Abuja Declaration Research Articles

ECOWAS and the challenge of preventing a resurgence of coups d’état in West Africa: An assessment of the ‘Zero Tolerance’ policy

ABSTRACT Since the adoption of the Abuja Declaration of Political Principles (1991) and the Supplementary Protocol on Democracy and Good Governance (2001) by the Economic Community of West African States (ECOWAS), the regional organisation has declared ‘zero tolerance’ for unconstitutional changes of government, particularly military coups d’état. Despite these declarations, West Africa has continued to experience coups, with a resurgence in the number of these since 2020. This article examines ECOWAS' structures and strategies designed to work against such a resurgence of coups in the region. The article demonstrates that ECOWAS has advanced both diplomatic and non-diplomatic measures to respond to the phenomenon. However, while the regional body has appeared proactive in responding to the coups, it has appeared to have little success thus far; a mix of domestic, regional and international geopolitical factors – which the regional body has failed to address – continues to undermine political stability in the region.

Government Health Care Financing and Health Care Outcomes in Africa

This paper uses the World Bank data on healthcare expenditures as a percentage of gross domestic product to analyze the funding available to the public health care sectors in 54 African countries. In the 2001 Abuja Declaration, these African countries vowed to allocate at least 15 percent of their annual budgets to improving their health care sectors and infrastructures. We developed the Compliance with Abuja Declaration Index (CAD Index) to gauge the extent to which African governments complied with the pledge. Our empirical results reveal that health care financing is grossly inadequate in Africa. The failure to finance the health care sectors at or above the 15 percent pledged in the 2001 Abuja Declaration has undoubtedly slowed Africa’s march towards providing improved health care for its citizens. Furthermore, African countries face acute shortages of medical doctors, nurses, and medical infrastructures to provide the robust health care sectors required for sustainable economic growth and development. African governments must implement policies to attract health care professionals by providing the necessary medical infrastructures.

Funding primary health care service delivery in the West Nile sub-region, Uganda

The provision of primary health care services is a global concern and quality health service delivery is based on a number of factors, including motivated health workers, good-quality infrastructure, consistent supply of medicines and technologies, adequate funding, sound health plans, and evidence-based policies. This study investigated the funding of primary health care service delivery in three local government districts in Uganda’s West Nile sub-region, and identified deficiencies in the allocation, disbursement and timeliness of health funding which have a negative impact on service delivery. Inadequate funding affects the quality of services, limits essential supplies and causes excessive reliance on private financing, which is not sustainable in poor rural economies. In view of these findings, the study recommended deliberate action by both central government and district councils to increase the percentage of funding allocated in their annual budgets to the health sector, in line with the 2001 Abuja Declaration. The government of Uganda should consider prioritising an increase in total national budget allocations to local governments; primary health care disbursements from central government should be paid on time directly to health facilities by use of the ‘straight-through processing system’ for all types of funding; the government should introduce, support and encourage additional community financing initiatives such as Community Health Insurance Schemes; and district and local community leaders should be sensitised on the benefits of this approach.

Effect of Human Capital Investment on Income Inequality in Kenya

Human capital investment has a crucial role in economic growth, and as such, it has been regarded as a significant aspect of government spending. The Gini index score reported an average of 41.6 percent in 2018, which is higher than the generally recognized perfect equality Gini index of 20%, suggesting that Kenya has been suffering from high income disparity. There has been a widespread belief that income inequality and human capital investment are mutually exclusive. The theoretical and empirical approaches in the literature provide mixed findings on the relationship. From 1990 to 2019, this study examined the effect of human capital investment on income inequality in Kenya while adjusting for interest rates and GDP per capita. The study adopted a causal research design to determine if a cause-and-effect association between the variables occurs. The time series data were subjected to diagnostic tests to ensure the presumptions of ordinary least squares held. Health expenditure was found to have a negative and statistically significant effect on income inequality after controlling for the interest rate and GDP per capita. After accounting for changes in interest rates and GDP per capita, the result shows that education investment has a negative and statistically insignificant effect on income inequality. The human development index was discovered to have a negative and statistically significant effect on disparity in income which was verified by the robust check. An inverted U was found using the Kuznets test, which was performed to broaden the scope of the research but yielded an insignificant result. The study recommends the formulation and implementation of policies that adhere to the Abuja Declaration on Health, which requires that 15% of government expenditure be allocated to health. The study recommends strict adherence to the 100% transition from primary to post-primary education. The study's conclusions are pertinent to the development and implementation of successful policies that encourage human capital investment, resulting in a decrease in Kenya's levels of income inequality.

GOVERNMENT HEALTH EXPENDITURE (GHE) AND HEALTH SECTOR PERFORMANCE IN NIGERIA

This study examined government health expenditure (GHE) and health sector (HS) performance from 1981 to 2021. The ex-post facto study examined how GHE affects infant mortality (IM) and life expectancy (LE) in Nigeria. The study's main goal is to examine how GHE (GHE) affects Nigeria's health sector (HS), with research hypotheses stating that the independent variables have no significant effect on IM and LE. ARDL showed mixed integration in the research variables. The analysis used time series data from the Central Bank of Nigeria Statistical Bulletin, World Bank Development Indicator, Nigeria's budget, CPIA database, and World Medical Association Report, 2021. This study's independent variable is GHE, measured by domestic spending, income per capital, foreign health grants, corruption, health insurance, Health provider (HP) remuneration, and medical consultants. LE and IMR evaluate health sector success. The analysis found that government health domestic spending and income per capital enhanced LE and reduced newborn mortality. Foreign health grants increase LE but decrease IM. Corruption also shortens LE and increases infant mortality. Health insurance again lowered LE. It temporarily lowered Nigeria's newborn mortality rate but greatly raised it. Medical provider remuneration marginally increases LE. It drastically lowers newborn mortality. Medical consultants decrease lifespan and raise IM. In Nigeria, GHE, particularly domestic spending, income per capital and international health grants, increases LE but decreases IM. Thus, the research recommends that Nigeria dedicate 15% of its budget to health to implement the 2001 WHO Abuja Declaration. The Nigerian government should also promote UHC ventures with health care regulators. Finally, Nigeria should institutionalise PPP healthcare.
 Keywords: Health Expenditure, Health Sector Performance and Life Expectancy.

Health outcome convergence in Africa: the roles of immunization and public health spending

BackgroundReducing health outcomes disparities in Africa is a major concern for policymakers. Inter-country disparities in Africa is well documented. However, little is known about the accurate trajectory of these disparities over time. Thus, this paper investigates the convergence hypothesis in health outcomes in 40 African countries using data from the World Development Indicators. The study used panel data from 2000 to 2019.MethodThe study employs a nonlinear time-varying factor model to test the convergence hypothesis on infant mortality rate, under-five mortality, and life expectancy at birth. Then, we use the marginal effects of the ordered logit regression model to investigate the factors that explain club memberships.ResultsThe findings showed the absence of overall convergence for the three variables of interest. However, we identified the presence of convergence clubs. Moreover, we observed substantial gaps between the estimated clubs. The marginal effect results reveal that real GDP per capita, population structure, urbanization, trade, access to basic sanitation, and external health expenditure are essential to club formation. In addition, DTP immunization and the general government health expenditure as a percentage of the general government expenditure (our Abuja Declaration instrument) also play a significant role in explaining the club membership.ConclusionThe findings suggest that policymakers should develop and implement targeted club-specific health policies. Furthermore, interventions to promote increased immunization, particularly among children, should be encouraged. Governments should also make substantial efforts to increase the share of their national budget allocated to the health sector by at least 15 percent.

Sustainable financing of AYSRH programs by local governments through the TCI model.

Despite the existence of a legal policy framework, financing of adolescent and youth sexual and reproductive health (AYSRH) services has remained weak. External donors are the main financing agents, which has implications for the sustainability of service provision. International development partners have reduced funding for health programs from historically high levels. In Kenya, the health sector's budget allocation has remained below the 15% committed to under the Abuja declaration. With Kenya's devolved government structure, a greater proportion of financial resources are dedicated towards recurrent and structural expenses as opposed to addressing health systems gaps. The purpose of this manuscript is to assess the contribution of The Challenge Initiative (TCI) Business Unusual model on AYSRH services in the counties of Kilifi and Migori, as well as to examine the institutionalization of high impact interventions (HIIs) within the annual work plan, budget, and systems of the said counties. Additionally, this study aims to analyse the trend in contraceptive uptake among adolescent and young women aged 15 to 24 in Kilifi and Migori counties. Migori and Kilifi Counties chose to partner with TCI to implement the Business Unusual model. Interested counties apply for the initiative's support and commit to contributing a portion of the funding needed to adapt and implement high impact interventions (HIIs). Based on the identified gaps, TCI supported the counties to prioritize the HIIs including integrated outreaches, youth fixed days, whole site orientation, youth champions, and youth dialogues. The program was implemented between July 2018 to June 2021 in 60 and 68 public health facilities of Kilifi and Migori Counties, respectively. The county teams identified and selected program implementation team whose key role was to coordinate, review, monitor, mobilize resources and report AYSRH program implementation progress. The results showed a 60% increase in financial commitments on AYSRH programming from 2018 to 2021 in both counties. The average expenditure for committed funds for Kilifi and Migori Counties was 116% and 41% respectively. As the counties continued to allocate and spend funds on the implementation of HIIs, there was a noticeable increase in contraceptive uptake among the young people aged 15 to 24 who visited health facilities for services. There was a 59% and 28% percentage increase in contraceptive uptake among young people (15-24 years) between 2018 and 2021. The proportion of adolescents amongst those presenting for first ANC clinic dropped from 29.4% in 2017 to 9% in 2021 in Kilifi County and from 32.2% in 2017 to 14% in 2021 in Migori County. Using the TCI's Sisi kwa Sisi coaching model of lead-assist-observe-monitor, 20 master coaches were trained. The master coaches cascaded the training to over 97 coaches. The coaches will continue to build capacity of peers in advocacy for resource mobilization and implementation of HIIs. At least nine of TCI's HIIs have been adopted in Kilifi and Migori County strategies and annual work plans, and there is financial support for their sustainability. The increase in adolescent contraceptive uptake might have been as a result of the system strengthening through self-financing of AYSRH programs, the institutionalization of HIIs, and the coaching. Local governments can invest in and sustain their own AYSRH programs, which will lead to an improvement in adolescent and youth access to contraceptive services and, as a result, a reduction in adolescent pregnancies, maternal mortality, and infant mortality.

Government Educational Spending and Human Capital Development in ECOWAS Sub-Region: Implication For Sustainable Development

Abstract The critical need to create economic prosperity and ensure inclusive and equitable education and lifelong learning for all, especially in developing countries has been the motivation behind the various advocacies by the policymakers and other stakeholders in these countries to achieve the SDGs comes 2030. Meanwhile, ECOWAS sub region is characterized with the lowest human capital development alongside the highest rates of illiteracy in the world despite the continuous rise in government educational spending over the years. Against this backdrop, the role of government educational spending on human capital development in ECOWAS sub-region has been investigated with a view to driving one of the strategic goals of Sustainable Development- inclusive and equitable education and lifelong learning for all. In order to achieve this, annual data from 1990 to 2019 was utilized using a panel ARDL as a technique of estimation. The findings that emerged in this work are summarized as follows; the relationship between government educational spending and human capital development in ECOWAS sub region is more of a long run phenomenon. Therefore, government educational spending and human capital development have a positive and significant relationship in the long run. In the light of the above findings, this study therefore makes the following recommendations for the policymakers in ECOWAS sub region and by extension developing countries, any time the goal of these policymakers is inclusive and equitable lifelong learning via human capital development, the government at levels should embark on sustainable educational spending. In the same vein, these policymakers should be committed to funding of educational sector as stipulated by both the United Nations and the Abuja declaration of 2001, advocating for 26% of annual budget for educational sector in developing countries.

Protecting the Deity Called Neoliberalism from Shame: Uganda’s 2020 Covid-19 Lockdown and Violations of the Right to Health

The Covid-19 pandemic struck Uganda like a storm. On 18 March 2020, President Museveni ordered the closure of schools and suspended religious gatherings, public rallies and cultural meetings with effect from 20 March. This was aimed at safeguarding the right to health in general, and the right to life in particular, of all Ugandans. By 30 June 2020, Uganda had not registered a single Covid-19 death and had had less than 1 000 infections. The Covid-19 pandemic, however, created great panic among the leadership of Uganda’s neoliberal regime. For three decades, the Ugandan state has deliberately underfunded the health sector, using the neoliberal logic that the market will address the challenges of the health sector. The state has treated economic and social rights as mere aspirations and not as genuine human entitlements. Museveni’s regime has rejected pleas from civil society organisations to allocate 15% of the budget to the health sector, as per the Abuja Declaration. The New Public Management philosophy of neoliberalism advocates for public hospitals and health facilities to be run like private-sector enterprises that employ fewer personnel in order to cut the costs of salaries and wage expenses. This article argues that the Ugandan state violated the right to health of Ugandans during the 2020 Covid-19 lockdown. It contends that the ruthless enforcement of the lockdown in Uganda in the wake of the coronavirus pandemic aimed to protect the neoliberal state from embarrassment occasioned by the prioritisation of markets over people’s social and economic rights.

Budgetary allocation and social services deterioration in the fourth Nigerian republic (1999 to 2021)

The deterioration in the education and health sectors is alarming and a concern to major stakeholders in Nigeria. This study examined the effect of the budgetary allocation based on 20% United Nations Educational Scientific and Cultural Organization (UNESCO) benchmark for education and 15% 2001 African Union Abuja declaration on the social services deterioration in the fourth Nigerian republic. Specifically, the study examined the effect of budgetary allocation efficiency in education and health sectors on human development index from 1999 – 2021. Corruption perspective index (CPI) and gross national income (GNI) per capita was introduced as control variables. Robust multiple regression analysis was used to analyzed the data. Results revealed that budget allocation efficiency in the education sector has significant negative effect on human development index while budgetary allocation efficiency on the health sector has positive significant effect on human development index. The implication of these findings is that the Nigerian state didn’t take education serious or that endemic corruption and budgetary indiscipline has overwhelmed the entire process. We recommend that state of emergency should be declared on education funding to avert further degeneration; funding of health sector should be increased at least to the level of the 2001 Abuja declaration; and increase citizen participation in the budgetary process to address the menace of corruption to foster accountability and transparency. Keywords: Budgetary allocation, Social services deterioration, Corruption, Human Development Index (HDI), Gross National Income (GNI) per Capita DOI: 10.7176/DCS/12-7-06 Publication date: November 30 th 2022

Household Catastrophic Health Care Expenditure: Evidence on the Effects of Out-of-pocket Health Care Payments on Household Income in East African Region

Out Of Pocket Payments (OOPP) refers to the amount of money a patient pays for medical expenses that are not covered by a health insurance plan (National Cancer Institute, 2022). The World Health Organization (WHO) defines OOPP as the individuals’ direct payments to healthcare providers at the time of service use (Kalantari, 2012). Developing countries are exposed to considerable socio-economic vulnerabilities. Catastrophic out-of-pocket spending has adverse effects on individual and household income, especially where policies on healthcare financing does not favor the poor. Heath care funding and the quality of healthcare outcomes in development are inseparable. The World Health Organization Assembly resolution of 2005 on universal coverage and sustainable health financing, the Paris Declaration of 2001 on greater Investments in the Health Sector, Health Insurance and Financing, and the Sustainable Development Goal number 1 on ending all forms of poverty forms the basis of this study. African Governments committed through the Abuja Declaration, to allocate and spend at least 15 percent of government funds of their National GDP on health. In June 2015, Countries in the East African Community concurrently released their National budgets for the Financial Years 2015/2016. None of the countries had fulfilled the Abuja declaration promise on healthcare investment in East African Community. This study examined how different countries in East Africa have invested in healthcare and the state of out-of-pocket spending on household income. Related literature review will be analyzed, and conclusions and the way forward in relation to household healthcare spending in East African Countries will be discussed.

Financing malaria.

The faltering of progress towards malaria elimination follows a plateauing in international financing since 2010. Despite calls for increased international financing, this will be hard to achieve. Both developed country donors and developing countries with malaria face severe fiscal constraints in expanding malaria funding in the next few years. Simply exhorting countries to spend more is unlikely to be successful, just as the Abuja declaration was not, and the developing countries with most malaria burden suffer from weaker economic growth and less capacity to increase domestic financing. One major prospect for substantial new financing is China, but this may depend on established funders yielding influence in the global financing architecture to China and other emerging economies. This argues for greater emphasis on spending available financing better, but improving the impact of international funding is not straightforward. It is associated with significant transaction costs for recipients, impairs the ability of the WHO to coordinate global efforts, and may pressure recipient countries to focus more on commodities and easy wins instead of investing in health systems and management capacity. While more should be done to mitigate these perverse effects, much of this is the unavoidable price of such generosity and the inevitable need for accountability to funders. Ultimately, countries must do more with their own spending, which is often under-counted, but usually far exceeds the international contribution. The experience of Sri Lanka, El Salvador, and China-three countries that eliminated malaria-provides two pointers. First, achieving early and widespread treatment of most malaria cases, which is not the case in much of high burden Africa, may be critical to sustain accelerated elimination. Second, such coverage requires health systems that prioritize access for all services and conditions. Public opinion surveys indicate that this is consistent with what much of the affected population wants, prioritizes, and is willing to finance through higher taxes, which points to weaknesses in accountability of policy to people. International funders could do better to heed what affected populations want and let local partners be responsive to their own public's preferences.

Effect of public health expenditure on health outcomes in Nigeria and Ghana

Despite the prevailing literature examining the effect public health expenditure has on health outcomes in Africa, Malaria and HIV/AIDS mortality which are key indicators of the outcome variable were unconsidered when drawing inferences. In view of this oversight, we investigate the impact of public health expenditure on health outcomes in Nigeria and Ghana whilst reconceptualizing health outcome by capturing infant, maternal, Malaria and HIV/AIDS mortality. Using the health expenditure commitment at the 1999 United Nations General Assembly and the Abuja Declaration of 2000, we also assessed public policy’s role in this relationship via linear regression analysis. With hindsight, our findings disclosed a low public health expenditure in both countries despite the Ghanaian case revealing a negative relationship, which was primarily insignificant whilst Nigeria indicated a positive one. These empirical evidences accentuate the need to augment public health expenditure in both countries to boost health outcomes whilst bringing to bear the significant influence of GDP, school enrolment and residing in urban areas on health outcomes.

THE TREND IN FERTILIZER CONSUMPTION AND ITS IMPACT ON CROP OUTPUTS IN NIGERIA

The study analyzed the consumption trend of fertilizers (nitrogen, phosphorus, potassium and total/composite fertilizers) and examined its relationships with selected crop outputs from 1962 to 2019 in Nigeria. Time-series data were used and were sourced from the World Bank and Food and Agriculture Organization. The descriptive statistics, correlation analysis and Cobb Douglas production function were applied to analyze the data collected. The results revealed that fertilizer consumption over time exhibited a high level of volatility in Nigeria. The average consumption rate of 7.17 kg/ha for composite fertilizer was far below the minimum rate of 50kg/ha declared in Abuja in 2006 by African countries. Furthermore, the study established significant correlations between fertilizers and selected harvested land yields and crop outputs in the country. This implies that fertilizers can significantly regulate the outputs of crop enterprises in the country. The empirical results revealed that fertilizers were irrationally utilized in the majority of selected crop enterprises as their elasticities were either negative or greater than unity. Moreover, the decreasing return to scale was confirmed for each crop enterprise denoting decreasing contribution of fertilizer inputs to crop outputs growth in Nigeria. Based on the findings, it is recommended that the Nigeria government should work towards achieving the Abuja declaration on fertilizer use.

Health Budget Allocation and Performance; and the Budget’s Preparedness for Health Events such as COVID-19: Enugu State Perspective

This is an exploratory study of the health budget allocation and performance of a State against the background of its health indices and preparedness for any public health emergency such as COVID-19. This is aimed to guide future health programming in the state. Three research instruments (Questionnaire, data collection, and interview guides) were used to collect data, key informant interviews with health planners and managers; synthesis of relevant literature reviews to identify relevant documents; and responses gathered from the public and civil servants. The findings identified eight (8) Ministries, Departments, and Agencies (MDA) under the State Ministry of Health, which is the policy-making body that monitors and coordinates/regulates all health activities in the State. The government budget, donor partners, out-of-pocket expenditures, and contributory schemes are sources of funds for Health. The State’s budgetary allocations for health shows an annual increment from reaching 15% in 2016 to 16% in 2017 and over 17% in 2018, surpassing the Abuja Declaration target of 15% of the state budget. In nominal terms, allocation to the health sector fluctuated between 2011 and 2016 and finally went down in 2018. There is no clearly cut-out budgetary provision for emergency preparedness for health events in the State’s health budget. The government has proactively made budgetary provisions for the challenges facing the health care system to facilitate efforts towards addressing them. However, it remains to be seen whether the poor health indices will get better in the long run.

Assessment of the 2006 Abuja Fertilizer Declaration With Emphasis on Nitrogen Use Efficiency to Reduce Yield Gaps in Maize Production

The Abuja Fertilizer Declaration in 2006 recommended the increase of fertilizer use from the current practice for Sub-Saharan Africa (SSA) to achieve food sufficiency and improve soil fertility status. However, the current recommended rates of fertilizer have not been evaluated for specific crops on their potential to reduce the yield gap and optimize nitrogen use efficiency (NUE). In this study, with nitrogen (N) being a significant yield-determinant nutrient, four N use scenarios were drawn from existing recommendations and were evaluated under field conditions for maize crops in two catchments of the Lake Victoria basin. The scenarios included Business as Usual (BAU, 0 kg N ha−1), 25% of the Abuja declaration (ADS 12.5 kg N ha−1), 50% of the Abuja declaration (ADS 25 kg N ha−1), and Abuja declaration–Abuja scenario (ADS, 50 kg N ha−1). The results revealed that increasing N input levels significantly influenced the growth and yield of maize crops. The ADS scenario recorded the highest grain yield increase (167.39%) in Nyando and 103.25% in Rangwe catchments compared to the BAU scenario. N deficits were observed in all the N use scenarios with a range of −66.6 to −125.7 kg N ha−1 in Nyando and −62.5 to −105.4 kg N ha−1 in Rangwe catchments with the 50% ADS scenario having the highest deficits. The deficits imply that the added N input is insufficient to create an N balance for optimal NUE with consequent high risks of soil N mining. In both catchments, all N use scenarios were within the recommended agro-physiological N efficiency (APEN) level of between 40 and 60 kg kg−1 N. The partial N balance obtained at Nyando (1.56–3.11) and Rangwe (1.10–4.64) was higher than the optimal values, a sign of insufficiency of N inputs and possible risk of soil N depletion in all the scenarios. Our findings conclude that the proposed N rates in the region are still very low for food sufficiency and optimized NUE. Therefore, there is a need to explore other sources of N such as biological N fixation and organic manure and inform policy- and decision-makers to recommend higher rates beyond the “Abuja declaration” with the prospect of reaching target yield and optimizing NUE values based on specific crop recommendations.

Assessment of Health Purchasing Functions for Universal Health Coverage in Nigeria: Evidence from Grey Literature and Key Informant Interviews

Objective: Out of pocket expenditure is the primary means of financing healthcare in middle and low-income countries. The 2021 government health expenditure in Nigeria at 4.52% falls short of the 15% recommendation of the 2001 Abuja Declaration. This paper examines healthcare purchasing in Nigeria, in order to explore how resources were allocated and create better insight into healthcare purchasing for universal health coverage. Data Source/Study Setting: The study was conducted in the Federal Capital Territory and three states—Lagos, Enugu and Sokoto. Study Design: A cross sectional method was used to examine health purchasing functions in Nigeria. Key informant interviews and review of grey and published literature on health financing in the selected study areas. Data Collection Methods: Primary data were collected from relevant stakeholders across the selected study areas, using a structured interview guide. A search of grey and published literature gave a total of 57 references. Principal Findings: The NHIS has a clearly articulated benefit package, for its formal sector and pro-poor BHCPF program. NHIS covers only about 5% of the Nigerian population. BHCPF (SOML) program targets the bottom 40% of Nigerians on paper, but there is no specific design for reaching them. The NHIS uses both public and private sector providers. It is not clear which providers are used for the BHCPF (SOML) program. The NHIS uses actuarially calculated capitations for primary care services and market-based fee-for-service rates for reimbursing secondary and tertiary care. BHCPF (SOML) uses a macroscale pay-for-performance mechanism to reward states achieving specific health outcomes. Conclusion: Health purchasing functions have serious implication for UHC. However, health care provision in Nigeria is not pro-poor and government efforts do not promote efficiency. Available option is prioritization of health initiatives that ensure value for money through performance-based financing and partnering with the private sector.

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

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.

Health Expenditures and Health Outcomes in Kenya

Health inputs are critical in attaining a healthy nation and improving health outcomes. Kenya, like other developing countries, grapples with limited health expenditures and poor population health indicators. Specifically, Kenya is yet to achieve the allocation of least 15% of the government’s annual budget to improve the health sector as enshrined in the Abuja Declaration. Though there is an improvement with regards to infant mortality rate decreasing from 96.6 per 1, 000 live birth in 1970 to 30.6 per 1, 000 live birth in 2018. This indicator of population health outcome is currently far below the Sustainable Development Goals (SDGs) target of reducing the under five mortality rate to as low as 12 deaths per 1,000 live births by 2030. The literature suggests that increase in government’s budgetary allocation to the health sector can improve country’s health outcomes. Evidence on the impact of health expenditures on health outcomes is mixed and limited in developing countries. This study aims to analyze the impact of public health expenditures on health outcomes, among other control variables in Kenya. The study uses time series data from 1970 to 2018. The variables are found to be integrated of different orders suggesting the choice of Autoregressive Distributed Lag (ARDL) model. ARDL provides a useful link between long run equilibrium relationships and short run disequilibrium dynamics is estimated. The ARDL bounds test suggests presence of cointegration thus leading to the estimation of Error Correction Model (ECM). The findings suggest that improvements in public health expenditures enhance health outcomes in Kenya. The control variablesthat are found to be important determinants of infant mortality rate in Kenya include the national income and number of hospital beds per 100, 000. The study recommends that Kenyan government should increase annual budgetary allocation to health sector. Such increase is likely to lead to investments in physical and human capital in the health sector thus translating to improved health outcomes in Kenya.

Assessment of Health Budgetary Allocation and Expenditure Toward Achieving Universal Health Coverage in Nigeria

Context: The implementation of the Universal Health Coverage (UHC) promotes access to quality health care delivery through cost-effective initiatives to ensure good health and wellbeing without discrimination. This study examines government finance, budgetary allocation, and expenditure as key health development indicators towards achieving the UHC in Nigeria. Evidence Acquisition: Data analyzed in the study were gotten from journal articles, reports and other secondary sources. Searches were conducted in PubMed, Google Scholar, and WHO Library Database with pre-determined search terms. Further publications were identified through snowballing of citations and references. We reviewed only papers written in English with no date restrictions placed on searches. Results: Within the period of analysis, the annual national health budgetary allocation in Nigeria has been below the 2001 Abuja declaration of allocating 15% of the national budget to health. Our analysis also revealed that if the Abuja declaration was implemented, additional allocations of NGN 4.99 trillion should have been injected into the health sector between 2014 and 2020. In addition, Nigeria also lags behind relative to some other low-and middle-income countries in terms of government expenditure to the health sector in achieving the UHC. Conclusions: The inadequate budgetary allocation in Nigeria to healthcare has significantly influenced recurrent and capital health expenditure. It is worthy to note that the insufficient allocation will continue to significantly affect capital expenditure which is a large determinant of the development of any health system. With the current state of healthcare budget allocation in Nigeria, efforts need to be intensified to ensure the achievement of UHC. In the face of achieving UHC, reviewing the system of healthcare financing and ensuring prudent allocation of resources while shifting the focus from out-of-pocket payments for health is essential. We also recommend increase in political commitment towards improving the health of the populace so as to ensure health systems goals of efficiency, equity, quality of care, sustainability, financial risk protection for all citizens are achievable.