Background: The paper presents evidence about the distribution of the benefits of public expenditures on a
subset of priority public health services that are supposed to be provided free of charge in the public sector,
using the framework of benefit incidence analysis.
Methods: The study took place in 2 rural and 2 urban Local Government Areas from Enugu and Anambra states,
southeast Nigeria. A questionnaire was used to collect data on use of the priority public health services by all
individuals in the households (n=22,169). The level of use was disaggregated by socio-economic status (SES),
rural-urban location and gender. Benefits were valued using the cost of providing the service. Net benefit incidence
was calculated by subtracting payments made for services from the value of benefits.
Results: The results showed that 3,281 (14.8%) individuals consumed wholly free services. There was a greater
consumption of most free services by rural dwellers, females and those from poorer SES quintiles (but not for
insecticide-treated nets and ante-natal care services). High levels of payment were observed for immunisation
services, insecticide-treated nets, anti-malarial medicines, antenatal care and childbirth services, all of which are
supposed to be provided for free. The net benefits were significantly higher for the rural residents, males and
the poor compared to the urban residents, females and better-off quintiles.
Conclusion: It is concluded that coverage of all of these priority public health services fell well below target levels,
but the poorer quintiles and rural residents that are in greater need received more benefits, although not so for
females. Payments for services that are supposed to be delivered free of charge suggests that there may have
been illegal payments which probably hindered access to the public health services.