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.Redistributive effects, Healthcare financing, Catastrophic financing, Impoverishing effects, Equity, Nigeria

Distributional Analysis of Household Health Expenditure in Nigeria

The major means of financing healthcare in Nigeria, among other financing mechanisms is out-of-pocket expenditure. This is because most households (over 95%) are excluded from the financial risk protection of health insurance; hence the decision to utilize healthcare services by households implies the decision to pay directly out-of-pocket. This paper employs data from the Harmonized Nigerian Living Standard Survey 2009/2010. Using concentration index, Gini index and Kakwani index for the analyses, and also combining Lorenz curve and concentration curve to show inequality in health payment across socioeconomic groups in Nigeria, we found out-of-pocket payment to be a progressive healthcare financing mechanism across income quintile and geopolitical zones. It is therefore concluded that there exists a possibility of the Nigerian health system to exclude significant proportion of her population from the use of healthcare services simply because they cannot afford the cost of treatments. Keywords: Household out-of-pocket expenditure, Income quintile, Geopolitical zones, Kakwani index, Gini index, Concentration index, Nigeria

Financial Protection and Universal Health Coverage in Nigerian

Universal Coverage and financial protection are the goals of health systems the world over. Using data from the Harmonized Nigerian Living Standard Survey HNLSS 2009/2010 to calculate the catastrophic and impoverishing impacts of out-of-pocket health payment in Nigeria, we discovered that 19.5% of Nigerians suffered financial catastrophe, while 3.5% are pushed below the poverty line. Factors associated with catastrophic health expenditure include; household size, number of spouse in the household, geopolitical zones, place of residence, household sex. We also utilized the tool of financing incidence analysis to show the progressivity of out-of-pocket expenditure across socioeconomic groups in Nigeria. A health system dominated by excessive reliance on out-of-pocket expenditure cannot achieve the goal of financial protection and UC. Vulnerable households with high risks of catastrophic and impoverishing effects of OOP should be targeted. Keywords: Financial protection, Universal Health Coverage, Catastrophic health expenditure, impoverishment and Out-of-pocket expenditur

An Investigation of the Socioeconomic Determinants of Obesity in Nigeria

The ongoing demographic and epidemiologic transitions in Nigeria are some of the possible reasons why the prevalence of obesity is increasing in Nigeria. The economic impact of obesity in Nigeria may result to a decrease in productivity. It is based on this premise that this study investigates the socioeconomic determinants of obesity in Nigeria. The simultaneous equation model was used to analyse the study with a cross sectional data sourced from the Demographic and Health Survey 2013. A dummy variable was created to represent the regions in Nigeria. It was discovered that region has a greater impact on body mass index as it varies significantly across regions. Based on the findings it was recommended among others that sensitization programmes should be encouraged by the government at all levels to educate the people on the need for a proper diet and maintenance of a healthy life style. Keywords: Demographic, Epidemiologic transitions, Obesity, Body mass index (B.M.I) Productivity, Socioeconomic determinants, Nigeria

Inequality in Under-Five Child Malnutrition: Evidence from Nigeria Multiple Indicator Cluster Survey

This paper evaluates inequality in under-five child malnutrition in Nigeria; using cross-sectional data from 2011 multiple indicator cluster survey. The concentration curve was employed to ascertain whether inequality in under-five child malnutrition is pro-poor or pro-rich whereas the concentration index was used to determine the size of this inequality in Nigeria. We found that inequality in malnutrition concentrates amongst the poor under-five children and that the size of this inequality is reasonably large. This result is consistent for the three anthropometric measures of child malnutrition i.e., stunting, underweight and wasting. However, inequality in stunting and wasting were found to be fairly the same and bigger than that of wasting. Put differently, inequality in stunting and that of underweight were found to be the strongest in Nigeria, while that of wasting was discovered to be the weakest. We recommend increase in food production and distribution, investment in nutrition education and increase in access to nutritious food, mainly for children left behind (i.e., the poor children) in the country. Keywords: Under-Five Child Malnutrition, Inequality, Concentration Curve, Concentration Inde

A distributional analysis of healthcare financing in a developing country : a Nigerian case study applying a decomposable Gini index

Includes bibliographical references (leaves 253-282).The policy motivation for this research is primarily to investigate how in the direct absence of significant third-party financing mechanisms and government subsidies, direct purchase of healthcare affects the relative abilities of households to meet their other financial obligations after paying for the cost of health services. In other words, this study aims to analyze the redistributive effect of the direct healthcare financing in Nigeria

The demand for health care services in Nigeria : a nested logit model

Bibliography: leaves 96-99.The main aim of this study is to understand better the factors that influence the health care demand decisions of Nigerian households. The achievement of this objective involves the estimation of the parameters of the demand for health care services in order to understand the nature of health care choices that Nigerian households make under the present depressed economy. These demand parameter estimates are considered valuable inputs into health care policy. Yet, to date, there is neither sufficient information on the factors that shape households' utilization of health care services nor is there sufficient information on the relative importance of health care alternatives available to them. This is the knowledge gap this study helps to fill. Due to the dearth of data on the subject and the costs of collecting such data for the whole country, this study has been limited to a particular geographical area - Nsukka local government

Determinants of livelihood diversification strategies in Eastern Tigray Region of Ethiopia

Abstract Background In Ethiopia, farm households engage and pursue diverse off-farm and non-farm livelihood activities to cope with diverse challenges such as drought. Due to the unstable and meagre agricultural context of the study area, farm income alone could not feed the ever increasing population. Without adopting context based livelihood diversification strategies; the challenge it presents could neither meet nor attain household food security and improve livelihood security. The objective of the study was to analyse the determinants of livelihood diversification strategies among rural households in Eastern Tigray Region of Ethiopia. Methods Multistage sampling technique was used in selecting the study sites and 485 sample respondents. Data were triangulated with information collected using focus group discussion and key informants interview to draw qualitative conclusion. Results Majority (83.1%) of the farmers were able to diversify their livelihoods into either off-farm or non-farm or combined income activities, whereas the remaining 16.91% of the households were unable to diversify; often lacking the means to engage in any form of income-generating activity apart from agricultural activities. Results of the multinomial logistic regression model revealed that households choice and adoption of livelihood diversification strategies were positively affected by households level of education, access to credit, income, membership to cooperatives, land size, and farm input use, whereas age, dependency ratio, family size, access to extension services, distance to market, livestock ownership and agro-ecology negatively affected. Conclusions Diversification into non-farm activities plays a significant role in the context of inadequate and rain-fed-dependent agricultural income households. Households who diversified their livelihood activities are the ones who able to build better asset and less vulnerable than the undiversified ones. Smallholder farmers’ food security and livelihood improvement can only be realized if the government give due attention and put the right policy measures in place that support non-farm livelihood diversification as part of national job creation for saving life of many people and better livelihood