Background: In recent years, the pursuit of universal health coverage (UHC) has become a global priority; however, significant geographic and socioeconomic disparities have hindered equitable enrolment in social health insurance (SHI) programs. In Bayelsa State, Nigeria, a social health insurance program was implemented with the aim of providing universal access, but various barriers constrained uptake, particularly among the most vulnerable populations. This study aimed to understand how geographic, socioeconomic, and administrative factors influenced enrolment in Bayelsa State's social health insurance program, with the ultimate goal of assessing implications for achieving universal health coverage.

Methods: A cross-sectional, mixed-methods design was employed, involving data collection from 600 residents across eight local government areas in Bayelsa State. The study utilized structured questionnaires to gather quantitative data on demographic characteristics, enrolment status, and perceived barriers, supplemented by qualitative insights from community stakeholders.

Results: The findings revealed significant geographic disparities, with 76% of respondents living more than 20 kilometers from enrolment centers. Socioeconomic factors, including income levels and education, were shown to significantly impact enrolment likelihood, with higher rates observed among those with stable employment and educational attainment. Administrative barriers, such as the requirement for national identity cards, further excluded marginalized groups from the program.

Conclusion: The study identified critical barriers to SHI enrolment in Bayelsa State, underscoring the need for targeted interventions to address geographic, socioeconomic, and administrative challenges. By implementing mobile enrolment units, simplifying documentation processes, and providing subsidies for low-income individuals, the potential to advance universal health coverage in Bayelsa could be enhanced, ensuring access for all residents, particularly the most vulnerable populations.