Determinants of Health Investment in Nigeria: A Case of Infant Mortality (2000-2014)

Abstract

The paper examines the determinants of health investment in Nigeria: A case of infant mortality, with the aim of determining the impact of government expenditure, maternal education, and poverty on infant mortality in Nigeria. The study employs descriptive statistics and the Ordinary Least Square econometrics regression method of data analysis, using time series data in Nigeria. Secondary data from WHO, retrieved from indexmundi.com were used for our analysis. The results show that per capita income and maternal education have significant impact on infant mortality in Nigeria. These variables are significant policy variables in achieving lower infant mortality in Nigeria. Introduction Health is very vital to human existence. It is one of the most important conditions that guarantee long life. Grossman (1972) argued that good health is required for the production of optimal output based on our education. Therefore, without good health, the scarce resource which is time would not be optimized. There is increasing empirical evidence that health matters for economic growth and development. Literature on economic growth has clearly showed the role of health in influencing economic performance, at least at the micro level. 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 diseases ridden workers. Babatunde (2012) posited that poor health infrastructure, illness and diseases shorting the working lives of people thereby reducing their life time earnings. All healthy habits and activities that are deliberately cultivated towards obtaining good health in return are healthy investment, Grossman (1972). Good health guarantees and saves wealth, therefore if health is lost; wealth is also lost because more wealth would be diverted to taking care of health. Hence, health endowment and investment in health determine how long and individual will live, all things being equal. International Journal of Academic Research in Business and Social Sciences Vol. 8 , No. 9, Sept. 2018, E-ISSN: 2222-6990 © 2018 HRMARS 937 Deaths of newborn babies are a major concern in Nigeria because it represents a quarter of the total number of deaths of children under-five. Despite the high quality and wide spread accessibility of infant intensive care technology all over the world, the rate of infant mortality still remains very high in Nigeria. Infant mortality rate is an important measure of well-being of the infants, children and pregnant women because it is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions and public health practices ( Sohler et al., 2003). Infant deaths, which account for half of child mortality, have increased from what they were in 1990. One explanation of the relationship between parental education and infant health is that greater maternal education translates into greater health care utilization, including formal prenatal visits. The relationship between maternal education and health care services utilization, particularly in developing countries, holds even after controlling for factors that affect both maternal schooling and health care utilization, such as childhood place of residence and ethnicity, as well as socioeconomic variables, such as current residence and husband’s education Besides health care utilization, maternal education can affect infant and child health through several other mechanisms. For example, better educated women have higher income and may “match” with better educated and higher income, husbands (Behrman and Rosenzweig, 2002). Educated women also have greater knowledge of modern health care services and ability to communicate with healthcare providers (Caldwell, 1979; Barrera, 1990). Moreover, education may affect smoking and other health behaviors during pregnancy (Currie and Moretti, 2003). Another channel is through greater female autonomy, which in turn influences health-related decisions and the allocation of resources within the household (Caldwell, 1979; Caldwell et al., 1983). Other possible explanations include greater knowledge about diseases and increased adoption of modern medical practices (Caldwell, 1979; Caldwell, 1990; Barrera, 1990). Health and income are strongly related across countries and, within countries, across individuals. In the United States, the life expectancy of people in the lowest ventile of the income distribution was about 25% lower than that of people in the highest ventile in 1980 (Rogot et al., 1992). In developing countries, dozens of studies have found that people with higher incomes have better health status and lower mortality (Gwatkin et al., 2007). It is expected that as countries become richer, life expectancy is also expected to rise, although many other factors are also important in explaining mortality declines. Despite the association between income and health status, the extent to which improvements in income have a causal effect on health status remains controversial. For example, it is said that higher income generally results in access to better parental care, as well as better nutrition for the mother. This finding is not surprising. Infant mortality is concentrated among the poor. If the rich are richer and the average level of income is the same, the poor are poorer. What is surprising, however, is that infant mortality appears to be positively related to the income share of the rich (the upper 5 percent of the income distribution) when the incomes of the poor (the lowest 20 percent) are equalized among countries (Waldmann, 1992). Children, and especially infants, have long been recognized as a group highly vulnerable to bad living conditions. Government expenditure is the expenses that Government incurs for its own maintenance, society and the overall economy. It is evident that Nigeria over the years spent huge amount of money with a view to improving health system, (Yusuf, 2016). Government in any given society is saddled with International Journal of Academic Research in Business and Social Sciences Vol. 8 , No. 9, Sept. 2018, E-ISSN: 2222-6990 © 2018 HRMARS 938 two basic roles; maintaining law and order as well as providing public goods such as good roads, education, health, defense, and power among other infrastructures (Samuel & Kabir, 2011). Health care is a core component of human capital investment, which in turn rising its spending also raises quality of life, prolonged life expectancy, reducing morbidity and mortality rates. Health Financing in Nigeria Nigeria has joined the rest of the world in seeking improvement in the health status of Nigerians as evidenced by the kind of government policies intervention in the development of the health sector to enhance the nation’s economic output. In realization of this, successive Nigerian governments have being making serious effort in budgeting allocation to the health sector. In CBN (2010) the total government expenditure to health as at 1986, 1990, 2000 and 2010 was N360.4M, N558.1M, N18181.8M, and N149269.8M respectively. The capital expenditure also show same continuous increase in trend in 1986, 1990, 2000 and 2010 recorded N18.2M, N157.0, N6569.2M and N46649.8M respectively. According to Imoughele & Ismaila (2013), the World Bank recommended that 15% of government budgetary allocation be assigned to the health sector; this has not been achieved by the government, thereby affecting government programs and policies for the development of the sector. In 2010 alone, Nigeria spent 635 billion Naira on wheat ($1=150 Naira), 356 billion Naira on importation of rice, and 217 billion Naira on sugar, 97 billion Naira on fish (with all the marine resources, rivers, lakes and creeks which the country is naturally blessed with). This is not fiscally, economically or politically sustainable. The budget that would have gone to health infrastructure is spent on undue foods importation, as nutrition is part of health. To bring about health care system change, local, state, and federal policymakers need to collaborate more often and more effectively (Atim & Bhatnagar, 2013). Across states, the level of financial mobilization for health by the public sector varies widely and depends on the roles they play in health care provision. In Northern Nigeria, the public sector provides over 90% of all health services, in contrast to states in Southern Nigeria, where the private sector provides over 70% of health services, mostly on a fee-for-service basis (Ichoku & Okoli, 2015) Evidence from a Public Expenditure Review of the health sector and National Health Accounts (NHA) suggests that on average, most states spend less than 5% of their total expenditure on health care. Expenditure from all tiers of government amounts to less than 6% of total government expenditure and less than 25% of total health spending in the country. The private sector accounts for the remaining 75% of health spending, with 90% of this coming from household out-of-pocket expenditures coupled with the lack of effective risk protection mechanisms such as fee exemptions and health insurance, the cost of seeking health care is prohibitive for many people in Nigeria (Ichoku H & Okoli C. I, 2015). Funding for health related expenses has been low primarily because tax-based health financing is limited. Considering the country’s current Gross Domestic Product (GDP) of about US$305 billion, an increase of tax revenue to 15% of the GDP will result in about US$21 billion. An allocation of 10% of this additional income would result in US$2.1 billion for the health sector. Such re-constitution of revenue collection can represent a great leap forward for the health sector, Ichoku H & Okoli CI (2012). International Journal of Academic Research in Business and Social Sciences Vol. 8 , No. 9, Sept. 2018,