In recent years, Sub-Saharan Africa (SSA) has seen a significant shift in its health landscape. While infectious diseases have long dominated the region’s health concerns, the World Bank projects that by 2030, non-communicable diseases (NCDs) will surpass infectious diseases as the leading cause of mortality in Africa.
This shift shows a growing public health challenge, as NCDs not only contribute to premature deaths but also lead to chronic disabilities that strain individuals and economies alike.
In 2019, NCDs accounted for 167 million disability-adjusted life years (DALYs) lost in Africa, slightly surpassing the 164 million DALYs lost to infectious diseases. In Nigeria, this epidemiological transition is particularly evident.
Nearly 30% of all deaths in the country are attributed to NCDs, with cardiovascular diseases (CVDs), cancers, respiratory diseases, and diabetes posing significant risks. The DALYs lost to NCDs in Nigeria surged by 21.3% from 2010 to 2019, while those lost to infectious diseases decreased by 6.5%. If this trend continues, NCDs will soon overshadow infectious diseases in terms of DALYs lost.
Economic Burden and Out-of-Pocket Expenditures
One of the less visible but equally critical aspects of NCDs is the financial burden they impose on households. In Nigeria, out-of-pocket (OOP) healthcare expenditure for NCDs places a significant strain on families. In 2017, Nigerian households spent ₦384.4 billion (US$1.26 billion) on NCDs, with public expenditure covering only 25.6% of this amount.
Consequently, households bore 74.4% of the healthcare costs for NCDs out-of-pocket. This financial burden often leads to catastrophic health expenditure (CHE), where healthcare costs exceed a substantial portion of a household’s income, forcing cutbacks on essential needs like food. Additionally, these expenditures can push families below the poverty line or further into poverty.
The economic repercussions of NCDs extend beyond healthcare costs. Productivity loss due to hospitalizations, chronic disabilities, and premature deaths also significantly impacts the economy.
Studies show that Nigeria accounts for 50.9% of productivity losses due to illness in low- and middle-income countries (LMICs), with nearly 40% of this loss attributed to NCDs. This economic toll exacerbates poverty and hampers economic growth.
The Devastating Financial Impact of NCDs on Nigerian Households
Understanding the full economic impact of NCDs requires comprehensive data and robust methodologies. However, research on the economic burden of NCDs in Nigeria is limited. Existing studies often have small sample sizes, outdated data, and do not cover all relevant NCDs.
For example, conditions like mental health disorders, musculoskeletal diseases, and endocrine disorders are frequently overlooked despite their significant contribution to DALYs. Moreover, there is a lack of quality research in SSA on the economic burden of diseases, especially NCDs.
A recent study sampled 22,200 households using data from the Nigerian Living Standard Survey (NLSS). The study revealed that on average, households affected by NCDs spend ₦122,313.60 (approximately $398.52) annually on healthcare, which accounts for about 24% of their food expenditure or 18.7% of Nigeria’s 2018 GDP per capita.
This expenditure is consistent with other findings from Southwestern Nigeria, where monthly OOP payments for NCDs range between $46 and $417. Specific conditions like cancer, mental health issues, and renal diseases incur especially high costs, sometimes exceeding $3,889.40 per year for cancer treatment alone.
These expenditures often exceed the threshold for catastrophic health expenditure (CHE), defined as spending more than 20-29% of income on healthcare.
The study found that about 30% of NCD-affected households experienced CHE, which aligns with previous research indicating significant financial hardship due to healthcare costs. The high costs of NCD medications further exacerbate the financial strain, driving many households into poverty.
Economic and Productivity Losses
The economic impact of NCDs extends beyond direct healthcare costs. The study found that individuals with NCDs lose an average of 58.51 workdays per year, leading to substantial productivity losses. This translates to significant income loss, estimated between 15-18.9% in previous studies. Such productivity losses not only affect individual households but also have broader implications for Nigeria’s economy.
Geographic and Socioeconomic Disparities
The burden of NCDs and associated CHE varies across different regions and socioeconomic groups in Nigeria. Rural areas and states like Ebonyi, Sokoto, Adamawa, Zamfara, and Jigawa are particularly affected due to high NCD prevalence, limited healthcare access, and higher poverty rates. Additionally, ongoing conflicts and internal displacement in the North East contribute to the region’s healthcare challenges.
Policy Implications and Recommendations
The study highlights the need for targeted policies to address the rising burden of NCDs in Nigeria. Recommendations include:
- Strengthening Public Healthcare: Increasing public expenditure on healthcare services, particularly for costly NCDs such as cancer, renal diseases, and mental health conditions.
- Expanding Health Insurance: Implementing universal health coverage to reduce OOP expenditures and financial hardship for vulnerable populations.
- Promoting Preventive Care: Integrating NCD prevention programs into primary healthcare and focusing on community-level interventions.
- Addressing Socioeconomic Inequalities: Implementing social income transfer programs to improve healthcare access for impoverished households and reduce economic disparities.
Related Article: Bridging Healthcare Gaps in Rural Nigeria: Strategies for Better Access and Quality
Bottom Line
NCDs are a growing public health and economic challenge in Nigeria. Addressing this issue requires a comprehensive approach that includes improving healthcare access, increasing public funding, and implementing targeted interventions to support vulnerable populations. By taking these steps, Nigeria can mitigate the financial and productivity losses associated with NCDs and improve overall health outcomes.
