Introduction: Reliance on out-of-pockets (OOP) payments for health services has continued to hamper access to quality healthcare across Nigeria. Socio-demographic and socio-economic characteristics of the gender of the household head as it influences and impacts health shocks and OOP payments have received very little attention globally. This study investigated the gender perspective on health shocks, health expenditures and coping mechanisms in North Central, Nigeria. Methods: This is a cross-sectional analytical study involving both quantitative and qualitative data collection methods. A total of 1,192 households were studied using multi-stage sampling technique in both rural and urban communities in North Central, Nigeria. Data was analysed with SPSS version 20, and qualitative analysis was done by thematic analysis. Results: The finding showed that 458 (38.4%) of the respondents were female-headed households (FHHs). Female-headed households were less educated, earned lower income, resided more in rural communities and were less insured than male-headed households (MHHs). Health shocks were higher among the FHHs and they also pay higher percentage of their household expenditure for healthcare through higher OOP payments. Also, more FHHs experienced Catastrophic Health Expenditure (CHE) and reported effects of health shocks on reduction in food consumption and loss of income than MHHs. Age, income, occupation and household size are all factors that influenced health shocks in this study. Conclusions: Innovative ways to financially protect women must be employed, to close up the equity gap and bring Nigeria closer to achieving UHC.

Introduction: Reliance on out-of-pockets (OOP) payments for health services has continued to hamper access to quality healthcare across Nigeria. Socio-demographic and socio-economic characteristics of the gender of the household head as it influences and impacts health shocks and OOP payments have received very little attention globally. This study investigated the gender perspective on health shocks, health expenditures and coping mechanisms in North Central, Nigeria. Methods: This is a cross-sectional analytical study involving both quantitative and qualitative data collection methods. A total of 1,192 households were studied using multi-stage sampling technique in both rural and urban communities in North Central, Nigeria. Data was analysed with SPSS version 20, and qualitative analysis was done by thematic analysis. Results: The finding showed that 458 (38.4%) of the respondents were female-headed households (FHHs). Female-headed households were less educated, earned lower income, resided more in rural communities and were less insured than male-headed households (MHHs). Health shocks were higher among the FHHs and they also pay higher percentage of their household expenditure for healthcare through higher OOP payments. Also, more FHHs experienced Catastrophic Health Expenditure (CHE) and reported effects of health shocks on reduction in food consumption and loss of income than MHHs. Age, income, occupation and household size are all factors that influenced health shocks in this study. Conclusions: Innovative ways to financially protect women must be employed, to close up the equity gap and bring Nigeria closer to achieving UHC.