Health Education System Strengthening and Primary Healthcare Outcomes in Sub-Saharan Africa: A Comparative Case Study of Nigeria and Ghana

Health education system strengthening is a critical but underinvestigated dimension of primary healthcare improvement in sub-Saharan Africa. This study conducted a comparative case study analysis of health education system strengthening and its relationship to primary healthcare outcomes in Nigeria and Ghana. A comparative case study methodology drawing on health system performance data, policy documents, and primary qualitative data was employed. In Nigeria, fieldwork was conducted across the South West, South South, and North Central zones, with 30 policy makers and 60 health education practitioners participating in interviews. Comparative data from Ghana were collected through 24 interviews and secondary data analysis. Cross-case analysis used the Health Education System Strengthening Framework as an analytical lens. Results showed that Ghana's more structured national health education workforce policy, supported by standardised training pathways and community health educator deployment systems, was associated with significantly better preventive health indicators including immunisation coverage (92 percent versus 67 percent) and antenatal care utilisation (98 percent versus 74 percent). Nigeria's fragmented health education system, characterised by inadequate workforce data, inconsistent training standards, and poor integration into primary healthcare governance, constrained programme effectiveness. The study makes an original contribution to comparative health systems science and recommends a national health education workforce policy for Nigeria. Keywords: health education system strengthening, primary healthcare, Nigeria, Ghana, comparative case study