Nigeria’s democracy has advanced another year. Yet three years into President Muhammadu Buhari’s presidency, telling him and his team how well or badly the administration has fared remains a hot-button issue. The opposition dwells on it. Nigerians regardless of social strata, consider it topical at the coffee table or buka joint. The polls try to stay neutral and reflective of the national consensus. Still as members of the ruling party and Buhari aficionados underline the accomplishments, they also upbraid anyone who says otherwise.
On the cusp of a general election year, what is required is unvarnished assessments. Nigeria needs someone or persons who can tell the president the truth, but not in President Obasanjo’s self-serving ways. Indeed, PMB needs to know the state of play, as he seeks re-election, if indeed he wants to correct past mistakes and move the nation forward.
To mark the president’s third anniversary in office, a public opinion poll conducted by NOIPolls in partnerships with Gallup (USA), evaluated ten critical governance and sectoral issues, and produced a cumulative result. The president did not reach the fifty percentile mark in any specific category.
The president’s highest score was 43% on security and his lowest 12% on poverty alleviation. His other performance indicators ranged from 32% for corruption; 34% for agriculture; 25% for healthcare; 21% for infrastructure; 24% education; 16% for economy; and 15% for job creation. Overall, the cumulative average is not-too-heart-warming. Bluntly, it was non-stellar. For street voices in Nigeria there’s nothing to celebrate. Then again, we must also consider that subjective core areas like national cohesion, peace and stability, patriotism, dividends of democracy and trust were not even ranked.
Looking forward, shall we tell the president he has not done so well without encountering a hard push back? Who will tell the president that our democracy, having arrived at the beyond nascent point, is experiencing de-consolidation. In my recently published book, Prime Witness – Change and Policy Challenges in Buhari’s Nigeria, policy performances relating to these ten categories, amongst others, were similarly evaluated, albeit, within the president’s first two years in office.
As I noted at a recent book presentation, my book, like every opinion poll, and constructive assessment seeks to “analyze evolving policies from the very onset of the Buhari administration; focusing on lessons learned, missed opportunities and choices before Nigeria.” Undertaking such assessment, more so, where it is non-partisan remains a national imperative. Yet any foray into that realm is not for the faint-hearted.
On the balance, one must acknowledge on its face value, Minister Lai Mohammed’s contention that “President Buhari’s administration had achieved a lot in the delivery of dividends of democracy and campaign promises despite the challenges it encountered in the last three years. We are putting our nation on the path of sustainable growth and development, diversifying our economy like never before, tackling corruption at its very core and devising creative measures to secure life and property.” A cogent assessment; but one with equally cogent flip-side.
As I observed recently, Nigeria’s democracy is foundering on the issue of restructuring. The contending point; were Nigeria to be doing so well, the clamour and clangour for transformation and restructuring would be at a lower din and decibel. If our national debate and assessment of government is dichotomous, reasons for such disposition abound.
Nigerians have become escapists in confronting critical national issues collectively. Now, expediency and convenience decree compartmentalization and sectionalism. Consequently, critical issues, “national questions, the quest for parity in resources, and attachment to identity” suddenly and conveniently become divisive, creating unwarranted dichotomy. Nonetheless, the assessment of any leadership, more so in a democracy cannot be avoided.
The observations and conclusions in my book are broad and the concluding assessment pointed. Some who have read the book have chided my seeming empathy towards President Buhari. One in particular, a revered “Silk” hitherto a hard core Buhari supporter wrote, “It appears to me that the marks…ought to be less charitable and patronizing than you awarded.” My response is that my evaluation was of policies not personalities, even as both often intertwine and are fungible.
Borrowing paragraph from my book might address and clarify the interface. “Effective political leadership is generally perceived as one that delivers on it’s promises. Statesmanship, on the other hand, entails employing great tact in steering the affair of state and in better management of unanticipated crisis that other leaders would have in similar circumstances.” It’s pertinent to recall that even President Buhari’s biographer, when confronted with a heady question on Buhari’s presidency and leadership prospects, responded thus: “Whether he can achieve further political change in Nigeria is hard to predict.”
So as we look back to President Buhari’s three years in office and look to his next year or next five years, we must assess the state of play forthrightly and with hope. Yakubu Mohammed hit the bull’s eye with this summation, “government usually gives hope that tomorrow would be better.” His views dovetail well into my closing summation in Prime Witness: “Buhari has the remaining part of his tenure to remediate his governance style and redeem his already damaged leadership image. He can do so by drastically altering his leadership style and running a much more inclusive government, where a crop of bipartisan skilled personalities can help him deliver his change agenda for Nigeria.”
Advisers around the president must accept that outside counsel or criticism have their salient value and merit. They must also recognize their unique role. They need to accept the ultimate public service dictum, paraphrased thus; “I have one master, Mr. President. I have one mistress, the Federal Republic of Nigeria.” They must serve both pari passu. That considered, shall we all resolve to tell the president the truth. Things ain’t as rosy as those in officialdom paint it. Nigeria and Nigerians can do better. And Nigerians remain hopeful.
Here is the upshot of our present circumstances. As president, the buck stops at President Buhari’s desk. He is the one Nigerians elected to lead them. Not everyone who evaluates Buhari’s presidency constructively, or even trenchantly is a traducer, detractor or opposition. Most speak truth to power in order to better and save Nigeria. Many still believe in the president as a change agent. Yet the realization persist that for Nigeria, it is not yet eureka.
Funding the National Health Service requires higher taxes
• Political cowardice obstructs solution as the population ages and costs increase
Martin Wolf
The contemporary British, it is said, do still share a common religion: the National Health Service. But however much they may desire a first-class service, free at the point of use, they have been unwilling to pay the taxes needed to sustain it. After years of stringency, underfunding has become severe, even though the spending has been relatively protected. Public spending on health (and grossly underfunded social care) must rise in the years ahead. Politicians must discuss higher taxation. Anything else is an evasion.
To help the discussion, we have the benefit of a superb new report, securing the future: funding health and social care to the 2030s from the Institute for Fiscal Studies and The Health Foundation. Its headline conclusion is that UK spending on healthcare will have to rise by an average of 3.3 per cent a year over the next 15 years just to maintain NHS provision at current levels, and by at least 4 per cent a year if services are to be improved. Social care funding will need to increase by 3.9 per cent a year. Ageing is the main reason for the pressure. But so is the rising relative cost of inputs.
If spending on the NHS were to rise by 4 per cent a year, it would go from 7.3 per cent of national income to 9.9 per cent over 15 years (based on the Office for Budget Responsibility’s forecast of 1.9 per cent for annual average economic growth). Overall, spending on health and social care would need to rise by 3 per cent of national income. As I have noted before, this sort of analysis raises big questions.
Is the prospective rise reasonable? Answer: yes. Spending on health (as a share of national income) of a number of prosperous European countries — Germany, the Netherlands and Sweden, for example — is already higher than the UK’s would be in the 2030s. They afford it. Why could the UK not do so too?
Is the NHS perhaps exceptionally inefficient? UK spending on health is close to the average of the EU-15 (which excludes the countries that joined in the 2000s). This does not suggest extraordinary waste. Moreover, notes the report, “unusually, since 2010 measured productivity in the health service has been growing faster than productivity across the economy as a whole”.
Comparative data suggests health outcomes for the UK are mediocre by international standards. This performance is in line with its moderate relative spending. At the extreme, in terms of ineffectiveness, is the US: there, governments spend a higher share of national income than the NHS, while not beginning to cover the population and delivering, to take one example, a life expectancy that is 2.2 years lower than the UK.
Would charging add significantly to efficiency or the resources in the system? No. Charging is inegalitarian: the higher the charges, the more unequal the outcome. It will also discourage people from what turn out to be necessary visits to doctor. The idea that making health free risks persuading many people to go to the doctor unnecessarily is quite implausible: it really is not fun.
Is compulsory insurance a better system? Obviously not. Compulsory insurance is a tax. In this respect at least, critics of the “mandate” in what came to be known as Obamacare were right. If it quacks like a tax, it is a tax.
Is there a trick way of raising the additional revenue? The report under discussion and a recent paper by Richard Murray of The King’s Fund analyse the possibility of a tax dedicated (or “hypothecated” in the jargon) to health spending. Such a tax would be either stupid or a fraud. It would be stupid to adjust spending up and down in response to changes in revenue from a single tax. It would be a fraud if we did not link the two in this way. In essence, those who favour hypothecation believe that people will be persuaded to pay more tax if they are told it pays for health (even if does not do so). But fibs, however clever, are politically corrosive.
Suppose, instead, that the UK simply accepted that dealing with the pressures of today and those still to come requires higher spending and, correspondingly, higher taxation. That would still leave the average tax ratio in the UK far below economically more successful northern European countries. A rise of 3 percentage points in the UK’s ratio of government revenue to national income, for example, would leave it 6 percentage points below Germany’s today. Under plausible assumptions, it should also allow a substantial rise in post-tax incomes. If it did not do so, it would be because of economic failure, not the higher taxes.
This nettle has to be grasped. The decision to fund health though taxation was a perfectly reasonable one. Political cowardice is no reason for refusing to live up to the evident consequences.
By Oseloka H. Obaze
Obaze is the author of a public policy book, Prime Witness- Change and Policy Challenges in Buhari’s Nigeria, published recently by Safari Book Ltd.
