Readiness to Implement the World Health Organization’s Integrated Care for Older People (ICOPE) Framework in Primary Health Care Settings in Nigeria: A Series of Focus Group Discussions

Background: In 2022, people aged 60 years and over, represented 4.7% of Nigeria’s population. This percentage of older adults is projected to triple by 2050. The World Health Organization has identified integrated care as one of the action areas within the UN Decade of Healthy Ageing, and the Integrated Care for Older Persons (ICOPE) is a framework recognized as a key initiative to address the complex issues surrounding care for older people. The study explored the human resource and policy readiness for implementation of ICOPE in primary healthcare setting in south-south Nigeria. Methods: Qualitative methodology, using focus group discussions (FGD), was used in the study. We conducted four interdisciplinary FDG with heads of primary healthcare facilities, directors of primary healthcare and management staff of state primary healthcare board. Results: A total of eighteen participants, within four separate FGD, participated in the study. Sixteen were female, and the majority were trained as nurse/midwives. Our analysis revealed that the primary human resource and policy challenges in the implementation of ICOPE in primary healthcare settings in Nigeria are the following: (1) workforce shortage/work-related stress, (2) need for further training, specialization and interprofessional collaboration, (3) underestimation of the importance and impact of care for older people, and finally (4) necessity for targeted resources and financing for care of older people. Our results highlight that there are important barriers and challenges that limit the implementation of ICOPE in the south-south region of Nigeria, which might further constrain the ability to effectively address the needs for the growing proportion of older persons. Conclusions: The findings provide insight into one of Nigeria’s regions, and its ability to implement WHO recommendations. Although speculative and beyond the scope of this study, other similar regions may face similar challenges at the implementation level. Our findings highlight the tension between establishing macro level policies such as the ICOPE, and the challenges of implementing such policies at the meso- and micro level in lower middle-income countries. These findings underscore the need for a collaborative approach between stakeholders to co-create a more age-friendly and accessible system for Nigeria's growing older population.