Integrating chronic diseases in Nigerian primary care: What do Nigerian health policies tell us?

Background

Integrated Primary Health Care (IPHC) emphasizes comprehensiveness, continuity and multiprofessional collaboration for chronic disease (CD) care. According to the WHO framework on integrated care, people-centred health services strategic development of policies is needed for strengthening delivery of quality health services to all people. However, the extent Nigerian health policies incorporate this approach for CD care in PHC remains unclear. This study therefore focuses on how Nigerian health policies consider IPHC for CD care.

Methods

Semi-structured interviews with 14 purposively sampled federal, state and local level policy stakeholders were conducted to understand how policies address CD care in PHC. Data was analysed using deductive-inductive content analysis.

Results

Policies such as the Multisectoral Action Plan for Noncommunicable Diseases, the National Health Policy and the Task Shifting-Task Sharing Policy recognize the need for coordinated CD care in PHC. However, specific dedicated IPHC policies are missing, thus integrated CD care in PHC remains an elusive concept for the stakeholders. Moreover, policy making occurs mainly at federal level with limited input from other tiers of government and civil society organizations. Approaches for integrating CD care in PHC have emerged notwithstanding existing urban-rural disparities. Barriers to dedicated IPHC policy development include lack of awareness, inadequate stakeholder engagement in policy design, scepticism on the feasibility due to resource constraints in the PHC setting, and deep fragmentation of service delivery across federal, state and local service delivery.

Discussion

The absence of dedicated policies limits the integration of CD care in PHC. Revising existing policies and developing specific IPHC policy for CD care with greater stakeholder engagement should guide future development. Future research should examine on the ground policy implementation with frontline health workers.

Key messages

• The absence of dedicated IPHC policies and fragmented governance limit access to structured and coordinated chronic disease care. This calls for policy reforms.

• The highlighted barriers to IPHC practice underscore the need for investment in CD care, and stronger multi-level, multi-professional collaboration in chronic disease management.