Integration of Environmental Health Services into Primary Health Care in Nigeria: A Scoping Review
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Introduction: Environmental determinants such as water quality, sanitation, waste management, and vector control significantly influence population health outcomes. Primary health care (PHC) systems are designed to deliver preventive and community-oriented services, making them a critical platform for integrating environmental health interventions. However, the extent of integration of environmental health services within PHC systems in Nigeria remains inadequately documented.
Methods: A scoping review methodology was employed to map and synthesise existing evidence on environmental health integration within Nigerian PHC systems. Relevant peer-reviewed and grey literature were identified through systematic database searches and screened based on predefined eligibility criteria. Extracted data were analysed thematically to identify patterns of integration, barriers, and enabling factors.
Results: Environmental health services intersect with PHC delivery across several domains including water, sanitation and hygiene (WASH), disease surveillance, vector control, environmental health education, waste management, and regulatory inspections. However, integration remains limited and often occurs through programme-driven initiatives rather than institutionalised PHC structures. Major barriers include workforce shortages, inadequate infrastructure, fragmented governance arrangements, limited funding, and weak intersectoral coordination. Facilitators include community participation mechanisms, donor-supported programmes, and national PHC revitalisation initiatives.
Conclusion: Environmental health services remain an under-integrated component of Nigeria’s PHC system despite their central role in disease prevention and health promotion. Strengthening policy alignment, workforce integration, infrastructure investment, and multisectoral coordination mechanisms could enhance environmental health integration within PHC and contribute to improved population health outcomes.
Keywords: Environmental health; Primary health care; Health systems integration; Nigeria; WASH; Health system strengthening.
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