Human Capital Public Expenditure and Institutional Review - An analysis of financing and governace constraints for the delievry of basic education and primary health care in Nigeria (English)

Table of Contents

• Box 3-1. 43
• Low domestic resource mobilization constrains investments in human capital 43
• Box 4-1. 71
• A needs- and performance-based system in Brazil 71
• List of Acronyms 9
• Acknowledgments 11
• Chapter 1. 12
• Introduction: Human Capital, Its Importance and Constraints to Improvement 12
• Why a focus on under-5 mortality rates and out-of-school children? 14
• Chapter 2. 16
• The State of Human Capital in Nigeria: Primary Health Care and Basic Education 16
• The state of basic health care services 17
• Access to health care 19
• Quality of care 20
• Equity in access to health care 22
• The Solutions are not simply technical 23
• The state of basic education services 24
• Equity 25
• Shortage of classrooms and teachers 25
• Out-of-school children: Magnitude and trends 27
• What are the main drivers of school attendance? 28
• Chapter 3. 32
• Public Spending in Primary Health and Basic Education: Inadequate and of Poor Quality 32
• Institutions 33
• Financing 34
• Adequacy of spending: Overall public spending in health and education 35
• Efficiency of spending 44
• Equity of spending 50
• Predictability, timeliness, transparency, and accountability 54
• Summary: Key messages 55
• Annex 3A. Overview of key MDAs/institutions 56
• Chapter 4. 57
• Understanding Intergovernmental Transfers for Human Capital: The Basic Health Care Provision Fund and the Universal Basic Education Fund 57
• Intergovernmental interaction and its challenges 58
• The Basic Health Care Provision Fund 59
• BPHCF as a complement to state-level efforts to expand UHC 61
• Fund flow to frontline service providers 62
• Accountability for results 64
• The Universal Basic Education Intervention Fund 66
• The UBE Fund arrangements and spending categories 66
• Flexibility of UBE funds to respond to state needs 67
• Equity in the allocation of resources across states 68
• Disbursements and utilization 69
• Accountability for results 70
• Fund flow to frontline service providers: Lack of direct school financing 72
• Coordination challenges 74
• Summary: Key messages 75
• Chapter 5. 76
• Teachers: Too Few in Number, Poorly Recruited and Trained, and Unevenly Distributed 76
• Introduction: The centrality of teachers 77
• Challenges in teacher recruitment, distribution, and deployment 77
• Low quality of teachers 82
• Teacher absenteeism 84
• Teacher well-being 85
• Summary: Key messages and potential reform areas 86
• Chapter 6. 87
• Strengthening Data Systems for Human Capital 87
• Introduction 88
• Challenges of the information systems in the health of Nigeria 88
• Data quality and digitizing HMIS 88
• Data use for decision making and harmonization of surveys 89
• Challenges of the education information systems in Nigeria 89
• Limited and sporadic learning data 92
• Summary: Key messages and potential areas of reform 94
• Recommendations: 95
• Matrix of Policy Actions to Address Financing and Governance Constraints in Primary Health care and Basic Education 95
• Background 96
• References 104
• Contents 3
• Recommendations: 95
• Chapter 6. 87
• Chapter 5. 76
• Chapter 4. 57
• Chapter 3. 32
• Chapter 2. 16
• Chapter 1. 12
• Figure 1-1. 14
• Analytical framework for analyzing service delivery challenges 14
• Figure 2-1. 17
• Under-5 mortality rates and national income, 2020 17
• Figure 2-2. 18
• Absolute number of under-5 deaths in India and Nigeria, 1960–2020 and projected 18
• Figure 2-4. 18
• Under-5 mortality rates, Nigeria and poorest income-quintile countries 18
• Figure 2-3. 18
• Child health outcomes in Nigeria, low-middle income countries, and Sub-Saharan Africa 18
• Figure 2-5. 18
• UHC service coverage in Nigeria, Sub-Saharan Africa, and the world, 2000–2021 18
• Figure 2-6. 20
• Availability of essential drugs and equipment, by geopolitical zone, 2016 20
• Figure 2-8. 20
• Adherence to clinical guidelines, by type of health worker, 2016 20
• Figure 2-7. 20
• Diagnostic accuracy, by type of health worker, 2016 20
• Figure 2-9. 20
• Diagnostic accuracy, Nigeria, by region, 2016 20
• Figure 2-10. 21
• Adherence to clinical guidelines, Nigeria, by region, 2016 21
• Figure 2-12. 21
• Diagnostic accuracy, other African countries 21
• Figure 2-11. 21
• Availability of basic equipment, other African countries 21
• Figure 2-13. 21
• Number of outpatients per provider, other African countries 21
• Figure 2-14. 22
• Maternal and child health services coverage, by region, 2021 22
• Figure 2-15. 23
• Leading causes of neonatal deaths in Nigeria, 2020 23
• Figure 2-16. 23
• Leading causes of under-5 deaths in Nigeria, 2020 23
• Figure 2-17. 24
• Learning-adjusted years of schooling for Nigeria and structural/aspirational peers, 2020 24
• Figure 2-18. 24
• Out-of-school rate among primary-school-age children, 2000–2022 24
• Figure 2-19. 24
• Net primary enrollment rates in Nigeria and selected comparable countries, 2022 24
• Figure 2-20. 25
• Net primary school attendance for children from the poorest and richest household wealth quintiles 25
• Figure 2-21. 25
• Primary students per classroom, Nigeria and selected countries in West and Central Africa 25
• Figure 2-22. 26
• Primary students per classroom in Nigeria, by state, 2022 26
• Figure 2-23. 26
• Estimated number of classrooms required to accommodate current out-of-school children (OOSC) and estimated additional children ages 6–15 as a result of population growth in 2020–25 and 2025–30 26
• Figure 2-24. 27
• School attendance status for children ages 6–15, by state and geopolitical zones, 2020 27
• Figure 2-25. 28
• Relationship between household wealth and formal school attendance, by gender and region, 2020 28
• Figure 2-26. 29
• In-school rate by age, gender, household income, and geographic region, 2020 29
• Figure 2-27. 30
• Primary schools situated within or beyond 3 km of the nearest junior secondary school, 2018 30
• Figure 2-28. 31
• Average students per classroom in primary and junior secondary schools. 2022 31
• Figure 3-1. 35
• General government (federal and state) budget allocations across government functions, 2021 (% of the total national budget) 35
• Figure 3-2. 35
• Nigeria’s government spending by tier of government, 2015–2019 (% GDP) 35
• Figure 3-3. 36
• Total government expenditure on education (federal and state) as a share of GDP and proportion of total government expenditures, 2010–21 36
• Figure 3-6. 37
• Distribution of world countries by level of government spending per primary school student and learning poverty, 2020 or latest available year 37
• Figure 3-4. 37
• Government expenditure on education as a share of GDP in Nigeria compared to Sub-Saharan African countries, 2021 or the latest available year (%) 37
• Figure 3-5. 37
• Distribution of countries by government expenditure on education as a share of GDP, 2021 (%) 37
• Figure 3-7. 38
• Scores on universal health coverage, Nigeria, Africa, and the world, 2000 to 2021 38
• Figure 3-10. 39
• General government health expenditure (% of GDP) versus GNI per capita, world countries, 2020 39
• Figure 3-8. 39
• Domestic general government health expenditure as share of GDP in selected African countries and Mexico, 2015–20 (%) 39
• Figure 3-9. 39
• Domestic general government health expenditure per capita in selected African countries, Mexico, and Indonesia, 2020 (US$) 39
• Figure 3-11. 40
• Education as a share of total expenditure and budget, by state, 2021 (%) 40
• Figure 3-12. 40
• Health as a share of total expenditure and budget, by state, 2021 (%) 40
• Figure 3-13. 41
• Budget execution: Ratio of expenditures to budgets in education and health in states of Nigeria, 2021 41
• Figure 3-14. 42
• Breakdown of the education and health budget and expenditures in selected states of Nigeria, 2021 (%) 42
• Figure 3-15. 42
• Education as a share of total government budget and government spending as a share of GDP, by state, 2021 (%) 42
• Figure 3-16. 43
• Health as a share of total government budget and government spending as a share of GDP in states of Nigeria, 2021 (%) 43
• Figure 3-17. 44
• Efficiency frontier of public spending in education and health (as % of GDP) in terms of human capital development (Human Capital Index) in Sub-Saharan African countries 44
• Figure 3-18. 45
• Efficiency frontier of public spending in primary education in terms of educational coverage in Sub-Saharan African countries 45
• Figure 3-19. 45
• Efficiency frontier of public spending in primary education in terms of educational quality in Sub-Saharan African countries 45
• Figure 3-20. 46
• Efficiency frontier of public spending on health in terms of outcomes: survival rates to age 65 (%) 46
• Figure 3-21. 46
• Efficiency frontier of public spending on health in terms of outcomes: probability of survival to age 5 (%) 46
• Figure 3-22. 46
• Efficiency frontier of public spending in primary education in terms of education coverage, by state, 2021 46
• Figure 3-23. 47
• Distribution of states of Nigeria by the level of public spending per school-age child and primary out-of-school rates, 2021 47
• Figure 3-24. 48
• Efficiency frontier of public spending in health terms of under-5 mortality rates in Nigeria, 2021 48
• Figure 3-25. 49
• Cost of health care personnel and teacher absenteeism in US$ millions (state and LGA spending on health and education), 2021 49
• Figure 3-26. 50
• Pupil-teacher and pupil-classroom ratios at the school level by poverty levels around school and school remoteness from urban centers 50
• Figure 3-27. 51
• Availability of infrastructure, by state, 2013 51
• Figure 3-28. 52
• Distribution of Nigeria’s states by public expenditures on health per capita (Naira) and access to health services in states of Nigeria (left panel) and the relationship between access to health care services and household wealth quintiles at the national 52
• Figure 3-29. 53
• Average state spending on health per capita by state poverty rate quintiles and state GDP per capita, 2021 53
• Figure 4-1. 60
• BHCPF fund flow arrangements: BPHCF, NHIA, and NEMTC plus NCDC gateways 60
• Figure 4-2. 60
• NPHCDA fund flow and process 60
• Figure 4-3. 60
• NHIA fund flow and process 60
• Figure 4-4. 61
• BHCPF allocation, number of PHC facilities via NPHCDA, and number of people enrolled via NHIA, 2019–23 61
• Figure 4-5. 62
• BPHCF allocated funds, 2021: Only 45% reached frontline service providers 62
• Figure 4-8. 63
• Total NHIA funds unspent, Q3, by state (in N billions) 63
• Figure 4-6. 63
• NPHCDA gateway funds, spent and unspent, 2021 and 2022 ( in billion of Naira) 63
• Figure 4-7. 63
• Number of facilities that received NPHCDA funds, by quarter, 2022 63
• Figure 4-9. 67
• UBE Fund allocation formula 67
• Figure 4-10. 68
• Per child allocation by state, 2019 68
• Figure 4-11. 69
• Allocations and disbursements of matching grants, 2017–21 69
• Figure 4-12. 72
• Students per classroom and percentage of classrooms in need of renovation, by state, 2022 72
• Figure 5-2. 78
• Deployment of teachers in primary schools, by enrollment, 2018 78
• Figure 5-1. 78
• Pupil-to-teacher ratio by state, 2022 78
• Figure 5-3. 79
• Deployment of teachers in primary schools, by enrollment, by state, 2022 79
• Figure 5-4. 79
• Deployment of teachers in primary schools, by enrollment, urban versus rural, 2018 79
• Figure 5-5. 80
• Distribution of states by overall PTR and efficiency in teacher allocation 80
• Figure 5-6. 81
• Number of male and female teachers in public primary schools and female share of teachers, by state, 2022 81
• Figure 5-7. 82
• Teachers’ content knowledge in core content and in pedagogical knowledge, distribution of teacher test scores by score quartile (%) 82
• Figure 5-9. 84
• Teachers’ attitudes toward classroom absenteeism 84
• Figure 5-10. 84
• School principals’ and head teachers’ perceptions of teacher absenteeism and related issues 84
• Figure 5-8. 84
• Teacher classroom absenteeism 84
• Figure 6-1. 90
• Percentage of schools with complete ASC/NPA data between 2016/17 and 2019/20 90
• Figure 6-2. 90
• Number of states included in recent data collection exercises, 2016/17 to 2019/20 90
• Table 2-2. 28
• Average annual per-child out-of-pocket education expenses for children ages 6–15 attending public schools 28
• Table 3-1. 36
• State government spending by sector, 2021 36
• Table 3-2. 38
• Average learning poverty and government spending on education in 124 countries by learning poverty quintile 38
• Table 3-3. 47
• Efficiency of public spending on education in terms of coverage, by state, 2021 47
• Table 3A.1. 56
• Overview of key MDAs/institutions contributing to the different outcomes 56
• Table 5-1. 83
• Teacher content knowledge 83