The economic burden of non-communicable diseases in Nigeria: Evidence from the COVID-19 era

Abstract

Background: Non-communicable diseases (NCDs) impose a significant economic burden on households in low- and middle-income countries (LMICs). Nigeria's health system vulnerabilities, compounded by COVID-19, have worsened the economic burden for NCD-affected households. Methods: A scoping review was undertaken to synthesise the existing evidence from the literature and to identify the gaps on NCD economic burden in Sub-Saharan Africa (SSA). We then used three nationally representative panel data sets from the Nigeria Living Standards Survey 2018/2019, Nigeria's General Household Survey Panel (Waves 3- 5) and the National Longitudinal Phone surveys to analyse measures of financial protection from the economic burden of NCDs in Nigeria, filling critical gaps in our literature. Results: We found a growing incidence and intensity of catastrophic health expenditure (CHE) in NCD-affected households from 2015 to 2024. We also found that the risk of CHE onset increased with the NCD ratio of household members with NCDs. These risks persist with a projection of 36% for high-NCD compared to just 10% for non-NCD households after 8 years. Our causal analysis also reveals that the pandemic led to an 11.9 percentage point increase in CHE risk and a 5.9 percentage point increase in impoverishment risk for NCD households compared to their non-NCD counterparts. Therefore, NCD-affected households had to combine many maladaptive strategies and sacrificed healthy food and cooking energy to pay for healthcare. The COVID-19 pandemic worsened unmet needs primarily because of financial reasons and the mobility restriction policy. Conclusion: The pandemic created lasting financial protection gaps for NCD households in Nigeria. Recovery policies require targeted interventions, including automatic health insurance enrolment, NCD-specific benefit packages, and strengthened social protection systems to address persistent vulnerabilities in NCD financing.

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