The long walk to universal health coverage: patterns of inequities in the use of primary healthcare services in Enugu, Southeast Nigeria

Ijeoma L Okoronkwo,Obinna E Onwujekwe,Francis O Ani

doi:10.1186/1472-6963-14-132

Abstract

BackgroundKnowledge and understanding of health service usage are necessary for health resource allocation, planning and monitoring the achievement of universal coverage (UHC). There is limited information on patterns of utilization among adult users of primary health care (PHC) services. Lack of understanding of current and past utilization patterns of health services often hinders the improvement of future Primary Health Care (PHC) delivery in the remote areas of developing countries. This paper presents new knowledge on the patterns of utilization of PHC services among adults in Enugu metropolis southeast Nigeria.MethodsA cross-sectional study was conducted in 15 PHC facilities of Enugu North Local Government Area (LGA) from June to July 2012. A total of 360 consenting adult users aged 18 years and above were consecutively recruited as they attended the health facilities. An interviewer-administered questionnaire was used to collect data from the respondents. A modified Likert scale questionnaire was used to analyze data on patterns of utilization. Utilization of PHC services was compared by gender, socio-economic status (SES) and level of education.ResultsOut of the 360 respondents, (46.9%) utilized PHC services regularly. The components of PHC mostly utilized by respondents were immunization with a mean score of 3.05, treatment of common ailments (2.99) and maternal and child health (2.64). The least poor SES group utilized PHC services the most while the very poor and poor SES groups used PHC services least. There were statistically significant relationships between utilization of PHC services and gender (p = 0.0084), level of education (p = 0.0366) and income (p = 0.0001).ConclusionsMost adult users in this study did not utilize the health facilities regularly and there were gender, educational and SES inequities in the use of PHC services. These inequities will negate the achievement of universal health coverage with PHC services and should be remedied using appropriate interventions.

Highlights

Knowledge and understanding of health service usage are necessary for health resource allocation, planning and monitoring the achievement of universal coverage (UHC)
They include: absence of health worker 57(29.8%); it is not necessary 37(19.4%); spouse disapproval 28(14.7%); poor service hours 26(13.4%); poor attitude of health workers 22(11.5%); and Primary Health Care (PHC) services coincide with market days 21(11.0%)
To achieve equitable universal health coverage (UHC), the right to access to health must be achieved across the society so that those who need care are able to access it regardless of who or where they live or their ability to pay

Summary

Introduction

Knowledge and understanding of health service usage are necessary for health resource allocation, planning and monitoring the achievement of universal coverage (UHC). Lack of understanding of current and past utilization patterns of health services often hinders the improvement of future Primary Health Care (PHC) delivery in the remote areas of developing countries. Knowledge and understanding of health service usage are necessary for health resource allocation, planning, tracking the achievement of UHC and ensuring that informed decisions are made on how to improve access and achieve UHC [3]. Lack of understanding of current and past utilization patterns of health services often hinders the improvement of Primary Health Care (PHC) delivery in the remote areas of developing countries and retards the achievement of UHC. Patterns of utilization of health care services can be measured based on frequency of use for those making at least one visit to a health facility and identification of predictors of the number of subsequent visits [4]

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Conclusion