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Payment Patterns in Nigeria’s Public Facilities: Unexpected costs and implications for health-seeking behavior in Nigeria

Adequate health financing is a critical element of any strong healthcare system.  In Sub-Saharan Africa, financing and payment models for primary, secondary, and tertiary health care can be significant tools for improving issues of access, quality, and equity in care delivery.  While much effort is made to understand the financing approaches that may be optimal for health systems at large, little is known about financing mechanisms that may work best considering the dominance of out-of-pocket payment and, more importantly, the impact that unexpected, informal costs for care may have on health-seeking behaviour.  The abolition of user fees for public health facilities has become increasingly popular in many low-income countries, with results from numerous studies noting an increase in access and utilization for the poorest populations.  However, abolishing user fees often does not remove the cost of many goods and services related to a care episode.  Though some patients may pay no initial fees for a basic service such as an initial consultation, there are often treatment-related costs that are unknown to the patient.

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Nigeria Education in Focus (Issue3)

Given that government does not fully cover the direct costs, parents bear a proportion of the costs of education. Although contributions from parents are expected to be small, this can still present a significant burden depending on households’ income level. Some of the costs reportedly paid by pupils in public schools in Nigeria are shown in Table 3. On average, these costs added up to N25800. For poor households that live below N700 a day, these associated costs amounts to a significant burden to sending their children to school. Essentially, the associated costs of education is the monetary cost that parents were alluding to for children dropping out  or not attending school at all.

A further dissection of the costs paid in public schools in Nigeria reveals another dynamics at play. Government has not been sufficiently funding the institutional and direct costs components as promised in the UBE Act. Some of the reported expenses are for items supposedly cover under the free education programme. For example, school development levy, school supplies and to some extent textbook and exercise books are part of the institutional and indirect costs promised under the UBE Act. Invariably, school administrators are using various creative means to transfer the shortfall in government funding to parents.

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Nigeria Education in Focus (Issue2)

Inclusive education implies that education (quantity and quality) is accessible to all children, irrespective of their individual circumstances. However, in Nigeria, some vulnerable groups of children are found to be excluded from quality education. These include children with disabilities, children from nomadic groups, many of the children in the Almajiri education system, and internally displaced children. Worryingly, the socio-cultural and economic backgrounds of children in Nigeria continue to influence their access to education. Furthermore, education data shows gaps in access and learning between the popular dimensions of exclusion: gender, location of residence, region, and wealth. These figures often mask the most critical dimensions and their underlying drivers. Such insights are what CSEA’s ongoing research project, on Educational Performance in Nigeria under the framework of the Southern Voice on the State of the SDGs (SVSS), aims to unveil. In this issue, we highlight some equity concerns relating to access and quality of basic education in Nigeria.

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State-owned enterprises

The Nigeria Natural Resource Charter (NNRC) Benchmarking Exercise Report (BER) 2017[1] assessed the operational activities in the nation’s oil and gas sector between 2015 and 2017 against the Natural Resource Charter[2]. The exercise sought to unveil the true state of oil resource extraction, governance, and transparency among others based on a set of underlying economic principles in line with international best practices. One of the precepts assessed is on State Owned Enterprises (SOE) with Nigeria National Petroleum Corporation (NNPC) as a case study. Although the report recognized mild positive changes in the NNPC, it scored the corporation low on the aggregate in the focus period. In sum, it concludes that the country is not getting the most from the nation’s oil and gas firm in many fronts and suggests a reform that gravitates the corporation towards a commercially-driven and globally-competitive entity. This brief provides actionable policy recommendations that can enhance the operational and financial competitiveness of NNPC, especially in response to the challenges identified in the 2017 BER.

[1] http://www.nigerianrc.org/2017-benchmark-report/

[2] The Natural Resource Charter is a set of principles on how to best harness the opportunities created by extractive resources for development for governments and societies rich in non-renewable natural resources.

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Nigeria Education In Focus (Issue 1)

The existing education data in Nigeria are Millennium Development Goal (MDG) centric with focus on enrolment, transition and completion statistics, with no statistics on the extent of learning taking place in schools. However, with the new global agenda, Sustainable Development Goals (SDGs), focusing on quality education, huge data gap exits in Nigeria to track progress and this should be the immediate task ahead of the National Bureau of Statistics (NBS) and the Federal Ministry of Education, which is saddled with ensuring uniform education standard in Nigeria.

       
Picture Source: Global Partnership for Education
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