ECONOMIC POLICY AND PUBLIC HEALTH OUTCOMES: ANALYZING THE IMPACT OF GOVERNMENT SUBSIDIES ON ACCESS TO AFFORDABLE HEALTHCARE SERVICES IN SOUTH EAST NIGERIA

Abstract

Nigeria records one of the highest out-of-pocket (OOP) health expenditures globally, reaching approximately 71.9% of current health expenditure in 2023. This financing structure imposes a heavy burden on poor and informal-sector households. To address this challenge, the federal government activated the Basic Health Care Provision Fund (BHCPF) under the National Health Act 2014, while Anambra, Enugu, and Ebonyi States introduced complementary subsidy programmes, including health insurance schemes and free maternal and child health services. This study evaluated the impact of these government subsidies on access to affordable healthcare and selected public health outcomes in the three states from 2018 to 2025. Employing a mixed-methods sequential explanatory design, the research surveyed 1,200 households, assessed 110 health facilities, conducted 36 key informant interviews, and held 12 focus group discussions. Findings revealed modest but meaningful improvements in service utilisation, especially antenatal care and institutional deliveries in areas supported by insurance schemes. Propensity score matching estimates showed that access to subsidized facilities reduced catastrophic health expenditure by 12–18 percentage points among enrollees. However, overall health insurance coverage remained below 5% in most communities, while stock-outs, informal fees, and delayed fund releases continued to limit financial risk protection. Benefit incidence analysis indicated pro-rich bias in urban areas, with rural and poorest quintiles deriving fewer benefits from supply-side subsidies. The study concludes that government subsidies have produced positive, albeit limited, effects on healthcare access and financial protection. It recommends a hybrid framework that strengthens demand-side insurance, improves supply-side financing, and incorporates targeted equity mechanisms.