Health Care Financing In Nigeria Research Articles

Trends and Challenges of Health Care Financing in Nigeria

Introduction: Health care financing is concerned with how financial resources are generated, allocated and used in health care system. Worldwide, every year 100 million people are pushed into poverty because they have had to pay directly for their health care. Objective: To assess the trends and challenges of health care financing in Nigeria. Methodology: A literature review was conducted. Results: In Nigeria, health care is financed through Tax revenues, out of pocket payments (user payment), health insurance (social, community-based insurance, private health care financing), donor funding, exemptions/deferrals/subsidies. Majority (69%) of the health care financing in Nigeria is from out-of-pocket payments made by the patient to the health care provider. The federal government provides 12% of health care finances. The rest of financing of health care in Nigeria come from the state governments (8%), Local Government areas (4%), and development/donor partners (3%). Nigeria allocates between 3.5% and 6.24% of her total budget to health care financing. The challenges of health care financing in Nigeria include: inefficiency of the health system across the country, limited institutional capacity, corruption, unstable and dwindling economic, and lack of political will. Conclusion: Nigeria’s expenditure on health is very low, and domestic resource mobilization for health care is weak. Nigeria’s health system has to be strengthened. Nigeria also has to inject more fund into health care for its citizens. She should embrace equitable modes of health care financing such as compulsory social insurance system for all citizens of Nigeria. The role of different levels of government in financing health care should be clearly defined. Also, prudent management of available scarce funds will go a long way in changing the Nigerian health care financing situation. The private sector (telecommunications and banks) and local philanthropists has to be involved in financing health care. There should be effective monitoring and evaluation (M&E) of performances and tracking of the use of resources, health policies and reforms.

Healthcare Financing in Nigeria: A Policy Review.

A good health financing system is crucial for the effective performance of a country's health system. Many health systems around the world, especially in lower- and middle-income countries such as Nigeria, grapple with perennial challenges such as chronic underfunding, wastefulness, and lack of accountability rendering these systems inefficient. Nigeria's health system faces additional extraneous challenges such as a huge and rapidly growing population, a stagnant economy, and worsening insecurity of lives and property. Furthermore, recent disease outbreaks such as the Ebola epidemic and the COVID-19 pandemic and an evolving disease demography evidenced by an increasing prevalence of chronic, noncommunicable diseases asphyxiate an already floundering health system. To address these challenges and to bolster its efforts in attaining universal health coverage (UHC) and meeting the targets of the Sustainable Development Goals, the Nigerian government launched a new health policy in 2017. A review of the health financing section of this policy shows a focus on improving funding for health care by all levels of government and guaranteeing affordable and equitable access to health services by all Nigerians, albeit with insufficient clarity on how these will be achieved. A more critical review of the country's health financing system also reveals deep-seated systemic issues. Its out-of-pocket payments for funding health care are among the highest in the world, with abysmally low government contributions to health. Successive governments seem to lack the political will to address these shortfalls. Critical gaps exist in the country's health laws, making it difficult to implement the strategies proposed in the new policy. Nigeria must strengthen its health laws to, among other things, mandate health insurance and provide adequate funding for the health system by the government. It should also formulate a dedicated, more precise health financing policy with specific, measurable aims targeting identified problems to enable it to attain universal health coverage.

Gender Variations and Inequity in Healthcare Financing in Nigeria

Healthcare is central to sustainable development, but it is underfunded in many developing countries like Nigeria. This study empirically examined gender variations and inequity in healthcare financing in Nigeria. It specifically analyzed inequity by gender and differences in healthcare financing among states in Nigeria using Dagum's approach for decomposition of the Gini coefficient. The data was sourced from the National Bureau of Statistics National Living Standard Survey. Empirical results showed that healthcare financing gender inequity exists in Nigeria. In addition, variations in healthcare financing inequity among states in Nigeria were found. It is recommended that different population groups be covered to achieve the broader equity and effectiveness goals when implementing healthcare financing reforms. Furthermore, governments in various states should step up efforts to assist disadvantaged and oppressed communities, such as poor indigenous people, in terms of healthcare utilization, which could reduce the healthcare financing burden. Keywords: Healthcare Financing, Inequity, Gini Coefficient, Gender Variation, Income Distribution

Comparative Analysis of Health Research Financing as a Veritable Tool for Achieving and Sustaining Universal Health Coverage in Nigeria and South Africa

Background: Nigeria is a signatory to the Abuja Declaration on allocation of 15% of the national budget to health and World Health Organization declarations that call on countries to allocate at least 2% of the national health expenditure to research. This review estimated the percentage share allocation of Nigeria’s national budget to health and health research. Method: This is a documentary review of the national budget and research literature on healthcare financing in Nigeria and South Africa, Africa’s largest economies. No date restrictions were placed on the searches except the special focus on the national treasury reports and annual institutional financial reports published between 2012 and 2018. We searched nine electronic databases (PubMed, EMBASE, Web of Science, SCOPUS, Cochrane library, Academic Search Complete, Google and Google Scholar and HINARI) and, national treasury Databases of Nigeria and South Africa with search terms that included public health financing. Results: Nigeria’s total budget increased by 83% from N4.7 trillion (USD13.1 billion) in 2012 to N8.6 trillion (USD23.9 billion) with a corresponding 26% increase in health allocation and 55.4% growth in health research allocation between 2012 and 2018. In contrast, South Africa’s total budget increased by 57.5% from R1.06 trillion (USD74.3 billion) in 2012 to R1.67 trillion (USD117.1 billion) with a corresponding 68.4% increase in health allocation that fluctuated between R122 billion (USD8.6 billion) and R205.4 billion (USD14.4 billion) in the same period. The percentage increase in health research allocation for South Africa was 69.3% in the same period. While South Africa with near universal health coverage (UHC) allocated an average of 11.7% and 1.2% to health and health research respectively in 2012-2018, Nigeria allocated only an average of 5.0% and 0.74% to health and health research respectively in the same period with no trajectory towards achieving the 15% and 2% targets. Conclusions: Findings underscore very poor health sector and health research funding in Nigeria and still far from meeting the targets of international declarations in contrast to SA. Realizing the pivotal role of a strong health research base, substantial increase in health and health research budget allocations to meet the 15% and 2% targets respectively are required to achieve and sustain UHC and improved health outcomes in Nigeria by 2030.

Healthcare Financing in Nigeria: The Analysis of the Inequity Perspective

The volume and quality of healthcare needs vary from one individual to another but promoting access to the use of healthcare is germane to reduce/eliminate inequity in healthcare. This paper examines the extent of equity in healthcare financing in Nigeria, and determine the relative progressivity of each source of healthcare financing in the country using waves 2 and 3 of the General Household Survey. Kakwani and Modified Kakwani (MDK) indexes were used to estimate progressivity of out of pocket payment (OOP) and social health insurance. Overall result indicates a vertical inequity favouring the non-poor (pro-rich), OOP as a source of financing was regressive and social health insurance was moderately progressive. Given that a more progressive healthcare financing approach tends to promote welfare and improve health status of the population, Nigeria will be better off promoting health insurance as a means of eliminating inequity in healthcare financing.

Equity in healthcare financing in Nigeria

Using both graphical and geometric analyses, this paper examines the extent of inequity in healthcare finance among the Nigerian population. One of the acclaimed plans in healthcare in this teeming community is the mix method of financing but the system in practise is dominated with Object Oriented Programmings (OOPs) meanwhile the degree of income inequality still remain high. Using the Nigerian Living Standard Survey (NLSS) data conducted in 2004, the framework for this study relies on Kakwani Progressivity Index (KPI). A decomposition of the groups into lower and upper bound however, reveal that health payment for lower bound is regressive while payment for upper bound is progressive. Although, the upper bound result dominates the entire result which finally suggests a progressive system arising from the spending habit of the rich in seeking for healthcare services abroad.

Health care financing in Nigeria: Implications for achieving universal health coverage.

The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.

Operationalizing universal health coverage in Nigeria through social health insurance.

Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme.

Healthcare financing in Nigeria: A systematic review assessing the evidence of the impact of health insurance on primary health care delivery

Strengthening health systems, improving health outcomes, as well as finding answers to the competing alternatives of healthcare financing are critical issues that continue to bother health policy makers. Irrespective of the options, the choice of health care financing should mobilize resources for health and improve access to quality care at the same time. Notably, the health financing policy in Nigeria provides a framework for establishing health insurance schemes so as to expand coverage in health care delivery for the formal and informal sectors as a strategy towards universal access to healthcare. Accordingly, the authors, through this review, systematically assess the evidence of the extent to which health insurance impacts on access to services and quality of primary healthcare in Nigeria. While this comes to bear, the findings reveal an evidence of moderate-to-high strength that health insurance increases access to care and improves the quality of care received; however, it remains equivocal in some instances. The review therefore contributes to the literature on healthcare financing by extending and qualifying existing knowledge and advocating for accelerated reforms if universal coverage will be achieved.

Sociodemographic Correlates of Choice of Health Care Services in Six Rural Communities in North Central Nigeria

Household expenditure on health has increasingly remained a major source of health care financing in Nigeria despite the introduction of several social health scheme policies provided by the government for meeting the health care costs of patients. Recognizing these limitations, this study assessed the type of health care services people commonly use in various illnesses and the sociodemographic correlates of the preferred health care services by household heads in six rural communities of North Central Nigeria. A cross-sectional community-based descriptive study design was used to study 154 household heads in the settlements using a multistage sampling method. Multiple logistic regressions were performed to investigate independent predictors that had significant chi-square atP<0.05. The leading causes of illness experienced by respondents were medical conditions (42.0%) and 41.7% of them sought treatment from patent medicine vendors. The dominant reasons for health-seeking preferences were financial access (53.7%) and proximity (48.6%). Age had a higher impact (Beta = 0.892) on the health-seeking preferences of the respondents as compared to their occupation and religion (Beta = 0.368 and −0.746, resp.). Therefore, in order to meet the health care of patients, it is pertinent that the unmet needs of patients are properly addressed by appropriate agencies.

Trends And Challenges Of Public Health Care Financing System In Nigeria: The Way Forward

One of the basic functions of government is to provide quality and effective health care services to its citizens as it is only when the people are healthy that any reasonable development can take place. Funding of health care sector in Nigeria is still face with enormous challenges that must be overcome if quality and effective health care service is to be made available to the people. This article reviewed relevant literatures related to public health care financing in Nigeria which were published by journals within and outside the country. An overview of the literatures showed that public health care services in Nigeria is financed through; out-of-pocket payments, tax revenue, donor funding and through health insurance. Trends have shown that the bulk of public health care is financed by households through out-of-pocket payments with government contributing just about 25% of the total health expenditure. The major challenges of health care financing includes, poor funding by government, high out of pocket payment, inadequate implementation of health care financing policy and corruption. This article concluded by recommending that there should be an increase in government funding of public health care, adequate implementation of health care policies, proper monitoring and evaluation of utilization of funds, discourage government sponsorship for treatment of personnel abroad and finally encouraging local production of drugs and other medical equipments.

Public health care financing in Nigeria: Which way forward?

The way a country finances its health care system is a key determinant of the health of its citizenry. Selection of an adequate and efficient method(s) of financing in addition to organizational delivery structure for health services is essential if a country is set to achieve its national health objective of providing health for all. Health care in Nigeria is financed by tax revenue, out-of-pocket payments, donor funding, and health insurance (social and community). However, achieving successful health care financing system continues to be a challenge in Nigeria. This article examines the different financing mechanisms that have been used in Nigeria, including the National Primary Health Care Development Fund proposed for increasing the resource allocation to primary health care. It draws on available and relevant literature to provide an overview and the state of public health care financing in Nigeria. This article concludes by recommending the need for Nigeria to explore and strengthen other mechanisms of health system and shift focus from out-of-pocket payments, address the issues that have undermined public health care financing in Nigeria, improve on evidence-based planning, and prompt implementation of the National Health Bill when signed into law.

Estimating the Willingness to Pay for Community Healthcare Insurance in Rural Nigeria

Health care financing in Nigeria is dominated by private out-of-pocket payment that is not affordable to the poor. This has greatly reduced access to quality health care for the predominantly rural poor. Insurance schemes as options for increasing access to health care services have not received considerable attention in Nigeria. In this regard, a community health prepayment scheme is proposed, and the Contingent Valuation Method is used to investigate the willingness of rural households to pay for this scheme. Contributing through agricultural commodities produced statistically higher estimates than through direct cash. Also, by incorporating uncertainty in responses using the Random Valuation Model, higher contribution amounts were obtained. This provides an option for its use in healthcare contingent valuation studies where respondents are uncertain about their true responses. The groups that are willing to pay lesser amounts into the scheme as compared with their counterparts are women, the less educated, and the less wealthy households.

Estimating the Willingness to Pay for Community Healthcare Insurance in Rural Nigeria

Health care financing in Nigeria is dominated by private out-of-pocket payment that is not affordable to the poor. This has greatly reduced access to quality health care for the predominantly rural poor. Insurance schemes as options for increasing access to health care services have not received considerable attention in Nigeria. In this regard, a community health prepayment scheme is proposed, and the Contingent Valuation Method is used to investigate the willingness of rural households to pay for this scheme. Contributing through agricultural commodities produced statistically higher estimates than through direct cash. Also, by incorporating uncertainty in responses using the Random Valuation Model, higher contribution amounts were obtained. This provides an option for its use in healthcare contingent valuation studies where respondents are uncertain about their true responses. The groups that are willing to pay lesser amounts into the scheme as compared with their counterparts are women, the less educated, and the less wealthy households.

The Distributional Impact of Healthcare Financing in Nigeria: A Case Study of Enugu State

The deregulation of healthcare financing and supply in Nigeria has shifted the healthcare system towards competitive market ideals. Households' decision to utilize healthcare is identical with healthcare financing. This financing arrangement has potentials for income redistribution in a society with already high levels of inequality in resource redistribution. This study attempts to examine the extent to which this system of healthcare financing leads to catastrophic expenditures, defined as a threshold percentage of a household's income, and the extent of impoverishment arising from healthcare spending. It also uses the Aronson, Johnson, and Lambert (1994) decomposition framework to analyze redistributive effects in terms of vertical and horizontal inequities, as well as re-ranking effect. The study finds that healthcare spending engenders high incidence of catastrophic spending and impoverishment in the population. It also finds that healthcare spending is pro-rich in its redistributive effect, with significant vertical and horizontal inequities as well as reranking inherent in the system. The paper suggests policy reforms that separate healthcare utilization from healthcare financing if the poor are to have access to healthcare services.

Primary health care financing in Nigeria via privatization using shareholders contribution mechanism - a survey

A survey using shareholders' contribution mechanism of primary health care financing was conducted in the Eastern part of Nigeria. The willingness of the shareholders in private and public corporations to offer a part or whole of their annual dividend in financing primary health care programme was assessed. The research design of the study is the randomized questionnaire distribution control to the shareholders of different classes involved in the study. It was ascertained that 70% of the respondents are willing to participate in primary health care financing. The degree of responsiveness in the percentage of dividend they were willing to offer ranged from 1–75% with 25 % attracting the largest response followed by 1–10%. Possible alternative methods of financing were determined and suggestions were made on how to incorporate the results of the study in the sustainability of the scheme. Keywords : primary health care, financing, privatization, shareholders Journal of Pharmaceutical and Allied Sciences Vol. 3(1) 2006: 300-309

The Distributional Impact of Healthcare Financing in Nigeria: A Case Study of Enugu State

The deregulation of healthcare financing and supply in Nigeria has shifted the healthcare system towards competitive market ideals. Households' decision to utilize healthcare is identical with healthcare financing. This financing arrangement has potentials for income redistribution in a society with already high levels of inequality in resource redistribution. This study attempts to examine the extent to which this system of healthcare financing leads to catastrophic expenditures, defined as a threshold percentage of a household's income, and the extend of impoverishment arising from healthcare spending. It also uses the Aronson, Johnson, and Lambert (1994) decomposition framework to analyze redistributive effects in terms of vertical and horizontal inequities, as well as re-ranking effect. The study finds that healthcare spending engenders high incidence of catastrophic spending and impoverishment in the population. It also finds that healthcare spending is pro-rich in its redistributive effect, with significant vertical and horizontal inequities as well as reranking inherent in the system. The paper suggests policy reforms that separate healthcare utilization from healthcare financing if the poor are to have access to healthcare services.

Out-of-pocket health expenditure for under-five illnesses in a semi-urban community in Northern Nigeria

Background: Household expenditure on health is increasingly becoming a major source of health care financing in Nigeria. Recognizing the limitations of this pattern of financing health care, the government has introduced a social health insurance scheme policy that has provided for government meeting the health care costs of children. However, there is a dearth of information on the pattern and costs of under-five illnesses at community level. This study therefore sought to determine the magnitude and causes of illnesses among under-fives, sources of healthcare and out of pocket expenditure among children under-five in Layin Zomo, a semi-urban area of Northern Nigeria Methodology: A cross-sectional community-based descriptive study design was used to study a population of under-fives in the settlement. A 50% sample of all under-fives in the settlement was drawn using systematic sampling method. Information was sought from the mothers/caregivers on illness episodes in the three months preceding the study, place and cost of treatment among the 324 sampled population. Result: The findings showed that 26. 9% of the children had been ill within three months of the study with fever; cough and diarrhoea being the leading causes of illness. Majority of respondents, 41.7% sought treatment from patent medicine vendors. The median out of pocket expenditure on treatment per illness episode was 171 Naira ($ 1.2) and the estimated annual per capita out of pocket treatment cost per child was 255 Naira ($1.8). Conclusion: While the study has provided some data for computation of the out of pocket health expenditure for treatment of under-five illnesses, the poverty context within which such expenditures are incurred limits the utilization of such information to determine the premium rate for the proposed children under five programme under the National Health Insurance Scheme. Key Words: Healthcare; Out-of-pocket expenditure; Under-fives; Zaria Journal of Community Medicine & Primary Health Care Vol.16(1) 2004: 29-32

ANNOTATION: Implementation of the National Health Insurance Scheme: The Dawn of a New Era in Health Care Financing in Nigeria?

The Decree establishing the National Health Insurance Scheme (NHIS) was promulgated in 1999, however, actual implementation of the NHIS commenced in 2002. The goal of the NHIS is to provide easy access to qualitative healthcare services at an affordable price to all Nigerians. The NHIS operates on the principles of Social Health Insurance and has a total of 6 programmes designed to cater for all sections of the populace. 4 of the six Programmes of the NHIS have been commenced on a small scale. Further development of the NHIS to the stage of universal implementation will depend on several factors amongst which are continued political will, adequate funding, human resource development and public sensitization and mobilization to ensure widespread participation. KEYWORDS: National Health Insurance Scheme, Programmes, Political will Sahel Med. J. Vol.6(1) 2003: 1-5

Implementation of the national health insurance scheme: The dawn ′of a new era in health care financing in Nigeria?

Implementation of the national health insurance scheme: The dawn ′of a new era in health care financing in Nigeria?