Healthcare systems in fragile regions face persistent challenges of inadequate financing and workforce shortages, both of which undermine service delivery and long-term sustainability. This study examined the role of healthcare financing models and workforce attitudes in sustaining healthcare utilization in Yobe State, Nigeria, a region severely affected by conflict and poverty. Using a cross-sectional field survey design, data were collected from 456 households and healthcare facilities through structured questionnaires and checklists. Descriptive and inferential statistics, including logistic regression, were applied using SPSS version 28. Results showed that poverty and inflation significantly reduced healthcare utilization, while community-based health insurance (CBHI) improved access (β = 0.431, p = 0.007). Government funding, particularly when linked to performance-based financing, strongly enhanced facility survival (β = 0.733, p < 0.001), whereas donor support, though beneficial in emergencies, lacked long term significance. Out-of-pocket payments were associated with inequity and low sustainability. Workforce motivation emerged as a decisive factor, with motivated staff improving patient trust and service uptake, while burnout and insecurity discouraged utilization. These findings show that sustainable healthcare in fragile regions requires a dual strategy: expanding institutional financing through CBHI and government led funding, while simultaneously strengthening workforce resilience through incentives, training, and security guarantees. The study concludes that only by integrating economic, financing, and workforce strategies can health systems in conflict prone regions is functional and equitable.
Abubakar et al. (Fri,) studied this question.