Urban-Rural Disparities in Primary Healthcare Service Delivery and Implications for Sustainable Development Goal 3 in Southern Nigeria

Rationale: Urban–rural inequities in primary healthcare (PHC) service delivery remain a major barrier to achieving Sustainable Development Goal 3 (SDG 3) in low- and middle-income countries. In Nigeria, limited empirical evidence exists on how structural capacity, governance, and utilisation pathways jointly shape these disparities at the frontline health system level, particularly in underserved riverine states such as Bayelsa. Objectives: This study assessed urban–rural disparities in PHC service delivery in Bayelsa State, southern Nigeria, with a focus on service readiness, governance and performance management, utilisation pathways, and prospects for strengthening PHC systems to advance SDG 3. Methods: A cross-sectional facility-based assessment was conducted across 34 government-owned PHC facilities (17 rural and 17 urban). Standardised indicators were used to evaluate human resources, infrastructure and utilities, equipment readiness, infection prevention and control, medicine availability, health information systems, governance practices, and service utilisation pathways. Urban–rural differences were analysed using chi-square or Fisher’s exact tests, with statistical significance set at p<0.05. Results: Rural PHC facilities exhibited significantly greater weaknesses in infrastructure, electricity and water supply, basic medical equipment, infection prevention and control, waste management, essential medicine availability, and referral system functionality. Rural facilities were more likely to experience frequent medicine stock-outs (64.7% vs. 11.8%, p=0.001), lack electricity (64.7% vs. 0.0%, p<0.001), and report non-functional referral systems (58.8% vs. 11.8%, p=0.004). Despite these deficits, rural PHCs demonstrated high service utilisation and stronger routine data reporting. Governance indicators—including planning, target setting, and community engagement—were largely comparable across settings, although urban facilities achieved a higher proportion of planned service targets. Urban PHCs showed relatively stronger infrastructure and equipment readiness but notable weaknesses in essential drug availability and health information reporting. Conclusion: Urban–rural disparities in PHC delivery in Bayelsa State are driven primarily by unequal distribution of foundational health system inputs rather than deficiencies in governance structures. Persistent rural infrastructure, supply chain, and referral gaps undermine equitable progress toward SDG 3 despite high service demand and community engagement. Recommendation: Context-specific, equity-oriented PHC reforms are required, prioritising rural infrastructure, utilities, equipment, supply chain reliability, and referral integration, alongside targeted improvements in urban system management and data use. Significant Statement: Addressing spatial inequities in PHC capacity is essential to reducing preventable morbidity and mortality, strengthening universal health coverage, and achieving SDG 3 in resource-constrained and hard-to-reach populations.