The organisation of primary health care service delivery for non-communicable diseases in Nigeria: A case-study analysis

Whenayon Simeon Ajisegiri; Seye Abimbola; Azeb Gebresilassie Tesema; Olumuyiwa O Odusanya; David Peiris; Rohina Joshi

doi:10.1371/journal.pgph.0000566

The organisation of primary health care service delivery for non-communicable diseases in Nigeria: A case-study analysis

PLOS Glob Public Health. 2022 Jul 1;2(7):e0000566. doi: 10.1371/journal.pgph.0000566. eCollection 2022.

Authors

Whenayon Simeon Ajisegiri¹, Seye Abimbola^{1

2}, Azeb Gebresilassie Tesema^{1

3}, Olumuyiwa O Odusanya⁴, David Peiris¹, Rohina Joshi^{5

6}

Affiliations

¹ The George Institute for Global Health, University of New South Wales (UNSW), Sydney, Australia.
² School of Public Health, University of Sydney, Sydney, Australia.
³ School of Public Health, Mekelle University, Mekelle, Ethiopia.
⁴ Department of Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja, Nigeria.
⁵ School of Population Health, University of New South Wales (UNSW), Sydney, Australia.
⁶ The George Institute for Global Health, New Delhi, India.

Abstract

As chronic diseases, non-communicable diseases (NCDs) require sustained person-centred and community-based care. Given its direct link to communities and households, Primary Health Care (PHC) is well positioned to achieve such care. In Nigeria, the national government has prioritized PHC system strengthening as a means of achieving national NCD targets. However, strengthening PHC systems for NCDs require re-organization of PHC service delivery, based on contextual understanding of existing facilitators and barriers to PHC service delivery for NCDs. We conducted a mixed method case study to explore NCD service delivery with 13 PHC facilities serving as the cases of interest. The study was conducted in two northern and two southern states in Nigeria-and included qualitative interviews with 25 participants, 13 focus group discussion among 107 participants and direct observation at the 13 PHCs. We found that interprofessional role conflict among healthcare workers, perverse incentives to sustain the functioning of PHC facilities in the face of government under-investment, and the perception of PHC as an inferior health system were major barriers to improved organisation of NCD management. Conversely, the presence of physicians at PHC facilities and involvement of civil society organizations in aiding community linkage were key enablers. These marked differences in performance and capacity between PHC facilities in northern compared to southern states, with those in the south better organised to deliver NCD services. PHC reforms that are tailored to the socio-political and economic variations across Nigeria are needed to improve capacity to address NCDs.

Copyright: © 2022 Ajisegiri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The project was supported by the George Institute for Global Health, Australia through the Seed Grant funds dedicated for under-served populations in LMICs for 2019/2020. The UNSW Scientia Scholarship program supports WSA and AGT. WSA is also supported through the Australian Government Research Training Program Scholarship. SA was supported by the Australian National Health and Medical Research Council (NHMRC) through an Overseas Early Career Fellowship (APP1139631). RJ is supported by the Australian National Heart Foundation (APP 102059) and UNSW Scientia Fellowship. DP is supported by NHMRC career Development Fellowship, Level 2 and Australia National Heart Foundation Future Leader Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.