Abstract Primary health care (PHC) remains central to human capital development and productivity, particularly in rural regions where agriculture is the dominant livelihood. Effective and accessible PHC services contribute directly to agricultural and rural development by reducing morbidity, enhancing labour efficiency, and sustaining household wellbeing. This study aims to assess how accessibility, affordability and attitudes influence PHC utilisation, and hence their perceived effectiveness in Ogun State, Nigeria. We collect cross-sectional data from 120 randomly sampled users of PHC centres across communities, covering the three senatorial districts of the state using validated interview schedules. We use Structural Equation Modeling (SEM) to examine the interrelations among these constructs. Descriptive findings reveal that 86.7% of respondents experienced high accessibility to PHC services, and 90% experienced high affordability. However, we find an interesting paradox – an unfavourable attitude (67.5%) toward PHC services, but high utilisation (85.8%) and perceived effectiveness (92.5%) of these services among users. The SEM results demonstrate significant relationships, with accessibility (β = 0.30, p < 0.01) and affordability (β = 0.45, p < 0.05) positively affecting utilisation. Utilisation significantly influences perceived effectiveness (β = 0.87, p < 0.01). The study highlights the need to address negative attitudes towards the PHC services despite high levels of accessibility, affordability, and utilisation, suggesting improvements in service quality to enhance overall effectiveness.
Olutegbe et al. (2026) studied this question.