States with low investment have worst health outcomes, data shows

Nigerian states with low investment in their respective health sectors continue to record poorest health outcomes, according to available data, thereby worsening citizens’ access to quality healthcare.

The trend is particularly evident in states which fail to utilise the Basic Health Care Provision Fund (BHCPF) meant for primary healthcare delivery, resulting in high maternal mortality, under-five and infant mortality rates, low immunisation coverage, and high malnutrition rates.

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An analysis of the 2021 Multiple Indicator Cluster Survey (MICS) &
National Immunization Coverage (NICS) and a 2023 report on maternal mortality by the Nigerian Economic Summit Group all show that Zamafara, Bauchi, Sokoto, Kebbi, Rivers, Jigawa, Gombe, Katsina, Borno, Bayelsa, Ondo, Ogun are some of the states with poor health outcomes.

Other states are Cross River, Edo, Bayelsa, Akwa-Ibom, Plateau, Imo, and Kaduna.

Incidentally, most of these states have failed to access and utilise the BHCPF.

The ONE Campaign specifically identified Zamfara as the worst state in Nigeria for healthcare access, while the Federal Capital Territory (FCT) was considered the best. The report assessed indicators such as BHCPF implementation, budgetary commitment, under-five mortality rates, state of public health facilities, and human resources for health. It found that 1 in 9 public health facilities in these states are in deplorable condition, and lack critical resources.

These states top with highest infant mortality and under-five mortality rates. The 2021 MICS shows Sokoto has the highest under-five mortality and infant mortality at 202 deaths per 1,000 live births and 104 deaths per 1, 000 live births respectively.

In Jigawa state, the rate was reported at 175 and 95 per 1 000 live births. Kebbi also had one of the worst death rates with 179 and 95 per 1,000 live births respectively. In seven Local Government Areas of Borno alone, the rate was 140 and 70 per 1,000 live births, while the rate in Zamfara was put at 136 and 83, and Bauchi state had 153 and 83.

Other states are Bayelsa (100 and 70); Gombe (117 and 65); Katsina (159, 89); Rivers (100 and 87) Plateau (105 and 78); Ogun (85 and 68). The state with the lowest rate is Ebonyi at 3 and 24 per 1,000 live births.

Nationally, Nigeria had the third highest infant and child mortality rates globally in 2021, with 111 per 1,000 live births according to a World Bank report.

Immunisation rates, a critical medical intervention, are also low in these states. The 2021 MICS published by the National Bureau of Statics in collaboration with the United Nations Children Fund (UNICEF) shows that Sokoto, Bauchi and Gombe states have the highest number of zero-dose children – meaning those who have never been vaccinated.

In Sokoto, more than half of the children (50.7%) were never vaccinated. Bauchi and Gombe also had high rates of zero-dose children at 35.3% and 34.4%, respectively. Other states with low immunisation rates include Zamfara (22.9%), Ondo (23.6%), Ogun (21.3%), Kano (30.2%), and Borno (32.3%).

Nigeria leads globally in the number of zero-dose children, with over 2.3 million unvaccinated, a figure the Pediatrics Association of Nigeria estimates has risen to 6.2 million.

Maternal mortality is another severe issue. Nigeria ranks as the second largest contributor to maternal mortality globally, losing an estimated 145 women daily according to UNICEF. The World Health Organization and Integrated African Health Observatory in 2023 listed Nigeria among countries with extremely high maternal mortality rates, with 1,047 deaths per 100,000 live births.

The 2023 report by NESG shows the national maternal mortality ratio was 196.6 per 100,000 live births in 2020, with states like Katsina (653), Zamfara (576), Kano (506.7), Sokoto (469.7), Jigawa (424.1), and Kebbi (286.3) exceeding this average. Ekiti State reported zero maternal mortality in the same period.

Katsina recorded 653 per 100,000 live births, Zamfara (576), Kano (506.7), Sokoto (469.7), Jigawa (424.1), Kebbi (286.3, Lagos (225.3), Abia (211.7), Akwa Ibom (202.3), Ebonyi (199.9), and Gombe (191).

According to the report, contributing factors to high maternal mortality rates include poor access to quality healthcare, inadequate infrastructure, and poorly equipped hospitals. Many women did not receive antenatal care and often gave birth at home without skilled attendants.

Available reports also suggest that limited access to antenatal, natal and post-natal care increases the risks of maternal deaths.

The 2021 MICS survey reveals that a significant proportion of women in some states did not attend antenatal care. Zamfara has the highest with 65.8%, followed by Sokoto (58.8%), Kebbi (50 5%), Katsina (37.0%), Bayelsa (32 3%) and Bauchi (31.3%).

These poor health outcomes in several states contribute to Nigeria’s overall negative health indices, positioning the country at an unenviable top spot in Africa and globally.