Rural-urban disparities in Emergency Medical Services: a qualitative study of barriers and opportunities in Rivers State, Nigeria

Introduction: Emergency Medical Services (EMS) are critical for reducing morbidity and mortality in low- and middle-income countries (LMICs), yet significant disparities persist between urban and rural areas. This qualitative study explores barriers and opportunities in EMS utilisation among residents of Rivers State, Nigeria. Methods: Using a hybrid deductive-inductive approach guided by the Levesque framework for healthcare access, we conducted a focus group discussion with 20 purposively selected stakeholders representing nine categories, including healthcare providers, policymakers, community leaders and EMS users. Data was analysed thematically to identify barriers and opportunities in EMS utilisation. Results: Analysis revealed systemic barriers across five dimensions: accessibility (delayed response times, poor communication), acceptability (cultural beliefs favouring faith-based interventions), availability (inadequate infrastructure and staffing), affordability (high out-of-pocket costs), and appropriateness (gender and mental health disparities). These challenges were more pronounced in rural areas where they faced more compounded barriers, including geographic isolation and limited ambulance coverage. Several opportunities for improvement emerged, including community first-responder training, technology integration (e.g., GPS tracking), and multi-level collaborations, both inter-agency and with local non-governmental organisations (NGOs). Conclusion: The findings underscore the urgent need for policy reforms to decentralise EMS management, enhance public awareness, and address socioeconomic inequities. This study contributes to the discourse on healthcare disparities in LMICs and provides actionable recommendations for stakeholders to strengthen EMS systems in Nigeria through multi-sectoral collaboration.