1.1 Introduction
The health care is relevant to individuals, national productivity and growth cannot be over–emphasized. This is evidenced by the numerous enquiries into the relationship between health and human welfare in the literature. Evidence of the importance of health in growing the economy of a country have shown that good health raises the level of human capital, promotes the productivity capability of individuals in the country and facilitates the rate of economic growth (Cooray, 2013; Nkpoyen, Bassey, & Uyang, 2014). It enhances labour productivity by limiting incapacitation and un-healthiness among workers as well as reduces absenteeism associated with sick leave.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Limitation of the study and Definition of technical terms.
1.2 Background of Study
The incidence of poverty has brought variations in living standards around the globe. Some people are fairly well off and others are not. Some individuals are considered rich and others poor. However, everything is relative and that is certainly the case with poverty. For instance, even in countries considered to be rich, we read and hear of such things as ‘Millions of Americans can’t make a decent living” (Schwarz October, 1998:14).
Similarly, a poor person in Nigeria might not be perceived as such by other Africans in dire economic needs. Thus poverty is partly a matter of how one person’s income stacks up against the other person’s and partly how one earns his living. Due to the arming increase of poverty, the Nigerian government has designed a lot of stabilization measures or programmes to curb or reduce the menace of poverty in this country. Each past administration came up with a unique programme mire in order to eradicate or alleviate poverty in Nigeria (Dike 2000:5). Some of these programmes include; General Olusegun Obasanjo’s Operation Feed The Nation of 1976, Alhaji Shehu Shagari’s Green Revolution Programme of 1979, General M. Buhari’s Operation “Go Back To Land Programme of 1983, Genral Babangida’s Directorate Of Food, Roads and Rural Infrastructure (DFFRI) of 1986, Genral Sani Abach’s Family Economic Advancement Programme (FEAP). Chief Olusegun Obasanjo later came back to power on May 29, 1999 and introduced another Poverty Alleviation Programme (PAP) in the year 2000 (Dike 2000:7).
The challenges faced by most low and middle-income countries, such as Nigeria, are those of identifying sources of financing health care and being able to pool these resources together for the general benefit of the citizens. Failure to harness these components of health care financing leads to high poverty incidence and therefore large failure of citizens to utilize available healthcare services. Health is one of the most important factors that determine the quality of human capital, a necessary factor for economic growth. In line with the above, a consensus of opinion have been formed among researchers recognizing health as a public good, the demand and supply of which cannot be left at the mercy of invisible hands or profit maximizing individual as well as on considerations of utility maximizing conduct alone . Hence, the need for the government to play a major role in delivering good and qualitative healthcare services that is accessible and affordable for the teeming population. The recognition of the importance of the above led the World Health Organisation (WHO) to propose at the 2010 World Health Assembly, issues that will address financing of health, which will ensure qualitative and affordable healthcare services (Ataguba and Akazili, 2010).
The pattern of health financing is therefore closely and indivisibly linked to the quality of health outcomes (health status), capable of achieving the long term goal of enhancing a nation’s economic development (Riman, 2012). Alluding to the above fact and as an evidence of its commitment towards the restructuring of the health sector in its fiscal operation, the Nigeria government has taken up the responsibility of providing good healthcare facilities for its citizens by improving on the amount of its expenditure on health. Available data indicated that on the average about 2.1% to 5.8% of total government expenditure were expended on health within 2000 and 2007 (Mordi, 2010). The belief is that this would improve the health of the citizenry that can translate into healthy human capital base with its multiplier effects on economic growth and development.
Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Effect of Poverty and Access to Health Care.
1.3 Statement of Problems
The cost of health care service in both public and private health facilities has sky rocketed in the recent past and it seems this will continue in years to come except an urgent intervention is put in place. While the ability to purchase health care is diminishing there is increasing poverty in the country (Nigeria), as it is the case with most developing nations. Therefore there is the need for urgent intervention at all levels and quarters to bring about access to all, no matter their position or where they live.
The continuous inability of the sick and households to pay for health services is a common phenomenon in many health facilities across the length and breadth of Nigeria. This is, however, more common among the poor rural households and semi-urban dwellers. The situation may be so precarious that the sick's relation may have to sell some properties of the sick or of the household in order to pay for medical bills. In other instances loans with high interest rates may be obtained on behalf of the sick and this are usually not devoid of the consequence of impoverish of both the sick and the household. In extreme cases of poverty the sick are often left at home without treatment or if already on treatment at a health center she/ he is taken home and left at the mercy of death. These unfortunate happenings could be attributed to lack of commitment on part of government at the three levels, federal, state and local governments.
The almost nonexistence of Private health insurance has further compounded the problem. As at the end of 2006 not many health insurance organization were in existence, even the mutual health organizations that were operating in early 1990s are almost in nonexistence today, except a few in Lagos State, e.g. Jas Medical Service in Mushin and Lawanson in surulere, Lagos.16 The other contributing factor and probably the most crucial for now is the lack of savings for Health (or illness) by households. It could be said that two factors are responsible for the failure to save for health. First, the high level of poverty in the country, where 60% of its citizens live below poverty line and secondly, there is significant level of lack of awareness among Nigerians and it’s households that they and the community could come together and save for their health care and thereby minimize the ugly, incessant and unnecessary incidence of catastrophic expenditure on health care and its impoverishment.
1.4 Aim and Objectives of Study
The aim of the study is to determine the level and frequency of poverty incidence on health care among households in Keffi. In achieving this aim, the following specific objectives were laid out as follows:
- To quantify the proportion of household income spent on health care;
- To determine the source of household financing for health care; and
- To measure the perception of household on the best method of payment for health care services.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Does poverty incidence significantly affect household access to health care?
- What is the source of household financing for health care?
- What is the proportion of household income spent on health care?
- What is the perception of household on the best method of payment for health care services?
1.6 Justification of Study
Out-of-pocket payment for health care by households has been estimated by several studies and estimations to have contributed between 64 and 70 percent of health care financing in Nigeria and has largely contributed to the inability of households to access adequate and desirable health care be it in the public or private1. This unfortunate situation has not only contributed to the high morbidity and mortality but has also impoverished many households.
The National Health Insurance Scheme (NHIS) introduced to alleviate this high out-ofpocket expenditure on health is still not accessible by majority of those in the informal sector and the probability of reaching these sets of Nigerians in the nearest feature seems more of mirage than reality. It is in view of the urgent need to finding solution(s) to these challenges that calls for the necessity for an alternative, at least for now. Community Health Organization (CHO) and other forms of health insurance that are almost in nonexistence need to be explored with the aim of establishing a less-burdensome health care payment mechanism for households in Keffi.
1.7 Scope of the Study
The scope of this research is focused on the Effect of Poverty and Access to Health Care in Keffi Local Government Area of Nasarawa State.
1.8 Limitations of the Study
The absence of proper house numbering, inadequate ward and district population figures, made the sampling method rather cumbersome. Some findings of test statistics could not be subjected to test of statistical significance because of multiple roles and columns. Inadequate fund was also a limiting factor as it was the major reason the study could not cover more than a town in the state.
