By Shahida Salihu

When 13yrs old Rafe’a (not real name) was wheeled into the operations theater of the Murtala Muhammad Specialist Hospital Kano for a surgical procedure due to a severe typhoid perforation, her relatives and benefactors never envisaged that the aftermath of that surgery was going to be catastrophic.

The lack of equipment for post operative care and absence of necessary drugs particularly antibiotics to prevent further infection, secured Rafe’a’s painful and untimely death at the hospital.

Similar situation is not unlikely across the board in the healthcare provision circle. Despite Kano’s free maternal and child healthcare program funded by the Kano State Government which offers free healthcare services to pregnant women and children under the age of five with the aim of reducing maternal and child mortality rates, many pregnant women in the state have decried lack of access to routine drugs, vaccines and birthing kits under the free maternal care program.

“Situations like this usually bring about war on the homefront contributing to broader domestic violence, because a pregnant woman’s husband understands that there is free maternal care catered for by the state government, but here’s his wife demanding for money from him for the same items that’s supposedly free. We have on several occasions spent money from our purse to provide for some of these pregnant women even when the allocations for this programs are there in the budget,” says Khadijah Aliyu Ammani, the Founder and Executive Director of White Heart Development Initiative, a Kano based non profit that caters for women and children’s needs true empowerment and self development.

According to Ammani who planned to celebrate her forthcoming birthday by crowdsourcing and donating free maternal care drugs to some facilities in the state, the absence of these care materials despite allocations made in the budget is widening the maternal and child mortality problem in the state.

She says the situation is so dire that sometimes even sterilisers cannot be found in children’s wards.

“Even when Doctors make prescriptions that require dressing of wounds twice or more a day, the kids end up not getting even one. There was a time we had a patient in that ward, he rarely got the needed care, the room was just smelling. At the end of the day we had to take the child away and switch to a private facility,” Ammani recalled.

Khadijah who once picked it up with a Doctor on duty says he confided in her that there was no supply of the required equipment made to the hospital despite allocations for the same in the budget, year in and year out.

“He even admitted that sometimes, in a situation where a patient is in extreme need, he had no option than to take out of his pocket to make the necessary provision,” Ammani narrated further.

Despite Challenges, Healthcare Allocation Plummets as Non Essential Spending Devours 2024 Budget

While the solutions to most of these concerns rely heavily on budget accountability in terms of allocation and expenditure, a gap in the 2024 approved healthcare budget might have tanked the situation further.
Kano State’s recently approved budget for 2024 marks a troubling shift in healthcare prioritization with non essential spending taking a large chunk of the budget. For the past four years (2019-2023), Kano consistently exceeded the Abuja Declaration’s 15% health spending target. However, the 2024 budget slashes funding to a mere N34 billion (7.7%) as approved by the state assembly, a significant drop from the initially proposed N51.4 billion (14.7%) by the state government and a stark contrast to previous years’ commitments.
This dramatic decrease in health spending, despite exceeding the benchmark in recent years, raises concerns about Kano’s dedication to improving its healthcare system. While realising this and yet to make the detailed breakdown of the approvals public, recurrent expenditures, encompassing salaries and administrative costs, devour a substantial 38% of the budget, leaving less for crucial capital projects that could strengthen healthcare infrastructure.
For instance, the Kano State Government budgeted over N5.32 billion for meals and the renovation of the governor’s lodge and some other buildings at Government House.
The state proposed N800 million for the renovation of governor Yusuf’s office at the Government House and N500 million for the renovation of his personal residence at ‘Kwankwasiyya City’ in the Kano metropolis according to a report by PREMIUM TIMES.
Mr Yusuf also proposed N200 million for phase one of the construction of a new governor’s lodge in the same Kwankwasiyya City
The budget document seen by PREMIUM TIMES, shows that N15 million was allocated for the construction of a Banquet Hall and another N15 million for the reconstruction of roofing at Coronation Hall, both at the Government House.
Another N45 million was earmarked for the renovation of the Coronation Hall and N20 million for the construction of a two-bedroom house at the Government House.
Meanwhile, in the 2024 budget, over N3.72 billion was allocated for various expenses at the Government House, including recurrent expenditure of over N2.5 billion, and N1.56 billion as overhead cost.
About N775,860,07 was budgeted for refreshments and meals; N77,586,206 for local training, and N800 million for unspecified services.
Also in the 2024 budget, N90 million was allocated for fuel and lubricants, N38 million for motor vehicle fuel; N47 million for plant and generator fuel, and N1 billion for capital expenditures.
The budget also allocated over N232 million for ‘travel and transport’; N77 million for local travel; N3 million for telephone charges; N3 million for internet access charges, and over N4.6 million for satellite broadcasting access charges.
The amount is contained in the state’s 2023 supplementary budget and 2024 budget Governor Abba Yusuf signed into law last year.
After presenting an initial budget of N350bn in October, Mr Yusuf had presented to the State House of Assembly a supplementary budget of N58 billion last September and another N24 billion in November, making it a total of N432 billion after he assumed office on 29 May.
The Abuja Declaration and a History of Healthcare Budget Records in Kano

23yrs ago, specifically in the year 2001, an agreement was signed by African heads of state, committing to allocate at least 15% of their annual budgets to the health sector, that agreement was known as the Abuja declaration.

The declaration aimed to strengthen Africa’s health systems and prepare for disease outbreaks, but many countries have yet to meet this target.

However, for the past four years – 2019-2023, Kano consistently exceeded the Abuja Declaration’s 15% health spending target.

Between 2014 and 2019, the Kano State government increased the health sector budgetary allocation from six percent to 15 percent. By 2021, the health sector budgetary allocation had increased to 16 percent, and by 2022, it had increased to 17 percent . The 2021 health budget was 14,277 for non-Covid-19 health budget lines and 30,719 for the total proposed 2021 health budget.

A Tale of Allocation vs. Utilization

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.

According to a medical doctor who prefers to remain anonymous, “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.

Doctor’s Experience Amidst Challenges

Many Doctors practicing with the State government have decried the situation, dubbing the state of healthcare delivery in Kano as grossly substandard due to persistent multifaceted challenges especially chronic manpower shortage and dilapidated infrastructure.
While acknowledging additional recruitment, a Doctor who preferred to remain anonymous for fear of backlash pointed out a focus on renovating tertiary and some secondary healthcare facilities, neglecting the primary health centers, stating, “The primary health centres which cater for most of the burden in healthcare have been largely neglected.”
He further 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.
Detailing their own struggles, the Doctor said while on duty, sometimes he has to borrow a sphygmomanometer from the ward to measure blood pressure or wait for family members to buy essential drugs even in critical situations.
“I have to wait for patient relatives to go outside the hospital to buy essential, life-saving drugs even if my patient is convulsing or bleeding after delivery . In addition to lengthy lab procedures due to lack of bedside testing equipment , I have to deal with frustration due to lack of basic gadgets… so that I have to go through time consuming protocols…”
He described a hostile work environment with inadequate lighting, ventilation, and a lack of functioning ambulances, “I have to work in a hostile, inadequately lit and ventilated environment… No functional ambulance to transfer critical patients…”
Many health workers fear that inadequate budgeting, funding release and accountability will worsen these issues over time, especially with a growing population demanding more healthcare services. They also warned of potential brain drain among healthcare workers, stating, “With inadequate funding and budgetary allocation to the health sector, these problems are likely to persist or even get worse… which is already taking a heavy toll on the health sector.”

Government Officials React

Speaking on the issues raised, the Public Relations Officer, Kano State Ministry of Health, Ibrahim Abdullahi says he does not have the authority to speak on issues of the Ministry’s finance and expenditure due to the technicality involved. He then promised to persuade the Commissioner of Health to grant access to the Director Planning and Statistics for details.

However, while responding to the question of accountability mechanism put in place by the ministry to ensure effective utilisation of allocated monies, Mr Abdullahi affirmed that the Kano State Commissioner for Health, Abubakar Yusuf has since inaugurated a committee to drive the preparation of the budget and track its implementation.

Also, speaking the Public Relations Officer Kano State Ministry of Budget and Planning, Aisha Musa Iliasu said, the Primary Duty of the Ministry is to plan and allocate budgets, it has no no business with tracking effectiveness.

She however disputed the alleged amount allocated to the Ministry of health stated that the actual amount allocated was Seventy-two billion, one million, nine hundred thirty-two thousand, two hundred ninety-seven dollars and seventy-seven kobo (NGN72,001,932,297.77).

“This is 17% of the total budget with capital expenditure standing at NGN42, 505,229,887.86 while recurrent expenditure stands at 29,496,702,409.91,” she said.

However, there is no publicly published document that corroborates these figures.

On his part, the Director Press and Public Enlightenment, Kano State Ministry of Finance, Bashir Habibu Yahaya, insists that it is the responsibility of the Ministry of Budget and Planning to ensure effective tracking of budget utilisation, despite denial by the same Ministry.

He however acknowledged that since budgetary allocations remain expectation and does not necessarily translate to funds, there are certain times approvals for release of funds are not adequately met with equal disbursement.

Expert Speak

Musa Abdulahi Sufi a public health expert and freelance development journalist has highlighted several key health areas requiring attention, including maternal and child health, malaria, hypertension, diabetes, and emerging health issues.

According to him, a comprehensive approach in areas of health awareness, equipped care facilities, research and genuine commitment and actions of government in terms of allocating resources, underscores the need to address a wide range of healthcare needs in the state.

“Intensive awareness on different health concerns, particularly prevention measures can help a population stay healthy and ease up on some increasing demand for health services,” he opined.

In addition to the above, Sufi stressed that access to quality healthcare, particularly primary healthcare facilities with adequate equipment and manpower, will enrich quality of care.

He however stated that the need for a more transparent and action-oriented approach from the government in terms of budgetary allocation, expenditure, research and monitoring through innovative approaches is indispensable to achieving key health priorities.

“There needs to be an honest and genuine commitment of the government in terms of allocating resources and ensuring they are targeted to needs. These need to be linked to work plans developed by the healthcare agency and supervised by the mother ministry,” he concludes.

In essence, the need for transparent and timely disbursement of funds, effective budget tracking, and regular assessments to identify areas of improvement in healthcare service delivery cannot be overemphasized.

By addressing these issues, Kano State can ensure that allocated funds are used judiciously to make a meaningful impact on the healthcare sector.