Healthcare Financing in Nigeria: A Policy Review.

A good health financing system is crucial for the effective performance of a country's health system. Many health systems around the world, especially in lower- and middle-income countries such as Nigeria, grapple with perennial challenges such as chronic underfunding, wastefulness, and lack of accountability rendering these systems inefficient. Nigeria's health system faces additional extraneous challenges such as a huge and rapidly growing population, a stagnant economy, and worsening insecurity of lives and property. Furthermore, recent disease outbreaks such as the Ebola epidemic and the COVID-19 pandemic and an evolving disease demography evidenced by an increasing prevalence of chronic, noncommunicable diseases asphyxiate an already floundering health system. To address these challenges and to bolster its efforts in attaining universal health coverage (UHC) and meeting the targets of the Sustainable Development Goals, the Nigerian government launched a new health policy in 2017. A review of the health financing section of this policy shows a focus on improving funding for health care by all levels of government and guaranteeing affordable and equitable access to health services by all Nigerians, albeit with insufficient clarity on how these will be achieved. A more critical review of the country's health financing system also reveals deep-seated systemic issues. Its out-of-pocket payments for funding health care are among the highest in the world, with abysmally low government contributions to health. Successive governments seem to lack the political will to address these shortfalls. Critical gaps exist in the country's health laws, making it difficult to implement the strategies proposed in the new policy. Nigeria must strengthen its health laws to, among other things, mandate health insurance and provide adequate funding for the health system by the government. It should also formulate a dedicated, more precise health financing policy with specific, measurable aims targeting identified problems to enable it to attain universal health coverage.

Evaluation of a website that promotes social connectedness: lessons for equitable e-health promotion.

The online provision of health information and services has been viewed as having the potential to inform and empower health consumers and, ultimately, to promote better health. The Internet can be an innovative tool to deliver services to 'hard-to-reach' population groups, including geographically isolated populations. However, the online platform raises questions regarding the equitable distribution of health services. In this paper we examine a case study of a website that aims to promote health by fostering social connectedness. The website provides information to connect people to locally based community events across Australia. We draw on evaluation findings to examine the socioeconomic and geographical distribution of website usage. A descriptive analysis of web usage statistics revealed a gradient whereby more information is listed and viewed about events in affluent socioeconomic areas. Furthermore, the analysis showed that a greater proportion of information listed and viewed related to urban areas. These results are consistent with broader gradients of Internet access and usage. Drawing on these findings, we identify implications for online health promotion across different population groups, particularly for interventions that do not incorporate an explicit equity focus.

Do perceived neighbourhood cohesion and safety contribute to neighbourhood differences in health?

This paper reports on a survey (N=3344) and in-depth interviews (N=80) from four socio-economically contrasting postcode areas in Adelaide. Logistic regression was used to examine locational differences in self-rated health, controlling for demographic, socio-economic factors, health behaviours, individual social capital (social networks, support, reciprocity, trust) and perceived neighbourhood cohesion and safety. Statistically significant locational differences in health emerged. Perceived neighbourhood cohesion and safety accounted for this difference. Interviews explored perceptions of cohesion and safety and found that they were intricately related and varied between the areas. The implications of the findings for understanding locational differences in health are discussed.