Theoretical Framework for Integrating Oral and Maxillofacial Surgery into Nigeria’s Universal Health Coverage Architecture: A Policy Analysis

Universal health coverage (UHC) represents a central pillar of Nigeria's National Health Act and the Sustainable Development Goal 3.8 framework, yet oral and maxillofacial surgical services remain conspicuously absent from the Basic Minimum Package of Health Services currently operative under the Basic Health Care Provision Fund. This policy analysis develops a theoretical framework for the systematic integration of oral and maxillofacial surgery into Nigeria's UHC architecture, drawing on health systems theory, surgical systems strengthening evidence, and comparative policy analysis from analogous low- and middle-income countries. A multi-method approach was employed, incorporating documentary analysis of national health policy texts, key informant interviews with 28 policymakers, oral surgery stakeholders, and civil society actors from across Nigeria's six geopolitical zones, and a Delphi consensus exercise with 22 expert panelists. The proposed theoretical framework articulates four integrative pathways: benefit package design, workforce normalization, financing mechanism reform, and governance accountability structures. Findings reveal that institutional siloing of oral health from mainstream health policy, absence of oral health advocates in federal health planning bodies, and weak epidemiological evidence linking oral surgical burden to broader health outcomes are the primary structural barriers to integration. The study makes an original theoretical contribution to global surgical UHC discourse by positioning oral and maxillofacial surgery as a neglected essential surgical specialty and recommends actionable policy levers for its formal inclusion in Nigeria's revised national health benefit package. Keywords: universal health coverage, oral surgery, health policy, Nigeria, essential surgical care.