What's wrong with our idea of budgets?
How many drops can fill an ocean?
Our typical way of thinking about health budgets is a farce. According to the 2001 Abuja Declaration, and other similar benchmarks, so much percentage of so and so must be devoted to this particular sector.
In my candid view, it doesn’t matter what percentage of a budget we devote to health. Whatever the number, 5 percent? 10 percent? 15 percent? Take Nigeria for example. Our range of budget percentages is wide - while states like Imo have about 3 percent for health, states like Kano devote about 15 percent.
Yet not one of them is effective in delivering quality health for all.
Productivity first
The real question we should be asking is, what percent of what???
In the Nigerian example, all states are economically non self-sustaining, with an unproductive focus on federal allocations. Relative to our state populations, our economies are tiny. Tiny because, we produce nothing, all 36 of us. We were bottled fed from birth and now 36 old men are still collecting from mummy. Because of this developmental anomaly, our entire state budgets are so insignificant, that any sector budget is inherently a drop in the ocean.
5 percent, 10 percent of nothing, is still nothing.
Think at Scale
The population of the average Nigerian state is the size of several actual countries. Until our economic productivity increases to reflect our population sizes, and our actual economic needs, “meeting the Abuja declaration target” will be both impossible and ineffective.
What then is a practical scale for our health budgets?
Imagine if for example, one Nigerian state can have the same total budget as the Netherlands, a country which has a smaller population than many Nigerian states? Then, 5 to 10 percent of that would be something, wouldn’t it? There’s no Nigerian state that is not more resource endowed than the Netherlands. But there is also no Nigerian state that even one tenth as productive as the Netherlands.
Now, the Netherlands devotes just 10 to 11 percent of its total budget to health. In principle, why can’t Kano state for example, which devotes a whopping 15 percent, have a better health system than the Netherlands?
Because, 15 percent of nothing is still nothing.
Economic productivity is not a major point in most donor technical advise. In fact, donors are more likelyy to say that health will lead to economic productivity, instead the other way around. You already know why: if we start to understand economic productivity, donors will be put out of business.
Let’s answer one quick question: what low-hanging, immediate aspects of economic productivity are key to develop health systems?
