Healthcare Financing, Service Quality, and Utilisation in Delta State, Nigeria: An Integrative Literature Review.

Abstract

Background: Nigeria's health system has been heavily dependent on out-of-pocket (OOP) payments, exposing households to financial hardship and limiting access to essential care. Empirical evidence on how financing arrangements shape service quality and healthcare utilisation at the subnational level is limited. This integrative review synthesised studies from Delta State to clarify these relationships and inform strategies for advancing Universal Health Coverage (UHC). Methodology: A systematic search of major biomedical and regional databases identified English-language primary studies published between 2010 and 2024 on healthcare financing, service quality, utilisation, and related access barriers in Delta State. Eight eligible studies were critically appraised using established tools and integrated through narrative synthesis. Results: Across the studies, OOP payments dominated healthcare financing, particularly at tertiary facilities. Prepayment through the NHIS and DSCHS was concentrated among formally employed, urban, or more health-literate groups. User fees, difficulties completing insurance enrolment, medicine stock-outs, long waiting times, and negative staff attitudes were consistently reported as barriers undermining both perceived service quality and actual service use. Maternal health evidence highlighted continued reliance on traditional birth attendants, driven by perceptions of more respectful interpersonal care and stronger sociocultural alignment. The studies suggest limited risk pooling, operational weaknesses in insurance schemes, and persistent organisational and sociocultural barriers interact to constrain equitable utilisation. Conclusion: Despite the small and heterogeneous evidence base, the findings suggest that reducing OOP dependence, strengthening State and National insurance schemes, and addressing service delivery and sociocultural barriers are essential for equitable progress toward UHC in Delta State.