According to the United Nations Children’s Education Fund (UNICEF) in September 2016, Nigeria each day loses about 2,300 under-five years old and 145 women of childbearing age.
Accounting for the most MMR deaths in Nigeria, the Northern country has an estimated maternal mortality ratio (MMR) of 1,549 deaths per 100,000 live births, which is more than 5 times the global average, as, at 2013, this trend has seen no significant change over time.
According to the United Nations Population Fund (UNFPA), Nigeria requires between $12 million and $16 million yearly to procure family planning commodities and lifesaving drugs. Of these figures, successive government administration at both national and sub-national levels through the ministry of health has made commitments through their health budgets to increase funding to the entire sector and family planning in specific. However, the extents to which these commitments are backed with actual actions remain questionable.
Political will across both the national and sub-national (state and local governments) in Nigeria have not only been grossly inadequate, but also hypocritical. There is a huge lack of coordination and ownership of Family planning programmes that have on the overall affected family planning performances and invariably the high maternal and child deaths in the region.
Data evidence shows that the Northern part of Nigeria stands as the highest contributors to the disturbing figures. Indeed, maternal mortality in the North West and North East is six times and nine times higher than the rate of 165/100,000 live births recorded in the South West Zone. The main causes of maternal mortality in Nigeria, according to UNFPA, are: haemorrhage (23%), infections (17%), unsafe abortion (11%), eclampsia (11%), malaria (11%), anaemia (11%), and others (including HIV/AIDS) contribute about (5%) of maternal death. Aside these medically related causes, other causes of the high maternal and child deaths include the availability and accessibility of health services and facilities as well as the level and number of skilled health workers in the state which can be traced back to availability and efficiency in the allocation and management of basic funding for health; MNCH specifically family planning; benchmarked on the government commitment and political will to turn the tides.
The Kaduna CIP aligns with the state’s broad health plans and the National Family Planning Blueprint developed in 2014. The aim of the CIP is to specify the interventions and activities to be implemented, and itemise the financial resources needed to meet the state and national FP goals to help women achieve their human rights to health, education, autonomy, and personal decision making about the number and timing of their childbearing, and support the achievement of gender equality. Furthermore, voluntary rights-based family planning reduces maternal mortality and morbidity, decreases unwanted teenage pregnancies, improves child health, facilitates educational advances, reduces poverty, and is a foundational element for the economic development of a nation
The objective of Kaduna State is to increase the CPR for married women to 46.5 percent by 2018 (Table 1). This target was set based on Nigeria’s objective to increase the national CPR to 36 percent and contribute to the reduction of maternal mortality by 75 percent and infant mortality by 66 percent across the nation by 2018. Kaduna State is committed to positively contributing to the increase in the total CPR of the country.
From Table 4, the annual budgetary allocation to the health sector in the State grew from 7.82% in 2011 to approximately 9.2% in 2012, and declined to 7.31% in 2013, before increased to 8.69% in 2014. The percentage allocation for the health sector under the 2015 approved budget slightly declined back to about 8.49% and deeper by 2016 to 7.56%. This decline may be attributed to the implemented review by the newly inaugurated government in the State following the successful conclusion of 2015 general elections in the country. It is worthy of commendation; the tremendous increase in the allocation to the health sector in the 2017 health budget from 7.56% in 2016 to 11.51% of the total budget for health expenses.
In nominal terms, the proportion of health sector allocations was still less than the 15% WHO recommended benchmark for health; as well as the 2000 Abuja Health Sector Declaration not until 2017. After the 33.36% growth rate in the allocation from 2013 to 2014, the allocation to the sector has experienced significant decline; as shown in the negative fall in the rates at -2.40%, and -23.51% for 2015 and 2016 respectively. Impressively in 2017, the growth rate in the health allocation grew by a whopping 89.93%; from N13bn in 2016 to N24.7bn in 2017; this met up with the 1st Presidential Health Summit Declarations of 25% annual increase in allocation to the sector. Figures 4 and 5 show the picture;
Table 10 above shows the proportion of family planning allocated from the overall Kaduna state budget from 2012 to 2017. The allocation for the procurement for family planning commodities as well as distribution between 2012 and 2016 was less than 1% of the entire health cost from the Kaduna state government. While this is indeed minimal, the case is worst as less than 31% of the overall family planning allocation for procurement was actually released. As of 2014, of the total N73,178,250 allocated for the procurement for family planning commodities, only N2,700,000 or 3.69% of this was released. Years before that only 30.5% and 30.1% of the entire family planning budget was released. Data for actual releases for 2015 to 2017 was not available, but the historical trend suggests that less than 50% of what the government of the state allocates to family planning would not be released and used. Unfortunately, such poor releases continue towards family planning, even when international donor support towards family planning is on the decline.
Failure to plan, they say is planning to fail. However, when performance is way below the planned target, success becomes impossible. Table 11 and figure 11 shows a comparison between the budgeted allocation for family planning and the Kaduna State Costed implementation for family planning from 2016 to 2018. The Kaduna CIP as already stated aims at specific interventions and activities to meet the state and national FP goals to help women achieve their human rights to health, education, autonomy, and personal decision making about the number and timing of their childbearing, and support the achievement of gender equality. The cost as shown below are Kaduna State is commitments to positively contributing to the increase in the total Contraceptive Prevalence Rate (CPR) of the state, however, the budget to family planning projects are programmes do not match the commitments. the table below shows that the actual budget for both 2016 and 2017 is less than the planned figures by more than N1billion.
From the figures analyzed above, not only have it been shown that the allocation for family planning in state is below what is required, just like the entire health budget for the state, the releases for family planning are poor, and inconsistent but over N1.2billion less than what the state commits to the planned costed implementation for family planning. Without any external funds to augment this huge funding gap annually, the objective of the Kaduna state government to actualize the aim of increasing the state CPR for married women to 46.5 percent by 2018, as well as its desire to meet the state and national FP goals to help women achieve their human rights to health, education, autonomy, and personal decision making about the number and timing of their childbearing, will be a mirage.
Download the 2018 Proposed Health Budget Analysis (FINAL) (pdf)