Assessing demand and supply-side enabling and constraining factors on the provision and use of health services in urban slums of Southeast Nigeria

In the face of rapid urbanization, developing countries like Nigeria are witnessing a surge in rural-urban migration, with a predominant concentration in low-income neighborhoods known as slums. The provision of appropriate health services in slums is limited due to their unplanned nature. Similarly, access and utilization of health services are constrained by many factors, especially the unavailability of formal healthcare providers in urban slums. This study investigated challenges and opportunities to the provision and use of health services in urban slums in two states in southeast Nigeria. The study is anchored in Andersen’s Behavioral Model of Health Services Use (1995). A cross-sectional survey was conducted in four urban slums in Onitsha in Anambra state, and Enugu in Enugu state. Eligible formal and informal health providers and householders were randomly selected for the interviews. A total of 255 health providers and 1025 primary caregivers in households were randomly selected from the households and interviewed using different structured pre-tested questionnaires for the consumers and providers, respectively. Univariate, bivariate, and multiple regression analyses were used to analyze the data. The major perceived challenge to accessing healthcare was poverty, since many people stated that they were unable to pay for health services (80%). Other challenges were health system factors such as the lack of drugs in government facilities (52%) and the high cost of treatment (76%). The major challenge to the provision of health services was poor availability of quality medicines (14.9%) and lack of supportive supervision of health workers (9.4%). In multiple regression analysis, the type of health provider’s facility (OR -1.69, CI 0.07–0.51) and training received on the type of health services they provide (OR -0.91, CI 0.21–0.79) were significantly associated with health workers’ provision of healthcare services. The consumers’ utilization of healthcare services was explained by employment status (OR 0.53, CI 1.02–2.83). Respondents suggested that subsidizing or providing free healthcare services, improving the capacity of informal health providers, and the quality of health services provided by the existing health facilities are opportunities for improving health service utilization by urban slum dwellers. The provision and utilization of appropriate health services in urban slums is severely constrained by multiple, interconnected barriers. Addressing these through targeted financial protection, provider regulation, slum-specific infrastructure and improving the capacity of informal healthcare providers is essential to bridge the gap between demand and supply gap and improve healthcare access and quality in these underserved communities.