Table 5

Opportunities to improve low government spending on health (summary of participants’ quotes)

SubthemesQuotes
Low government commitment to health spending1. ‘The percentage of 15% budget for health from each state that was supposed to be put in the health sector, those percentages are not up to, it’s not up to 3%. Some states find it difficult to even get 5% of their budget to be channeled to health or thereabout.’ (State-level stakeholder)
2. ‘We just analyzed expenditure for HIV, TB, and malaria recently and it will shock you that in 2018, it was 2018 or 19. No, I think it was 18, 2018, on expenditure on tuberculosis, every TB drug that was swallowed in the country came from the donors. Not one came from the government of Nigeria, not [the] federal government, not [the] state government.’ (Federal-level stakeholder)
3. ‘Let’s take the HIV for example, we’ve known for years now that it [donor funding] is going to reduce [and] it’s not sustainable. They [donors] are not going to continue to do everything for Nigeria but Nigeria still doesn’t budget adequately for these services.’ (Federal-level stakeholder)
Accountability and multisectoral collaboration4. ‘Not just putting money into health, but also accounting for how it is used and the result and performance out of the use of that. That conversation is very, very mute, and therefore with even more money going into health, and less accountability and documentation from revised outcomes of use for funding for health, we still have a problem with relating resources, financials, with the outcomes and how those are then driving our efforts to UHC.’ (Development partner)
5. ‘You need resources. So, I mean, we are just talking about the health system actors, but you know UHC has more people outside the [health] system like [the] ministry of finance, the presidency, national assembly, you know so they need to work more, it needs a multisectoral action.’ (Academic stakeholder)
Prioritisation of health spending at subnational levels6. ‘I think part of our problem too is that you know the states, most times they keep looking up to the federal to do something [fund].’ (Federal-level stakeholder)
7. ‘So, for me, if we want to achieve universal health coverage, we have to restructure the health system. We have to decentralize; we have to stop all these Abuja business.’ (Federal-level stakeholder)
  • TB, tuberculosis; UHC, universal health coverage.