An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

Introduction

The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states.

Methods

We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state.

Results

We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano.

Discussion

Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

OUP accepted manuscript

Objectives

Methods

Results

Conclusions

Determinants of immunisation coverage among children in Mathare Valley, Nairobi

OBJECTIVE

To establish the factors that determine the levels of immunisation coverage among children under five years in Mathare Valley.

DESIGN

A cross-sectional study describing the situation at a point in time.

SETTING

Mathare Valley slum with a population of 50,000 people in the city of Nairobi.

SUBJECTS

The study population was mothers with children under five years in Mathare Valley and had been resident there for a period not less than five years prior to the study.

OUTCOME MEASURES

Level of immunisation coverage among children in the study population and the factors that contribute to the low immunisation coverage.

RESULTS

Knowledge on immunisation was high with 90% of the respondents able to define immunisation. The attitude on immunisation was positive (74.4%) and immunisation coverage stood at 62.2%. Age, level of education, attitude and knowledge on immunisation among the residents were significant determinants of immunisation coverage.

CONCLUSION

Immunisation coverage was lower than the national average in Mathare Valley. Advanced mother's age, low level of education and relative lack of knowledge on immunisation were responsible for the low coverage.