Factors influencing primary health care service provision to older adults in lagos, nigeria: understanding the experiences of the demand population

Background: As the population in Nigeria ages, primary health care (PHC) is a critical, inclusive, and cost-effective approach to improving the health status and care for older adults who require regular care for noncommunicable diseases and age-related conditions. To address age-related healthcare disparities and promote healthy aging there is a need to identify barriers and facilitators to PHC access for older adults in Nigeria. Methods: We conducted a qualitative study using focus group discussions (FGDs) with older adults in Lagos State. We purposefully sampled two groups of adults aged 60 years and above: recent users (within the last six months) and past users (more than six months ago) of PHC centers. A rapid thematic analysis was conducted using an inductive approach to identify themes, with any discrepancies resolved through consensus. Results: We interviewed 19 participants in two FGDs. Using a healthcare accessibility framework (5As), we identified shared barriers across both groups in multiple areas. These included Affordability (high cost of laboratory tests and medications), Availability (frequent drug shortages, too few healthcare workers, long wait times) and Appropriateness (lack of services tailored to meet the specific needs of older adults). Differences in barriers were also observed with recent users highlighting the need for more compassionate care from healthcare providers (Acceptability), while past users advocated for improved services for chronic conditions and the availability of specialized equipment (Appropriateness). Facilitators identified by both groups included the accessibility of PHC facility locations and user-friendly facility designs (Accessibility). Both groups emphasized the importance of addressing the barriers to improve PHC service delivery for older adults including expanding health insurance coverage and implementing system redesign. Conclusions: Barriers including high service costs and long waiting times hinder the utilization of PHC centers by older adults, while geographic location and building accessibility serve as significant facilitators for care-seeking. There are opportunities to improve the access, affordability, and delivery of age-friendly health services in primary healthcare facilities in Lagos, Nigeria, an area where future research is underway.