Nigeria’s healthcare system is a complex mix of public and private sectors. The public sector is primarily managed by the federal, state, and local governments, while the private sector consists of private hospitals, clinics, and pharmacies. The healthcare system in Nigeria is divided into three tiers: primary, secondary, and tertiary care.

While primary healthcare is the first point of contact for individuals seeking healthcare like immunisation, maternal and child health, and basic medical care, Secondary Healthcare includes general hospitals that provide more specialised care, such as surgeries and treatment for common illnesses. Tertiary healthcare, on the other hand, is the highest level of care, and it is provided by teaching hospitals and specialised medical centers. It includes advanced medical procedures and treatments.

Nigeria’s economic landscape and its influence on healthcare funding
The World Health Organisation (WHO) recommends that countries allocate at least 15 per cent of their national budgets to healthcare. Despite Nigeria being the largest economy in Africa, the country’s healthcare spending is below this global recommendation. The country consistently falls below the WHO benchmark for healthcare budget, averaging around 4–6 per cent in recent years, even with an increase in the Naira going into funding healthcare. This percentage of spending is slightly less than one-third of the 15 per cent commitment made in the Abuja Declaration.

It is no longer news that the Nigerian economy has steadily declined. According to the National Bureau of Statistics, as of June 2024, the inflation rate increased to 34.19 per cent relative to the May 2024 headline inflation rate, which was 33.95 per cent. High inflation and currency depreciation have strained the government’s ability to adequately fund healthcare as purchasing power has drastically decreased and costs of imported medical supplies and equipment have increased.

Also, when inflation rates were lower, the government’s funding for healthcare was relatively more stable, and the cost of medical supplies was a little more predictable, which allowed for better planning. Due to these ongoing economic challenges, the public healthcare sector remains underfunded, which has led to an increased reliance on private healthcare providers. This shift has increased inequities, as access to and quality of care now largely depend on an individual’s financial capacity.

Correlation between budget allocation and health outcomes
The 2024 National Budget was released in late 2023, and overall expenditure was marked at just over N27 trillion. However, rather unfortunately, the allocation for the health sector of N1, 228, 100, 390, 765 (4.6 per cent) once again fell significantly short of the minimum 15 per cent recommendation of the 2001 Abuja Declaration. What, then does this mean for the nation’s health sector? How well can the allotted funds address the country’s health needs and improve health outcomes?

The data used in this analysis was sourced from publicly released figures on reputable statistical websites. It was entered and formatted into an Excel Sheet, then analysed and visualised in Excel.

To evaluate the correlation between healthcare budget allocation and health outcomes, we will focus on specific indicators, including healthcare expenditure per capita, maternal and child mortality rates, and the healthcare index.

Over time, the Federal Government has made commitments to address healthcare issues such as the affordability of healthcare and reduction in out-of-pocket spending for all citizens, which aligns with Sustainable Development Goal three of Universal Health Coverage. Despite a marginal increase in healthcare expenditure per capita from N4,431 ($2.70) in the previous five-year average to N6,326 ($3.86) in 2024, only a mere five per cent of Nigeria’s 200 million population have access to some form of health coverage. This suggests that the government’s allocation of resources to health may not be commensurate with the nation’s needs.

A positive correlation between healthcare expenditure per capita and reduced under-five mortality rates has been observed at the state level over the past three years. However, geographic clustering and confounding factors, such as educational status, must be carefully considered to establish a causal relationship.

More money, less problems?
It has now been established that insufficient funding contributes to the nation’s healthcare challenges. However, does spending more money equate to having better health outcomes?  Typically, larger budget allocations to health result in better health outcomes, including lower maternal and infant mortality rates, higher life expectancy, and improved overall public health.

Despite consistent increases in healthcare budgets over the past few years, Jigawa (98.2 per cent), Sokoto (15.5 percent), Katsina (32.1 percent), and Kebbi (85.7 percent) states continue to exhibit the highest ‘under-five mortality rates in Nigeria’, as revealed by the earlier discussed 2021 Multiple Indicator Cluster Survey (MICS) conducted by the National Bureau of Statistics.

This persistent challenge is rooted in a complex interplay of some factors, including socioeconomic conditions, geographic constraints, healthcare system challenges, disease burden, and inequality.

Socioeconomic factors, such as poverty, religious beliefs, and low education levels, significantly affect the health-seeking behaviours of residents of these regions, hampering the effectiveness of healthcare initiatives, regardless of the amount of money allocated.

To be continued tomorrow.

Agbonle, Odutoye and Adetula wrote from Lagos.