A Systematic Review of Social Franchising Models for Enhancing Quality and Access in Private Primary Healthcare across Nigerian Megacities

This systematic literature review addresses the critical challenge of inadequate quality and access within Nigeria's overstretched primary healthcare system, focusing on the potential of private sector social franchising models in its megacities. The objective was to synthesise evidence from 2021 to 2026 on how these models—where independent private providers are networked under a common brand and standards—impact healthcare delivery in dense urban African contexts. Employing the PRISMA framework, we systematically searched electronic databases including PubMed, Scopus, and African Journals Online, identifying and critically appraising relevant peer-reviewed studies and grey literature. Findings indicate that social franchising can standardise clinical protocols and medicines supply, leading to measurable improvements in service quality for conditions like malaria and hypertension. Furthermore, these networks enhance geographical access for low-income urban populations through strategic placement of franchisees. However, significant barriers persist, including high initial setup costs, variable provider compliance, and regulatory hurdles within the Nigerian health system. The review concludes that while social franchising presents a viable strategy for leveraging the extensive private sector to achieve universal health coverage in Nigerian megacities, its long-term sustainability requires innovative domestic financing, robust performance monitoring, and stronger integration into national health insurance schemes. This evidence provides crucial insights for policymakers and implementers across Africa seeking scalable private-sector engagement models.