1.1 Introduction
Healthcare is defined by the World Health Organization (WHO, 2010) as the services provided to individuals or communities through the application of medical, nursing, and allied health knowledge and practices for the promotion of health, prevention of disease, and management of illness. Access to healthcare, therefore, refers to the ability of individuals to obtain needed health services at the right time, in the right place, and without financial or systemic barriers (Peters et al., 2008). However, access to healthcare is not equitably distributed across all populations, particularly in developing countries, where marginalized communities such as those living in urban slums often face significant barriers.
Urban slums are densely populated areas characterized by inadequate housing, poor sanitation, limited infrastructure, and social exclusion (UN-Habitat, 2020).As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.
1.2 Background of Study
Historically, the barriers to accessing healthcare services in urban slums are rooted in the broader dynamics of urbanization, poverty, and inequality. According to UN-Habitat (2016), the emergence of slums is closely tied to the rapid growth of cities in developing countries, which often outpaces the ability of governments to provide adequate housing, infrastructure, and social services. As rural migrants flood into cities in search of better economic opportunities, many end up in informal settlements characterized by overcrowding, and poor access to health facilities.
Global studies on health in slums have consistently shown that the barriers to healthcare access are not new but are the result of historical patterns of exclusion and marginalization. Peters et al. (2008) accentuated that poverty has always been a key determinant of healthcare access, as financial constraints prevent the urban poor from seeking care. On the other hand, mistrust in formal healthcare systems, which has developed over time due to discriminatory treatment and lack of culturally sensitive practices, has further reduced the willingness of slum residents to engage with health institutions (Peters et al., 2008).
Urban slums have become a defining feature of rapid urbanization in many developing countries, including Nigeria. According to UN-Habitat (2020), slums are characterized by substandard housing, poor sanitation, limited access to clean water, overcrowding, and inadequate healthcare facilities, all of which contribute to poor health outcomes. The growth of slum communities in cities like Lagos is driven by rural-to-urban migration, economic hardship, and lack of affordable housing, leaving large segments of the population in conditions that undermine their right to health. Makoko, one of the largest informal settlements in Lagos, has been described as a community where social and health inequalities are deeply entrenched (Adelekan, 2016).
Ezeh et al. (2017) reported that residents of urban slums globally experience a disproportionate burden of disease compared to non-slum populations, with higher incidences of communicable diseases such as malaria, tuberculosis, and diarrheal infections, as well as maternal and child mortality. They contended that the absence of accessible healthcare services in such settings perpetuates cycles of illness and poverty. Similarly, Peters et al. (2008) asserted that poverty is a central determinant of access to healthcare in developing countries, as the financial burden of medical costs often discourages slum dwellers from seeking timely medical care.
In the Nigerian context, Olanrewaju et al. (2019) stated that healthcare services remain largely inaccessible to marginalized groups due to economic hardship, inadequate facilities, and systemic neglect. They affirmed that many urban poor communities rely on informal healthcare providers such as patent medicine vendors, traditional healers, and self-medication practices, which often result in poor health outcomes. On the other hand, even when public health facilities are available, mistrust of healthcare providers, lack of health literacy, and cultural perceptions about illness contribute to low utilization rates among slum residents.
Makoko, which is home to thousands of Lagos residents, exemplifies the challenges of healthcare accessibility in urban slums. The community suffers from infrastructural neglect, as many households are built on stilts over the Lagos lagoon with little or no access to basic amenities. Adelekan (2016) reported that this environmental setting exacerbates health vulnerabilities by exposing residents to poor sanitation, flooding, and waterborne diseases. Furthermore, limited transport networks and the geographical isolation of the community make it difficult for residents to reach existing health facilities, leading to delays in receiving care during medical emergencies (Adelekan, 2016). The broader implication is that healthcare inequalities in communities such as Makoko undermine Nigeria's progress toward achieving universal health coverage and the Sustainable Development Goals (SDGs). As WHO (2010) contended, equitable access to healthcare is essential for promoting public health and reducing poverty, yet slum populations remain excluded from health policy priorities. This study is set against the backdrop that this study seeks to investigate the barriers to accessing healthcare services in the Makoko community of Lagos State.
1.3 Statement of Problems
Investigation revealed that slum dwellers are frequently exposed to environmental hazards such as polluted water, overcrowded housing, and poor sanitation, which increase the risk of communicable and non-communicable diseases, yet they face significant challenges in seeking medical attention (World Health Organization, 2019). In addition, many households in Makoko rely on informal jobs with irregular incomes, making it difficult to afford healthcare costs, including consultation fees, medications, and transportation (Olanrewaju et al., 2019).
On the other hand, even when healthcare services are free or subsidized, lack of awareness, mistrust of formal healthcare providers, and cultural beliefs about illness often limit utilization. Also, Makoko, being a largely water-based community, suffers from poor road networks and transportation challenges that hinder residents from reaching health facilities on time. Emergencies such as maternal complications or outbreaks of infectious diseases often escalate into preventable deaths due to delays in seeking or accessing care (Ezeh et al., 2017).
Furthermore, the lack of adequately staffed and well-equipped health centers within or close to the community worsens the situation, as residents often must travel long distances to urban health facilities that are already overstretched. Slum populations like those in Makoko are rarely prioritized in urban healthcare planning, resulting in their exclusion from healthcare initiatives and social protection schemes (UN-Habitat, 2020). It is against this backdrop that this study seeks to investigate the barriers to accessing healthcare services in the Makoko community of Lagos State.
1.4 Aim and Objectives of Study
The aim of this study is to investigate the barriers to accessing healthcare services in urban slums with a particular focus on Makoko community in Lagos State.
The specific objectives of the study are as follows:
- To evaluate the role of government and health policies in addressing healthcare inequalities in urban slums.
- To investigate the infrastructural and systemic challenges affecting healthcare delivery in the community.
- To identify cultural and behavioral perceptions that influence healthcare utilization among Makoko residents.
- To examine the socio-economic factors that limit access to healthcare services in Makoko Community.
- To provide recommendations for improving access to healthcare services in Makoko and similar communities.
1.5 Research Questions
Based on the objectives of the study, the following research questions have been formulated:
- What socio-economic factors limit access to healthcare services in Makoko community?
- What infrastructural and systemic challenges affect healthcare delivery in the community?
- How do cultural beliefs and behavioral perceptions influence healthcare utilization in Makoko?
- What role has government intervention and policy played in addressing healthcare inequalities in Makoko?
- What measures could be implemented to improve healthcare access in urban slums such as Makoko?
1.6 Significance of Study
The outcome of this research will serve as an evidence base that will guide policymakers, government agencies, and non-governmental organizations in designing more inclusive and community-specific interventions. The study will also be significant to public health practitioners and researchers as it will accent the health risks associated with poor living conditions, poverty, and systemic neglect, thereby encouraging more targeted health initiatives in underserved communities.
Furthermore, the study will contribute to academic discourse by expanding existing literature on health inequalities and social determinants of health within the Nigerian and African context. It will open new directions for future research and interventions that will address healthcare disparities in other informal settlements across the country.
Lastly, the research study will have a practical significance for the residents of Makoko community as its recommendations will serve as a roadmap for improving their access to quality healthcare.
1.7 Scope of Study
The scope of this research is focused on the barriers to accessing healthcare services in urban slums, using Makoko Community, Lagos State as a case study.
1.8 Limitations of the Study
Several limitations were encountered during the course of this study, which may have influenced the results and conclusions.
- Time Constraints: A study of this nature needs relatively long time during which information for accurate or at least near accurate inference could be drawn. The period of the study was short, time posed as constraints to the research.
- Financial Constraints: The research would have extended the survey to other area at the empirical level, but limitation as included cost of transportation to the source of material and the cost of time setting of the already completed work.
- Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.
1.9 Definition of Terms
Healthcare Access :
According to Peters et al. (2008), healthcare access refers to the timely use of personal health services to achieve the best possible health outcomes. In this study, it refers to the ability of Makoko residents to obtain affordable and quality healthcare services.
Urban Slums :
UN-Habitat (2020) defined urban slums as settlements characterized by poor housing conditions, inadequate infrastructure, and lack of access to basic services. Here, it specifically refers to Makoko community in Lagos.
Barriers :
Barriers are obstacles that prevent individuals from achieving a desired outcome. In this study, they refer to the economic, cultural, infrastructural, and systemic challenges that limit healthcare access in Makoko.
Socio-economic Factors :
These refer to the social and economic conditions that influence individuals' lives, such as income, education, and occupation, which affect healthcare-seeking behavior (WHO, 2010).
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