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Paper short abstract

This paper examines how gender, poverty, and spatial location intersect to shape health access in Northern Nigeria. Using a political economy lens, it shows how structural inequalities and power relations constrain equitable service use and health system responsiveness.

Paper long abstract

Access to health care in the global South is shaped not only by income constraints but by the intersection of multiple, reinforcing inequalities. This paper analyses how gender, poverty, and spatial disparities jointly influence access to health services in Northern Nigeria, a region characterised by high poverty rates, entrenched gender norms, and pronounced rural–urban divides. Drawing on a development economics and political economy framework, the study moves beyond single-axis explanations of health inequality to examine how power relations embedded in households, markets, and public institutions structure health-seeking behaviour and service provision.

Using secondary survey data and contextual evidence from Northern Nigeria, the paper explores disparities in service utilisation, financial protection, and access to maternal and primary health care. It highlights how women in poor and remote communities face compounded barriers arising from limited economic resources, restrictive gender norms, weak infrastructure, and under-resourced health facilities. These constraints are further exacerbated by governance failures and uneven public health financing, which tend to privilege urban centres and politically connected populations.

The findings suggest that policies focused solely on expanding coverage or introducing technological solutions risk reproducing existing inequalities if underlying power asymmetries are not addressed. The paper argues for an intersectional approach to health policy that centres gender equity, spatial justice, and community agency in the design of financing and governance reforms. By grounding the analysis in Northern Nigeria, the study contributes to broader debates on reimagining equitable and resilient health systems in uncertain futures across the global South.