Opinion | Profligacy, Opacity, Corruption, And Governance Failure: The Underlying Public Health Pandemic In Nigeria

Let me begin with my conclusion. The ongoing COVID 19 Pandemic is happening on the back of a preexisting structural and congenital pandemic of dysfunctional, irresponsible, opaque and incompetent governance, engendering a monumental failure in the delivery of basic social services in general, and public health care service delivery in particular.

Profligacy, opacity, corruption, and governance failure: the underlying public health pandemic in Nigeria. Op-Ed by Jaye Gaskia.

I will now proceed to illustrate the basis for this conclusion with the following:

According to a Premium Times report, in mid July of 2017, the FGN had announced plans to revamp 10,000 Primary Healthcare Centers (PHCs) across the country at an average cost of N25M per PHC.

The reason for this initiative had been laudable – to reverse the dilapidated and discredit condition of PHCs across the country.

As at the initiative was announced by the then Health Minister, investigative reports by some journalists had found that between 2004 and 2015, there were 806 abandoned PHC projects across the country for which a whopping total of N25.2bn had been expended. The report had found that contractors had vanished into the tin air with contract sums without ever undertaking the contract, or after executing part of the contract and abandoning the projects, leaving communities unaware that they were supposed to have had a PHC, or at a loss as to what had become of the uncompleted PHC.

SE Nigeria for instance accounted for N5.8bn (23%) of the total, with 96 such PHC projects which were either untraceable or abandoned.

The ICiR Nigeria, an online investigative media which conducted the investigative report had found a total of 1250 contracts valued at N30.59bn awarded by the FGN for supply of equipment and construction of PHCs nationwide in the 10 years from 2004 to 2014 were either abandoned or not properly excited to specifications.

Yet inspite of this, and since then, no one had been indicted, prosecuted and punished, nor has any of the apparently embezzled funds recovered. And this by a supposedly corruption fighting regime, for which healthcare delivery is supposed to be a priority!

Furthermore in December 2018, the same government through the previous Health Minister (let us not forget that the current Health Minister was then the Minister of State for Health), had with funfair at a colorful media ceremony inaugurated a Special Health Intervention Fund (SHIF) of N28bn to be disbursed and utilised in 2019.

According to Premium Times report of December 7th 2018, in a report of their coverage of the Ministerial inauguration of the Fund, the Special Health Intervention Fund was to cover the following:

Revitalization of 774 PHCs across the country (one PHC per LGA);

The purchase and provision of additional ant retroviral drugs for 20,000 Nigerians living with HIV-AIDS;

The conduct of nationwide screening for common cancers like Cervical, Breast and Prostate cancers;

Performance of free surgeries for 10,000 persons suffering from cataract (with at least 250 per each state of the federation and the FCT);

Free Treatment for 800 patients with confirmed diagnosis for Hepatitis C infection;

Revitalisation of 21 Federal Teaching Hospitals (FTHs) spread across the country, with each of the benefiting 21 FTHs to get N300M; (N6.3bn total)

Revitalisation of 31 Federal Medical Centers (FMCs) again across the 6 geopolitical zones, with each getting N150M; (N4.65bn total)

Refurbishment and equipping of 4 Specialist Hospitals (SHs) – across the country at a cost of N200M each (N800M total); and

The refurbishment and equipping of 14 Fistula and Cleft Palate Centers across the country at the cost of N150M each (N2.1bn total).

Now, what is the point of going into this much detail? Simple – what has happened to these funds and to the purpose for which they were designated?

Where are the 774 PHCs that benefitted from these funds located? In which communities? And in which LGAs? Were the Local Government Council administrations and the state governments where these 774 PHC s are located involved in Any way in the execution of the projects? Were the communities hosting the PHCs involved? Who are the contractors that handled these projects? How were they selected? Was the money ever actually disbursed?

Let us add to the forgoing another instance. In 2018 for the first time the NASS appropriated for the 1% of the consolidated revenue fund to be designated for primary health care delivery development in a Basic Health Care Provision Fund (BHCPF).

This 1% which is in accordance with the National Health Act amounted to N55bn in the federal 2018 appropriation act.

If we recall, the 2018 Appropriation Act was signed into law by the President in June 2018. However, according to the Business Day Report of May 21st 2019, one year on, and almost at the tail end of the budget, only 22 states out of the 36 states of the federation had registered and signified their intention to fulfill the conditions to access the funds. 14 states as at that time, had not registered. The fund is specifically set aside for meeting the needs of primary health care delivery across the country.

And What were these conditions? To qualify by law each state is expected to establish their own primary health care agency; as well as establish a state health insurance scheme to fund coverage of citizens and residents. The final condition, was that each state was to provide a counterpart fund of N100M to add to whatever amount the state was applying to access from the BHCPF.

The import of the above instances is that in 2019 alone from the Federal Government the total sum of N83bn (N55bn + N28bn) was made available for public investment in improving primary health care delivery.

This sum does not include what states and LGAs were to allocate to primary health care.

If we set this N83bn available in 2019 against the backdrop of the N30.59bn that had been expended on 1250 primary health care delivery contracts that were either not executed, or improperly executed between 2004 and 2014; within the context of lack of information and opacity surrounding the 2018/2019 allocations, then we should be very wary indeed.

Why is the relevant NASS committees not raising any issues? That such huge sums of public funds appropriated by the NASS could have disappeared into abandoned projects speaks volume of the capacity and the ability of the legislature to perform effective and efficient oversight functions over the executive. It is also a manifest indication of the faulty foundations of our budgetary processes.

If all the resources allocated for primary health care delivery since the inauguration of this 4th Republic had found their way to the PHCs and had been diligently utilised, primary health care delivery as the foundation of public health care delivery would have been enhanced, the PHCs would not have been in their current state of dilapidation and disrepair, and perhaps, they would have been better placed to play a significant role in preventive and containing measures for infectious diseases in general, and the current COVID 19 Pandemic in particular. The PHCs would have been as to support an efficient contact tracing and tracking system, as well as an provided efficient support for containing community transmission through community testing.

But alas we are where we are now. Questions need to be asked, answers need to be provided, and culprits need to be identified, punished and prosecuted, with looted public funds recovered.

So, once again, where are the 774 revamped PHCs? Where are the 21 revitalized Federal Teaching Hospitals? Whatever has become of the 31 Federal Medical Centers? And what on heart happened to the 4 Specialist Hospitals and the 14 Fistula and Cleft palate Centers?
The Joint Health Sector Unions (JOHESU), the Nigeria Medical Association (NMA), the National Association of Resident Doctors (NARD); and the central trade union centers – The NLC and TUC), along with journalists and media practitioners as well as Civil Society, all need to take up these issues, raise these questions and demand answers from appropriate authorities.

Citizens as the ultimate beneficiaries of services and right holders must raise their voice.

I conclude by urging all citizens to demand action, to demand accountability from relevant authorities on these issues.

What is the current status of the N28bn Special Health Intervention Fund inaugurated in December 2018? What is the current status of the BHCPF – from the 2018, 2019 & 2020 Federal budgets?

Let us demand accountability for these routine and previous funds, and by so doing also signal our determination to demand accountability for the billions and trillions already being set aside for special COVID 19 Intervention funds – the N50bn TCF for MSMEs and the N100bn Special facility for the medical and pharmaceutical sector, both already established by the CBN for instance.

  • Jaye Gaskia, the Director, Praxis Center, Co-convener, Say No Campaign and Convener, Take Back Nigeria Movement (TBN), writes from Abuja.