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Effect of public health expenditure on health outcomes in Nigeria and Ghana.

ABSTRACT: Despite the prevailing literature examining the effect public health expenditure has on health outcomes in Africa, Malaria and HIV/AIDS mortality which are key indicators of the outcome variable were unconsidered when drawing inferences. In view of this oversight, we investigate the impact of public health expenditure on health outcomes in Nigeria and Ghana whilst reconceptualizing health outcome by capturing infant, maternal, Malaria and HIV/AIDS mortality. Using the health expenditure commitment at the 1999 United Nations General Assembly and the Abuja Declaration of 2000, we also assessed public policy's role in this relationship via linear regression analysis. With hindsight, our findings disclosed a low public health expenditure in both countries despite the Ghanaian case revealing a negative relationship, which was primarily insignificant whilst Nigeria indicated a positive one. These empirical evidences accentuate the need to augment public health expenditure in both countries to boost health outcomes whilst bringing to bear the significant influence of GDP, school enrolment and residing in urban areas on health outcomes.

SUBMITTER: Oladosu AO

PROVIDER: S-EPMC10297781 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Effect of public health expenditure on health outcomes in Nigeria and Ghana.

Oladosu Ayomide Oluwaseyi AO Chanimbe Timothy T Anaduaka Uchechi Shirley US

Health policy OPEN 20220418

Despite the prevailing literature examining the effect public health expenditure has on health outcomes in Africa, Malaria and HIV/AIDS mortality which are key indicators of the outcome variable were unconsidered when drawing inferences. In view of this oversight, we investigate the impact of public health expenditure on health outcomes in Nigeria and Ghana whilst reconceptualizing health outcome by capturing infant, maternal, Malaria and HIV/AIDS mortality. Using the health expenditure commitme ...[more]

PMID: 37383572

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Project description:BackgroundThe effect of number of health items on out-of-pockets (OOPs) has been identified as a source of bias in measuring OOPs. Evidence comes mostly from cross-sectional comparison of different survey instruments to collect data on OOPs. Very few studies have attempted to validate these questionnaires, or distinguish bias arising from the comprehensiveness of the OOPs list versus specificity of OOPs questions.ObjectivesThis study aims to estimate biases arising from the specificity of OOPs questions by comparing provider and household's information.MethodsA generic questionnaire to collect data on household's OOPs was developed following the nomenclature proposed in division 6 of the classification of household final consumption 2018. The four categories within such division are used to set the comprehensiveness of the OOPs list, the specificity within each category was tailored to the design of the nationally representative living standard survey in Ghana where a field experiment was conducted to test the validity of different versions. Households were randomised to 11, 44 or 56 health items. Using data from provider records as the gold standard, we compared the mean positive OOPs, and estimated the mean ratio and variability in the ratio of household expenditures to provider data for the individual households using the Bland-Altman method of assessing agreement.FindingsWe found evidence of a difference in the overall mean ratio in the specificity for OOPs in inpatient care and medications. Within each of these two categories, a more detailed disaggregation yielded lower OOPs estimates than less detailed ones. The level of agreement between household and provider OOPs also decreased with increasing specificity of health items.ConclusionOur findings suggest that, for inpatient care and medications, systematically decomposing OOPs categories into finer subclasses tend to produce lower OOPs estimates. Less detailed items produced more accurate and reliable OOPs estimates in the context of a rural setting.

Project description:BackgroundTraditional and faith healers (TFH) provide care to a large number of people with psychosis in many sub-Saharan African countries but they practise outside the formal mental health system. We aimed to assess the effectiveness and cost-effectiveness of a collaborative shared care model for psychosis delivered by TFH and primary health-care providers (PHCW).MethodsIn this cluster-randomised trial in Kumasi, Ghana and Ibadan, Nigeria, we randomly allocated clusters (a primary care clinic and neighbouring TFH facilities) 1:1, stratified by size and country, to an intervention group or enhanced care as usual. The intervention included a manualised collaborative shared care delivered by trained TFH and PHCW. Eligible participants were adults (aged ≥18 years) newly admitted to TFH facilities with active psychotic symptoms (positive and negative syndrome scale [PANSS] score ≥60). The primary outcome, by masked assessments at 6 months, was the difference in psychotic symptom improvement as measured with the PANSS in patients in follow-up at 3 and 6 months. Patients exposure to harmful treatment practices, such as shackling, were also assessed at 3 and 6 months. Care costs were assessed at baseline, 3-month and 6-month follow-up, and for the entire 6 months of follow-up. This trial was registered with the National Institutes of Health Clinical Trial registry, NCT02895269.FindingsBetween Sept 1, 2016, and May 3, 2017, 51 clusters were randomly allocated (26 intervention, 25 control) with 307 patients enrolled (166 [54%] in the intervention group and 141 [46%] in the control group). 190 (62%) of participants were men. Baseline mean PANSS score was 107·3 (SD 17·5) for the intervention group and 108·9 (18·3) for the control group. 286 (93%) completed the 6-month follow-up at which the mean total PANSS score for intervention group was 53·4 (19·9) compared with 67·6 (23·3) for the control group (adjusted mean difference -15·01 (95% CI -21·17 to -8·84; 0·0001). Harmful practices decreased from 94 (57%) of 166 patients at baseline to 13 (9%) of 152 at 6 months in the intervention group (-0·48 [-0·60 to -0·37] p<0·001) and from 59 (42%) of 141 patients to 13 (10%) of 134 in the control group (-0·33 [-0·45 to -0·21] p<0·001), with no significant difference between the two groups. Greater reductions in overall care costs were seen in the intervention group than in the control group. At the 6 month assessment, greater reductions in total health service and time costs were seen in the intervention group; however, cumulative costs over this period were higher (US $627 per patient vs $526 in the control group). Five patients in the intervention group had mild extrapyramidal side effects.InterpretationA collaborative shared care delivered by TFH and conventional health-care providers for people with psychosis was effective and cost-effective. The model of care offers the prospect of scaling up improved care to this vulnerable population in settings with low resources.FundingUS National Institute of Mental Health.

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Effect of public health expenditure on health outcomes in Nigeria and Ghana.

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Effect of public health expenditure on health outcomes in Nigeria and Ghana.

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