How Nigerian households with non-communicable diseases combine coping strategies during health shocks: evidence from the Nigeria Living Standards Survey (2018–2019)

Introduction Health shocks, sudden serious illness, disability, or death of income-earning members, threaten household welfare in developing countries. This study examines how Nigerian households with non-communicable diseases (NCDs) combine coping strategies in response to health shocks, thereby addressing gaps in understanding multi-strategy decision-making processes.Theory We employ a two-hurdle decision-making framework, where households first decide whether to engage in active coping and then determine the strategy combinations. The political economy perspective frames how healthcare financing systems and social protection infrastructure shape vulnerability and coping capacity.Method Using the 2018/2019 Nigeria Living Standards Survey data, we analysed 2,568 households through double-hurdle extended regression models, addressing endogeneity. We examined 10 active coping strategies, applying community-clustered standard errors and multiple robustness checks.Results The results indicate that 68.65% of participants employed coping strategies, with 51.48% utilising multiple strategies. NCD-affected households used more strategies (3.65 vs. 3.29) and were 8% more likely to participate and 20% more likely to use multiple strategies, most of which were maladaptive. Common strategies included reducing food consumption (61%), informal assistance (57.8%), and reducing non-food consumption (52.3%). Credit access increased participation (26%) and strategy count (53%); health insurance reduced participation (12%). Socioeconomic disparities were substantial, with Southern zones exhibiting 21%–25% higher participation rates, and the poorest households being 42% less likely to employ multiple strategies.Discussion The findings reveal a heightened vulnerability of NCD-affected households because of the limited availability of formal support. We recommend conditional cash transfers, subsidised insurance, targeted interventions, including employment-based health benefits, for NCD-affected households.