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Francis Koce

PhD Student

Francis KoceCourse Start: October, 2013
Supervisor: Prof. Gurch Randhawa
Supervisor 2: Dr Bertha Ochieng

Thesis title

Understanding healthcare self-referral in Niger state (Nigeria): the service users and healthcare provider’s perspective


The Nigerian healthcare referral system has continued to be a challenging area for healthcare delivery, with 60-90% of patients presenting to the referral facilities reported as self-referred (presenting to referral facilities without any form of referral) service-users. This has led to the distortion of the normal pyramidal structure of the referral system. Consequently the primary healthcare facilities in Nigeria have become underutilised and unrecognised, wasting the resources and skills of the healthcare providers serving those facilities. The referral facilities in turn have become overloaded with patients beyond what they are able to cater for and healthcare providers are over worked with minor ailment that could have been easily taken care of at the primary healthcare facilities, as a result, the sick patients that actually need the referral facilities are unlikely to get the desired attention due to lack of the desired expertise/ specialist. This has further resulted in patients seeking care abroad, which has been termed ‘medical tourism', which gulps about £156 million annually from the Nigerian system. However, studies available on self-referral are majorly from developed settings like UK, Netherlands, United states etc., notably healthcare delivery differs markedly between developed settings and a developing setting like Nigeria. Hence the need for a contextual exploration of this problem as it applies to the Nigerian system.

Research Objectives

  • To identify the facilitators and barriers of service users self-referral to secondary healthcare facilities from the service users and healthcare providers perspective (Qualitative phase).
  • To utilise the findings from the qualitative phase to inform and influence the development of a patient-centred questionnaire, regarding the facilitators and barriers of healthcare self-referral to the secondary healthcare facilities in the Niger state, Nigeria.
  • To examine the factors identified in objective 1 as facilitators and barriers of self-referral to secondary healthcare facilities among a larger sample of service users in the Niger state (Quantitative phase).

T: 01268 425063
E: francis.koce@study.beds.ac.uk
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