An Empirical Investigation into Measurement and Determinants of Healthcare Access in Rural Nigeria: A Multidimensional Perspective

Despite numerous reforms and initiatives within the healthcare system, Nigerias performance on universal health coverage (UHC) indicators remains sub-optimal. This study aims to empirically examines multidimensional access to healthcare and identifies the key determinants influencing levels of access among rural households in Nigeria. We utilize cross-sectional data from 625 rural households collected between June and October 2022. Multidimensional access to healthcare was measured using a 10-item instrument capturing participants psychological experiences of access. Data were analyzed using Confirmatory Factor Analysis (CFA) and an Instrumental Variable ordered probit (IV-Oprobit) model.Two items were excluded from the scale due to non-convergence and high residual correlations. The resulting eight-item scale demonstrated acceptable internal consistency (Cronbachs = 0.70). Among the four dimensions of access, availability recorded the lowest mean score, while geographical accessibility had the highest. Overall, only one in eight rural households achieved adequate access to healthcare, with the majority either vulnerable to or experiencing inadequate access. Monthly per capita expenditure (MPCE), household size, educational attainment, region of residence, facility operating hours, perceived quality of care, and waiting time are all significantly associated with the probability of reporting adequate, moderate, or inadequate access to healthcare. While expanding financial protection through broader health insurance coverage for rural populations remains critical, such efforts must be complemented by interventions that address persistent supply-side constraints to healthcare access. Key messagesO_LIAt 38, Nigeria has one of the lowest Universal Healthcare Coverage (UHC) index in sub-Saharan Africa suggesting under-performance in healthcare system. C_LIO_LIAn important but under-explored challenge in the pursuit of UHC particularly in LMIC countries is the conceptualization and measurement of healthcare access. C_LIO_LIFindings show that, overall access to healthcare remains inadequate with one out of eights households in rural Nigeria achieved adequate access. C_LIO_LIThe strong influence of consumption expenditure underscores the continued dominance of out-of-pocket (OOP) financing, emphasizing the need to expand financial protection through health insurance coverage. C_LIO_LIDistinguishing nominal from quality-adjusted access and embedding multidimensional access measures into routine health surveys can strengthen evidence-based planning and support targeted efforts to reduce rural health inequities. C_LI