Inequities in Household Out-Of-Pocket Spending Among Urban Slum Dwellers in Southeast Nigeria

Objectives: This study examines the economic burden and inequities in out-of-pocket expenditures (OOPEs) to access healthcare in urban slums in Nigeria.

Methods: The cross-sectional study was undertaken in eight urban slums in Enugu and Anambra, Nigeria. Participants (n = 1,025) responded to questions on health expenditures and access to healthcare. Gamma regression was used to estimate the mean differences in OOPE. Financing incidence analysis was used to estimate inequities in OOPE.

Results: Enugu residents and individuals with formal occupations incurred lower costs than the residents in Anambra and those employed in informal occupations. Households in the middle wealth quintile incurred higher costs than those in the poorest quintile. Gini, concentration, and Kakwani indices indicated a progressive financing system, with the richest contributing proportionately more than their share of ability to pay (ATP). Poorest households used informal healthcare more.

Conclusion: Although payment for healthcare in urban slums is progressive, the poorest households may be at risk of poor health outcomes due to reliance on informal healthcare providers. Our findings highlight the role ATP may play in healthcare denial among the urban poor.