Urbanization, spatial distribution of healthcare facilities and inverse care in Ibadan, Nigeria

Abstract

The global rate of urbanization outstrips the provision of social services, particularly healthcare. This situation, and the hypothesis that healthcare services are more accessible to people of higher socio-economic groups who live in the best parts of a city than to the relatively poor who live in the other parts of the city, inform this study. The study examines the trend of urbanization in Ibadan, Nigeria, assesses the spatial distribution of healthcare facilities in the city, and establishes the relationship among these and the population’s access to healthcare based on their places of residence within the city. Secondary data for the study was analyzed using a combination of Pearson’s Product Moment Correlation, ratios, Gini Coefficient and Lorenz Curves. The results show that while the population grew by 12.4% between 1999 and 2014, the number of hospitals and doctors changed by -53% and 38% respectively. These changes increased the hospital-population ratio from 1:1,000 in 1999 to 1:2,600 in 2014. The doctor-population ratio also increased from 1:79,000 to 1:86,000. The population in the more affluent neighbourhoods of the city was also found to have better access to the healthcare facilities when compared with the other neighbourhoods where the bulk of the urban poor reside. The study further showed that the increase in the number of PHCs in the poorest of the LGAs proved to be a determinant in increasing healthcare access for the population in the LGA in 2014. The study concludes that the inverse care and underclass hypothesis hold true in the study area, but that the provision of PHCs, despite their limited level of service provision, can enhance access to healthcare as societies urbanize.