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Are the poor differentially benefiting from provision of priority public health services? A benefit incidence analysis in Nigeria

Obinna Onwujekwe12*, Kara Hanson3 and Benjamin Uzochukwu124

Author Affiliations

1 Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu-Campus, PMB 01129, Enugu, Nigeria

2 Department of Health Administration and Management, University of Nigeria Enugu-Campus, Enugu, Nigeria

3 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom

4 Department of Community Medicine, College of Medicine, University of Nigeria Enugu-Campus, Enugu, Nigeria

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International Journal for Equity in Health 2012, 11:70  doi:10.1186/1475-9276-11-70

Published: 16 November 2012



The paper presents evidence about the distribution of the benefits of public expenditures on a subset of priority public health services that are supposed to be provided free of charge in the public sector, using the framework of benefit incidence analysis.


The study took place in 2 rural and 2 urban Local Government Areas from Enugu and Anambra states, southeast Nigeria. A questionnaire was used to collect data on use of the priority public health services by all individuals in the households (n=22,169). The level of use was disaggregated by socio-economic status (SES), rural-urban location and gender. Benefits were valued using the cost of providing the service. Net benefit incidence was calculated by subtracting payments made for services from the value of benefits.


The results showed that 3,281 (14.8%) individuals consumed wholly free services. There was a greater consumption of most free services by rural dwellers, females and those from poorer SES quintiles (but not for insecticide-treated nets and ante-natal care services). High levels of payment were observed for immunisation services, insecticide-treated nets, anti-malarial medicines, antenatal care and childbirth services, all of which are supposed to be provided for free. The net benefits were significantly higher for the rural residents, males and the poor compared to the urban residents, females and better-off quintiles.


It is concluded that coverage of all of these priority public health services fell well below target levels, but the poorer quintiles and rural residents that are in greater need received more benefits, although not so for females. Payments for services that are supposed to be delivered free of charge suggests that there may have been illegal payments which probably hindered access to the public health services.

Benefit-incidence- analysis; Public health services; BIA; Equity; Nigeria