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

Socio-Cultural Political Model Evaluating Primary Health Care Policy in Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Socio-Cultural Political Model Evaluating Primary Health Care Policy in Nigeria Olunike Blessing Olofinbiyi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7000109/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Primary Health Care (PHC) is a cornerstone of global health systems, aimed at ensuring universal health coverage and equitable access to care. In low- and middle-income countries such as Nigeria, the effective implementation of PHC policies continues to face significant challenges, largely due to complex socio-cultural and political dynamics. Despite numerous reforms and policy initiatives, gaps remain in translating these policies into practice at the community level. In Ekiti State, Nigeria, contextual issues, such as political interference and cultural misalignment, have hindered successful implementation. This study was therefore undertaken to develop a Socio-Cultural Political Model (SCPM) for evaluating PHC policy implementation, focusing on the lived experiences of PHC coordinators. Methods An exploratory-descriptive qualitative design was employed to enable an in-depth understanding of the experiences and perceptions of PHC Coordinators in Ekiti State. A purposive sampling technique was used to select twenty PHC Coordinators, based on predefined inclusion criteria. Data were collected using a structured interview guide, and the interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Ethical considerations, including informed consent, confidentiality, and voluntary participation, were strictly adhered to throughout the research process. Results Thematic analysis of the data revealed several recurring issues that significantly hinder the effective implementation of Primary Health Care (PHC) policy. One major theme was political interference, as frequent disruptions by political actors were reported to impede program continuity, reduce accountability, and often lead to abrupt policy shifts unrelated to community needs. Another key issue was the lack of community engagement. Policymakers were frequently criticized for excluding local stakeholders from the planning and execution of PHC initiatives, which resulted in poor community buy-in and weakened the impact of health interventions. Cultural misalignment also emerged as a critical factor. Participants observed that many PHC policies did not sufficiently consider traditional beliefs, customs, and social norms, which contributed to resistance, misunderstanding, and non-compliance within communities. Additionally, the study highlighted a persistent problem of inadequate situational evaluation. Policies were often developed and implemented without real-time, context-specific assessments, leading to poorly adapted interventions that failed to address local realities effectively. Overall, participants emphasized that PHC policies tend to follow a top-down approach, disconnected from the grassroots. This lack of community involvement and contextual relevance undermines community ownership and contributes to poor implementation outcomes. Conclusion The study highlights the pressing need for context-sensitive, community-informed approaches in the development and evaluation of PHC policies. The proposed Socio-Cultural Political Model (SCPM) integrates five interdependent dimensions: economic, political, educational, social, and cultural factors. This model provides a comprehensive framework for assessing the relevance, responsiveness, and effectiveness of PHC policies. By adopting the SCPM, policymakers and health authorities can enhance stakeholder participation, improve the cultural and political adaptability of health policies, and strengthen the overall performance of PHC systems. The study recommends the integration of SCPM into future health policy development and evaluation processes to promote sustainable and inclusive health outcomes in Nigeria. Health Policy Health policy Health promotion Model Prevention Primary health care Figures Figure 1 Figure 2 What do we already know about this topic? There is a partially implemented Primary Health Care Policy There are policymakers who were appointed to analyse the Primary Health Care Policy. How does your research contribute to the field? This paper establishes the proper way of analysing Primary Health Care Development of a socio-cultural political model to analyse Primary Health Care Policy. What are your research’s implications for theory, practice, or policy? The Primary health care Coordinators need to reconstitute the PHC policy makers. The Primary Health Care Policy should be analysed once in two years Introduction A health policy is needed to make plans, decide, and take actions to achieve specific health care goals within a society. Recently, there have been several health policies being evaluated, and some have been restructured to achieve quality health for all [1]. The World Health Organisation provides the building blocks for the establishment of health care systems and these building blocks are structured around the six core components of a health care system, to strengthen the primary health care aspect of the system [2]. However, some health systems are not as effective as they should be, hence the evaluation and restructure of some, as mentioned. This study proposes the Socio-Cultural Model based on the Health Policy Triangular Framework, for use in the evaluation of the PHC in Nigeria. The health policies in high-income countries are different from those in middle- and low-income countries [3]. However, another study argues that despite the differences between high- and low-income countries, their PHC policies are all changing all the time, but especially when there is an epidemic or pandemic. Unfortunately, many low- and middle-income countries are faced with weak health systems, and this usually impedes the progress of their PHC policies. In addition, the key challenges to public health in most low middle-income countries are poverty and corruption, while the biggest enemy of the health care system in the developing world is poverty [4]. Therefore, this study will be of great help to the Nigerian health care system and to other nations at large. More specifically, the findings of this study may be used to update the health policies that are fundamental to the improvement of health care delivery to patients and to reduce morbidity and mortality rates across various countries. The evaluation of health policies is a complex process, and it is usually influenced by a variety of scientific, economic, social, and political forces. However, there is always a considerable gap between the evaluation of health policies and the formulation of new health policies [5]. This study will help in improving the active involvement of community members in the implementation and evaluation of a PHC policy. Conceptual Framework The conceptual framework for this study was based on the evaluation of a health policy, a crucial aspect of the change, formation, reformation, and evaluation of health policies in low middle-income countries. The evaluation of a health policy is a critical mechanism for ensuring best practices, considering new evidence and the promotion of good health. The Health Policy Triangle (HPT) framework was applied as the conceptual framework in this study. The framework was developed by Walt and Gilson [6], and this approach helped the researcher to have a better understanding of the study. Methodology The study adopted an exploratory-descriptive qualitative design, which allowed the researchers to gain a deep understanding of PHC Coordinators’ experiences with the implementation of primary health care policy. This design was particularly suitable for capturing participants’ narratives, which formed the basis for developing the Socio-Cultural Political Model (SCPM). The model was designed to evaluate PHC policy within its broader social, political, and cultural context. To analyze the qualitative data obtained from in-depth interviews, the study employed thematic analysis, a method used to identify, interpret, and organize patterns (themes) across the data. This analytical approach was selected for its flexibility and effectiveness in examining the complex interplay of socio-political and cultural factors influencing health policy implementation. Setting The study was conducted among PHC coordinators at Ado-Ekiti Primary Health Care Centers. Ado-Ekiti is one of the sixteen local governments in Ekiti State in Nigeria (see Fig. 1 ). Ado-Ekiti is the state capital of Ekiti State, and this state capital consists of Forty-eight PHC Centres. The study purposively selected the coordinators of the most equipped twenty PHC Centres that are familiar with the objectives of the Primary Health Care Policy in Ado-Ekiti. The PHC Centres are guided and overseen by the Ado-Ekiti local government, and their main duties are to provide primary health care services to the people within the community and to refer the complicated medical conditions to the nearest secondary hospitals. Patients using these facilities present with several medical conditions, while some bring their children for immunizations and some patients come for antenatal care as well. Figure 1 diagrammatically represent the map of Ekiti state showing the sixteen local governments and other states that form the boundaries, while the red star showed the location of the study which is Ado-Ekiti. Ekiti State is situated entirely within the tropics. It is located between longitudes 40°51′ and 50°451′ East of the Greenwich meridian and latitudes 70°151′ and 80°51′ north of the Equator. It lies south of Kwara and Kogi State, Osun State and bounded by Ondo State in the East and in the south, with a total land Area of 5887.890sq km. Ekiti State has 16 Local Government Councils. Study Population Ado-Ekiti currently has 48 Primary Health Care Centres (PHCCs), each managed by a designated PHC coordinator. This means the total number of PHC coordinators in the area is 48, representing the full population of potential participants for the qualitative component of the study. To ensure consistency and relevance, the following inclusion criteria were used to select eligible PHCCs: The centre must have a minimum of 15 beds, employ at least 15 PHC workers, be well-equipped, and have implemented the 2016 National Health Policy on Primary Health Care Service Delivery in Nigeria since 2017 Applying these criteria, 20 PHCCs were purposively selected from the population of 48. Consequently, 20 PHC coordinators, one from each selected center, were recruited to participate in the qualitative interviews. This means the interviewees represent approximately 41.7% of the total PHC coordinator population in Ado-Ekiti (20 out of 48). All 20 selected coordinators were approached and consented to participate, resulting in a 100% response rate for the qualitative component. Sampling and Participants Purposive sampling was employed to select the twenty PHC Coordinators meeting the inclusion criteria of (i) the PHC coordinators in one of the twenty selected PHCCs in Ado-Ekiti, (ii) PHC coordinators who are willing to participate in the study, (iii) the PHC coordinators with at least ten or more years of work experience (iv) the PHC coordinators overseeing a well-equipped PHC Centre located in Ado-Ekiti. Twenty PHC Coordinators participated in the study. Ethical Considerations A fully approved ethical clearance letter with the protocol number of HSSREC/00002401/2021 was obtained from the University of KwaZulu-Natal’s Research Ethics Committee before obtaining data from the respondents. The Gatekeeper’s Permission letter from the Ado-Ekiti Local Government Area and the ethical clearance certificate from the university were submitted to the health centres’ coordinators and heads as part of securing permission to use the health centres selected as the study locations and to secure access to the health workers in the designated health centres. The coordinators of the 20 PHCCs were also given prior notification before conducting the study. The participants were made to understand that their participation was strictly voluntary, and that their information would be handled confidentially. A two-page participation information document was administered to the Participants and the purpose of the research was explained in details. They also signed before answering the questions. Before the data collection processes, the researcher instructed the Participants not to print their names on the questionnaires and not to mention their names while their responses were recorded. The respondents were made to understand that participation was voluntary and that they had the right to renegotiate their consent during the research process or to ignore any question without giving an explanation, and they could withdraw from the study at any point if they felt the need to do so. The participants signed the consent forms and they all agreed to publish the findings for global utilization. Validity of the Study The validity of this study was ensured through a rigorous approach grounded in the principles of trustworthiness, including credibility, transferability, dependability, and confirmability (Cypress, 2017). Credibility was strengthened through prolonged engagement, member checking, participant debriefing, and referral adequacy. Participants reviewed their interview transcripts to confirm that their experiences were accurately represented, and any concerns were addressed. Their feedback informed both the analysis and the development of the Socio-Cultural Political Model. Transferability was supported by providing rich, contextual descriptions of the research setting and incorporating literature and media sources to validate findings. The mixed-method approach and participant-derived recommendations enhance the potential for applying the findings to similar contexts beyond Ekiti State. Dependability was addressed through transparent documentation of the data collection and analysis process, including regular discussions with participants and the pilot study. Consistent themes, such as the negative influence of political actors, emerged and were validated across multiple sources. Confirmability was ensured through detailed field notes, ongoing self-reflection (reflexivity), and oversight by a research supervisor. Data and interpretations were derived from participant input rather than researcher bias. Participants also confirmed that the study’s conclusions accurately reflected their lived realities of the 2016 PHC policy. In summary, the study demonstrates strong methodological and ethical rigor, and the findings offer a credible and contextually grounded contribution to PHC policy evaluation in Nigeria. The developed model is both theoretically sound and practically relevant, with potential for adoption in similar socio-political environments. Data Analysis and Validation The qualitative data gathered from in-depth interviews with the 20 PHC coordinators were analyzed using a thematic analysis approach. This process involved systematically coding the transcripts to identify recurrent patterns, categories, and themes that aligned with the study's objectives, particularly the socio-cultural and political influences on PHC policy implementation. To ensure rigor and minimize researcher bias, a second independent analyst was engaged in the coding and theme development process. This analyst, who was not part of the original data collection team, independently reviewed the interview transcripts and developed a parallel coding framework. The primary researcher and the second analyst then compared their coding structures and resolved discrepancies through discussion, resulting in a consensus on the final themes. This inter-coder agreement strengthened the credibility and dependability of the findings. Further, member checking was conducted with the original cohort of 20 PHC coordinators. Participants were provided with summaries of the analyzed data and emerging themes to verify whether their perspectives were accurately captured. This process allowed for clarification, correction, or expansion of interpretations, reinforcing the confirmability of the study. Additionally, the findings and the developed Socio-Cultural Political Model (SCPM) were shared with external stakeholders, including health policy experts, PHC supervisors, and academic peers. Feedback from these stakeholders was incorporated into the model refinement process, thereby enhancing its practical relevance, theoretical robustness, and transferability to similar policy contexts in other regions. Through this multi-step validation process, comprising independent analysis, participant verification, and external expert review, the study ensured that the conclusions drawn were well-grounded, transparent, and reflective of the real-world conditions influencing PHC policy in Ado-Ekiti. Results Theme 1: Awareness of the 2016 National Health Policy (NHP) Most participants demonstrated a general awareness of the 2016 NHP, especially its intended relevance to Primary Health Care (PHC). However, this awareness varied in depth. “The 2016 National Health Policy is a more advanced policy, with many benefits to PHC.” (P11, Female) “I know that the 2016 National Health Policy is still the current health policy we are using in Nigeria... it is a very good and well-designed health policy, but with a poor implementation method.” (P20, Female) Theme 2: Perceived Advantages of the NHP to PHC While participants generally acknowledged that the NHP was designed to support PHC, many doubted its practical benefits due to poor implementation. “The policy is a modern policy, but I am yet to see its effectiveness.” (P13, Female) “It is filled with so many benefits, be it at the federal level, state, and local government level.” (P4, Female) Theme 3: Lack of Evaluation and Policy Monitoring A prominent concern was the absence of effective evaluation mechanisms for PHC delivery by policymakers. “They do not analyse or evaluate any policy.” (P5, Nurse, Female) “I have not heard anything like that among our policymakers in Nigeria. All they know is how to design new policies, because that is where they can have access to the national cake.” (P6, Nutritionist, Female) Theme 4: Views on Developing a New Health Policy There was a strong consensus that instead of drafting a new policy, the current one should be fully analyzed and implemented. “Let us analyse the designed one before talking of a new one.” (P15, Female) “No! No! No! And capital NO! Because that is a waste of time.” (P8, Nurse, Male) Theme 5: Cultural Barriers to Policy Implementation Participants highlighted that certain traditional beliefs and superstitions act as barriers to PHC implementation. “Some superstitions, like do not eat okro during pregnancy, and some others can impede the teachings of the health care workers.” (P10, Male) “People’s beliefs and patterns of their behaviour are great cultural factors that can impede the implementation of PHC.” (P1, Female) Theme 6: Socio-Economic Influences on PHC Policy Poverty, lack of education, and political interference were the most cited socio-economic challenges. “Poverty is one of the major factors.” (P12, Female) “Politics is the major factor influencing the effective implementation of PHC policy.” (P2, Female) “I think poverty, lack of proper education, and some local policies.” (P19, Feale). The findings indicate that while the 2016 NHP is widely recognized and theoretically beneficial, its implementation is marred by a lack of evaluation, cultural resistance, and socio-economic challenges. Participants strongly advocated for reinforcing the existing policy through proper monitoring rather than introducing new frameworks. Development of the Model An in-depth interview was used to generate the data for this study. The Socio-Cultural Political Model (SCPM) was developed from the findings obtained from the data obtained through an interview guide. This study aimed to develop a model that can be used to develop, implement, and evaluate PHC policy. This was because such a model will help policymakers to design and implement a more effective policy. The participants were required to identify the factors that had been impeding the effectiveness of the existing well-designed primary health care policy (PHCP), and an open-ended interview guide was used to solicit the information. This was done to ensure global acceptability and adoption of the research findings. The study passed through four steps or stages. Step one emphasised the need for the study to evaluate the PHC policy. In step two, the in-depth interviews were conducted among the PHCC coordinators, and the qualitative data were obtained from a total of 20 such coordinators. It was revealed that politicians were the ones influencing the health policies. The notion of ‘political will' was introduced in the Alma-Ata policy document on primary health care, which formally acknowledged the role of politics in health policy [7]. Added to the strong influence of politics on socio-economic development, there had also been policy inconsistency with each successive political administration, each distinguished by new policies which were often incongruous with those of the previous administrations [8]. Another study also argued that the changing political economy had had a negative influence on the primary health care policies in the country [9]. In step three, the Socio-Cultural Political Model (SCPM) was developed from the data through the collaborative efforts of the researcher and the supervisor, and by using additional intellectual materials. The model was developed and then validated by the supervisor and the members of the research team, using the interview guide. This was done a month after the initial research, at a separate primary health care centre in the South-Western part of Nigeria. In step four, the study utilised four research assistants (RAs) and these RAs were Master’s Students at Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria. In addition, the researcher, the supervisor, and other members of the research team collaborated on implementing the Socio-Cultural Politically Influenced Model (SCPM). Model Assumptions For the model to be fully accepted in this kind of context, four assumptions were established: A- Acceptability The model believed that a health policy should be designed in a way that the community would embrace it. The model established that the community had to be effective actors (policy makers). A- Accessibility The health policy was a kind of advanced guideline in the form of information, and it had to be well publicised so that the concerned bodies and the lowest person in the community would be aware of the health policy and how and when it was implemented. All the materials and resources needed for the smooth implementation of the health policy had to be easily accessible. R- Reinforcing : The implementation of the health policy had to be guided and supervised strictly and thoroughly. E- Evaluation The health policy implemented needed to be evaluated regularly to establish whether the set goals had been achieved or not. Description of the Model The Socio-Cultural Political Model (SCPM) identified five major components, namely local social, educational, cultural, economic, and political components that needed to be integrated fully into any primary health policy while it was being designed and then implemented. These components had to be incorporated in order for the policy to be successful in terms of acceptability, accessibility, reinforcement and enabling full evaluation. The Socio-Cultural Political Model was based on the Health Policy Triangle framework, which emphasized the four elements of context (why did you want to evaluate this policy?); content (what was the existing policy primarily about?); process (how was the existing policy brought forward and implemented?); and actors (who participated in and influenced the formulation and implementation of the existing policy?) [9]. The main limitation of this framework was its inability to juxtapose the influence of the society, the economy, the culture, and the local politics on the development and implementation of a primary health care policy. The Socio-Cultural Political Model (SCPM) instead expatiated more on how the local society, economy, culture, and politics were essential in the formulation and implementation of a primary health care policy, and indeed any other policy. This model stressed that the possibility of any particular policy achieving all of its set goals depended more on the accountability and transparency of the government. Situational Analysis As shown in Fig. 1 above, before policy makers could start the development of a PHC policy for any community or country, they first had to do a thorough situational evaluation. So, what is a situational evaluation? According to the World Health Organization, a situational evaluation is an assessment of the current health situation that is fundamental to designing and updating national policies, strategies, and plans [10]. The situational evaluation of the health sector could begin as a once-off activity, but parts of the evaluation could be updated and revisited on a regular basis for programming and monitoring purposes. This was what the SCPI model stressed; that the first step to be taken when looking at a health policy was a situational evaluation of the policy. Policymaking was recognized as a complex process that had to be guided clearly by scientific knowledge and experts’ views. Figure 2 represents the socio-cultural model’s and the diagram explains further that the cultural, social, educational, economic, and political factors need to be considered while evaluating the health policy. Discussion of Findings This study revealed that the success of Primary Health Care (PHC) policy implementation in Nigeria is highly dependent on a comprehensive understanding of the socio-cultural, political, economic, and educational contexts of the communities being served. A recurring theme from participants was the centrality of community participation. As one participant explained, “Community partnership and participation are essential to secure a successful PHC, because the local people’s ideas are indispensable in decision-making and on how to improve the PHC service delivery” (P16, female). Participants consistently argued that external input from international organisations was less impactful compared to community-generated information. “No amount of information from the global sphere (such as WHO, USAID, UNICEF) can help us improve our PHC, but information drawn from the local community is fundamental to PHC development” (P12, female). This view is reinforced by literature, which states that situational evaluation is a fundamental prerequisite in designing effective PHC policies, as it enables full community participation and involvement [11]. However, despite its importance, situational evaluation is often overlooked due to the high financial costs involved [12]. According to the Health Policy Triangle framework [13], three contextual factors influence policy outcomes: situational, structural, and cultural. Participants demonstrated clear awareness of these layers. For instance, P12 stressed that “It is through the information obtained from the community members that a situational evaluation of the community will be done” , highlighting the practical use of local knowledge. Similarly, the structural challenges, such as political systems and economic constraints, were frequently mentioned, alongside cultural values that shaped health behaviour. The cultural dimension was particularly impactful. As P16 shared, “Self-care, morals, traditions, and norms have a high effect on any policy. For instance, we do not eat okra and snails during pregnancy, and research has shown that these food items are rich in iron. But up to date, we do not eat them because we believe our children will be salivating excessively.” This illustrates how local traditions—if not considered during policy formulation—can undermine well-intentioned health initiatives. Literature supports this by arguing that the absence of cultural integration can result in the rejection of policies, regardless of the resources invested [14]. Culture also influences how problems are perceived, the objectives of policy actors, and the power dynamics that shape decision-making [15,16]. The social component also emerged strongly. One participant (P8, nurse, male) noted, “Society is so powerful that it can accept or reject it [the policy] at any given time. For example, well-to-do members of society, philanthropists, and NGOs may volunteer to assist in the financing of the PHC centres.” This illustrates how community engagement goes beyond consultation to include resource mobilisation. The WHO emphasises PHC as a people-centred strategy critical to broader social and economic development [17]. Thus, society’s involvement is not optional—it is foundational. Similarly, education was recognised as a major enabler or barrier to effective PHC policy. Participants observed that recruitment practices within the Ministry of Health were sometimes flawed. P13 (nurse, female) explained: “Sometimes the Human Resources Department in the Ministry of Health is biased in the recruitment exercise, considering candidates with poor educational qualifications… This corruption is eating up every sector in this country.” Poorly educated health workers hinder both policy implementation and community awareness. A participant (P10, nurse, female) further emphasised: “Education is the most powerful weapon which you can use to change the world... No country can develop unless its citizens are educated.” Supporting studies confirm that without educated health workers and informed citizens, PHC policy remains ineffective [19]. The economic environment also posed a significant barrier. Respondents widely believed that economic mismanagement is crippling PHC delivery. “Corruption and embezzlement of health funds, and the lack of accountability and transparency in PHC are the main reason for the present crippled status of the PHC services in Nigeria” (P11, nurse, male). The ability to fund and sustain health policy is tied to national economic strength. Without financial commitment and transparency, policies remain unexecuted [20,21]. Lastly, politics was overwhelmingly identified as the most dominant and obstructive influence on PHC policy. As P16 (female) stated, “Currently in Nigeria, politics is the major factor influencing the progress of the PHC policy. However, many politicians are filled with the habit of corruption and embezzlement.” Participants echoed the view that political instability and regime changes have led to inconsistent and often incompatible policies. One remarked, “Besides the various national development plans that have been implemented, the country has witnessed a plethora of developmental policies and strategies” (P16, female), yet few of these policies have translated into sustainable change [22,23]. Supporting studies concur that Nigeria’s PHC policy suffers from poor implementation due to political interference and lack of continuity [24,25]. According to the model illustrated in Fig. 1 , political factors influence all other domains, economic, educational, cultural, and social, and exert a direct impact on PHC service delivery. In summary, this study’s findings affirm that contextualizing PHC policy within the realities of the target community is indispensable. Socio-cultural alignment, community participation, economic stability, educational capacity, and political integrity are all prerequisites for achieving effective and sustainable PHC in Nigeria. Failure to incorporate these components will continue to impede the goal of universal health coverage. Conclusion This study introduced the Socio-Cultural Political Model (SCPM), a framework developed to evaluate the implementation of Primary Health Care (PHC) policy in Nigeria. The model is grounded in five key dimensions: economic, political, educational, social, and cultural factors. Among these, political influences emerged as the most dominant, as illustrated in Fig. 2. The Health Policy Triangle framework served as the foundation for this analysis, effectively guiding the exploration of these contextual elements that shape PHC outcomes, particularly in low- and middle-income countries. The SCPM holds substantial practical value at both the local and national levels. Locally, it offers a context-sensitive, community-based approach that policymakers in Ado-Ekiti and similar regions can utilize to strengthen the planning, execution, and assessment of PHC services. By addressing the realities of the local socio-cultural, economic, and political environment, the model fosters more inclusive, accessible, and sustainable health initiatives. At the national level, the SCPM presents a flexible and scalable tool for reviewing and refining PHC policies across Nigeria. In light of ongoing issues such as policy discontinuity, political influence, and insufficient community involvement, the model equips government agencies with a practical framework for creating more coherent, participatory, and contextually appropriate health policies. Its adoption can support improved stakeholder collaboration, greater policy stability, and better health system performance, ultimately contributing to the nation’s progress toward achieving Universal Health Coverage. Recommendations There is a need for the PHCC coordinators to be highly sensitive to corruption and embezzlement in the primary health care settings. There is a need for the active involvement of community members in the development, implementation, and evaluation of PHC policies. A newly developed primary health care policy should be well publicised before implementing it. This will give the community members full knowledge of the policy and they will then accept the policy more readily. Declarations "I, Olunike Blessing Olofinbiyi, declare that this research paper is my original work, and to the best of my knowledge, contains no material previously published elsewhere, except where duly acknowledged. All sources used have been properly cited, and I take full responsibility for the accuracy of the information presented herein." Availability of data and materials All data underlying the results are available as part of the article. Competing Interests The author declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article. Fundings This study was not funded by any organisation and was fully supported by the researcher. Author’s Contribution The model was developed and implemented by OBO. Acknowledgement The researcher gratefully acknowledges the invaluable guidance and mentorship of Professor Sogo Angel Olofinbiyi, whose support greatly contributed to the successful completion of this study. 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Olofinbiyi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYDACdgaGDwkMB3gYmBkYDzAwSBgwsDcAhQ0scGsBqpwB1cIA0cJzAKRFAr8WsGIGCGnAIJEAYuPWws/MfLDh4Y47MgbHmQ8c5t1hYcwv+fzqhh8FEgz87d0J2LRINrMlNiSeecZjcJgt4TDvGQkzydk5ZTd7gA6TOHN2AzYtBod5zB8kth0GagEi3jYJG4PbOWk3eIBaDCRycWkxbEDRYn/zTNrNP6RoMTOQYD92G58tEL+0PeORBPrl4Nw2CWOJMzlst2UMJHhw+YWfvflg48+2O/Z85w8ffPC2rc6wv/34s5tv/tjI8bf3YtUCBwoH4EweAzCJVzkIyDfAmewPCKoeBaNgFIyCEQUAj0JlmvSjFR0AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-2484-9098","institution":"Montana Technological University","correspondingAuthor":true,"prefix":"","firstName":"Olunike","middleName":"Blessing","lastName":"Olofinbiyi","suffix":""}],"badges":[],"createdAt":"2025-06-29 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(2019)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7000109/v1/81d194bd350bb6c22dba47d1.jpg"},{"id":85924753,"identity":"04d1650c-a5a0-400b-82bd-8f19fe035645","added_by":"auto","created_at":"2025-07-03 08:29:10","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39415,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDiagram of the Socio-Cultural Political Model (SCPM)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7000109/v1/9bedc2df9cee083750301ab2.jpg"},{"id":85926818,"identity":"bddc7e3e-cd2b-4391-8cc8-b050f387a4f4","added_by":"auto","created_at":"2025-07-03 08:45:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":883803,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7000109/v1/23f70383-01a0-4b35-8cd2-828f93d6bedc.pdf"},{"id":85924752,"identity":"b11a1ae1-f606-49c3-9680-2ec38f29adfa","added_by":"auto","created_at":"2025-07-03 08:29:10","extension":"odt","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":25832,"visible":true,"origin":"","legend":"","description":"","filename":"REBUTTALFORM.odt","url":"https://assets-eu.researchsquare.com/files/rs-7000109/v1/a9c6f09ad98712298f6a8678.odt"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSocio-Cultural Political Model Evaluating Primary Health Care Policy in Nigeria\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"What do we already know about this topic?","content":"\u003cul\u003e\n \u003cli\u003eThere is a partially implemented Primary Health Care Policy\u003c/li\u003e\n \u003cli\u003eThere are policymakers who were appointed to analyse the Primary Health Care Policy.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eHow does your research contribute to the field?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThis paper establishes the proper way of analysing Primary Health Care\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDevelopment of a socio-cultural political model to analyse Primary Health Care Policy.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eWhat are your research\u0026rsquo;s implications for theory, practice, or policy?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe Primary health care Coordinators need to reconstitute the PHC policy makers.\u003c/li\u003e\n \u003cli\u003eThe Primary Health Care Policy should be analysed once in two years\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eA health policy is needed to make plans, decide, and take actions to achieve specific health care goals within a society. Recently, there have been several health policies being evaluated, and some have been restructured to achieve quality health for all [1]. The World Health Organisation provides the building blocks for the establishment of health care systems and these building blocks are structured around the six core components of a health care system, to strengthen the primary health care aspect of the system [2]. However, some health systems are not as effective as they should be, hence the evaluation and restructure of some, as mentioned. This study proposes the Socio-Cultural Model based on the Health Policy Triangular Framework, for use in the evaluation of the PHC in Nigeria.\u003c/p\u003e \u003cp\u003eThe health policies in high-income countries are different from those in middle- and low-income countries [3]. However, another study argues that despite the differences between high- and low-income countries, their PHC policies are all changing all the time, but especially when there is an epidemic or pandemic. Unfortunately, many low- and middle-income countries are faced with weak health systems, and this usually impedes the progress of their PHC policies. In addition, the key challenges to public health in most low middle-income countries are poverty and corruption, while the biggest enemy of the health care system in the developing world is poverty [4].\u003c/p\u003e \u003cp\u003eTherefore, this study will be of great help to the Nigerian health care system and to other nations at large. More specifically, the findings of this study may be used to update the health policies that are fundamental to the improvement of health care delivery to patients and to reduce morbidity and mortality rates across various countries.\u003c/p\u003e \u003cp\u003eThe evaluation of health policies is a complex process, and it is usually influenced by a variety of scientific, economic, social, and political forces. However, there is always a considerable gap between the evaluation of health policies and the formulation of new health policies [5]. This study will help in improving the active involvement of community members in the implementation and evaluation of a PHC policy.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \n\u003ch3\u003eConceptual Framework\u003c/h3\u003e\n\u003cp\u003eThe conceptual framework for this study was based on the evaluation of a health policy, a crucial aspect of the change, formation, reformation, and evaluation of health policies in low middle-income countries. The evaluation of a health policy is a critical mechanism for ensuring best practices, considering new evidence and the promotion of good health. The Health Policy Triangle (HPT) framework was applied as the conceptual framework in this study. The framework was developed by Walt and Gilson [6], and this approach helped the researcher to have a better understanding of the study.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e The study adopted an exploratory-descriptive qualitative design, which allowed the researchers to gain a deep understanding of PHC Coordinators’ experiences with the implementation of primary health care policy. This design was particularly suitable for capturing participants’ narratives, which formed the basis for developing the Socio-Cultural Political Model (SCPM). The model was designed to evaluate PHC policy within its broader social, political, and cultural context. To analyze the qualitative data obtained from in-depth interviews, the study employed thematic analysis, a method used to identify, interpret, and organize patterns (themes) across the data. This analytical approach was selected for its flexibility and effectiveness in examining the complex interplay of socio-political and cultural factors influencing health policy implementation.\u003c/p\u003e\u003cp\u003e \u003cb\u003eSetting\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThe study was conducted among PHC coordinators at Ado-Ekiti Primary Health Care Centers. Ado-Ekiti is one of the sixteen local governments in Ekiti State in Nigeria (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Ado-Ekiti is the state capital of Ekiti State, and this state capital consists of Forty-eight PHC Centres. The study purposively selected the coordinators of the most equipped twenty PHC Centres that are familiar with the objectives of the Primary Health Care Policy in Ado-Ekiti. The PHC Centres are guided and overseen by the Ado-Ekiti local government, and their main duties are to provide primary health care services to the people within the community and to refer the complicated medical conditions to the nearest secondary hospitals. Patients using these facilities present with several medical conditions, while some bring their children for immunizations and some patients come for antenatal care as well.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e diagrammatically represent the map of Ekiti state showing the sixteen local governments and other states that form the boundaries, while the red star showed the location of the study which is Ado-Ekiti. Ekiti State is situated entirely within the tropics. It is located between longitudes 40°51′ and 50°451′ East of the Greenwich meridian and latitudes 70°151′ and 80°51′ north of the Equator. It lies south of Kwara and Kogi State, Osun State and bounded by Ondo State in the East and in the south, with a total land Area of 5887.890sq km. Ekiti State has 16 Local Government Councils.\u003c/p\u003e\u003cp\u003e \u003cb\u003eStudy Population\u003c/b\u003e \u003c/p\u003e\u003cp\u003eAdo-Ekiti currently has 48 Primary Health Care Centres (PHCCs), each managed by a designated PHC coordinator. This means the total number of PHC coordinators in the area is 48, representing the full population of potential participants for the qualitative component of the study. To ensure consistency and relevance, the following inclusion criteria were used to select eligible PHCCs: The centre must have a minimum of 15 beds, employ at least 15 PHC workers, be well-equipped, and have implemented the 2016 National Health Policy on Primary Health Care Service Delivery in Nigeria since 2017\u003c/p\u003e\u003cp\u003eApplying these criteria, 20 PHCCs were purposively selected from the population of 48. Consequently, 20 PHC coordinators, one from each selected center, were recruited to participate in the qualitative interviews. This means the interviewees represent approximately 41.7% of the total PHC coordinator population in Ado-Ekiti (20 out of 48). All 20 selected coordinators were approached and consented to participate, resulting in a 100% response rate for the qualitative component.\u003c/p\u003e\u003cp\u003e \u003cb\u003eSampling and Participants\u003c/b\u003e \u003c/p\u003e\u003cp\u003ePurposive sampling was employed to select the twenty PHC Coordinators meeting the inclusion criteria of (i) the PHC coordinators in one of the twenty selected PHCCs in Ado-Ekiti, (ii) PHC coordinators who are willing to participate in the study, (iii) the PHC coordinators with at least ten or more years of work experience (iv) the PHC coordinators overseeing a well-equipped PHC Centre located in Ado-Ekiti. Twenty PHC Coordinators participated in the study.\u003c/p\u003e\u003cp\u003e \u003cb\u003eEthical Considerations\u003c/b\u003e \u003c/p\u003e\u003cp\u003eA fully approved ethical clearance letter with the protocol number of HSSREC/00002401/2021 was obtained from the University of KwaZulu-Natal’s Research Ethics Committee before obtaining data from the respondents. The Gatekeeper’s Permission letter from the Ado-Ekiti Local Government Area and the ethical clearance certificate from the university were submitted to the health centres’ coordinators and heads as part of securing permission to use the health centres selected as the study locations and to secure access to the health workers in the designated health centres. The coordinators of the 20 PHCCs were also given prior notification before conducting the study. The participants were made to understand that their participation was strictly voluntary, and that their information would be handled confidentially. A two-page participation information document was administered to the Participants and the purpose of the research was explained in details. They also signed before answering the questions. Before the data collection processes, the researcher instructed the Participants not to print their names on the questionnaires and not to mention their names while their responses were recorded. The respondents were made to understand that participation was voluntary and that they had the right to renegotiate their consent during the research process or to ignore any question without giving an explanation, and they could withdraw from the study at any point if they felt the need to do so. The participants signed the consent forms and they all agreed to publish the findings for global utilization.\u003c/p\u003e\u003cp\u003e \u003cb\u003eValidity of the Study\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThe validity of this study was ensured through a rigorous approach grounded in the principles of trustworthiness, including credibility, transferability, dependability, and confirmability (Cypress, 2017). Credibility was strengthened through prolonged engagement, member checking, participant debriefing, and referral adequacy. Participants reviewed their interview transcripts to confirm that their experiences were accurately represented, and any concerns were addressed. Their feedback informed both the analysis and the development of the Socio-Cultural Political Model. Transferability was supported by providing rich, contextual descriptions of the research setting and incorporating literature and media sources to validate findings. The mixed-method approach and participant-derived recommendations enhance the potential for applying the findings to similar contexts beyond Ekiti State. Dependability was addressed through transparent documentation of the data collection and analysis process, including regular discussions with participants and the pilot study. Consistent themes, such as the negative influence of political actors, emerged and were validated across multiple sources. Confirmability was ensured through detailed field notes, ongoing self-reflection (reflexivity), and oversight by a research supervisor. Data and interpretations were derived from participant input rather than researcher bias. Participants also confirmed that the study’s conclusions accurately reflected their lived realities of the 2016 PHC policy. In summary, the study demonstrates strong methodological and ethical rigor, and the findings offer a credible and contextually grounded contribution to PHC policy evaluation in Nigeria. The developed model is both theoretically sound and practically relevant, with potential for adoption in similar socio-political environments.\u003c/p\u003e\u003cp\u003e \u003cb\u003eData Analysis and Validation\u003c/b\u003e \u003c/p\u003e\u003cp\u003eThe qualitative data gathered from in-depth interviews with the 20 PHC coordinators were analyzed using a thematic analysis approach. This process involved systematically coding the transcripts to identify recurrent patterns, categories, and themes that aligned with the study's objectives, particularly the socio-cultural and political influences on PHC policy implementation.\u003c/p\u003e\u003cp\u003eTo ensure rigor and minimize researcher bias, a second independent analyst was engaged in the coding and theme development process. This analyst, who was not part of the original data collection team, independently reviewed the interview transcripts and developed a parallel coding framework. The primary researcher and the second analyst then compared their coding structures and resolved discrepancies through discussion, resulting in a consensus on the final themes. This inter-coder agreement strengthened the credibility and dependability of the findings.\u003c/p\u003e\u003cp\u003eFurther, member checking was conducted with the original cohort of 20 PHC coordinators. Participants were provided with summaries of the analyzed data and emerging themes to verify whether their perspectives were accurately captured. This process allowed for clarification, correction, or expansion of interpretations, reinforcing the confirmability of the study.\u003c/p\u003e\u003cp\u003eAdditionally, the findings and the developed Socio-Cultural Political Model (SCPM) were shared with external stakeholders, including health policy experts, PHC supervisors, and academic peers. Feedback from these stakeholders was incorporated into the model refinement process, thereby enhancing its practical relevance, theoretical robustness, and transferability to similar policy contexts in other regions. Through this multi-step validation process, comprising independent analysis, participant verification, and external expert review, the study ensured that the conclusions drawn were well-grounded, transparent, and reflective of the real-world conditions influencing PHC policy in Ado-Ekiti.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eTheme 1: Awareness of the 2016 National Health Policy (NHP)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Most participants demonstrated a general awareness of the 2016 NHP, especially its intended relevance to Primary Health Care (PHC). However, this awareness varied in depth.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The 2016 National Health Policy is a more advanced policy, with many benefits to PHC.\u0026rdquo;\u003c/em\u003e (P11, Female)\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I know that the 2016 National Health Policy is still the current health policy we are using in Nigeria... it is a very good and well-designed health policy, but with a poor implementation method.\u0026rdquo;\u003c/em\u003e (P20, Female)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 2: Perceived Advantages of the NHP to PHC\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWhile participants generally acknowledged that the NHP was designed to support PHC, many doubted its practical benefits due to poor implementation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The policy is a modern policy, but I am yet to see its effectiveness.\u0026rdquo;\u003c/em\u003e (P13, Female)\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It is filled with so many benefits, be it at the federal level, state, and local government level.\u0026rdquo;\u003c/em\u003e (P4, Female)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 3: Lack of Evaluation and Policy Monitoring\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA prominent concern was the absence of effective evaluation mechanisms for PHC delivery by policymakers.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;They do not analyse or evaluate any policy.\u0026rdquo;\u003c/em\u003e (P5, Nurse, Female)\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I have not heard anything like that among our policymakers in Nigeria. All they know is how to design new policies, because that is where they can have access to the national cake.\u0026rdquo;\u003c/em\u003e (P6, Nutritionist, Female)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 4: Views on Developing a New Health Policy\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere was a strong consensus that instead of drafting a new policy, the current one should be fully analyzed and implemented.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Let us analyse the designed one before talking of a new one.\u0026rdquo;\u003c/em\u003e (P15, Female)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;No! No! No! And capital NO! Because that is a waste of time.\u0026rdquo;\u003c/em\u003e (P8, Nurse, Male)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 5: Cultural Barriers to Policy Implementation\u003c/b\u003e \u003c/p\u003e \u003cp\u003eParticipants highlighted that certain traditional beliefs and superstitions act as barriers to PHC implementation.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Some superstitions, like do not eat okro during pregnancy, and some others can impede the teachings of the health care workers.\u0026rdquo;\u003c/em\u003e (P10, Male)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;People\u0026rsquo;s beliefs and patterns of their behaviour are great cultural factors that can impede the implementation of PHC.\u0026rdquo;\u003c/em\u003e (P1, Female)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 6: Socio-Economic Influences on PHC Policy\u003c/b\u003e \u003c/p\u003e \u003cp\u003ePoverty, lack of education, and political interference were the most cited socio-economic challenges.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Poverty is one of the major factors.\u0026rdquo;\u003c/em\u003e (P12, Female)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Politics is the major factor influencing the effective implementation of PHC policy.\u0026rdquo;\u003c/em\u003e (P2, Female)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think poverty, lack of proper education, and some local policies.\u0026rdquo;\u003c/em\u003e (P19, Feale).\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe findings indicate that while the 2016 NHP is widely recognized and theoretically beneficial, its implementation is marred by a lack of evaluation, cultural resistance, and socio-economic challenges. Participants strongly advocated for reinforcing the existing policy through proper monitoring rather than introducing new frameworks.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDevelopment of the Model\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAn in-depth interview was used to generate the data for this study. The Socio-Cultural Political Model (SCPM) was developed from the findings obtained from the data obtained through an interview guide. This study aimed to develop a model that can be used to develop, implement, and evaluate PHC policy. This was because such a model will help policymakers to design and implement a more effective policy. The participants were required to identify the factors that had been impeding the effectiveness of the existing well-designed primary health care policy (PHCP), and an open-ended interview guide was used to solicit the information. This was done to ensure global acceptability and adoption of the research findings.\u003c/p\u003e \u003cp\u003eThe study passed through four steps or stages. Step one emphasised the need for the study to evaluate the PHC policy. In step two, the in-depth interviews were conducted among the PHCC coordinators, and the qualitative data were obtained from a total of 20 such coordinators. It was revealed that politicians were the ones influencing the health policies. The notion of \u0026lsquo;political will' was introduced in the Alma-Ata policy document on primary health care, which formally acknowledged the role of politics in health policy [7]. Added to the strong influence of politics on socio-economic development, there had also been policy inconsistency with each successive political administration, each distinguished by new policies which were often incongruous with those of the previous administrations [8]. Another study also argued that the changing political economy had had a negative influence on the primary health care policies in the country [9].\u003c/p\u003e \u003cp\u003eIn step three, the Socio-Cultural Political Model (SCPM) was developed from the data through the collaborative efforts of the researcher and the supervisor, and by using additional intellectual materials. The model was developed and then validated by the supervisor and the members of the research team, using the interview guide. This was done a month after the initial research, at a separate primary health care centre in the South-Western part of Nigeria.\u003c/p\u003e \u003cp\u003eIn step four, the study utilised four research assistants (RAs) and these RAs were Master\u0026rsquo;s Students at Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria. In addition, the researcher, the supervisor, and other members of the research team collaborated on implementing the Socio-Cultural Politically Influenced Model (SCPM).\u003c/p\u003e \u003cp\u003e \u003cb\u003eModel Assumptions\u003c/b\u003e \u003c/p\u003e \u003cp\u003eFor the model to be fully accepted in this kind of context, four assumptions were established:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eA- Acceptability\u003c/strong\u003e \u003cp\u003eThe model believed that a health policy should be designed in a way that the community would embrace it. The model established that the community had to be effective actors (policy makers).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eA- Accessibility\u003c/strong\u003e \u003cp\u003e The health policy was a kind of advanced guideline in the form of information, and it had to be well publicised so that the concerned bodies and the lowest person in the community would be aware of the health policy and how and when it was implemented. All the materials and resources needed for the smooth implementation of the health policy had to be easily accessible.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eR- Reinforcing\u003c/b\u003e: The implementation of the health policy had to be guided and supervised strictly and thoroughly.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eE- Evaluation\u003c/strong\u003e \u003cp\u003eThe health policy implemented needed to be evaluated regularly to establish whether the set goals had been achieved or not.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eDescription of the Model\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe Socio-Cultural Political Model (SCPM) identified five major components, namely local social, educational, cultural, economic, and political components that needed to be integrated fully into any primary health policy while it was being designed and then implemented. These components had to be incorporated in order for the policy to be successful in terms of acceptability, accessibility, reinforcement and enabling full evaluation. The Socio-Cultural Political Model was based on the Health Policy Triangle framework, which emphasized the four elements of context (why did you want to evaluate this policy?); content (what was the existing policy primarily about?); process (how was the existing policy brought forward and implemented?); and actors (who participated in and influenced the formulation and implementation of the existing policy?) [9]. The main limitation of this framework was its inability to juxtapose the influence of the society, the economy, the culture, and the local politics on the development and implementation of a primary health care policy. The Socio-Cultural Political Model (SCPM) instead expatiated more on how the local society, economy, culture, and politics were essential in the formulation and implementation of a primary health care policy, and indeed any other policy. This model stressed that the possibility of any particular policy achieving all of its set goals depended more on the accountability and transparency of the government.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSituational Analysis\u003c/strong\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above, before policy makers could start the development of a PHC policy for any community or country, they first had to do a thorough situational evaluation. So, what is a situational evaluation? According to the World Health Organization, a situational evaluation is an assessment of the current health situation that is fundamental to designing and updating national policies, strategies, and plans [10]. The situational evaluation of the health sector could begin as a once-off activity, but parts of the evaluation could be updated and revisited on a regular basis for programming and monitoring purposes. This was what the SCPI model stressed; that the first step to be taken when looking at a health policy was a situational evaluation of the policy. Policymaking was recognized as a complex process that had to be guided clearly by scientific knowledge and experts\u0026rsquo; views.\u003c/p\u003e \u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e represents the socio-cultural model\u0026rsquo;s and the diagram explains further that the cultural, social, educational, economic, and political factors need to be considered while evaluating the health policy.\u003c/p\u003e"},{"header":"Discussion of Findings","content":"\u003cp\u003eThis study revealed that the success of Primary Health Care (PHC) policy implementation in Nigeria is highly dependent on a comprehensive understanding of the socio-cultural, political, economic, and educational contexts of the communities being served. A recurring theme from participants was the centrality of community participation. As one participant explained, \u003cem\u003e\u0026ldquo;Community partnership and participation are essential to secure a successful PHC, because the local people\u0026rsquo;s ideas are indispensable in decision-making and on how to improve the PHC service delivery\u0026rdquo;\u003c/em\u003e (P16, female).\u003c/p\u003e \u003cp\u003eParticipants consistently argued that external input from international organisations was less impactful compared to community-generated information. \u003cem\u003e\u0026ldquo;No amount of information from the global sphere (such as WHO, USAID, UNICEF) can help us improve our PHC, but information drawn from the local community is fundamental to PHC development\u0026rdquo;\u003c/em\u003e (P12, female). This view is reinforced by literature, which states that situational evaluation is a fundamental prerequisite in designing effective PHC policies, as it enables full community participation and involvement [11]. However, despite its importance, situational evaluation is often overlooked due to the high financial costs involved [12].\u003c/p\u003e \u003cp\u003eAccording to the Health Policy Triangle framework [13], three contextual factors influence policy outcomes: situational, structural, and cultural. Participants demonstrated clear awareness of these layers. For instance, P12 stressed that \u003cem\u003e\u0026ldquo;It is through the information obtained from the community members that a situational evaluation of the community will be done\u0026rdquo;\u003c/em\u003e, highlighting the practical use of local knowledge. Similarly, the structural challenges, such as political systems and economic constraints, were frequently mentioned, alongside cultural values that shaped health behaviour.\u003c/p\u003e \u003cp\u003eThe cultural dimension was particularly impactful. As P16 shared, \u003cem\u003e\u0026ldquo;Self-care, morals, traditions, and norms have a high effect on any policy. For instance, we do not eat okra and snails during pregnancy, and research has shown that these food items are rich in iron. But up to date, we do not eat them because we believe our children will be salivating excessively.\u0026rdquo;\u003c/em\u003e This illustrates how local traditions\u0026mdash;if not considered during policy formulation\u0026mdash;can undermine well-intentioned health initiatives. Literature supports this by arguing that the absence of cultural integration can result in the rejection of policies, regardless of the resources invested [14]. Culture also influences how problems are perceived, the objectives of policy actors, and the power dynamics that shape decision-making [15,16].\u003c/p\u003e \u003cp\u003eThe social component also emerged strongly. One participant (P8, nurse, male) noted, \u003cem\u003e\u0026ldquo;Society is so powerful that it can accept or reject it [the policy] at any given time. For example, well-to-do members of society, philanthropists, and NGOs may volunteer to assist in the financing of the PHC centres.\u0026rdquo;\u003c/em\u003e This illustrates how community engagement goes beyond consultation to include resource mobilisation. The WHO emphasises PHC as a people-centred strategy critical to broader social and economic development [17]. Thus, society\u0026rsquo;s involvement is not optional\u0026mdash;it is foundational.\u003c/p\u003e \u003cp\u003eSimilarly, education was recognised as a major enabler or barrier to effective PHC policy. Participants observed that recruitment practices within the Ministry of Health were sometimes flawed. P13 (nurse, female) explained: \u003cem\u003e\u0026ldquo;Sometimes the Human Resources Department in the Ministry of Health is biased in the recruitment exercise, considering candidates with poor educational qualifications\u0026hellip; This corruption is eating up every sector in this country.\u0026rdquo;\u003c/em\u003e Poorly educated health workers hinder both policy implementation and community awareness. A participant (P10, nurse, female) further emphasised: \u003cem\u003e\u0026ldquo;Education is the most powerful weapon which you can use to change the world... No country can develop unless its citizens are educated.\u0026rdquo;\u003c/em\u003e Supporting studies confirm that without educated health workers and informed citizens, PHC policy remains ineffective [19].\u003c/p\u003e \u003cp\u003eThe economic environment also posed a significant barrier. Respondents widely believed that economic mismanagement is crippling PHC delivery. \u003cem\u003e\u0026ldquo;Corruption and embezzlement of health funds, and the lack of accountability and transparency in PHC are the main reason for the present crippled status of the PHC services in Nigeria\u0026rdquo;\u003c/em\u003e (P11, nurse, male). The ability to fund and sustain health policy is tied to national economic strength. Without financial commitment and transparency, policies remain unexecuted [20,21].\u003c/p\u003e \u003cp\u003eLastly, politics was overwhelmingly identified as the most dominant and obstructive influence on PHC policy. As P16 (female) stated, \u003cem\u003e\u0026ldquo;Currently in Nigeria, politics is the major factor influencing the progress of the PHC policy. However, many politicians are filled with the habit of corruption and embezzlement.\u0026rdquo;\u003c/em\u003e Participants echoed the view that political instability and regime changes have led to inconsistent and often incompatible policies. One remarked, \u003cem\u003e\u0026ldquo;Besides the various national development plans that have been implemented, the country has witnessed a plethora of developmental policies and strategies\u0026rdquo;\u003c/em\u003e (P16, female), yet few of these policies have translated into sustainable change [22,23].\u003c/p\u003e \u003cp\u003eSupporting studies concur that Nigeria\u0026rsquo;s PHC policy suffers from poor implementation due to political interference and lack of continuity [24,25]. According to the model illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, political factors influence all other domains, economic, educational, cultural, and social, and exert a direct impact on PHC service delivery.\u003c/p\u003e \u003cp\u003eIn summary, this study\u0026rsquo;s findings affirm that contextualizing PHC policy within the realities of the target community is indispensable. Socio-cultural alignment, community participation, economic stability, educational capacity, and political integrity are all prerequisites for achieving effective and sustainable PHC in Nigeria. Failure to incorporate these components will continue to impede the goal of universal health coverage.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study introduced the Socio-Cultural Political Model (SCPM), a framework developed to evaluate the implementation of Primary Health Care (PHC) policy in Nigeria. The model is grounded in five key dimensions: economic, political, educational, social, and cultural factors. Among these, political influences emerged as the most dominant, as illustrated in Fig.\u0026nbsp;2. The Health Policy Triangle framework served as the foundation for this analysis, effectively guiding the exploration of these contextual elements that shape PHC outcomes, particularly in low- and middle-income countries. The SCPM holds substantial practical value at both the local and national levels. Locally, it offers a context-sensitive, community-based approach that policymakers in Ado-Ekiti and similar regions can utilize to strengthen the planning, execution, and assessment of PHC services. By addressing the realities of the local socio-cultural, economic, and political environment, the model fosters more inclusive, accessible, and sustainable health initiatives. At the national level, the SCPM presents a flexible and scalable tool for reviewing and refining PHC policies across Nigeria. In light of ongoing issues such as policy discontinuity, political influence, and insufficient community involvement, the model equips government agencies with a practical framework for creating more coherent, participatory, and contextually appropriate health policies. Its adoption can support improved stakeholder collaboration, greater policy stability, and better health system performance, ultimately contributing to the nation\u0026rsquo;s progress toward achieving Universal Health Coverage.\u003c/p\u003e "},{"header":"Recommendations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eThere is a need for the PHCC coordinators to be highly sensitive to corruption and embezzlement in the primary health care settings.\u003c/li\u003e\n \u003cli\u003eThere is a need for the active involvement of community members in the development, implementation, and evaluation of PHC policies.\u003c/li\u003e\n \u003cli\u003eA newly developed primary health care policy should be well publicised before implementing it. This will give the community members full knowledge of the policy and they will then accept the policy more readily.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u0026quot;I, Olunike Blessing Olofinbiyi, declare that this research paper is my original work, and to the best of my knowledge, contains no material previously published elsewhere, except where duly acknowledged. All sources used have been properly cited, and I take full responsibility for the accuracy of the information presented herein.\u0026quot;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data underlying the results are available as part of the article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp id=\"_Toc120150792\"\u003eThe author declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp id=\"_Toc120150793\"\u003e\u003cstrong\u003eFundings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not funded by any organisation and was fully supported by the researcher.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc120150794\"\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eThe model was developed and implemented by OBO.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researcher gratefully acknowledges the invaluable guidance and mentorship of Professor Sogo Angel Olofinbiyi, whose support greatly contributed to the successful completion of this study.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEngelman A, Case F, Meeks R, Fetters S. Conducting health policy evaluation in primary care research: turning clinical ideas into action. \u003cem\u003eFam Med Community Health\u003c/em\u003e. 2019;7(4):e000076. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. \u003cem\u003eThe building blocks\u003c/em\u003e. Geneva: World Health Organization; 2018.\u003c/li\u003e\n\u003cli\u003eHudson VM, Day BS. \u003cem\u003eForeign policy evaluation: classic and contemporary theory\u003c/em\u003e. United States of America: Rowman \u0026amp; Littlefield; 2019.\u003c/li\u003e\n\u003cli\u003ePantoja T, Opiyo N, Lewin S, Paulsen E, Ciapponi A, Wiysonge CS. Implementation strategies for health systems in low-income countries: an overview of systematic reviews. \u003cem\u003eCochrane Database Syst Rev\u003c/em\u003e. 2017;9(9):CD011086.\u003c/li\u003e\n\u003cli\u003eBirkland TA. \u003cem\u003eAn introduction to the policy process: theories, concepts, and models of public policy making\u003c/em\u003e. 4th ed. London: Routledge; 2019.\u003c/li\u003e\n\u003cli\u003eWalt G, Gilson L. Reforming the health sector in low- and middle-income countries: the central role of policy evaluation. \u003cem\u003eHealth Policy Plan\u003c/em\u003e. 2014;9(1):353\u0026ndash;70.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. \u003cem\u003eHealth policy\u003c/em\u003e. Geneva: WHO; 2018.\u003c/li\u003e\n\u003cli\u003eCrano WD, Brewer MB, Lac A. \u003cem\u003ePrinciples and methods of social research\u003c/em\u003e. 3rd ed. London: Routledge; 2014.\u003c/li\u003e\n\u003cli\u003eGilson L. Reflections from South Africa on the value and application of a political economy lens for health financing reform. \u003cem\u003eHealth Syst Reform\u003c/em\u003e. 2019;5(3):236\u0026ndash;43.\u003c/li\u003e\n\u003cli\u003eBowen S, Zwi AB. Pathways to \u0026quot;evidence-informed\u0026quot; policy and practice: a framework for action. \u003cem\u003ePLoS Med\u003c/em\u003e. 2005;2(7):e166.\u003c/li\u003e\n\u003cli\u003eDaprim B. The Nigerian health care system: evolution, contradictions, and proposal for future debates. \u003cem\u003eFam Med Community Health\u003c/em\u003e. 2015;7(1):e000076.\u003c/li\u003e\n\u003cli\u003eKeller M. Wasted windfalls: inefficiencies in health care spending in oil-rich countries. \u003cem\u003eResour Policy\u003c/em\u003e. 2020;66:101618.\u003c/li\u003e\n\u003cli\u003eLi X, Lu J, Hu S, Cheng KK, De Maeseneer J, Meng Q. The primary health-care system in China. \u003cem\u003eLancet\u003c/em\u003e. 2017;390(10112):2584\u0026ndash;94.\u003c/li\u003e\n\u003cli\u003eWang L, Kong Q, Guo Y, Meng Q. The disequilibrium in the distribution of the primary health workforce among eight economic regions and between rural and urban areas in China. \u003cem\u003eHum Resour Health\u003c/em\u003e. 2020;18(1):1\u0026ndash;10.\u003c/li\u003e\n\u003cli\u003eLiburd LC, Hall JE, Mpofu JJ, Williams S, Biesecker K. Addressing health equity in public health practice: frameworks, promising strategies, and measurement considerations. \u003cem\u003eJ Glob Health\u003c/em\u003e. 2015;6:34\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eKhan NA, Fahad S, Faisal S, Naushad M. Quarantine role in the control of coronavirus in the world and its impact on the world economy. \u003cem\u003eOther Economics Research eJournal\u003c/em\u003e. 2020. Corpus ID: 219336438.\u003c/li\u003e\n\u003cli\u003eMcKay N. Towards a history of medical missions. \u003cem\u003eMed Hist\u003c/em\u003e. 2017;51(1):547\u0026ndash;51.\u003c/li\u003e\n\u003cli\u003eReich MR. Introduction to the HS\u0026amp;R Nigeria issue. \u003cem\u003eHealth Syst Reform\u003c/em\u003e. 2016;2(1):273\u0026ndash;6.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization, Regional Office for Europe. \u003cem\u003eGovernance for health in the twenty-first century\u003c/em\u003e. Geneva: WHO; 2021.\u003c/li\u003e\n\u003cli\u003eMcHale J. \u003cem\u003eThe changing information environment\u003c/em\u003e. London: Routledge; 2019. Available from: https://doi.org/10.4324/9780429051760\u003c/li\u003e\n\u003cli\u003eTracy SJ. \u003cem\u003eQualitative research methods: collecting evidence, crafting analysis, communicating impact\u003c/em\u003e. 2nd ed. Lanham, MD: Rowman \u0026amp; Littlefield; 2019.\u003c/li\u003e\n\u003cli\u003eLenton-Brym H, Rodrigues V, Johnson Y, Couturier Y, Toulany S. A scoping review of the role of primary care providers and primary care-based interventions in the treatment of pediatric eating disorders. \u003cem\u003eJ Prim Health Care\u003c/em\u003e. 2020;28(2):47\u0026ndash;66.\u003c/li\u003e\n\u003cli\u003eGorky S. Politics and government, social economics, and social movement studies. \u003cem\u003eLabour Issues\u003c/em\u003e. 2020.\u003c/li\u003e\n\u003cli\u003eChukwuemeka EO, Ikechukwu UB. The obstacles to effective policy implementation by the public bureaucracy in developing nations: the case of Nigeria. \u003cem\u003eJ Bus Manag Rev\u003c/em\u003e. 2013;2:7\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eFawehinmi F. How Nigerian politicians are the luckiest in the world. \u003cem\u003eThe Guardian\u003c/em\u003e. 2018;1\u0026ndash;2.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Montana Technological University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health policy, Health promotion, Model, Prevention, Primary health care","lastPublishedDoi":"10.21203/rs.3.rs-7000109/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7000109/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary Health Care (PHC) is a cornerstone of global health systems, aimed at ensuring universal health coverage and equitable access to care. In low- and middle-income countries such as Nigeria, the effective implementation of PHC policies continues to face significant challenges, largely due to complex socio-cultural and political dynamics. Despite numerous reforms and policy initiatives, gaps remain in translating these policies into practice at the community level. In Ekiti State, Nigeria, contextual issues, such as political interference and cultural misalignment, have hindered successful implementation. This study was therefore undertaken to develop a Socio-Cultural Political Model (SCPM) for evaluating PHC policy implementation, focusing on the lived experiences of PHC coordinators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn exploratory-descriptive qualitative design was employed to enable an in-depth understanding of the experiences and perceptions of PHC Coordinators in Ekiti State. A purposive sampling technique was used to select twenty PHC Coordinators, based on predefined inclusion criteria. Data were collected using a structured interview guide, and the interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Ethical considerations, including informed consent, confidentiality, and voluntary participation, were strictly adhered to throughout the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThematic analysis of the data revealed several recurring issues that significantly hinder the effective implementation of Primary Health Care (PHC) policy. One major theme was political interference, as frequent disruptions by political actors were reported to impede program continuity, reduce accountability, and often lead to abrupt policy shifts unrelated to community needs. Another key issue was the lack of community engagement. Policymakers were frequently criticized for excluding local stakeholders from the planning and execution of PHC initiatives, which resulted in poor community buy-in and weakened the impact of health interventions. Cultural misalignment also emerged as a critical factor. Participants observed that many PHC policies did not sufficiently consider traditional beliefs, customs, and social norms, which contributed to resistance, misunderstanding, and non-compliance within communities. Additionally, the study highlighted a persistent problem of inadequate situational evaluation. Policies were often developed and implemented without real-time, context-specific assessments, leading to poorly adapted interventions that failed to address local realities effectively. Overall, participants emphasized that PHC policies tend to follow a top-down approach, disconnected from the grassroots. This lack of community involvement and contextual relevance undermines community ownership and contributes to poor implementation outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study highlights the pressing need for context-sensitive, community-informed approaches in the development and evaluation of PHC policies. The proposed Socio-Cultural Political Model (SCPM) integrates five interdependent dimensions: economic, political, educational, social, and cultural factors. This model provides a comprehensive framework for assessing the relevance, responsiveness, and effectiveness of PHC policies. By adopting the SCPM, policymakers and health authorities can enhance stakeholder participation, improve the cultural and political adaptability of health policies, and strengthen the overall performance of PHC systems. The study recommends the integration of SCPM into future health policy development and evaluation processes to promote sustainable and inclusive health outcomes in Nigeria.\u003c/p\u003e","manuscriptTitle":"Socio-Cultural Political Model Evaluating Primary Health Care Policy in Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-03 08:29:05","doi":"10.21203/rs.3.rs-7000109/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e172f21e-bdc0-4361-aab6-ee0f7aaaae66","owner":[],"postedDate":"July 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50899807,"name":"Health Policy"}],"tags":[],"updatedAt":"2025-07-03T08:29:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-03 08:29:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7000109","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7000109","identity":"rs-7000109","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}