Despite recording an almost five-fold increase in health expenditure since 2001, Nigeria had worse health outcomes than some countries with lower expenditure in 2018, a comparative study of health performance in West Africa has shown.
Individual health expenditure in Nigeria rose from about $19 in 2001 to $83.7 in 2019, moving the country up from 11th to third highest in West Africa in spending, according to the report titled “Population health outcomes in Nigeria compared with other West African countries, 1998–2019.’
But the growth in spending failed to tame death rates, years of life lost (YLL), years lived with disability (YLD), healthy life expectancy (HALE) and health system coverage.
The analysis ranked Nigeria sixth in West Africa for age-standardised mortality, seventh for healthy life expectancy, 10th for YLLs, 12th for health system coverage, and 14th for YLDs in 2019.
Malaria and neonatal disorders topped the leading causes of losses in years lived, positioning the country as the fourth-highest for under-five mortality.
Senegal, with a lower GDP and health expenditure of $59 per individual and Mauritania with $54, for instance, had lower mortality, higher HALE, and lower disability than Nigeria, with a health expenditure of $84. Cape Verde ranked first in all of the indicators.
The study co-authored by Ifedayo Adetifa, director-general of Nigeria Centre for Disease Control, suggests that health system strengthening and targeted interventions to address unsafe water sources, poor sanitation, malnutrition and air pollution, could have aided improved health in these countries, despite lower budgets.
Citing data from the Global Disease Burden report 2019, the authors show that Nigeria had the highest proportion of health spending paid out of pocket in the region at 77 percent but has failed to yield better health system coverage. Coverage was estimated at 43 percent in 2019, according to the GBD Universal Health Coverage Indicator.
According to them, to improve the effectiveness of the current amounts of expenditure, it is necessary to reallocate resources and redirect investment to preventive care and primary care.
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The report noted that primary health care remained underdeveloped and constrained by extreme poverty, health worker shortages and absenteeism and brain drain.
It said uneven distribution of skilled professionals compounded these issues, further restricting access to care and reducing its quality for large parts of the population
It said, “Progress seen in some health outcomes is attributable to successful programmes, such as access to antiretroviral treatment, skilled birth attendants, immunisation and improved diagnosis and treatment of malaria. There is room for substantial gains if the system can fully implement successful programmes across Nigeria.
“Cost-effective strategies to improve system coverage, for example by building on the existing community health workforce, may generate substantial gains in population health if this workforce is properly trained to deliver appropriate and cost-effective care.”
Other issues raised include how the increasing burden of non-communicable diseases (NCDs) adds to the challenges faced by the already stretched health system.
However, effective actions to prevent NCDs could improve outcomes, the authors said. “Interventions such as this could reduce demand on the system and conserve scarce resources spent towards late-stage care for these conditions at the expense of efforts to prevent and reduce neonatal, child, and maternal mortality.”
They called for further investments to blot out existing inefficiencies and inequities in resource allocation across the system.
The analysis also identified the potential for better health gains through strategic investment outside the health system such as in nutrition, sanitation and air pollution. Some of these areas drive the largest disease burden in the country and account for almost 90 percent of under-five mortality.
About 31.5 percent of Nigerians do not have access to clean water; 71 percent lack improved sanitation facilities while malnutrition accounts for 54 percent of under-five mortality in Nigeria, the report shows.
“Without population-wide access to clean water and sanitary conditions, under-five mortality will remain stubbornly high in Nigeria, the authors say, citing the example of Ghana having an under-five mortality rate less than half that of Nigeria, with similar GDP and health expenditure per person,” the report said.
