Social Stratification and Access to Quality Healthcare in Kwara State

Social stratification profoundly shapes healthcare access in Nigeria, where income, occupational status, and educational background determine the quality of health services individuals can access within a largely out-of-pocket payment system. This study examines how social stratification affects access to quality healthcare among residents of Kwara State, North Central Nigeria. A descriptive survey design was employed, with structured questionnaires administered to 350 adult respondents stratified by occupational category across Ilorin, Offa, and Lafiagi. Healthcare access was operationalized through measures of physical proximity, affordability, perceived quality, and utilization frequency. The Weberian three-component model of stratification was used as the theoretical framework. Results reveal significant stratification in all access dimensions. Respondents in the highest income quintile were six times more likely to utilize private specialist facilities than those in the lowest quintile. Healthcare expenditure consumed more than 30% of monthly income among bottom-quintile households compared to 7% among top-quintile households, confirming catastrophic health expenditure patterns. Proximity to healthcare facilities did not significantly moderate the stratification effect on utilization, suggesting that cost barriers override geographic accessibility. Traditional medicine use was highest among lowest-income respondents. The study identifies a significant middle-class squeeze, with formally employed but moderately paid civil servants reporting high dissatisfaction with available public healthcare quality but insufficient income for private alternatives. Recommendations include expansion of the National Health Insurance Scheme to informal workers and investment in upgrading primary healthcare quality in Kwara's low-income residential areas. Keywords: social stratification, healthcare access, Kwara State, inequality, NHIS.