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. 2025 May 27:13:1561158.
doi: 10.3389/fpubh.2025.1561158. eCollection 2025.

Referral experiences of healthcare consumers: results from a cross-sectional study in urban slums in southeast Nigeria

Chinelo Obi  1   2 , Ifeyinwa Arize  1   2 , Chukwudi Nwokolo  1   3 , Benard Okechi  1   4 , Bassey Ebenso  5 , Obinna Onwujekwe  1   2
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Referral experiences of healthcare consumers: results from a cross-sectional study in urban slums in southeast Nigeria

Chinelo Obi et al. Front Public Health. .

Abstract

Introduction: The inadequate referral system in Nigeria is partly due to the proliferation of informal healthcare providers (IHPs) and constraints within formal providers in urban slums. With limited data on patient referral experiences across these providers, this paper explores referral experiences in urban slums in southeast Nigeria.

Methods: This study involved 1,025 people in eight slums in Enugu and Anambra states, using multi-stage purposive sampling. Data on referral experiences were collected through a pre-tested questionnaire and analyzed using descriptive statistics and logistic regression. Ethical approval was obtained, and informed consent was secured.

Results: It found that only 7.4% of patients received referrals from their primary healthcare sources, mostly from patent medicine vendors, private clinics, and primary healthcare (PHC) centres to private clinics and laboratories. Verbal referrals were the dominant modality, although the types of referrals varied significantly between facilities that initiated referrals and between states.

Conclusion: This paper highlights the need for innovative solutions to integrate informal healthcare providers into the formal system, improving referrals and enhancing health services in urban slums.

Keywords: healthcare consumers; healthcare providers; healthcare system; informal health providers; referral; urban slums.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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