Evaluation of the Implementation of an Emergency Medical Care System in Nigeria as Perceived by Stakeholders Utilizing the Consolidated Framework for Implementation Research

Objective: In 2014, the Nigerian National Health Act (NHA) was signed into law, which included the Basic Health Care Provision Fund (BHCPF). One of the primary goals of the BHCPF is to establish a national emergency medical response service. The study strives to evaluate the early implementation process of this service as perceived by key stakeholders nationally and statewide, with the goal of a future consensus conference. Methods: A cross-sectional study interviewing key stakeholders was conducted in Nigeria, utilizing a semi-structured interview consisting of two surveys. One survey was a self-designed quantitative instrument to assess participants’ knowledge of national and international guidelines and resources regarding emergency care. The second survey was a validated open-ended interview built from the Consolidated Framework for Implementation Research (CFIR) tool. Interviews were analyzed and coded by CFIR constructs. A correlation analysis was performed utilizing Spearman’s rho. Results: There was a large concordance among the respondents regarding innovation source, tension for change, and resources. There was notable variability observed among goals and feedback. Surprisingly, a significant disparity was also found in the knowledge assessment scores among the respondents. A correlation analysis between the knowledge assessment and the goals and feedback rating was conducted using Spearman’s rho. The R-squared was 0.743, with a p-value of 0.035. This reflects a correlation between increased knowledge and a perceived strong feedback and goal system, with a statistically significant association. Conclusion: This study highlights stakeholders' shared recognition of the urgent need for a national emergency medical response system in Nigeria. However, disparities in knowledge and goal perception suggest uneven preparedness, potentially hindering progress. The strong correlation between knowledge and perceptions of goals and feedback underscores the need for targeted education and information sharing. These findings lay the groundwork for a stakeholder-driven consensus conference and strategic frameworks to support effective NHA implementation.