Critical review of healthcare financing and a survey of system quality perception among healthcare users in Nigeria (2010–2023)

Nigeria aims to enhance its healthcare quality index score of 84th out of 110 countries and its Sustainable Development Goals Index ranking of 146th out of 166. Due to increased population, disease burden, and patient awareness, healthcare demand is rising, putting pressure on funding and quality assurance. The Nigerian healthcare financing and its impacts are complex; this study gives insights into the trends. This questionnaire-based cross-sectional survey (conducted from June to August 2023) and 2010-2023 health budget analysis examined healthcare finance patterns and user attitudes (utilisation, preference and quality perceptions) in Nigeria. Data from government health budgets and a stratified random sample of 2,212 from nine states, obtained from the socioculturally diverse 237 million population, were analysed with a focus on trends, proportions, frequency distributions, and tests of association. Results show that the average rating of healthcare experiences did not vary significantly over the last decade. Healthcare system quality was rated mainly poor or very poor; structure (74.09%), services (61.66%), and cost (60.89%). While 87.36% used government healthcare facilities, 85.00% paid out-of-pocket, and 72.60% of them were dissatisfied with the value for money. Despite a preference for government facilities (71.43%), respondents cited high costs (62.75%), poor funding (85.65%), inadequate staffing (90.73%), and lack of essential medicines (88.47%) as major challenges. The budget analysis reveals an average government healthcare fund allocation of $7.12 compared with an estimated expenditure of $82.75 per person annually. Nigeria allocates only an average of 0.37% of GDP and 4.61% of the national budget to healthcare, comprising a maximum of 13.56% of total health expenditure. This study emphasises the urgent need for policy reforms and implementations to improve Nigeria's healthcare financing and service quality. Targeted interventions are essential to address systemic challenges and meet population needs while aligning with international health services and best standards.

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Publication Details

Journal
PLOS Global Public Health
Published
2025-05-28
DOI
https://doi.org/10.1371/journal.pgph.0004615
Citations
3
Primary Topic
Healthcare Systems and Reforms
Type
article
Field-Weighted Citation Impact
6.62
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article

Critical review of healthcare financing and a survey of system quality perception among healthcare users in Nigeria (2010–2023)

Mercy Emmanuel, France Ncube, Timothy Wale Olaosebikan, Emmanuel Chukwunwike Enebeli et al.
3 citations
PLOS Global Public Health
Healthcare Systems and Reforms
6.62
article

Critical review of healthcare financing and a survey of system quality perception among healthcare users in Nigeria (2010–2023)

Mercy Emmanuel, France Ncube, Timothy Wale Olaosebikan, Emmanuel Chukwunwike Enebeli, Israel Opeyemi Fawole, Muhammad Baqir Shittu, Marios Kantaris, Joshua Okonkwo, Ufuomaoghene Jemima Mukoro, Blessing Osagumwendia Josiah, Oluwadamilare Akingbade, Prisca Olabisi Adejumo, Ndidi Louis Otoboyor, Joy Chioma Obialor, Blessing Onyinye Obialor, Gloria Oluwakorede Alao, Brontie Albertha Duncan, A.A. Adebayo, Oghosa Gabriel Josiah, Blessing Chiamaka Nganwuchu, Lordsfavour Uzoma Anukam, Chinelo Cleopatra Josiah, Kelechi Eric Alimele, Oyinye Prosper Martins-Ifeanyi, Busiroh Mobolape Ibraheem, Ubiebo Ataisi Ekenekot, Mudiaga Sidney Edafiejire, Solomon Oluwaseun Olukoya, Siyouneh Baghdasarian, Precious Ebinehita Imoyera, Ajao Adewale Gbolabo, Olukayode Joseph Oladimeji
article en
3 citations

Abstract

Nigeria aims to enhance its healthcare quality index score of 84th out of 110 countries and its Sustainable Development Goals Index ranking of 146th out of 166. Due to increased population, disease burden, and patient awareness, healthcare demand is rising, putting pressure on funding and quality assurance. The Nigerian healthcare financing and its impacts are complex; this study gives insights into the trends. This questionnaire-based cross-sectional survey (conducted from June to August 2023) and 2010-2023 health budget analysis examined healthcare finance patterns and user attitudes (utilisation, preference and quality perceptions) in Nigeria. Data from government health budgets and a stratified random sample of 2,212 from nine states, obtained from the socioculturally diverse 237 million population, were analysed with a focus on trends, proportions, frequency distributions, and tests of association. Results show that the average rating of healthcare experiences did not vary significantly over the last decade. Healthcare system quality was rated mainly poor or very poor; structure (74.09%), services (61.66%), and cost (60.89%). While 87.36% used government healthcare facilities, 85.00% paid out-of-pocket, and 72.60% of them were dissatisfied with the value for money. Despite a preference for government facilities (71.43%), respondents cited high costs (62.75%), poor funding (85.65%), inadequate staffing (90.73%), and lack of essential medicines (88.47%) as major challenges. The budget analysis reveals an average government healthcare fund allocation of $7.12 compared with an estimated expenditure of $82.75 per person annually. Nigeria allocates only an average of 0.37% of GDP and 4.61% of the national budget to healthcare, comprising a maximum of 13.56% of total health expenditure. This study emphasises the urgent need for policy reforms and implementations to improve Nigeria's healthcare financing and service quality. Targeted interventions are essential to address systemic challenges and meet population needs while aligning with international health services and best standards.

PLOS Global Public HealthVol. 5(5)
Abia State University (NG), Queen's University Belfast (GB), Ahmadu Bello University (NG), University of Ilorin (NG), University of Zimbabwe (ZW), University of Jos (NG), University of Ibadan (NG), Queen Margaret University (GB), Delta State University (NG), Joseph Ayo Babalola University (NG), Leeds Teaching Hospitals NHS Trust (GB), Delta State Polytechnic Ogwashi-Uku (NG), Scripps Mercy Hospital (US), Windsor University School of Medicine (KN), Ross University School of Veterinary Medicine (KN), Institute of Health Services and Policy Research (CA), University of Zimbabwe-University of California San Francisco (ZW), RED Consulting (Norway) (NO), Irrua Specialist Teaching Hospital (NG), Federal Institute of Industrial Research Oshodi (NG), Anchor University Lagos, Ladoke Akintola University of Technology (NG), National Open University of Nigeria (NG), University of Sunderland (GB), University of Benin (NG), Lead City University (NG), Delta State University (US), Rivers State University (NG)
Openalex Percentile: Top 4%
Healthcare Systems and Reforms
6.62
DOIOpen Access PDFOpenAlex
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