Assessment of School-Based Healthcare Service Practices in Secondary Schools within a University Environment

School-based healthcare services (SHS) are healthcare systems integrated within schools to support children's health and well-being. However, in Nigeria, SHS remains largely under-implemented, and where they do exist, are often inadequate. This study examined SHS practices in secondary schools within a university environment to determine whether being located in a university setting influences the quality of SHS. A descriptive cross-sectional study design using a mixed-method approach was employed. Through a multistage sampling method, 346 students across five secondary schools within the university were selected for the study. SHS practice was assessed on a scale of 60, with scores of ≥ 48.37 indicating good health service quality. Qualitative data from six key informant interviews were analysed thematically, identifying commonalities and differences in participants' perspectives. Findings revealed that overall SHS practice in these schools was below average (47.7%), with private schools demonstrating a significantly better practice (84.2%; OR 11.48, 95% CI 6.19–21.29). Qualitative findings revealed that first aid was the most frequently practiced health service and the major barrier to effective SHS implementation was inadequate financial resources. Meanwhile, students' overall attitude toward SHS was predominantly negative (57.8%), with an overall average mean of 3.15 ± 0.65. Only 56.4% of students demonstrated good health assessment, with a mean score of 78.99 ± 7.12. Both quantitative and qualitative analyses confirmed that school-based healthcare remains insufficient, even for schools within a university setting. These services rely primarily on self-funding, highlighting an urgent need for government and stakeholder intervention to enhance healthcare accessibility and effectiveness in Nigerian schools.