Accessibility Standards of Community Health Facilities in Southeast Nigeria
Urban-Rural Comparative Analysis
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Abstract
Access to healthcare remains a bothersome challenge, with stark inequalities between urban and hinterland settlements hindering the progress of the Universal Health Coverage. In light of this development, this study investigates the standards of accessibility of community healthcare facilities (CHFs) in Southeastern Nigeria through a detailed urban-rural comparison. A comparative cross-sectional research design was implemented, drawing on key informant interviews (KIIs), focus group discussions (FGDs), and structured questionnaires. Data were extracted from 40 CHFs across Anambra and Ebonyi states, which present extremes of urban and rural peculiarities. Access to healthcare facilities was assessed across the four dimensions: infrastructural, geographical, financial and cultural. Quantitative data were analysed using descriptive statistics, while qualitative perceptions were decoded thematically. Results showed pronounced imbalances between CHFs in urban and rural areas. Mean travel distances to urban and rural CHFs were recorded as 2.3km and 5.75km, respectively, underscoring significant geographic disparity. CHFs in rural areas showed notable infrastructural deficits and extended waiting periods, with an average delay of 59 minutes (≈1 hour). Conversely, facilities in urban locales presented non-reimbursable expenses that doubled rural expenditure, highlighting financial barriers for urban uCHFs. Despite these challenges, there is a higher cultural acceptability and contentment level observed in rural uCHFs. This shows a stronger communal cohesion, social bonding, and trust within rural social cohorts. Finally, the study affirms a region with multidimensionally unequal access to CHFs. While community members in urban locales grapple with fiscal constraints, their counterparts in rural areas contend with infrastructural rot and locational challenges. Enactment of enforceable benchmarks for accessibility and fair locational distribution of CHFs are some of the recommendations floated by the study. Others include revamped road networks and economic subsidies extended to users. This would help to curtail financial exclusion. Implementing these measures would encourage inclusive and fair delivery of healthcare across Nigeria’s diverse regions.
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Copyright (c) 2026 Arc. Onwukwe Chukwuemeka Ozioma Stanislaus (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Arc. Onwukwe Chukwuemeka Ozioma Stanislaus, Department of Architecture, Federal University of Technology, Owerri, Nigeria.
Arc. Onwukwe, Chukwuemeka Ozioma Stanislaus is a registered architect and accomplished academic whose professional and scholarly pursuits intersect across architecture, technology, and sustainability. He is a full member of the Nigerian Institute of Architects (NIA) and is duly registered with the Architects Registration Council of Nigeria (ARCON), affirming his commitment to professional excellence and regulatory standards in the built environment sector. With a career spanning architectural design, teaching, research, and technological innovation, Arc. Onwukwe, Chukwuemeka Ozioma Stanislaus serves as an Academic Staff and Chief Technologist in the Department of Architecture at the Federal Polytechnic Nekede, Owerri. In this dual capacity, he plays a pivotal role in advancing architectural education by integrating hands-on technical expertise with contemporary design pedagogy. His work supports the training of future architects through studio instruction, laboratory management, curriculum enhancement, and the application of emerging digital and sustainable technologies. Arc. Onwukwe, Chukwuemeka Ozioma Stanislaus is currently pursuing a PhD in the Department of Architecture at the Federal University of Technology Owerri (FUTO), where his research contributes to expanding knowledge on sustainable design, environmental performance, indoor air quality, regenerative architecture, and community-focused development. His scholarly interests extend across climate-responsive architecture, innovative construction technologies, urban resilience, and the socio-technical dimensions of the built environment. Beyond academia, he has participated in professional design projects, collaborative research initiatives, and capacity-building programmes aimed at improving Nigeria’s architectural standards and community well-being. His broader mission is to promote evidence-based architectural solutions that address contemporary challenges in housing, environmental health, and sustainable urban development. Driven by a commitment to professional growth, academic excellence, and societal impact, Ozioma continues to bridge the gap between architectural theory and practice. His work reflects a strong dedication to creating functional, sustainable, and inclusive spaces that improve quality of life and advance the architectural profession in Nigeria and beyond.
Abdulraheem, I. S. (2017). Primary Health Care Services in Nigeria. Journal of Public Health in Africa, 13-17.
Adejare, J. A., Omoakin, J., & Muili, A. B. (2024). Patronage Pattern and Accessibility of Healthcare Facilities in Urban Slums and Informal Settlements in Ibadan Metropolis. Urban and Regional Planning, 71-87. DOI: https://doi.org/10.11648/j.urp.20240903.12
Adepoju, L. A., Onafuye, B. A., Megbuwon, T., & Ogunseye, O. O. (2025). Community Health Workers' Role in Enhancing Health Outcomes and Rural Primary Healthcare in Nigeria: A Review. Journal of Medicine and Health Research, Volume 10, Issue 1: pp. 9-19. DOI: https://doi.org/10.56557/jomahr/2025/v10i19082
Adomi, S., Asogun, D., Rwuaan, R. K., Iliya, B. T., & Adebanjo, O. (2024). Equity of Healthcare Access in Nigeria: A Scoping Review. The Nigerian Health Journal, 1345-1354.
Agnese, I., Funmilayo, S., Timothy, C., Julius, S., Damola, B., Ajobami, A. B., . . . Rochelle, B. (2023, November 16). Community perceptions matter: a mixed-methods study using local knowledge to define features of success for a community intervention to improve quality of care for children under-5 in Jigawa, Nigeria. Retrieved from BMJ Open: https://pubmed.ncbi.nlm.nih.gov/37973546/
Alkhawaldeh, A., Alhuwailah, A., & Alzahrani, M. (2023). Application and Use of Anderson's Behavioural Model as Theoretical Framework: A Systematic Literature Review. Iranian Journal of Health, 1346-1354. DOI: https://doi.org/10.18502/ijph.v52i7.13236
Andersen, M. R. (1995, March 23). Revisiting the Behavioral Model and Access to Medical Care: Does it Matter? Retrieved from Journal of Health and Social Behaviour: https://www.jstor.org/stable/2137284?origin=crossref
Aregbesola, B. S., Onigbogi, O. O., & Khan, S. M. (2017). Challenges and opportunities to access health care in urban slums of Lagos State in Nigeria. Pakistan Journal of Public Health, 11-18. DOI: https://doi.org/10.32413/pjph.v7i1.19
Averik, P. D., Obafemi, A. A., Ogoro, M., Ndabula, C., Jidauna, G. G., & Akawu, C. B. (2024). Spatial Analysis of Physical Accessibility to Public Primary Healthcare Centers in Kaduna State, Nigeria. FUDMA Journal of Earth and Environmental Sciences, 0101/07. DOI: https://doi.org/10.33003/jees.2024.0101/07
Awofeso, N. (2010). Improving health workforce recruitment and retention in rural and remote regions of Nigeria. Rural and Remote Health, 10(1): article 1319. DOI: https://doi.org/10.22605/RRH1319
Bhattacharya, A. A., Allen, E., Umar, N., Audu, A., Felix, H., Schellenberg, J., & Marchant, T. (2020). Improving the quality of routine maternal and newborn data captured in primary health facilities in Gombe State, Northeastern Nigeria: a before-and-after study. BMJ Open, 10: e038174. DOI: https://doi.org/10.1136/bmjopen-2020-038174
Bright, T., Wallace, S., & Kuper, H. (2021). Physical accessibility of primary care facilities for people with disabilities: a cross-sectional survey in 31 countries. BMC Health Services Research, 21:724. DOI: https://doi.org/10.1186/s12913-021-06120-0
Campbell, J. (2013). Human resources for health and universal health coverage. Bulletin of the World Health Organization, 91(11): 888–894. DOI: https://doi.org/10.2471/BLT.13.126698
Chukwuechefulam, K. I., Nicole, D. B., & Uche, C. I.-A. (2022, September 12). The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study. Retrieved from National Library of Medicine: https://pubmed.ncbi.nlm.nih.gov/36100949/
Daniel, H. K., Yanfang, S., & Hong, W. (2016, October 24). Assessment of Primary Health Care System Performance in Nigeria. Retrieved from National Library of Medicine: https://pubmed.ncbi.nlm.nih.gov/31514724/
Delamater, P. L., Messina, J. P., Shortridge, A. M., & Grady, S. C. (2012). Measuring geographic access to health care: raster and network-based methods. International Journal of Health Geographics, 11(1),15. DOI: https://doi.org/10.1186/1476-072X-11-15
Fayehun, O., Ajisola, M., Uthman, O., Oyebode, O., Oladejo, A., Owoaja, E., . . . Omigbodun, A. (2022). A contextual exploration of healthcare service use in urban slums in Nigeria. PLOS One, 17(2). DOI: https://doi.org/10.1371/journal.pone.0264725
Federal Ministry of Health. (2025, December 12). National Health Facility Registry (NHFR). Retrieved from Federal Ministry of Health: https://hfr.health.gov.ng
Fulus, D. F. (2025). A Survey of Healthcare Access and Utilization in Selected Rural and Urban Settlements of Plateau State, Nigeria. FUDMA Journal of Sciences, 164-168. DOI: https://doi.org/10.33003/fjs-2025-0903-3217
Gulliford, M. (2002). What does 'access to health care' mean? BMJ (British Medical Journal), 1015–1018.
Hilson, R., Alejandre, J. D., Jacobsen, K. H., Ansumana, R., Bockarie, A. S., & Bangura, U. (2015). Stratified Sampling of Neighborhood Sections for Population Estimation: A Case Study of Bo City, Sierra Leone. PLoS ONE, 10(7): e0132850. DOI: https://doi.org/10.1371/journal.pone.0132850
Kieny, M. P. (2017). Strengthening health systems for universal health coverage. Bulletin of the World Health Organization, 95(11): 801–802. DOI: https://doi.org/10.2471/BLT.16.187476
Konstantina, V., Julie, B., Susan, T., & Terry, Y. (2018). Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC Medical Research Methodology, Volume 18, Article No. 148. DOI: https://doi.org/10.1186/s12874-018-0594-7
Lawan, T. B. (2021). Spatial Analysis of Spatio-Physical Accessibility to Rural Healthcare Facilities in Nangere Local Government Area of Yobe State, Nigeria. IOSR Journal of Humanities and Social Science, 8-17.
Lorretta, F. C., Julius, O., Wilson, I., Sanni, Y., & Friday, E. (2021, November 11). Assessment of service readiness for maternity care in primary health centres in rural Nigeria: implications for service improvement. Retrieved from National Library of Medicine: https://pubmed.ncbi.nlm.nih.gov/34970393/
Maidoki, A. (2017). Give me source. Journal article. Author. Title. Journal name. Year. pages. Health Policy and Planning, 257-264.
Martin, A., Pauline, B., Remare, E., Catherine, K., & Simon, C. (2015, December 4). Strengthening health system governance using health facility service charters: a mixed methods assessment of community experiences and perceptions in a district in Kenya. Retrieved from Springer: https://link.springer.com/article/10.1186/s12913-015-1204-6
McKing, I. A., & Ifunanya, C. E. (2021, September 25). Improving access, quality and efficiency in health care delivery in Nigeria: a perspective. Retrieved from PAMJ - One Health: https://www.one-health.panafrican-med-journal.com/content/article/5/3/full DOI: https://doi.org/10.11604/pamj-oh.2021.5.3.28204
Munos, M. K., Maiga, A., & Do, M. (2018). Linking household survey and health facility data for effective coverage measures: a comparison of ecological and individual linking methods using the Multiple Indicator Cluster Survey in Côte d’Ivoire. Journal of Global Health, 8(2). DOI: https://doi.org/10.7189/jogh.08.020803
NBS. (2020, December 12). Social Statistics in Nigeria 2020. Retrieved from National Bureau of Statistics: https://www.nigerianstat.gov.ng/elibrary/read/1241101?utm_source=chatgpt.com
Nnadi, H. C., Ossai, O. G., & Nwokocha, V. C. (2024). Urbanization factors and the vagaries of the rural health care industry in Nigeria: An analysis of the accessibility of healthcare services by older adults in the Nsukka Local Government Area. Humanities and Social Sciences Communications, 11(1), 1355. DOI: https://doi.org/10.1057/s41599-024-03799-4
Nnamdi, A., & Igwe, A. A. (2025). Analysis of Accessibility, Affordability, and Quality Concerns in Private Healthcare Delivery in Southeast Nigeria. African Journal of Management Studies, 45-61.
Obinna, E. O., Benjamin, S. U., Eric, N. O., Ogbonna, G. O., Ijeoma, O., Chima, A. O., . . . Chijioke, O. (2010). Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria. BMC Health Services Research, 67-77.
Obubu, M. (2023). Evaluation of healthcare facilities and personnel distribution in Lagos State, Nigeria. Journal of Health Systems and Policy, 1-10.
Omonona, B. T., & Akinmoladun, O. O. (2015). Addressing healthcare inequalities in Nigeria. Journal of Advanced Research and Multidisciplinary Studies, 5(1), 1–10.
Onyenoro, U., Ogah, O. S., Ukegbu, A. U., Chukwuonye, I. I., Madukwe, O. O., & Moses, A. O. (2016). Urban–Rural Differences in Health-Care-Seeking Pattern of Residents of Abia State, Nigeria, and the Implication in the Control of NCDs. Health Services Insights, 29-36.
Onyeonoro, U. U., & Okafor, H. U. (2016). Urban–rural differences in health-care-seeking patterns in Abia State, Southeast Nigeria. Health Services Insights, 9, 1–9. DOI: https://doi.org/10.4137/HSI.S31865
Otieno, P. O., Wambiya, E. O., & Mohammed, S. M. (2020). Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. BMC Public Health, Vol. 20:98. DOI: https://doi.org/10.1186/s12889-020-09106-5
Oyekale, A. S. (2017). Assessment of primary health care facilities’ service readiness in Nigeria. BMC Health Services Research, 1-12. DOI: https://doi.org/10.1186/s12913-017-2112-8
Ramsey, J. B. (1969). Tests for Specification Errors in Classical Linear Least Squares Regression Analysis. Journal of the Royal Statistical Society, Series B (Methodological), 350–371. DOI: https://doi.org/10.1111/j.2517-6161.1969.tb00796.x
Roy, P., & William, T. J. (1981). The Concept of Access: Definition and Relationship to Consumer Satisfaction. Medical Care, 127-140. DOI: https://doi.org/10.1097/00005650-198102000-00001
Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient Centeredness, Cultural Competence and Healthcare Quality. Journal of the National Medical Association, 1275-1285. DOI: https://doi.org/10.1016/S0027-9684(15)31505-4
Sampson, S., Umar, L., & Obi-Jeff, C. (2024). Assessment of the compliance with minimum quality standards by public primary healthcare facilities in Nigeria. Health Research Policy and Systems, 22: 133. DOI: https://doi.org/10.1186/s12961-024-01223-6
Santhos, C. M., Pimenta, C. A., & Nobre, M. R. (2007). The PICO strategy for the research question construction and evidence search. Revista Latino-Americana de Enfermagem, 15(3), 508–511. DOI: https://doi.org/10.1590/S0104-11692007000300023
Semeeh, A. O., & Laurent, C. D. (2024, October 21). An evaluation of the surveillance system for monitoring and reporting adverse events following immunization in Kebbi State, Northern Nigeria: a mixed method approach. Retrieved from Springer: https://link.springer.com/article/10.1186/s12889-024-20356-5
Sibeudu, F. T., Uzochukwu, B. S., & Onwujekwe, O. (2019). Rural–urban comparison of routine immunization utilization and its determinants in communities in Anambra State, Nigeria. SAGE Open Medicine, 23-34. DOI: https://doi.org/10.1177/2050312118823893
Soltani, S., & Sadeghi, N. (2019). Financial barriers to access to health services for adult persons with disabilities in Iran. BMC Health Services Research, 19(1), 1–8. DOI: https://doi.org/10.18502/ijph.v48i3.895
Tina, Q. T. (2019). Principles of Inclusion, Diversity, Access, and Equity. The Journal of Infectious Diseases; Supplement 2, S30-S32. DOI: https://doi.org/10.1093/infdis/jiz198
Titus, O. B., & Akinmoladun, O. O. (2015). Health-care access and utilization among rural households in Ogun state, Southwestern Nigeria. African Journal of Health Sciences, 18(1-2), 1–10.
Uchenna, I. (2024). Evaluating the implementation of the National Primary Health Care Development Agency (NPHCDA) gateway for the Basic Healthcare Provision Fund (BHCPF) across six Northern states in Nigeria. BMC Health Services Research, 11867-11881.
Udochukwu, U. O. (2023). Demand and supply analysis for maternal and child health services at the primary healthcare level in Nigeria. BMC Health Services Research, 1280-1297.
Ugbaja, G., Okumagba, M., Igweh, F., & Odigie, O. (2023). A Mixed-Method Study of Mental Health Practices and Policy among Practitioners in Southern Nigeria: A Study of Mental Health Policies in Nigeria. Tropical Journal of Medical Research, 127-136.
Umar, F. S., & Zubairu, A. G. (2024). Constraints to Rural Road Transport Development in Nigeria. Journal of Transportation Technologies, 125-138.
Usman, A., & Ibrahim, A. A. (2020). Analysis of Spatio-Physical Accessibility of Healthcare Facilities in Nangere Local Government Area of Yobe State, Nigeria. The International Journal of Humanities & Social Studies, 8(9). DOI: https://doi.org/10.24940/theijhss/2020/v8/i9/HS2007-080
Waters, H. R. (2000). Measuring equity in access to health care. Social Science & Medicine, 51(4): 599-612. DOI: https://doi.org/10.1016/S0277-9536(00)00003-4
White, H. (1980). A Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity. Econometrica, 817–838. DOI: https://doi.org/10.2307/1912934
Yanful, B., Kirubarajan, A., Bhatia, D., Mishra, S., & Allin, S. (2023). Quality of care in the context of universal health coverage: a scoping review. Health Research Policy and Systems, Volume 21, Article number 21. DOI: https://doi.org/10.1186/s12961-022-00957-5
Yemi, A., Clifford, O. O., Theresa, B., Olukemi, F. A., & Oluwakemi, A. (2022). National and subnational variations in gender relations and the utilization of maternal healthcare services in Nigeria. Pan African Medical Journal, 42:28. DOI: https://doi.org/10.11604/pamj.2022.42.28.25689
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