A comparative assessment of accessibility and affordability of services at child Welfare Clinics of University of Abuja Teaching Hospital and Kwali General Hospital, Federal Capital Territory

Abstract

Accessibility and affordability remain key pillars in the delivery of equitable and effective healthcare services, particularly in maternal and child health. Child Welfare Clinics (CWCs) provide essential preventive services such as immunization, growth monitoring, and health education. However, the ease with which caregivers can access these services and bear their financial costs influences utilization and health outcomes. This study comparatively assessed the accessibility and affordability of services at CWCs of University of Abuja Teaching Hospital (UATH) and Kwali General Hospital (KGH), Abuja. A cross-sectional mixed-methods design was employed. Quantitative data were collected using structured questionnaires from 362 respondents (181 per facility), and qualitative data were obtained through Focus Group Discussions (FGDs). Key indicators analysed included travel distance, transport availability, clinic hours, service costs, and perceived financial burden. Data were analysed using descriptive statistics, chi-square tests, logistic regression, and thematic analysis for qualitative insights. A higher proportion of respondents at KGH (74.0%) reported the clinic to be easily accessible compared to UATH (40.3%) (χ² = 33.072, p < 0.001). Affordability was significantly better at KGH, where 179 (98.9%) respondents considered services affordable, compared to only 13 (7.2%) at UATH (χ² = 295.518, p < 0.001). FGDs reinforced these findings, with participants at UATH citing high transport and service costs as key barriers. Accessibility was influenced by clinic proximity, alignment with caregiver schedules, and transport ease, while affordability was shaped by out-of-pocket expenditures and hidden costs. Significant disparities exist between tertiary and secondary healthcare facilities regarding access and cost of child welfare services. While UATH offers higher-tier services, barriers related to distance and financial burden limit service uptake. Interventions to improve transportation support, reduce user fees, and align service hours with caregiver schedules are essential to ensure equitable access and affordability across facility levels.