Aligning national policy with post-elimination reality: a documentary analysis of Nigeria’s trachoma and eye health policy frameworks, 2026

Abstract Background Achieving disease elimination thresholds does not guarantee the long-term sustainability of health-system functions needed to preserve those gains. Nigeria has made substantial progress towards trachoma elimination, with most formerly endemic states achieving WHO elimination thresholds, creating an urgent need to ensure the sustainability of trichiasis (TT) services and post-elimination surveillance. This study assessed whether Nigeria’s national policy architecture supports this transition and identified gaps in institutionalisation. Methods A documentary analysis of six national policy documents spanning NTD programme management, trachoma, eye health, primary health care and health financing was conducted using a six-domain sustainability framework and the Policy Triangle. Provisions were extracted and rated using predefined three-point criteria; 11 of 36 document-domain combinations (30.6%) were independently double-coded (Cohen’s kappa = 0.81). Results All six domains were rated Partial; none met the criteria for Adequate. Disease-specific provisions were concentrated in the National Trachoma Action Plan, while eye-health, PHC, financing and information-system policies supplied potential receiving structures. Surveillance and service delivery showed the clearest transition pathways; governance, financing, workforce succession and commodity continuity showed weaker pathways. Policy content, context and actors were generally identifiable, but processes for transferring, financing and sustaining functions within routine systems were consistently under-specified. Conclusions Nigeria’s policy architecture provides a foundation for sustaining TT services after elimination, but not yet a coherent transition framework. The principal gap lies in institutionalisation and transition processes. Priorities include explicit ownership, costed financing, workforce succession, post-elimination surveillance-response protocols, and secured commodity continuity, specified before programme structures withdraw.