Nigeria’s top five most efficient states for healthcare

Anambra has the most efficient health care system in the country closely followed by those of Osun, Ogun, Lagos and Rivers states to make up the top five states according to WellNewMe, the health technology company that generated the report, in ranking the states.

The publication evaluated all 36 states including the Federal Capital Territory (FCT) using each metric, the top state based on the raw data was given 1 point and the bottom state was given 37 points, including categories such as education, infrastructure, economy and healthcare.

To rank the most efficient states for healthcare in Nigeria, WellNewMe, used a modified version of the model used by New York based Common Wealth Fund, a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, young children, and elderly adults.

The report reveals that the top half of the list was dominated by states from the southern part of the country, with the highest ranking state from the north, Nasarawa coming in at 13th spot.

“We used 27 indicators that measure performance in four domains important to policymakers, providers, patients, and the public: Care Process, Access, Equity, and Health Care Outcomes,” said Obi Igbokwe, chief executive officer (CEO) of WellNewMe. “Our data came from a variety of sources including the National Bureau of Statistics, The Demographic and Health Surveys (DHS) Program, The World Health Organization (WHO), Oxford Poverty & Human Development Initiative (OPHI) and Kingmakers.com.ng. Except where stated, most of the data was from the year 2018.”

Igbokwe explained that in ranking the states, they created an index score for each metric for each state. In each metric, the top state based on the raw data was given 1 point and the bottom state was given 37 points. States between these were indexed proportionally. For the overall rankings, an average of the four category rankings was created, and then the outcome ranked. This method was chosen for the overall ranking so that it would not be skewed by large differences in scores at a metric level.

“For instance, with certain metrics such as assisted birth deliveries, 98.2% of all deliveries in Imo were handled by a trained healthcare professional, which is close to what you get in some developed countries, as compared to just 3.4% in Kogi. This demonstrates a huge disparity in the delivery of health services that can occur between the states. Going the route we did in ranking the states, it helped give us a clearer idea on how well each state was performing in relation to their peers when it comes to public health management” He continued.

“Public health management which covers the administrative and managerial capacities, organizational structures, and systems needed to finance and deliver health services more efficiently, effectively, and equitably is a really tough job, especially for the states with minimal resources.

This is why states like Osun, Enugu and Ondo deserve special mention as despite having smaller budgets than some of their peers, they performed really well to find themselves in the top 10 best performing states.”

While our rankings are by no means entirely fool proof, they do provide an interesting and valuable insight into areas that the various states are deficient in, and require in some instances urgent attention in order to provide their citizens with high quality healthcare, ” he said.

However, the chief executive officer (CEO) of WellNewMe further said the current coronavirus pandemic has brought to the fore the importance of having a strong health system, as many countries were faced with a unique challenge on how to best handle a novel disease which was killing people around the world at a rapid rate.

“This has brought about the reassignment of almost all resources in fighting the disease, affecting other health services available to patients.”

According to Igbokwe, some countries, such as Nigeria where caught in a unique situation where we already had an underfunded and poorly resourced national health system, which saw a scrambling by the various state governments in the country to put in place temporary health facilities to deal with the lack of resources needed should the disease get a firm footing in the country.

Fortunately, it seems that has been avoided, but it did expose the geographical disparity in healthcare service availability and delivery across the country,” said Igbokwe. “Healthcare in Nigeria is largely influenced by different local and regional factors that impact the quality or quantity of care received by its citizens, and large denotes the efficiency of the health system in each state.”

“Health care efficiency is a comparison of delivery system outputs, such as health outcomes, with inputs like cost, time, or material. Efficiency can be reported then as a ratio of outputs to inputs or a comparison to optimal productivity using stochastic frontier analysis or data envelopment analysis. This is sometimes difficult to do, especially in a country where data is hard to come by,” Igbokwe stressed.