Background: This study assessed the impact of a multi-payer capitation model on service utilization patterns and enrollment dynamics in primary health centers (PHCs) across Bayelsa State, Nigeria. The capitation system aimed to enhance healthcare access and incentivize preventive care, particularly for maternal and child health services amidst varying socio-demographic characteristics across Local Government Areas (LGAs).

Methods: A retrospective observational design was employed, analyzing existing records from 105 PHCs serving catchment populations of approximately 10,000 residents each. Data were collected from routine facility records, including enrollment registers, service utilization logs, and capitation payment ledgers from multiple payers such as NPHCDA Gateway, NHIS Gateway, UNICEF/GAVI, and others. Statistical analyses were conducted to explore associations between capitation characteristics and key utilization indicators over the study period from 2023 to 2025.

Results: The findings revealed a significant increase in service utilization, with general attendance visits rising from 647,467 in 2023 to 1,033,692 in 2025. Specific services, including antenatal care and deliveries attended by skilled birth attendants, also experienced substantial growth. Notably, the data indicated a higher female representation in enrollment across all LGAs, which correlated with increased utilization of maternal health services. However, disparities in service utilization relative to enrollment numbers were observed, suggesting barriers to effective engagement.

Conclusion: The multi-payer capitation model positively influenced service utilization in primary healthcare settings, particularly for maternal and child health services. The study underscored the importance of enhanced coordination among payers and the need for improved outreach strategies to optimize engagement and health outcomes in Bayelsa State. Continued investment in the capitation framework was deemed essential for sustaining healthcare access and improving overall health outcomes for vulnerable populations.