Research on Humanities and Social Sciences ISSN 2222-1719 (Paper ISSN 2222-2!"# ($nline %ol.#& No.

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Inequality and Class Difference in Access to Healthcare in Nigeria

*ems+ ,erwase -udu1./ ,a0im -su $1ua& Ph*1/ *a2id 3e2er Ishor& Ph*2 and 4hristopher -5aager -6ari#. 1. *epartment o7 Sociolog+& 8ni2ersit+ o7 4ala6ar& 4ala6ar-Nigeria. 2. *epartment o7 Sociolog+& 9ederal 8ni2ersit+ :a7ia-Nigeria. #. *epartment o7 Sociolog+& ;enue State 8ni2ersit+& <a0urdi-Nigeria. . =-mail o7 corresponding author> dems+audu?gmail.com. Abstract ,he paper e@amines ineAualit+ and social class di77erences in the pro2ision and access to healthcare in Nigeria. ,he paper shows that the ineAualit+ and class di77erences in access to health are 6+ and large associated with the erroneous conception o7 health in terms o7 its curati2e potenc+ as against the pre2enti2e 6+ the 6ourgeois class. 9urthermore& a large part o7 the paper concentrates on the discussion o7 ineAualit+ in the pro2ision o7 health care 7acilities in Nigeria& while at the time pointing to the regional and rural-ur6an ineAualities and the conseAuences thereo7. ,he paper concludes that there is a class di2ide and ineAualit+ in the pro2ision and access to healthcare in Nigeria. Keywords: IneAualit+& class di77erence& access& healthcare& Nigeria. 1. Introduction ,his paper e@amines social class di77erences in healthcare pro2ision and access to healthcare in Nigeria. ,he paper 6egan with the assumption that class is an important point in the discussion o7 health and illness. ,he paper is 7urther premise on the 2iewpoint that e2en disease is not e2enl+ distri6uted amongst the population in an+ gi2en societ+. 4ertain people are more prone to sic0ness and death than others. ,his indicates that where indi2iduals are situated in the strati7ication order o7 societ+ determines the range o7 conditions that the+ contend with (-lu6o& 2''! . Indi2iduals ma+ encounter similar illness 6ut the e@periences and manner in which the+ respond to such illness di77er. Bhile some ma+ see0 the pro7essional assistance o7 a ph+sician& others ma+ attempt sel7-care or dismiss the s+mptoms as not needing attention. ,he reason 7or de7ining other s+mptoms as not needing attention is more common among the poor in societ+. ,he poor are more li0el+ to under-utilise health ser2ices 6ecause o7 the 7inancial cost and or the culture o7 po2ert+ (4oc0erham& 2''7 . ,his means that in order to understand illness and how indi2iduals react and respond to them& such indi2idualsC socio-economic& ph+sical and mental en2ironment that resulted to the pain and illness condition in the 7irst place must 6e ta0en into consideration. ,his is 6ecause ill health is o7ten determined 6+ oneCs relationship to the means o7 production& with a 7undamental di2ision 6etween wor0ers and owners. ,his 2iew was long pointed out 6+ =ngels in his classic wor0 DThe Conditions of the Working ClassE& in which he showed the lin0ages 6etween the Industrial Re2olution& the capitalist mode o7 production and ill-health. =ngels clearl+ showed how disease was triggered 2ia the rapid growth o7 an alienated& ur6an dwelling hoi polloi whose li2es were t+pi7ied 6+ a lac0 o7 sanitation& ha5ardous wor0ing condition& poor and congested housing& inadeAuate nutrition& and po2ert+. Hence& indi2idualCs socio-economic status has the most re7lecti2e pull on health and illness. In this paper& we maintain that illness 6eha2iour is shaped 6+ indi2idualCs position in the social structure o7 societ+. $ur argument is anchored on the understanding that health in Nigeria is o6scure 6ecause o7 its emphasis on medical cure as a su6stitute to medical care. Second& there is a huge ineAualit+ in healthcare pro2ision amongst class and among geo-political 5ones in Nigeria. ,hirdl+& health indicators shows that li7e e@pectanc+ at 6irth is low& (7 7or males and )2 7or 7emales& and the pro6a6ilit+ o7 under-)sC mortalit+ is 1)! per 1&''' li2e 6irths. <aternal mortalit+ is among the highest in the world at )() per 1''&'''. In some states itCs as high as 1&)'' per 1''&''' li2e 6irths (National ;ureau o7 Statistic& 2'11 . Nigeria has a large num6er o7 children under the age o7 7i2e su77ering 7rom se2ere to moderate malnutrition& with an estimated (# per cent o7 children su77ering stunted growth. 9urthermore& there is growing pro6lem o7 HI%F-I*S as well as a signi7icant rise o7 other non-communica6le diseases. ,he adult HI% rate was (.1 per cent adults in 2'12. In the same& there were 217&1(! deaths 7rom -I*S (National -genc+ 7or the 4ontrol o7 -I*S& 2'12 . 4oupled with this is the lac0 o7 a structured healthcare s+stem and the issue o7 medical 6rain drain which sees man+ o7 the countr+Cs top 6rains mo2e a6road in search o7 higher income and 6etter li2es 7or themsel2es and their 7amilies G this has contri6uted to a dearth o7 trained human resources. In such circumstances& it is the poor and sociall+ disad2antaged that 6ear the 6runt o7 NigeriaCs iniAuitous health s+stem. -t least 7' to 7) percent o7 health e@penditure comes 7rom out o7 poc0et e@penses. ,he wealth+ and middle classes either ha2e access to pri2ate or insurance 6ased healthcare access& or will tra2el o2erseas to access it.

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Research on Humanities and Social Sciences ISSN 2222-1719 (Paper ISSN 2222-2!"# 2!"# ($nline %ol.#& No.1"& 2'1#

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Figure 1. nder !" " #ortality and infant #ortality rates by urban and rural areas

$ource: National ;ureau o7 Statistic& 2'11. <oreo2er& human de2elopment inde@ puts Nigeria at an a6+smal state. Nigeria is in the 1)#rd position according to the ran0ing& there6+ categorising it under countries descri6ed as ha2ing a low human de2elopment indices. *espite 6eing descri6ed as the giant o7 -7rica and the "th largest oil producer in the world& NigeriaCs human de2elopment inde@ was ran0ed 6ehind Nami6ia (which had a medium human de2elopment inde@ 4ongo (with long +ears o7 ethnic con7licts & Hen+a& -ngola and 4ameroun (8N*P& 2'1# . %. &he Conce'tion of Health h in Nigeria ,he importance attached to health in Nigeria is o2erwhelming as indicated 6+ 2arious dictum> DHealth is wealthE/ D- health+ nation is a wealth+ nationE& etc (-lu6o& 2'1' . -lu6o 7urther stated that this importance is also reproduced in the wa+ people greet themsel2es and in the annual 6udgets o7 6oth the state and 7ederal go2ernment. ,he proper 7unctioning o7 a societ+ depends largel+ on how health+ its mem6ers are/ a ma1or social concern. In all historical epochs& human societies ha2e e2ol2ed institutions& which pro2ide health and medical ser2ices 7or the pre2ention and treatment o7 diseases whene2er sic0ness occurs. -ll these are geared towards the promotion o7 o2erall health and well 6eing o7 citi5ens. ,his a6ilit+ 6+ human societ+ to e2ol2e e2ol2e mechanisms 7or the treatment o7 illness di77ers 7rom one societ+ to the other and 7rom a particular historical epoch to the ne@t. Se2eral 7actors accounts 7or these 2ariations& 6ut one 7actor remain distinct/ the de7inition associated with what constitutes constitutes and causes disease and illness among indi2idualsC or groups. ,he allocation and management o7 health resources largel+ depends on the de7inition a societ+ attri6utes to the concept o7 health& illness and diseases. Prior to colonialism& Nigeria had its de7inition d and conception o7 health which was altered through the process o7 coloni5ation. ,his 7orm o7 medicine that was introduced into Nigeria was +et to reach its ad2anced stage when Nigeria gained her independence 7rom ;ritain (It+a2+ar& 19!! . ,he dominant minant e@planation o7 this new 7orm o7 medicine was anchored on the germ theor+ o7 disease causation. Hence& sic0ness is attri6uted to pathogenic micro organisms o7 which diagnosis largel+& consist o7 identi7+ing the disease agent and its 7urther remo2al through through surgical remed+ or cure. Bith this conception in mind& the human 6od+ 6ecame an o61ect o7 stud+ and o6ser2ation in order that ph+siological processes could 6e dem+sti7ied and 6rought under medical control (4oc0erham& 2''7 . -s a result& disease was no longer considered an entit+ outside the 6oundaries o7 0nowledge& 6ut an o61ect to 6e studied& con7ronted and control scienti7icall+. ,his conception o7 medicine& o6scure the origins o7 su77ering and pre2ent people 7rom understanding the sources o7 po2ert+ t+ and disease. ,his was the case with de2eloped economies& in that the modernisation o7 medicine and healthcare deli2er+ ser2ed the purpose o7 the upper class 6+ creating a huge mar0et 7or their manu7actured drugs and hospital eAuipment. <oreo2er& this path path to the moderni5ation o7 healthcare de2elopment seemed replicated among underde2eloped countries o7 the world. -s <6uru pointed out> ,he poorer ... countries ha2e tended to cop+ 6oth the philosoph+ and de2elopment priorities o7 the de2eloped world& e2en though their pro6lems and population structures are di77erent. In 7ollowing the health deli2er+ trends o7 the technologicall+ sophisticated societies& -7rican countries ha2e so 7ar 7ailed to ma0e their health s+stem e77ecti2e& let alone e77icient. 4learl+& the s+stem does not 7it the population (Auoted in -lu6o& 2'1' . ,he e@plosion o7 scienti7ic 0nowledge and the sophistication and comple@ medical diagnosis and treatment that 7urther ensued reached the status o7 determinants o7 diagnosis rather than aids. Increasing pu6lic demand 7or medical ser2ices 6rought a6out an increase in the cost o7 health care& the e@pansion o7 ser2ice deli2er+ and the mo2ement 7rom treating patients in hospitals. ,hus& treatment is more directed towards the scienti7icall+ de7ined s+mptoms rather than the person as a whole. 4onseAuentl+& patients are simpl+ discharged as IcuredC 6ecause their 6lood pressures are de7ined as 6eing within InormalC limits& despite the 7act that the+ still complain o7 the ("

Research on Humanities and Social Sciences ISSN 2222-1719 (Paper ISSN 2222-2!"# ($nline %ol.#& No.1"& 2'1#

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7eelings o7 illness that 7irst too0 them to the doctor in the 7irst place. ,his mechanistic nature is associated with illness in the modern world& e2en when cure seem impossi6le& doctors are willing to 0eep the person in the hospital simpl+ 6ecause o7 the economic gain the+ deri2e 7rom the personCs presence in the hospital. ,his uncertaint+ in the medical conte@t has conseAuences 7or the increasing cost o7 medical ser2ices. 9or this reason& <echanic argued& there is a pro7essional norm to treat the patient without regard to the patientCs a6ilit+ to pa+. Ph+sicians there7ore ta0e actions in the interests o7 their clients without signi7icant consideration o7 the cost or long-term economic conseAuences o7 medical treatment. -nd in the long-run patients are ta0en hostage in hospitals 6ecause o7 their ina6ilit+ to settle their 6ills. Importantl+ also is the issue o7 cure and care& with the 7ormer gi2en more attention in terms o7 in2estment. ,his& -lu6o argued is a deli6erate ideological strateg+ o7 the capitalist s+stem. In the same 2ein Na2arro and others (Auoted in -lu6o& 2'1' long argued that the capitalist s+stem reduces the pro6lems o7 political and economic origins to medical pro6lems... this the+ do in order to ma0e people 6elie2e that structural pro6lems can 6e resol2ed through the indi2idualist approach o7 modern medicine. ,here6+ di2erting peopleCs attention 7rom the po2ert+ and depri2ation state in which the capitalist s+stem has put them in the 7irst place. ,his modern capitalist in2erted manner and nature in which health is concei2ed particularl+ 6+ the ruling elites goes a long wa+ in in7luencing the ineAualit+ associated with healthcare pro2ision in Nigeria& to which we now turn. (. Inequality in Healthcare )ro*ision and Access ,he s+stem o7 health care deli2er+ in Nigeria seems comple@. ,he comple@it+ is e2idence in the disparit+ in which healthcare 7acilities are pro2ided 6+ the go2ernment. Bith a so-called pu6lic 7unded s+stem o7 healthcare& one should e@pect the a2aila6ilit+ and 7ree at the point o7 use& 6ut this is not the case in realit+. 9urthermore& irrespecti2e o7 the pro6lem o7 pro2ision the situation with regard to access is 7urther complicated 6+ the 7act that ma1orit+ o7 Nigerians including the poor pa+ 7or healthcare 7rom their pri2ate poc0ets. ;ut 6e7ore we continue& let us understand how the healthcare s+stem in Nigeria 7unctions. In Nigeria& there e@ist di77erent t+pes o7 7acilities& le2els& pro2iders and the t+pes and wa+s through which ser2ices are pro2ided. ;ut& one o7 the ma1or pro6lem associated with the Nigerian health s+stem is her health 7inancing. 9or e@ample& the Borld Health $rganisation (2'11 sees health 7inancial as concerned with the mo6ilisation& accumulation and allocation o7 mone+ to co2er the health needs o7 the people& indi2iduall+ and collecti2el+ in the health s+stem. Hence& the s+stem is e@pected to 6e structured in a wa+ that e2en the poorest in the remote 2illages should 6e a6le to recei2e needed care without worr+ing a6out the cost& which is the hallmar0 o7 an eAuita6le and 7air health s+stem (Sho6i+e& 2'12 . It is also important to state that utili5ation o7 healthcare is not the same thing as access. -ccess is a comple@ (and contested concept (4ulle+& 2''9 & which entails need& demand and suppl+. Hence& an eAuita6le ser2ice reAuires the pro2ision o7 eAual access 7or eAual need (-spinall and Jaco6son& 2''( . =2idence on class di77erences in IneedC 7or healthcare ser2ices (considered as pre2alence & as we ha2e seen& is unclear. ,he e2idence on suppl+ o7 healthcare 7acilities certainl+ suggests restricted access to man+ 7orms o7 ser2ices in go2ernment owned hospitals& although the Isuppl+C in the independent sector is a6undant and instantl+ a2aila6le 7or those who can a77ord it. Healthcare in Nigeria is paid 7or through di77erent mechanisms G allocation 7rom go2ernmentCs 6udget/ through out-o7-poc0et pa+ments/ 2ia health insurance (social and pri2ate and through e@ternal 7unding. In Nigeria& ma1orit+ o7 health care is pri2atel+ 7inanced. Pri2ate e@penditure on health as a percentage o7 total health e@penditure was "#.#K (BH$& 2'11 / that is a6out two-thirds o7 the total amount spent on health care. -nd out o7 this& prepa+ment through pri2ate health insurance plans is onl+ #.1K and a huge 9).(K is paid out-o7-poc0et (Sho6i+e& 2'12 . ,his means that at the time o7 access a large percentage o7 Nigeria including the poor pa+ 7or health care out o7 their poc0ets. Hence& as It+a2+ar argued> In the capitalist philosoph+& pu6lic goods (healthcare are implicitl+ dictated 6+ the mar0et& i.e. price determination. -ccess to an+ ser2ice such as health& education& transport etc& is strictl+ 6ased on a6ilit+ to pa+. In the 7irst place& suppl+ o7 an+ ser2ice comes 7rom owners o7 the means o7 production who accumulate and sell in order to ma@imise pro7it (It+a2+ar& 19!!>122(& emphasis mine . $ur position here is that this out-o7-poc0et pa+ment 7or healthcare ser2ices put ma1orit+ o7 Nigerians in a great deal o7 7inancial ris0 and 7urther restricts their direct access to healthcare when needed. <a1orit+ are compelled to sell their personal possessions and e77ects and are 7urther inde6ted in their search 7or health. 4onseAuentl+& this pri2ate out-o7-poc0et pa+ment has created a 6arrier 7or man+ and is there7ore not eAuita6le in pro2iding care to all Nigerians& thus ineAualit+. -s a result& It+a2+ar argued that> -s its prominent 7eature& social ineAualit+ is 6ut another e@pression o7 class con7iguration engendered 6+ capitalism. 8neAual access to social ser2ices onl+ re2eals the 7undamental contradictor+ logic o7 capitalism... 7or the poor ma1orit+ ha2e no access to the means o7 production and ser2ice that is 7ounded on the logic o7 pro7it... the 7undamental 6asis o7 social

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ineAualit+ (It+a2+ar& 19!!>122( . 9rom the 7oregoing there& it can 6e deduced that ineAualit+ in access to health ser2ices in Nigeria tend to assume that e2er+one has an occupation& whereas increase in unemplo+ment and earl+ retirement seems to 6e the case in Nigeria and hence an increasing num6er o7 men and married women who do not ha2e a paid 1o6 and thus the necessit+ to consider to which occupational class the+ should 6e assigned. Similarl+& despite the growth and e@pansion witnessed o2er the +ears in Nigeria& structural changes and the ineAualities associated with healthcare o7 the colonial period ha2e remained unaltered e2en though more hospitals and trained manpower seem a2aila6le. ,his pri2ate dri2en idios+ncras+ o7 the 6ourgeois class and out-o7-poc0et pa+ment 7or healthcare ser2ices in Nigeria was 7urther compounded with the o2erture o7 Structural -d1ustment Program (S-P & there6+ locating healthcare under the capitalist ideological 7rame o7 pro7it accumulation. ,his e@plains wh+ most o7 the modern hospitals onl+ spread in areas o7 anticipated high pro7it and thus& the ur6an G rural and geopolitical disparit+ in the distri6ution o7 healthcare 7acilities. &able 1. Distribution of healthcare facilities by tiers in Nigeria+s ,eo'olitical -ones in 1.... ,eo!'olitical /ones )ri#ary $econdary &ertiary )ri*ate )ublic &otal )ri*ate )ublic &otal )ri*ate )ublic &otal South-Best 1&29' 1&!(! #&1#! 191 2)# ((( ' " " South-=ast 0 1&19) "17 1&!12 )1) #" ))1 ' " " South-South 00 "!' 1&2)9 1&9#9 (9' 1() "#) ' 7 7 North-4entral 1&!!2 #&'99 (&9!1 19) 2'9 ('( 1 # ( North-=ast ### 2&12" 2&()9 2' !' 1'' ' 2 2 North-Best 000 #"( #&2#) #&)99 #7 1'( 1(1 ' ( ( ,otal "1233 1%1143 121.%4 11334 4%2 %1%2" 1 %4 %. $ource: (National Health <anagement In7ormation S+stem& in =rinosho& 2'') 0 =@cluding data 7or -nam6ra and =6on+i States. 00 =@cluding data 7or 4ross Ri2er state. 000 =@cluding data 7or He66i state. 9rom the a6o2e 7igures& States in Nigeria with ur6an status li0e :agos& -6u1a etc en1o+ more patronage than those with rural status li0e Jigawa state. 4onseAuentl+& all the pri2ate hospitals are located in ur6an centres where anticipated pro7it accumulation is the 6asic aim 7or esta6lishment 7rom the 7irst instance. 9or e@ample& the South-Best that ha2e a more ur6an outloo0 than rural has more general hospitals. 9urthermore& tertiar+ hospitals are located more in the South-Best& South-=ast and South-South also with a more ur6an than rural settlements. ,his ur6an G rural and geopolitical 5one dichotom+ is a capitalist ideolog+ o7 demand and suppl+ with pro7it accumulation as the 6ase and there7ore has tremendous in7luence on the structural distri6ution o7 health care 7acilities. ,he result o7 health ineAualit+ (ta6le 1 indicates that health ineAualit+ is pre2alent in the Northern region o7 Nigeria. Statistics indicates that households in the North ha2e the highest incidence o7 po2ert+& since most o7 the poorest states are in this region. ,his there7ore means that the amount o7 resources that can 6e spent on accessing health care ser2ice deli2er+ centres is limited. Hence& healthcare pro2ision in Nigeria is aimed at ser2ing onl+ those who can pa+ 7or the ser2ices as is the case in ad2anced economies where the 7orces o7 demand and suppl+ are gi2en a 7ree rein& and the go2ernment inter7ering minimall+ 6+ simpl+ pro2iding the polic+ thrust. &able %. Hos'ital beds by ty'es of hos'ital 51..67. &y'e of Hos'ital No of 8ed )ro'ortion 9:; 3eneral Hospital )"&"!! )#.' <aternit+ 2'&#7' 19.' ,eaching 7&1#' ".7 $rthopaedics 7## '.7 $thers 2 22&'2) '." &otal 16<1.3< 166.6 $ources: -de6an1o and $lade1i& 2''".

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&able (. Key health 'ersonnel in Nigeria in %66%. $=N Health )ersonnel Nu#ber )ercentage 1 Ph+sicians #(&92# 9.(' 2 Nurses and <idwi2es 21'&#'" )"."' # *entists and ,echnicians 2&(!2 '."7 ( Pharmacists and ,echnicians "&#(( 1.7' ) =n2ironmental and Pu6lic Health Bor0ers n.a. n.a. " :a6orator+ ,echnicians "9' '.1" 7 $ther Health Bor0ers 1&22' '.## ! 4ommunit+ Health wor0ers 11)&7"1 #1.1( 9 Health <anagement and Support n.a. n.a. &otal (2112%< 166.66 $ource: Borld Health $rganisation (BH$ & 2''". 9rom the a6o2e ta6le 2& it can 6e seen that the 6ed-population 6ed population ratio is a6+smal in that the a2aila6le 6ed space in all the general hospital cannot ser2e the ur6an population alone let alone the ma1orit+ who are ar resident in rural communities. -lso& the doctors-patient patient ratio is 2er+ poor in that as at 1999 there were onl+ two (2 ph+sicians a2aila6le to ser2ice the pu6lic hospitals and attend to patients. ,his calculation does not include the pri2ate primar+& secondar+ ondar+ and tertiar+ hospitals in Nigeria. 9urthermore& the inclination o7 recent shows that apart 7rom primar+ health wor0ers and in some cases nurses and midwi2es who ma+ li0el+ wor0 in the rural areas and partl+ in general hospitals& ma1orit+ o7 ph+sicians ph+sicians pre7er to wor0 mainl+ in the ur6an centres where there is the a2aila6le o7 most o7 the social amenities. Figure %. Infant #ortality rate by geo'olitical /one1 %611.

$ource: National ;ureau o7 Statistic& 2'11. It is there7ore not surprising that in7ant mortalit+ across the si@ (" geopolitical 5ones show o62iousl+ this ineAualit+ in health as in7ant and under-) under mortalit+ rates are lowest in the South-Best Best 5one with )) per thousand li2e 6irths respecti2el+ while 7or North Best& rates are 12# per thousand li2e 6irths (9ig. 2 . 9urthermore& the 0e+ indicators 7or monitoring the nutritional status o7 a child under ) are underweight& stunting and wasting (9ig # and ( . In Nigeria& 2( percent o7 children under ) are underweight underweight (9 percent se2erel+ & #" percent are stunted (19 percent se2erel+ and 1' percent are wasted (# percent se2erel+ . <alnutrition rates in the North Best and =ast regions are higher than in the South (9ig ( . 4hildren in rural areas a are more li0el+ to ha2e nutritional de7iciencies than those in ur6an areas with 19 percent underweight as against #1 percent. Figure (. )ercentage of children under " who are underweight1 stunted1 and wasted1 Nigeria1 %611.

$ource: National ;ureau o7 Statistic& 2'11.

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Figure 3. )ercentage of children under " who are underweight1 by ,eo!'olitical ,eo 'olitical /one1 Nigeria1 %611.

$ource: National ;ureau o7 Statistic& 2'11. ,hese ineAualities in health care pro2ision in rural-ur6an rural areas and as re7lected in the 2arious geo-political geo 5ones as can 6e seen in the chart a6o2e arise 6ecause o7 the circumstances in which people grow& li2e& wor0& and age& and the s+stems put in place to deal with illness. ,his conditions are shaped 6+ political& social soci and economic 7orces (3raham& 2''7 & and in that wa+ undermines the o2erall health interest o7 the common people. :ittle wonder& emphasis is alwa+s on the curati2e than pre2enti2e healthcare as earlier mentioned elsewhere. ,his is 6ecause the curati2e ser2es r2es the elite& whereas the pre2enti2e ser2es the poor (=rinosho& 2''" . 3. Conclusion and >eco##endations 8nderstanding di77erences in access to healthcare is highl+ comple@. ,his is 6ecause ser2ices can 6e needed& 6ut neither demanded nor supplied/ the+ + can 6e 6oth needed and demanded 6ut not supplied and the+ ma+ 6e 6oth needed and supplied& 6ut not demanded (Sma1e and 9ield& 1997 . In Nigeria& the e2idence suggests that healthcare is limited in rural and semi-ur6an semi slums where ma1orit+ o7 the poor who cannot pa+ 7or capitalist modern healthcare resides. ,he limited a2aila6ilit+ o7 health care 7acilities in such areas hinders people in the lower strata o7 societ+ 7rom see0ing medical care. Hence& this group o7 persons ha2e 6een 7orced to contend with higher gher mor6idit+ and mortalit+ rates o7 almost e2er+ disease or illness. ;eside& indi2idualsC a6ilit+ to access healthcare in Nigeria is correlated with such indi2idualsC a6ilit+ to pa+ 7or such ser2ices. 9urthermore& the distri6ution o7 healthcare in7rastructure cture is highl+ ur6an particularl+ in ma1or cities o7 Nigeria where residents ha2e the a6ilit+ to pa+ 7or the ser2ices. ,his is e2ident in the wa+ and manner health care 7acilities are distri6uted on the 6asis o7 ur6an and geo-political political 5ones within the countr+ countr+ and a 7lare 7or curati2e rather than pre2enti2e. 9urthermore& ineAualities in health stem 7rom the conditions o7 li7e in which people are placed under and this 7urther a77ect peopleCs a6ilit+ to respond to illness. ,his conditions in which indi2iduals indi2iduals are placed are 7urther shaped 6+ political& social& and economic structures. ;ased on the 7oregoing there7ore& it is important 7or the go2ernment the primar+ pre2ention o7 disease in addition to those approaches that merel+ 7ocus on treatment o7 the sic0. sic0. Such pre2enti2e approaches must in2ol2e communit+ and en2ironmental inter2entions rather than one-to-one one one pre2enti2e encounters. Hence& the li6eral class must pa+ increasing attention to the role o7 political& social and economic structures that in7luences in7luence the pro2ision and access to healthcare& as espouse 6+ <ar@ in the distri6ution o7 resources in the societ+ and 7urther enlighten the masses to challenge this ineAualit+ through mass protests. 9urthermore& a new health strateg+ to 6rea0 the c+cle o7 ill-health ealth due to po2ert+ and depri2ation must 6e put in place 6+ the Nigerian go2ernment. National health 7inancing s+stems need to 6e pro-poor pro poor i7 healthcare targets are to 6e met. Hence& as ;ennett and 3ilson (2''1 stated& such s+stems should there7ore incorporate incorporate three important dimensions> the+ should ensure that contri6utions to costs o7 healthcare are in proportion to di77erent householdsC a6ilit+ to pa+/ protect the poor 7rom 7inancial shoc0s associated with se2ere illness/ and enhance the accessi6ilit+ o7 ser2ices to the poor. >eferences -de6an1o& -.-. and $lade1i& S.I. (2''" & DHealth Human 4apital 4ondition> -nal+sis o7 the *eterminants in NigeriaC& in 9alola et al.& (eds. Traditional and Modern Health Systems in Nigeria. ,renton and -smara> -7rica -7ric Borld Press. -lu6o& S.$. (2''! & D$ntological Response to Illness in -7ricaE. Jos Journal of Social Issues& "& 1-2#. -lu6o& S.$. (2'1' & DIn Sic0ness and in Health> Issues in the Sociolog+ o7 Health in NigeriaE. University of Jos Inaugural Lecture Series& (1& <arch 19& 2'1'. -spinall& P. and Jaco6son& ;. (2''( & thnic !is"arities in Health and Healthcare. :ondon> *epartment o7 Health&

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;ennett& S. and 3ilson& :. (2''1 & Health #inancing$ !esigning and Im"lementing %ro&%oor %olicies. :ondon> *9I* Health S+stems Resource 4entre. 4oc0erham& B.4. (2''7 & Medical Sociology (1'th edition . New Jerse+> Pearson. 4ulle+& :. (2''9 & D*ominant narrati2es and e@cluded 2oices> Research on ethnic di77erences in access to assisted conception in more de2eloped societies. In 4ulle+& :. =t al.& (eds & <arginali5ed reproduction> =thnicit+& in7ertilit+ and reproducti2e technologies. :ondon> =arthscan. =rinosho& $.-. (2'') & Sociology for Medical' Nursing and (llied %rofessions in Nigeria. -6u1a and I1e6u-$de> ;ulwar0 4onsult. =rinosho& $.-. (2''" & Health Sociology for Universities' Colleges and Health )elated Institutions. -6u1a> ;ulwar0 4onsult. 3raham& H. (2''7 & Une*ual Lives$ Health and Socio& conomic Ine*ualities. New Lor0> $pen 8ni2ersit+ Press. It+a2+ar& *.-. (19!! & DHealth Ser2ices IneAualities in NigeriaE& Soc Sci+ Med+ 27(11 > 122#-#). :eonard& H.:. M :eonard& *.H. (2''( & D,he Political =conom+ o7 Impro2ing Health 4are 7or the Poor in Rural -7rica> Institutional Solutions to the Principal--gent Pro6lemE. ($nline 1(th Januar+ 2'1'. -2aila6le 7rom> http>FFwww.high6eam.comFdocF13111!'#(!!2.html. National -genc+ 7or the 4ontrol o7 -I*S (2'12 & ,lo-al (I!S )es"onse Country %rogress )e"ort . Nigeria. -6u1a> 93 Printers National ;ureau o7 Statistic (2'11 & Nigeria Multi"le Indicator Cluster Survey /011Summary )e"ort+ -;8J-> 93 Printers Sho6i+e& H. (2'12 & Pa+ing 9or Health in Nigeria Part $ne. ($nline 29th -ugust& 2'1#. -2aila6le 7rom> http>FFnigerianstal0.orgF2'12F')F'7Fpa+ing-7or-health-in-nigeria-part-1F. Sma1e& 4. and 9ield& *. (1997 & D-6sent minoritiesN =thnicit+ and the use o7 palliati2e care ser2icesE& in 9ield et al.& (eds !eath' gender and ethnicity. :ondon> Routledge. 8N*P (2'1# & Human !evelo"ment )e"ort /012. New Lor0> 8N*P. BH$ (2''" & Country Health System #act Sheet 3Nigeria4+ 3ene2a> BH$. BH$ (2'11 & World Health Statistics /011. 3ene2a> BH$.

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