3. Statement of Problem

As a result of the low levels of health and
health care delivery system in developing and poor countries,
the Millennium Development Goals (MDG’s) has made it clear that health and health
care delivery system be made free to all by the year 2015. And the SDG as an
offshoot of MDG’s aiming to ensure healthy lives and promote wellbeing for all
at all age (WHO 2000). The low level of health demands that government at
both the national, state and local levels should invest more on health despite
the limited resources at its disposal; this necessitates the need for the little resources allocated to
health to be efficiency utilized.

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Despite the rising improvement on allocation
and different policy initiatives implemented over the years in Nigeria and
India, there is a view that the public health system’s performance is below the
expected level. For instance, Nigeria spends 1.03 percent of its GDP on health
care; in 2012 India spends 1.3 per cent of its GDP in 2015. This is
extremely low, in particular when compared to other developing countries such
as South Africa (8.6 percent), Brazil (8.3 percent) and Democratic Republic of
Congo with (7.9 percent), this is much lower than the $35 per capita
recommended by WHO macroeconomic commission for Health for low income countries
to provide basic health care services (WHO, 2009).

One of the greatest challenges facing the
health system in Nigeria is in the area of child health, where available data
points a depressing picture. The United Nations, reports indicated that India,
Nigeria and the Democratic Republic of Congo togather account for 40 percent of
the world mortality of children below five (UN 2009;
2012). Similarly, according to the World Health Organization (2008) Nigeria
is among five countries that contribute 50 per cent of annual global mortality among infants and children under-five years of
age. Larger proportion of the
budgetary expenditure on health does not reflect on the health situation of the country. Poverty, poor health
status of mothers and whole population, high prevalence of malaria,
pneumonia, Measles, diarrhea, HIV/AIDS, malnutrition
and inadequate immunization coverage in the country are blamed for most
of the death. Worse still, according to the African Development Bank (ADB), Nigeria was among twelve (12) developing
countries identified as lagging behind and in danger of not meeting the 2015 Millennium Development Goals (MDGs) ofreducing infant mortality by two-thirds (Nnamuchi,
2007).   India has relatively
consider as among the nations that poor rural health indicators and its health
care systems are among the most privatized in the world, this high degree of
privatized healthcare  attributed to
inadequate access to medical care and poor quality of public health care.

According to World Health Statistics (2015)   India accounts for 21 per cent of the global
disease burden ‘despite rapid economic growth, India was ranked 143rd,
below Comoros and Ghana” on the first annual assessment of Sustainable
Development Goals (SDG’s) health performance published in the Lancet and
launched at a special event at the UN General Assembly in New York (Lancet
2015).  India’s poor performance on
hygiene, air pollution, mortality rate are among factors that place it lower
than countries like Bhutan, Botswana, Syria and Sri Lanka. The ranking further
score India 10 points for Malaria, Hygiene 8 points. Similarly, for under-five
mortality it scored 39 points while for maternal mortality rate (MMR) it scored
28 points. Generally, the state of the world’s children indicated that about
12.9 million children die every year in developing world (UNICEF, 2007).
Basically, it is expected that budgetary allocations to health sector would
improve health outcome and relatively reduce all kinds of mortality rate, and
other diseases. Remarkably, the total components of health care expenditure in
these countries were increased over the years.


In Nigeria it was increased from 4.2 percent
in 2009 to 5.3 percent in 2014, while in India it was increased from 4.0
percent in 2009 to 4.4 in 2014 (WDI 2014). Nevertheless, the government
allocation to health as share to GDP is still low, given this level of
government spending, it will be very difficult to provide the essential health
care services to the entire population in these countries. Thus, it becomes
imperative tostudy public expenditure on health and assesses its impact on the
healthoutcomes with view to inform policy
and influence discussions on the need to improve health. Similarly,
studies on efficiency of health expenditure have consistently shown that the
Nigeria and India is less efficient in converting health expenditure into
improved health outcomes compared to other developing countries. Moreover, a
number of cross-country studies have tried to understand the nature of the
relationship between health expenditure and health outcomes, some find no
meaningful empirical evidence to support such conclusions. The literature
therefore, suggests that the contending augments is far from over, hence the
research continues and therefore, the justification of undertaking the present
study. Consequently in the light ofthe above background the present study
is designed to provide answers to the following research questions:

What is the
impact of public health expenditure on health outcomes?

What is the
relationship between public health expenditure and health outcomes?

What is the trend of public health
expenditure and health outcomes in Nigeria and India?

4. Objectives
of the Study

The main
objective of this study is to examine the impact of public health expenditure
on health outcomes in Nigeria and India. However other specific
objectives that are formulated to guide the study are as follows:

To determine the impact of  public
health expenditure on health outcomes;

To determine
the relationship between public health expenditure and health outcomes.

To examine the trend of public health expenditure and health outcomes in
Nigeria and India.



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