The Primary Healthcare Delivery Compact

Nigeria's primary healthcare system is not only underfunded; it is under-delivered. Budgets are approved, policies are announced, and commodities are procured, yet at the ward health center where care either happens or does not, the chain between promise and verified care breaks down. The Primary Healthcare Delivery Compact names that breakdown precisely, and rebuilds delivery as an accountable operating system for primary care.

Drawing on the Consolidated Framework for Implementation Research (CFIR) and on Nigeria's own evidence base, including the National Demographic and Health Survey, national health accounts, and two decades of peer-reviewed Nigerian health systems research, the book sets out a delivery compact among the actors who must perform together: federal and state governments, local government health authorities, ward development committees, frontline health workers, and the communities they serve.

At its core is a seven-function operating model for delivery: Locate, Rank, Engage, Assign, Complete, Verify, and Improve. Around that model, the book builds the full architecture of accountable primary care: financing that reaches the frontline, a workforce deployed by role and competency, supply chains that end in verified availability rather than dispatched paperwork, health information that managers actually use, and governance that ties every level of the system to results a community can see.

Across 23 chapters in six parts, the book moves from Nigeria's health delivery contradiction through comparative lessons from other countries, and into detailed designs for service delivery, workforce, financing, information, and accountability. It closes with an implementation agenda that researchers, policymakers, funders, and health workers can test, adapt, and audit.

Written for scholars of health systems and implementation science, public health leaders, policy makers, development partners, and Nigerian health professionals at home and in the diaspora, this is a rigorous, evidence-dense blueprint for turning borrowed promise into verified community care.

Paul Arthur Osaroejii is a Nigerian-born health services researcher based in Fort Worth, Texas, a PhD Health Services candidate at Walden University, and the founder of Axiom Preventive Health Systems, LLC. He brings more than twelve years of experience in medical claims and health insurance operations to the study of how health systems actually deliver.