Strengthening older adults’ healthcare reform in Nigeria through policy analysis and lessons from participatory health system innovations in Africa

Nigeria has expanded its policy architecture for ageing, yet older adults continue to face fragmented services, weak financial protection, limited age responsive care, and substantial barriers to healthcare access. This study examined why increasing policy recognition has not translated consistently into implementation and whether participatory health system innovations elsewhere in Africa offer relevant lessons for reform. A desk-based policy analysis was undertaken using Walt and Gilson’s Health Policy Triangle to examine the context, actors, content, and process shaping older adults’ healthcare in Nigeria. Purposively identified legislation, policy documents, institutional reports, and peer reviewed literature were interpreted deductively across the four HPT domains, with particular attention to five major national legislative and policy developments enacted or approved between 2004 and 2022. Comparative evidence from Zimbabwe’s Friendship Bench, South Africa’s older adult peer support model, Ghana’s Community Based Health Planning and Services programme, and Rwanda’s community health worker system was examined for potentially transferable principles rather than models for direct replication. The analysis identified an implementation gap arising from interacting constraints across all four policy domains. Demographic and epidemiological pressures are increasing within a resource constrained health system; institutional responsibilities remain fragmented; older adults and caregivers have limited influence in health governance; and broad policy commitments are not consistently matched by operational provisions for long term care, age responsive primary healthcare, workforce development, financing, monitoring, and accountability. The comparative cases highlighted potentially relevant principles including community participation, task sharing, peer support, integration with primary healthcare, structured supervision, and stronger referral pathways. However, the evidence base is heterogeneous: only some interventions were designed specifically for older adults, and differences in governance, financing, workforce capacity, and health system organisation constrain direct transferability. Strengthening older adults’ healthcare in Nigeria therefore requires greater attention to implementation rather than additional policy commitments alone. Reform should strengthen coordination, financial protection, age disaggregated monitoring, meaningful participation, and integration of community-based approaches within existing health system structures. Comparative innovations should be contextually adapted and evaluated through phased implementation before wider scale up.