Economics
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Item Health expenditure and child health outcomes in Sub-Saharan Africa(Porthologos Press, 2017-06) Novignon, J. N.; Lawanson, A. O.This study sought to understand the relationship between child health outcomes and health spending while investigating lagged effects. The study employed panel data from 45 Sub-Saharan African countries between 1995 and 2011 obtained from the World Bank’s World Development Indicators. Fixed and Random effect models were estimated. Under-five, infant and neonatal mortality were used as child health outcomes while total health spending. The effects of one and two period lags of expenditure were estimated. The results show a positive and significant relationship between health expenditure and child health outcomes with elasticities of -0.11 for infant mortality, -0.15 (under-five mortality) and -0.-8 (ne0natal mortality). Public health expenditure. Positive and significant lagged effects were also estimated between health expenditure and child health. The findings suggests that, while health expenditure is crucial for the improvement of child health, it is equally important for this expenditure to be sustainable as it has delayed effects.Item Inequity in healthcare utilization: analysis of the Nigeria situation(Center for Promoting Ideas (CPI), USA, 2016-05) Lawanson, A. O.; Opeloyeru, O. S.This paper analysis the extent of inequity in the utilization of healthcare services in Nigeria, and the determinants of healthcare utilization inequity. Applying the concept of horizontal inequity, the paper used the Nigeria Living Standard Survey (NLSS) 2010 data set to investigate the disproportionality in healthcare utilization. The result shows that inequity in utilization of healthcare in the country is generally skewed against the poor, as the analysis established evidence about the poor with similar medical needs as the rich having access to lesser healthcare service. The observed inequality in utilization of healthcare is mainly driven by the differences in health expenditure, residence location (rural or urban), and morbidity rate. The utilization rate of healthcare services is found to be positively related to household expenditure It is recommended that government should intensify greater equity measure to guarantee healthcare to all with minimal discrimination. While the private facilities may not be attracted to rural area, due to weak patronage arising from the poor economic fortune of the people, government will be in better position to argument and fill the deficiency gap in the rural area. Utilization of healthcare services, especially by rural dwellers can be promoted by establishing more health facilities in the rural areas.Item Efficiency of health systems in Sub-Sahara Africa: a comparative analysis of time varying stochastic frontier models(2016-06) Lawanson, A. O.; Novignon, J.The purpose of the current study was to estimate efficiency of health systems in sub-Sahara Africa (SSA) and to compare efficiency estimates from various time-varying frontier models. The study used data for 45 countries in SSA from 2005 to 2011 sourced from the Word Bank World Development Indicators. Parametric time varying stochastic frontier models were used in the analysis. Infant survival rate was used as the outcome variable, while per-capita health expenditure was used as main controllable input. The results show some variations in efficiency estimates among the various models. Estimates from the ‘true’ random effect model were however preferable after controlling for unobserved heterogeneity which was captured in the inefficiency terms of the other frontier models. The results also suggest a wide variation in the efficiency of health systems in sub-Sahara Africa. On average health system efficiency was estimated to be approximately 0.80 which implies resource wastage of about 0.20. Cape Verde, Mauritius and Tanzania were estimated to be relatively efficient while Angola, Equatorial Guinea and Sierra Leone were among the least performers in terms of health system efficiency. The findings suggest that the omission of unobserved heterogeneity may lead to bias in estimated inefficiency. The ‘true’ random effect model was identified to address the problem of unobserved heterogeneity. The findings also suggest a generally poor performance of health systems in terms of efficiency in the use of resources. While resource commitment to the health sector is critical, it is important to also ensure the efficient use of these resources. Improving the performance of institutions in the health sector may go a long way in improving the general health status of the African population.Item Health expenditure and health status in Northern and Southern Nigeria: a comparative analysis using National Health Account Framework(African Health Economics and Policy Association (AfHEA), 2013) Lawanson, A. O.; Olaniyan, O.Introduction: The financing of healthcare by government in Nigeria is complemented by contributions from the household, donor agencies, and the private sector. This paper examines the disparity in healthcare financing flows between the northern and southern regions of Nigeria and the implication for health outcomes. Methods: The paper uses data from the latest round of Sub-National Health Accounts for 17 states in Nigeria, from 2003 to 2005. The methodology was structured to give a complete accounting of all spending on health, regardless of the origin, destination, or object of the expenditure. Results: The paper found that healthcare financing in the north is relatively lower, accompanied by significant poor health status, with heavy dependence on the households in both regions. The share of households in the north was proportionally disproportionate, because of the high poverty incidence vis-a-vis public providers. This raises equity concerns as those least able to pay were made to bear more burden. Conclusion: The stewardship role of the government has to increase in terms of funding health care, in the light of low income of majority of the people, especially in the north, if the health status of the populace is to improve. Without government being directly involved in the provision of healthcare services, attempt should be made to subsidise the private sector health services to the citizenry. The pooling mechanism approach is identified to be an appealing alternative to finance healthcare.Item National health accounts estimation: lesson from the Nigerian experience(2012-12) Lawanson, A. O.; Olaniyan, O.; Soyibo, A.Objective: This paper seeks to summarize the estimation of two rounds of Nigeria’s National Health Accounts (NHA), 1998-2002 and 2003-2005 and draw some lessons on the NHA methodology and health financing policy challenges towards enhancing government stewardship role in the health sector. Method: The paper uses the results of the two rounds of NHA estimations for Nigeria as basis for analysis. In each round of estimation, three matrices were estimated. Additional three matrices of sub-National Health Accounts were also estimated for 17states in the second round. Results: With Nigeria’s per capital Total Health Expenditure (THE) increasing from US$9.39 in 1998 to US$55,04 in 2005, the THE represent about 5% of GDP. The households accounted for around 68.6% of THE, while government shoulders about 25%. Major lessons learnt relate to skewed spending, challenges of record-keeping and data collection at the federal and state levels, and commitment of government and other stakeholders in ensuring institutionalized procedures for collection, reporting, and retrieval of health financing data. Conclusion: Though NHA results indicate increase in spending on health over time, there is a very high burden on households. Besides, there are institutional challenges inhibiting the estimation process. There is need for government to lessen burden on households to improve its stewardship by increasing its contribution. The institutional capacity need to be strengthen to collect and analyse health expenditure data and interpret results in terms of their policy implication, while government takes ownership of the process to ensure the institutionalization and sustainability of the estimation process.