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

Onwujekwe O, Hanson K, Uzochukwu B. , 2012

The paper presents evidence about the distribution of the benefits of public expenditures on a set 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.

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.

The results showed that 3,281 (14.8%) individuals consumed wholly free services. Most free services were disproportionately consumed by rural residents, women, and those from poorer SES quintiles; those in the poorer quintiles were less likely to access insecticide-treated nets and antenatal care services. High levels of payment were observed for immunisation services, insecticide-treated nets, antimalarial 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. Coverage of all of these priority public health services fell well below target levels. 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

Journal publication | Financing