When Urban Crime Undermines Health Systems: Determinants and Implications of Crime Reporting for Access to Care in Nigerian Cities
1
1. Department of Psychology , Agbani, Enugu, Nigeria., Enugu State University of Science and Technology, Agbani, Enugu, Nigeria
2
2. Health Policy Research Group, University of Nigeria, Enugu, Nigeria
3
5. Department of Psychology, University of Nigeria, Nsukka, Nigeria
4
4. Stanford school of medicine, California, United States
5
3. Department of Psychology, Alex Ekwueme Federal University, Ndufu Alike, Abakiliki, Ebonyi, Nigeria, Ndufu Alike, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A1633
ABSTRACT
BACKGROUND:
Urban crime poses an underexplored challenge to equitable health system functioning in low- and middle-income countries. While the health consequences of crime exposure are well-documented, less is known about factors influencing crime reporting and how these impact healthcare access. Understanding these dynamics is critical for sustainable urban health systems.
METHODS:
We conducted a cross-sectional mixed-methods study in two cities in southeast Nigeria, analyzing survey data from 304 households using hierarchical multiple regression and qualitative data from 52 in-depth interviews and 8 focus group discussions with key stakeholders using thematic analysis, N ivo 15.
RESULTS:
33.6% of respondents had ever reported a crime to law enforcement. Fear of retaliation, distrust in police effectiveness, and fear of being labelled a snitch were key barriers to reporting. Fearfulness for personal safety was positively associated with crime reporting (β = .14, p < .05), while perceived law enforcement responsiveness was inversely associated (β = −.15, p < .01). Male (β = −.13, p < .05) and higher household income (β = .14, p < .05) were also significant predictors, with the model explaining 10% of the variance in reporting. Crime reporting (β = .18, p < .01), fearfulness for safety (β = .34, p < .001), and perceived law enforcement responsiveness (β = −.16, p < .01) were associated with poorer access to health services, jointly explaining 18% of the variance. Qualitative findings corroborated these patterns and showed how shortened service hours especially at nights, staff absenteeism, delayed care seeking and increased reliance on unregulated providers were driven by institutional mistrust, fear and weak accountability.
CONCLUSIONS:
Crime undermines equitable access to health services through individual fears and institutional failures in relation to reporting and response. Strengthening health systems requires addressing community safety alongside measures to strengthen trust, protect health workers and service users.
Urban crime poses an underexplored challenge to equitable health system functioning in low- and middle-income countries. While the health consequences of crime exposure are well-documented, less is known about factors influencing crime reporting and how these impact healthcare access. Understanding these dynamics is critical for sustainable urban health systems.
METHODS:
We conducted a cross-sectional mixed-methods study in two cities in southeast Nigeria, analyzing survey data from 304 households using hierarchical multiple regression and qualitative data from 52 in-depth interviews and 8 focus group discussions with key stakeholders using thematic analysis, N ivo 15.
RESULTS:
33.6% of respondents had ever reported a crime to law enforcement. Fear of retaliation, distrust in police effectiveness, and fear of being labelled a snitch were key barriers to reporting. Fearfulness for personal safety was positively associated with crime reporting (β = .14, p < .05), while perceived law enforcement responsiveness was inversely associated (β = −.15, p < .01). Male (β = −.13, p < .05) and higher household income (β = .14, p < .05) were also significant predictors, with the model explaining 10% of the variance in reporting. Crime reporting (β = .18, p < .01), fearfulness for safety (β = .34, p < .001), and perceived law enforcement responsiveness (β = −.16, p < .01) were associated with poorer access to health services, jointly explaining 18% of the variance. Qualitative findings corroborated these patterns and showed how shortened service hours especially at nights, staff absenteeism, delayed care seeking and increased reliance on unregulated providers were driven by institutional mistrust, fear and weak accountability.
CONCLUSIONS:
Crime undermines equitable access to health services through individual fears and institutional failures in relation to reporting and response. Strengthening health systems requires addressing community safety alongside measures to strengthen trust, protect health workers and service users.
| eISSN: | 2654-1459 |
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