Lived Poverty and Healthcare Access: Afrobarometer Data Shows Progress in Africa

Background: Persistent poverty and the residential environment both significantly affect how Africans experience the healthcare system. However, evidence on the interaction of these factors on perceived access to healthcare is limited.Methods: This analysis used pooled data from the Afrobarometer Round 8 surveys across 34 African countries (n ≈ 46,885 adults) to assess perceived ease or difficulty of obtaining necessary healthcare. The primary predictor was residential poverty status, classified using a composite of the Lived Poverty Index (LPI) and urban, semi-urban, and rural residency, resulting in eight groups, with non-poor urban/semi-urban residents serving as the reference category. The analysis employed complementary log–log regression, sequentially adjusting for various biosocial and socioeconomic predictors, including age, sex, education, employment, and religion, while incorporating country fixed effects and Afrobarometer survey weights.Results: Residential poverty status remained a strong predictor of healthcare access, even after sequential adjustment for biosocial and socioeconomic factors. When biosocial controls were accounted for, the odds ratios for all residential poverty categories remained largely stable, with only minimal attenuation, suggesting that age and gender do not mediate the relationship between deprivation and healthcare access in any substantial way. Moderately-poor rural residents had 72.5% higher odds of reporting access compared to non-poor urban/semi-urban residents (OR = 1.725, P< 0.001), while highly-poor rural residents had 66.0% higher odds (OR = 1.660, P< 0.001).Women and older adults reported better access than men and younger individuals (P<0.001). Higher education levels were linked to lower odds of reporting access (secondary: OR=0.870; post-secondary: OR=0.878; both P<0.001). Conclusion: The relationship between poverty and healthcare access in Africa is more nuanced than often assumed. In some contexts, poorer individuals reported higher odds of access, reflecting potential effects of subsidized care and infrastructure investments. Residential context—especially the rural–urban divide—proved a stronger predictor than poverty alone, with notable cross-country variation. These findings challenge uniform exclusion narratives and underscore the need for integrated policies addressing place, education, and financial protection to promote equitable healthcare access.