How does the Nigerian health system serve people living with disabilities? A socio-ecological analysis on people living with visual impairment.

People living with disabilities (PLWD) in Nigeria experience significant disparities in health outcomes and access to care. Among them, individuals living with visual impairment (VI) face compounded barriers due to structural inequities and social exclusion. This paper explores how the Nigerian health system serves PLWD through a socioecological lens, with a focus on those living with VI. We conducted a narrative review using databases such as Medline, Scopus, Embase and Google Scholar, along with policy repositories, to identify peer-reviewed and grey literature. Inclusion criteria focused on studies addressing disability, healthcare access, and Nigeria. Thematic analysis was guided by the Dahlgren and Whitehead's socioecological model to explore multilevel determinants affecting access to care for PLWD, particularly those living with VI. Findings reveal systemic failures across political, economic, sociocultural, and environmental domains that limit equitable access to care. Attitudinal barriers, inadequate infrastructure, and weak enforcement of anti-discrimination laws emerged as critical challenges. This analysis underscores the need for multisectoral reforms that address both institutional and societal barriers to inclusion. Strengthening legal frameworks, increasing budgetary allocations for inclusive services, and involving PLWD and people living with VI in policy processes are critical steps toward equitable healthcare delivery.