Implementing prevention interventions for non-communicable diseases within the Primary Health Care system in the Federal Capital Territory, Nigeria

Background: Nigeria as well as other low and middle-income countries have double burden of communicable diseases and non-communicable diseases (NCD). This study examined the implementation of the NCD component of the National Minimum Health Care Package in Nigeria’s Federal Capital Territory where the prevalence of diabetes and hypertension is increasing. Methods: This descriptive study was organised along two lines of inquiry: document review (guidelines, policies, programme documents and services records in the Federal Capital Territory, Nigeria) and a qualitative study (focus group discussions with community representatives and frontline health workers, interviews with health program managers and non-participant observations of primary care facilities). Results: Existing policies and guidelines for NCD prevention have several implementation shortfalls including insufficient recognition of the burden of disease at primary care level and associated low prioritisation of NCDs; poor resourcing of NCD-related activities and poor operationalisation of relevant guidelines. Other constraints were: inadequate human resources for PHC services in numbers and mix of cadres, deficiencies in knowledge on management of diabetes and hypertension by PHC workers, insufficient job aids in primary care facilities for prevention, management and referral of hypertension and diabetes, weak information systems and referral linkages between primary care and secondary/tertiary care facilities for NCDs. Conclusion: The capacity of the PHC system to implement NCDs interventions is weak, necessitating a need to strengthen coordination, partnership and funding for better response to NCD prevention in primary care. Capacity building specific to NCD prevention should involve tools/technology, skills, infrastructure, manpower, referral linkages and community participation.