Abstract / Summary
Abstract Background Delta State implemented the Delta State Contributory Health Commission to expand healthcare access and financial protection, yet gaps in service availability and system readiness threaten the realisation of universal health coverage. This study examined public healthcare access, users’ perceived challenges, and proposed strategies for improvement. Methods A cross-sectional mixed-methods design was used in six local government areas, involving 1,191 quantitative surveys and 23 interviews. Quantitative data were summarised descriptively and analysed using chi-square tests, while qualitative data were explored through thematic analysis. Results Overall, 75.66% of respondents lived within one hour of a government health facility, whereas 24.35% lived farther away; only 14.69% were aware of emergency-service hotlines. Reported challenges included inadequate healthcare funding (76.57%), poor facility condition and maintenance (75.05%), insufficient medicines and equipment (73.22%), inadequate staffing or incompetent providers (73.21%), management problems or strike actions (72.80%), healthcare costs (60.29%), and distance to facilities (60.12%). Perception of most challenges varied significantly by local government area, except healthcare costs. Education, age, marital status, family size, and employment status were associated with reported challenges. Respondents strongly supported building a system with improved administrative transparency (93.45%), facility renovation (93.12%), subsidised healthcare costs (92.44%), enhanced training and research (90.01%), recruitment of healthcare professionals (89.84%), and construction of additional facilities (85.64%). Support for selected strategies varied by local government area, education, age, gender, family size, income, and employment status. Qualitative findings reinforced concerns about distance, infrastructure, essential resources, staffing, affordability, and accountability. Conclusion Users believe that investments in facilities, medicines, workforce, financial protection, emergency awareness, and transparent management could strengthen healthcare access and quality in Delta State, Nigeria.