Informal–Formal Healthcare Services Delivery Nexus in Nigeria’s Urban Slums: A Reconnaissance Study

Urban slums are human habitats with poor habitation qualities that are vulnerable to infectious diseases and public health crises. Low coverage from formal healthcare services providers created opportunity for informal providers to thrive in urban slums. This study examined the nature of relationship between informal and formal healthcare services providers in urban slums and explored opportunities for strengthening collaborations between them. Reconnaissance research method, a qualitative research approach for exploring under-researched terrains, guided the interview of 104 slum healthcare stakeholders across eight purposively selected slums in Enugu and Onitsha cities, in southeastern-Nigeria. Findings show that informal healthcare service providers are dominant in urban slums, and many of them cooperate and compete with formal providers. Supervision of informal providers in slums is inadequate, and the formal providers report that the informal providers find acceptance, despite their lack of adequate training and professionalism. Authorities governing health systems in slums are encouraged to establish a mechanism to profile informal providers, delineate the scope of services, and bridge the gap through the creation of referral channels. Subsequent studies may explore what character any mechanism created to institutionalize the collaboration toward improving healthcare services delivery should take and what challenges could undermine it.