On Wednesday, October 25, 2023, the Federal Ministry of Health and Social Welfare and the Corporate Accountability and Public Participation Africa (CAPPA) in collaboration with the National Sugar-Sweetened Beverages (SSB) Tax Coalition hosted an inaugural national conference on Sugar-Sweetened Beverages Tax in Abuja, Nigeria.

The event was hosted with support from the Global Health Advocacy Incubator (GHAI), and attracted the leadership of critical government ministries, departments, and agencies, alongside representatives from the legislature, civil society, academia, research groups, concerned advocacy groups, religious institutions, and the media.

The conference aimed to provide a platform for gathering practical ideas related to innovative health financing through pro-health taxes. The national conference tagged ‘Towards a Sustainable Pathway for Pro-Health Tax in Nigeria,’ encouraged critical thinking aimed at proposing solutions that are feasible within the Nigerian healthcare financing system and that can contribute to healthcare improvement.

In his welcome words, CAPPA’s Executive Director, Akinbode Oluwafemi raised alarm about the health crisis in Nigeria. He revealed that over 30% of all deaths in the country are now linked to Non-Communicable Diseases (NCDs). Oluwafemi cited a World Health Organization (WHO) report, indicating a significant 22% risk of premature death from NCDs, such as cardiovascular diseases, cancers, respiratory diseases, and diabetes, among Nigerians aged 30 to 69. This crisis, he noted, is intrinsically tied to increasing urbanization-driven dietary patterns, particularly the widespread consumption of sugar-sweetened beverages. Addressing NCDs in Nigeria is becoming an urgent necessity to safeguard public health and well-being, he emphasized.

Dr. Adeolu Adebiyi (Senior Regional Policy Advisor, Global Health Advocacy Incubator, GHAI) expressed his delight in attending the conference which was supported by the GHAI. He said the GHAI will continue to collaborate with partners as he hoped that the conference will help to identify sustainable actions that will prioritise the health of the common man.

The Coordinating Minister of Health and Social Welfare who was represented by the Director of Public Health, Federal Ministry of Health and Social Welfare, Dr. Chukwuma Anyaike hinted at the Ministry’s commitment to saving the lives of Nigerians through health systems that are functional. He said ‘excessive consumption of SSBs has a lot of risk factors, especially in adolescents and children. Limiting these risks can be curbed through the SSB tax’.

While appreciating CAPPA and other development partners, he challenged everyone, especially the media, to put up a strong advocacy to champion awareness creation on the dangers of consuming SSBs.

In a keynote address titled “Nigeria’s Weak Health Systems and the Quest for Sustainable Healthcare Financing: A Case for Pro-Health Taxes,’’ Dr. Gafar Alawode, a Public Health Care Financing Expert, and CEO, Development Governance International established that the conditions associated with the consumption of SSBs increase health care costs, cause lost wages, and reduce productivity due to disability and illness, and adversely affect general well-being and individual quality of life. He informed participants that it is no longer news that funding for health is suboptimal and far below the 15% recommended by the Abuja Accord on health funding. Unstable government financing and low health insurance penetration in Nigeria therefore reinforce the need for alternative means of financing healthcare. Though there is a current tax in Nigeria, it is too small to have any impact.

At the end of the engaging conference participants, technical discussions, and panelists, noted the following observations:  

1. Nigeria is the largest consumer of SSBs in Africa increasing the risk of overweight and obesity, Type 2 diabetes mellitus (T2DM), cardiovascular disease, cancer, and other non-communicable diseases among its citizens.

2. While the decision of the Nigerian government to impose a N10 per litre Excise Tax on SSBs is commendable, it falls short of the minimum recommended taxation by the World Health Organization (WHO), and global best practices backed by evidence to ensure the effective performance of the tax.
3. There is a dearth of funding to address the health impact of illnesses associated with excessive consumption of SSB and other unhealthy dietary lifestyles that are prevalent in Nigeria.

4. Since April 2001, when the African Union (AU) members jointly made the resolution at a summit in Abuja to allocate at least 15% of their budgets to the health sector, Nigeria has failed to reach the 15% allocation of its annual budget to the health sector.

5. The Nigeria Customs Service reported they have started the collection of tax on SSBs since July 2022.

6. The renewed hope agenda of the government is committed to instituting health financing and comprehensive healthcare for at least 50 million Nigerians, especially the vulnerable and the elderly by 2027 through pro-healthcare interventions such as SSBs taxes.

7. The legislature is open to collaboration on pathways for improving public health and also committed to developing a legislative framework and agenda to bolster the sustainability and effectiveness of the SSB tax.

8. The purported aversion of consumers to the SSB Tax regime in Nigeria is largely driven by the misinformation and misrepresentation of SSB Taxes as orchestrated by the soft drinks and beverages industry. False marketing and advertising campaigns of the SSB industry reinforce this misinformation.

9. The alarming rise in the consumption of SSBs in Nigeria is primarily due to the availability and affordability of SSBs as well as the pseudo-luxurious picture of its consumption painted through false marketing.

10. SSBs offer no nutritional value to consumers rather their habitual consumption constitutes a huge public health and economic burden for the country.

11. There is still a yawning gap in the level of behavioural change education required by Nigerians to wean themselves off the consumption of SSBs than presently obtains.

12. The media has an important role to play in amplifying the challenges linked to the consumption of SSBs in their news reporting. There is room for improvement in giving greater attention to the issues.

Participants also offered the following Recommendations as pathways for improving public health and tax on sugar-sweetened beverages which includes:

1. The SSB tax must be retained and increased in the 2024 fiscal policy to ensure that the purpose is achieved and the government benefits maximally from its implementation.    

2. The Inter-agency AdHoc committee on SSB Tax must continue high-level advocacy to ensure that all stakeholders are carried along in driving the charge for a sustainable legislation to aid effective taxation.

3. SSB Tax should be key on the agenda of the National Council on Health.

4. Relevant stakeholders, including traditional and religious institutions, educational institutions, civil society organizations, the media, and healthcare professionals should be actively engaged in a bid to address the SSB menace. These stakeholders should also be encouraged to be at the forefront of correcting industry-driven misinformation on SSB tax.

5. Educational campaigns at the community level must be intensified.

6. Stakeholders should be prepared for likely resistance from the SSB industry and strategize on actions to overcome them and keep the public focused on the benefits of the SSB tax,

7. The Federal government should work in collaboration with the state governments to expand the coverage of the tax to include other sugar-sweetened beverages that are currently not taxed.

8. The proceeds from the SSB tax should be earmarked to the health sector to support and strengthen public health systems in Nigeria.

9. Stakeholders must commit to engaging central budget agencies to improve public healthcare and influence increased allocation to the healthcare sector.

10. Need for the establishment of a monitoring, evaluation, and accountability framework to track the implementation and impact of the current SSB tax policy. This must be reviewed periodically.

11. Need for complementary regulatory instruments like Front-of-Pack Labelling, restricting availability and marketing of SSBs in school environments among others to offer consumers more information about products.

12. Need for the government to ensure healthier alternatives to SSBs are affordable and readily available.    

13. Increase current excise tax on SSBs to #50 in the next fiscal year.

14. State authorities must strive to bring Nigerians into its social health insurance scheme to achieve universal healthcare coverage.

15. There is a need for a dedicated national pro-health tax legislation.

16. The Federal Government and regulatory authorities must design and enforce penalties for companies that default on SSB tax obligations.

17. The government must ensure a periodic review of the SSB tax which is indexed on inflation.

Signatories:

1. Corporate Accountability and Public Participation Africa (CAPPA)
2. Federal Ministry of Health and Social Welfare

Participating MDAs/State Government/Legislators:

3. Federal Ministry of Finance, Budget, and National Planning
4. Federal Ministry of Education
5. National Orientation Agency
6. Nigeria Customs Service
7. Federal Ministry of Agriculture and Rural Development.
8. Federal Competition and Consumer Protection Agency
9. Standard Organisations of Nigeria
10. National Agency for Food and Drugs Administration and Control
11. National Health Insurance Agency
12. Federal Inland Revenue Service.
13. Bayelsa State Government
14. Sokoto State Government
15. Enugu State Government
16. Senate Committee on Health
17. House Committee on Health Institutions

Civil Society Organisations

18. National SSB Tax coalition
19. Gatefield Nigeria
20. National Action on Sugar Reduction
21. One Campaign
22. Christian Initiative for Nation Building
23. Nigeria Tobacco Control Alliance
24. New Initiative for Sustainable Development
25. Child Health and Adult Protection Initiative (CCAPI)
26. Keen and Care Initiative (KCI)
27. Open Sunshine
28. Ecumenical Water Justice Network
29. Goldheart Foundation
30. Nigeria Dental Association
31. Ave Health Sense
32. Molife Foundation
33. LIFT HUMANITY FOUNDATION
34. Siva Community Initiative
35. NEW INITIATIVE FOR SOCIAL DEVELOPMENT
36. Centre for Human Rights, Health, Ethnic Harmony, and Livelihood Development (CHHELD)
37. Policy Roundtable
38. Policy Innovation Centre
39. Oxlade Consulting
40. Development Governance International
41. CEE-HOPE
42. Youthrise Nigeria
43. Epiphy Youth
44. Kukah Centre
45. University of Abuja Medical Students Association
46. Beulah Future Leaders
47. Youth Against Drug and Substance Abuse (YADASA)
48. iLead Africa
49. ICCDI
50. Centre for the Study of the Economies of Africa (CSEA)

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