Urbanization factors and the vagaries of the rural health care industry in Nigeria: an analysis of the accessibility of healthcare services by older adults in the Nsukka Local Government Area

Urbanization is the movement of people to the cities from the rural and hinterlands and the steady rise in the percentage of urban residents (Eckert and Kohler, 2014, Adewoyin, Chukwu and Sanni, 2018). The proportion of persons residing in the cities worldwide have had a steady rise between 13% in 1900, 29% in 1950, 49% in 2005, and it is predicted that by 2030, 60% of people would be urban dwellers (Aliyu et al., 2017, Aliyu and Amadu, 2017). The urban population grew from 220 million in 1900 to 732 million in 1950, and this trend reflects that rise. Overtime, urban areas have served as the global hubs for industry, commerce, and economic growth. Urban areas provide significant opportunities for social and technological advancement as well as enhance the spread of information through cross-cultural interaction provided they are administered correctly. They have served as hubs for political activity, legal frameworks, effective government,employment social and physical infrastructural facilities such as roads, pipe borne water, hospitals ans healthcare centers. In Nigeria, there is more than 5% gap between the rate of urbanization and the rate of natural population growth. This is because of the conception that urban areas provide better opportunities for health care services, education, work, and research which serves as the “pull” factor. Research has found that when compared to urban communities, rural areas have worse health outcomes including challenges with mental health, substance abuse, physical health, and sexual health. For instance, the work of Liu et al. (2018) demonstrated that when selecting healthcare facilities in the urban areas of China, factors such as the severity of the disease, the availability of drugs, medical staff, and accessibility of transportation all played significant roles. To boost primary care utilization in rural regions, however, it might be beneficial to strengthen primary care in proportion. Using a descriptive, cross-sectional and random-sample survey, the work of Oladapo et al. (2010) advocated for a better medical services for the management of Cardiovascular disease CVD and other chronic non-communicable diseases, as they indicate a significant prevalence of cardiometabolic risk factors in a rural Nigerian community. This is reiterated by the work of Nwankwo et al. (2007). which found that Nigerian rural communities have greater prevalence rates of cardiovascular risk factors than Nigerian metropolitan areas, suggesting the need for preventive and intervention measures to lessen the burden of these risk factors.

In view of this, Sivakumar et al. (2020) in their study found that all kinds of health care facilities are not being accessed by rural communities in India. Furthermore, Mariolis et al. (2008) found that the three most frequent reasons for people choosing health centers in the urban areas are low waiting time, proximity to residence and satisfaction with the services provided in previous visits. Erlyana, Damrongplasit and Melnick (2011) also showed that when making a decision about which healthcare providers to see, urban dwellers consider both distance and the expense of the treatment as indicated by the medical fee. Using a bivariate analysis and logistic regression, the work of Lutfiyya et al. (2013) revealed that adults above 40 years of age in the rural areas of United States have a higher prevalence of arthritis and other health service deficits among those with arthritis.the study showed that many individuals with arthritis experience a health service deficit and rural residents are at greater risk when compared to their urban counterparts. The work of Banerjee (2021) found that rural-urban inequality and lack of healthcare infrastructure contribute to the 7% point higher healthcare utilization among the older adults in urban India compared to rural India. Thakur, Banerjee and Nikumb (2013) in their studies also found that rural areas and marginalized groups have a high number of unmet health requirements, including untreated cataracts, uncontrolled hypertension, uncorrected hearing impairment, and tobacco use. In poorer nations, these require health interventions and priorities should also be given to preventive programs like initiatives to help older people quit smoking.

In a cross-sectional study, Miao et al. (2021) discovered that, as a result of their poor willingness and the crisis workforce in the areas, older persons living in remote communities had a high demand for chronic disease management. Rural residents are insensitive to medical fees, but they are sensitive to the non-medical component of care costs as determined by travel distance. Effiong et al. (2021) demonstrated that while urbanization has a negative and large impact on death rates, it has a positive and significant impact on life expectancy. While the work of Nnadi and Ezeh (2023) highlighted that older people experience issues like loneliness, isolation, and abandonment in the healthcare system in the rural areas, Mbam et al. (2022) emphasized the significance of putting in place efficient government policy interventions for the training of gerontological experts for the assistance of older adults in Nigeria. Ogidigo et al. (2023) found that geographical disparity and structural inequalities in rural Nigeria contribute to poor awareness, diagnosis, and care for older adults with Alzheimer’s disease and related dementias (ADRD).

Furthermore, there have been a series of arguments on access to healthcare by citizens of various countries, studies have shown that even with the increasing number of private healthcare facilities, it is still worrisome that there are lapses in the provision of quality healthcare facilities and access to these facilities are somewhat limited, therefore, there is a need to provide and/or equip healthcare centers in the rural communities to mitigate the impact of moving a long distance to access healthcare facilities in Nigeria (Mbam and Emma-Echiegu, 2018; Olasehinde et al., 2023). A thorough study on healthcare access found that 43.3% of the world’s population (or 3.16 billion people) cannot walk to a healthcare facility within an hour, and 8.9% of the population (or 646 million people) cannot reach healthcare within an hour even if they have access to motorized transportation (Weiss et al., 2020). According to Khakh and Fast (2017), urban environments need to be improved in order to increase the accessibility of healthcare for all residents, and Loera (2008) proposed that telemedicine could have a positive impact on enhancing access to healthcare services for both users and providers. Access to healthcare is also needed more in rural areas where majority of the older adults who are not among the workforce needed in urban areas resides. According to Ramanadhan et al. (2022), service delivery for tobacco control in India is often influenced by socio demographic characteristics. Despite this, guidance is frequently lacking in low-resource systems. According to Santamaría-Ulloa et al. (2019), making healthcare services available to everyone, regardless of location, is necessary to achieve Sustainable Development Goals.

In Nigeria, accessibility and usage of healthcare facilities go hand in hand because the majority of community health initiatives concentrate on raising awareness of the importance of utilizing the delivery services that are offered at the healthcare facility (Arogundade et al., 2021). According to Chukwuani et al. (2005), the facilities that are now available do not offer all the services that are expected of them, are not well-maintained, do not have enough competent health personnel, and do not have a budget. According to the poll, the two biggest problems facing Nigeria’s public healthcare facilities are low PHC utilization and subpar service delivery. Furthermore, a study by Ekenna et al. (2020) demonstrated that at least 50% of the recommended infrastructure/basic services and the presence of a medical officer were connected with the urban location of the facilities. More specifically, Onwujekwe et al. (2021) emphasized the key ideas that support social inclusion and fair access to health services, with the provision of functioning and upgraded health infrastructure being of the utmost importance. Other issues with the healthcare facilities that are available in Nigeria include a lack of skills, subpar care, dubious recognition, and immense difficulties in administering a diversified health system (Onwujekwe et al., 2022). According to Kabir (2022), while more than 55% of women had access to media, just 26.9% of women used mobile to get health services. Access to the media has a strong correlation with prenatal and postpartum care. Chun and Nam (2019) suggested that, in order to promote social equity, patient welfare should be given top priority. Studies on older individuals’ access to healthcare facilities concentrate mostly on the barriers that prevent them from gaining access to high-quality healthcare facilities. Studies like those by Akanji et al. (2002) advice giving older people’s health needs more attention through better budgetary allocation, change of the training curriculum for all cadres of health staff to include geriatrics, and exploitation of existing healthcare resources (Correia et al., 2022).

According to Khakh and Fast (2017), four aspects of healthcare access for the older adults were found to be deficient: availability, appropriateness, approachability, and affordability. The primary obstacles were the following: the present financial situation and pension cuts; the inadequate provision and increased user fees in primary care; the lack of long-term care facilities; the increased out-of-pocket costs; and the poor, unadapted housing conditions for older adults people. More older adults healthcare users are being advised to use the phone internet for easy health accessibility, through which they are given sufficient information to help them make informed decisions regarding their health, according to other studies that have shown a gap between old and young users of computers and the Internet for information appears to have widened in recent years (Lorence and Park, 2006; Lothian and Philp, 2001). In order to ensure fair access to residential care resources among the senior population, the spatial optimization of residential care facility locations is urgently required (Tao et al., 2014). According to (Thorpe et al., 2011), older individuals who live in rural areas and do not get a pension are more likely to face access barriers to healthcare facilities. This is the reason Woo et al. (2002) stated that there has to be an improvement in services for older people, namely in areas such as medical service adequacy, accessibility, and affordability, coordination of health and social care, long-term care quality, unfavorable views, and training requirements.

The majority of research has shown that older persons who live in rural locations have difficulty accessing healthcare facilities due to the concentration of the majority of functional public healthcare facilities in urban areas. The issues in older patients’ access to healthcare have been extensively discussed in previous studies, but only a limited number of those studies have recognized urbanization as a barrier to access to healthcare services, which is the focus of the current study.