Five states from the northeast geopolitical zone have fallen short of 15% budget recommendation for healthcare at the subnational levels in their 2023 expenditure, according to BudgIT report.
Stakeholders had adopted the Abuja Declarations and Frameworks for Action on Roll Back Malaria since 2001 which recommended allocating at least 15% of the state’s annual budget to health sector.
The report said only Bauchi State expended the recommended 15% on health sector.
The 2023 BudgiT‘s State of States report recently released revealed poor commitment to healthcare among the six northeastern states – Adamawa, Bauchi, Borno, Gombe, Taraba, and Yobe.
The report by the Nigerian civic organization, which leverages technology to enhance citizen engagement and drive institutional improvement, highlights the region’s challenges in managing limited fiscal resources amidst vast health demands.
The report explained that despite some effort, persistent issues such as inefficient spending, short of personnel, lack of transparency, and the strain of conflicts in some states hinder the realization of impactful health outcomes.
The report also revealed that most of the states failed to meet up with the World Health Organisation (WHO) recommended 10,000 people per health facility.
Adamawa State
The report indicates that Adamawa, with 795 primary healthcare (PHC) facilities aside from other secondary and tertiary hospitals, spent just 5.8% of its budget on healthcare.
The state health spending showed a focus on investment in infrastructure, with N1.08 billion dedicated to the construction and rehabilitation of hospitals and health centres.
Comparatively, smaller amounts were allocated to medical supplies (N5.67 million) and laboratory equipment (N115.69 million).
The expenses suggest a priority to enhance physical health facilities, although the limited budget for medical supplies could undermine patient care and service delivery.
According to the report, due to multiple challenges, the state has 224,000 internally displaced persons, who are in need of health service delivery in addition to the need of the other residents of the state.
The World Health Organisation (WHO) said “Among people who have experienced war or other conflict in the previous ten years, one in five (22%) will have depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia.
It added that people with severe mental disorders are especially vulnerable during emergencies and need access to mental health care and other basic needs.
Bauchi State
According to BudgIT, Bauchi has 1,111 PHC facilities that provide basic healthcare services to the state’s population.
With health spending of N2.02 billion for construction and rehabilitation, N5.69 billion on health and medical equipment, and about 60 million on medical supplies, Bauchi is the only state in the region to have achieved the 15% allocation for the health sector.
Despite these figures, questions arise about whether this spending meets the urgent needs for healthcare personnel and access to consumable medical supplies.
Bauchi state boasts of an additional 138 higher tier of hospitals and clinics across the state, has highest number of health facilities in the Northeast.
However, despite this, the state’s patient-to-facility ratio of 6.608 patients per facility is still significantly high, suggesting that the state should prioritise the construction of new well-equipped health centres and improve the existing ones to meet quality standards.
Similarly, the report revealed that the state suffers from a chronic shortage of health professionals to effectively managed the facilities.
Borno State
In Borno, the report said has the least number of primary healthcare facilities in the entire subregion.
The State total health expenditure of N9.16 billion had N4.21 billion directed toward hospital construction and rehabilitation, implying effort at expanding health infrastructure amid a strained healthcare system.
However, the spending remains below the recommended spending of 15% of the annual budget.
Yet, with a hospital per capita ratio of 17,411, concerns persist about adequate service coverage. The state’s spending on drugs and medical supplies amounted to N138.37 million, a relatively modest figure given its large population and healthcare challenges.
The report revealed that with a population of 7.43mn, its hospital per capita stands at 17,411, which is distressing for the people of Borno, the state healthcare has fallen far below the WHO recommended 10,000 per facility.
The report attributed the limited availability of health centres to hospitals closing down or professionals having fled or even died due to attacks from insurgents.
In 2016, the WHO reported that one-third of the 700 health facilities within the state were destroyed.
Gombe State
Gombe allocated N2.24 billion to the construction and rehabilitation of health facilities, and N1.57 billion for medical equipment.
Despite these figures, spending on drugs and medical supplies was only N9.71 million, raising issues about the adequacy of medical stock and treatment capacity.
The state’s investment strategy leans heavily on physical development rather than immediate consumable needs.
Gombe State has 598 primary health centres that provide basic healthcare services to the people.
This means that if the distribution of drugs and medical supplies purchased in 2023 were equally allocated to each primary health centre, each facility would get only N16,240 worth of drugs and medical supplies for approximately 6,813 persons.
It is alarming for the state, which is also why out-of-pocket health expenditure is so high, further plunging people into poverty in the 6th state with the highest multidimensional poverty index in the country.
Regarding the Gombe State Contributory Healthcare Management Agency (GoHealth) initiated by the state, the report recommended the need to create a strategy to evaluate the initiative’s impact on health financing security, so it doesn’t just become another scheme that is abandoned.
Taraba State
The report indicated that Taraba has 784 primary healthcare centres that attend to the basic healthcare needs of the residents.
The State’s healthcare expenditure in 2023 revealed that N13.29 billion was allocated for construction and rehabilitation of health facilities.
Additionally, N4.48 billion was spent on the supply of drugs and hospital consumables, reflecting an effort to support both facility development and operational needs.
However, only N106.54 million was allocated to medical equipment, which may limit the utility of newly constructed facilities.
Taraba, according to the report, has chronic dearth of professionals, revealing that it is evident that not up to one-third of the facilities can boast of a full-time resident doctor.
This shortage of health professionals is a cause for alarm and has a grave impact on health care and service delivery, suggesting that Taraba state must invest more in recruiting professionals and training existing ones to improve service delivery.
The National Centre for Disease Control and Prevention had reported a case count of 137 for Lassa fever and 108 cases of measles, which is 5.34% and 0.83% of the total 2,565 Lassa fever and 12,957 measles case count recorded across the country.
Yobe State
Yobe State has spent 8.16% on healthcare barely above the half of the Abuja declaration of 15%.
With 480 primary healthcare facilities, Yobe is the second with the least facilities after its neghbouring Borno State.
According to the report, the state expended a paltry sum of N156.26 million for hospital construction and rehabilitation.
However, the state allocated N2.98 billion for medical equipment and N652.32 million for drugs and medical supplies.
Yobe State, with an estimated population of 4.2 million people, has population ratio of 8,367 patients per facility.
The state also has also suffered more than a decade of the Boko Haram insurgency leading to the closure of hospitals, professionals fleeing, and direct attacks on the facilities to retrieve drugs and medical supplies.
Although it does not exceed the WHO recommendation of one basic facility to 10,000 people, the report said it is clearly insufficient for the population, putting a lot of pressure on the existing infrastructure.
The Region
The annual report said the overall investment in health in the Northeastern sub-region has fallen short in most states to enable comprehensive service delivery.
The report also indicates that while there is still a need for the provision of more health facilities across the states, it must be balanced with investments in essential supplies, medical equipment, and healthcare personnel to ensure that existing and new facilities are adequately equipped and functional.
The per capita spending figures also reveal inequities in health access, particularly in Borno, where the hospital-to-population ratio remains critical.
The report suggests that the states need a more balanced approach that includes sufficient funding for medical supplies, equipment, and human resources to help improve healthcare outcomes and ensure that citizens benefit fully from public spending.
Babaji Usman Babaji is an investigative journalist with over four years of experience, renowned for his impactful reporting on corruption, human rights violations, and holding those in power accountable in Nigeria.
His career is distinguished by participation in numerous media training programs and conferences, which have honed his investigative and reporting skills. Babaji’s data-driven stories have made a significant impact, particularly in Northern Nigeria, shedding light on critical issues and driving meaningful change.
As a reporter under WikkiTimes’ Collaborative Media (CMEDIA) Project, Babaji has led several groundbreaking investigations. He was a 2022 fellow of the Centre for Journalism Innovation and Development (CJID) and a 2024 Media Foundation for West Africa DPI/DPG fellow. His contributions to accountability journalism earned him a Certificate of Recognition from Xchange Hama Media for impactful community work.
