Distance and the utilization of health facilities in rural Nigeria

The distance patients must travel in order to obtain treatment has long been recognized as a primary determinant of the utilization of health care facilities. The distance factor is especially significant in rural Third World settings where the density of Western-type health facilities is often low, where the majority of patients are likely to make the journey for treatment as pedestrians and where there are viable and usually more accessible alternate sources of medicine. This study examines the impact of distance on the utilization of health care facilities in the Hadejia area of Kano State, Nigeria. Per capita utilization was found to decline exponentially with distance. The rate of distance decay in utilization levels varies according to the type of facility, socio-demographic variables and illness. Hausa perceptions about sickness and about specific illnesses are reflected in the varying incidence of health facility utilization in the treatment of particular illnesses and distance decay gradients of varying steepness. Although the per capita consumption of health care decreases exponentially for concentric distance bands, individual villages show great disparities in utilization rates which are only partly attributable to distance.