Are the poor differentially benefiting from provision of priority public health services? A benefit incidence analysis in Nigeria

International Journal for Equity in Health

Benjamin Uzochukwu¹  Kara Hanson²  Obinna Onwujekwe³ 

[1] Department of Community Medicine, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria;Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom;Department of Health Administration and Management, University of Nigeria Enugu-Campus, Enugu, Nigeria

关键词: Nigeria;    Equity;    BIA;    Public health services;    Benefit-incidence- analysis;   

Others  :  826108
DOI  :  10.1186/1475-9276-11-70

 received in 2012-06-07, accepted in 2012-11-11,  发布年份 2012

【 摘 要 】

Background

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.

Methods

The 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.

Results

The 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.

Conclusion

It 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.

【 授权许可】

   
2012 Onwujekwe et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Mays GP, Smith SA: Evidence links increases in public health spending to declines in preventable deaths. Health Aff 2011, 30(8):1585-1593.
• [2]Bennett S, Gilson L: Health financing: designing and implementing pro-poor policies. London: DFID Health Systems Resource Centre; 2001.
• [3]National Population Commission (NPC) [Nigeria] and ICF Macro: Nigeria Demographic and Health Survey 2008. Abuja: National Population Commission and ICF Macro; 2009.
• [4]Barat LM, Palmer N, Basu S, Worrall E, Hanson K, Mills A: Do malaria control interventions reach the poor? A view through the equity lens. Am J Trop Med Hyg 2004, 71(Suppl 2):174-178.
• [5]O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M: Analysing health equity using household survey data: a guide to techniques and their implementation. Washington DC: World Bank; 2007.
• [6]Meerman J: Public expenditure in Malaysia: who benefits and why. New York; Oxford University Press (for The World Bank; 1979.
• [7]Selowsky M: Who benefits from government expenditures? A case study of Colombia. New York: Oxford University Press; 1979.
• [8]Demery L: Benefit incidence: a practitioner’s guide. Washington DC: Poverty and Social Development Group, Africa Region, World Bank; 2000.
• [9]Ataguba J: Implications of the analysis of financing and benefit incidence in Ghana, South Africa and Tanzania for health insurance policy debates. Beijing: 7th World congress on Health Economics: harmonizing health and economics; 2009.
• [10]Onwujekwe O, Dike N, Chukwuka C, Uzochukwu B, Onyedum C, Onoka C, Ichoku H: Examining catastrophic costs and benefit incidence of subsidized anti-retroviral treatment programme in south-east Nigeria. Health Policy 2009, 90:223-229.
• [11]Federal Office of Statistics (FOS): Nigeria Living Standard Survey (NLSS) 2003/2004. Abuja: FOS; 2004.
• [12]Filmer D, Pritchett LH: Estimating wealth effects without expenditure data - or tears: an application to educational enrolments in states of India. Demography 2001, 38:115-132.
• [13]Wagstaff A, Van Doorslaer E, Paci P: On the measurement of inequalities in health. Soc Sci Med 1991, 33:545-557.
• [14]Anambra State Ministry of Health [AMOH]: Pricelist for services in publci health facilities in Anambra state. Awka: AMOH; 2007.
• [15]Enugu State Ministry of Health [EMOH]: Pricelist for services in publci health facilities in Enugu state. Enugu: EMOH; 2007.
• [16]Federal Ministry of Health [FMOH]: The National Strategic Health Development Plan (NSHDP). Abuja: FMOH; 2009.
• [17]Wolfson LJ, Gasse J, Lee-Martin S, Lydon P, Magan A, Tibouti A, Johns B, Hutubessy R, Salama P, Okwo-Bele J: Estimating the costs of achieving the WHO–UNICEF Global Immunization Vision and Strategy, 2006–2015. Bull World Health Organ 2008, 86(1):27-39.
• [18]Wagstaff A: Benefit Incidence Analysis. 25th edition. World Bank: Research Working papers; 2010:1-25.
• [19]O'Donnell O, van Doorslaer E, Rannan-Eliya RP, Somanathan A, Adhikari SR, Harbianto D, et al.: Who pays for health care in Asia? J Health Econ 2008, 27(2):460-475.
• [20]Armstrong-Schellenberg J, Victora CG, Mushi A, de Savigny D, Schellenberg D, Mshinda H, Bryce J: Tanzania Integrated Management of Childhood Illness MCE Baseline Household Survey Study Group. Inequities among the very poor: health care for children in rural Tanzania. Lancet 2003, 361:561-566.
• [21]Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E: Explaining trends in inequities: evidence from Brazilian health studies. Lancet 2000, 356:1093-1098.
• [22]Chen B, Cammett M: Informal politics and inequity of access to healthcare in Lebanon. International Journal for Equity in Health 2012, 11:23. BioMed Central Full Text