A mixed-methods assessment of school-based healthcare services in secondary schools within a university environment in Western Nigeria

School-based healthcare services (SHS) are healthcare systems integrated within schools to support children’s health and well-being. However, in Nigeria, SHS remains largely under-implemented, and where they do exist, are often inadequate. This study investigated SHS practices in secondary schools within a university environment in Western Nigeria to determine whether being located in a university setting influences the quality of SHS practices. This study utilized a mixed-methods cross-sectional design and through a two-stage sampling method, 346 students across five secondary schools within the university were selected to complete questionnaire on SHS practices. Qualitative data (key informant interviews) were obtained from six head teachers and/or school health officers to further give insight into the barriers limiting the proper practice of SHS within the school. Quantitative data were analysed using IBM SPSS version 20 and Chi-square was used to test for associations, with significance set at p < 0.05. Qualitative data were analysed thematically, identifying similarities and differences in participants’ perspectives. Findings revealed that overall SHS practices in these schools were below average (47.7%), with private schools demonstrating a significantly better practice (84.2%; OR 11.5, 95% CI 6.2–21.3). Meanwhile, students’ overall attitude toward SHS was predominantly negative (57.8%) and only 56.4% of students demonstrated good perceived health assessment. Qualitative findings revealed first aid as the most frequently practiced health service and the major barrier to effective SHS implementation was inadequate financial resources. Both quantitative and qualitative analyses confirmed that school-based healthcare remains insufficient, even for schools within a university setting. These services rely primarily on self-funding, highlighting an urgent need for government and stakeholder intervention to enhance healthcare accessibility and effectiveness in Nigerian schools.