Abstract

Aim: Internal displacement in North Central Nigeria has created severe public health challenges. Despite the scale of displacement, empirical evidence systematically linking healthcare delivery processes to specific health outcomes in this region remains limited. This study assessed the effects of healthcare delivery specifically coordination mechanisms, resource allocation, and service delivery on health outcomes among IDPs at two camps in North Central Nigeria: Wassa IDP Camp (FCT-Abuja) and Rahoss IDP Camp (Plateau State).
Research Questions: The study was guided by the following questions: (i) What is the nature and effectiveness of coordination mechanisms for health service delivery in Wassa and Rahoss IDP camps? (ii) How adequate is resource allocation for health services across the two study sites? (iii) What are the characteristics and quality of health service delivery models in the two camps? (iv) What is the relationship between healthcare delivery processes and health outcomes among IDPs in the study sites?
Methods: A quantitative cross-sectional survey design was employed. Data were collected between January and February 2026 at both sites. A multi-stage sampling technique was used to recruit 400 respondents per study site (N = 800 total), comprising IDP residents (70%), healthcare workers (15%), and key stakeholders/officials (15%). Quantitative data were analyzed using IBM SPSS Statistics (version 26.0; IBM Corp., Armonk, NY, USA). The study acknowledges that a mixed-methods design incorporating key informant interviews and semi-structured qualitative inquiry would strengthen future research in this area.
Results: Two-week illness prevalence was 61.5% at Wassa and 67.0% at Rahoss. Malaria was the leading morbidity at both sites (Wassa: 35.5%; Rahoss: 40.5%), accounting for 35–40% of all reported morbidity across both study sites. Full immunization coverage was 47.0% at Wassa versus 41.0% at Rahoss, both below national targets. Institutional delivery was 53.5% at Wassa and 49.0% at Rahoss. Coordination satisfaction (62.5% vs. 52.0%) and essential medicine adequacy (60.0% vs. 50.0%) were markedly higher at Wassa. Ambulance and emergency transport services were critically deficient at both sites, constituting the most acutely under-resourced element of the health management architecture in both camps.
Conclusions: Healthcare delivery processes are significantly associated with health outcomes in IDP settings in North Central Nigeria. The findings suggest, but do not establish causal directionality, that deficits in coordination, resource allocation, and service delivery are associated with poorer measured health outcomes. Strengthening inter-agency coordination, ensuring equitable health resource allocation with particular urgency regarding emergency transport provision and improving service delivery models are critical to reducing preventable morbidity and mortality among IDPs in the region. Future research using longitudinal designs is recommended to establish causal pathways.

Key words: Internally Displaced Persons; Health Services Accessibility; Health System Strengthening; Humanitarian Health Response; Nigeria; Sub-Saharan Africa; Communicable Diseases