A decade after the implementation of primary healthcare under one roof: policy evaluation and recommendations for integrated quality healthcare delivery in Nigeria

This study sought to evaluate the progress made over a decade of implementing the Primary Healthcare Under One Roof (PHCUOR) policy in Nigeria. A longitudinal study design using predefined scorecard was used. The scorecards are Scorecard 2 (2014) to Scorecard 6 (2022); Scorecard 1 (2012), corresponding to the programme’s inaugural year, was unavailable and therefore excluded. Data on state scores across the thirty-six states and the Federal Capital Territory were extracted and recorded. The primary outcome was the cumulative national progress achieved over the study period, while the secondary outcome assessed performance across each of the nine PHCUOR pillars. A Linear Mixed-Effects Model (LMEM) was used to evaluate overall policy progress. At the same time, the K-nearest neighbour (KNN) machine learning algorithm was applied to cluster states into three performance categories. Analyses were conducted in Python version 3 via Google Colab. The mean progress coefficient for PHCUOR implementation across the nation was 56.4 ± 26.8. Despite a statistically significant overall improvement ( P < 0.05) from baseline (Scorecard 2) to endline (Scorecard 6), substantial variation was observed across the nine pillars. Progress coefficients, from lowest to highest, were: Legislation (3.999), Office Set-up (5.599), Governance and Ownership (8.199), Minimum Service Package (8.599), Operational Guideline (11.199), System Development (11.699), Repositioning (12.499), Funding Sources (14.599), and Human Resources (16.799). While some states are struggling to meet implementation targets, others are excelling. Underperforming states need to prioritise legislative enactment and office set-up as critical enablers of improved access to quality healthcare and better health outcomes in Nigeria. Clinical trial registration: Not applicable.