Primary Health Care Services in Secondary and Tertiary Institutions: The Impacts and Challenges of Community Health Practitioners in the Nigerian Health System

References

[1] W. S. Ajisegiri, S. Abimbola, A. G. Tesema, O. O. Odusanya, D. Peiris, and R. Joshi, “‘We just have to help’: Community health workers' informal task-shifting and task-sharing practices for hypertension and diabetes care in Nigeria,” Frontiers in Public Health, vol. 11, Art. no. 1038062, 2023, doi: 10.3389/fpubh.2023.1038062.

[2] T. N. Anand, L. M. Joseph, A. V. Geetha, D. Prabhakaran, and P. Jeemon, “Task sharing with non-physician health-care workers for management of blood pressure in low-income and middle-income countries: A systematic review and meta-analysis,” The Lancet Global Health, vol. 7, no. 6, pp. e761–e771, 2019.

[3] M. Balogun, B. Akodu, D. Shoemaker, V. Yesufu, A. Onyenwenyi, R. Udeh, C. Ezeaka, O. Ayankogbe, and F. Ogunsola, “A blended curriculum to improve student community health officers’ competencies in newborn infection prevention and control,” Annals of Medicine, vol. 55, no. 1, Art. no. 2205167, 2023, doi: 10.1080/07853890.2023.2205167.

[4] S. Bawa, C. McNab, L. Nkwogu, F. Braka, E. Obinya, M. Galway, A. J. Mirelman, K. I. Hammanyero, G. Safiyanu, M. Chukwuji, et al., “Using the polio programme to deliver primary health care in Nigeria: Implementation research,” Bulletin of the World Health Organization, vol. 97, no. 1, pp. 24–32, 2019, doi: 10.2471/BLT.18.211565.

[5] A. Cockcroft, K. Omer, Y. Gidado, M. C. Baba, A. Aziz, U. Ansari, A. I. Gamawa, Y. Yarima, and N. Andersson, “The impact of universal home visits with pregnant women and their spouses on maternal outcomes: A cluster randomised controlled trial in Bauchi State, Nigeria,” BMJ Global Health, vol. 4, no. 1, Art. no. e001172, 2019, doi: 10.1136/bmjgh-2018-001172.

[6] Community Health Practitioners Registration Board of Nigeria and National Primary Health Care Development Agency, National standing orders for community health extension workers. CHPRBN/NPHCDA, 2024.

[7] E. A. Eboreime, N. Nxumalo, R. Ramaswamy, L. Ibisomi, N. Ihebuzor, and J. Eyles, “Evaluating the sub-national fidelity of national initiatives in decentralized health systems: Integrated primary health care governance in Nigeria,” BMC Health Services Research, vol. 17, Art. no. 758, 2017.

[8] E. A. Eboreime, N. Nxumalo, R. Ramaswamy, L. Ibisomi, N. Ihebuzor, and J. Eyles, “Putting institutions at the center of primary health care reforms: Experience from implementation in three states in Nigeria,” BMC Health Services Research, vol. 19, Art. no. 913, 2019.

[9] E. A. Eboreime, O. Idika, K. Omitiran, O. Eboreime, and L. Ibisomi, “Primary healthcare coordination, bottleneck analysis and performance improvement: An evaluation of processes and outcomes in a Nigerian context,” Evaluation and Program Planning, vol. 77, Art. no. 101712, 2019.

[10] Federal Ministry of Health, Nigeria, National task-shifting and task-sharing policy for essential health care services in Nigeria. Federal Ministry of Health, 2014.

[11] Federal Ministry of Health, Nigeria, National health policy 2016. Federal Ministry of Health, 2016.

[12] Federal Ministry of Health, Nigeria, National task-shifting and task-sharing policy for essential health care services in Nigeria, revised ed. Federal Ministry of Health, 2022.

[13] S. L. Leong, S. L. Teoh, W. H. Fun, and S. W. H. Lee, “Task shifting in primary care to tackle healthcare worker shortages: An umbrella review,” European Journal of General Practice, vol. 27, no. 1, pp. 198–210, 2021, doi: 10.1080/13814788.2021.1954616.

[14] S. Lewin, U. Lehmann, and H. B. Perry, “Community health workers at the start of a new era: 3. Programme governance,” Health Research Policy and Systems, vol. 19, Suppl. 3, Art. no. 129, 2021.

[15] National Primary Health Care Development Agency, Strategic blueprint 2023–2026. NPHCDA, 2024.

[16] National Primary Health Care Development Agency, Basic Health Care Provision Fund (BHCPF). NPHCDA, 2025.

[17] T. I. A. Oseni et al., “The role of community health workers in the management of hypertension in Nigeria: A scoping review,” BMC Public Health, vol. 24, Art. no. 1384, 2024.

[18] World Health Organization, Declaration of Astana. World Health Organization, 2018a.

[19] World Health Organization, WHO guideline on health policy and system support to optimize community health worker programmes. World Health Organization, 2018b.

[20] World Health Organization, Operational system for primary health care: Transforming vision into action. World Health Organization & United Nations Children’s Fund, 2020.

[21] World Health Organization, Building health systems resilience for universal health coverage and health security during the COVID-19 pandemic and beyond: WHO position paper. World Health Organization, 2021.

[22] World Health Organization, Human resources for health: Global strategy on human resources for health: Workforce 2030. World Health Organization, 2022.

[23] World Health Organization, Primary health care on the road to universal health coverage: 2023 monitoring report. World Health Organization, 2023.

[24] World Health Organization, Global patient safety report 2024. World Health Organization, 2024.

[25] World Health Organization and United Nations Children’s Fund, Operational system for primary health care: Transforming vision into action. World Health Organization, 2020.

@article{1723535,
      author = {Aderibigbe, Adewale Hameed, Prof. Bashir Idris, Umar Jibril El-Muqaddas},
      title = {Primary Health Care Services in Secondary and Tertiary Institutions: The Impacts and Challenges of Community Health Practitioners in the Nigerian Health System},
      journal = {Iconic Research And Engineering Journals},
      year = {2026},
      volume = {10},
      number = {3},
      pages = {3703-3709},
      issn = {2456-8880},
      url = {https://www.irejournals.com/formatedpaper/1723535.pdf},
      abstract = {Background: Primary health care (PHC) is the foundation of universal health coverage, but continuity of care depends on effective linkages between community, primary, secondary and tertiary services. In Nigeria, Community Health Practitioners (CHPs) Junior Community Health Extension Workers (JCHEWs), Community Health Extension Workers (CHEWs) and Community Health Officers (CHOs) are primarily deployed within PHC. Their work nevertheless interfaces with secondary and tertiary services through referral, surveillance, health promotion, patient navigation, follow-up and selected task-sharing arrangements.

Objective: This review review analyzes CHP contributions to the continuum of care involving secondary and tertiary institutions, identifies barriers to effective integration, and proposes policy and practice measures for safer and more coordinated utilization.

Methods: Evidence was synthesized from Nigerian regulatory and policy documents and peer-reviewed literature concerning community health workers, task-sharing, referral, PHCUOR, workforce development and PHC integration. Evidence involving the wider community health worker category was distinguished from evidence specifically involving Nigeria's regulated CHP cadres.

Results: CHPs can contribute to referral initiation, community-to-facility linkage, preventive services, chronic disease support, surveillance, health education and post-discharge follow-up. Nigerian evidence also indicates that community health workers sometimes perform duties beyond formal guidance because of service needs, while referral feedback between PHC and higher-level facilities may be weak. International evidence indicates that task-sharing can improve selected outcomes when supported by training, clear roles, coordination, supervision and financing.

Conclusion: CHPs should not be regarded as substitutes for specialist hospital professionals. Their principal system value lies at the interface between communities, PHC facilities and higher levels of care. Harmonized scope-of-practice arrangements, competency-based continuing professional development, two-way referral systems, multidisciplinary governance, supportive supervision and measurable accountability mechanisms are required to integrate CHPs safely into Nigeria's continuum of care.},
      keywords = {Community Health Practitioners; primary health care; Nigeria; task-sharing; referral systems; continuity of care; universal health coverage; health-system strengthening},
      month = {September},
  }