Nigeria Living Standard Survey Research Articles

Impoverishing effects of catastrophic health out-of-pocket payments in Nigeria

Out-of-Pocket (OOP) expenditure on healthcare is a major share of total healthcare expenditure in many developing countries, including Nigeria. Households in different income groups in Nigeria spent a larger share of income mainly on consumption and basic needs, hence, OOP expenditure for health constituted a burden with attendant effects on household well-being. Catastrophic headcount and Overshoot mean positive gap and concentration indexes were used to capture the incidence and severity of catastrophic health expenditure. The poverty headcount, poverty gap, normalized poverty gap, and its mean estimate were used to empirically identify the effect of catastrophic health expenditure using the national poverty line of ₦137,430 per year. Data on 22,110 households with non-zero expenditure were obtained from the 2018/2019 Nigeria Living Standard Survey. The incidence and severity of catastrophic health expenditure were higher for poorest and poor income quintiles using total consumption expenditure and total non-food expenditure at various catastrophic thresholds. The results indicated that about one million Nigerians were pushed into poverty due to OOP expenditure. Widening the coverage of the available social health insurance and implementation of alternative means of healthcare financing would minimize the financial burden on many poorest and poor households.

Are households with under-five children in Nigeria socioeconomically disadvantaged?

Although the sociodemographic and economic contributors to under-five mortality are well established, very little research has been done to assess the levels of disadvantage under-five children in Nigeria face along these dimensions. Nigeria has the second-highest under-five mortality rate (U5MR) in the world (111 deaths per 1000 live births) and contributed to the highest number of annual under-five deaths globally in 2020 (844,321 deaths). The country has also implemented several decades of policy interventions to reduce under-five mortality by improving sociodemographic and economic conditions at the household level. In this paper, we assess the sociodemographic and economic disadvantages that households with children under-five face compared to other households and discuss the implications for health policy. Using the Nigeria Living Standard Survey 2018-19, we conducted a bivariate analysis to compare the sociodemographic and economic characteristics of households with and without under-five children. We performed independent samples t-test and proportions test to assess whether these sociodemographic and economic factors were significantly different for both groups. We found that households with under-five children typically had larger sizes (6.6 vs. 3.6), lower mean adult age (36.5 vs. 45.3), and male household heads (91.3% vs. 71.5%) than households without under-five children. Furthermore, households with under-five children were less likely to have access to improved drinking water (77.2% vs. 86.0%) and sanitation sources (54.0% vs. 61.9%) than those without under-five children. Despite having more adult working members, 71.2% of households with under-five children lived below the poverty line compared to 37.7% of other households. Although their total consumption expenditure was lower than households without under-five children, they spent a higher proportion of their expenditure on health care and were at a higher risk of experiencing catastrophic health expenditure. Our study has shown that households with children under five are disproportionately disadvantaged than other households in Nigeria. The households with under-five children are larger, younger, and poorer than those without children. We also show a wide variation in the proportion of households with children under five by state. Any efforts to reduce under-five mortality and morbidity in Nigeria should recognize these sociodemographic and economic differences.

Economic burden of non-communicable diseases on households in Nigeria: evidence from the Nigeria living standard survey 2018-19.

The importance of non-communicable diseases (NCDs) in Nigeria is reflected in their growing burden that is fast overtaking that of infectious diseases. As most NCD care is paid for through out-of-pocket (OOP) expenses, and NCDs tend to cause substantial income losses through chronic disabilities, the rising NCD-related health burden may also be economically detrimental. Given the lack of updated national-level evidence on the economic burden of NCDs in Nigeria, this study aims to produce new evidence on the extent of financial hardship experienced by households with NCDs in Nigeria due to OOP expenditure and productivity loss. This study analysed cross-sectional data from the most recent round (2018-19) of the Nigeria Living Standard Survey (NLSS). Household-level health and consumption data were used to estimate catastrophic health expenditure (CHE) and impoverishing effects due to OOP health spending, using a more equitable method recently developed by the World Health Organization European region in 2018. The productivity loss by individuals with NCDs was also estimated from income and work-time loss data, applying the input-based human capital approach. On average, a household with NCDs spent ₦ 122,313.60 or $ 398.52 per year on NCD care, representing 24% of household food expenditure. The study found that OOP on cancer treatment, mental problems, and renal diseases significantly contribute to the cost of NCD care. The OOP expenditure led to catastrophic and impoverishing outcomes for households. The estimations showed that about 30% of households with NCDs experienced CHE in 2018, using the WHO Europe method at the 40% threshold. The study also found that the cost of NCD medications was a significant driver of CHE among NCD-affected households. The results showed heterogeneity in CHE and impoverishment across states and geographical regions in Nigeria, with a higher concentration in rural and North East geopolitical locations. The study also found that 20% of NCD-affected households were impoverished or further impoverished by OOP payment, and another 10% were on the verge of impoverishment. The results showed a negligible rate of unmet needs among households with NCDs. The study highlights the significant effect of NCDs on Nigerian households and the need for effective policy interventions to address this challenge, particularly among the poor and vulnerable.

Determinants of catastrophic household health expenditure in Nigeria

PurposeThe purpose of this paper is to examine the determinants of catastrophic household health expenditure in Nigeria, with particular focus on Out-of-Pocket (OOP) health expenditure. Payments for healthcare through OOP are the major means of channeling funds to healthcare providers in many developing countries including Nigeria. It has great consequence on household well-being, especially when it is difficult for household to meet up with spending on other necessity goods.Design/methodology/approachThe demand for health theory provided the theoretical framework. The study used data from 2018/2019 Nigeria Living Standard Survey (NLSS) with catastrophic thresholds of 10 and 25%. A logistic regression model was used, while Pearson chi-squared test was used for models' goodness of fit.FindingsBased on the obtained result using Pearson chi-squared, at 10% threshold of total non-food expenditure, the likelihood of experiencing catastrophic health expenditure increased with secondary education, for those without health insurance and for severely ill or injured by 1.48, 2.57 and 8.70, respectively. It fell for those who consulted patent medicine vendors/chemists for illness or injury by 0.63 compared to orthodox practitioners. Enhancement of post-secondary education and widening the coverage of the available social health insurance would minimise the financial burden on many households.Originality/valueThis paper fulfills the need to examine the determinants of catastrophic household health expenditure on two catastrophic thresholds and two forms of household expenditure.

The impact of sugar tax on carbonated soft drinks in Nigeria

A sugar tax is a fiscal intervention levied on sugar-sweetened beverages (SSBs) to discourage consumption and improve population health. The over-consumption of SSBs is linked with the prevalence of obesity and diet-related non-communicable diseases (NCDs). Nigeria in the year 2022 introduces a 10 naira per litre excise tax on all non-alcoholic SSBs. This study assessed the impact of a sugar tax on the consumption of carbonated soft drinks in Nigeria. The study explored a mathematical model to estimate the effect of the sugar tax on the consumption of SSBs, three tax scenarios were assessed using Monte-Carlo Simulation. Historical consumption data from the 2018/2019 Nigeria Living Standard Survey was utilised. The outcome of the tax simulation revealed that a 10-naira excise tax on soft drinks is predicted to have a small effect on the price and quantity demanded of SSBs. The overall reduction in quantity demanded of SSB could be negligible if the tax rate does not increase the price by at least 20%. A 50-naira excise tax on soft drinks is anticipated to comply with the World Health Organization's recommendation, which calls for an increase in retail prices by at least 20%.

Food Insecurity and its Correlates: Empirical Evidence from Fish Farming Households in Nigeria

Over the years, the Nigerian government and partner agencies have implemented several interventions to unlock the untapped food security potential of aquaculture. However, there still exists a dearth of knowledge on the effect of these programmes on household food security, particularly among fish farming households in Nigeria. Therefore, this study engaged the Foster-Greer-Thorbecke model and the Probit model to examine the food insecurity incidence and the drivers of food security among the fish farming households in Nigeria. The study engaged secondary data of 1,587 fish farmers from the 2018/19 Nigeria Living Standard Survey panel data. The food insecurity estimates show that about 52.49% of fish farmers are food secure. The result further shows that most food insecure households are males, married, have fish farming as a primary occupation, reside in a rural area and are from the Northern part of the country with no formal education. Empirical evidence reveals that education, household size, access to phone, occupation, sector and location of the household head are the major determinants of food security. The study concludes that educating the fish farmers and upgrading the rural facilities will increase the probability of food security among the fish farming households in Nigeria.

Spatial Profiles and Determinants of Multidimensional Energy Poverty in Rural Nigeria

This study aims at examining the multidimensional energy poverty (MEP) and its determinants in six geo-political zones of rural Nigeria. We utilized the 2018/2019 Nigeria Living Standard Survey (NLSS) data collected by the National Bureau of Statistics (NBS) in collaboration with World Bank. The data were analyzed using descriptive statistics, Multidimensional Energy Poverty Index (MEPI), Analysis Of Variance (ANOVA), Tobit model, and Pearson correlation. The analysis showed that over 90% of the respondents live below the MEP line with the North East (NE) and South West (SW) having the highest (98.7%) and lowest (82%) respectively. The intensity of MEP at the national level was 0.330. The results of the multidimensional energy poverty index (MEPI) which stood at 0.31 in the country, was highest in the NE (0.345) and lowest in the SW (0.279). Although with varying strength of relationships across the zones, cooking, lighting, and kitchen appliances are notable dimensions that have a significant positive correlation with aggregate MEP. Education, sex, and occupation of the household head as well as household size and monthly expenditure are determinants of the MEP in the country. There are implications for zone-specific and women-focused interventions relating to clean energy and access to kitchen appliances.

Modelling the Number of Household Visit to Health Care Centres in Some Nigeria Communities Using Count Data Regression Models

Introduction: The need to model the impact of some demographic indicators on the frequency of household visits to healthcare centres in Nigeria's community is very important for preventing and spreading community diseases. This study aimed to investigate the effect of the patents' age, gender, marital status, type of illness and amount spent on the frequency of visits to community health care centres in Nigeria and to compared Negative Binomial Regression (NBR) and Generalized Poisson Regression (GPR) models to determine the preferred count regression model for the number of household visits to health centres in some communities in Nigeria.
 Methods: Survey of 132640 households in some Nigeria communities obtained from the 2018/2019 Nigeria Living Standard Survey (NLSS) were extracted from the National Bureau of Statistics (NBS) in collaboration with the World Bank. The Negative Binomial and Generalised Poisson regression models were used to investigate the five demographic variables on the frequency of visit to the community health centres. The performance of the count regression model was assessed using the Chi-square -2log Likelihood Statistic (2logL), Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) selection criteria.
 Results: Findings from the study showed that the type of illness and amount spent has a significantly positive effect on the number of household members' visits to the community health care centres in Nigeria while age, gender, and marital status was discovered to have a negative effect on the number of household members' visits to the community health care centres in Nigeria.
 Conclusion: The Nigeria Government, health centre management and community healthcare service providers' need to be aware that the amount spent and the nature of illness determines the level of health care services utilisation in the Nigeria community, hence the need for the drastic reduction in charges to encourage a household visit to the community health centres whenever the need arises.

Out-of-pocket health-care spending and its determinants among households in Nigeria: a national study

This study estimated out-of-pocket health-care spending and its determinants among households in Nigeria. Using secondary data from the 2009/2010 Harmonized Nigeria Living Standard Survey, we estimated the determinants of out-of-pocket health-care spending in Nigeria. The Heckman two-step selection model was used to analyse household and individual decisions to seek care and how much to spend on health care. Data were analysed using STATA version 12 software. Results from the Heckman selection model indicated that having household heads with primary education, having household heads with secondary education, having more than five members in the household, households residing in the South East region, having head of the household being employed, households visiting public health facilities, and having household members with chronic illnesses were factors that increased the likelihood of incurring out-of-pocket health-care spending. Our findings suggest that individual and household characteristics increase the risk of incurring out-of-pocket health-care spending. Policy makers and political actors need to stop the high reliance on out-of-pocket health-care spending as a means of financing the Nigerian health system by increasing public health expenditure. The design and implementation of a tax-based non-contributory health financing system for the poor, vulnerable, and informal sector workers would be more helpful for implication at a national level.

Extreme Energy Poverty Incidence and Determinants in Nigeria: A Multidimensional Approach

Energy poverty has emerged in recent times as a crucial aspect of poverty, afflicting the developing world in general and Nigeria in particular. Drawing from some of the recent literature on energy poverty measurement, this study measures and discusses the incidence and determinants of extreme energy poverty in Nigeria based on a robust multidimensional energy poverty index that covers five major dimensions and six indicators of deprivation in basic energy services. The study uses the 2010 Harmonised Nigeria Living Standard Survey—obtained from the National Bureau of Statistics, Abuja, Nigeria—for its analysis. The results of the study show, among other things, that over a fifth of the Nigerian population are afflicted by extreme energy poverty and the phenomenon is more pronounced in the rural areas than in the urban areas as well as in Northern Nigeria than in Southern Nigeria. The results also indicate that the determinants of extreme energy poverty include region of residence, household composition as well as age, gender and educational level of household head. The Nigerian government should take urgent and adequate steps to eradicate extreme energy poverty in the country in order to pave the way for rapid and sustainable development in the country.

Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria 2010.

Background: There is high reliance on out-of-pocket (OOP) health payments as a means of financing health system in Nigeria. OOP health payments can make households face catastrophe and become impoverished. The study aims to examine the financial burden of OOP health payments among households in Nigeria. Methods: Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/2010 was utilized to assess the catastrophic and impoverishing effects of OOP health payments on households in Nigeria. Data analysis was carried out using ADePT 6.0 and STATA 12. Results: We found that a total of 16.4% of households incurred catastrophic health payments at 10% threshold of total consumption expenditure while 13.7% of households incurred catastrophic health payments at 40% threshold of nonfood expenditure. Using the $1.25 a day poverty line, poverty headcount was 97.9% gross of health payments. OOP health payments led to a 0.8% rise in poverty headcount and this means that about 1.3 million Nigerians are being pushed below the poverty line. Better-off households were more likely to incur catastrophic health payments than poor households. Conclusion: Our study shows the urgency with which policy makers need to increase public healthcare funding and provide social health protection plan against informal OOP health payments in order to provide financial risk protection which is currently absent among high percentage of households in Nigeria

Empirical evidence of child poverty and deprivation in Nigeria

Development economists and policy makers have in recent times focused attention on child poverty as a crucial aspect of poverty. The importance of the analysis of child poverty partly lies in the fact that children are the most vulnerable group in every society. This study used two poverty lines and the Foster-Greer-Thorbecke index to analyze extreme and overall child poverty headcount, depth and severity in Nigeria. The study also used the headcount ratio to analyze the extent of child deprivation in education, health, nutrition, child protection, water and sanitation. The study was based on the 2010 Harmonized Nigeria Living Standard Survey (HNLSS) and the 2011 Multiple Indicator Cluster Survey (MICS), obtained from the National Bureau of Statistics (NBS), Abuja, Nigeria. The study revealed that 23.22% of children in Nigeria were in extreme child poverty while 70.31% of children in the country were in overall child poverty. The study further showed that there was pronounced child deprivation in education, health, nutrition, child protection, water and sanitation. Both child poverty and child deprivation were more pronounced in the rural sector than in the urban sector and in Northern Nigeria than in Southern Nigeria. Therefore, the Nigerian government should take adequate steps to eradicate child poverty and obliterate all forms of child deprivation in Nigeria – particularly deprivation in basic needs. In taking such steps, more attention should be focused on rural areas and Northern Nigeria.

Determinants of catastrophic health expenditure in Nigeria.

Catastrophic health expenditure is a measure of financial risk protection and it is often incurred by households who have to pay out of pocket for health care services that are not affordable. The study assessed the determinants of catastrophic health expenditure among households in Nigeria. Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/10 was utilized to assess factors associated with catastrophic health expenditure in Nigeria. Household and individual characteristics associated with catastrophic health expenditure were determined using bivariate analysis and multivariate logistic regression. Results showed that irrespective of the threshold for the two concepts of total household expenditure and non-food expenditure, having household members aged between 6 and 14years, having household members aged between 15 and 24years, having household members aged between 25 and 54years, having no education, having primary education, having secondary education, lack of health insurance coverage, visiting a private health facility, households living in north central zone, households living in north east zone and having household members with non-chronic illnesses were factors that increase the risk of incurring catastrophic health expenditure among households. Policy-makers and political actors need to design equitable health financing policies that will increase financial risk protection for people in both the formal and informal sectors of the economy.

Analysis of energy poverty and its implications for sustainable development in Nigeria

AbstractThis study estimates and analyzes the incidence and determinants of energy poverty in Nigeria based on a simple multidimensional energy poverty index that it constructed. It also highlights the implications of energy poverty for sustainable development in Nigeria. The headcount ratio and the logistic regression technique are used. The study utilizes the Nigeria Living Standard Survey data set of 2004, obtained from the National Bureau of Statistics. The estimates show that energy poverty is pervasive in the country; it afflicts over 75 per cent of the population. The determinants of energy poverty in Nigeria include household size; educational level, gender and age of household head; general poverty; region of residence; and proportion of working members in the household. Efforts should be made to adequately tackle the problem of energy poverty in Nigeria. This is a major way to put the country on the path to rapid and sustainable development.

Building Savings and Investments Culture among Nigerians

Many Nigerians today live below the poverty line not necessarily because they have low incomes or poor salaries, but perhaps they lack savings and investments culture. The Harmonized Nigeria Living Standard Survey reports that Nigeria spends about N25 billion daily on food items. There is high propensity to consume but low propensity to save. This is quite alarming for a developing nation. High consumption would mean low savings, low investment, and low capital formation. If this persists, the Nigeria populace will be engulfed in poverty trap. It is therefore necessary to build among Nigerians savings and investments culture. A review of extant literature revealed that people save and invest for several reasons among which are to enhance the standard of living, take advantage of rare business opportunities, and meet unforeseen circumstances. Savings can be done through piggy, stokvel, thrift collection, credits unions, and banking system while investment is in the form of real asset, financial asset, and foreign exchange investment. Whatever form of investment one contemplates, it is very important to assess the risk-return trade off of such investment. Savings and investments guarantee your future. No matter how small is your income, you must learn to save to mobilize funds for investment. If the standard of living of Nigeria populace must be enhanced, there is therefore serious need for household savings and investment. Savings and investments must be our life style. We however in this study recommended the credit unions method of savings for Nigerians who belong to a field of membership.

Relationship Between Household Food Poverty and Vulnerability to Food Poverty: Evidence from Nigeria

Poverty and vulnerability to poverty are major challenges facing developing countries and have attracted the attention of development economists and policy analysts in recent years. This study examined the relationship between household food poverty and vulnerability to food poverty in Nigeria based on data from Nigeria Living Standard Survey (NLSS) (2004) obtained from the National Bureau of Statistics. A least-cost technique associated with the food-energy-intake approach was used to compute zone-specific food poverty lines based on the food baskets common to each geo-political zone; the Foster–Greer–Thorbecke (FGT) poverty index was used in computing food poverty incidence; the three-step feasible generalised least squares (3FGLS) procedure was used in estimating the magnitude of vulnerability to food poverty; cross tabulation and Pearson’s product moment correlation coefficient were utilised for the purpose of analysing the association between household food poverty and vulnerability to food poverty. The food poverty incidence was 50.23 % while the vulnerability to food poverty incidence was 61.68 % and the vulnerability to food poverty/food poverty ratio was 1.228. The food poor were more vulnerable to food poverty than the non food poor. There was significant positive correlation between food poverty incidence and vulnerability to food poverty incidence even though the correlation was not very strong. Thus, policies and programmes that will optimally reduce food poverty and vulnerability to food poverty should be adopted in Nigeria; these should be targeted more on the food poor. This is a major way to break the yoke of underdevelopment in Nigeria.

Food Poverty Profile for Nigeria

Poverty has remained largely unabated in Nigeria despite the efforts made in tackling it. Previous studies on poverty focused on total expenditure and did not adequately cater for regional differences in prices, needs, tastes and preferences. This study, therefore, examined the incidence, depth and severity of food poverty in Nigeria and produced a food poverty profile for the country based on zone-specific food poverty lines. The study used data from National Bureau of Statistics’ Nigeria Living Standard Survey, 2004. Linear programming technique in the spirit of the Food-Energy-Intake (FEI) approach, and the Foster-Greer-Thorbecke (FGT) index were utilized. The estimates of the study showed, among other things, that food poverty lines varied across zones, and food poverty was pervasive in the country and varied across zones. Thus policies and programs that will adequately increase people’s access to food and minimize the incidence of food poverty in Nigeria should be adopted.

Household Demand for Food Away from Home (FAFH) in Nigeria: The Role of Education

The aim of this study is to investigate the demand characteristics of household consumption of food-away-from-home (FAFH) with a focus on the role of education of household head in Nigeria. Using 2003/2004 Nigeria Living Standard Survey (NLSS) data, we employ the Cragg’s Double-Hurdle (DH) model, which estimate jointly, households’ decisions to consume FAFH and how much to spend on FAFH or the demand for FAFH. The empirical results show that education of household head decreases the demand and probability of consuming FAFH, while household income and households with younger age cohorts increase the demand and probability of consuming FAFH in the study. The findings also reveal that education reduces the demand for FAFH for the wealthier households twice as much as it does for the poorer households.

Interactions among Poverty, Access to Modern Energy Sources, and Gender in Nigeria

This study examines the interactions among poverty, access to modern energy sources and gender in Nigeria. Descriptive statistics and logistic regression technique are used. The 2010 Nigeria Living Standard Survey data set obtained from the National Bureau of Statistics is used. The findings of the study show, among other things, that contrary to what happens in many countries of the world, both incidences of poverty and lack of access to modern energy sources are more pronounced among male-headed households than among female-headed households. The logistic regression estimates show, among other things, that poverty reduces the odds in favor of having access to modern energy sources and while female headship of household reduces the odds in favor of being in poverty, it increases the odds in favor of having access to modern energy sources. The forgoing should serve as invaluable guide to the Nigerian government and policy makers.

Maternal Schooling, Public Health Programmes and Child Morbidity in Nigeria

The role of investment in human resources and subsequent multiplier on the economic growth of any nation has been adequately addressed in the literature. Education, a major investment in human resources helps in improving the productivity of labour in the labour market and also in influencing children mental alertness and health outcomes. Maternal education and public health programmes have been found to impact positively on child morbidity in developed countries thereby contributing to the growth of any economy, which will bring about sustainable development and inclusive growth. This work therefore examines the influence of maternal education and public health programmes on child health (morbidity) in Nigeria using the Harmonised Nigeria Living Standard Survey (2009). Descriptive Statistics and two stage least square estimation procedure were used to analyse the data. The results revealed a negative relationship between child immunisation and child health (morbidity) in Nigeria. Equally, the study found out that improving girl child education will go a long way in improving child morbidity. Based on our findings, the study recommends adequate publicity for public health programmes. Also, household income enhancing interventions should be put in place, doing this will go a long way in improving child health and survival, which in the long-run will improve per-capita income and consumption.