Comparative Analysis of Health Research Financing as a Veritable Tool for Achieving and Sustaining Universal Health Coverage in Nigeria and South Africa

Abstract

Background: Nigeria is a signatory to the Abuja Declaration on allocation of 15% of the national budget to health and World Health Organization declarations that call on countries to allocate at least 2% of the national health expenditure to research. This review estimated the percentage share allocation of Nigeria’s national budget to health and health research. Method: This is a documentary review of the national budget and research literature on healthcare financing in Nigeria and South Africa, Africa’s largest economies. No date restrictions were placed on the searches except the special focus on the national treasury reports and annual institutional financial reports published between 2012 and 2018. We searched nine electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, Cochrane library, Academic Search Complete, Google and Google Scholar and HINARI) and, national treasury Databases of Nigeria and South Africa with search terms that included public health financing. Results: Nigeria’s total budget increased by 83% from N4.7 trillion (USD13.1 billion) in 2012 to N8.6 trillion (USD23.9 billion) with a corresponding 26% increase in health allocation and 55.4% growth in health research allocation between 2012 and 2018. In contrast, South Africa’s total budget increased by 57.5% from R1.06 trillion (USD74.3 billion) in 2012 to R1.67 trillion (USD117.1 billion) with a corresponding 68.4% increase in health allocation that fluctuated between R122 billion (USD8.6 billion) and R205.4 billion (USD14.4 billion) in the same period. The percentage increase in health research allocation for South Africa was 69.3% in the same period. While South Africa with near universal health coverage (UHC) allocated an average of 11.7% and 1.2% to health and health research respectively in 2012-2018, Nigeria allocated only an average of 5.0% and 0.74% to health and health research respectively in the same period with no trajectory towards achieving the 15% and 2% targets. Conclusions: Findings underscore very poor health sector and health research funding in Nigeria and still far from meeting the targets of international declarations in contrast to SA. Realizing the pivotal role of a strong health research base, substantial increase in health and health research budget allocations to meet the 15% and 2% targets respectively are required to achieve and sustain UHC and improved health outcomes in Nigeria by 2030.