Comprehensive in Name, Selective in Practice: A Policy-Implementation Gap Analysis of Primary Health Care Service Delivery in Federal Capital Territory, Abuja, Nigeria

Nigeria's adoption of the Comprehensive Primary Health Care (CPHC) framework at Alma-Ata (1978) committed the country to a universal, equitable package of integrated health services at the community level. The National Primary Health Care Development Agency (NPHCDA) subsequently codified this commitment into minimum service standards mandating delivery of fifteen discrete PHC components across all facility types. Despite this comprehensive policy architecture, persistent gaps between policy mandate and service reality raise fundamental questions about implementation fidelity and governance quality. This study applies a policy-implementation gap framework to secondary data from a cross-sectional appraisal of 642 health workers across six Area Councils of the Federal Capital Territory (FCT), Abuja, Nigeria. Drawing on Pressman and Wildavsky's (1973) implementation gap theory, Rosenbloom's (2015) Trialectic of Public Administration, and Grindle's (1980) context of implementation, the study develops an original Service Gap Index (SGI) to categorize and explain differential implementation outcomes across all fifteen mandated PHC services. Results reveal a pronounced and systematic implementation gradient: eight services mandated by NPHCDA achieve near-full implementation (>90%), while mental health care (23.7%) and care of the elderly (43.0%) exhibit critical gaps of 76.3 and 57.0 percentage points respectively. The study argues that this gradient is not random but follows an institutional logic in which quantifiable, politically visible, and KPI-tracked services attract disproportionate managerial and political attention, while non-quantifiable and stigmatized services are systematically neglected. This constitutes a de facto reversion to Selective PHC despite official commitment to comprehensiveness. Policy recommendations center on revised performance management frameworks, dedicated budget lines for neglected services, and strengthened accountability mechanisms aligned with New Public Governance principles.