Article Text
Abstract
Health accounts provide accurate estimates of health expenditure, which are important for effective resource allocation and planning in the health sector. In Nigeria, four rounds of health accounts have been conducted at the national level. However, the national estimates do not necessarily reflect realities at the subnational level and may only provide limited information for decision making at that level. This study highlights the pattern of health spending in Kaduna State from the 2016 Health Accounts, with a view to providing more reliable evidence for decision making in the state.
Health accounts expenditure surveys were administered to government, donors, non-governmental organizations (NGOs), private health insurance organisations and employers in the health sector for the reference year 2016. Household health expenditure was derived from a household survey administered across a representative sample of 1024 households selected from six local government areas across the three senatorial districts in the state. We estimated disease expenditure by deploying a health provider survey across a sample of 100 health facilities. Analysis was conducted using Microsoft Excel, Stata and the Health Accounts Production Tool.
Findings show that current health expenditure (CHE) accounted for only 7% of the total health expenditure in 2016. Out-of-pocket spending among households was about 81% of CHE, compared with a national average of 71.5% of CHE between 2010 and 2014. The health expenditure findings highlight several policy imperatives for the Kaduna State Health System. Primary among these is the heavy dependence on out-of-pocket financing for health, which has negative implications on vulnerable households. A shift to pooled prepaid mechanisms would reduce the financial burden on the most vulnerable households in Kaduna State. In addition, considering the government’s current contribution to health expenditure, there is a strong need for increased government prioritisation of the Kaduna State health sector.
- health insurance
- health economics
- health systems
- public health
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Footnotes
Handling editor Stephanie M Topp
Contributors KO, YKO and CEA conceptualised the research. CEA conducted extensive literature review, performed data analyses and validation, and developed a comprehensive first draft of the manuscript. CEA also incorporated detailed feedback from reviewers into revised versions of the manuscript. YKO performed quality checks/control on the analysis. YKO and KO reviewed multiple drafts of the manuscript and provided critical internal feedback. YKO and KO also provided guidance for incorporating feedback from reviewers focusing on rewording the discussion and concluding sections of the manuscript. PD, NB and NO reviewed the document and provided contextual guidance from both subnational and national perspectives, especially for the conclusion and recommendation sections.
Funding The Bill and Melinda Gates Foundation (BMGF) are the funders of this original research.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Not required.
Ethics approval Kaduna State Health Research Ethics Committee (KSHREC) of the State Ministry of Health.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon request.