A governance framework for transitioning vertical donor programmes into integrated primary health care in Nigeria

Donor-funded vertical health programmes have contributed substantially to Nigeria’s HIV, tuberculosis (TB) and immunisation responses, while also supporting laboratory capacity, supply systems, workforce development and health information functions. As external financing and programme-specific delivery arrangements evolve, a central policy challenge is how to retain these institutional gains within routine primary health care (PHC) systems. We conducted a narrative policy analysis of publicly available secondary data, policy documents, programme reports and peer-reviewed literature on donor transition, health-system integration and governance in Nigeria. Sources were purposively selected for direct relevance to Nigeria or transferable experience in comparable settings. The analysis identified recurring gaps in domestic institutional ownership across financing, data, workforce, supply-chain and accountability functions. These domains were synthesised into the Structured Integration Transition Model (SITM), a conceptual governance framework comprising five interdependent pillars: Financing Convergence, Data Harmonization, Workforce Realignment, Supply Chain Consolidation and Governance Accountability. Nigerian examples were used to illustrate partial alignment with these domains, not to validate SITM effectiveness. The framework also proposes preliminary measurable indicators to support transition monitoring and future empirical testing. SITM reframes donor transition as an institutional absorption process rather than only a financing or service-continuity problem. Future research should refine the indicators, apply the framework prospectively and assess whether stronger institutional integration is associated with sustained service coverage and health-system performance.