By: Aloysius Odii, Obinna Onwujekwe, Prince Agwu, Pamela Ogbozor, Tochukwu Orjiakor, Eleanor Hutchinson, Dina Babalanova

Healthcare facilities are routinely regarded as fundamentally an institution or establishments housing local medical services or practices. In that sense, the enduring human interactions and economic transactions in these spaces are often overlooked. Yet, this could pose challenge to healthcare delivery and the overall intent to meet health-related goals.

In this study, we narrate how health facilities operate as a marketplace and drew attention to its implication for healthcare delivery. Our description of the marketplace follows an economic anthropological perspective, which sees them as sites for complex social processes, instigators of cultural activity and realms for economic exchange.

The study was based on eight weeks of observations of six Primary Health Centres (PHCs) and two local government headquarters by four fieldworkers in Enugu State, Nigeria. The data was supplemented with semi-structured interviews with health workers, service users, and health managers. The data were analysed using NVivo and followed a narrative analytical approach.

The narrative showcased that health facilities are not just centres for health delivery but are hubs for economic activities, intertwined with social and cultural processes that in turn affect access to care. Besides pharmaceutical products, snacks, wears and drinks are sold by marketers and health workers on duty within the premises. Sometimes, this interferes with care when health workers are absent from duty to attend to their private business. Our narrative also demonstrated that access to pharmaceutical products as well as other medical services can be influenced by social relations and perceived ability to pay while services that are free can be offered for a fee. These activities were made possible by weak institutional structures that hardly communicate policies or regulate health workers’ activities.

The study concludes that besides serving as a centre for healthcare delivery, health facilities also sustain social and economic activities which sometimes interfere with service delivery. Health managers must manage informal structures within this space to improve health care delivery.

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