisha Yesufu, a prominent Nigerian activist. “Citizens deserve to know that their tax money is being used effectively to improve healthcare services.”
Impact on Healthcare Delivery and Need for Independent Audit
Despite these reassurances, CSOs are calling for an independent audit of the Kano State health budget.
“An independent audit is essential to restore trust and ensure that allocated funds are truly reaching those who need them most.” said Muhammad of CISLAC.
“This will help to identify any areas where improvements can be made and ensure that resources are being used effectively to improve healthcare outcomes in Kano.”
The lack of clarity surrounding the health budget has raised concerns about the impact on healthcare delivery in Kano.
“If funds are not being allocated and spent appropriately, it can have a serious impact on the availability and quality of healthcare services.” said Dr. Bala Mohammed, a physician working in Kano.
“This can lead to shortages of essential medications and equipment, as well as inadequate staffing levels in hospitals and clinics.”
CSOs are urging the Kano State government to work with them to address these concerns. “We urge the Kano State government to open up a dialogue with CSOs and other stakeholders to ensure transparency and accountability in the health sector.” said Yesufu. “Together, we can work to improve healthcare delivery for all Kano residents.”
Dr. Aisha Ibrahim, a physician at a Kano government hospital, expressed her frustration, ‘We’ve been promised additional staff for months, but we haven’t seen any new faces. This puts a huge strain on the existing staff, leading to burnout and ultimately affecting the quality of care we can provide to our patients.'”
Government Response
Kano State health officials in the immediaye past administration have defended the budget, stating that the allocations are sufficient and have been distributed according to priorities.
“The Kano State government is committed to ensuring that all allocated funds are used effectively and efficiently to deliver quality healthcare to our citizens.” said Dr. Tijani Hussaini, then as Kano State Commissioner for Health.
“We welcome any inquiries or concerns from CSOs and are happy to provide clarification on the budget,” he added
Taking the bull by the horn as New Health Commission Inaugurates Budget Task Force
Commissioner for Health, Abubakar Yusuf has since inaugurated a committee to drive the preparation of the budget and track its implementation.
The terms of reference of the committee include promoting the collaboration by both departments about Monitoring and Evaluation (M&E) activities by coordinating joint monitoring and evaluation activities, facilitating quarterly monitoring visits to agencies and helping the Ministry get releases of the approved funds.
The committee has the Director of Planning, Research and Statistics, Muhammad Abubakar, as its chairperson, and Nasir Tafida as the secretary.
Members are the Director of Admin and General Services, Shehu Shehu, Deputy Director of Planning and Budget, Tijjani Kilishi, and the Officer in charge of the Monitoring and Evaluation Unit of the Ministry, Aminu El-Yakub.
Others are Health Finance Focal Person, Auwalu Shehu, Deputy Director Accounts, Muhammad Nayaya, Head of Expenditure Control, Shuaibu Abdullahi and Head of Salaries and Wages, Muhammad Bello.
With the new task force is just months into their inauguration, it remains to be seen how effective this committee will be in respect to overall health outcomes and delivery in the state.
