An Original Theoretical Framework for Pharmaceutical Care Integration into Nigeria’s Primary Healthcare System

The integration of pharmaceutical care into Nigeria's primary healthcare system is impeded by structural, financial, human resource, and organisational barriers that have not been comprehensively theorised into an actionable national integration framework. This study developed an original theoretical framework for pharmaceutical care integration into the Nigerian primary healthcare system, grounded in implementation science and health systems theory. The framework development followed a comprehensive five-stage methodology: systematic global review of pharmaceutical care models in primary healthcare systems from low and middle-income countries; stakeholder consultations including 60 semi-structured interviews with pharmacists, PHC managers, state health ministry officials, community health workers, and patients across all six geopolitical zones; in-depth case studies of pharmaceutical care integration pilots in two PHC programmes; theory-building using realist synthesis and complexity theory as conceptual foundations; and expert validation using a mixed Delphi-stakeholder consensus process. The resulting Nigerian Primary Healthcare Pharmaceutical Care Integration Framework (NPC-PHC) defines five theoretical pillars: contextualised pharmacist roles aligned with Nigeria's PHC task allocation, a tiered pharmaceutical care service package by facility level, an enabling policy and regulatory architecture, community-responsive pharmacist practice models incorporating indigenous care beliefs, and a sustainable financing mechanism drawing on NHIA and tax-funded PHC budget allocation. The framework was validated by 22 health systems, pharmacy practice, and primary care experts. The NPC-PHC constitutes an original theoretical contribution to pharmaceutical care system science in sub-Saharan Africa.

Keywords: pharmaceutical care, primary healthcare, health systems, Nigeria, integration framework