1.0 Introduction
1.1 Background of Study
Historically, public health expenditure in Nigeria from 1986 to 2016 is marked by various policy changes, economic fluctuations, and efforts aimed at improving the nation's health system. During the mid-1980s, Nigeria's health sector was characterized by underfunding and poor infrastructure, which contributed to low health outcomes (Federal Ministry of Health, 2014). In response, the government embarked on structural adjustment programs (SAP) in 1986, which led to the introduction of cost-sharing mechanisms in healthcare. This period saw a reduction in public health spending due to budgetary constraints, which adversely affected access to quality healthcare for many Nigerians (Onwujekwe et al., 2019).
In Nigeria, public health expenditure has been a significant focus of government policy since the 1980s, coinciding with global initiatives emphasizing health sector development and poverty reduction (Federal Ministry of Health, 2014). Between 1986 and 2016, Nigeria experienced various economic, political, and social changes that influenced health financing and service delivery. Despite increases in health spending during this period, health outcomes remained relatively poor compared to other developing countries (Akinyemi, 2017).
Public health expenditure according to World Health Organization (2010) refers to the total amount of government spending allocated to health services, infrastructure, and programs aimed at improving the population's health status. In Nigeria, public health expenditure has been a focal point of government policy over the last few decades, with various reforms aimed at increasing funding and improving health service delivery (World Health Organization [WHO], 2010). It includes investments in hospitals, primary healthcare centers, health personnel, disease prevention, and health promotion activities. The primary goal of public health expenditure is to ensure equitable access to quality healthcare services and ultimately improve health outcomes such as life expectancy, infant and maternal mortality rates, and disease prevalence.
Studies have reported that despite increases in public health spending, Nigeria's health outcomes have not improved proportionately. Akinyemi (2017) asserted that inefficiencies in the health sector, including poor management of funds and inadequate infrastructure, undermine the potential benefits of increased expenditure. Furthermore, Onwujekwe et al. (2019) stated that inequitable distribution of resources and weak health systems are significant barriers to achieving desired health outcomes. It has also been affirmed that socio-economic factors such as poverty, and poor sanitation contribute heavily to poor health indicators in Nigeria (Federal Ministry of Health, 2014).
National Bureau of Statistics (2016) reported that regional disparities in health outcomes across Nigeria have been reported, with some areas benefiting less from public health expenditure than others due to varying levels of governance and resource allocation (National Bureau of Statistics, 2016). According to the World Bank (2018), monitoring and evaluating health spending's impact remains a challenge, resulting in limited evidence-based policy adjustments. This study is set against the backdrop of these challenges and aims to examine the relationship between public health expenditure and health outcomes in Nigeria from 1986 to 2016.
1.2 Statement of Problems
Investigation revealed that health funds are often mismanaged or diverted, leading to insufficient resources reaching primary healthcare facilities where they are most needed (Onwujekwe et al., 2019). In addition, the allocation of funds may not prioritize essential services or target the most vulnerable populations, which affects the overall impact on health outcomes. On the other hand, socio-economic factors such as poverty, illiteracy, and poor infrastructure also influence health outcomes and may limit the benefits derived from public health spending (Akinyemi et al., 2017).
Furthermore, there is the lack of comprehensive data and monitoring systems to assess the direct impact of public health expenditure on population health, which hinders policy adjustments and effective planning (National Bureau of Statistics, 2016). This gap makes it difficult to ascertain whether increased funding is translating into tangible health improvements or if other systemic issues are undermining progress. It is against this backdrop that this study seeks to investigate the relationship between public health expenditure and health outcomes in Nigeria from 1986 to 2016, aiming to identify factors that enhance or impede the effectiveness of government health spending.
1.3 Purpose of the Study
The purpose of this study is to analyze the relationship between public health expenditure and health outcomes in Nigeria from 1986 to 2016. It aims to assess how government spending has influenced key health indicators and to identify factors that enhance or hinder the effectiveness of such expenditures. The research study will provide evidence-based recommendations to improve health financing policies for better health outcomes.
1.4 Aim and Objectives of Study
The aim of the study is to investigate the impact of public health expenditure on health outcomes in Nigeria between 1986 and 2016. In achieving this aim, the following specific objectives were laid out as follows:
- To evaluate the changes in health outcomes such as infant mortality rate, maternal mortality rate, and life expectancy over the same period.
- To examine the trends in public health expenditure in Nigeria during the period 1986-2016.
- To analyze the relationship between public health expenditure and these health outcomes.
- To identify challenges affecting the effectiveness of public health expenditure in improving health outcomes.
- To provide policy recommendations for optimizing public health spending to achieve better health outcomes.
1.5 Research Questions
Based on the objectives above, the following research questions will guide the study:
- What were the trends in public health expenditure in Nigeria from 1986 to 2016?
- How did key health outcomes (infant mortality, maternal mortality, life expectancy) change in Nigeria during this period?
- What is the relationship between public health expenditure and health outcomes in Nigeria from 1986 to 2016?
- What are the main challenges affecting the effectiveness of public health expenditure in Nigeria?
- What policy measures can be adopted to improve the impact of public health expenditure on health outcomes?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant relationship between public health expenditure and health outcomes in Nigeria between 1986 and 2016
- H1: There is a significant relationship between public health expenditure and health outcomes in Nigeria between 1986 and 2016
1.7 Significance of Study
It is believed that at the completion of the study, the findings will provide critical insights into how public health expenditure influences health outcomes in Nigeria. The study will also inform strategies to reduce health disparities and improve the overall quality of healthcare services in Nigeria.
Furthermore, health advocacy groups and development partners will also find this study useful as it will underline areas that require urgent attention and investment.
Lastly, the study will support efforts to improve population health outcomes by ensuring that public funds are used efficiently and effectively to address Nigeria's health needs.
1.8 Scope of Study
This study focuses on the public health expenditure and corresponding health outcomes within Lagos State, Nigeria, covering the period from 1986 to 2016.
1.9 Limitations of the Study
During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.10 Definition of Terms
Public Health Expenditure: This refers to the total financial resources allocated by government authorities towards health services, infrastructure, and programs intended to improve public health (World Health Organization, 2010). It includes funding for hospitals, clinics, health personnel salaries, disease prevention, and health promotion activities.
Health Outcomes: These are measurable changes in the health status of individuals or populations that result from healthcare interventions or health determinants, such as infant mortality rate, maternal mortality rate, life expectancy, and disease prevalence (Akinyemi, 2017).
Infant Mortality Rate: The number of deaths of infants under one year old per 1,000 live births in a given year, used as an indicator of healthcare quality and socio-economic conditions (Federal Ministry of Health, 2014).
Maternal Mortality Rate: The number of maternal deaths per 100,000 live births, indicating the risk of death related to pregnancy and childbirth (National Bureau of Statistics, 2016).
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