Socio-Cultural Political Model Evaluating Primary Health Care Policy in Nigeria

Background: Primary Health Care (PHC) is a fundamental component of global health systems, designed to ensure universal health coverage and equitable access to care. However, in low- and middle-income countries such as Nigeria, the effective implementation of PHC policies is often undermined by complex socio-cultural and political dynamics. Despite ongoing reforms and policy initiatives, a significant gap persists between policy development and community-level implementation. Aim and Objectives: The aims are to explore the lived experiences of PHC coordinators regarding policy implementation; identify socio-cultural and political barriers affecting PHC delivery, and to develop a holistic model integrating socio-cultural and political dimensions for evaluating PHC policy implementation. Materials and Methods: An exploratory-descriptive qualitative design was employed. Twenty PHC coordinators were selected through purposive sampling. Data were collected with the use of in-depth interviews and were analysed thematically to generate insights into barriers and enablers of PHC policy implementation. Results: Thematic analysis revealed multiple barriers to effective PHC implementation. Political interference emerged as a major challenge, with disruptions from political actors hindering program continuity and leading to abrupt policy changes. Another key finding was the lack of community engagement, as participants highlighted that excluding local stakeholders weakened policy relevance and effectiveness. These findings reflect a disconnect between top-down policy approaches and grassroots health system realities. Conclusion: The study developed the Socio-Cultural Political Model (SCPM), which integrates five interrelated dimensions, economic, political, educational, social, and cultural, to provide a holistic framework for evaluating PHC policy implementation. Adoption of the SCPM in health policy planning and evaluation can foster sustainable, context-sensitive, and community-driven PHC outcomes in Nigeria.