Mar 14, 2019 | 05:02 pm | 6
1.1 Background of the Study
Poverty in Nigeria is rising with almost a hundred million of its population living on less than $1 per day despite a strong growth in Africas largest economy (National Bureau of Statistics, 2014). The percentage of Nigerians living in absolute poverty those who cannot afford the bare essentials of food, shelter and clothing rose to 60.9% in 2014 compared with 54.7% in 2010 (National Bureau of Statistics, 2014). This is not unconnected to population growth and urbanization where larger percentage of the people resides in slum areas. Although Nigerias economy is projected to continue growing, poverty is likely to get worse as the gap between the rich and the poor has continued to widen. Chukwuemeka (2010) posited that poverty in Nigeria is a paradox that despite the fact that Nigerias economy has continued to grow, yet the proportion of Nigerians living in poverty has continued to increase every year.
According to the National Bureau of Statistics recent report, 46% out of an estimated 173 million of Nigerias population live in relative poverty (NBS,2015). Relative poverty is the comparison of the living standard of people living in a given society within a specified period of time. Comparing this figure with an estimated 37.58 million population of Uganda, then the poor in Nigeria is about thrice. Apart from the relative poverty index, Nigeria failed all poverty tests using all poverty measurement standards: absolute poverty measure puts the countrys poverty profile at 60.9%; the dollar per day measure puts the poverty profile at 61.2% and the subjective measure puts the poverty profile at 93.9% (NBS, 2014).
Variation in income is highly visible in most part of the country. The income and the wealth of the country seem to be unevenly distributed. We have some set of people who are very rich whose living standards are relatively high. Such people have access to the basic needs of life such as balance diet, convenient shelter, basic infrastructure, good clothing e.t.c. At the same time we have some other set of people that are very poor who are struggling to survive with less than the U.S $370 a year or a dollar a day. Such people are characterized by poor health, illiteracy, poverty, unstable job, lack of basic needs such as food, clothing and decent shelter. The extent and magnitude of the disparity is visible but not defined in quantitative terms. The gap between the rich and the poor appears wide, yet they are not vividly derived.
In Nigeria the poor are not just the rich with less money, but are the poorest of the poor. Households are not only poor; they also suffer from vast inequality in incomes, in assets (including education and health status), in control over public resources, and in access to essential services as well as pervasive insecurity (World Bank, 2000). The distributional consequences of economic growth is therefore one of the main policy issues in Nigeria.
Health economics literatures have shown that there are numbers of economic factors affecting the demand for health care services in any economy and these factors determine the level of health utilization choice to be used by the people (Ichoatku et al, 2003). The level of poverty also has linkage with the demand for healthcare services. The literature on poverty reduction has firmly demonstrated the role of health demand and poverty reduction (e.g. Oshofowo 2011; Sambo, Ejembi, Adamu, & Aliyu, 2004). It is suggested that, all things being equal, healthier workers are more likely to be able to work longer, be generally more productive than their relatively less healthy counterparts, thus able to secure higher earnings than diseased-ridden workers and will be able to afford the cost of healthcare services. It is posited that, given poor health infrastructure, illness and disease shorten the working lives of people, thereby reducing their lifetime earnings. Therefore, the health of a population determines, to a large extent, the earning power of the population by determining their ability to contribute to economic activities. This has implications for the level of earnings and therefore the level and state of poverty they have. Thus, better health enables better earning ability for both workers and enterprises (for example in the case of self-employment) which in turn enhances the tax base of the government leading to better fiscal posture. These interactions, all things being equal, will lead to poverty reduction. On the other hand, poor people find it difficult to pay for health services through out-of-pocket expenditure thus resulting to reduction in the demand for healthcare services.
It is imperative to define the concept of demand for health care within the context of this study, demand for healthcare can be defined as the amount of health services that the people are willing to obtain as a function of the service prices, given peoples economic and demographic characteristics, their perception of the quality of services, the peoples geographical location relative to health providers and the environment (Ichoatku et al, 2003). Nguyen, Lindholm and Thi (2008) are of the opinion that consumers demand for health care for two reasons. Firstly, health care makes the consumer better so that it is considered as a consumption commodity. Secondly, health care determined the number of hours or days available to the consumer for work and leisure, which also affect the time available for productive activity. Hence, it is an investment commodity; demand for health care comes from the desire for good health and preventive services are consumed with the expectation that the cost of prevention is less than the cost of illness. Preventive health services may also improve personal hygiene or immunological resistance, which affects health (Nguyen, Lindholm and Thi (2008). The demand for curative health is linked to symptoms of possible illness and desire for diagnosis, treatment or pain alleviation, which is influenced both by an individuals state of health (the frequency of illness) and economic factors. These two perspectives of health care by (Nguyen, Lindholm and Thi, 2008) provide the starting point in evaluation of the economic determinants of demand for medical care. Thus, since poverty is a determinant of the proportion of healthcare that will be demanded by household under the economic factors, then, this study examines the impact of poverty on demand for healthcare service among rural dwellers in Dekina Local Government Area, Kogi State.
1.2. Statement of the Problem
One issue that comes to mind when discussing the economy of Nigeria is the inability of most people in the country to have adequate access to social amenities. One social amenity that has become prominent in the discussion is health care service with its limited supply or lack of it telling so much on the physical and mental well-being of the people.
In Nigeria like other developing countries of the world the allocation of adequate resources to health continue to pose very serious problems to government; thus, the wealth of a nation does not necessarily ensure adequate health care rather the key is Proper Planning. The major problems facing the health care delivery system in Nigeria are majorly insufficient financial resources allocation to the health care services, the poor management of the health centers which results in wastages and inefficiency. Nigeria has recorded rapid growth in Gross Domestic Product in recent years but despite the rapid and high growth profile recorded in Nigeria in the past few years, there is growing consensus amongst analysts that there is widening inequality, increasing poverty, poor health, and reduction in educational standard and general poor socio-demographic indicators (Oshofowo, 2011).
The lack of adequate health care services and the inability of individuals within the rural society to acquire modern health care services at affordable rates have led to the deterioration of the health status of individuals in rural areas of Nigeria. Rural areas in Nigeria are often characterized by people living below the poverty line. This has hindered accessibility and utilization of such individuals to effective health care services. Also, in rural areas, it is common to see health institutions with no drugs and with dilapidated structures. The dwindling income and purchasing power of individuals in rural areas, coupled with the high cost of drugs and of treatment are factors combined to keep health care services out of the reach of many. The effects are high infant and maternal 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 increased poverty prevalence. For instance, an infant mortality rate of 81 per 1000 live births was recorded in 2001, while the maternal 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 in rural parts of Nigeria (ADB 2003).
Many low-income countries, Nigeria inclusive, have not been able to meet the basic healthcare needs of their people, especially those in the rural areas. In Nigeria, there has been a growing recognition of the challenge of rural peoples health issues and the need for it to be addressed (Hamid et al., 2005). There is a huge shortage of qualified practitioners in the rural areas. Accessing health care in rural areas is confounded by problems such as insufficient health infrastructure, the presence of chronic diseases and disabilities, socioeconomic and physical barriers (Ricketts, 2009).
National health management information system is weak, without an integrated system for disease surveillance, prevention and management. Research also indicates that there are high rates of absenteeism (about 40%) among medical doctors, especially in rural areas (Hamid et al., 2005). The high level of mortality, and morbidity which accounts for 157 deaths per 1000 live births (NDHS, 2008), non-attainment of international goals for health and survival, and the inequalities in access to health facilities are the challenges of rural populace.
There are over 62 million Nigerians currently residing in rural areas. It is estimated that 20 percent of the rural population is uninsured, and this number is projected to increase to 25 percent by 2019. The need for increased access to care and insurance coverage is especially crucial for rural populations because they earn less and have little or no resources to cater for their health needs. Rural area residents also receive less preventive care and have higher rates of all chronic diseases than their urban counterparts (Bailey, 2010). Out of the millions of rural residents living in the Nigeria, 17 percent are minorities. In general, minorities have poorer health and higher rates of serious diseases such as stroke, HIV/AIDS and certain types of cancer; often caused by poverty; as sufferers cant seek effective health care services. A national survey places access to quality health services as the top-ranking priority among rural health care stakeholders and leaders (Nelson & Gingrich, 2010). Unfortunately, this is also one of the hardest obstacles to overcome in rural areas due to high poverty prevalence, lack of health care providers and limited or no health insurance coverage for rural residents.
Severe physician shortages exist in rural areas, and the trends are not changing enough to compensate for the demands of health services. The national 2005 Nigerian Medical Association physician survey showed that from 2001 to 2012, medical school graduates had only a small increase in the amount of medical doctors (1.3 percent) and doctors of osteopathic medicine (1.5 percent) entering rural areas to practice medicine. This data also indicated that from 2001 to 2012 only 1.4 percent of medical graduates had residency experience in a rural setting (Chen, Fordyce, Andes & Hart, 2010).
1.3 Research Questions
The following research questions shall guide this study:
What is the trend in poverty prevalence in rural area over the years?
Can we say that health care service deliveries in rural areas have been effective over the past few decades?
Is there any relationship between poverty level and demand for health care services in rural areas in Dekina LGA?
Has there been effective distribution of modern health care services between urban and rural areas in the country?
How has poverty affected the accessibility and utilization of effective health care services in rural parts of the country?
Will factors such as insufficient health infrastructure, the presence of chronic diseases and disabilities, socioeconomic and physical barriers in rural areas determine level of health care service demand in such areas?
Will adequate health insurance coverage for the poor ensure effective health care service deliveries and health outcomes in rural areas in Dekina LGA?
Is there a link between poor supply of medical practitioners, health care service delivery centers and demand for health care in rural areas in Dekina LGA?
Are there any challenges facing effective delivery of health care services in rural parts of the country?
What steps have the Nigerian government / Dekina LGA taken to ensure the poor are not denied effective health care services in rural areas of the local government area and country at large?
1.4. Objectives of the Study
The main objective of this study is to empirically investigate the impact of poverty on demand for healthcare services among rural dwellers in Dekina LGA, Kogi State. The specific objectives are:
To assess poverty prevalence and its effect on demand for health care services among rural dwellers in Dekina LGA.
To determine the magnitude/extent at which poverty incidence in rural areas in Dekina LGA will affect demand for healthcare services.
1.5. Significance of the study.
Several studies have been conducted on the demand and supply of health care services in Nigeria but studies that specifically capture impact of poverty on the demand for healthcare services in Nigeria are scanty but this does not mean there are no studies on poverty but it has been linked with economic growth and other macroeconomic variables rather than on the demand for healthcare services which is the focus of this study. Therefore, this study contributes to the body of knowledge in the aspect of poverty impact on demand for healthcare services among rural dwellers of Dekina LGA.
Methodologically, previous studies used secondary data in sourcing for data, however, such data cannot explain real life effect of poverty on demand for healthcare services, it has to do with individual perception of how lack of basic necessities of life affect their demand for healthcare services. Therefore, this study will obtain data through primary data source which will enable first hand information to be obtained directly from the respondents.
The findings of this study will be relevant for policy formulation regarding issues pertaining to poverty eradication in order to enhance increase in demand for healthcare services.
1.6. Scope of the Study
The study investigates the impact of poverty on demand for healthcare services among rural dwellers in Dekina LGA. The study focuses on the consumers of healthcare services among the residents in Dekina local government area of Kogi state who patronize the three health care service providers available for the people which include private hospitals, traditional medical service providers (herbs sellers and native doctors) and public hospitals.
1.7. Organization of the Study
This research work is structured in five chapters. Chapter one is the introduction. Following this chapter is chapter two which focuses on theoretical framework and review of related or relevant literature, empirical review and methodological review. Chapter three deals with research methodology including method of data analysis. Data presentation, analysis and interpretation of empirical results are handled in chapter four. Finally, Chapter five which is the last deals with the summary of findings, policy recommendation based on the result of the study for both policy and further research and conclusion.