In four years, Jigawa state budgetary allocation on health sectors appears to prioritize healthcare personnel over other health sector components.
The state government allocated N29.1 billion to health personnel, but it eventually spent 29.3 billion on its staff, surpassing the allocated budget by 200 million naira.
Conversely, while the state overspent its personnel budget, substantial underspending occurred in various health budget components, with 6.9 billion underspending on infrastructure, 1.3 billion on medical supplies, 3.6 billion on health programs, and 2.4 billion on miscellaneous expenses. Actual spending by other health components summed up to 23.7 billion naira.
The overall budget underspent for the state’s health sector is 26%. Findings from key informant interviews suggest that the 0.6% increase in personnel expenditure may be due to an urgent need for healthcare workers in existing facilities which hitherto experienced a shortage of personnel.
The Nigerian Medical Association (NMA) has raised alarm over the shortage of doctors in Jigawa, highlighting a concerning ratio of one doctor to twenty-one thousand (1:21,000) patients in the state, which is against the WHO standard of 1 doctor to 600 patients.
Despite this, the report emphasizes that a 0.6% or N200 million increase in personnel expenditure cannot be the reason for N24.2 billion underfunding of other crucial components of the health sector.
Jigawa State Promotion Agency recognizes health as one of the two key human development services in the state’s overall development strategy.
According to the report, the Ministry of Health grappled with impediments to budget execution as a consequence of delayed fund disbursement from the state’s treasury, resulting in setbacks in the timely completion of projects.
The noticeable challenge in the implementation of the budget in Jigawa State is the inadequacy of revenue to fund various MDAs, including the Ministry of Health.
This challenge is evident in the revenue receipts from 2018 to 2021, where the total budgeted revenue over the four years amounted to N601 billion, but the actual revenue collected was only N512 billion, which is 15% less than the actual revenue and is insufficient to fund the actual budget expenditure of 580 billion.
As seen, adequate revenue is key to budget credibility. In 2018, the state’s revenue deviation was 1.8%, meeting the PEFA standard of less than a 5% deviation from the approved budget for that year. Additionally, the state adhered to the lower limit of less than a 15% deviation from the budget in both 2018 and 2020.
The state experienced the highest deviation from the amount budgeted in 2019 with 35% underspending and 38% under-collection in revenue. However, the figure for 2019 doesn’t represent the actual spending, as it is based on nine months and not the whole year and should not be compared to other deviations. In 2021, the state underspent its budget by 28% just as revenue collection was 24% short of the projected revenue.
The actual revenue of N512 billion from 2018 to 2021 was insufficient to fund the total budget of N580 billion in the same period, the Jigawa state government still underspent its actual revenues by 11%, with total cumulative actual expenses of N456 billion short of the actual receipts of N512 billion by N56 billion.
The health sector met the standard practice of 15% less budget deviation in 2018 and 2020. However, in 2019 (which budget expenditure in the information provided was for nine months) the deviation exceeded the 15% threshold to 35%, and to 28% in 2021.
The unavailability of sufficient funds from the state treasury to the budget of all MDAs often leads to the government prioritizing pressing issues of public concern during the fiscal year. For instance the need to speedily tackle public health emergencies such as disease outbreaks may result in funding the Ministry of Health at the expense of other ministries.
Furthermore, key interviewees noted that political pressures, crucial for the survival of elected and appointed officials, frequently lead to the reallocation of funds intended for budget implementation from one area to another.
State officials from the Ministry of Budget and Economic Planning clarify that the budget implementation challenges are related to resource availability: “When MDAs are given the authorization to release funds, but the treasury lacks sufficient funds, they must exercise patience until additional funds become available.” The researchers concluded that these delays make time-bound health projects not executable within the stipulated fiscal year.
Additionally, findings highlight inadequate time series analysis as a crucial factor affecting budget credibility, emphasizing the need for proper analysis to ensure budgeted funds can be procured within the budgeted timeframe.
Budgetary underfunding carries significant repercussions, including undermining public trust in the government’s financial acumen, impeding economic growth and development, dissuading potential investors, and compromising the effectiveness of policies.