Trends in Government Healthcare Budgets in Delta State, Nigeria, from 2018 to 2024: Implications for Universal Health Coverage
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Abstract
Background: Effective healthcare financing is crucial for Universal Health Coverage (UHC). Delta State's UHC efforts face funding and allocation challenges. This study analyses its healthcare budgeting from 2018 to 2024.
Methods: It is a mixed-methods analysis of Delta State’s healthcare budget from 2018 to 2024, combined with extracts from a rapid qualitative assessment of residents' perceptions of executed healthcare projects and programmes relevant to UHC and SDG-3.
Results: The healthcare budget increased by 152%, from ₦18.96 billion (2018) to ₦47.84 billion (2024), but remained below 5% of the state’s GDP of ₦4.05 – ₦4.87 trillion. It was less than 10% of the state's budget, peaking at 9.13% in 2020, below Abuja Declaration's 15% target. Personnel costs dominated the budget, capital expenditure rose post-2020, and overhead costs remained under 5%. Investment in the Delta State Contributory Health Commission dropped by 83%, while COVID-19 funding spiked to ₦2 billion in 2020. Infrastructure and equipment constituted most capital expenditure, peaking at 89.78% of the Total Health Expenditure in 2023. Overhead expenses varied, with hospitals seeing a 2,047% increase from ₦45 million in 2018 to ₦971 million in 2024. There was a focus on infrastructure and emergency responses, particularly during COVID-19, but these were not matched with sustainable funding strategies. Residents largely reported poor infrastructure and a lack of visible healthcare projects and interventions, indicating gaps between policy intent and community experience.
Conclusion: To achieve UHC and health equity, Delta State must commit to increased and sustained healthcare financing, equitable resource distribution, and enhanced administration.
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References
1. Kodali PB. Achieving Universal Health Coverage in Low- and Middle-Income Countries: Challenges for Policy Post-Pandemic and Beyond. Risk Manag Healthc Policy. 2023;16:607–21. https://doi.org/10.2147/RMHP.S366759
2.World Health Organization. Health financing [Internet]. Geneva: World Health Organization; 2023 [cited 2023 Sep 15]. Available from: https://www.who.int/health-topics/health-financing
3.Agrawal S, Chauhan G, Galhotra A, Goel S. Five Years of National Health Policy in India: Critical Analysis of the Public Health Expenditure from 2017 to 2022 and Way Forward. Indian J Community Med. 2024. https://doi.org/10.4103/ijcm.ijcm_823_22
4.Reeves A, Gourtsoyannis Y, Basu S, McCoy D, McKee M, Stuckler D. Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. Lancet. 2015;386(9990):274–80. https://doi.org/10.1016/S0140-6736(15)60574-8
5.Dieleman JL, Sadat N, Chang AY, Fullman N, Abbafati C, Acharya P, et al. Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40. Lancet. 2018;391(10132):1783–98. https://doi.org/10.1016/S0140-6736(18)30697-4
6.Mathauer I, Vinyals Torres L, Kutzin J, Jakab M, Hanson K. Pooling financial resources for universal health coverage: options for reform. Bull World Health Organ [Internet]. 2020 [cited 2025 Apr 11];98(2):132–39. https://doi.org/10.2471/BLT.19.234153
7.Patcharanarumol W, Panichkriangkrai W, Sommanuttaweechai A, Hanson K, Wanwong Y, Tangcharoensathien V. Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand. PLoS ONE [Internet]. 2018 [cited 2025 Apr 11];13(4):e0195179. https://doi.org/10.1371/journal.pone.0195179
8.Buchmueller TC, Levy HG. The ACA’s Impact on Racial and Ethnic Disparities in Health Insurance Coverage and Access to Care. Health Aff (Millwood). 2020;39(3):395–402. https://doi.org/10.1377/hlthaff.2019.01394
9.Ofosu-Amaah S. Reflections on the health budget. A preliminary analysis of the 1974/75 Ministry of Health budget. Ghana Med J. 1975;14(3):215–22. Available from: https://pubmed.ncbi.nlm.nih.gov/1234684/
10.Oxford Policy Management. Financing for Universal Health Coverage in low- and middle-income countries: a brief overview [Internet]. Oxford: Oxford Policy Management; 2016 [cited 2025 Mar 31]. 8 p. Available from: https://www.opml.co.uk/files/Publications/corporate-publications/working-papers/wp-financing-universal-health-coverage.pdf1
11.Ejughemre UJ. Out of pocket spending for healthcare services: a study assessing the relationship between payment methods and perceived satisfaction with the quality of care in a tertiary health facility in Delta State, Nigeria. J Community Med Prim Health Care. 2016;27(1):27–36. https://doi.org/10.4314/jcmphc.v27i1
12.Onwujekwe O, Ezumah N, Mbachu C, Obi F, Ichoku H, Uzochukwu B, et al. Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen? BMC Health Serv Res [Internet]. 2019 [cited 2023 Feb 11];19:661. https://doi.org/10.1186/s12913-019-4512-4
13.Ejughemre UJ, Ivrogbo S. User-Fees in Health Services: Assessing how it Impacts on Access, Utilization and Quality of Care in a Tertiary Health Facility in Delta State, Nigeria. Am J Public Health Res [Internet]. 2014 [cited 2023 Oct 6];2(4):119–24. https://doi.org/10.12691/ajphr-2-4-1
14.Owhojedo EE, Awuno ES, Enemuwe IM, Oyibo PG, Tettehfio P. Utilization of the Delta State contributory health scheme among teachers in government secondary schools in Delta-south senatorial district, Delta state, Nigeria. Kabale Univ Interdiscip Res J [Internet]. 2023 [cited 2023 Nov 25];2(2):127–40. https://kurj.kab.ac.ug/index.php/1/article/view/84
15.Egonu JI, Ilo IC. Utilization of National Health Insurance Scheme Among Healthcare Professionals in Federal Medical Centre Asaba Delta State. Int J Public Health Pharmacol. 2023;3(2):1–14. https://doi.org/10.52589/IJPHP-ME1YTRTC
16.Eze SU. Exploring the Knowledge, Attitude and Practice of Covid-19 Vaccination and Associated Factors in Relation to Covid-19 Vaccine Uptake among Residents of Abakaliki Metropolis in Ebonyi State, Nigeria. Texila Int J Public Health [Internet]. 2024 [cited 2024 Aug 17];12(2). https://doi.org/10.21522/TIJPH.2013.12.02.Art006
17.Antohi VM, Ionescu RV, Zlati ML, et al. Approaches to Health Efficiency across the European Space through the Lens of the Health Budget Effort. Int J Environ Res Public Health. 2022;19(5):3063. https://doi.org/10.3390/ijerph19053063
18.Fraser‐Hurt N, Hou X, Wilkinson T, et al. Using allocative efficiency analysis to inform health benefits package design for progressing towards Universal Health Coverage: Proof-of-concept studies in countries seeking decision support. PLoS ONE. 2021;16(11):e0260247. https://doi.org/10.1371/journal.pone.0260247
19.Okumagba PO. Family Support for the Elderly in Delta State of Nigeria. Stud Home Comm Sci [Internet]. 2011 [cited 2023 Nov 25];5(1):21–7. https://doi.org/10.1080/09737189.2011.11885325
20.Onotai LO. A Review of the Appropriateness of User Fees and Social Health Insurance to Fund the Health Care Systems in Low and Middle-Income Countries. Niger Health J [Internet]. 2008 [cited 2025 Apr 11];8(1-2):1. https://doi.org/10.60787/tnhj.v8i1-2.4
21.Alfred E, Akpata GO, Akintoye AE. Health Care Financing in Nigeria: An Assessment of the National Health Insurance Scheme (NHIS). Eur J Bus Manag [Internet]. 2016 [cited 2025 Mar 31];8(27):24–34. Available from: https://www.iiste.org/Journals/index.php/EJBM/article/view/33191
22.Efe I. Health care problem and management in Nigeria. J Geogr Reg Plann [Internet]. 2013 [cited 2025 Feb 17];6(9):244–54. https://doi.org/10.5897/JGRP2013.036623
23.Ranabhat CL, Jakovljevic 4M, Ki5m C-B, Simkhada P. COVID-19 Pandemic: An Opportunity for Universal Health Coverage. Front Public Health. 2021;9:673542. https://doi.org/10.3389/fpubh.2021.673542
24.Kigozi E. Application of Mixed Methods Approach in Studies on Quality Assurance in Educational Institutions: A Systematic Review of Literature from 2005-2019. Int J Inf Bus Manag [Internet]. 2020 [cited 2024 Mar 1];6(4):396–410. https://doi.org/10.20533/ijibs.2046.3626.2020.0051
25.Leal I, Engebretson J, Cohen L, Fernandez-Esquer ME, Lopez G, Wangyal T, et al. An Exploration of the Effects of Tibetan Yoga on Patients’ Psychological Well-Being and Experience of Lymphoma: An Experimental Embedded Mixed Methods Study. J Mix Methods Res [Internet]. 2018 [cited 2025 Apr 2];12(1):31–54. https://doi.org/10.1177/1558689816645005
26.City Population. Delta (State, Nigeria) - Population Statistics, Charts, Map and Location [Internet]. 2022 [cited 2023 Apr 24]. Available from: https://citypopulation.de/en/nigeria/admin/NGA010__delta/
27.Delta State Investment Development Agency (DIDA). Areas of Investment Opportunities [Internet]. Delta State; 2024 [cited 2024 Dec 28]. Available from: https://dida.deltastate.gov.ng/areas-of-investment-opportunities/
28.Delta State Government. Delta State Debt Sustainability Analysis Report [Internet]. Delta State, Nigeria; 2023 [cited 2024 Dec 27]. Available from: https://deltastate.gov.ng/wp-content/uploads/2023/12/DSA-DMS-REPORT-2023-FORWARDED.pdf
29.Exchange Rates UK. US Dollar to Nigerian Naira Spot Exchange Rates for 2024 [Internet]. 2024 [cited 2024 Dec 30]. Available from: https://www.exchangerates.org.uk/USD-NGN-spot-exchange-rates-history-2024.html
30.World Bank. Asia and the Pacific Health Financing Forum: Financing Primary Health Care [Internet]. Washington, DC: World Bank; 2022 [cited 2023 Dec 2]. Available from: https://www.worldbank.org/en/events/2022/09/15/financing-primary-health-care-opportunities-at-the-boundaries
31.OECD. Health Expenditure [Internet]. Paris: OECD; 2023 [cited 2023 Dec 2]. Available from: https://www.oecd.org/els/health-systems/health-expenditure.htm
32.Madu AC, Osborne K. Healthcare Financing in Nigeria: A Policy Review. Int J Soc Determinants Health Health Serv. 2023;53(4):434–43. https://doi.org/10.1177/27551938231173611
33.Ogbodo OC. Trends and Challenges of Health Care Financing in Nigeria. Int J Multidiscip Res Rev. 2023;2(1):1–9. https://doi.org/10.59657/2837-8172.brs.23.030
34.Anselmi L, Lagarde M, Hanson K. Equity in the allocation of public sector financial resources in low- and middle-income countries: a systematic literature review. Health Policy Plan [Internet]. 2015 [cited 2025 Feb 19];30(4):528–45. https://doi.org/10.1093/heapol/czu034
35.Naseri S, Safi N, Sidhu LS, et al. Analysis of human resources for health in Afghanistan. East Mediterr Health J [Internet]. 2023 [cited 2025 Feb 19];29(1):11–20. https://doi.org/10.26719/emhj.23.031
36.Seixas BV, Dionne F, Mitton C. Practices of decision making in priority setting and resource allocation: a scoping review and narrative synthesis of existing frameworks. Health Econ Rev [Internet]. 2021 [cited 2025 Feb 20];11:2. https://doi.org/10.1186/s13561-020-00300-0
37.World Health Organization. Global Health Expenditure Database [Internet]. 2024 [cited 2025 Feb 21]. Available from: https://apps.who.int/nha/database
38.Kutzin J. Health financing for universal coverage and health system performance: concepts and implications for policy. Bull World Health Organ. 2013;91(8):602–11. https://doi.org/10.2471/BLT.12.113985
39.Adewole DA, Adebayo AM, Udeh EI, Shaahu VN, Dairo MD. Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria. Am J Trop Med Hyg. 2015;93(3):648–54. https://doi.org/10.4269/ajtmh.14-0245
40.Hansen S, Brandt CJ, Søndergaard J. Beyond the Hype—The Actual Role and Risks of AI in Today’s Medical Practice: Comparative-Approach Study. JMIR AI. 2024;3:e49082. https://doi.org/10.2196/49082
41.Delta State Contributory Health Commission. PharmAccess, DSCHC, Host Access to Finance Impact Evaluation Report Dissemination [Internet]. 2023 [cited 2023 Oct 6]. Available from: https://dschc.org.ng/PharmAccess,%20DSCHC,%20host%20Access%20to%20Finance%20Impact%20Evaluation%20Report%20Dissemination.html
42.Smith E. Foreign investors are gearing up to plug Nigeria’s $82 billion health-care gap [Internet]. CNBC; 2021 [cited 2023 Apr 26]. Available from: https://www.cnbc.com/2021/01/04/nigerias-82-billion-health-care-gap-investors-stand-by.html
43.Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3
44.Delta State Contributory Health Commission (DSCHC) [Internet]. 2024 [cited 2025 Feb 21]. Available from: https://dschc.org.ng/
45.Economics By Design. Health Financing Explained: Risk Pooling [Internet]. 2022 [cited 2024 Dec 30]. Available from: https://www.economicsbydesign.com/health-financing-risk-pooling/
46.Juma PM, Kihara A. Determinants of Efficient Healthcare Service Delivery Among Public Hospitals in Kenya: A Case of Makueni County Referral Hospital. J Bus Strategic Manag. 2023;8(5):83–107. https://doi.org/10.47941/jbsm.1566
47.Kumar P. Challenges in Healthcare Delivery in Sant Kabir Nagar District: In the View of Healthcare Infrastructure and Healthcare Workforce. Res Hub Int Multidiscip Res J. 2024;11(2):19–26. https://doi.org/10.53573/rhimrj.2024.v11n2.003
48.Obuaku-Igwe CC. Essential medicines in Nigeria: foregrounding access to affordable essential medicines. Afr Sociol Rev [Internet]. 2014 [cited 2023 Oct 12];18(2):42–60. Available from: http://www.codesria.org/spip.php?article2507
49.Bigdeli M, Shroff ZC, Godin I, Ghaffar A. Health systems research on access to medicines: unpacking challenges in implementing policies in the face of the epidemiological transition. BMJ Glob Health. 2018;2(Suppl 3):e000941. https://doi.org/10.1136/bmjgh-2018-000941
50.Mustafa A, Yasmeen A. Access to Medicine. Int J Pharm Int Health Sci. 2022;3(2):118–21. https://doi.org/10.56536/ijpihs.v3i2.34
51.Collins C, Green A, Hunter D. Health sector reform and the interpretation of policy context. Health Policy. 1999;47(1):69–83. https://doi.org/10.1016/S0168-8510(99)00003-2
52.Douthit NT, Alemu HK. Social determinants of health: poverty, national infrastructure and investment. BMJ Case Rep. 2016;2016:bcr2016215670. https://doi.org/10.1136/bcr-2016-215670
53.World Health Organization. Integrated Health Services—What and Why? [Internet]. Geneva: World Health Organization; 2008 [cited 2024 Dec 30]. Report No. 1. Available from: https://terrance.who.int/mediacentre/data/sage/SAGE_Docs_Ppt_Apr2014/10_session_child_health_services/Apr2014_session10_integrated_health_services.pdf
54.UNICEF. SDG Goal 3: Good Health and Well-being [Internet]. UNICEF DATA; 2015 [cited 2023 Sep 10]. Available from: https://data.unicef.org/sdgs/goal-3-good-health-wellbeing/
55.World Bank, World Health Organization, et al. UHC in Africa: A Framework for Action [Internet]. Washington, DC: International Bank for Reconstruction and Development; 2016 [cited 2024 Dec 30]. 60 p. Available from: https://documents1.worldbank.org/curated/en/735071472096342073/pdf/108008-v1-REVISED-PUBLIC-Main-report-TICAD-UHC-Framework-FINAL.pdf
56.Thomas S, Sagan A, Larkin J, et al. Strengthening health systems resilience: Key concepts and strategies [Internet]. Copenhagen: European Observatory on Health Systems and Policies; 2020 [cited 2024 Dec 30]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559803/
57.GOV.UK. Health systems strengthening for global health security and universal health coverage: FCDO position paper [Internet]. London: GOV.UK; 2021 [cited 2024 Dec 30]. Available from: https://www.gov.uk/government/publications/health-systems-strengthening-for-global-health-security-and-universal-health-coverage/
58.World Health Organization. Health Systems Resilience [Internet]. 2024 [cited 2024 Dec 30]. Available from: https://www.who.int/teams/primary-health-care/health-systems-resilience
59.Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260(12):1743–48. https://doi.org/10.1001/jama.260.12.1743
60.World Health Organization. What are the overall principles of HBP design [Internet]. 2021 [cited 2025 Apr 13]. Available from: https://www.who.int/teams/health-financing-and-economics/economic-analysis/health-technology-assessment-and-benefit-package-design/
61. Osakede UA. Public health spending and health outcome in Nigeria: the role of governance. Int J Dev Issues [Internet]. 2021 [cited 2025 Feb 26];20(1):95–112. https://doi.org/10.1108/IJDI-10-2019-0169