The Health Policy Research Group (HPRG), University of Nigeria, Nsukka through its CHORUS Project, has intensified efforts to improve healthcare delivery in urban slums by strengthening linkages between the formal health sector and informal healthcare providers in Nigeria.
At a policy dialogue held in Abuja on February 19, the group highlighted how rapid urbanisation has led to the expansion of informal settlements where access to quality healthcare remains limited.
The workshop provided a platform for stakeholders to review research findings and discuss pathways for integrating them into existing policies and ongoing health system–strengthening initiatives across the country.
In his address, Professor Obinna Onwujekwe, Coordinator of the Health Policy Research Group, said evidence shows that linking informal healthcare providers to the formal system significantly improves healthcare delivery in urban slums.
Speaking on the CHORUS Project, a multi-country research initiative focused on improving health outcomes in urban settings, Onwujekwe said one of the two projects being implemented in Nigeria targets urban slums, where informal providers dominate service delivery.
“What we are doing is a policy dialogue on how to link informal healthcare providers to the formal system in order to improve the quality of healthcare in urban slums,” he said.
He noted that although urban slums are located within cities, they remain largely neglected by policymakers.
“There is a lot of suffering in urban slums, yet these communities are often overlooked,” he said.
Onwujekwe explained that the intervention was prompted by the high concentration of informal providers in slum communities and the lack of oversight over their activities.
“When informal providers are not linked to the formal system, it becomes an ungoverned space. Our findings show that linking them works and improves services across both the formal and informal sectors,” he stated.
He disclosed that the Enugu State Government has adopted the model by establishing an Urban Health Unit within the Ministry of Health and the State Primary Health Care Agency to sustain the intervention.
According to him, the research team presented the evidence in Abuja to encourage nationwide adoption.
“These informal providers will always exist. They provide over 50 per cent of health services generally, and more than 90 per cent in urban slums. We must integrate, train and support them for better health outcomes,” he added.
The group further revealed that the study was conducted across eight slum communities in Enugu State. Findings showed that before the intervention, only 6.49 per cent of households reported receiving referrals from informal healthcare providers, while after the intervention, referral rates rose to 44.27 per cent in intervention communities.
The study also found that informal healthcare providers were willing to make a one-off payment to be linked to the formal health system to improve service delivery. In addition, consumers showed a high willingness to pay for improved services from informal providers, particularly in control slum communities.
On the role of financial factors, the study revealed that fear of hospital costs led many households to avoid formal healthcare and rely on chemists or home care, even when unsafe. However, community sensitisation helped residents understand that Primary Healthcare Centres (PHCs) are often more affordable than expected, reducing fear and increasing acceptance of referrals to formal facilities.
Also speaking at the event, Dr. Emmanuel Sokbo, Country Director of the Network for Equity and Development, called for stronger regulation and coordinated engagement among government, private healthcare providers, community practitioners and traditional institutions.
He stressed that healthcare reform must extend beyond major hospitals to include grassroots providers, where most Nigerians, especially the poor seek care.
“Regulation should not focus only on big private hospitals. What happens at the community level must also be properly regulated,” Sokbo said.
He added that private practitioners, including traditional healers, should view healthcare as a public service rather than a purely profit-driven venture, stressing the need for training and collaboration with the formal health sector.
Sokbo identified weak coordination between higher-level hospitals and community-based practitioners as a major gap in the health system, advocating improved information-sharing, referral mechanisms and self-regulation through professional associations.
On the role of traditional institutions, he urged constructive engagement with community leaders to eliminate harmful cultural practices that compromise patient safety.
“Traditional institutions are custodians of culture. They must be part of efforts to eliminate practices that undermine patient safety and quality of care,” he said.
