Achieving universal health coverage in Nigeria: the dilemma of accessing dental care in Enugu state, Nigeria, a mixed methods study

Objective: Equitable access to oral healthcare is a major focus of the Universal health coverage debate in Nigeria. However, a great majority of the population still do not have full coverage for essential oral healthcare services. This study will determine the extent of inequities in accessing oral healthcare services and the factors influencing access to equitable oral healthcare in Enugu state Nigeria. Methods: A descriptive cross-sectional, urban and rural study conducted over two months in Enugu state Nigeria, using a mixed method approach. The quantitative study design used interviewer administered questionnaires to elicit information from 774 household members (394 urban and 380 rural) in study area who had sought dental care 6 months prior to study, and dental care providers (52) in selected dental health facilities. The qualitative study design involved in-depth interview of heads of selected dental health facilities to investigate factors influencing provision of dental care. Household data was collected house to house from randomly selected households in the LGA, while a face-to-face in-depth interview was conducted for purposively selected oral health professionals from study facilities. Results: Majority of respondents sought care when they had toothache (72%). There was inequity in utilization of dental care across socioeconomic status groups (SES). The least poor SES (Q5) sought dental care in the private facilities, and chose to have dental fillings more than the poorest (Q1) and very poor SES (Q2) who visited public facilities and patent medicine dealer shops more and opted more for tooth extractions.(p < 0.05) Cost of services influenced access and treatment choice more among Q1 and Q2 than Q5 (p < 0.05) Qualitative results show that facility location, low awareness, human resource shortage and oral health financing methods influenced access. Conclusion: Increased awareness and inclusion of oral healthcare in all health insurance schemes with expansion of current oral healthcare benefit package will improve access to care and further improve chances of attaining universal health coverage.