This study sought to describe the patterns of household expenditure among urban slum dwellers and non-slum dwellers in a southwestern state of Nigeria. Expenditure pattern for a four week duration prior to the admission for an emergency surgical care, was sought. As expected, majority of both groups were Christian and of Yoruba ethnicity – consistent with the characteristics of the inhabitants of the geographical location of study area. Ethnic predominance differs and is largely determined greatly by the three major regions of the country - northern, eastern and western parts of the country. The predominance of Yorubas in our study thus, is a much expected finding since the research was conducted in southwestern region of the country that is mainly inhabited by this ethnic group [28].
An interesting observation in this study was that despite their lower educational status, slum dwellers spent more on education fees and supplies than non-slum dwellers. A factor that might have played an important factor in this observation is the average family size of both categories of respondents. Studies have consistently reported higher family sizes among slum dwellers, indicating that they have more children than non-slum dwellers [29,30]. This, in turn, leads to more spending in order to cater for the educational needs of their children.
Furthermore, studies have established that a major contributor to the low educational attainment among slum dwellers might be as a result of poor or limited access to educational facilities in slum areas. Since majority of slum areas are not government-approved, there is poor attention to provision of standard educational facilities within them [31], often times complicated by disabling home environments and child labor [32]. A pertinent but subtle factor that has received attention in literature is the importance and high value attached to quality education that slum dwellers possess. Empirical evidence from other low-income slum settings show that slum parents are not disinterested in their children’s education and this may motivate them to allocate a substantial part of their income to their children’s education [2,29] – in a search for more standard educational facilities which are more likely to be situated in non-slum regions.
Nevertheless, as direct links have been established between educational levels and income [11,33], underlying and plausible reasons are provided for the low earning capacity experienced by slum dwellers. Literature has emphasized that discontinuation of children’s education is a major coping strategy when faced with financial catastrophe from health costs among slum dwellers [34,35], which explains the higher rates of drop out despite the genuine interest and motivation to achieve literacy for children. Mugisha, in a study among Kenyan children, found higher enrolment rates among slum children below the age of 9 for females and below the age of 11 for males, compared to their urban counterparts [32]. Thus, higher expenditures on education may not necessarily translate into improved educational attainment.
Low earning capacity of slum dwellers as demonstrated in this study, accompanied by predominance of informal jobs, is consistent with other research findings [36,37]. A body of literature attests to the evidence, demonstrating that slum dwellers usually suffer from fewer employment opportunities, under-employment and other factors that contribute to their lower earning power [5,10,12]. In another study, Pramanik and Mukherjee (2013) were able to establish high wage rates and greater employment opportunities as important economic pull factors for migration that often results in the growth and proliferation of urban slums [38]. In the same study, income differential was significantly higher in the inner city compared to the periphery – a finding that refutes the income pattern in our study. This is because our slums are located within the inner core of the metropolis while the regions inhabited by non-slum counterparts are in the periphery. According to a United Nations report, slum dwellers rate lower on human development indicators than other urban households due to income inequalities, resultant health problems, less access to education, social services and poor employment [39].
Food was found to take the highest proportion of household expenditure amongst both slum and non-slum dwellers. This is consistent with findings in literature [40] that showed that respondents averagely spent more of their income on food. In another study, 'food was the single most important component of household spending’, consuming up to 42.8% of total household expenditure [41]. Other than food expenditure, this study observed that slum dwellers spent considerably higher proportion of their mean monthly income on utilities (rent, telephone and construction repair), education and transportation, and health care costs. - consistent with findings in studies done in Asia, Africa and Latin America [18] and there may be several reasons for this disparity. First, as discussed earlier, is the issue of income. Low earning capacity (income) of slum dwellers relative to the non-slum dwellers’ seemingly portrays the assumption that slum dwellers spend more on these household items. A second possibility is the poor living condition associated with slums. Non-governmental approved infrastructure in slums, probably associated with poorer quality, will promote larger expenditures as observed in the construction repairs of slum dwellers. Lack of access to basic amenities such as potable drinking water and waste disposal services, conditions which characterize slum areas, have been associated with increased morbidity among different population segments [2,42,43] that very well explains the relatively large health expenditures incurred by the slum dwellers.
Two theories are proposed for why the non-slum dwellers consistently incurred larger proportions of their mean monthly income on voluntary insurance, health care costs requiring overnight stay and all other health care products not listed; and these are income and access. Better income fostered with improved and unhindered access to health care may translate to a higher demand by non-slum dwellers for available health care services and vice versa for the slum dwellers. The consequent better health enjoyed as a result of increased demand and access has led to wider gap in disparities that has been the underlying factor why the rich are healthier while the poor are sicker. The disparities have been a major concern in literature[44]. Consumer directed healthcare has also promoted health care disparities with wealth dimensions (promoting disparities), age dimensions (disparities occurring when the young and healthy pay less compared to middle aged) and gender related dimensions (disparities occurring when women spend more than male counterparts) [45] . Conversely, the reduced demand on available health care services also alludes to why the slum dwellers incurred more on herbal (traditional) care which are presumably more available in the slums and at more affordable rates. Herbal (traditional) care was found to be the first treatment choice for infertility in slums of Bangladesh [46]. Not surprisingly the availability of herbalists more in the slums will favour this patronage.
As partially discussed above, it is not surprising also that non-slum dwellers spent more on voluntary insurance. The popular and widely known form of insurance currently in Nigeria; the National Health Insurance Scheme (NHIS) is a government regulated social scheme that was launched in 2005 [33]. The coverage of scheme today is still largely limited and mandatory for the employees within the public and organized private sectors. As noted in the socio-demographic distribution of the respondents, non-slum dwellers are more likely to belong to this group than slum dwellers, thus validating the higher amounts spent by non-slum dwellers on health insurance premiums. Other studies among slum dwellers in similar sub-Saharan Africa settings show that slum dwellers are less likely to participate in health insurance schemes due to poor earning power, the need to prioritize immediate expenses and affordability of premiums [30,47].
Our study must be interpreted bearing in mind a few limitations. First, the amounts provided by the respondents are subject to varying degrees of recall bias. However, this was minimized by requesting provision of receipts or recall of events that assisted better with accurate recalls. Secondly, our study could not substantiate that this was the steady pattern of expenditure over several months before the study for both slum and non-slum dwellers. For instance, in the four weeks prior to the surgical emergency when the study was conducted, the influence of major life events that would have influenced spending patterns could not be eliminated nor accounted for during the recall process. Thirdly, the economies of scale that can be influenced by family settings (nuclear or extended) and marriage types (monogamy or polygamy), on total income was also not investigated nor accounted for. Lastly, considering that the research was carried out in the southwestern region of the country, findings from this study should be cautiously applied to slum regions in other areas of the country. Nonetheless, despite these limitations, our study provides empirical and preliminary findings that document the spending patterns of slum and non-slum households in southwestern Nigeria.