Assessing Architectural Barriers and Inclusive Design in Secondary Healthcare Facilities in Akure, Ondo State, Nigeria.

Universal Design (UD) refers to the design of the environment, goods and services to be usable, enjoyable and accessible by all people irrespective of age, sex, ability or disability. Nigeria's population has over 25 million people with varying disability types, and the environment of most public health care facilities is not accommodating, a contravention to access right to health, which is a promise upheld by the Discrimination Against Persons with Disabilities (Prohibition) Act 2018, but empirical evaluation of architectural barriers in Nigerian secondary level health care facilities in medium sized city such as Akure, Ondo state, is limited. The study adopted a quantitative methodological approach, using physical observation and a structured observation checklist of 88 items derived from the seven principles of UD, to examine architectural barriers to inclusive health care delivery in three secondary-level health care facilities in Akure. A weighted compliance index (WCI) was developed and implemented by incorporating the state and availability of each component, graded on a scale of 0 (Not Available) to 100 (Good). Overall WCI for the facilities revealed that none of the three facilities complied with any of the four PWD-specific sanitary criteria, which are door width, turning space, grab bars, and accessible approach. A Kruskal-Wallis H-test was conducted; the result revealed no statistically significant difference among the three facilities, while variations existed in fire safety system design, rooms for sensory access, exit-way finding strategy, and assistive equipment across all buildings. These findings indicate that architectural exclusion is systemic and calls for universal design-based retrofitting and periodic accessibility audits in secondary healthcare facilities.

Universal Design, architectural barriers, healthcare accessibility, persons with disabilities (PWD), Weighted Compliance Index, Nigeria.

1. AEL Data. (2023). Inclusive vs. universal design: Why it matters? https://aeldata.com/inclusive-vs-universal-design/ [Google Scholar] [Crossref]

2. Ahmed, S., Muhammad, I. B., Abdulrahman, M. E.-H., & Adebisi, G. O. (2022). Visual accessibility and inclusive way finding design in hospital environment in Nigeria. International Journal of Architecture and Planning, 10(1), 97–114. https://doi.org/10.15320/ICONARP.2022.195 [Google Scholar] [Crossref]

3. Akinluyi, M., Ayoola, H. A., Morakinyo, A., & Fadamiro, J. (2020). A review of physical facilities design settings: Standard for hospital building performance in Southwest, Nigeria. Science Park Journals, 6(4), 638–658. https://doi.org/10.14412/SRI2020.658 [Google Scholar] [Crossref]

4. Ayub, A. O., & Rasaki, A. J. (2021). Barriers in accessing healthcare services by patients with disabilities in Nigerian hospitals. International Journal of Management and Social Sciences, 4(1). [Google Scholar] [Crossref]

5. Ayub, A., & Abubakar, U. (2022). Institutional challenges faced by persons with disabilities in Nigeria. Ife Social Sciences Review, 30(2), 124–135. https://issr.oauife.edu.ng/index.php/issr/article/download/196/116/243 [Google Scholar] [Crossref]

6. Azubuike, P. C., Akinreni, T., Adai, S. G., Ogbonna, C. K., Abba, M. E., Udofia, M. D., Odo, O. J., Nwadichie, M., & Imo, U. F. (2025). Equity and social justice perspectives on disability inclusion in healthcare services in Nigeria. Communications Medicine, 5(1), 371. https://doi.org/10.1038/s43856-025-01070-8 [Google Scholar] [Crossref]

7. Burns, S. P., Mendonca, R. J., & Smith, R. O. (2023). Accessibility of public buildings in the United States: A cross-sectional survey. Disability & Society, 39(11), 2988–3003. https://doi.org/10.1080/09687599.2023.2239996 [Google Scholar] [Crossref]

8. Centers for Disease Control and Prevention. (2012). PT6 working paper. https://www.cdc.gov/nchs/data/icd/icfoverview_finalforwho10sept.pdf [Google Scholar] [Crossref]

9. Centre for Excellence in Universal Design. (2022). About universal design. https://universaldesign.ie/about-universal-design [Google Scholar] [Crossref]

10. Clemente, K. A. P., Silva, S. V. d., Vieira, G. I., Bortoli, M. C. d., Toma, T. S., Ramos, V. D., & Brito, C. M. M. d. (2022). Barriers to the access of people with disabilities to health services: A scoping review. Revista de Saude Publica, 56(64). https://doi.org/10.11606/s1518-8787.2022056003893 [Google Scholar] [Crossref]

11. Erdtman, E., Rassmus-Grohn, K., & Hedvall, P.-O. (2021). Universal design as guiding, striving and unifying: A qualitative study about how universal design is understood, practised and realised in contemporary Sweden. Scandinavian Journal of Disability Research, 23(1), 158–168. [Google Scholar] [Crossref]

12. https://doi.org/10.16993/sjdr.777 [Google Scholar] [Crossref]

13. https://www.uwyo.edu/wind/_files/docs/resources/ud_review.pdf [Google Scholar] [Crossref]

14. Heldak, M., Stacherzak, A., & Przybyla, K. (2018). Demand and financial constraints in eliminating architectural and technical barriers for people with disabilities in Poland. Journal of Healthcare Engineering, 2018(1). https://doi.org/10.1155/2018/1297396 [Google Scholar] [Crossref]

15. https://thehospitalbook.com/general-hospital-iju-itaogbolu/ [Google Scholar] [Crossref]

16. Jelsma, J. (2009). Use of the International Classification of Functioning, Disability and Health: A literature survey. Journal of Rehabilitation Medicine, 41(1), 1–12. [Google Scholar] [Crossref]

17. Kuper, H., Azizatunnisa, L., Gatta, D. R., Rotenberg, S., Banks, L. M., Smythe, T., & Heydt, P. (2024). Building disability-inclusive health systems. The Lancet Public Health, 9(5), 316–325. https://doi.org/10.1016/S2468-2667(24)00042-2 [Google Scholar] [Crossref]

18. Leonards, U., Davies, J., Ross, J., Talas, L., & Stevanov, J. (2024). Putting the sensory individual at the centre of architectural design. Architectural Science Review, 68(5), 392–401. https://doi.org/10.1080/00038628.2024.2421926 [Google Scholar] [Crossref]

19. Mactaggart, I., Ssemata, A. S., Menya, A., Ndlovu, T., Willan, S., Zulu, N., Mhlongo, S., Mabunda, A., Padayachee, T., Lloyd, J., Mthethwa, T., & Carpenter, B. (2024). Adapting and pilot testing a tool to assess the accessibility of primary health facilities for people with disabilities in Luuka District, Uganda. International Journal for Equity in Health, 23, 237. https://doi.org/10.1186/s12939-024-02314-0 [Google Scholar] [Crossref]

20. Mohapatra, S., Maiya, G. A., Nayak, U. U., Benny, L., Watson, J., Kinjawadekar, A., & Nandineni, R. D. (2024). Centering social justice and equity in research on accessibility to public buildings for individuals with mobility disabilities: A scoping review. F1000Research, 13(930). https://doi.org/10.12688/f1000research.153797.2 [Google Scholar] [Crossref]

21. Morena, M., Trupi, T., & Kluger, A. (2024). Inclusive design, architecture for everyone. [Google Scholar] [Crossref]

22. Morenikeji, O. B., Alagbe, T., Akande, I., & Oyeniyi, O. (2022). A study of universal design strategies in selected public buildings in Lagos State. IRE Journals, 6(4). https://www.researchgate.net/publication/364553784 [Google Scholar] [Crossref]

23. Mosca, E. I., & Capolongo, S. (2023). Design for all A.U.D.I.T. (Assessment Universal Design & Inclusion Tool): A tool to evaluate physical, sensory-cognitive and social quality in healthcare facilities. Acta Biomedica, 94(3). [Google Scholar] [Crossref]

24. Mosca, E. I., White, J., Steinfield, E., & Capolongo, S. (2022). Designing hospitals through the lens of universal design: An evaluation tool to enhance inclusive healthcare facilities. In Transforming our world through universal design for human development (Vol. 297, pp. 331–339). https://doi.org/10.3233/SHTI220857 [Google Scholar] [Crossref]

25. Moscoso-Porras, M., Fuhs, A. K., & Carbone, A. (2019). Access barriers to medical facilities for people with physical disabilities: The case of Peru. Cadernos de Saude Publica, 35(12). https://doi.org/10.1590/0102-311X00050417 [Google Scholar] [Crossref]

26. Olodeoku, M. E., Alokun, A., Alagbe, O., Egwabor, J. E., & Buseri, J. (2024). Exploring universal design principles in the built environment: An empirical review. African Journal of Environmental Sciences & Renewable Energy, 16(1), 84–98. https://doi.org/10.62154/ajesre.2024.016.010352 [Google Scholar] [Crossref]

27. Persson, H., Ahman, H., Yngling, A. A., & Gulliksen, J. (2014). Universal design, inclusive design, accessible design, design for all: Different concepts, one goal? Universal Access in the Information Society, 14(4). 10, 41–61. https://doi.org/10.29053/2413-7138/2022/v10a3 [Google Scholar] [Crossref]

28. Rooke, C. N., Rooke, J. A., Tzortzopoulos, P., & Koskela, L. (2023). Wayfinding in complex medical facilities: The indexicality of directional arrows. HERD: Health Environments Research & Design Journal, 16(4), 118–131. https://doi.org/10.1177/19375867231180908 [Google Scholar] [Crossref]

29. Saha, P., Biswas, B., & Chauhan, M. (2025). Universal design principles in healthcare environments. Journal of Progress in Civil Engineering, 7(5). https://doi.org/10.53469/jpce.2025.07(05).01 [Google Scholar] [Crossref]

30. Szewczenko, A., & Pronobis, S. (2020). Implementing Inclusive Design in Architectural Education and Design Practice. IOP Conference Series: Materials Science and Engineering, 960(2). https://doi.org/10.1088/1757-899X/960/2/022015 [Google Scholar] [Crossref]

31. Tsami, C. A., & Chrysikou, E. (2024). Towards specialized accessibility standards for healthcare facilities: A mixed-methods study on the needs of people with disabilities in hospitals. Effects of Design on Health and Wellbeing, 103–115. https://discovery.ucl.ac.uk/id/eprint/10198674/ [Google Scholar] [Crossref]

32. Uduu, O. (2020). Over 25 million Nigerians excluded due to disability. Dataphyte. [Google Scholar] [Crossref]

33. https://archive.dataphyte.com/latest-reports/governance/over-25-million-nigerians-excluded-due-to-disability/ [Google Scholar] [Crossref]

34. Unuebho, G. I., & Adeola, J. A. (2024). Universal accessibility: An assessment of Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria. Ethiopian Journal of Environmental Studies & Management, 17(5), 623–632. https://ejesm.org/doi/v17i5.6 [Google Scholar] [Crossref]

35. World Health Organization. (2002). Towards a common language for functioning, disability and health: ICF. WHO. https://cdn.who.int/media/docs/default-source/classification/icf/icfbeginnersguide.pdf [Google Scholar] [Crossref]

36. World Health Organization. (2022). Global report on health equity for persons with disabilities. [Google Scholar] [Crossref]

37. WHO. [Google Scholar] [Crossref]

• Re-Validating the Uniqueness of Urban Morphology of the Shekhawati Region Through Reconnaissance Using Hotspot Analysis
• Golden Ages and Emerging Needs: Rethinking old Age Homes as Self Sustained Communities
• The Missing Link between Colonial Jack Arch Roofing and Indigenous Construction Practices in India
• Archiving Kolakopa - A Study on the Present Condition and the Architectural Features of an Evanescing Historic Settlement.
• Analysing Vendor Lock-In in Serverless Architectures