The Most Efficient States for Healthcare in Nigeria
To rank the most efficient states for healthcare in Nigeria we used a modified version of the model used by New York based Common Wealth Fund, a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, young children, and elderly adults.
We used 15 indicators that measure performance in four domains important to policymakers, providers, patients, and the public: Care Process, Access, Equity, and Health Care Outcomes. Our data come from a variety of sources including the National Bureau of Statistics, The Demographic and Health Surveys (DHS) Program and The World Health Organization (WHO). Except where stated, most of the data was from the year 2013.
Performances of the States
Care Process
This was primarily covered three subdomains which were
· Patient Engagement: This was measured by the assessing how many people who visit facilities consider the attitude of the health worker as a barrier for accessing healthcare
· Coordinated Care: This involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient’s care to achieve safer and more effective care. This means that the patient’s needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient. We used rates of antenatal visits, assisted delivery, postnatal visits that were handled by a health professional.
· Preventive Care Measures: This measures the efforts made by the individual states in taking precautions in reduce the toll of diseases have on the population. Such measures include the vaccination rates to prevent communicable diseases, encourage the use of mosquito nets to prevent malaria which is a major cause of death, safe disposal of child stool & knowledge of ORS to tackle diarrhoea, knowledge of HIV preventive methods; and finally knowledge of contraceptives for aid planned pregnancies and reduce maternal deaths due to child birth.
Access
· Affordability: We got total out of pocket (OOP) expenditure per capita for healthcare in Nigeria in the year 2013 from the WHO, we then worked out what percentage it was of the GDP per capita for each state to determine how affordable healthcare was in each of the state when compared to one another. The GDP per capita for the year 2013 for each state was projected by Kingmakers.com.ng and its methodology can be found here.
· Distance to Health Facility: This measured the percentage of the population that said that the distance to the nearest facility was an issue in accessing healthcare from a trained health professional.
Equity
· Lack of Access because of No Money: While GDP per capita might be higher in some states than others and the cost of healthcare might be cheaper, but it might be inaccessible as wealth is not equally distributed. We ranked the states based on the percentage of the population that said that money for health services was a barrier.
Health Outcomes
The life expectancy at birth, child mortality and maternal mortality rates in 2013 was got from Kingmakers.com, who had projected the rates for each of the states in Nigeria.
· Life Expectancy: is a statistical measure of the average time a person is expected to live, based on the year of their birth, their current age and other demographic factors including sex. Life expectancy increases with age as the individual survives the higher mortality rates associated with childhood.
· Child Mortality Rate: also known as under-5 mortality or child death, refers to the death of infants and children under the age of five or between the age of one month to four years depending on the definition.
· Maternal Mortality Rate: The Maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes).
The Results
States were allotted points for each variable based on their relative position in that category’s ranking. The states with the least-performance measure for each variable received 1 point, while the country with the best performance level received 37 points. All other states were scored depending on their position between the two extremes.
Points for the variables were totaled and the total scored again on a percentile basis for a final score from 0 to 100, with a higher score indicating more efficient performance.
