IMPLICATION OF ECONOMIC RECESSION ON THE ACCESSIBILITY TO HEALTH CARE SYSTEM IN NIGERIA (A FOCUS ON THE TINUBU ADMINISTRATION)

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Health continues to be a fundamental aspect of human existence, especially during times of economic distress (Abiola et al., 2019). Prior to the ongoing economic crisis, many modern societies, particularly in third world countries, were still grappling with widespread illness epidemics. Meanwhile, other nations consistently faced the persistence of certain diseases, impacting millions of lives (Yusuf, 2022). The ongoing economic crisis in Nigeria and other developing nations is causing a further decline in the structure and functioning of the healthcare sector.

The economic crisis in Nigeria has had a negative impact on multiple areas of the economy, including the health sector. This has resulted in decreased productivity, subpar service delivery, and unfavourable health outcomes. The Nigerian health system is facing challenges in delivering basic healthcare services despite the combined efforts of the three levels of government. However, the current status of the Nigerian economy makes it difficult to attain this goal (Shobowale et al., 2023). The prevailing economic conditions in Nigeria have had a negative impact on the financing and funding of public healthcare. As a result, both public and private healthcare institutions, particularly those serving the rural poor, have experienced a decrease in patronage. This may be attributed to the rising levels of poverty and deprivation in the country (Ekpo, 2024). Although economic recession can significantly impact health outcomes, it also presents an opportunity for intentional government health reforms to enhance the functioning of the health system (Anya, 2021).

Health is intricately connected to various areas, including food security and nutrition, household income generation, housing, education, employment status, and other social security services (Ekpo, 2024). Health is a crucial area in every political system. During an economic recession, vulnerable populations, including the rural and urban poor, individuals with disabilities, Internally Displaced Persons (IDPs), pregnant women, children, and the elderly, face significant challenges in accessing healthcare. Health Care Financing and Organisation (2023) states that an economic recession can influence the cost and availability of healthcare, financial access to medical services, existing health policies, and health outcomes.

It is widely known that Nigeria is currently experiencing an economic recession. What is noteworthy, however, is her manner of emerging from it.  The decrease in economic activity affects all aspects of life, including business, technology, industry, education, health, and more (Ekpo, 2024). It is important for us to analyse the impact of the recession on the public's ability to get healthcare. The National Bureau of Economic Research (NBER, 2018) has defined a recession as a substantial decrease in economic activity that affects various sectors of the economy and lasts for more than a few months. This decline is typically observed in indicators such as real gross domestic product (GDP), real income, employment, industrial production, and wholesale-retail sales. An economic recession is characterised by a sequential decline in the real GDP growth rate for two quarters, often the first and second quarters. Based on the criteria provided above, it can be inferred that Nigeria is now undergoing an economic recession. According to the BBC (2024), Nigeria, which has the largest economy in Africa, is currently experiencing an economic crisis. The nation has experienced severe inflation and a currency crisis due to a failed currency redesign, the elimination of fuel subsidies, and the implementation of a currency float. These events have had significant and widespread implications.

The health care system in Nigeria is primarily financed through out-of-pocket spending. As stated by Chudi et al. (2023), out-of-pocket expenditure refers to the average amount of money paid by individuals for the healthcare services they receive at a medical facility. This payment encompasses the costs associated with the consultation, treatment, laboratory services, and procurement of medications. For patients who are admitted to the hospital, out-of-pocket expenses encompass the costs associated with medical bills, meals, and specialised medications (Akpan et al., 2021). When public health facilities are excessively crowded or provide inadequate service, individuals opt to utilise private health facilities, which necessitates them to pay a higher cost for services. In addition to the essential costs incurred within the hospital, out-of-pocket expenditure on health also includes expenses for transportation, nutrition, and the purchase of other basic necessities (Olayemi et al., 2019). During an economic recession, the amount of money spent directly from one's own funds on healthcare increases by two or three times (Femi et al., 2022).

Nigeria's healthcare system, while being a major economy in Africa, suffers from issues such as limited budget, inadequate healthcare facilities, a scarcity of medical personnel, and unsatisfactory healthcare outcomes (Ekpo, 2024). These problems are worsened by economic recessions, which put additional pressure on the already delicate healthcare system. The Bola Ahmed Tinubu administration, which commenced in May 2023, inherited these difficulties in the midst of economic uncertainty. This study aims to examine the impact of economic recession on the availability of healthcare in Nigeria under President Tinubu's administration and propose strategic solutions to improve healthcare services for the population.

1.2 Statement of the Problem

Economic recessions are defined as substantial periods of economic contraction, usually characterised by a decrease in gross domestic product (GDP), an increase in unemployment rates, and a reduction in both consumer and corporate confidence (CBN, 2017). These economic declines have wide-ranging consequences, impacting diverse sections of society. The healthcare system is frequently adversely affected during economic recessions. Access to healthcare services can be significantly limited, especially for marginalised people. In Nigeria, this matter is of utmost importance, considering the country's current difficulties with healthcare facilities and services.

Undoubtedly, during times of economic recession, there is a noticeable increase in prices for most goods and services in the broader market. Similarly, within the healthcare industry, there is a phenomenon of inflation affecting commodities like medications (Segun et al., 2022). As a result, individuals may be more susceptible to purchasing low-quality or fake medications from retail sellers because of their affordability. This could have adverse effects on individuals' health and significantly contribute to the country's dismal health indicators. Given the exorbitant expenses associated with conventional treatment, individuals may opt for self-medication using traditional or local herbs as a viable alternative to maintain their well-being and survival.  According to Ekpo (2024), the health care sector is plagued by insufficient funding, which is the primary catalyst for enhancing service delivery. The funds supplied to the health sector are utilised for many purposes such as improving infrastructure, procuring medications and medical equipment, maintaining hospital administration and facilities, compensating auxiliary staff, and implementing projects and programmes (Oriaku et al., 2024). Insufficient funds in this scenario hinder the successful completion of certain obligations. Consequently, the health sector's ability to function effectively is contingent upon the presence of a sufficient finance mechanism. The annual government budget would also be impacted during an economic recession, resulting in a decrease in the cash given to the sector. In Nigeria, the financial allocation to the health sector decreased significantly from 258 billion Naira in 2016 to 51 billion Naira in 2017 due to the economic slump experienced in 2016 (Gbenga et al., 2018).

When hospital staff and health care professionals are not paid their pay, salary, incentives, and allowances, their motivation to provide high-quality service is typically diminished. This is the primary reason why healthcare workers occasionally go on frequent and continuous strikes. Ogunbanjo (2018) noted that enhanced compensation and improved working conditions are significant factors contributing to industrial action among healthcare workers. Occasionally, the remuneration and bonuses provided might not align with the job responsibilities of employees, potentially impacting their job performance. In order for an efficient healthcare system to develop, healthcare providers must be adequately incentivized by an increase in pay, particularly during times of economic recession (Ijimakinwa et al., 2023). Failure to address this issue may lead to neglect of responsibilities, negative attitude towards clients, inadequate reaction to emergencies, higher incidence of corruption and fraudulent activities, and so on. This study aims to investigate the influence of economic recession on the accessibility of healthcare in Nigeria during President Tinubu's administration.

Objectives of the study

The primary objective of this study is to critically investigate the implication of economic recession on the accessibility to health care system in Nigeria (a focus on the Tinubu administration). Specific objectives of this study are to:

To assess the impact of economic recession on healthcare funding 

To evaluate the challenges healthcare facilities face in providing services during economic recession under President Tinubu administration

To offer strategies to enhance healthcare system resilience to economic fluctuations.

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What is the impact of economic recession on healthcare funding?

What are the challenges healthcare facilities face in providing services during economic recession under President Tinubu administration?

What are the strategies to enhance healthcare system resilience to economic fluctuations?

1.6 Significance of the study

The study's importance rests in its capacity to provide insights for enhancing policy, addressing socio-economic inequalities in healthcare access, strengthening public health resilience during economic downturns, and contributing to academic understanding in health economics and policy analysis.

This study aims to analyse the impact of economic recessions on healthcare accessibility, with the goal of shedding light on the efficacy of healthcare policies and interventions during periods of economic decline. This assessment can provide guidance for future policy-making procedures aimed at improving healthcare resilience. This work can make a valuable contribution to the creation of effective methods to reduce the adverse impact of economic recessions on healthcare accessibility by suggesting policy recommendations that are supported by empirical evidence. These guidelines can provide guidance to decision-makers and stakeholders in the healthcare industry.

Moreover, comprehending the impact of economic recession on the maintenance, expansion, and accessibility of healthcare infrastructure can identify specific areas that require investment or policy modifications. Acquiring this knowledge is essential for maximising the efficiency of resource distribution in healthcare planning.

During periods of economic decline, there is a tendency for existing inequalities in healthcare access to become more severe. This study can provide insights into the disparate impacts experienced by various socio-economic groups, therefore pushing for the implementation of more equitable healthcare policies and initiatives. Examining the influence of economic recession on public health outcomes, such as the incidence of diseases and mortality rates, can offer valuable evidence regarding the wider health consequences of economic policies. Comprehending this is crucial for formulating efficient public health tactics amongst economic downturns.

 Moreover, this study contributes to the academic discourse on economic recessions and their impact on vulnerable populations, particularly in the context of developing countries like Nigeria. This paper fills a void in the existing literature by presenting empirical evidence from the Tinubu administration, offering a contemporary perspective on the subject matter. The findings can serve as a benchmark for future research and comparative analysis in similar situations. 

1.7 Scope of the study

Broadly, this study focus is to critically investigate the implication of economic recession on the accessibility to health care system in Nigeria (a focus on the Tinubu administration). 

The study will be carried out among selected primary healthcare in Ogun State.

1.8 Limitations of the study

Like in any human attempt, the researchers encountered several small limits during the investigation. The primary constraint was the scarcity of comprehensive literature on the topic, as there is a paucity of data regarding implication of economic recession on the accessibility to health care system in Nigeria (a focus on the Tinubu administration). Therefore, a substantial investment of time and effort was required to find the suitable materials, books, or information and collect data. 

Moreover, this study is limited by its limited sample size and restricted geographical reach, namely concentrating just on Nigeria. Hence, the findings of this study cannot be extrapolated, thereby necessitating additional research. 

Furthermore, the researcher's limitations were predominantly attributable to budgetary restraints, as they are a student and lack a means of financial support. The research location's transportation charges were difficult to afford due to the exorbitant cost of transportation, which is directly impacted by the current inflation in Nigeria.

In addition, the researcher encountered a time limitation as a result of having to conduct this research while simultaneously meeting the responsibilities of attending lectures and engaging in other educational pursuits.

1.9 Definition of terms

Economic recession: Economic recession as: "a significant decline in economic activity spread across the economy, lasting more than a few months, normally visible in real GDP, real income, employment, industrial production, and wholesale-retail sales

Inflation: Inflation is the rate of increase in prices over a given period of time. Inflation is typically a broad measure, such as the overall increase in prices or the increase in the cost of living in a country.