The aim of the study was to generate new knowledge about the burden of different mechanisms for financing the use of health services by households, and to assess the distribution of the benefits from government expenditure on a set of priority public health interventions. This research was undertaken with the aim of using the findings to improve the equity of financing and provision of healthcare services in Nigeria. The specific objectives of the study were: to estimate the relative contributions of the major healthcare financing mechanisms at household level to the health expenditure in Enugu and Anambra states, Nigeria; to assess the financing incidence (based on socio-economic groups and rural-urban location) of the different financing mechanisms; to determine the level of catastrophic healthcare payments and their distribution across socio-economic groups; and to evaluate the benefit incidence (based on socio-economic groups, gender, rural-urban location) of a subset of publicly-funded priority health services.
THe study found that the high levels of out-of-pocket expenditure in the study population indicate a lack of financial risk protection for healthcare in the study areas. Those that experienced the highest burden of health expenditure were the rural dwellers and those from the poorest socio-economic quintile. Out-of-pocket payments is still the principal payment mechanism for healthcare and accounts for the very high levels of catastrophic spending that were found in the study.
People expressed a desire for increased free public health services, subsidised healthcare services, and the construction of more public hospitals. Hence, policymakers and programme managers should introduce health reform mechanisms to develop, implement and scale-up financial risk protection initiatives in the two states. In addition, reforms should identify constraints which impede the equitable distribution and access of free or subsidised public health services for the general population especially poor people and rural dwellers. Reforms should also ensure that priority healthcare services such as immunisation services are increased become more equitable in terms of coverage.
