Research Article
Beyond Insurance Enrolment: An Implementation-Constrained Stochastic Health-Financing Model of Out-of-Pocket Spending in Nigeria, 2024-2035
Issue:
Volume 11, Issue 4, December 2026
Pages:
159-168
Received:
6 August 2026
Accepted:
14 August 2026
Published:
9 November 2026
DOI:
10.11648/j.hep.20261104.11
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Abstract: Background: Nigeria's health system remains dominated by direct household payment despite mandatory-insurance legislation. Policy debate often treats enrolment growth as equivalent to financial protection, although the effect of new pooled funds depends on budget execution, provider absorptive capacity and the extent to which prepayment replaces rather than supplements out-of-pocket expenditure. Methods: We developed a dynamic stochastic accounting model using annual Nigeria health-expenditure series for 2000-2023. Correlated mean-reverting processes generated reference trajectories for current health expenditure, domestic government health expenditure, external financing and voluntary prepayment. We simulated four 2024-2035 scenarios: status quo, insurance-led expansion, fiscal expansion and integrated reform. Policy funds were filtered through implementation and substitution parameters. One hundred thousand Monte Carlo trajectories propagated empirical and scenario uncertainty. Primary outcomes were the out-of-pocket share of current health expenditure in 2035 and the probability of reaching 50%, 35% and 20% thresholds. Rolling-origin validation assessed the reference model. Results: In 2023, out-of-pocket payments were 71.9% of current health expenditure and domestic government health expenditure was 0.60% of gross domestic product (GDP). The model's one-step rolling predictions had a mean absolute error of 2.58 percentage points. Median 2035 out-of-pocket shares were 74.0% (95% uncertainty interval [UI] 62.4-81.9) under the status quo, 62.6% (47.6-73.5) under insurance-led expansion, 46.5% (24.5-62.4) under fiscal expansion and 36.5% (9.2-56.0) under integrated reform. The integrated scenario had a 45.0% probability of reaching 35% and a 10.2% probability of reaching 20%. Target-seeking analysis indicated that a 35% share would require median budgeted domestic government health expenditure of 2.27% of GDP (95% UI 1.37-3.69); reaching 20% required 3.01% (1.84-4.83). Conclusions: Enrolment-led reform without commensurate public revenue and implementation capacity is unlikely to deliver financial protection. Nigeria's financing strategy should use the out-of-pocket share as an explicit outcome, link compulsory pooling to supply-side readiness and budget execution, and treat 2.2% of GDP as a plausible but not sufficient integrated-reform test rather than a guaranteed route to the 35% threshold.
Abstract: Background: Nigeria's health system remains dominated by direct household payment despite mandatory-insurance legislation. Policy debate often treats enrolment growth as equivalent to financial protection, although the effect of new pooled funds depends on budget execution, provider absorptive capacity and the extent to which prepayment replaces ra...
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Research Article
Time-Series Econometric Analysis of Factors Associated with Under-Five Mortality in Senegal
Issue:
Volume 11, Issue 4, December 2026
Pages:
169-177
Received:
30 August 2026
Accepted:
9 October 2026
Published:
11 November 2026
DOI:
10.11648/j.hep.20261104.12
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Views:
Abstract: Under-five mortality remains a major public health challenge in sub-Saharan Africa, and Senegal is still far from the Sustainable Development Goal 3.2 target set for 2030. This study examines the factors associated with under-five mortality in Senegal over the period 2000-2023, using twenty-four annual observations drawn from the Demographic and Health Surveys and from official statistics of the National Agency for Statistics and Demography. A multiple linear regression model estimated by ordinary least squares is used. The explanatory variables cover malaria control (insecticide-treated net coverage), residential structure, children’s nutritional status (stunting and acute malnutrition), and maternal human capital (schooling). The model has high explanatory power (R2 = 0.964) and identifies two statistically significant factors with a negative effect on under-five mortality: insecticide-treated net use (β = −0.676; p = 0.003) and maternal schooling (β = −2.575; p < 0.001). The residuals meet the normality and homoscedasticity assumptions, and collinearity among the regressors remains moderate. Ramsey’s specification test points to possible non-linearity, and the trending nature of the series calls for cautious interpretation of the coefficients; the two main effects are nonetheless robust to Newey-West standard errors. The findings support strengthening girls’ education and vector-control programmes as central levers for reducing child mortality, together with sustained investment in health information systems for policy evaluation.
Abstract: Under-five mortality remains a major public health challenge in sub-Saharan Africa, and Senegal is still far from the Sustainable Development Goal 3.2 target set for 2030. This study examines the factors associated with under-five mortality in Senegal over the period 2000-2023, using twenty-four annual observations drawn from the Demographic and He...
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,
Felicia Nonye Egbeh
