Integrated primary health care for chronic diseases in Nigeria: a qualitative analysis of stakeholders’ perspectives on policy frameworks and emerging approaches

Abstract Background and objective Globally, the integration of chronic disease (CD) care into primary health care (PHC) is guided by health policies that aim to enhance the continuity and coordination of care with the goal of providing more holistic, efficient, and person-centred care to people living with CDs. In Nigeria, little information is available regarding the progress of the integrated primary health care (IPHC) concept. The objective of this study is to understand how IPHC for people with CDs is considered in national and regional health policy frameworks in Nigeria as well as to provide insights into current approaches used in IPHC practice in the southeast region of Nigeria. Methods Semistructured face-to-face, written and telephone-based interviews were conducted with 14 stakeholders involved in health policy development at the national, state and local government levels across five states in southeastern Nigeria and the federal capital territory Abuja. The interview data were analysed on the basis of a deductive-inductive qualitative content analysis. Results The findings of this research reveal that although national health policies in Nigeria recognize the value of IPHC for people with CDs, dedicated IPHC policies remain underdeveloped. The stakeholders highlighted existing national and international health policy frameworks that shape IPHC practices but expressed the concern that implementation suffers from weak operational guidance and limited coordination, especially at subnational levels. The currently promising IPHC approaches that were identified mainly included state-, community- and NGO-led programmes. However, these approaches remain regionally and locally concentrated and face challenges in terms of scale and sustainability because of limited policy anchoring as well as gaps between health policy intent and implementation. Conclusion Nigeria appears to lack a formalized, widely dispersed IPHC policy framework that can be used to address the specific needs of people with chronic conditions and achieve universal health coverage. Targeted strategies should focus on the development of cohesive national IPHC policies that can be adapted to diverse regions in Nigeria. Future research on IPHC should include frontline health workers such as nurses and community health workers who provide care on the ground in PHC centres. Understanding their experiences can help bridge the gap between policy visions and implementation in practice.