Patient-Level and Health-System Determinants of Effective Healthcare Service Utilisation in Nigeria: A Narrative Review

Effective healthcare service delivery and its utilisation remain central to the pursuit of universal health coverage in Nigeria, yet a substantial gap persists between the availability of services and their actual use by patients. This review synthesises evidence on the determinants of effective healthcare service utilisation among patients in Nigeria, with particular attention to South-West Nigeria. A narrative review approach was adopted, guided by established methodological frameworks for non-systematic reviews and appraised against the Scale for the Assessment of Narrative Review Articles (SANRA). Peer-reviewed studies, theoretical literature, and policy documents were purposively identified from bibliographic databases and organised thematically around patient-level, sociocultural, and health-system determinants. Findings were interpreted through the Health Belief Model and Andersen’s Behavioural Model of Health Services Use. Utilisation is shaped by an interacting set of factors operating at individual, community, and system levels. Patient knowledge and health literacy, perceptions of service quality, and attitudes toward formal care influence health-seeking decisions but are insufficient on their own. Sociocultural beliefs, trust in traditional medicine, financial hardship from out-of-pocket payments, geographical distance, workforce shortages, and perceived poor service quality operate as persistent barriers, while health insurance, community engagement, culturally responsive health education, and improved provider communication function as facilitators. Effective utilisation in Nigeria is best understood as a product of the alignment between patient predisposition, enabling resources, and the responsiveness of the health system. Interventions that integrate demand-side health education with supply-side improvements in affordability, proximity, and quality are most likely to convert access into use.