Income-related inequalities and inequity in access to inpatient healthcare in rural Nigeria

Healthcare inequality remains a major challenge for health systems globally. While previous studies have examined inequalities in specific healthcare services or sub-domains of care, evidence on disparities in access across formal inpatient healthcare settings in Nigeria remains limited. This study examines income-related inequalities and inequities in access to inpatient healthcare among rural households in Nigeria. The study used cross-sectional data from 624 rural households collected in 2022 as part of a human capital research project commissioned by the African Economic Research Consortium (AERC). Information on demographic characteristics, household income, consumption expenditure, health conditions, region of residence, and access to inpatient care was analyzed. Income-related inequalities and need-adjusted inequities were assessed using the Concentration Index (CI) and the Horizontal Inequity (HI) index. Overall, 81.4%, 49.9%, and 18.4% of respondents reported access to inpatient care at public primary, secondary, and tertiary health facilities, respectively, while 32.7% accessed inpatient care at private facilities. Access to public primary and secondary inpatient care decreased with household wealth, whereas access to public tertiary and private inpatient care increased with wealth. Significant pro-poor inequalities and inequities were observed in access to public primary (CI = -0.1054; HI = -0.0374) and secondary (CI = -0.1063; HI = -0.0377) inpatient care. In contrast, access to tertiary (CI = 0.2382; HI = 0.3660) and private (CI = 0.1502; HI = 0.2180) inpatient care exhibited significant pro-rich inequalities and inequities. Decomposition analysis indicated that non-need factors--particularly household economic status and region of residence--were the largest contributors to inequalities in access across all inpatient care types. ConclusionInequalities in access to inpatient healthcare were driven mainly by economic status and region of residence.