Determinants of healthcare access among internally displaced persons in a conflict-affected district of Burkina Faso: a cross-sectional study

In Burkina Faso, escalating violence since 2015 has triggered a humanitarian crisis, particularly in the Sahel region, where health service disruption is widespread. While universal health coverage remains a global priority, empirical evidence on the specific drivers of self-reported access to needed healthcare services among internally displaced persons (IDPs) in fragile Sahelian settings remains limited. This study used the multidimensional Levesque framework to identify structural and individual determinants of healthcare access among IDPs in the Dori health district. This article reports the quantitative cross-sectional component of a broader study conducted among 400 IDP household heads in the Dori health district. Participants were selected through stratified systematic random sampling with proportional allocation across the three municipalities (“communes” in the national administrative terminology) hosting the largest IDP populations: Bani, Dori, and Gorgadji. Data were collected between September and November 2022 using a structured instrument mapped to the five Levesque dimensions: availability, accessibility, affordability, acceptability, and appropriateness. The primary outcome was current self-reported access to needed healthcare services. Bivariate analyses and multivariate logistic regression were used to identify factors associated with access. Overall, 81.0% of respondents reported not currently having access to the healthcare services they needed. Lack of access was reported by 85.7% of respondents in Bani, 81.2% in Dori, and 80.1% in Gorgadji. In bivariate analyses, determinants across the five Levesque dimensions were associated with access, including availability of essential services, waiting time, distance, transport availability, understanding of care organization, reception, cost, financial and material support, coverage of health needs by available services, perceived quality of care, and provider engagement. In the multivariate model, availability of essential services (AOR: 6.43; 95% CI: 1.06–39.44), shorter or acceptable waiting time (AOR: 4.61; 95% CI: 0.77–27.64), understanding of care organization (AOR: 2.15; 95% CI: 1.07–4.30), acceptable cost (AOR: 6.65; 95% CI: 1.58–28.03), financial and material support (AOR: 1.52; 95% CI: 1.03–2.24), and coverage of health needs by available services (AOR: 2.69; 95% CI: 1.33–5.43) were associated with better self-reported access. Self-reported access to needed healthcare services among IDPs in the Dori health district remains critically constrained by financial, organizational, and service-responsiveness barriers. The findings suggest that the physical presence of services is insufficient unless displaced households can afford care, understand and navigate service organization, receive timely care, and obtain services that respond to their needs. Strengthening financial protection, reducing waiting times, improving reception and communication, and ensuring that available services cover IDPs’ health needs are essential for improving equitable access in conflict-affected settings.