Socio-spatial analysis of small-area need and accessibility of Primary Healthcare Services in Nigeria: A sequential mixed methods study

Abstract

Accessibility of primary healthcare (PHC) services is crucial for maintaining the good health of a population. Not only is health(care) associated with quality of life and socioeconomic productivity, systematic variations in healthcare accessibility are matters of social justice. Consequently, the overall goal of this project is to comprehensively analyze and explain smallarea need and accessibility of PHC services in Nigeria through a case study of Kogi State, with a view to making policy-relevant recommendations. To this end, both quantitative and qualitative methods are synthesized in an ‘explanatory sequential mixed methods research design’, which also features innovative data exploitations. This entails a synergy of: Automated Zone Design method, Spatial Microsimulation Modelling, and Generalized TwoStep Floating Catchment Area method for quantitative analysis as well as qualitative framework thematic analysis, to obtain research findings that are more robust than existing studies. In this way, genuine small-area variations in PHC need and accessibility are revealed and explicated, including extreme Medically Underserved Areas (eMUAs). Urban areas are more accessible than rural areas, as expected. Of senatorial districts, Kogi Central has the best healthcare accessibility because of its topography. Furthermore, these variations are mediated by the extant sub-optimal zoning system in Nigeria, which is a product of problematic historical political processes. Not only are eMUAs both very remote and rural, they also lack basic social amenities. Hence, it is not surprising that research participants expressed a myriad of dire disincentives in meeting their PHC needs. These difficulties can be mitigated by improving the quality of road infrastructure and ensuring an optimal socio-spatial configuration of PHC services. Broad mechanisms of social exclusion are also implicated in causing access-related disutility of PHC. It is therefore crucial that holistic interventions to alleviate social exclusion are enacted, since previous efforts at addressing only proximal concerns of PHC accessibility have proven unsuccessful. Keywords: Primary Healthcare Needs, Spatial Accessibility, Mixed Methods Research, Automated Zone Design, Spatial Microsimulation, Small-Area Variations.