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Oyindamola Popoola 



“Health cannot be a question of income, it is a fundamental human right” – Nelson Mandela. This quote emphasizes the need for basic health care to be provided by all governments of the world as a fundamental human right. In Nigeria, there are different types of facilities, levels, providers and the types and ways through which services are provided, but, one of the major problem associated with the Nigerian health system is her health financing. According to the World Health Organization (2011), health financing is concerned with the mobilization, accumulation and allocation of money to cover the health needs of the people, individually and collectively in the health system. Hence, the system is expected to be structured in a way that even the poorest in the remote villages should be able to receive needed care without worrying about the cost,; this is the hallmark of an equitable and fair health system (Shobiye, 2012).


WHO estimates that the minimum spending per person per year needed to provide basic life-saving services is between US$30 – US$40[1]. Yet most Sub-Saharan Africa (SSA) countries are far from meeting this benchmark. Similarly, the Abuja Declaration 2001 requires SSA countries to devote at least 15% of their annual budget to funding the health sector[2] however; Nigeria currently devotes only 18% government expenditure as a percentage of total government spending and US$31 as per capita government expenditure. The table below gives a picture of healthcare spending by governments of West African countries.

Table 1: General government expenditure on health as a percentage of total government expenditure and Per capita government expenditure on health at average exchange rate (US$) per capita of West African countries[3]

S/N Countries in sub-Saharan Africa General government expenditure on health as a % of total government expenditure Per capita government expenditure on health at average exchange rate (US$)Per capita
1 Cape Verde 10.0% $118
2 Ghana 10.6% $59
3 Nigeria 18.0% $31
4 Cote d’ivoire 8.1% $24
5 Togo 15.4% $24
6 Burkina Faso 13.5% $23
7 Senegal 7.5% $22
8 Benin 13.5% $21
9 Mauritania 5.5% $21
10 Gambia, the 12.4% $19
11 Mali 12.5% $16
12 Liberia 13.2% $13
13 Sierra Leone 9.5% $12
14 Guinea 6.8% $9
15 Guinea-Bissau 7.8% $8
16 Niger 8.7% $8


From the table, only two countries in West Africa (Nigeria and Togo) have invested above the 15% target set during the Abuja declaration and only three countries (Cape Verde, Ghana and Nigeria) have their per capita income above US$30-$40. Nonetheless, a critical look at the figures presented in the table will be incomplete without noting some of the flaws of both the WHO estimates and the Abuja Declaration, as these benchmarks did take into consideration inflation and population growth. Other factors  such as wars, conflict, terrorism, insurgency ad disease outbreaks, which exacerbate the African situation but are unfortunately akin to the continent, also need to be put in perspective when a country is said to “have met these targets”. Adequate investments in socio-economic factors that affect health outcomes such as proper nutrition, sanitation, lifestyle, poverty must be put alongside the ‘meeting of these targets’.


One way through which inadequate health financing manifests itself as a problem is in terms of women’s health. The unfairness of health inequalities are more grievous in terms of maternal health and more specifically the number of women that are delivered of their babies by skilled health professionals; midwives,  nurses, doctors or at whatever skill level. Unfortunately, inequalities exist in terms of women’s access to births by skilled health professionals. The graphs below show births by skilled health professional in West African countries by rural-urban divide, wealth quintile and educational level of the woman.


















Figure 2[5]

From figure 1, in Nigeria, only 67% of women that live in urban areas and 23% that live in rural areas have their babies delivered by skilled health professionals. Figure 2 shows that 85% of women in the highest wealth quintile and only 6% of women in the lowest wealth quintile have access to deliveries by skilled health professionals. The need for increased government spending on health cannot be over-emphasized as the poorest in both urban and rural areas are the most affected (as the case with most other things) by an inequitable healthcare system.


Figure 3[6]

The educational level of the woman also influences her health seeking behavioral patterns as the more educated a woman is, the more likely she is to see the need and afford the services of skilled health professionals during deliveries. It is however important to state that religious beliefs and cultural factors sometimes influence a woman’s choice to engage or not the services of skilled health professionals during delivery but does not negate the need for such services to be made available at an affordable cost or free (as a safety net for very poor people).


Although, the Nigerian government’s spending on health as a percentage stands at 18% and as such has met the requirement of the Abuja Declaration 2001; per capita government investment in health at US$31 again meets the$30-$40[7] Per capita International benchmark. However, this spending has not translated into better healthcare provision for the Nigerian citizenry. Moreover, this spending has to be accompanied with separate investment in key social determinants to make meaningful progress. For instance, the role of education in health outcomes is crucial in terms of helping to appropriately shape health seeking behavior but more importantly highly skilled human resource for health can only be achieved through providing quality education at all level, but more specifically at the tertiary level.  In addition, when the healthcare system is properly funded, the inequalities in access to care by women (or any other group of individuals) are reduced as there are more resources for the generality of the populace.







[7]WHO: Report of the Commission on Macroeconomics and Health; 2003


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