Zulaiha Danjuma

This story X-rays the 2024 Kano State budgetary allocations for combating hepatitis B, revealing the implications of none allocation and release of funds, alongside government’s inaction on public health security. The story further highlights stories of large hepatitis B cases in Karaye Local Government; as the story also spotlights experiences of Journalists who first uncovered the outbreak in Karaye.

On the 2024 Kano state budget, under the State Agency for Control of AIDs (KSACA) there are nine (9) budgetary items intended to tackle and control the spread of Hepatitis B. 

Kano Focus reports seven (7) out of the nine items lined up received zero allocations, while the remaining two items got less than a fraction of the allocation received in 2023.

Also allocations made for the year 2023 were without releases as the budget performance throughout was zero, as indicated on the 2024 budget.

Hepatitis B is a viral disease that attacks and causes chronic liver and kidney disease. The disease is transmitted through blood and sexual fluids.

It is spread through direct contact and transfusion of infected blood, it is transmitted from pregnant women to their newborn, it is transmitted through the use of unsterilized medical & dental equipments, by unprotected sex, and the sharing of toothbrush, nail clippers, razors earrings and body jewelry.

Budgetary allocation

Spread of Hepatitis B in Karaye Local Government Area

Karaye is one of the five first class emirates in Kano state. Karaye is home to Challawa Gorge Dam, which is a major reservoir on the Challawa River, and a main tributary of Hadejia River. The people of Karaye are known for their agricultural activities.

In December 2023, a report broke out on the large spread of Hepatitis B disease in Karaye town.

Mrs. Salihu contracted hepatitis B from her husband, Mr. Salihu who did not know he had the virus infected his wife.

“I always thought it was Malaria, so I took antimalarial drugs” Mr. Salihu said.

Mr. Salihu painfully narrates how he only got to know when he finally went for a medical test.

He went on to narrate that both him and his wife live in fear not knowing what might happen next as they have used all the medications prescribed for them but are yet to be cleared from the virus.

Mr & Mrs. Salihu are constantly getting sick, they have been living with the hepatitis B virus for over a year now.

Aliyu Inuwa Mansir, a reporter with Solacebase was the first journalist to cover the stories of hepatitis B victims in Karaye.

In his story Mr. Mansir highlighted Karaye people’s lack of awareness about the disease.

“When I did the report, it was gathered that at least 25 cases of Hepatitis B (HBV) is recorded at the Karaye Emirate Specialist Hospital.

“There was even a serology register o was prevailed to look into while at the hospital, the record was date September 2022 and it showed that cases of HBV increases a month with at least 23 laboratory confirmed cases” he said.

Kano Focus enquired from Mr. Mansir about his experience conducting the report. According to him, when he embarked on the report little to nothing was known about the surging case of hepatitis B in Karaye.

But after his story was published and it threw a spotlight to the plights of residents of Karaye the Kano Health Ministry sent envoys to the various hospitals mentioned in the story and a lot of hospital staff were reprimanded for speaking to him.

“After the story was published the commissioner of health had sent representatives from the ministry of health to go to Karaye.

“I gathered that hospital staff and personeels that spoke to me on the issue were queried, some were said to have almost lost their jobs” he said.

Interestingly, in his report Mr. Mansir had spoken to the Commissioner of Health Dr. Abubakar Labaran Yusuf, who had admitted that the ministry was aware of the situation.

In the report by Mr. Mansir, the Commissioner was quoted to say “Our attention has been drawn to this several times, and we are fully aware of the situation, we are still setting out plans to use in combating the situation. We understand a lot of persons have contracted the virus while many have also died from the virus.

“In no distance time, we will flag off a campaign on that and the government will make available the necessary medications and vaccines needed to help fight this disease in Karaye and across the state” the commissioner for Health said.

Similarly, another journalist with Daily Trust, by the name Idris Jibrin in January, 2024 also covered the rising cases of Hepatitis B disease in Karaye Local Government.

On his part, Mr. Jibrin’s report revealed how the reasons for the spread of Hepatitis B disease among residents of Karaye was still unknown as laboratory technicians were recommending to run hepatitis B tests routinely for any person who visits the Karaye Specialist Hospital for blood testing.

2024 Budget on Hepatitis B in Kano state

Despite health having the sum of 16.5% of Kano states total budget designated to it, a figure exceeding the agreed upon 15% of the total budget as contained in the Abuja Declaration.

Vital health related issues like the response and control plans to combat Hepatitis B still received zero allocation in the 2024 Kano state budget.

Below are the list of items and allocation given for both year 2023 and 2024 as plans set aside to combat, respond and control Hepatitis B, the mentions are in no particular order

First SACA proposed to conduct viral hepatitis screening for the General and high risk population on each of the five (5) emirates. A sum of 38,000,000 Million Naira was approved for it in 2023, while nothing was allocated in 2024.

10,000,00 Million Naira was also set aside to Print Hepatitis Data Tools in 2023, while in 2024 there is no fund allocated to it, despite it being stated in the budget. Also, a procurement of viral hepatitis test kits and consumables had 500,000 Million Naira approved for it in 2023 and nothing was given in the 2024 budget.

Interestingly, none of the above items and funds mentioned have any budget performances attached to them, as the budget performance for the full year of 2022 and that of January to August 2023 was zero as reflected in the 2024 Budget.

Other items on the budget without any allocations are; Massive sensitization Programmes for viral hepatitis B across the state, conduct world Hepatitis day, Improving care treatment for HIV & viral Hepatitis, procurement of viral hepatitis B test kit & consumables for Newly Employed & Existing Health workers.

While, the budget items that received allocation despite it been significantly lower than what was allocated in 2023 are; Conducting Health workers sensitization on viral Hepatitis, in 2023 it got an allocation of 100 million and 12,245,800 million in 2024.

The second item is Establishing screening Programmes for viral Hepatitis general & high risk population, this particular items location code is designed as ‘31944500’ which is meant to be a state wide activity but it was allocated a miserly amount of 2,939.500 from 250 million allocated in 2023, even though there was no release with the 2024 budget showing zero budget performance.

Despite the poor prioritization given to Hepatitis B response and control, a sum of 375,000.00 was released to conduct an Annual Award Ceremony to beneficiary at all levels on the 2024 Kano state budget.

Health Budget Expert Reacts

According to Mr. Salisu Yusuf who is a a health budget analyst, he said ideally everything that has to do with KSACA in terms of kits, provisions of PLCs and outreach activities are supposed to come from funds designated from the budget.

“No withstanding sometimes development partners ask the state government to fulfill some part of funding activities while the government also does the rest” Salisu said.

Both contributions from state government and development actors are supposed to be put into one basket and utilized for accomplishing public health goals.

However, Mr. Yusuf said developmental partners have been largely involved in funding KSACA activities.

Global Fund is KSACA prime donor

“The issues is so severe that there were some concerns in many corners as to how KSACA would fair if development partners pulled off support” Mr. Yusuf said.

Kano Focus enquired as to the reason why an agency as strategic as KSACA lack both budgetary allocations and releases for those items that get allocations on the budget.

Mr. Yusuf said the reason was linked to not raising memo’s by designated personnels in KSACA to push for budget releases.

He went to say that after the issue was identified the Local Health System Strengthening (LHSS) organized a capacity building on how to raise memo’s for all the program officers and personnels of KSACA.

“That was the issue identified that lead to halting the releases of funds to KSACA” Mr. Yusuf said.

Mr. Yusuf added that, The issue of KSACA is quite complex, because they highly rely on service providers in facilities.

“What they mostly do is if kits are brought by donor agencies, they simply hand it over to facilities for distribution.

“KSACA’s activities are more of partnership driven and are not informed by the budget, this is the situation year in year out” Mr. Yusuf said.

It is worthy of mention that the Global Fund which is the main donor of KSACA is not primarily focused on donating to the elimination of Hepatitis B (HBV), but rather on HIV/AIDs, Tuberculosis and Malaria.

Although, it was announced in January, 2023 by the International Network on Health and Hepatitis in Substance Users (INHSU) that the Global Fund to fight HIV/AIDs, TB and Malaria (GFATM) policies now enables countries to request resources to support Viral Hepatitis.

Nevertheless, The Hepatitis Fund (THF) which is based in Geneva is the only grant-making organization working on Hepatitis elimination. The Hepatitis Fund (THF) and The Clinton Health Access Initiative (CHAI) on April 4, 2024 announced the inaugural Global Hepatitis Resource Mobilization Conference which took place on 17, May 2024 in Geneva.

The high level conference is a global call to action to build financial and political commitment towards viral hepatitis elimination by 2030.

While responding to questions about why vital health concerns like Hepatitis B were noticeably lacking in budgetary prioritization. Meanwhile, Kano state received 16.5% of the total budget for 2024 allocated to the Health Ministry.

Mr. Yusuf decried the push to met the Abuja Declaration of 15%, as he said that no one is quite concerned with the performance base of the allocation of that 15% to the Ministry of Health.

“This year we have about 16.5% of the total budget designated to the Ministry of Health, now we have passed first quarter of the budget, ideally we should see 25% out of 100% of the budget performance rate and hopefully see another 25% performance rate in the second quarter and so on for four quarters, which will total 100%.

“But that is not the case, as KSACA and other agencies keep having zero performance rates throughout the budget” Mr. Yusuf said.

The One Health Approach among Healthcare Agencies

The Kano state Agency for the Control of AIDs (KSACA) is an agency under and located at the premises of the Kano State Primary Healthcare Management Board (KPHCMB).

Both the Kano state Agency for the Control of AIDs (KSACA) and the Emergency Operation Center (EOC) are both agencies who are particularly involved with the monitoring, control and response to human diseases and infections.

KSACA aside being in charge of issues around HIV/AIDs is also responsible for issues around Hepatitis B. However, both agencies are ideally supposed to compliment each other when it has to do with public health issues.

The concept of One Health system is a collaborative, multisectorial and transdisciplinary approach which focuses on the workings of health from the local, regional, national and global levels, with the goal of achieving optimal health outcomes which recognizes the interconnection between people, animals, and their shared environment.

Dr. Abdulwahab Kabir Suliaman the Kano state Epidemiologist said everything they do is moved towards the One Health approach.

“There is an integration and collaboration, we partner KSACA, among other agencies and partners as well,” he said.

However, the reporter asked why the N400 million allocated in 2022 & 2023 as well as the N500 million allocated for funding Epidemic Preparedness and Response were not at the disposal of KSACA when the Hepatitis B outbreak issue was reported in Karaye Local Government.

Mr. Sulaiman said that the Emergency Operation Center was not responsible for anything that has to do with Hepatitis B, as that health issue was solely the responsibility of KSACA.

The reporter went further to enquire from Mr. Sulaiman about the primary role of the EOC which he said was meant to monitor, control and respond to epidemic prone diseases.

A follow-up question was asked by the reporter, asking whether Hepatitis B has the possibility of escalating into an epidemic if certain health indications are not properly handled.

Mr. Sulaiman said “In medicine we never say never”

Attesting that Hepatitis B disease if not properly managed, especially with presence of the disease already occurring among Karaye community; without any concrete knowledge as to the cause of the outbreak, as well as non allocation and budget releases in tackling the disease in a case where bigger outbreaks occur.

This is also not forgetting the issue of an over dependence on donors by KSACA, as a agency critical for public health security, which by implications might greatly affect Kano state public health delivery in a case were donors pull out and there are no budgetary allocations nor releases on issues of public health importance.

Furthermore, Mr. Yusuf a Health Budget Analyst said ideally there is supposed to be a synergy of all health agencies when it comes to the concept of One Health.

“The One Health system talks about synergy on financial, operational, personnel and service levels.”

But Mr. Yusuf argues that the Emergency Operation Center, may not easily have its Emergency Preparedness Response (EPR) funds accessible to an agency like KSACA to tackle outbreaks like that of Karaye’s hepatitis B, largely because the initial reason for the establishment of the EOC was as a Polio Emergency Operation Center and it’s EPR funds are for cases of Emergencies within its coverage scope.

However, due to the fact Polio was not the only epidemic emergency faced in kano, the status of the center was upgraded from simply a Polio Emergency Operation Center to a general Epidemic Emergency Operation center.

However, Mr. Yusuf maintained that as agencies working to achieve a common goal of health security, all resources will be better utilized if an multisectorial collaboration were given prioritization in unexpected occurrence of diseases like in the case of Karaye with the outbreak of Hepatitis B.

“One health system should not be just on the lips or on paper it has to be acted out in actions and implementation.

“If we look at issues in parallel we won’t go anywhere, all the destinations are one; a good & sustainable health provision & delivery for all.

“If KSACA is left alone to to be the only one to look into any issue of hepatitis B, how much is it’s budget allocation, for years their budget performances has been zero,” Mr. Yusuf said

While, reacting on the issue of the Emergency Operation Center (EOC) strictly claiming funds set aside for Epidemic Preparedness Response (EPR) as meant for outbreaks which does not include Hepatitis B.

Mr. Yusuf said, “EPR funds are kept as an unforeseen contingency fund. When something of health emergency happens; the governor and the House of Assembly members will not be waited upon, everyone knows there is a health crisis and the funds will be utilized for any such health crisis”

“Hepatitis B is part of an Emergency,” Mr. Yusuf said.

The reporter inquired from Mr. Salisu what measures needs to be taken to possibly avert a breakdown of health security, particularly on the issue of zero budget allocation and release on an issue like Hepatitis B.

Mr. Yusuf said the government needs to prioritize the issue of Hepatitis B when it comes to allocation & releases because hepatitis B death rates is more than that of HIV presently.

“Hepatitis B is said to kill people even more than HIV and Covid19 presently, but the disease has been neglected” Mr. Salisu said.

Interestingly, Mr. Yusuf’s concern about Hepatitis B presently being a fast killer, even more than some other viral diseases. Is applified by projections indicating that viral Hepatitis deaths are expected to outnumber HIV, Tuberculosis and Malaria deaths by 2040.

The projection was published by the Clinton Health Access Initiative (CHAI) in April 2024.

Mr. Yusuf went on to demand that the 2025 Kano state budget should speak to the reality of public health and have Hepatitis B combat strategies properly translated in the budget to meet the maximum health security level required.

“Both the Kano state Ministry of Health and KSACA need to improve in allocations on Hepatitis B, come 2025 budget, KSACA also needs to push for raising memo’s to facilitate budget allocation releases.

“KSACA especially on issues of Hepatitis B should take budgeting and memo raising very seriously to facilitate budget release as top priority come 2025.

“Despite the fact that partners and donors are important, KSACA activities need to be more inclined and informed by the budget, because some of this donor funding are duration based, and if the state does not have funds designated on ground to cover contingencies in a case of an emergency the public and the health system will suffer great losses” Mr. Yusuf said.

Cover-up on outbreak of Hepatitis B at Karaye, a Ploy to save Kano’s face

According to an inside source close to the Ministry of Health, the outbreak of Hepatitis B which was confirmed by the Commissioner of Health, Dr. Abubakar Labaran Yusuf, in journalist Aliyu Inuwa Mansir’s report on the outbreak in Karaye was later refuted by the Commissioner.

The inside source who prefers to remain anonymous said, “Indeed the commissioner went to Karaye when the news of the outbreak was released.

“But when he came back he refuted it that there was no outbreak of Hepatitis in Karaye,” the anonymous source said.

It should be recalled that the commissioner of health, Dr. Abubakar Labaran Yusuf agreed to the existence of the Hepatitis B outbreak in Karaye, when he was interviewed by Aliyu Inuwa Mansir.

The Health Commissioner said “Our attention has been drawn to this several times, and we are fully aware of the situation, we are still setting out plans to use in combating the situation. We understand a lot of persons have contracted the virus while many have also died from the virus.

“In no distance time, we will flag off a campaign on that and the government will make available the necessary medications and vaccines needed to help fight this disease in Karaye and across the state.”

The reporter inquired from the the anonymous source about information gathered that healthcare personnel’s at Karaye are currently terrified to speak to journalist about Hepatitis B related questions asked by journalists.

The anonymous source said, the reason why the news was not allowed to escalate was because the reputation of Kano state was being protected.

“The reason why the Hepatitis B issue was played down was because it was thought that adversaries of the state would capitalize on the issue to tarnish the state” the anonymous source said.

None Response from Health Commissioner and KSACA Officials

The reporter reached out to the office of the Kano state Commissioner of Health, Dr. Abubakar Labaran Yusuf severally through calls and physical visitation to his Public Relations officer Ibrahim Abdullahi at the Ministry of Health, and to the Commissioner of Heal at the Emergency Operation Center (EOC) but all efforts to have the Commissioner comment on the plans and actions he claimed will be put in place to curb the Hepatitis B outbreak at Karaye since it was first reported in December, 2023.

On one occasion, the Commissioner of Health Dr. Yusuf directed his security orderly to escort the reporter to a Director at the EOC who was ordered to call the state Epidemiologist to answer to the reporters questions.

However, the state Epidemiologist Dr. Abdulwahab Kabir Suliaman could not answer most of the questions as he evaded them and referred the reporter to the Kano state Agency for the Control of AIDs (KSACA).

“The EOC does not handle Hepatitis B cases, you should go to KSACA, they are responsible for issues on Hepatitis B not us” Dr. Suliaman said.

Meanwhile, when contacted officials at the Kano state Agency for the control of AIDs (KSACA) did not contact the reporter as promised, when the reporter seeked to have an interview session with the Director General (DG) of KSACA Usman Bashir.

The reporter reached out to a certain Dr. Abdulrahman, who works directly with the DG and Abubakar Tudun Wada the Monitoring and Evaluation Officer, but all to no avail, as they kept telling the reporter that the DG of KSACA would have to give clearance before they could speak and the DG was not available either to speak to the reporter at the time of filing this report.