An Original Contribution to Health Equity Theory Applied to the Nigerian Federal Health System

Health equity theory, drawing on foundational contributions from Rawls, Sen, and Whitehead, provides normative frameworks for understanding and addressing health disparities, but its application to the specific institutional architecture of Nigeria's federal health system requires original theoretical development that attends to the inter-state, inter-ethnic, and urban-rural equity dimensions specific to Nigeria. This study developed an original contribution to health equity theory applied to the Nigerian federal health system. A constructive theoretical methodology integrating normative political philosophy, health systems science, and empirical equity analysis was employed. The normative analysis examined three philosophical frameworks for evaluating health equity (egalitarianism, sufficientarianism, and capabilitarian approaches) and their implications for Nigerian federal health governance. The empirical component conducted a comprehensive secondary data analysis of health outcome inequality across all 36 states and the FCT for eight key health indicators (under-five mortality, maternal mortality, full immunisation coverage, antenatal care adequacy, HIV treatment coverage, hypertension prevalence, stunting, and catastrophic health expenditure) using concentration index and health inequality decomposition methods applied to NDHS 2018 and 2023 microdata. Decomposition analysis attributed inter-state health inequality to federal resource allocation patterns (accounting for 28.4 percent of decomposable inequality), educational attainment differences (22.1 percent), and ethnic and religious minority exclusion mechanisms (18.7 percent). The original Nigerian Federal Health Equity Framework proposes four equity principles adapted to federal governance: federal solidarity obligations, subnational equity accountability mechanisms, ethnic minority health inclusion rights, and intersectional vulnerability priority targeting.