Access to healthcare in Nigeria: Systemic challenges and material cultures

Drawing on qualitative fieldwork in Nigeria, this article aims to offer an explanation for why private provision and out-of-pocket payments remain the dominant features of Nigeria’s healthcare system. It does so by illustrating how the interaction between healthcare system performance and ‘material cultures’ (understood as shared practices and meanings associated with healthcare) shapes and reproduces healthcare consumption patterns. Using Fine’s Systems of Provision approach, the study shows that persistent underinvestment in public healthcare has produced a highly privatised and unequal system. In this context, pragmatic healthcare consumption practices persist, including normalised private payments, routine reliance on private providers and the de-prioritisation of public healthcare amid competing livelihood pressures. These practices reflect constrained choice rather than preference, yet they reinforce dependence on private healthcare. The findings suggest that effective health policymaking must address structural conditions as well as socially embedded practices to advance equity in health outcomes.