Factors influencing access to primary healthcare services among households in urban slums of Mogadishu, Somalia: a cross-sectional study.

backgroundAccess to primary healthcare (PHC) is essential for achieving universal health coverage (UHC), particularly in fragile and resource-limited settings such as Somalia. Urban slum populations often face multiple barriers that limit timely use of essential health services. This study assessed factors associated with household access to PHC among residents of Wadajir District in Mogadishu.

methodsA community-based cross-sectional study was conducted between October and November 2023 among 300 households selected using purposive sampling to capture underserved areas with limited health service availability. One adult household representative (≥ 18 years) was interviewed using a structured questionnaire. Descriptive and bivariate analyses were conducted using SPSS, while multivariable analysis was performed using modified Poisson regression with robust variance estimation in R to identify factors independently associated with access to PHC. Results were reported as adjusted prevalence ratios (APR) with 95% confidence intervals (CI).

resultsOverall, 30% of households reported easy access to primary healthcare services. Most respondents were female (65.7%), and a large proportion reported that healthcare services were unaffordable (79.7%). In the multivariable model, respondents aged 60 years and above were significantly more likely to report easy access to PHC compared with those aged 18–29 years (APR = 2.31; 95% CI: 1.06–5.04; p = 0.035). Additionally, households reporting comfort with healthcare providers had significantly higher prevalence of easy access to PHC compared with those who did not feel comfortable with their providers (APR = 8.11; 95% CI: 5.33–12.33; p < 0.001). Other factors including sex, type of healthcare facility, waiting time, affordability of healthcare services, availability of services, and perceived quality of care were not significantly associated with access to PHC after adjustment.

conclusionsAccess to primary healthcare in Wadajir District remains limited, with only one-third of households reporting easy access to services. The findings highlight the critical role of patient–provider relationships in shaping perceived access to healthcare. Interventions aimed at improving respectful communication, trust, and patient-centered care within healthcare facilities may enhance access to PHC in urban slum settings. Strengthening these interpersonal dimensions of care, alongside broader health system improvements, may help improve equitable access to healthcare.