Utilization of Primary Health Care Services in Communities of Enugu State, Nigeria

Background Primary healthcare (PHC) is central to achieving equitable health outcomes and universal health coverage. Although PHC facilities are widely distributed across Nigeria, utilization patterns remain variable and incompletely understood, particularly at subnational levels. This study assessed PHC utilization and its determinants in selected communities in Enugu State, Nigeria. Methods A descriptive cross-sectional study was conducted among residents selected through a multistage sampling technique from six communities across the three senatorial districts of Enugu State. Data were collected using a pretested, structured questionnaire. PHC utilization was defined as use of PHC services within the preceding 12 months. Variables were categorized into predisposing, enabling, and need factors based on Andersen’s Behavioral Model of Health Service Use. Data were analyzed using descriptive statistics, bivariate tests, and multivariable logistic regression. Results Most respondents reported the presence of a PHC facility in their community (88.4%) and physical access to care (97.5%). While 67.6% had utilized PHC services within the last year, regular use was uncommon. In multivariable analysis, younger age, rural residence, lower educational attainment, and perceived staff competence were independently associated with higher odds of PHC utilization. Respondents with tertiary education were less likely to utilize PHC services. Distance and cost were commonly perceived barriers but did not remain significant after adjustment. Conclusion PHC utilization in Enugu State was moderate but largely infrequent, suggesting episodic rather than routine engagement. Beyond physical access, service quality, particularly perceived staff competence, plays a critical role in shaping utilization. Strengthening the PHC workforce and improving service quality may enhance sustained PHC use and support progress toward universal health coverage.