Barriers and Pathways to Healthcare for Low-Income Residents in Etche LGA, Rivers State, Nigeria: Implications for Policy and Practice

Equity of health care services among the rural poor In Nigeria, access to healthcare remains unequal especially in rural areas for the poor. Residents of Etche Local Government Area (LGA) in Rivers State, Nigeria's second richest oil-producing state experience and negotiate access to health facilities by the poor informed this qualitative case study. Based on Andersen’s Behavioral Model of Health Services Use and the Social Determinants of Health (SDH) framework, the study investigates facility availability, patterns of utilization, barriers and coping strategies among the poor. The accounts of 15 residents interviewed who were low income, as well as five primary care workers, show that government services are restricted to a handful of basic clinics often located far away and poorly resourced. The vast majority of the respondents postpone treatment—using home remedies, encased drugs, and traditional healers(SE) —for lack of money and difficulty accessing/expensive transportation. Findings illuminate enabling (insurance, poor travel infrastructure, drug stockouts) and predisposing (low education, gender norms) factors restricting service use. Consistent with earlier studies, this research indicates that cost-related issues and poor infrastructure deter rural Nigerians from formal health services. Policy recommendations include fairly building primary care, subsidizing poor people's access to care, boosting the provider workforce and setting up community outreach (like mobile clinics or insurance schemes) to close gaps. These type of multi-sectoral interventions are also needed to address health equity in Etche, and similar environments.