Introduction
Nigeria operates a three tiered health care delivery system with a large percentage of health care
delivery vested at the primary care level. There has been over the years a continued effort by the
government to decentralize health care service thereby increasing the range of services provided
at the primary care level. Despite all these efforts there is still low utilization of primary health
care services. This study therefore seeks to explore the factors that may be responsible for poor
utilization of primary health service in Nasarawa State, Nigeria using two primary health clinics
in Lafia local government area as case studies.
Methodology
The study was carried out using the qualitative research methodology primarily using two data
collection methods, the focus group discussions and individual interviews. A total of sixty
participants were sampled, these consisted of ten members of staff, twenty non facility users and
thirty facility users. Thirty individual interviews were conducted and four focus group
discussions held with staff and facility users at the two clinics. Facility users were randomly
selected as they attended the clinic on the data collection days and were invited to participate in
the study. Every second patient attending the clinic was selected for the focus group discussion
and every third person for the interviews. The staff participants were randomly selected based on
their availability while non-facility users were selected using snowballing. Data was analyzed
using thematic analysis method.
Findings
Two major themes emerged following data analysis; these were perception and experiences of
facility users and barriers to utilization of health services. Users had a good perception of the
services they received and are reasonably satisfied but certain deficiencies in the health care
systems compromised the quality of service. Several factors were however hindering the
utilization of these services and these include mainly institutional factors such as lack of
infrastructure, equipment and staffing constraints; household factors such as cost of service and
responsibility of decision making and other factors such as stigmatization and beliefs.
Conclusion
Facility users of these clinics seem to have an overall good impression of services at the clinics;
however there are certain fundamental deficiencies that need to be urgently addressed to improve
the care provided at these clinics as these constitute barriers to utilization. These deficiencies
such as the absence of electricity and water, lack of basic work equipment and inappropriate staff
composition need to be addressed by the local government health department to ensure
utilization and improved quality of service.