NIGERIA’S accountant-general, the administrative head of the country’s treasury, has been arrested by the Economic and Financial Crimes Commission for allegedly stealing 80 billion naira ($134 million). This is a staggering theft in a country that has an estimated poverty rate of 95 million (48% of the population) and some of the worst health indices in the world.
As a universal health coverage and global health equity advocate, I know that Nigeria’s health system would be stronger and work better by blocking these leakages and channelling the funds to provide universal health coverage for every Nigerian.
Indeed, the stealing of public funds denies millions of people healthcare, which comes with severe health consequences. These include citizens living with chronic debilitating illnesses, loss of productivity, worsening poverty and even death. In our country, about 58,000 women die during pregnancy and childbirth yearly; and 1 in 8 children do not live to witness their 5th birthday. Simply put, corruption is a matter of life and death.
These are five examples of how the missing 80 billion naira could improve the health of Nigerians if rechanneled.
First, 80 billion naira would fund President Muhammadu Buhari’s plan to provide health insurance for 83 million poor Nigerians, as part of his implementation of the new National Health Insurance Authority Act that he recently signed into law.
Further, the missing 80 billion naira is 114 times the 701 million naira budgeted for the defunct National Health Insurance Scheme in 2022. It is unsurprising that the Scheme did not achieve a national health insurance coverage of up to 5% for the past 18 years.
A mandatory health insurance program is a way to achieve universal health coverage for Nigerians because out-of-pocket spending at the point of healthcare pushes people into poverty. Isn’t it ironic that millions of Nigerians are pushed into poverty when they access healthcare and the accountant-general is alleged to have stolen 80 billion naira? This is a classic case of suffering in the midst of plenty.
Second, the stolen 80 billion naira can fund tertiary healthcare for millions of Nigerians who access care at teaching hospitals. Lagos University Teaching Hospital, University of Nigeria Teaching Hospital, University of Ibadan Teaching Hospital, Aminu Kano Teaching Hospital and Jos University teaching Hospital collectively have a budget of 78 billion naira for 2022.
Teaching hospitals do not just provide tertiary healthcare. They also provide primary and secondary healthcare services. In addition, they train medical students and other health professionals. They are also training institutions for doctors specialising to become consultants.
Third, the stolen 80 billion naira is 13 times the 6 billion naira collectively budgeted for National Obstetric Fistula Centres at Abakaliki, Bauchi and Katsina states in 2022. The World Health Organization describes obstetric fistula as an abnormal opening between a woman’s genital tract and her urinary tract or rectum.
It is caused by long obstructed labor and affects more than 2 million young women globally. The abnormal opening leads to leakage of urine and/or faeces from the vagina. Obstetric fistulas destroy the dignity of women. Victims are ostracized, stigmatized and lose economic power. It said that you smell victims before you see them.
That is the huge burden that victims carry. In Nigeria, prevalence of obstetric fistula is 3.2 per 1000 births. There are 13,000 new cases yearly. A review of obstetric fistula in Nigeria showed that the backlog of cases could take 83 years to clear.
In contrast, the stolen 80 billion naira would shorten the time it takes to clear this backlog. I know from my experience as a grantmaker. In 2012, I led the community health initiatives at the TY Danjuma Foundation. A one-year grant of 11 million naira awarded to a grantee in Kano state, northwest Nigeria provided surgical repairs of obstetric fistulas; training of health workers on repair and care of patients; economic empowerment of patients; and advocacy to communities to discourage early marriage and encourage health-facility-based deliveries.
Fourth, the missing 80 billion naira if allocated to the National Primary Health Care Development Agency would improve COVID-19 vaccines procurement, distribution and administration in Nigeria. Indeed, that amount is more than 3 times the 24 billion naira budgeted for the NPHCDA in 2022.
So far, Nigeria is mostly depending on the generosity of vaccines donated by rich countries such as the U.S. through the COVAX facility. This is not sustainable. Recent news out of South Africa reveals that Aspen Pharmacare could shut down the production of Johnson & Johnson COVID-19 vaccine because African countries are not placing orders as expected.
At a cost of $7.50 per dose of Johnson & Johnson COVID-19 vaccine, $134 million would buy 18 million doses to vaccinate Nigerians and help the country achieve herd immunity as quickly as possible. Nigerians should not be pushing against global COVID-19 vaccine inequity amid widespread looting of the national treasury.
Lastly, the stolen 80 billion naira is 1.5 times the amount budgeted for the 54-billion-naira Basic Health Care Provision Fund. According to the National Primary Health Care Development Agency, the fund is to improve access to primary health care by making provision for routine costs of running primary health centres, and ensure access to health care for all, particularly the poor, by contributing to national productivity. Eighty billion naira increases the number of poor and vulnerable Nigerians who could access healthcare through the Basic Health Care Provision Fund.
Sadly, while still trying to come to terms with the allegation against the accountant-general, there is more news of fraud in Nigeria. A former Managing Director of the Niger Delta Development Commission was arrested for allegedly stealing 47 billion naira. Also, the only female to have served as the speaker of Nigeria’s federal House of Representatives was also arrested for 130 million naira fraud.
These thefts must stop, and the funds should be put where they are most needed: funding healthcare. Without health, we have nothing.