Demand For Health Care Services In Nigeria: Implications For Poverty Reduction

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1.1.Background to the study

The poverty problem in Nigeria has been noted to be a growing phenomenon and has widened its breadth and depth in the past few decades embracing more comprehensive conceptualizations. Multidimensional poverty has captured the attention of researchers and policy-makers alike, to the compelling conceptual writings of Sen (1985) and the unprecedented availability of relevant data. (Alkire and Foster, 2008). According to Sen’s (1985, 1992, 1999) theory of capabilities, there is unanimity about the Multidimensional Conception of Poverty and others whose arguments have essentially reshaped the way we think about poverty, going beyond the notion of economic well-being embedded in the traditional approaches (uni-dimensional measure). Poverty is profoundly endemic in many countries especially in less developed countries. In Nigeria, poverty is a reality that depicts the lack of food, clothes, education, and other basic amenities. Severely poor people lack the most basic necessities of life. There are several effects and deficiencies associated with poverty in Nigeria. One of the main effects of poverty is poor medical services, as is reflected in Nigeria’s high infant mortality and low life expectancy. Poor people in Nigeria face several medical issues as they lack basic health amenities and competent medical practitioners. Most children do not have the opportunity of being immunized and this leads to certain physical defects in some of the children, they live with whatever they are provided with, whether healthy or not. The key factors that contribute to poverty in Nigeria as cited in Ucha (2010) are: unemployment, especially among young graduates, corruption, especially among political office holders, non-diversification of the economy, income inequality, laziness, especially among those who come from wealthy households, and a poor educational system.

There have been several reports on poverty trends in Nigeria, that is, on changes in the depth and incidence of poverty over time. For instance, poverty statistics showed that poverty level declined from 46.3 percent in 1985 to 42.7 percent in 1992, and later rose sharply to 65.6 percent of the population in 1996 (Nigeria  Bureau of Statistics, NBS, 1996). However, in absolute terms the population of the poor Nigerians increased four-fold between 1980 and 1996. Also, poverty rate was reduced from 65.8 percent in 1996 to 54.4 percent in 2004 (NBS, 2004). Although there was a drop in poverty rate to 46 percent in 2009 (NBS, 2010), the number of people living in poverty is approximately 70 million (NBS, 2011).

Nigerians in terms of Physical Quality of Life Index (PQLI) value for 2007 is 0.470 ranking 158th among 177 countries, value for 2010 is 0.429 ranking 157th among 187 countries and value for 2011 is 0.459 ranking 156th among 187 countries. Thus, poverty reduction is undoubtedly one of the highest ranking issues in the national strategies of Nigeria which is reflected in Millennium Development Goal (MDG 1).

Table 1.1.  Shows Nigeria’s progress in each of the Human Development Index (HDI) indicators. Between 1980 and 2013, Nigeria’s life expectancy at birth increased by 6.9 years, mean years of schooling increased by 0.2 years and expected years of schooling increased by 2.3 years. Nigeria’s GNI per capita increased by about 25.7 percent between 1980 and 2013.

(UNDP, 2013).

Table 1.1: Nigeria’s HDI trends based on consistent time series data and new goalposts.

Years Life       expectancy

at birth

Expected years schooling of Mean years of


GNI per capita

(2011 PPP$)



198045.66.7  4,259 
198546.48.6  3,202 
199046.16.7  2,668 
199546.17.2  2,594 
200046.68.0  2,711 
200548.79.0 5.03,8300.466
201051.39.0 5.24,7160.492
201151.79.0 5.24,9490.496
201252.19.0 5.25,1760.500
201352.59.0 5.25,3530.504

Source: UNDP, 2013

Source: Author’s computation from UNDP, 2013

Fig. 1.0. Shows Nigeria’s HDI Trends based on consistent data for the periods, 1980 to 2000. From the figure it clearly depicts similarity in Life expectancy at birth for the periods. 45.6 for 1980, 46.4 for 1985, 46.1 for 1990, 46.1 for 1995 and 46.6 for 2000, all within a close percentage.



Source: Author’s computation from UNDP, 2013

Fig. 1.1. Shows Nigeria’s HDI Trends based on consistent data for the periods, 2005 to 2013.

The figure also depicts similarity in Life expectancy at birth for the periods, only for the year 2005, that had a life expectancy at birth of 48.7. The Life expectancy at birth for 2010 was

51.3, 51.7 for 2011, 52.1 for 2012 and 52.5 for 2013.



Fig. 1.2. Line Graph showing Nigeria’s HDI trends based on Mean Years of Schooling, Expected Years of Schooling and Life expectancy from 1980-2013

Source: Author’s computation from UNDP, 2013

Fig.1.2. shows a line graph of Nigeria’s HDI trends based on mean years of schooling, expected years of schooling and life expectancy from 1980-2013. From the line graph, it is shown that mean years of schooling with data from 2005, is almost 100 percent from 2010 to 2013, this could be resulting from the increase in awareness of the importance of education. The Expected years of schooling were at 100 percent in 2005 but came down to around 92 percent in 2010 and maintained that percentage till 2013. Life expectancy was at 88 percent in 1980 and has continued to rise and fall as shown in the line graph with a slight level maintenance from 2005 t0 2013.

The Government of Nigeria has over the years put in place a number of economic reform programmes which have had very minimal impacts on employment creation, poverty reduction and growth of the national economy (Abiola & Oladeji, 1998; Akinbobola & Saibu, 2004; Amaghionyeodiwe, 2009 as cited in Ogunrinola, Oluranti, 2011). Precisely, Structural Adjustment Programme (SAP) was implemented in 1986. Though some benefits were achieved at the initial stage of implementing SAP, such benefits could not trickle down to the poor. Rather, the incidence of poverty increased (Aigbokhan, 1999). Also, adverse macroeconomic shocks that inhibit economic growth and inability of some proposed reforms to tactically address unfavourable macro-economic performances are notable among the factors that contributed to increasing poverty (Aigbokhan, 2000). Other programs embarked upon include National Directorate of Employment (NDE), the Family Support Programme (FSP), the National Agricultural Land Development Agency (NALDA), Family Economic Advancement Programme (FEAP), National Poverty Eradication Programme (NAPEP) and

Directorate for Food, Roads, and Rural Infrastructure (DFRRI) (Osinubi, 2003 as cited in Oyekale, 2011). The programme failed because it had no human face in its implementation. Between 1999 and 2007, the civilian government initiated a number of programmes and policies directed at reducing poverty. The first programme was the Poverty Alleviation Programme (PAP) which was later metamorphosed into the Poverty Eradication Programme (PEP) because of the need to improve participatory approach for sustainability. In the face of the growing concern to sustain the gains of the poverty reduction efforts, the government came up with a comprehensive home-grown poverty reduction strategy known as National Economic Empowerment and Development Strategy (NEEDS) 2004. The NEEDS (2003) as conceptualized is a medium term strategy (2003-2007) which derives from the country’s long term goals of poverty reduction, wealth creation, employment generation and value reorientation which still exist till date.

Multidimensional poverty measures see poverty in terms of the functioning and capabilities of individuals as espoused by Sen (1985). Moreover, it also involves a broader measurement of poverty that goes beyond just income measures. In fact, it entails the measurement of poverty using dimensions as household assets, household characteristics, household welfare, household living environment, and household consumption per capita expenditure, household education, household health conditions, and household nutritional status among others. Poverty measurement is the quantitative assessment of the level and depth of poverty in aggregate for a region or across the world. It is also seen as an index, synthesizing all information available about the poor (Dercon, 2005).

However, broadening our understanding of poverty and the related deprivations helps to produce in-depth poverty profile which describes the overall pattern of poverty and deprivation (Ataguba et al, 2011). Rather than viewing poverty as a result of a lack or lowness of single resource variable or trait, the multidimensional approach weighs in a more comprehensive set of information.



1.2.Statement of Problem

Poverty reduction has been one of the cardinal policy thrusts in Nigeria since independence in 1960. This is one major problem facing this country despite its abundant resources which is enough to tackle this menace; yet positive and significant response to the anti-poverty programmes seems to be a mirage. Over the years, poverty alleviation programmes have been designed to raise people above the poverty line, and control market price of basic commodities. This is because effective poverty alleviation efforts are dependent upon the individual’s ability to accumulate productive assets and wealth. The rationale of the study is to consciously move away from the process of measuring poverty with income as indicator of poverty and concentrate on a more asset-based focus and non-income dimensions. The use of multidimensional framework might actually alter the particular set who are identified to be poor thereby questioning the potency of a uni-directional approach to poverty eradication measures (Qizilbash, 2003).

The lives of people living in poverty are affected by more than just a lack of income. The multidimensional poverty index complements income poverty measures by reflecting the deprivations that each poor person faces all at once with respect to education, health and other aspects of living standards globally. The multidimensional poverty index can be broken down to show a vivid picture of people living in poverty, both across countries, regions and the world but within countries such as Nigeria by ethnic group, urban/rural location, or other key household characteristics.

Previous works on poverty have been uni-dimensional using income or consumption expenditure as the proxy for poverty, for example, Aigbokhan, (1997); Aigbokhan, (2000); Arinze, (1995); Achime et al, (1997); Canagarajah et al, (1997, 2002); Obadan, (1997);

Ogwumike, (2001); Ogwumike et al, (2006); Okumadewa (2006); Onyekale and

Okumadewa, (2008); Van da walle, (1990); World Bank, (1991), and various studies by National Bureau of Statistics all use the uni-dimensional measures.  The current Nigeria National Gini coefficient of 0.42 shows that there is an unequal distribution in monetary terms and little is known about the distribution of other welfare attributes and dimensions such as household assets, health, education, nutrition, living environment, housing environment, consumption per capita expenditure, food accessibility, calories intake, political freedom among others. These uni-directional poverty measures only lead to partial understanding and ineffective poverty reduction programmes. This is because they do not give comprehensive information about the poor especially in terms of other attributes like social welfare and various dimensions mentioned above and this may lead to limited knowledge of the problem since the different dimensions of poverty and the correlates are not certain. However, a multidimensional approach has also been used in certain work recently, through states analysis, for example, Williams (2003), Bibi (2005), Ayala et al (2009), Oyekale et al (2008), Ogunrinola (2011), Ataguba et al (2011). Also some studies have been carried out in other countries like Ghana, Cameroon among others. Some authors however, have researched on multidimensional poverty in Nigeria such as Aigbokhan (2000), Ogwumike (2001) and Ifelunini (2011) using primary data and core welfare data, none of them used Demographic and Health Survey (DHS) data that appears to be richer in terms of coverage and instruments such as household violence which has been very instrumental in recent multidimensional poverty analysis. The use of this survey data (DHS, 2013) gives us more information about multidimensional poverty. Thus, this study exposes us to other dimensions of poverty in order to have a multifaceted approach to alleviating poverty by a better understanding of the various dimensions of poverty in Nigeria like living environment poverty, nutritional poverty, health poverty, asset poverty, violence poverty, and educational poverty which form the bedrock of this research gap using 2013 data from Demographic and Health Survey.

1.3.Research Questions

Against this background therefore, the research questions seeking for plausible answers are thus:

  1. What are the various dimensions of poverty in Nigeria?
  2. What is the nature of the profile of multidimensional poverty in Nigeria?
  3. What are the correlates of multidimensional poverty in Nigeria?

1.4.Objectives of the Study

The broad objective of this work is to study the multidimensionality of poverty in Nigeria using the 2013 Demographic and Health Survey (DHS) data, which is the latest DHS comprehensive survey. Specifically, the study intends to achieve the following:

  1. To determine the poverty level in terms of various dimensions of poverty in Nigeria using DHS
  2. To construct a relevant poverty profile of various dimensions of poverty in Nigeria by groups identified in objective 1
  3. To identify the correlates of various dimensions of poverty in Nigeria

1.5.Research hypothesis

The study is guided by the following hypotheses:

  1. The various dimensions among poverty measures are not statistically significant
  2. The correlation among poverty measures are not statistically significant

1.6.Scope of the study

This study is limited to the Nigerian economy, and intends to know the level of poverty from a multidimensional perspective. Here, the study appraises a multidimensional poverty measurement for Nigeria using Demographic and Health Survey (DHS, 2013). The survey covers such non-monetary dimensions as living environment poverty, nutritional poverty, health poverty, violence poverty, and Assets poverty under various groups as sector, gender of head, age, region, religion, household size and education.

1.7.Justification for the Study

Empirically, a multidimensional measure of poverty is more useful in the general assessment of individual well-being. They address the policy outcomes of poverty rather than the means of income (inputs). In the light of these, this study will be very informative in the understanding of multidimensional poverty measurement in Nigeria. Also, the study will add to the contemporary methodological debate that is on-going in the poverty measurement circle. The poverty analyses will help to deepen our understanding on its various causes in Nigeria. Moreover, it will help the national measures such that governments can tailor the multidimensional poverty index to the indicators and cut-offs that are most appropriate in Nigeria and use it to complement income poverty. Also, the Non-Governmental organizations,  NGOs and private sectors will use it to monitor and account for the impacts of their work.

The result of the study will be useful to the National Planning Commission (NPC), International donor agencies, United Nation, and governments of Nigeria, who are faced with a myriad of poverty indices.

In addition, the expected result of this study will assist researchers through the provision of framework on which further research can be carried out; and an exposition to various deprivation (poverty) dimensions other than the traditional and conventional approach.

Therefore, with the assessment on how different multidimensional poverty measure correlates with each other in Nigeria, policy makers can understand the main causes of poverty and identify socio-economic policies to reduce its spread.

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