POOR PRIMARY HEALTHCARE SYSTEM AND UTILIZATION OF MATERNAL AND INFANT HEALTHCARE SERVICES IN ABIA CENTRAL SENATORIAL ZONE, NIGERIA
Maternal and infant health outcomes are key indicators of health system performance, particularly in low and middle-income countries like Nigeria. Primary healthcare (PHC) serves as the first point of contact for communities and is essential for providing maternal and child health services. However, weaknesses within PHC can hinder access, utilization, and quality of care, contributing to high maternal and infant morbidity and mortality. This study examined the specific weaknesses in the PHC system in Abia Central Senatorial District, Nigeria, assessed their impact on maternal and infant healthcare utilization, and proposed evidence-based strategies for strengthening PHC delivery. A cross-sectional and mixed-methods design was adopted, using surveys and key informant interviews across selected PHC centers. Quantitative data were analyzed descriptively and inferentially, while qualitative data were thematically analyzed. Findings revealed critical PHC weaknesses, including shortages of trained personnel (68%), frequent drug stock-outs (62%), inadequate infrastructure (59%), and poorly functioning referral systems (57%). These challenges significantly limited service utilization, with only 61% of pregnant women attending four or more antenatal visits and 54% delivering in PHC facilities. Governance and financing gaps further compounded service inefficiencies. The findings align with Health Systems Theory, showing that deficiencies in workforce, infrastructure, financing, governance, and referral mechanisms interact to undermine PHC effectiveness. Strengthening PHC through workforce development, adequate funding, improved infrastructure, functional referral systems, and community engagement can enhance service utilization and maternal and infant health outcomes. This study provides evidence-based insights for policymakers and health managers to address systemic PHC weaknesses, contributing to improved maternal and infant health in Abia Central Senatorial District and similar resource-limited settings.