Abstract
BackgroundThe paper presents evidence about the distribution of the benefits of public expenditures on a subset of priority public health services that are supposed to be provided free of charge in the public sector, using the framework of benefit incidence analysis.MethodsThe study took place in 2 rural and 2 urban Local Government Areas from Enugu and Anambra states, southeast Nigeria. A questionnaire was used to collect data on use of the priority public health services by all individuals in the households (n=22,169). The level of use was disaggregated by socio-economic status (SES), rural-urban location and gender. Benefits were valued using the cost of providing the service. Net benefit incidence was calculated by subtracting payments made for services from the value of benefits.ResultsThe results showed that 3,281 (14.8%) individuals consumed wholly free services. There was a greater consumption of most free services by rural dwellers, females and those from poorer SES quintiles (but not for insecticide-treated nets and ante-natal care services). High levels of payment were observed for immunisation services, insecticide-treated nets, anti-malarial medicines, antenatal care and childbirth services, all of which are supposed to be provided for free. The net benefits were significantly higher for the rural residents, males and the poor compared to the urban residents, females and better-off quintiles.ConclusionIt is concluded that coverage of all of these priority public health services fell well below target levels, but the poorer quintiles and rural residents that are in greater need received more benefits, although not so for females. Payments for services that are supposed to be delivered free of charge suggests that there may have been illegal payments which probably hindered access to the public health services.
Highlights
Increasing public health expenditure does not automatically translate into better outcomes for all population groups if the expenditures are not equitably distributed
The 2008 National Demographic Health Survey (NDHS) in Nigeria showed that only 23% of children are fully immunized by age 12–23 months, whilst 8% of households owned at least one insecticide-treated mosquito net, 58% of pregnant women received antenatal care (ANC) from a skilled provider, and only 35% of births take place in a health facility [3]
The NDHS data were disaggregated into different population groupings to provide evidence of equity or inequity, and show evidence of an inequitable distribution of utilisation for most services such as immunisation in children, contraceptives, treatment of acute respiratory infections, malaria and diarrhoea, and ownership of insecticidetreated nets (ITNs)
Summary
Increasing public health expenditure does not automatically translate into better outcomes for all population groups if the expenditures are not equitably distributed. In Nigeria and many sub-Saharan African countries, skewed resource allocation towards urbanbased hospital services, and services that tend to be National health financing systems need to be pro-poor if healthcare targets are to be met Such systems should incorporate three important dimensions: they should ensure that contributions to costs of healthcare are in proportion to different households’ ability to pay; protect the poor from financial shocks associated with severe illness; and enhance the accessibility of services to the poor [2]. Such systems can only be achieved if healthcare planners are well-informed about the distribution of the benefits of public subsidies and of the burden of paying for health services. The paper presents evidence about the distribution of the benefits of public expenditures on a subset of priority public health services that are supposed to be provided free of charge in the public sector, using the framework of benefit incidence analysis
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