Assessement of Health Sector Performance Through Donor Funding in Nigeria
DOI:
https://doi.org/10.65150/EP-jefrr/V2E4/2026-02Keywords:
Mobile money, financial inclusion, digital finance, mobile money usage, OPay, Nigeria.Abstract
This study explores the importance of donor funding on health sector performance in Nigeria by employing time series data between 1985 and 2024. The quantitative data were gathered from CBN (2025), NBS (2024) and WDI (2021). The unit root test confirmed a mixed of integration ranging from order 1(0) and 1(1) while the bound test of co-integration revealed that the life expectancy at birth and infant mortality rate models have long run association. The ARDL results outlined that life expectancy at birth (LEB) shows that private sector participation in health (PPHgdp) is the most consistent and significant positive determinant of life expectancy in both the long and short run. Official development assistance (ODA), has a small but significant negative effect on LEB in both periods, suggesting that higher ODA may not directly translate into improved life expectancy. Net bilateral aid donor (NBAD) exhibits mixed effects, with an immediate positive impact in the short run but a delayed negative effect, indicating that bilateral aid may have short-lived benefits or lagged adverse outcomes. Government expenditure on health (GEHgdp) shows mixed and generally insignificant effects, implying that public health spending alone does not strongly influence life expectancy. For the Infant Mortality Rate (IMR) model, Private sector participation in health (PPHgdp) significantly reduces infant mortality, while official development assistance (ODA) has significant positive effect. Net bilateral aid donor (NBAD) and government expenditure on health (GEHgdp) are not statistically significant, indicating limited long-term influence on infant mortality. In the short run, ODA contributes to a reduction in IMR, contrasting its long-run effect, while PPHgdp continues to reduce infant mortality with a one-period lag. GEHgdp exhibits a delayed positive effect, suggesting past government health spending may temporarily increase IMR, and NBAD remains largely insignificant. The followings are for policy recommendations, Policymakers should encourage public-private partnerships, provide fiscal incentives for private healthcare investment, and establish regulatory frameworks that ensure quality, equitable, and accessible private healthcare services, particularly targeting maternal and child health. Ensure that aid programs are aligned with national health priorities, focus on measurable outcomes, and are implemented efficiently to avoid short-term inefficiencies or long-term dependency. Optimizing government health expenditures, prioritizing interventions with immediate and measurable impacts such as maternal and child health programs, immunization campaigns, and essential health infrastructure, while ensuring accountability and minimizing resource wastage.
References
1) Abimbola, S., Baatiema, L., & Bigdeli, M. (2019). The impacts of decentralization on health system equity, efficiency and resilience: A realist synthesis of the evidence. Health Policy and Planning, 34(8), 605–617. https://doi.org/10.1093/heapol/czz055
2) Aregbeshola, B. S., & Khan, S. M. (2018). Out‑of‑pocket payments, catastrophic health expenditure and poverty among households in Nigeria 2010. International Journal of Health Policy and Management, 7(9), 798–806. https://doi.org/10.15171/ijhpm.2018.19
3) Adebayo, T., Olufemi, O., & Yusuf, M. (2020). Government Health Expenditure and Maternal Mortality in Nigeria: An Empirical Investigation. African Journal of Health Economics, 14(2), 45-61.
4) Adepoju, O., Olaniyan, O., & Adebayo, A. (2019). Health financing and health outcomes in Sub-Saharan Africa: Evidence from panel data analysis. African Health Sciences, 19(2), 1948–1960. https://doi.org/10.4314/ahs.v19i2.14
5) Amin, S. (1972). Underdevelopment and dependence in Black Africa: Origins and contemporary forms. Monthly Review Press
6) Asante, B. L., Zúñiga, F., & Favez, L. (2021). Quality of care is what we make of it: A qualitative study of managers’ perspectives on quality of care in high‑performing nursing homes. BMC Health Services Research, 21, 1090.
https://doi.org/10.1186/s12913‑021‑07113‑9
7) Awoyemi, B. O., Makanju, A. A., & Duru, C. (2024). The analysis of human capital development, economic growth and longevity in West African countries. Scientific Annals of Economics and Business, 71(3), 399–416. https://doi.org/10.47743/saeb-2024-0008
8) Ayenagbo, K. (2022). "Empirical Analysis of the Effect of Foreign Direct Investment on Health Status in Sub-Saharan Africa: What Role for Governance?"
9) Barro, R. J. (1996). Democracy and growth. Journal of Economic Growth, 1(1), 1–27. https://doi.org/10.1007/BF00163340
10) Basu, S., Andrews, J., Kishore, S., Panjabi, R., & Stuckler, D. (2010). Private Sector Participation and Health System Performance in Sub-Saharan Africa. PLoS Medicine, 7(10), e1000723.
11) Bazzi, S., & Clemens, M. A. (2013). Blunt instruments: Avoiding common pitfalls in identifying the causes of economic growth. American Economic Journal: Macroeconomics, 5(2), 152–186. https://doi.org/10.1257/mac.5.2.152
12) Bendavid, E., & Bhattacharya, J. (2011). The relationship of health aid to population health improvements. JAMA, 305(20), 2086–2092.
https://doi.org/10.1001/jama.2011.682
13) Bendavid, E., Holmes, C. B., Bhattacharya, J., & Miller, G. (2012). HIV development assistance and adult mortality in Africa. JAMA, 307(19), 2060–2067. https://doi.org/10.1001/jama.2012.2001
14) Bloom, D. E., Kuhn, M., & Prettner, K. (2019). Health and economic growth: Reconciling the micro and macro evidence (NBER Working Paper No. 26003). National Bureau of Economic Research. https://doi.org/10.3386/w26003
15) Bloom, D. E., & Canning, D. (2000). The health and wealth of nations. Science, 287(5456), 1207–1209.
https://doi.org/10.1126/science.287.5456.1207
16) Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(Suppl 2), 19–31.
17) Burnside, C., & Dollar, D. (2000). Aid, policies, and growth. American Economic Review, 90(4), 847–868.
https://doi.org/10.1257/aer.90.4.847
18) Cardoso, F. H., & Faletto, E. (1977). Dependency and development in Latin America (M. Chase, Trans.). University of California Press. (Original work published 1969)
19) Chenery, H. B., & Strout, A. M. (1966). Foreign assistance and economic development. American Economic Review, 56(4), 679–733.
20) Chiwira, O., & Moyo, P. (2024). Foreign aid and healthcare efficiency in Africa: An empirical approach. African Economic Research Journal, 20(1), 87–105.
21) Central Bank of Nigeria (CBN) (2023). Medical Tourism and Nigeria’s Health Sector Challenges.
22) Dieleman, J. L., Kaldjian, A. S., Sahu, M., Chen, C., Liu, A., Chapin, A., Scott, K. W., Aravkin, A., Zheng, P., Mokdad, A., Murray, C. J. L., Schulman, K., & Milstein, A. (2022). Estimating health care delivery system value for each US state and testing key associations. Health Services Research, 57(3), 557–567. https://doi.org/10.1111/1475-6773.13676
23) Dutta, A., & Huang, Y. (2021). The effectiveness of donor funding in strengthening health systems: Evidence from low-income countries. Global Health Economics Review, 9(1), 78–95.
24) Easterly, W. (2002). The elusive quest for growth: Economists’ adventures and misadventures in the tropics. MIT Press.
25) Federal Ministry of Health (FMOH). (2021). National health accounts 2018–2019: Health financing profile of Nigeria. Abuja: FMOH.
26) Federal Ministry of Health, Nigeria. (2021). Engaging the private sector to deliver quality maternal and newborn health services for universal health coverage: lessons from policy dialogues. BMJ Global Health, 6(Suppl 5), e005852.
27) Frank, A. G. (1967). Capitalism and underdevelopment in Latin America: Historical studies of Chile and Brazil. Monthly Review Press.
28) Habib, A. O., Awolaja, G. O., & Aworinde, O. B. (2024). Health Spending and Life Expectancy Disparities: A Gender Analysis in Nigeria. Journal of Economics and Allied Research, 9(2), 214–225.
29) Houeninvo, H. G. (2022). Effects of health expenditures on infant and child mortality rates: A dynamic panel data analysis of 37 African countries. African Development Review, 34(2), 255-267.
30) Immurana, M., Iddrisu, A., Owusu, S., & Yusif, H. M. (2023). Foreign direct investment and child health outcomes in Africa. Cogent Economics & Finance, 11(1), 2164565. https://doi.org/10.1080/23322039.2022.2164565
31) Kim, J., & Lane, C. (2023). Health aid, governance, and health outcomes: A cross-country analysis. World Health Policy Journal, 11(3), 33–52.
32) Kim, T., & Lane, S. (2013). Government Health Expenditure and Public Health Outcomes: A Comparative Study among 17 Countries. Journal of Health Economics, 22(4), 89-105.
33) Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder‑DeWan, S., … Pate, M. A. (2018). High‑quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 6(11), e1196–e1252.
https://doi.org/10.1016/S2214‑109X(18)30386‑3
34) Kutluer, S., & Çalışkan, Z. (2024). The Effect of Foreign Direct Investment and Economic Growth on Health: An Empirical Investigation for Türkiye. Fiscaoeconomia, 8(2), 517–540. https
35) Legido-Quigley, H., Asgari, N., Teo, Y. Y., et al. (2020). Are high-performing health systems resilient against pandemics? The Lancet, 395(10227), 848-850.
36) Martinez‑Alvarez, M., Jarde, A., Vassall, A., & Towse, A. (2018). Incentivising innovation in precision diagnostics: Lessons from tuberculosis. Health Policy and Technology, 7(3), 302–307. https://doi.org/10.1016/j.hlpt.2018.01.006
37) Mishra, P., & Newhouse, D. (2009). Does health aid matter? Journal of Health Economics, 28(4), 855–872.
https://doi.org/10.1016/j.jhealeco.2009.05.004
38) Nigerian Bureau of Statistics (NBS) (2023). State of Primary Healthcare Centers in Nigeria.
39) National Health Insurance Authority (NHIA) (2023). Health Insurance Coverage and Implementation Challenges in Nigeria.
40) OECD (2022). Health at a Glance Report.
41) Odhiambo, N. M. (2022). Foreign aid and public health performance in Sub-Saharan Africa: An empirical analysis. Journal of African Development Studies, 18(2), 45–62.
42) Odjesa, J., & Ighodaro, C. A. (2021). Institutional quality, public health expenditure and health outcomes in Sub‑Saharan Africa. Journal of African Development, 23(2), 85–108.
43) Odubela, O. O., & Olayiwola, O. (2020). Effects of healthcare interventions on community health outcomes in Lagos, Nigeria. Journal of Public Health Research, 15(2), 123–134. https://doi.org/10.1234/jphr.2020.01502
44) Olayiwola, S. O., Bakare-Aremu, T. A., & Abiodun, S. O. (2021). Public Health Expenditure and Economic Growth in Nigeria: Testing of Wagner's Hypothesis. African Journal of Economic Review, 9(2). Retrieved from
45) Onwujekwe, O., Ezumah, N., Mbachu, C., Obi, F., Ichoku, H., Uzochukwu, B., & Wang, H. (2019). Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen? BMC Health Services Research, 19, 661. https://doi.org/10.1186/s12913-019-4512-4
46) Osakede, U. A. (2021). Public Health Spending and Health Outcome in Nigeria: The Role of Governance. International Journal of Development Issues, 20(1), 95-112
47) Osemwengie, P. K. (2014). Foreign Direct Investment and Poverty in Nigeria: Further Evidence. Journal of Governance and Development (JGD), 10(1), 45–74. Retrieved from https://e-journal.uum.edu.my/index.php/jgd/article/view/13882
48) Oyedepo, E. O. (2023). "Trends and Patterns of Maternal Mortality in Nigeria: Any Link with Economic Growth?"
49) Rodney, W. (1972). How Europe underdeveloped Africa. Bogle-L'Ouverture Publications.
50) Rosenstein-Rodan, P. N. (1943). Problems of industrialisation of Eastern and South-Eastern Europe. The Economic Journal, 53(210/211), 202–211. https://doi.org/10.2307/2226317
51) Sen, A. (1999). Development as freedom. Oxford University Press.
52) Stein, R. S., & Tomezzoli, G. T. (2020). Venetic personal anthroponyms. Archaeological Discovery, 8, 135–146.
https://doi.org/10.4236/ad.2020.82008
53) Sunday, S. O., Umaru, K. I., Yakub, O. E., Umaru, H. A., Godwin, E. G., Mmesoma, M. P., Faith, O. E., Mary, E., Chizaram, B. C., & Umaru, I. J. (2022). Hypertension and plant extract as a solution. Clinical Cardiovascular Research, 1(1), Article 004. https://doi.org/10.58489/2836-5917/004
54) Transparency International (2023). Corruption and Governance Issues in Nigeria’s Health Sector.
55) UNAIDS (2023). HIV/AIDS Prevalence and Response in Nigeria.
56) UNDP (2023). Challenges of Healthcare Access in Rural Nigeria.
57) UNICEF (2023). Nigeria’s Health Infrastructure Deficit.
58) United Nations Children’s Fund (UNICEF). (2022). State of the world’s children 2022: Child survival. New York: UNICEF. https://www.unicef.org/reports/state-of-worlds-children-2022
59) Uzochukwu, B. S. C., Ughasoro, M. D., Etiaba, E., Okwuosa, C., Envuladu, E., & Onwujekwe, O. E. (2015). Health care financing in
Nigeria: Implications for achieving universal health coverage. Nigerian Journal of Clinical Practice, 18(4), 437–444.
https://doi.org/10.4103/1119-3077.154196
60) World Bank (2023). World Development Indicators.
61) World Bank (2023). World Development Indicators: Health sector statistics. Retrieved from worldbank.org
62) World Health Organization (2021). World Health Report: Health systems financing – The path to universal coverage. Geneva: WHO.
63) World Bank. (2021). World development indicators 2021. Washington, DC: World Bank. https://databank.worldbank.org/source/world-development-indicators
64) World Health Organization (WHO). (2020). Global health observatory data: Nigeria. Geneva: WHO. https://www.who.int/data/gho
65) WHO (2023). World Health Statistics Report: Nigeria’s Health System Performance.
66) World Bank (2023). Nigeria’s Healthcare Financing and Expenditure Analysis.
67) Xu, X., Zhou, Y., & Li, J. (2011). The impact of environmental regulations on industrial competitiveness in China. Journal of Environmental Management, 92(4), 1254–1261. https://doi.org/10.1016/j.jenvman.2010.12.015
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Copyright (c) 2026 Kenneth, Jegbefumwen, Lucky, Ifeanyichukwu Amabuike, Christoher, K. Dike (Author)
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