In October, President Muhammadu Buhari presented an Appropriation Bill of N20.51trn ($43.7bn) for the fiscal year 2023 to the joint session of ... the lower and upper Chambers of the National Assembly. He described the 2023 proposed budget as one “of fiscal sustainability and transition" - his very last budget as Nigeria's president. However, what financial legacy is he leaving behind?
When he arrived in office, Buhari promised to raise the standard of living for the many, with basic healthcare part of the deal.
“I am aware that out of pocket payment for health constitute over 70% of total health expenditure”, said Buhari at the opening of a new healthcare facility in 2017. “My presence here today demonstrates our Administration’s commitment to put [the] health of Nigerians as a top priority”.
Now, in his sixth year in office, Buhari has elected not to risk treatment in a Nigerian hospital. On Tuesday 30 March, just as Nigerian doctors were about to commence a nationwide strike to protest poor conditions, the 78-year-old took off to the UK for his fifth medical trip as president.
do you know how much they pay for hardship allowance at the House of Reps and Senate? They pay N1.2 million ($3,150) and we get a hazard allowance of N5,000 ($13).”
Although the presidency announced it was a routine medical check-up, which would last about two weeks, it appears to be yet another sign that the president does not trust Nigeria’s poor healthcare system and cannot do much to salvage it.
Since his medical to the UK in June 2016, Buhari – who ruled Nigeria as military head of state from 1983–1985 – has so far spent 170 days abroad for treatment. He had stayed the longest in 2017 when he spent 103 days in the UK treating an undisclosed ailment.
Ekiti State Governor Kayode Fayemi, who helped manage the Buhari election campaign, recently said the ruling APC has failed to deliver on its campaign promises.
Striking doctors, helpless citizens
On Thursday 1 April, the National Association of Resident Doctors (NARD) embarked on a nationwide strike over demands that the Nigerian government had, in 2020, agreed to carry out including the payment of salary arrears of their members, review of the current hazard allowance and payment of the outstanding COVID-19 inducement allowance.
Ironically, when they first announced plans to go on strike and rob citizens of healthcare, the Nigerian presidency responded a day after with a statement announcing that Buhari will be travelling to attend to his own health in the UK.
Uyilawa Okhuaihesuyi, president of the doctors’ association, says that while the president is not listening to their demands, what worries the doctors is that none of the other arms of government were acting to respond to their demands.
“Some of our members are being owed four months salary. The government does not honour their memorandum of understanding and that is one of the major reasons we are still where we are,” Okhuaihesuyi says.
“There are a lot of issues concerning our remuneration and conditions of service that we may not finish from now till tomorrow. There is no health insurance for any of the doctors, they don’t want to pay a hazard allowance – do you know how much they pay for hardship allowance at the House of Reps and Senate? They pay N1.2m ($3,150) and we get a hazard allowance of N5,000 ($13).”
In addition to his choice of overseas treatment, President Buhari also overlooks Nigeria when it comes to the education of his children. In 2016, his son and two daughters graduated from a UK university. Now, activists argue that in addition to showing how he does not care about the critical sectors of the economy, his preferences could also be sending the wrong message to the citizens.
“It’s quite a shame that Mr. President at this crucial time is taking a medical trip to the United Kingdom; this is undemocratic, a failure of governance and an indictment on the president,” says Hamzat Lawal, founder of Follow The Money, a social accountability initiative, and chief executive of Connected Development (CODE).
“As a leader of the most populous black nation, since he took office for over six years, he has not invested as much as he should in the sector. If Mr. President had a plan, a vision and a purpose for Nigeria that he currently leads from behind, he could have been able to access good and quality health care in Nigeria. This shows that even Mr president does not trust the Nigerian healthcare system.”
The Nigerian doctor’s dilemma: Serve fatherland or travel overseas?
A study of the budgetary allocation for health from 1999 to 2020 shows that the highest percentage of annual government spending provided for the health sector was in 2015 when N259bn allocation equalled 5.9% of the entire federal government budget.
As a result, it is now common practice for health workers associations to return to the streets with placards or down tools to protest the poor welfare of their members.
“It is very frustrating practising in Nigeria. It is a frustrating experience you face daily because what we are asking is not new and should be the basic things,” says Agwu Nnanna, the immediate past president of the resident doctors at one of the federal medical centres in north-central Nigeria.
“I can tell you that there is no doctor in Nigeria that [has] not thought of travelling to practise abroad. You can imagine a situation whereby despite all that is going on now with the pandemic and all the doctor or health worker gets is just N5,000 ($13) as hazard allowance for a month for all the risks you are facing. It is not something that you can think of.”
The bigger problem: Federal lawmakers are blinded by party loyalty
In 2018, when the federal House of Representatives considered a proposed law that sought to regulate overseas treatment for public officers, it was stepped down with the ruling All Progressives Congress (APC) as the majority party in the legislative chamber.
Now, the proposed legislation is back at the National Assembly, Hon. Sergius Ogun – the sponsor – confirmed in an interview, although he feared the bill might have difficulty scaling through with expected opposition from the APC lawmakers.
“You have ministers, governors, national assembly members and everybody travelling for treatment. If you don’t fix the healthcare system and you keep moving all this money out, we are never going to fix it. Why should everybody be going overseas for treatment when we can save that money?” he asks.
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He also believes that if there is a law that prohibits public officer holders from travelling out of the country for medical treatment, the government will be more serious regarding funding the health sector “since we know we don’t have the option of hopping on a plane and going abroad for treatment.”
While the strike is expected to last a long time as announced by the resident doctors, many Nigerians are going to be left unattended at the hospital as the country continues to fight the coronavirus that has already killed 2,000 out of about 163,000 cases.
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