Out-of-pocket expenditures, equity in maternal health care utilisation and health outcomes in Nigeria
Loading...
Date
2016-11
Authors
Salewa, Adetsav Asen Omonike
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Health is a highly valued asset and a prerequisite for productive activities. This is
because poor health limits the production capacities of the affected person and their
ability to enjoy the good things of life. To achieve desirable and sustainable health
outcomes, health care expenditure must focus on promoting health service delivery and
improving health service utilisation. Despite Nigeria's commitment to international and
regional agreements, her health sector has been continually underfunded by successive
governments. Public health expenditure as a percentage of government expenditure
stood at 3.2 per cent in 2001, increased to 9.4 per cent in 2007 but fell consistently to
5.2 per cent in 2013. This is low compared to the Abuja Declaration target of 15 per
cent. Also, a greater proportion of the country's total health expenditures are borne by
households through out-of-pocket expenditures. Out-of-pocket expenditure as a
percentage of total health expenditure was 67.9 per cent in 1995 but dropped to 61.7 per
cent in 2000 after which it increased to 69.4 per cent in 2013. This fell short of the
Millennium Development Goals target of 30-40 per cent. It is also considerably below
the 2015 Sustainable Development Goal target of zero per cent. The health sector in
Nigeria also suffers low prevalence of risk-pooling arrangements and inequity in
maternal health care utilisation. This makes Nigeria to be one of the countries with the
highest rate of infant and maternal mortality in the world. India and Nigeria together
account for more than a third of all under-five deaths and second highest maternal
mortality rate globally at 14 per cent after China's 20 per cent. This study aimed at
examining out-of-pocket expenditure, equity in maternal health care utilisation and
health outcomes in Nigeria. The study adopted a cross-sectional research design. Data
was obtained from the 2013 General Household Survey as well as 2008 and 2013
Demographic and Health Surveys. Two-part, Logistic Regression and Recursive
Bivariate Probit models were estimated. The study found that the major determinants of
out-of-pocket expenditure in Nigeria were: region of residence, sex, age, insurance
coverage, household size, reported illness, admission in hospitals and occupation. In
addition, the differences in equity gaps in skilled birth attendant and delivery in health
facility for rural-urban and poor-rich gaps, widened but antenatal visits improved
greatly with the richest wealth quintile being favoured. However, along regional
divides, the differences in equity gaps in delivery in health facility widened while equity
gaps for skilled birth attendant and antenatal visits improved with the South West zone
being favoured. Lastly, increased utilisation of skilled birth attendant improved health
outcomes significantly in Nigeria. This study, therefore, recommended that: greater
consideration should be given to increasing the level of government budget for health,
efforts on sensitising citizens on good health seeking behaviours should be intensified,
Primary Health Care should be strengthened by government, health insurance coverage
should be scaled up and policy makers at all levels should put in place effective and
efficient monitoring mechanism to ensure accountability and enforcement of best
practices.
Description
A thesis submitted to the school of economics in partial fulfillment of the requirements for the award of the degree of Doctor of Philosophy in economics of Kenyatta University. November, 2016