Equitable geographical access to healthcare is an important component of universal health coverage, yet rapid urbanisation can produce substantial inequalities in the location of health infrastructure within cities. This study evaluates the spatial distribution of healthcare facilities in Abuja Municipal Area Council (AMAC), Federal Capital Territory, Nigeria, using Geographic Information Systems (GIS) and spatial analytical techniques. Primary data were obtained through field identification and georeferencing of healthcare facilities, while secondary data included population, administrative and planning information. A questionnaire survey involving 384 residents was also used to examine perceived consequences of the existing distribution pattern. The analysis employed ward-level facility counts, facility-to-population ratios, Nearest Neighbour Analysis, Kernel Density Estimation, Location Quotient, and proximity/buffer analysis. The results reveal a pronounced spatial imbalance. Of the 233 facilities recorded in the ward-level inventory, Gwarimpa contained the largest share (15.9%), followed by City Centre (11.6%), Kabusa (11.2%) and Garki (10.7%); collectively, these four wards accounted for 49.4% of the facilities. In contrast, Karshi and Kanshi contained only 1.7% and 0.9%, respectively. Kernel density analysis identified high-density clusters around Wuse, Garki, Gwarimpa and the Central Area, while Karshi, Kanshi, parts of Orozo and interior Jiwa constituted low-density areas. Location Quotient values ranged from 2.06 in Gwarimpa to 0.11 in Karshi, confirming substantial territorial imbalance. The findings also indicate a pronounced core–periphery accessibility gradient, with residents in peripheral wards facing greater distances to higher-order healthcare services. Survey responses reinforce these findings, particularly regarding emergency response, personnel pressure and increased healthcare costs. The study concludes that healthcare provision in AMAC reflects urban development, infrastructure concentration and market forces more strongly than population-based spatial equity. A GIS-led, needs-responsive planning framework is therefore required to redirect investment towards underserved communities and integrate healthcare provision with ongoing urban expansion.