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

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.