Desktop versionMobile version
OpenEdition Books

IFRA Special Research Issue Vol. 1

Demand for modern health care services and the incidence of poverty in Nigeria: a case study of Ilorin Metropolis

Gafar .T. Ijaiya and Raji A. Bello

Abstract

This paper examines the impact of poverty on the demand for modem health care services in llorin metropolis, the study, carried out using a structural questionnaire to 510 heads of households, reported that 349 of them are poor, based on these samples, the ability of the heads of households to seek modem health care service was also examined, the data were analyzed by multiple linear regression, the regression results show that the incidence of poverty in llorin metropolis is inversely related to the demand for modem health care services, this indicates that the poorer the people, the less they are able to demand for modem health care services when they are sick, the paper further suggests measures that will enable the poor in llorin metropolis to have access to modem health care services prominent among them are the provision of subsidies by the government and greater commitment in the delivery of modem health care services.

Author's note

Note portant sur l’auteur1

Full text

Introduction

1The lack of adequate health care services and the inability of individuals within a given society to acquire modem health care services at affordable rates have led to the deterioration of the health status of individuals, in Nigeria, it is common to see health institutions with no drugs and with dilapidated structures, the dwindling income and purchasing power of individuals, coupled with the high cost of drugs and of treatment, combined to keep health care services out of the reach of many, the effects are high infant and maternai mortality, increase in the death rate, reduction of life expectancy and of the productive capacity of the people, absenteeism at work, low output, low income, and poverty, for instance, an infant mortality rate of 81 per 1000 live births was recorded in 2001, while the maternai mortality rate was 1000 per 100,000 live births in the same year, an under-fïve mortality rate of about 133 per 100,000 live births and life expectancy at birth of about 52 years were also registered (ADB 2003).

2To what extent are the above findings true with respect to the situation in llorin metropolis? This paper examines the link between the demands for modem health care services and the incidence of poverty in llorin metropolis, [using the probability of patronage by the sick to any modem health care centre].

3In the next section of the paper, a conceptual overview of poverty and the demand for modem health care services are discussed, section three provides a brief background of the study area and the methodology, section four presents and discusses the results, the conclusion and recommendations are contained in the last section.

Conceptual Issues: Poverty and The Demand For Modem Health Care Services

4Poverty: Definition, Measurement, Causes and Consequences

5According to Narayan (2000), poverty is lack of material well-being, insecurity, social isolation, psychological distress, lack of freedom of choice and action, unpredictability, lack of long-term planning horizons, because the poor are continually trying to survive in the present, low self-confidence and self-esteem.

6Schubert (1994) saw poverty as either absolute or relative or both, absolute poverty is the kind which is true at all times in all societies, for instance, there is a minimum level of income necessary for bare subsistence, relative poverty relates to the living standard of the poor to the standards that prevail elsewhere in the society in which they live.

7Related to the definition of poverty are the measurements of poverty, according to Foster, et, al (1984) the most frequently used measurements are: (i) the head count poverty index, given by the percentage of the population that live in a household with a consumption percapita less than the poverty line; (ii) the poverty gap index, which reflects the depth of poverty by taking into account how far the average poor person’s income is from the poverty line; and (iii) the distributionally sensitive measure of squared poverty gap, defined as the means of the squared proportionate poverty gap w hich reflects the severity of poverty.

  • 1 The World Bank provides $1 and $2 per day per person for eore poor and moderate poor respectively, (...)

8The importance of the measurement of poverty is to know who is poor. how many people are poor, and where the poor are located, levy (1991) stresses that in measuring poverty two tasks have to be taken into consideration: (i) a poverty line must be determined, this is set at $275 and $370 per person a year for the extremely poor and for the moderately poor, respectively;1 and (ii) the poverty levels of individuals have to be aggregated, to determine the poverty line, two methods are employed: (a) the use of nutritional intake. which is set at 2°500 calories per head per day: Recently the use of income as a basis for determining the poverty line has lost much of its relevance, because the method of calculation was not adapted to the new economic trends resulting from a high rate of inflation, the prevailing high increase in interest and exchange rates and devaluation, thus the use of consumption-expenditure is now advocated, according to Aigbokhan (1997) total consumption-expenditure is preferred to income because it is usually better reported in household budget surveys, furthermore, there is the important theoretical consideration that expenditure reflects better the long-term permanent income and life cycle consumption pattern because it is usually stable and devoid of short-term fluctuations, moreover, if expenditure data are used for welfare analysis, there is a compelling advantage: the poverty line can be derived from the data and need not be adopted from other surveys.

9Recent studies by the UNDP advocate the use of the Human Development Index (HDI) and Capability Poverty Measure (CPM), according to the UNDP (1998) HDI combines three components in the measure of poverty, these include: life expectancy at birth (longevity); educational attainment; and improvement in the standard of living, determined by per capita income, the first relates to survival-vulnerability to death at a relatively early age, the second relates to know ledge-being included or excluded from the world of reading and communication, the third relates to a decent living standard in terms of overall economic provisioning, on the other hand, CPM focuses on the average state of peoples’ capabilities by reflecting on the percentage of people who lack basic or minimally essential human capabilities that are ends in themselves needed to lift one from income poverty and to sustain strong human development.

10According to the World Bank (2001), poverty has various manifestations, including lack of income and productive resources sufficient to ensure sustainable livelihood, hunger and malnutrition, ill health, limited or lack of access to education and other basic services, increased morbidity and mortality from illness, homelessness and an inadequate, unsafe and degraded env ironment, and social discrimination and exclusion, it is also characterized by the lack of participation by the people in decision making in civil, social and cultural activities that affect their lives.

11The causes of poverty can also be viewed from the problems of urbanization, according to Ward (1999) the factors that cause poverty in most urban cities can be linked to the inner urban decay caused by poor urban public facilities because most infrastructure assets have been allowed to run down through lack of maintenance and investment, facilities have broken down because local administrations have had insufficient resources and inadequate skills to maintain them, in addition, many amenities have been unable to cope with the increasing demands being placed on them, it is also observed that the local authorities, over the years, have eut expenditure on infrastructure development and raised tax rates, these policies are counter-productive since these encourage the private firms to migrate; thus reduces employment, it allows the burden of taxes to fall disproportionately on a residential community less free to move, since the capacity (and willingness) of private households to pay the increased levies is minimal, the quality of social services, particularly education and health, has drastically fallen, this places poorer families at a disadvantage and encourages the richer and better educated families to move out or to resort to the private provision of such services.

12Discussing the consequences of poverty, Narayan et al (2000) observed that because of poverty, most households are crumbling. While some households are able to remain intact, many others disintegrate as men, unable to adapt to their failure to earn adequate incomes under harsh economic circumstances have difficulty accepting that women are becoming the main breadwinners, the resuit is often alcoholism and domestic violence visited by men on women and a break-down of the family structure. Women, by contrast, tend to swallow their pride and go out into the streets to do demeaning jobs or anything it takes to put food on the table for their children and husbands.

13Aku et al (1997) also observed that with mass poverty there tends to be a general loss of confidence in constituted authority (thereby generating disrespect and rendering government policies ineffective); political apathy among contending forces; and disillusionment with respect to societal objectives and peoples’ responsibilities towards the attainment of those objectives.

Poverty Trends in Nigeria

14The causes and consequences of poverty discussed above are relevant to the poverty situation in Nigeria, in Nigeria, the incidence of poverty was 28.1 percent in 1980 but increased to 88.0 percent in the year 2002, as indicated in Table 1, this percentage increase represents in absolute terms 86.0 million people out of an estimated population of about 116.4 million people.

15The poverty situation in Nigeria also has a regional variation, for example, within these periods the poverty rate was higher in the northern agro-climatic zone (40 percent) compared with the middle and southern zones (38 percent and 24 percent, respectively) (Francis, et, al 1996; FOS 1999), similarly, Nigeria’s rank in the Human Development Index in the year 2000 remained low (0.452), 148th out of 174 countries (ADB 2003).

Table 1: Estimated Total Population and Rate of Poverty in Nigeria (1980-2002)

Table 1: Estimated Total Population and Rate of Poverty in Nigeria (1980-2002)

Sources: (a) National Population Commission 1993; Central Bank of Nigeria, annual Report and Statement of Account (varions issues) and Federal Office of Statistics Annual Abstract of Statistics (various issues), (b) Computed by the authors front (a) and (c). (c) Federal Office ofStatistics (FOS) (1999) Poverty Profile for Nigeria 1980-1996: Federal Office of Statistics’ National Household Consumer Survey (various issues)

Demand for Modern Health Care Services

16According to the New Book of Knowledge (1980), when a person’s body is well, when his mind is sound and active and he feels in good spirits he is said to be in good health, in other words, health is a state of complete physical, mental and social well-being, the Oxford English Dictionary (1989) defined it as the sound-ness of the body and the condition in which its functions are duly and efficiently discharged.

17Demand for health care services is therefore what people select from the array of possible choices, given their own perception of their health condition and their socio-economic circumstances (Overholt and Saunders 1996), bitran and Mclnnes (1993) saw the demand for a particular type of health care service as the quantity of that service that people are willing to obtain as a function of the characteristics of the individuals (for example, their perception of need, their income, location and insurance coverage) and the characteristics of all the prov iders (for example, price, location, quality).

18Related to the above definitions are the factors that determine the demand for health care, according to Bitran (1994) the main factors that determine the demand for health care serv ices include: illness incidence rate, out-of-pocket price, household income, population size and distribution. He further elaborated that the demand for health care from provider / for each unit of time (Q1) includes the product of two probabilities or proportions as follows: Q1 = H, Prs, Pr1. where: H is the number of people With a health problem for each unit of time (for example, one month), Pr denotes the proportion of people, among those with a health problem, seeking care outside the home, and Pr is the proportion of people who choose prov ider i among those who seek care outside the home, both Pr and Pr are assumed to be the functions of the out-of-pockets price faced by the consumer, the travel distance to the provider i and the consumer’s income. (Pr and Pr are obviously functions of many other variables, such as education, type of health problem, etc.).

19Overholt and Saunders (1996) also observed that the demand for health care services depends on the following factors: (i) the individual’s perception of illness, which depends on other circumstances such as urbanization and schooling, that is, whether a person is literate and what level of education that person has attained are important factors on how an individual perceives illness; (ii) prices and in-comes, indicating that as the price of a service or commodity goes up, purchase and consumption declines, and as the income of the people increases, the goods or services they are able to purchase and consume also increase; and (iii) the quality of the services provided and the influence of competitors. With respect to quality, as it increases, the demand for health care services increases (quality having a positive effect on demand), for competitors, the extent of competition within the health sector can influence relative prices and quality options, for instance, if acompetitor increases its price, two simultaneous effects take place, first fewer people seek care in the market, second, among those seeking care, a smaller proportion chooses the provider that raised its price.

20The World Bank (1993b) reiterates that the individual’s ability to demand for health care depends on his income and his level of schooling, beyond the individual household every society’s health care services are affected by the national income and by that society’s ability to acquire and apply new scientific knowledge, these depend on the level of schooling of the population.

21As an indicator of poverty, the inability of some individuals to demand for health care or to have access to health care has taken its toll on their quality of life, life expectancy and mortality rate, as observed by Narayan (2000), the inability of the poor to have access to health care is not surprising, quite often they do not go for treatment if they are sick because they are usually faced with personal considerations of distance, availability of transportation, time required to travel, fear of death while traveling, and the cost of transportation and treatment, they also have to consider the potential problems at the treatment centres: shortages or lack of drugs, sfaff absenteeism and callousness, and ineffective treatment, all or some of these considerations can combine to act as disincentives in any given situation, and they are amplified by uncertainties at every step.

22The World Bank (1995) provides an empirical instance of where the overall demand for health care (broadly expressed in terms of self-medication and of the frequency of medical care contacts with public and private providers) is somewhat lower among the poor by citing the case of Vietnam, a number of factors are said to be the causes of decline in the demand for health care services in Vietnam, one factor is the deterioration in the quality of government health services resulting from the compression of public expenditures in the late 1980s, large proportions of health facilities have become dilapidated to the point of being unusable for want of equipment and medical supplies, at the same time salaries of health personnel have declined in real terms, leading to low morale and productivity, another factor is the increase in the costs of access to health services as a resuit of the introduction of user fees.

23In Nigeria, the problems of underutilization and under supply of health facilities and personnel have for long undermined the quality of health care services, these problems can be traced to the following: (i) compensation problems, especially in the public sector where wages and salaries are low, consequently, morale and motivation are negatively affected; and (ii) Poor management, weak supervision and unsatisfactory training, poor management is reflected in the creation of numerous categories of health personnel whose functions overlap or are ill defined, large numbers of low-level functionaries and the absence of standard managerial procedures, dw indling income and purchasing power of most people, coupied with the high costs of drugs and treatment, have also put health services out of the reach of many people, most of them poor, the effects of these are high infant and maternai mortality rates and low life expectancy at birth, for instance, in Nigeria the life expectancy at birth in 2001 was 52 years, 20 years less than that of Mauritius (ADB 2003).

Study Area and Methodology

Study Area

24The study area covered some parts of llorin metropolis, llorin metropolis is located some 300 kilometres from Lagos and 500 kilometres from Abuja, the Federal Capital of Nigeria, on latitude North 8° 301 and longitude East 4° 351 of the equator, the city is situated in the transition zone between the forest and savanna regions of Nigeria, currently, the city is the capital of Kwara State of Nigeria and has an estimated population (by the 1991 census Figure) of about 572, 178 people (Adedibu 1988; NPC 1993)

Methodology

Data Source

25In addition to the use of secondary data, a survey aimed at generating primary data on the influence of poverty on the demand for modem health care services in Ilorin metropolis was conducted between the months of August and December 2003 through the adminstration of copies of the questionnaire and participatory assessment method, the questionnaire was structured after the World Bank Living Standards Measurement Study which, among other things, provides a comprehensive measure of welfare and its distribution and describes the pattern of access to and the use of social services, the participatory assessment method was used to obtain information from key members of the household on their perception of the impact of poverty on the demand for modem health care services (see Grootaert 1986; Robb 2000).

  • 2 The sampie units include Oja oba, pakata, kuntu, gambari, balogun Fulani, taiwo, basin, fate, tanke (...)

26A stratified sample method was used to select the respondents, to obtain an unbiased selection of samples, the study area was divided into eleven-sample units2 based on proximity, ecological, socio-cultural and economic variations, in accordance with the sample units, the structured questionnaire was distributed to about 600 respondents, out of which only 510 responded.

27The issues raised in the questionnaire include the background of the respondents, (i.e, their marital status, educational status, occupational status, household size and composition), the income of the respondents, their perception of illness, prices of health care services, time required to travel and wait for health care services, quantity or amount of health care services consumed, judgment about the quality of services and the characteristics of the medical provider.

  • 3 Note that even if children dominate the household 0.7 is still used with the assumption that the ch (...)

28In line with most recent works on poverty, the poverty analysis in this study was based on a money-metric measure of utility and welfare, for the measure of utility and welfare, the total household consumption-expenditure was used as a measure of household welfare and for determining the poverty line, the analysis also took into consideration differences in needs due to the differences in household size and composition: it therefore used household expenditure per adult equivalent as the welfare measure3, there are wide choices of adult equivalent scales and different scales used in different countries, the most commonly used is that of the Organization for Economic Co-operation and Development (OECD) because of its simplicity of use and wide popularity. This scale is expressed as follows:

29EXPeq = EXP/ n(07) ———(1)

30where:

31EXP = total household expenditure

32n = household size

330.7 = exponential formation representing other adults in a particular household (Glewwe 1990; Grootaert and Braithwaite 1998).

34A cut-off point needs to be selected to serve as a poverty line across the distribution of real household expenditure per adult equivalent, an absolute line such as $ 1 a day (Purchasing Power Parity PPP$) was used in identifying the poor and non-poor (World Bank 2001 ).

35The next stage in the analysis of poverty in the study area is the use of the popular P-alpha class of poverty measures introduced by Foster, Greer and Thorbecke in 1984.The index is defined as:

36where:

37n = number of people

38q = number of poor people.

39Z1 = poverty line

40Y1 = total consumption-expend iture of individual i

41µ = poverty aversion parameter.

42The poverty aversion parameter (µ) can take any positive value or zero, the higher the value, the more the index weights the situation of the poor i.e, the people farthest below the povertv line, of specitlc interest are the cases where µ = 0,1 and 2 If µ = 0 the index becomes:

43Po = q/n …………… (3)

44which is the simple head count povertv rate, i.e, the number of poor in llorin metropolis as a percentage of the total population, as a useful first indicator it fails to pay attention to the depth (or gap) and severity of povertv in the metropolis, to arrive at the depth of poverty and severity of povertv one needs to look at the extent to which the expenditure of the poor in the metropolis falls below the poverty line, this is customarily expressed on the “income gap ratio” or “expenditure gap ratio” which expresses the average shortfalls as a fraction of the poverty line itself, i.e.:

45z1,-y1/ z1 ………… (4)

46where y1 is the average income or expenditure of the poor in the metropolis.

47A useful index is therefore obtained when the head count poverty ratio is multiplied by the income or expenditure gap ratio, thus corresponding to:

48P1 =q/n (z1-y1/z1)………….. (5)

49which reflects both the incidence and depth of poverty, these measures have a particularly useful interpretation because they indicate what fraction of the poverty line would have to be contributed by every indiv idual in the metropolis to eradicate poverty through transfer, under the assuniption of perfect targeting.

50The severity of the poverty index is the mean of the squared proportion of the poverty gap expressed as:

51P2, = q / n (zi-yi/zi)2………….. (6)

52This index allows for concern about the poverty of the poor people through attaching a greater weight to the poverty of the poorest ones among them than to those just below the line.

53In determining the demand for modem health care services, the product of the number of people that are sick and the probability ofthe number of people that sought for modem health care serv ices outside their homes, multiplied by the total number of people in the households are used and expressed as:

54DemandlljT = PopulationljT * Incidence of illness + injury

55IINT * ProbSeekljT * ProbChooseljT....(7) where:

56PopulationlT = the number of people in l in time period T

57Incidence of illnesses and injuries is expressed for time period T

58ProbSeekljT = the probability that individual i, with a self-perceived health problem w ill seek care outside the home, it is expressed as a function of price and travel time of all providers and the individual’s characteristics.

59ProbChooseljT = the probability that individual i, with a self-perceived health problem and seeking care outside the home will choose provider j is expressed as a function of provider j’s price and travel time and the person’s characteristics (see Bitran and Mclnnes 1993).

60In the course of the analysis a multiple linear regression analysis of Ordinary Least Square (OLS) was used to test if any relationships exist between the incidence of poverty and the demand for modem health care services in llorin metropolis.

Model Specification

61In specifying the model, emphasis was placed on whether the incidence of poverty has any significant influence on the demand for modem health care services in llorin metropolis, the model is therefore formulated as:

62DMHCs1 = f (POV1, HHC) __________ (8)

63With HHC = f (Hhs1, Occ, eatt1) __________ (9)

64When equation (9) is substituted to equation (8)

65DMHCs1 = f (POV. Hhs1, occ1, Eatt) ________ (10)

66With a multiple linear relationship such as:

67DMHCS1 =bo + b1 InPOV1 + b2 Hhsi3 + b3Occ3+ b4 Eatt1 + U_______ (12)

68where:

69DMHCS1 = the demand for modem health care services

70InPOV1 = log of the incidence of poverty proxied by per capita con consumption-expenditure per adult equivalent of a poor individual head of household.

71HHC1= vector of some household characteristics which are Hhs1, Occ1 and Eatt1.

72Hhs1 = household size of an individual head of household.

73Occ1 = occupational status of an individual head of household.

74Eatt1 = educational attainment (years spent) of an individual head of household.

75bo = the intercept

76b1,…………b4 = estimation parameters associated with the influence of the incidence of poverty and the vector of household characteristics on the demand for modem health care services in llorin metropolis.

77U= disturbance term or other variables not included in the model.

78To estimate the model, a multiple regression analysis is used in order to reflect the explanatory nature of the variables, to verify the validity of the model, two major evaluation criteria are used: the a-priori expectation criteria. which are based on the signs and magnitudes of the coefficients of the variables under investigation; and (ii) statistical criteria which are based on statistical theory, which is referred to as the First Order Least Squares (OLS), consisting of R-squared (R2), the F-statistic and the t-test, the R-squared (R2) is concerned with the overall explanatory power of the regression analysis; the F-statistic is used to test the overall significance of the regression analysis; and the t-test is used to explain the significance of the contributions of the independent variables to the dependent variable (Oyeniyi 1997).

79Drawing from the model, our a-priori expectations or the expected effects of the independent variables (POV1. Hhs1, occ1 and Eatt1) on the dependent variable (DMHCS) are:

80POV1 < 0; Hh1 > 0; Occ >; Eau > 0, an indication that an increase in poverty in llorin metropolis is expected to reduce the demand for modem health care services, and an increase in household size, better occupation status and higher education status are expected to increase the demand for modem health care services, the test was conducted at the 5 percent level of significance.

Results and Discussion

Incidence of Poverty in llorin Metropolis

81In estimating the indices of poverty, this study uses the adult equivalent scale to measure the well-being of indiv idual respondents in the metropolis by their total consumption-expenditure and by their household size. Having established the individual’s consumption-expenditure, a cut off point that serves as the poverty line (using one dollar a day as the consumption-expenditure of the whole population under study) was established at N2.431.00 per month per adult equivalent, from this the popular P-alpha class of poverty measures was used in determining the incidence, the depth and the severity of poverty in llorin metropolis.

82As indicated in Table 2, the head count poverty index (0.68) represents 68 percent of the respondents with a consumption level below the poverty line, thus 68 percent of them lived in households that are poor since their adult equivalent consumption-expenditure faits below the poverty line (N2, 431. 00 per month).

83Within the same period the poverty gap index was 0.45 (representing 45 percent of those whose average consumption-expenditure falls below the poverty line), this gap is referred to as the poor’s degree of misery, it represents the percentage of expenditure required to bring each person below the poverty line up to the poverty line, the severity of poverty index was 0.20, this represents 20 percent of the poorest of the poor in the town whom policy makers must pay attention to in the distribution of the standards of living indicators, such as health care serv ices, clean water, sanitation, food and income generating activities.

84In summary, therefore, the use of these three (3) measures of poverty clearly indicates that the rate of povertv in llorin is relative high when compared w ith the total population of poor people in Nigeria (56 percent), according to data provided by the Organization for Economic Co-operation and Development (OECD) and the African Development Bank in 2000 (see OECD/ ADB 2002).

Table 2: Poverty Incidence, Depth and Severity in llorin Metropolis
(in Percentage°%)

Table 2: Poverty Incidence, Depth and Severity in llorin Metropolis(in Percentage°%)

Authors‘ computation

Table 3: Regression Results of the Demand for Modem Health Care Services and the incidence of Poverty in llorin Metropolis

Table 3: Regression Results of the Demand for Modem Health Care Services and the incidence of Poverty in llorin Metropolis

Results of the Multiple Regression Analysis of the Demand for Modern Health Care Services and the incidence of Poverty in Ilorin Metropolis

85The results of the regression analysis conducted at the 5 percent level of significance are presented in Table 3.

86A look at the model shows that it is fairly good because it has an R2 of 0.51, this shows that a 51 percent variation in the dependent variable (demand for modem health care services) is accounted for by the explanatory variables (the incidence of poverty and the vector of household characteristics of the respondents that are poor), while the error term takes care of the remaining 49 percent, these are variables in the study that can not be included in the model because of certain qualitative features, at the 5 percent level of significance the calculated F-statistic, that is 9.5, is greater than the tabulated F-statistic (4.. 349 degrees of freedom) valued at 3. 2.

87In terms of the individual independent variables, the coefficients and the associated t-values show that (at the 5 percent level of significance) the increase in poverty is inversely related to demand for modem health care services: and the increase in household size and better occupational and higher educational status are directly related to the demand for modem health care services in llorin metropolis, this satisfies our a-priori expectation, which states that the more the rate of poverty the less the demand for modem health care services; the greater the household size, the better the occupational and the higher the education status of the people, the more their demand for modem health care services when they are ill, statically none of the independent variable is significant, this conclusion therefore conforms with the views of other researchers, such as Overholt and Saunders (1996), Bitran (1994) and the World Bank (1995) namely, that the demand for modem health care services depends, among other factors, on the price of the health care services provided and the income of the individual that needs it, as the price increases, the purchase and consumption of these serv ices decline, and as the income of the people increases, the services they are able to purchase and consume increases. When they are poor and lack adequate income to purchase modem health care services, their demand reduces.

88Drawn from the perception of some of the respondents, their inability to seek modem health care services can be linked to their low level of income in relation to the costs of treatment, according to some of them, at times the cost of treatment itself can be expensive but in many cases there are other hidden costs that add to the overall financial burden of health care services, these hidden costs include expenses incurred in travelling to a place where health care can be received and the psychological costs due to waiting time, costs are also incurred from bribes that must be paid to some health workers in order to see a doctor or nurse, or in order to ensure adequate treatment.

Conclusion and Recommendations

89An empirical study of the impact of poverty on the demand for modern health care services in llorin metropolis was carried out by the use of a collection of household data and regression analysis, the findings show that the incidence of poverty is inversely related to the demand for modem health care services in llorin metropolis, an indication that the more people find themselves in poverty, the less their demand for modem health care services whenever they are ill.

90To make modem health care services accessible to the poor will therefore require government’s heavy investment in primary health care services at the community level, the nature of investment should first give consideration to the people’s responsiveness to the services provided by involving them in the design and implementation of the health policies, coupled to this, the government should try as much as possible to reduce waste and inefficiency in the delivery of the health care facilities by spending less on personnel relative to drugs, supplies and maintenance of equipment.

91Since one of the factors that impede most people’s demands for modem health care services is income, the government should continue to subsidize the delivery of modem health care services (most especially primary health care) to the poor, given its basic objectives of efficiency and equity. However, the provision of subsidies should take into consideration a strong" targeting mechanism" that will not only identify those that are poor but also reach them and monitor the services provided to them, in addition, the government should provide an enabling environment for households to improve and to utilize modem health care services, the government should involve non-government organizations, community-based organizations and individuals in the provision of modem health care serv ices to the less privileged in the society.

92The government at the local, state and national levels should make adequate provisions for portable water and sanitation facilities at the homes of the poor and in the environment where they live, at least for the purpose of preventing diseases that would make them want to visit modem health care centres.

93Good governance. which encompasses accountability, openness and transparency, must be allowed to thrive in the delivery of modem health care services to the poor, this in fact is essential in order to check and guard against the diversion of modem health care facilities and resources for personal use by persons in charge of the delivery of these facilities.

Bibliography

References

Adedibu A.A (1988), “Measuring Waste Generation in Third World Cities: A Case study of Ilorin, Nigeria”, Environmental Monitoring and Assessment. Vol. 10, n°2, pp. 89-103.

AFRICAN DEVELOPMENT BANK (ADB) (2003), Gender, Poverty and Environmental Indicators on African Countries, Abidjan: ADB.

Aigbokhan B.E (1997). “Poverty Alleviation in Nigeria: Some Macroeconomic Issues”, in Proceedings of the Nigerian Economic Society Annual Conference on Poverty Alleviation in Nigeria 1997, Ibadan: NES, pp. 181-210

Aku P.S, M.T Ibrahim MD And Balas Y.D.(1997) “Perspectives on Poverty Alleviation Strategics in Nigeria” in Proceedings of the Nigerian Economic Society Annual Conference on Poverty Alleviation in Nigeria 1997, Ibadan NES, pp.41-54.

Bitran R.A. (1994). “A Supply-Demand Model of Health Care Financing with an Application to Zaire”. World Bank Economic Development Institute Technical Materials. Washington DC: The World Bank

Bitran R.A, and Mclnnes D.K. (1993), “The Demand for Health Care in Latin America: Lessons From the Dominican Republic and EL Salvador”. World Bank Economic Development Institute, Seminar Paper n°. 46.

CENTRAL BANK OF NIGERIA (CBN) (Various issues), Annual Report and Statement of Account, Lagos: CBN

FEDERAL OFFICE OF STATISTICS (FOS) (1999), Poverty Profile for Nigeria 1980-1996, Lagos: FOS.

FEDERAL OFFICE OF STATISTICS (FOS) (Various Issues), National Household Consumer Survey, Lagos: FOS.

FEDERAL OFFICE OF STATISTICS (FOS) (Various Issues), Annual Abstract of Statistics, Lagos: FOS.

Foster J., Greer J, and Thorbecke E. (1984), “A Case of Decomposable Poverty Measures” Econometrical, Vol. 52, pp. 761-765

Francis P., Akinwumi J.A., Ngwu P., Nkom S.A., Odili J., Olamajeye J.A., Okunmadewa F, AND Shehu D.J. (1996), State, Community and Local Development in Nigeria. World Bank Technical Paper n° 1440.

Grootaert C. (1986), Measuring and Analyzing Levels of Living in Developing Countries: An Annotated Questionnaire. World Bank Living Standards Measurements Study Working Paper n°. 24

Grootaert C, and Braithwaite J. (1998), Poverty Correlates and Indicators, Based Targeting in Eastern Europe and Former Soviet Union. World Bank

Policy Research Working Paper n° 1942.

Levy S. (1991), Poverty Alleviation in Mexico. World Bank Policy Research Working Paper n° 679.

Narayan D. (2000). “Poverty is Powerlessness and Voicelessness”, IMF, Finance and Development, Vol. 37, n° 4, pp. 18-21.

Narayan D., Patel R., Schafft K., Radermacher A, and Koch-Schulte S. (2000), Voices of the Poor: Can Anyone Hear Us? Oxford University Press, New York.

NATIONAL POPULATION COMMISSION (NPC) (1993), Population in Census 1991: National Summary, NPC: Lagos.

NEW BOOK OF KNOWLEDGE (1980), Health, Canada: Grilier Inc.

ORGANIZATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT/ AFRICAN DEVELOPMENT BANK (OECD/ADB)

(2002), African Economic Outlook 2001/2002, Abidjan: ADB.

Overhalt C.A, and Saunder M.K. (1996) (eds.), Policy Choices and Practical Problems in Health Economics: Cases From Latin America and the Caribbean. World Bank Economic Development Institute Learning Resources Services. Washington D.C: The World Bank

Oyeniyi T.A. (1997), Fundamental Principles of Econometrics, Lagos: Cader Publication Ltd.

Robb M. (2000), “How the Poor Can Have a Voice in Government Policy”, IMF Finance and Development, Vol. 37 n°.4, pp. 22-25.

Schubert R. (1994), “Poverty in Developing Countries: Its Definition, Extent and Implication”, Economic, Vol. 49/50, pp. 17-40

UNITED NATIONS DEVELOPMENT PROGRAMME (UNDP) (1998), Nigeria: Human Development Report 1998, Lagos: UNDP.

Ward M. (1999), “Perceptions of Poverty: The Historical Legacy”, IDS Bulletin. Vol. 30, n°.2, pp. 23-32.

WORLD BANK (1990), Poverty. World Development Report 1990, New York: Oxford University Press.

WORLD BANK (1993a), Investing in Health. World Development Report 1993, New York: Oxford University Press.

WORLD BANK (1993b), Implementing the World Banks Strategy to Reduce Poverty: Progress and Challenges. Washington D.C: World Bank.

WORLD BANK (1995), Vietnam: Poverty Assessment and Strategy. Washington D.C: The World Bank

WORLD BANK (2001), Attacking Poverty. World Development Report 2000/ 2001, New York: Oxford University Press

Notes

1 The World Bank provides $1 and $2 per day per person for eore poor and moderate poor respectively, this method is also referred to as Purchasing Power Parity (PPP) (see World Bank 1993a).

2 The sampie units include Oja oba, pakata, kuntu, gambari, balogun Fulani, taiwo, basin, fate, tanke, Oloje, Okelele, and Okesuna

3 Note that even if children dominate the household 0.7 is still used with the assumption that the children will one day become adults

Endnotes

1 Department of Economics, University of Ilorin.

List of illustrations

Title Table 1: Estimated Total Population and Rate of Poverty in Nigeria (1980-2002)
Caption Sources: (a) National Population Commission 1993; Central Bank of Nigeria, annual Report and Statement of Account (varions issues) and Federal Office of Statistics Annual Abstract of Statistics (various issues), (b) Computed by the authors front (a) and (c). (c) Federal Office ofStatistics (FOS) (1999) Poverty Profile for Nigeria 1980-1996: Federal Office of Statistics’ National Household Consumer Survey (various issues)
URL http://books.openedition.org/ifra/docannexe/image/807/img-1.jpg
File image/jpeg, 164k
URL http://books.openedition.org/ifra/docannexe/image/807/img-2.jpg
File image/jpeg, 24k
Title Table 2: Poverty Incidence, Depth and Severity in llorin Metropolis(in Percentage°%)
Caption Authors‘ computation
URL http://books.openedition.org/ifra/docannexe/image/807/img-3.jpg
File image/jpeg, 64k
Title Table 3: Regression Results of the Demand for Modem Health Care Services and the incidence of Poverty in llorin Metropolis
URL http://books.openedition.org/ifra/docannexe/image/807/img-4.jpg
File image/jpeg, 102k

© IFRA-Nigeria, 2005

Terms of use: http://www.openedition.org/6540

Buy

Print version

amazon.fr