AUTHOR=Ozor Okechukwu , Nwokolo Chukwudi , Teixeira de Siqueira Filha Noemia , Odii Aloysius , Hicks Joseph Paul , Li Shushan , Ezenwaka Uchenna , Dawkins Bryony , Onwujekwe Obinna TITLE=Inequities in Household Out-Of-Pocket Spending Among Urban Slum Dwellers in Southeast Nigeria JOURNAL=International Journal of Public Health VOLUME=Volume 70 - 2025 YEAR=2025 URL=https://www.ssph-journal.org/journals/international-journal-of-public-health/articles/10.3389/ijph.2025.1607969 DOI=10.3389/ijph.2025.1607969 ISSN=1661-8564 ABSTRACT=Objectives

This study examines the economic burden and inequities in out-of-pocket expenditures (OOPEs) to access healthcare in urban slums in Nigeria.

Methods

The cross-sectional study was undertaken in eight urban slums in Enugu and Anambra, Nigeria. Participants (n = 1,025) responded to questions on health expenditures and access to healthcare. Gamma regression was used to estimate the mean differences in OOPE. Financing incidence analysis was used to estimate inequities in OOPE.

Results

Enugu residents and individuals with formal occupations incurred lower costs than the residents in Anambra and those employed in informal occupations. Households in the middle wealth quintile incurred higher costs than those in the poorest quintile. Gini, concentration, and Kakwani indices indicated a progressive financing system, with the richest contributing proportionately more than their share of ability to pay (ATP). Poorest households used informal healthcare more.

Conclusion

Although payment for healthcare in urban slums is progressive, the poorest households may be at risk of poor health outcomes due to reliance on informal healthcare providers. Our findings highlight the role ATP may play in healthcare denial among the urban poor.