FOR many years, Dauda Abdulkadir lived with his family in Guyaba, Bauchi State, and he often dealt with rats feeding from their food. Despite several precautions to reduce these pests in their home, they were unaware of the danger of consuming food contaminated by rats.

In 2023, Dauda’s wife fell ill with a fever, vomiting, and diarrhoea. He had attempted to treat her with a drug from a local makeshift shop, but this only made things worse. On getting admitted into Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), his wife was diagnosed with Lassa fever disease, The ICIR reported. 

Meanwhile, the lack of access to clean water in another community in the Federal Capital Territory (FCT), Abuja, housing more than 500 people, put residents at risk of water-borne diseases like Cholera, due to unhealthy practices of open defecation. 

The ICIR learnt that residents in the Shishipe community, in the Katampe area of FCT, drink from an impure stream on the outskirts of the village. 

Within the last eight years, Nigeria has recorded a rising number of cases from the spread of the two diseases, Lassa fever and Cholera, in various states. The spread of both outbreaks has led to the death of 5,768 people within the last eight years.

This report provides an in-depth analysis of the 2024 state health budget, comparing it to the approved budget to assess its adequacy in combating emerging epidemics throughout the year.

The epidemics: Lassa fever, Cholera

Lassa fever is a deadly viral hemorrhagic illness that lowers the platelet count in the blood and its ability to clot, causing internal bleeding. The disease was first identified in Nigeria in Borno State in 1969 and is endemic in Nigeria.

Upon its re-emergence in December 2016 to becoming a major epidemic in Nigeria, The ICIR findings from multiple documents uploaded by the Nigeria Centre for Disease Control (NCDC) and Prevention showed that Lassa fever has killed more than 1,300 people in eight years. 

Table showing the spread rate of Lassa Fever in Nigeria in eight years. Source: NCDC. Note that 2024 data ends on July 7, 2024.

Between 2017 and July 2024, more than 45,000 suspected cases were recorded of which 6,555 cases were confirmed positive in no fewer than 24 states and 105 local government areas. 

On the other hand, Cholera, an endemic disease, is still one of the major diseases that affect Nigerians, particularly in the rural region of the country. Findings by The ICIR showed that between 2021 and July 2024, more than 141,000 suspected cases have been reported. 

Furthermore, 4,406 deaths have been recorded within the four years in no fewer than 32 states and 255 local government areas on average.

Table showing the spread rate of Cholera in Nigeria in four years. Source: NCDC. Note that 2024 data ends on July 7 2024.

2024 epidemic data

Between January and July 7, 2024, Lassa fever had spread to at least 28 states and 125 local governments. The number of suspected cases of Lassa fever hit 7,122 with 933 of those cases confirmed positive. The disease killed 163 people within seven months. 

Similarly, Cholera disease has been reported in 33 states and 148 local government areas. No fewer than 2,800 people had suspected symptoms with 82 deaths recorded within the first 27 weeks of the year.

Breaking down the numbers, the data reveals that approximately 53 people in Nigeria were impacted by one or both diseases every day, with a daily fatality rate of one person, throughout the observed timeframe.

Inside state’s health allocation

A comprehensive review of approved budgets by the legislative assemblies in all 36 states reveals a total expenditure of N16.15 trillion. Of this amount, The ICIR gathered that N1.33 trillion was cumulatively allocated to the health sector.

Collectively, this represents eight per cent of the total approved budget. 

Meanwhile, in 2001, member states of the African Union (AU) convened in Abuja and pledged to allocate 15 per cent of their annual budgets towards healthcare. This commitment is aimed at addressing the significant funding gaps in the health sector to improve the alarming epidemic prevalence across the country.

Using the 15 per cent pledge as a benchmark, an analysis by The ICIR showed that only four states across the 36 states met the health benchmark in their 2024 budget. These states are Abia, Bauchi, Kano and Yobe states. 

Meanwhile, aside from the above four states, the data also showed that more than 10 states budgeted between 10 to 14 per cent of the budget to the health sector. These states are Borno, Edo, Jigawa, Kogi, Kwara, Nassarawa, Ogun, Oyo, Sokoto and Taraba.

The ICIR further observed that states like Lagos, Bayelsa, Ebonyi, Ondo and Benue which have the highest prevalence of epidemic cases recorded in 2024 failed to allocate up to 10 per cent of their budget to the health sector. 

The poor allocations indicate that some states’ negligence to adequate healthcare might be putting several residents at risk of epidemic outbreaks in the country. The ICIR reported some of these issues in states like Anambra, Niger, Benue, Kaduna, Abuja, Nasarawa, Oyo, Ogun and others.

On the federal level, The ICIR has reported how each citizen has been allocated N524 only for healthcare after a review of the 2024 budget for the health sector. 

The chief executive officer of TalkHealth9ja, Laz Eze, told The ICIR that while poor funding has become a recurrent challenge to the health sector, there is no value commensurate with the allocations made to the sector over the years. 

He added that human capacity to manage epidemics in most states has been very poor and whether more funding is channelled to the sector, the lack of capacity may detar improvement. 

He said, “Adequate budgeting for health is important. With the budget, we ensure we budget in accordance with priority needs. It is not just about the total budget put to health but what is the details? Both should go hand in hand, that is adequate budging and efficient or effective utilisation to get value for money. Many times we do an incremental budget without it being informed by appraisal of an existing budget .”

Mpox, the new epidemic

On August 14, the World Health Organization declared monkeypox (Mpox) a global public health emergency, which was the second time the declaration was made in two years. The declaration came just after an outbreak of the infection was reported in the Democratic Republic of Congo.

Following this declaration, the ECOWAS Regional Centre for Surveillance and Disease Control said that Nigeria, Côte d’Ivoire, Liberia, and Ghana are the most affected countries in West Africa.

The ICIR tracked the development of the outbreak within the country and findings showed that in 2024, as of August 25th, 868 suspected cases have been reported with 48 of these cases confirmed in 35 local government areas.

Mpox data was gathered from the NCDC website as of August 25 2024. 

The Nigerian Centre For Disease Control (NCDC) said that children between ages zero to five are mostly affected by the mpox disease outbreak in the country. However, The ICIR reported that the United States donated 10,000 doses of the Jynneos vaccine to Nigeria as part of efforts to combat the spread of mpox in the country.

Recently, the National Assembly and major stakeholders in Nigeria’s health system demanded better healthcare delivery for all Nigerians by all tiers of government in the country stressing that that indices about Nigeria’s health development were abysmally poor.

Kehinde OGUNYALE

Kehinde Ogunyale tells stories by using data to hold power into account. You can send him a mail at [email protected] (jameskennyogunyale@gmail) or Twitter: Prof_KennyJames