Health Financing Equity and Out-of-Pocket Expenditure Among Rural Households in Zamfara State, North West Nigeria

High out-of-pocket health expenditure is a major driver of financial catastrophe and impoverishment among poor households in Nigeria, and rural communities in North West states such as Zamfara face particularly acute health financing equity deficits. This study examines health financing equity and out-of-pocket expenditure patterns among rural households in Zamfara State. A cross-sectional household survey is conducted with 380 heads of household from rural communities in Gusau, Maru, and Bungudu local government areas, selected through multistage cluster sampling. The household questionnaire captures monthly income and expenditure, healthcare utilisation over the preceding three months, health facility types attended, total out-of-pocket spending per episode, informal payment practices, exposure to financial hardship or debt due to health costs, and health insurance enrolment status. Catastrophic health expenditure is computed as health spending exceeding 10 percent of total household income. Concentration indices are calculated to assess pro-poor equity, and logistic regression in SPSS identifies predictors of catastrophic expenditure. The 2021 Nigeria Living Standards Survey and National Health Accounts data indicate that out-of-pocket spending accounts for over 70 percent of total health expenditure in North West states. The Health Financing Equity framework of Wagstaff and van Doorslaer guides the analytical approach. Findings will inform Zamfara State on designing social health protection mechanisms and community-based insurance models. Keywords: health financing, out-of-pocket expenditure, health equity, rural households, Zamfara State.