EARLY IMPACTS OF FUEL SUBSIDY REMOVAL ON MENTAL HEALTH STATUSOF PRIMARY HEALTHCARE WORKERS AND COMMUNITY MEMBERS IN NIGERIA: A CROSS-SECTIONAL STUDY.

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D. Bakare¹, J. Salako¹, A. Sogbesan¹, A. A. Bakare^2,3

1. Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
2. Department of Community Medicine, University College Hospital, Ibadan, Nigeria
3. Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden

Abstract

Background: The abrupt removal of fuel subsidy in Nigeria led to exponential increase in fuel prices. The resultant economic pressure may have effects on the mental health status of Nigerians.
The objective is to understand this impact, we assessed changes in mental health status among primary healthcare workers and community members after fuel subsidy removal.

Materials & Methods: We carried out cross-sectional study in six Local Government Areas (LGA) across three Nigerian states and surveyed healthcare workers and community members. We analysed respondents’ socio-demographic characteristics and their perceptions of fuel subsidies and mental health risks using summary statistics. Additionally, we evaluated depression and anxiety severity among respondents before and after the subsidy removal using the PHQ-9 and GAD-7 scales, reporting findings by state and percentage increases in the subsidy removal’s impact on healthcare workers and community members.

Results: We found a rise in depression and anxiety, particularly among younger adults. HCWs in Jigawa state faced the most severe increase, with depression rates nearly tripling. Similarly, community members across various demographics saw a significant rise in depression and anxiety after the policy change. According to state, Jigawa state bore the brunt, with depression and anxiety rising by over 200% while market women experienced the highest increase within occupational groups.

Conclusion: This study shows that younger adults, single individuals, residents of disadvantaged areas, and market women were mostly affected. The widespread mental health crisis necessitates broad interventions targeting these groups..

Keywords: Fuel subsidy, Mental health, Depression, Anxiety, Nigeria.

Introduction

Fuel subsidy is a policy implemented by the government to lower the cost of petroleum products for the citizens and guarantee a steady supply.^1,2 The debate over fuel subsidies has increased all over the world because of their effect on citizens’ welfare, and role in bolstering a nation’s economy. Fuel subsidy costs have seen a notable rise in the last few years in many countries, hitting record-high numbers.³ According to the International Monetary Fund (IMF), global fuel subsidies estimates surpassed $7 trillion in 2022, primarily due to the instability of energy markets and geopolitical complexities stemming from the Ukraine crisis.^4,5 While the intent behind fuel subsidies is to benefit low income households, they can also distort markets, encourage smuggling, and hinder investment in renewable energy, leading to volatile pricing dynamics in the international oil market, which have strained governments’ finances.^6,7

Despite Nigeria’s status as a leading exporter of crude oil in Africa8, its ability to fully leverage its petroleum resources is hindered by high fuel subsidies, as it relies heavily on imported petroleum due to operational deficiencies and inadequate maintenance of local refineries.^8-10 Consequently, President Bola Ahmed Tinubu, in his inaugural speech on May 29, 2023, announced the complete removal of the fuel subsidy.¹¹ The rationale behind this decision was the government inability to meet up with the financial implications of the fuel subsidies due to growing external debts and diminishing internal revenue

However, due to the absence of a well-structured implementation plan, the directive to remove fuel subsidies has led to rising fuel prices, adversely affecting individuals, businesses, and critical sectors like healthcare and agriculture. This economic hardship is likely to exacerbate mental health problems in Nigeria, a country that already severely neglects this issue.¹² In 2019, the age-standardized suicide mortality rate per 100,000 population was 6.87, and government spending on mental health accounted for only 4.1% of the total health budget.¹³ This lack of investment is particularly concerning given the established link between economic hardship and mental health issues. Moreover, essential mental health services for conditions like psychosis, bipolar disorder, and depression are not covered by the national health insurance scheme, further limiting access to care during this time of increased need.¹³

Previous studies on fuel subsidy impacts in Nigeria have identified various potential negative outcomes, including increased transportation costs, higher prices for essential goods.¹⁴ Currency devaluation, inflation¹⁵ , rising poverty, and increased crime rates. ¹⁶ Furthermore, the removal of fuel subsidies can create barriers to healthcare access for Nigerians, as increased cost of care and services renders them unaffordable.¹⁷ International studies also suggest a link between subsidy removal and worsened mental health.^18,19 However, the existing literature on Nigeria’s fuel subsidy removal focuses primarily on economic consequences, neglecting the potential mental health impact on the population.

Therefore, this research aims to assess how the removal of fuel subsidies may affect the mental health of two crucial stakeholder groups: Nigerian healthcare professionals and local residents.