Summary of findings & recommendations
A nation’s health policy and commitment to ensuring a healthy population defines its development and contributes to its influence among the comity of nations. The right to health is indeed an internationally recognized human right, which is reflected in several human rights treaties.
Apart from undermining the quality of conditions and infrastructure of health care, corruption also impedes citizens’ access to basic care and deprives the health sector of much-needed resources to establish an environment to carry out a government’s obligations regarding the right to health.
Pregnant women who are poor are disproportionately affected during both prenatal and postnatal periods. Large scale official corruption in the health sector exacerbates inequality in already unequal and unfair political, social, and economic environments, and it produces a ‘cash and carry’ health care system based on one’s ability to pay for care.
In addition to being subjected to long waiting periods, the vulnerable are more frequently seen not by a doctor, but by a nurse, physician’s assistant, or other health care professional who may not necessarily possess the requisite expertise or experience. Additionally, while middle- and upper-class citizens can access health care services from private clinics, the vulnerable cannot afford such clinics and are therefore compelled to seek services and treatment in unsafe and unregulated environments, leaving them susceptible to avoidable injuries and death.
On the part of Nigerian legislatures, the National Assembly from 1999 to 2015 neither provided comprehensive oversight for the health sector, nor ensured Nigeria’s health sector gets the 15 percent budgetary allocation recommended globally. On the other hand, the Executive arm of government and public agencies have been characterized by financial misappropriation and corruption in the procurement processes which divert meager budgetary allocations to the health sector.
This report revisits and highlights various unresolved cases before anti-corruption agencies such as the Economic and Financial Crimes Commission (EFCC). These corruption cases include the $300 million scam by former health ministers; MDG fund embezzlement, and the Ebola Fund scam. This report also reviews the attitude of Nigeria’s judicial system to corruption in the health sector illustrated by delayed justice in cases of corruption while interpreting the law, handling of cases of avoidable deaths by health professionals, amongst others. Data for the report were collated through desk and field research, information obtained from investigation carried out by Premium Times, interviews, as well as print and electronic media. The report was researched and written by SERAP consultants Dapo Olorunyomi, MD/Editor in-Chief, Premium Times, and Joshua Olufemi, Lead, Knowledge and Innovation, Premium Times.
Overview of Budgetary Allocation and International Grants
According to budget allocations from 1999 to 2014, the Nigeria health sector received more than two trillion naira. These funds even though smaller than expected, had potential to yield substantial outcomes for the sector such that could reduce out-of-pocket spending to the desirable 20 per cent level. However, mismanagement and corruption scandals by top officials within the health ministry provide strong explanations for why this was not attained.
In the same vein, for over sixteen years (1999 to 2014) period, the health sector received about three hundred and eight million dollars ($308million) and one hundred and thirty-eight euros (€138 million) as grants to support vaccines, immunization and polio eradication initiatives. Various audits of the Ministry of health and its allied agencies consistently established manipulations of contracts and many instances of inflated prices of supplies. Several suppliers are controlled by the same party and frequently submit separate quotations/bids in order to create the appearance of competition. These suppliers compete for the same contracts and share the same addresses and/or telephone numbers. Multiple companies registered to one individual are used to augment the chances of obtaining contracts.
The country is bedeviled with proliferation of private hospitals without any successful attempt to close down illegal and substandard ones. Most of those that were closed down by the government later re-opened while some resumed operations underground. This continuously exposes the Nigerian population to great danger and no concrete hope of quality healthcare is in sight.
Nigerians were elated with the National Health Insurance Scheme (NHIS), which posed as an initiative to alleviate the burden of user fees (i.e. out-of-pocket payment for health) through the prepayment schemes. The corrupt practices on-going with the scheme however, has restricted current beneficiaries to only workers in the private sector and a little fraction of public servants. And even so, there is a strict limit to the number of household members that an enrollee can insure under the programme. The rural poor are almost out of the scheme and actually represent the larger percentage faced with the burden of out-of-pocket payment for health services.
Some Key Unresolved Cases of Corruption in Nigerian Health Sector
$29 million Vaccine Grants Scam – GAVI Report
The recent allegations of malpractices and fraud against the Nigerian Federal Ministry of Health and the National Primary Health Care Development Agency (NPHCDA) by the Global Alliance for Vaccines and Immunization (GAVI), is one in many of foreign aids that got walloped by corruption.
In October 2014, GAVI released its Nigerian audit report of $29 million USD in funding given to Nigeria between 2011-2013 and to assess level of compliance and financial propriety relating to the expenditures incurred and procurement activities conducted by the Federal Ministry of Health (FMH) and the National Primary Health Care Development Agency (NPHCDA).
The audit found out that the two health agencies – FMH and NPHCDA – were guilty of extreme procurement malpractices and financial fraud. It stated clearly “systemic weaknesses regarding the operation of controls and procedures in national systems used to manage GAVI cash-based support,” Specifically, the report found out that only an approximated “40 per cent of the total expenditure of N4.5bn (US$29m) in the period 2011-2013 was spent on procurement with the main categories being; printing N919m (US $5.8m); incinerators N184m (US $1.2m); drugs N243m (US $1.6m); rehabilitation and equipping of medical facilities N437m (US $2.8m); other procurement N90m (US $397k), motor vehicles N17.8 (US 113k).”
The Vaccine Alliance’s allegations forced the Federal Government to agree to repay funds deemed to have been misused, quantified as US$ 2.2 million. Even though the Federal Government agreed to pay, there was no attempt by the former President Goodluck Jonathan administration to probe or institute any committee to investigate the matter and bring to justice suspected perpetrators, thereby exacerbating impunity for corruption and adding to the bad image of Nigeria at the international level.
N1.9 billion Special Intervention Fund Ebola Fund Scandal
The Ebola epidemic that struck Nigeria in 2014 provided an avenue for top officials of the Federal Ministry of Health to exhibit their corrupt practices. During the wake of the Ebola outbreak in Nigeria, former President Goodluck Jonathan approved a Special Intervention Fund for Ebola with immediate release of N1.9 billion for its implementation. The fund was to further strengthen on-going steps to contain the virus such as the establishment of additional isolation centres, case management, contact tracing, deployment of additional personnel, screening at borders, and the procurement of required items and facilities.
So far, the main corruption allegations associated with the Ebola fund have been gross diversion of funds for other purposes outside the intended. The Ebola fund became the reason behind recent arrest of top officials of the Ministry of Health (FMH). It was reported that the arrest was in relation to a 15-page document obtained by the police, which showed that top officials of the Ministry of Health (FMH) and National Centre for Disease Control (NCDC) were involved in the mismanagement of the N1.9 billion funds.
Also the scandal continued as with the diversion of N63.6 million meant for pre-departure training of Nigerian volunteers who left the country on December 5, 2014, for Liberia and Sierra Leone to assist in the fight against Ebola. It was revealed that the said amount withdrawn by the Ministry’s official was actually bankrolled by the African Union Commission in Addis Ababa who paid for all the expenses relating to this activity. Further allegations arose of a whooping sum of N14.4 million was allegedly spent to organise a meeting for just 15 people!
The MDG Fraud: N5.4 billion Benzly Benzoate Procurement Scam
Millennium Development Goals (MDGs) goals 4 (reducing child mortality), 5 (Improving maternal health), and 6 (Combating HIV/AIDS, malaria and other diseases) of the MDGs are particular to the health sector. So various funding towards MDGs 4, 5 and 6 were directly and indirectly channeled through the Ministry of Health, its departments and agencies.
The investigation beamed a searchlight on a particular case of fraud involving the procurement of benzyl benzoate for the treatment of people living with HIV/AIDS. According to the investigation, “the Ministry claimed a total cost of N5.4 billion for all procurement of Benzly Benzoate used in treating scabies and other skin ailments.”
It was however found that the Ministry quoted an extremely outrageous amount that was 59,400 per cent higher than the amount same was sold in the retail market. The investigation recounted an instance where the Ministry claimed it paid N64.7 million to buy 544 cartons and further revealed that the same amount could only have cost a maximum N2.6 million. This showed strong and prima-facie evidence that officials and others in the Ministry embezzled about N62 million in that one deal.
We want the Federal Government of Nigeria to instruct the Attorney General of the Federation and Minister of Justice to promptly refer to appropriate anticorruption agencies for thorough and transparent investigations the $29 million Vaccine Grants Scam; N1.9 billion Special Intervention Fund Ebola Fund Scandal; and Nigeria Pharmaceutical Institute Ghost Workers and Illegal Recruitment Scam, and to prosecute suspected perpetrators of corruption and recover stolen public funds;
- We want the Federal Government of Nigeria to encourage anticorruption commissions and agencies to proactively launch and follow through investigations into credible allegations of corruption in the Ministry of Health including by investigating other pervasive allegations of corruption in the health sector in greater depth and promptly and satisfactorily concluding any pending investigations on corruption in the spending of budget allocations and international aids to the ministry;
- We want the Federal Government of Nigeria to improve upon and vigorously enforce laws on financial disclosure to require senior ministry officials to annually disclose and widely publish information about their income, assets, liabilities, and positions held outside public office;
- We want the Federal Government of Nigeria to require the Ministry of Health to make public quarterly budget execution reports, and expenditure reports;
- We want the Federal Government of Nigeria to fully implement the Freedom of Information Act, including by enforcing the judgment of the Federal High Court ordering the government to publish information on the spending of recovered stolen public funds since the return of democracy in 1999;
- We want the Federal Government of Nigeria to recognize the right to health as legally enforceable human right and ratify the optional protocol to the International Covenant on Economic, Social and Cultural Rights that would allow individual victims access to international accountability mechanism for effective remedies;
- We want the Federal Government of Nigeria to incorporate the International Covenant on Economic, Social and Cultural Rights in the domestic legal order to enable court adjudicate cases of violations of the right to health;
- We want the Federal Government of Nigeria to comprehensively review and reform the operation of the NHIS in practice to remove the risks of corruption and to allow it to achieve its intended purposes;
- We want the Federal Government of Nigeria to regularly supervise and monitor the operation of private hospitals and clinics to ensure their compliance with international standard and best practices;
- We want the Federal Ministry of Health to carry out robust due diligence on the human rights impacts of corruption in the health sector and establish mechanisms to improve transparency and accountability in the spending of budget allocations by the ministry;
- We want the Federal Ministry of Health to authorize and fund the publication of performance data for the Ministry of Health to improve healthcare delivery and service, and introduce public bulletin boards outside of the ministry to post budget allocations and spending;
- We want the Federal Ministry of Health to publish annual budget allocations immediately upon their passage and disseminate these widely, including by posting them on the internet, and make public quarterly budget execution reports that detail spending on projects;
- We want the Federal Ministry of Health to hold public hearings across the country to allow for greater public scrutiny of spending priorities by the ministry;
- We want the Attorney General of the Federation and Minister of Justice to refer to the Economic and Financial Crimes Commission (EFCC) and the Independent Corrupt Practices and Other Related Offences Commission (ICPC) for thorough and transparent investigation of the $29 million Vaccine Grants Scam; N1.9 billion Special Intervention Fund Ebola Fund Scandal; and Nigeria Pharmaceutical Institute Ghost Workers and Illegal Recruitment Scam, prosecution suspected perpetrators of corruption and recovery of stolen public funds;
- We want the Attorney General of the Federation and Minister of Justice to refer other pervasive allegations of corruption in the health sector for investigation by the EFCC and the ICPC and instruct appropriate anticorruption commissions and agencies to promptly conclude any pending investigations on corruption in the spending of budget allocations and international aids to the ministry of health;
- We want the Economic and Financial Crimes Commission to thoroughly and transparently investigate the $29 million Vaccine Grants Scam; N1.9 billion Special Intervention Fund Ebola Fund Scandal; and Nigeria Pharmaceutical Institute Ghost Workers and Illegal Recruitment Scam, prosecute suspected perpetrators of corruption and recover stolen public funds;
- We want the Attorney General of the Federation and Minister of Justice to proactively launch and follow through investigations into credible allegations of corruption in the Ministry of Health;
- We want the Attorney General of the Federation and Minister of Justice to investigate other pervasive allegations of corruption in the health sector in greater depth and promptly and satisfactorily conclude any pending investigations on corruption in the spending of budget allocations and international aids to the ministry;
- We want Foreign Governments and Donor Agencies to insist on transparency and accountability and prosecution of suspected perpetrators of corruption and recovery of stolen public funds as conditions for providing aids and support to the ministry of health;
- We want Foreign Governments and Donor Agencies to insist upon the timely publication and wide dissemination of budgets, expenditure reports, and audits when providing aid and other forms of cooperation to the ministry;
- We want Foreign Governments and Donor Agencies to in the event that the ministry is unwilling to undertake these measures, examine the feasibility of ways to provide needed aids directly to health centers and hospitals, civil society organizations