Accessibility Standards of Community Health Facilities in Southeast Nigeria

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 burghal 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.