Geographical accessibilities to health facilities across borders: Implications for the determination of Nigeria's health system performance

This study investigates the question of whether there are potential geographical accessibilities to health facilities across borders between Nigeria, a source country, and its neighbours. For a source country with porous borders and a non-functioning vital registration system, there is a tendency for cross-border utilisation of health services, especially by non-citizens, within geographical proximity. Using geographical information system methods, Euclidean distances from neighbouring country settlements to the nearest health facility across the border were estimated to measure accessibility. Three sets of shapefiles were used for this analysis, including a settlement shapefile, a population shapefile, and a health facility shapefile. The study finding shows evidence of potential cross-border use of health facilities. For settlements within the geographical accessibility threshold, individuals are likely to utilise the health facilities across borders. This may constrain the maximisation of efficiency gains from scarce public resources spent on health and could explain the persistent health financing gap in the source country. Hence, health interventions in the source must be designed to internalise the possible cross-border utilisation of health care to attain desired targets.