Integrating Mental Health into Universal Health Coverage in Nigeria: A Multi-Level Governance and Implementation Science Analysis

Universal health coverage (UHC) in Nigeria explicitly incorporates mental health, yet implementation remains fragmented and inequitable across geopolitical zones. This study applies implementation science frameworks to examine the governance, financing, and delivery factors that facilitate or impede mental health integration into UHC in Nigeria. A multi-level qualitative case study design will be employed across three states selected for maximum variation in mental health policy development: Lagos (South West), Borno (North East), and Anambra (South East). Data collection will include 60 key informant interviews with federal and state health officials, NHIA administrators, civil society actors, and service users, alongside document analysis of relevant policy texts, budgets, and program reports. Framework analysis using the Consolidated Framework for Implementation Research (CFIR) will organize findings across innovation, inner setting, outer setting, individuals, and implementation processes. The study will identify leverage points for strengthening mental health financing, workforce deployment, and service organization within Nigeria's UHC framework. Findings will constitute an original implementation science contribution and directly inform National Health Insurance Authority policy and the Federal Ministry of Health's mental health action plan. Keywords: universal health coverage, mental health integration, implementation science, Nigeria, governance