Utilisation of Community-Based Health and Social Services and Its Association with Healthcare Access and Outcomes in Lagos State, Nigeria

The use of community-based health and social services (CBHSS) has been expanding to complement primary healthcare (PHC) and social support for underserved populations in Nigeria, but evidence linking CBHSS use with healthcare access and health outcomes in Lagos State is limited. This cross-sectional mixed-methods study assessed awareness and use of CBHSS, individual- and household-level correlates, and association with timely care-seeking and self-rated health in six local government areas (LGAs) of Lagos State. Multi-stage cluster sampling yielded 864 adults aged ≥18 years (response rate 96%). Data were collected through interviewer-administered questionnaires, 12 focus group discussions and 18 key informant interviews, and analysed using descriptive statistics, multivariable logistic regression and thematic analysis. Overall, 61.3% of respondents had used at least one CBHSS in the preceding 12 months. Utilisation was associated with awareness of available services (AOR = 3.82, 95% CI: 2.51–5.81), trust in community health workers (AOR = 3.15, 95% CI: 2.12–4.68), community health committee membership (AOR = 2.94, 95% CI: 1.98–4.36) and residence within 2 km of a service point (AOR = 2.41, 95% CI: 1.67–3.48). Among respondents with a recent common illness, CBHSS users (any use in the preceding 12 months) sought timely care more often than non-users (68.4% vs 41.2%, p < 0.001). Stakeholders identified irregular funding, weak intersectoral coordination and low male engagement as barriers. CBHSS use is associated with better healthcare access, although the cross-sectional design precludes causal inference. The Lagos State Ministry of Health should fund CBHSS predictably and formalise their referral links with PHC centres.