Equity of Healthcare Access in Nigeria: A Scoping Review
DOI:
https://doi.org/10.60787/tnhj.v24i3.891Keywords:
Health Equity, Public Health, Healthcare, Health systems, NigeriaAbstract
Background: Health is a fundamental right for all living beings, and ensuring health equity is crucial. In our society, the primary, secondary, and tertiary healthcare systems are tasked with delivering health services. However, people's perception of these systems varies based on the quality of services provided. This study aimed to identify the barriers contributing to health inequity and elaborate on these obstacles.
Method: To conduct this review, a comprehensive search of reputable sources including PubMed and Google Scholar was performed. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, a total of 13 studies were identified, spanning from 2016 and 2023, that focused on health care delivery, health seeking behaviour and health utilization.
Result: From the thirteen articles consulted, a total of 9,720 respondents were included in the study. The South-West zone had the most publications (eight) while the North-West had no published article with data. 30.8% of the reviewed publications highlighted level 1 factors as a prominent barrier to healthcare access, while 38.5% were on level 2 factors. A significant 69.2% of the literature emphasizes the role of level 3 factors as a barrier responsible for health inequity.
Conclusion: Achieving universal health coverage by 2030 in Nigeria requires significant transformation for equitable healthcare access. Ongoing monitoring of regional challenges is essential, along with increased research on primary healthcare accessibility, especially in northern regions. Initiatives to improve health insurance access nationwide are also crucial for creating a more inclusive healthcare system.
Downloads
References
World Health Organization. Declaration of Alma-Ata [Internet]. World Health Organization. 1978. Available from: https://www.who.int/teams/social-determinants-of-health/declaration-of-alma-ata
Fullman N, Yearwood J, Abay SM, Abbafati C, Abd-Allah F, Abdela J, et al. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. The Lancet 2018 ;391(10136):2236–71. Doi: https://doi.org/10.1016/s0140-6736(18)30994-2
Park S, Abrams R. Alma-Ata 40th birthday celebrations and the Astana Declaration on Primary Health Care 2018. Br J Gen Pract [Internet]. 2019 May;69(682):220–1. Doi: https://bjgp.org/lookup/doi/10.3399/bjgp19X702293
Health Equity and the Circle of Human Concern. AMA J Ethics [Internet]. 2021 Feb 1;23(2):E166–74.
Whitehead M. The Concepts and Principles of Equity and Health. Int J Heal Serv [Internet]. 1992 Jul 1;22(3):429–45.
Ramadan M, Tappis H, Uribe MV, Brieger W. Access to primary healthcare Services in Conflict-Affected Fragile States: a subnational descriptive analysis of educational and wealth disparities in Cameroon, Democratic Republic of Congo, Mali, and Nigeria. Int J Equity Health [Internet]. 2021 Dec 11;20(1):253.
Koce F, Randhawa G, Ochieng B. Understanding healthcare self-referral in Nigeria from the service users’ perspective: a qualitative study of Niger state. BMC Health Serv Res [Internet]. 2019;19(1):209.
O. Abah V. Poor Health Care Access in Nigeria: A Function of Fundamental Misconceptions and Misconstruction of the Health System. In: Healthcare Access - New Threats, New Approaches [Working Title] IntechOpen; 2022. Available from: https://www.intechopen.com/online-first/84695
Abimbola S, Oyedeji R. How tertiary hospitals can strengthen primary health care in Nigeria. Niger Med J [Internet]. 2014;55(6):519.
Pettigrew LM, De Maeseneer J, Anderson MIP, Essuman A, Kidd MR, Haines A. Primary health care and the Sustainable Development Goals. Lancet. 2015;386(10009):2119–21.
Bitton A, Ratcliffe HL, Veillard JH, Kress DH, Barkley S, Kimball M, et al. Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries. J Gen Intern Med. 2017;32(5):566–71.
Primary Health Care Performance Initiative. Primary Health Care Performance Initiative [Internet]. [cited 2023 Jul 9]. Available from: http://www.phcperformanceinitiative.org/
Levesque JF, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health [Internet]. 2013;12(1):18.
Kress DH, Su Y, Wang H. Assessment of Primary Health Care System Performance in Nigeria: Using the Primary Health Care Performance Indicator Conceptual Framework. Heal Syst Reform. 2016;2(4):302–18.
Adeleye O, Adebowale A, Adeyemo O, Adeoye I, Afolabi R, Fagbamigbe A, et al. Decomposition and Spatiotemporal Analysis of Barriers to Healthcare Access among Women of Childbearing age in Nigeria, using Nigeria Demographic and Health Survey from 2003 to 2018. J African Popul Stud. 2023 Mar 17; Available from: https://journal.uaps-uepa.org/published-article/?id=10391
Nneka EU, Timothy AE, Agnes NA, Elizabeth OO. Building a strong and sustainable health care system in Nigeria: The role of the nurse. Int J Nurs Midwifery [Internet]. 2019;11(7):61–7.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021, n71. Doi: https://www.bmj.com/lookup/doi/10.1136/bmj.n71
Anakwenze CP, Ntekim A, Trock B, Uwadiae IB, Page BR. Barriers to radiotherapy access at the University College Hospital in Ibadan, Nigeria. Clin Transl Radiat Oncol. 2017; 5:1–5. Available from: https://www.sciencedirect.com/science/article/pii/S2405630817300071
Egbunu Abiodun Abosede, Makolo Daniel, Alkali Daniels Emmanuel. A spatial analysis of health care accessibility and utilization among rural households in Kogi State, Nigeria. Int J Life Sci Res Arch [Internet]. 2022 Sep 30;3(1):101–9. Available from: https://sciresjournals.com/ijlsra/content/spatial-analysis-health-care-accessibility-and-utilization-among-rural-households-kogi-state
Fatima Samuel Medugu, Tpl James Jesse Shinggu SMD. The Distribution of Healthcare Facilities in Mubi North Local Government Area: The Physical Planning Perspective. African Sch J Built Env Geol Res [Internet]. 2022;25(4):143–51. Available from: https://www.africanscholarpublications.com/wp-content/uploads/2022/08/AJBEGR_Vol25_No4_June_2022-12.pdf
Ahmed A, Imhonopi G, Fasiku M, Ahmed A, Osinubi M, Soyannwo T. Predictors of Healthcare-Seeking Behaviour, Health Services Access and Utilization in Ajebo Community, South-West, Nigeria. Ann Heal Res. 2021;7(4):374–90.
Ahuru RR, Iseghohi OJ, Nzoputam CI, Ekomoezor E. Health insurance ownership and maternal health service uptake among Nigerian women. Ibadan J Sociol. 2021 Jun 1;12(1). Available from: https://ibadanjournalofsociology.org.ng/abst?sid=12_1_2
Ahmed Babatunde Jimoh. Community Perceptions on the Preference and Impediments to the Utilization of Healthcare Services in Omu-Ijebu, Ogun State, Nigeria. Am J Heal Res. 2022;10(5):185–92. Available from: https://www.researchgate.net/profile/Ahmed-Jimoh-2/publication/363891416_Community_Perceptions_on_the_Preference_and_Impediments_to_the_Utilization_of_Healthcare_Services_in_Omu-ijebu_Ogun_State_Nigeria/links/6333f7935f6370520d015f31/Community-Perceptions
Sibeudu FT, Uzochukwu BS, Onwujekwe OE. Rural–urban comparison of routine immunization utilization and its determinants in communities in Anambra States, Nigeria. SAGE Open Med. 2019; 7:205031211882389. Available from: http://journals.sagepub.com/doi/10.1177/2050312118823893
Osunde N, Olorunfemi O, Oduyemi R. Awareness, willingness, and challenges of the informal sector toward state National Health Insurance Services in Benin City, Nigeria. MGM J Med Sci. 2023;10(1):30. Available from: https://journals.lww.com/10.4103/mgmj.mgmj_191_22
Akinyemi PA, Fajobi O, Owoade IA, Elugbaju OT, Wuraola FO. Community perception and determinants of willingness to uptake COVID-19 vaccines among residents of Osun State, South-West Nigeria. Int J Community Med Public Heal. 2021;8(4):1551.
Ogunyemi A, Egemba T, Onigbogi O. Health-seeking Behaviour and Self-rated Health of Adult Men in an Urban Local Government Area in Lagos, Nigeria. Ann Heal Res. 2021;7(2):153–64.
Justina Kwaskebe, James E. Atolagbe BK. Factors Affecting Service Delivery of Primary Health Care Centers in Nigeria: A Case Study of Isiala-Ngwa North Local Government. Sapientia Found J Educ Sci Gend Stud. 2022;4(1):225–36.
Ajayi AI, Ahinkorah BO, Seidu AA. “I don’t like to be seen by a male provider”: health workers’ strike, economic, and sociocultural reasons for home birth in settings with free maternal healthcare in Nigeria. Int Health. 2023,15(4):435–44.
Adekunmi A, Wright T, Folorunsho O, Oluwatusin F, Ajiboye M, Awoyemi A. Assessment Of Rural Womens’ Access To Primary Health Care Services In South West Nigeria. Int J Innov Res Adv Stud. 2020, ;7(4):191–4.
Teleayo A. Assessing the Impact of Universal Healthcare Coverage on Maternal and Child Health Outcomes in Nigeria. J Community Heal Provis. 2023;3(1):1–7.

Published
Issue
Section
License
Copyright (c) 2024 Adomi S, Asogun D, Rwuaan RK, Iliya BT, Adebanjo O

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Journal is owned, published and copyrighted by the Nigerian Medical Association, River state Branch. The copyright of papers published are vested in the journal and the publisher. In line with our open access policy and the Creative Commons Attribution License policy authors are allowed to share their work with an acknowledgement of the work's authorship and initial publication in this journal.
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author.
The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
TNHJ also supports open access archiving of articles published in the journal after three months of publication. Authors are permitted and encouraged to post their work online (e.g, in institutional repositories or on their website) within the stated period, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). All requests for permission for open access archiving outside this period should be sent to the editor via email to editor@tnhjph.com.