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Influence of Primary Healthcare Centre Accessibility on Healthcare Utilization among Rural Residents in Nigeria

Abstract

Accessibility to primary healthcare is essential for ensuring equitable access to essential health services, particularly among rural populations that may experience substantial geographical, financial, transportation, and infrastructural barriers to healthcare. Primary Healthcare Centres (PHCs) serve as the first point of contact between individuals and the formal healthcare system and provide preventive, promotive, curative, maternal and child health, immunization, health education, and referral services. Primary healthcare centre accessibility refers to the extent to which rural residents can conveniently reach and obtain appropriate healthcare services from PHCs, considering factors such as geographical distance, travel time, transportation availability, affordability, operating hours, availability of healthcare personnel, essential medicines, equipment, and range of services. Healthcare utilization refers to the actual use of available healthcare services by individuals, including preventive services, outpatient consultations, maternal and child healthcare, immunization, diagnostic services, treatment services, and referrals. In Nigeria, inadequate accessibility to PHCs remains a concern in many rural communities because of long distances to health facilities, poor road networks, transportation difficulties, financial constraints, inadequate staffing, limited service availability, shortages of medicines and equipment, and irregular operating hours. Improved accessibility may reduce barriers to healthcare and encourage rural residents to seek appropriate healthcare services when needed. Against this background, this study investigates the influence of primary healthcare centre accessibility on healthcare utilization among rural residents in Nigeria. The study is anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and the Theory of Planned Behavior. Andersen's Behavioral Model provides a framework for understanding healthcare utilization through predisposing characteristics, enabling resources, and healthcare needs, with accessibility to healthcare facilities representing an important enabling factor. The Health Belief Model explains how perceptions of illness, perceived benefits of healthcare, perceived barriers, and cues to action may influence residents' decisions to seek healthcare. The Theory of Planned Behavior provides additional insight into how attitudes, social influences, and perceived behavioural control may influence healthcare-seeking and utilization. Collectively, these theoretical perspectives provide a suitable framework for explaining how accessibility to primary healthcare centres may influence healthcare utilization among rural residents in Nigeria. The study will adopt a quantitative cross-sectional research design. Primary data will be collected from residents of selected rural communities in Nigeria using a structured interviewer-administered questionnaire and healthcare utilization assessment tool. A multistage sampling technique will be employed to select states, local government areas, rural communities, households, and eligible adult residents. Primary healthcare centre accessibility will be assessed using indicators such as distance from residence to the nearest PHC, travel time, availability and cost of transportation, road conditions, operating hours, waiting time, availability of healthcare personnel, availability of essential medicines and equipment, range of services provided, and perceived ease of obtaining care. Where appropriate, geographical information and facility-level data may be used to complement respondents' assessments of accessibility. Healthcare utilization will be assessed using indicators such as frequency of PHC visits, outpatient consultations, preventive healthcare use, immunization, antenatal and postnatal care, family planning, child healthcare, diagnostic services, treatment of common illnesses, and referral services. Additional indicators may include timeliness of healthcare-seeking, usual source of healthcare, and use of alternative sources of care when PHC services are inaccessible. Descriptive statistics will be used to summarize residents' sociodemographic characteristics, accessibility conditions, healthcare-seeking patterns, and utilization of PHC services. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the influence of PHC accessibility on healthcare utilization. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, multicollinearity, and robustness of the findings. The study is expected to find that primary healthcare centre accessibility has a significant positive influence on healthcare utilization among rural residents in Nigeria. Residents who live closer to accessible and adequately functioning PHCs are expected to demonstrate greater utilization of preventive, promotive, curative, maternal and child health, immunization, diagnostic, and referral services. Reduced travel distance and transportation costs are expected to encourage earlier healthcare-seeking and reduce delays in obtaining professional care. The availability of healthcare personnel, medicines, equipment, and a broader range of services is also expected to strengthen residents' willingness to use PHCs rather than relying on self-medication, traditional remedies, informal drug vendors, or distant healthcare facilities. However, geographical accessibility alone may not guarantee healthcare utilization if facilities lack essential medicines, qualified personnel, functional equipment, or reliable services. Consequently, improvements in physical accessibility may need to be accompanied by improvements in the quality, affordability, availability, and reliability of PHC services. The study is expected to contribute to the literature on primary healthcare accessibility, healthcare utilization, rural healthcare, primary healthcare services, health-seeking behaviour, healthcare access, and public health in Nigeria by providing empirical evidence on the relationship between accessibility to PHCs and healthcare utilization among rural residents. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state primary healthcare development agencies, state ministries of health, local government health authorities, primary healthcare facilities, community health workers, public health practitioners, development partners, and policymakers regarding strategies for improving rural healthcare access. The study will also provide evidence-based recommendations for expanding and strategically locating PHCs, improving rural road and transportation access, strengthening staffing and essential medicine availability, extending appropriate operating hours, improving facility infrastructure, reducing financial barriers, and ensuring that accessible PHCs provide reliable and quality healthcare services to rural residents in Nigeria.

Keywords: Primary healthcare centre accessibility, healthcare utilization, rural residents, Nigeria, primary healthcare, healthcare access, rural healthcare, health-seeking behaviour, healthcare utilization, primary healthcare services, geographical accessibility, healthcare barriers, public health.