Households’ perceived benefits and willingness-to-accept linkage between informal provider and formal health systems in urban slums of southeast Nigeria

Informal healthcare providers (IHPs) like patent medicine vendors and traditional birth attendants are key healthcare providers in urban slums - densely populated areas with poor living conditions and limited access to basic services in Nigeria. While IHPs can improve access to health services, their lack of linkage to the formal health system can lead to inappropriate care. Hence, institutionalizing and strengthening linkages between IHPs and the formal health systems could lead to improved access to quality health services in urban slums. This study assesses the level of households’ willingness for IHPs to be linked to the formal health system and the benefits they perceived linkages would provide in urban slums. A cross-sectional household survey was conducted in eight urban slums in Anambra and Enugu states, southeast Nigeria. The multi-stage sampling technique was used to select eligible households. A total of 1025 households were interviewed between October and November 2022 using a structured pre-tested interviewer-administered questionnaire. Univariate, bivariate, and binary logistic regression analyses were undertaken. We observed a high level of acceptability (92%) of linking IHPs to the formal health system. The preferred aspects of linkages were training IHPs on services they render (62.6%), supervision of IHPs’ activities (53%), and building an effective referral system from IHPs to formal providers (44%). The major perceived benefits of linkage include improvement in knowledge about illnesses (29%), proper treatment procedures by IHPs, availability of quality drugs (28%), and improvement in access to appropriate treatment (26%). Regression analysis showed that household size (AOR 0.90; CI 0.83–0.97), age (AOR 0.85; CI 0.76–0.95), and educational level (AOR 0.92; CI 0.85–0.99) were associated with lower willingness of households to accept linkage between IHPs and the formal health system. There is a high acceptance level of institutionalizing linkage between IHPs and formal health systems, with many perceived benefits. However, it is crucial to explore why larger households, older households, and more educated households exhibit lower willingness and to address the factors that sustain a linkage in urban slums.