Primary Health Care Services in Secondary and Tertiary Institutions: The Impacts and Challenges of Community Health Practitioners in the Nigerian Health System

Abstract

-Background: Primary health care (PHC) is the foundation of universal health coverage, but continuity of care depends on effective linkages between community, primary, secondary and tertiary services. In Nigeria, Community Health Practitioners (CHPs) Junior Community Health Extension Workers (JCHEWs), Community Health Extension Workers (CHEWs) and Community Health Officers (CHOs) are primarily deployed within PHC. Their work nevertheless interfaces with secondary and tertiary services through referral, surveillance, health promotion, patient navigation, follow-up and selected task-sharing arrangements. Objective: This review review analyzes CHP contributions to the continuum of care involving secondary and tertiary institutions, identifies barriers to effective integration, and proposes policy and practice measures for safer and more coordinated utilization. Methods: Evidence was synthesized from Nigerian regulatory and policy documents and peer-reviewed literature concerning community health workers, task-sharing, referral, PHCUOR, workforce development and PHC integration. Evidence involving the wider community health worker category was distinguished from evidence specifically involving Nigeria's regulated CHP cadres. Results: CHPs can contribute to referral initiation, community-to-facility linkage, preventive services, chronic disease support, surveillance, health education and post-discharge follow-up. Nigerian evidence also indicates that community health workers sometimes perform duties beyond formal guidance because of service needs, while referral feedback between PHC and higher-level facilities may be weak. International evidence indicates that task-sharing can improve selected outcomes when supported by training, clear roles, coordination, supervision and financing. Conclusion: CHPs should not be regarded as substitutes for specialist hospital professionals. Their principal system value lies at the interface between communities, PHC facilities and higher levels of care. Harmonized scope-of-practice arrangements, competency-based continuing professional development, two-way referral systems, multidisciplinary governance, supportive supervision and measurable accountability mechanisms are required to integrate CHPs safely into Nigeria's continuum of care