Community-rooted health workers, smart digital tools can strengthen Nigeria’s PHC system

Community health workers (CHWs) remain one of the most essential yet under-supported pillars of Nigeria’s primary healthcare (PHC) system, delivering maternal and child health services, supporting immunisation campaigns, educating families on hygiene and nutrition, and linking communities to health facilities.

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Yet, despite their central role, they continue to face persistent challenges, including inconsistent training, limited supervision, documentation burdens, and weak communication with higher-level facilities.

A new study led by Temitayo Okusanya, a Nigerian-born health systems researcher, has examined how CHWs can be better integrated into digital information systems to improve public health situational awareness.

Although conducted in the US, the findings have shown strong relevance for Nigeria, particularly in the context of PHC reforms and the need for real-time community-level data.

The research, titled “Designing Information Flow with Diverse Community Health Workers to Improve Public Health Situational Awareness During COVID-19,” was presented at the 21st Information Systems for Crisis Response and Management conference in Germany.

The findings were contained in a statement sent to PREMIUM TIMES on Saturday.

Lessons for Nigeria’s PHC system

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One of the key findings of the study is the importance of community-rooted health workers.

In the US model examined by the researchers, CHWs were not temporary external professionals but individuals who lived within the communities they served and maintained long-standing social ties.

According to Mrs Okusanya, this positioning enabled CHWs to build trust quickly, navigate cultural and linguistic nuances, and collect more accurate, context-rich data during household visits.

She said their identity within the community improved adherence to referrals, symptom reporting, and long-term engagement.

The researcher explained that Nigeria already operates structures such as Ward Development Committees and Community Health Extension Workers (CHEWs).

However, their integration into digital health systems and broader community engagement frameworks remains fragmented.

The study suggests that strengthening workforce models that prioritise cultural familiarity and trust could help Nigeria unlock the full potential of its CHWs, particularly in underserved rural and peri-urban areas where mistrust of the formal health system remains high.

Designing digital tools around CHW workflows

The study also highlights that digital tools are most effective when they enhance, rather than burden CHW workflows.

In the US model, CHWs used mobile phones and simple reporting applications to document household needs, capture health indicators, and initiate referrals. Crucially, these tools were designed around existing workflows and reduced administrative pressure.

Nigeria’s ongoing digital health transformation, including the expansion of DHIS2, SmartPHCs, and electronic medical record pilots, could benefit from a similar principle.

Mrs Okusanya noted that tools must be intuitive and aligned with how CHWs operate in the field.

She warned that many digital initiatives in low- and middle-income countries fail because they increase workload, require constant internet connectivity, or do not reflect local realities.

She suggested that a Nigeria-focused adaptation could include offline-first mobile tools for low-network settings, automated dashboards at local government and state levels, structured fields for recording context and follow-up needs, and built-in referral pathways linking CHWs directly to PHCs and secondary facilities.

By aligning digital innovations with day-to-day realities, she said, Nigeria could improve coordination, accountability, and real-time visibility into community health needs.

Stronger integration with health facilities

The research further highlighted the need for stronger integration between CHWs and formal health facilities.

In Nigeria, CHWs often operate in isolation, with limited supervision and weak mechanisms for clinical escalation.

The US model demonstrated that even simple digital linkages can clarify responsibilities, ensure timely referrals, reduce service fragmentation, and support consistent follow-up for chronic conditions such as hypertension, diabetes, and mental health disorders.

“Integration is not just about technology. It is about designing workflows that help CHWs, nurses, and facility staff communicate seamlessly. When CHWs are connected to the larger health system, everyone benefits,”she said.

Cross-context learning

Although based on an American health context, the study focused on underserved populations facing challenges similar to those in rural and peri-urban Nigeria.

Mrs Okusanya, whose broader research spans health systems strengthening, including mental health care for US veterans and traumatic brain injury care systems in civilian populations, emphasised the importance of cross-context learning.

“Health systems differ, but human needs and frontline realities often overlap. Lessons from one context can illuminate opportunities in another, especially when it comes to strengthening community-based care,” she said.

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Path forward

As Nigeria continues implementing PHC revitalisation strategies, health experts say adopting CHW-centred innovations that combine trust, training, and simple digital enhancements could strengthen service delivery.

By positioning CHWs not only as frontline workers but also as system connectors and data contributors, the country could build a more resilient, equitable, and responsive primary healthcare system, the statement added.

The lead researcher, Mrs Okusanya is a PhD candidate in Public and Community Health specialising in health systems research, with work spanning community-based care models, human-centred design, mental health system design, and traumatic brain injury care.

Other researchers are Jane Gresser, Marquette University, Michael Stevenson, University of Wisconsin-Madison, Ajay Kumar, University of Muenster, Md Romael Haque, Marquette University and Zeno Franco, Medical College of Wisconsin.