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Referral experiences of healthcare consumers: results from a cross-sectional study in urban slums in southeast Nigeria. 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Referral experiences of healthcare consumers: results from a cross-sectional study in urban slums in southeast Nigeria. 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The organisation of primary health care service delivery for non-communicable diseases in Nigeria: A case-study analysis. PLOS Global Public Health. 2023;3:e0000566.", "url": "https://www.ebi.ac.uk/europepmc/webservices/rest/PMC10021956/fullTextXML", "locator": { "locator_type": "xml_sections", "sections": [ "Methods", "Findings", "PHC referral linkages and feedback relations" ], "source_word_anchor": "All PHC facilities had linkage", "source_word_count": 5 }, "territory": "Thirteen primary-health-care facilities in four Nigerian states", "period": "Case study published 2023; fieldwork and source period stated in the article", "evidence_mode_candidate": "observed", "verification_source_layer": "research_literature", "source_version": { "response_sha256": "4bf441ed730672799e78b3f8a25090dc6c1b3793fca9173c5ef8f2de360a88a1", "detected_media_type": "text/xml", "hash_verified": true, "retrieved_at": "2026-08-22" }, "source_projection_id": "country-improvement-source:NGA:ncd-phc-case-study-2023", "display_source_id": "display-source:NGA:5bb0c2fa2e80220afc299efd", "source_version_id": "display-source-version:617600d4ca732fc66d4d313c" }, { "candidate_source_id": "country-improvement-source:NGA:childbirth-referral-data-sources-study-2021", "title": "Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria", "citation": "Radovich E, Banke-Thomas A, Campbell OMR, et al. Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria. BMC Health Services Research. 2021;21:927. doi:10.1186/s12913-021-06945-9.", "url": "https://www.ebi.ac.uk/europepmc/webservices/rest/PMC8420846/fullTextXML", "locator": { "locator_type": "xml_sections", "sections": [ "Abstract", "Methods", "Data source 1: NDHS 2018", "Results" ], "source_word_anchor": "three data sources on referral for childbirth", "source_word_count": 7 }, "territory": "Nigeria; nationally representative household-survey perspective plus bounded state and city facility-record perspectives", "period": "Published 2021; includes 2018 Nigeria Demographic and Health Survey and bounded facility records", "evidence_mode_candidate": "observed", "verification_source_layer": "research_literature", "source_version": { "response_sha256": "2914a5ff6cde0e575781abf81715db8e98421b70217f41f6beb661191820465e", "detected_media_type": "application/xml", "hash_verified": true, "retrieved_at": "2026-08-22" }, "source_projection_id": "country-improvement-source:NGA:childbirth-referral-data-sources-study-2021", "display_source_id": "display-source:NGA:934d5b55385a42ed81c26fef", "source_version_id": "display-source-version:935527dcca6f722aaab65053" } ], "typed_fields": { "observed_linkage": "All thirteen case-study PHC facilities had linkage with at least one secondary facility for patient referral.", "separate_referral_context": "The childbirth-referral study compares national household and bounded facility data sources rather than measuring a single national network.", "scope": "The linkage finding covers thirteen PHC facilities in four states; the childbirth data sources retain their separate national, state and city scopes.", "boundary": "Neither source establishes a national network, referral completion rate, counter-referral rate or bypass rate." }, "analytical_objects": { "provider_delivery_observations": [ { "label": "PHC-to-secondary referral linkage", "observation": "All case-study PHC facilities reported linkage with at least one secondary facility", "scope": "Thirteen PHC facilities in four Nigerian states", "display_claim_ids": [ "display-claim:70f5df940259b60db1237c9e" ], "display_source_ids": [ "display-source:NGA:5bb0c2fa2e80220afc299efd", "display-source:NGA:934d5b55385a42ed81c26fef" ], "source_version_ids": [ "display-source-version:617600d4ca732fc66d4d313c", "display-source-version:935527dcca6f722aaab65053" ], "display_evidence_object_id": "display-claim:70f5df940259b60db1237c9e" } ] }, "title": "Observed PHC-secondary links in a bounded case study", "statement": "The PHC study supports a place-bounded referral-linkage observation; the childbirth study reinforces that referral measures depend on their data source and scope.", "excerpt": "All PHC facilities had linkage", "citation": "Ojo T, et al. 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Health Research Policy and Systems, 2024; World Bank WDI, retrieved 2026.", "country_ids": [ "NGA" ], "coverage_domains": [ "authoritative_review", "facility_data", "governance", "hospital_organization", "patient_flows", "primary_care", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "direct observation at the 13 PHCs", "institution": null, "locator": { "description": "Ojo et al., XML Methods; Sampson et al., XML Abstract, Study design and Results; WDI API indicator SH.MED.BEDS.ZS." }, "material_id": "material:66a0406ed6f643a73aa06d53", "notes": [ "Do not turn thirteen observed PHCs, a public-PHC compliance assessment or a bed-density series into a current all-provider facility count, ownership profile, service-tier map or patient-flow measure." ], "origin": "candidate-analytical-mappings", "period": "Studies published 2023 and 2024; dated national WDI series", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "text/xml", "response_sha256": "4bf441ed730672799e78b3f8a25090dc6c1b3793fca9173c5ef8f2de360a88a1" }, "statement": "The mapping preserves distinct facility, national-public-PHC and aggregate observations without inferring a single national delivery architecture.", "tags": [], "territory": "Thirteen PHCs in four states; national public-PHC assessment; separate Nigeria aggregate indicator", "title": "Bounded PHC observation, national public-PHC assessment and separate capacity series", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.ebi.ac.uk/europepmc/webservices/rest/PMC10021956/fullTextXML" }, { "kind": "source_reference", "source": "Hospital beds per 1,000 people, Nigeria", "url": "https://api.worldbank.org/v2/country/NGA/indicator/SH.MED.BEDS.ZS?format=json" }, { "kind": "source_reference", "source": "Assessment of the compliance with minimum quality standards by public primary healthcare facilities in Nigeria", "url": "https://www.ebi.ac.uk/europepmc/webservices/rest/PMC11440655/fullTextXML" } ] }, { "analytical_mapping": { "mapping_basis": "Federal Ministry child-survival action plan", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:NGA:relationships-networks:formal-multilevel-accountability-plan", "source_projection_ids": [ "country-improvement-source:NGA:child-survival-action-plan-2025-2029" ], "support_state": "candidate_supported", "target_slot": "formal-national-state-lga-accountability-plan", "target_view": "functions", "typed_fields": { "boundary": "It is a programme-specific formal coordination and accountability design, not evidence of an operating all-condition clinical network.", "formal_plan": "The plan calls for child-health technical working groups and quarterly tracking at national, state, LGA and community levels." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Federal Ministry of Health and Social Welfare, Nigeria Child Survival Action Plan 2025-2029.", "country_ids": [ "NGA" ], "coverage_domains": [ "actors", "authoritative_review", "decision_rights", "governance", "government_responsibilities", "networks", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "track progress at National State level", "institution": null, "locator": { "description": "PDF pages 39-40, leadership, governance and accountability activity matrix." }, "material_id": "material:b3e8a0c018fa4eb2d5adb449", "notes": [ "Do not infer that the planned groups exist in every jurisdiction, have general statutory authority or demonstrate observed care-network performance." ], "origin": "candidate-analytical-mappings", "period": "Action-plan period 2025-2029", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "fe86e744a06305344ec97296bd9d6cce518740e0e897f473489e1ba9b04627b6" }, "statement": "The child-survival plan sets out a coordination design across levels; it does not itself prove network operation or clinical integration.", "tags": [], "territory": "Nigeria; national, state, local-government and community levels", "title": "Formal multi-level coordination and accountability plan", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://health.gov.ng/wp-content/uploads/2025/07/Nigeria-Child-Survival-Action-Plan.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "Official 2016 policy, 2018-2022 strategic plan and 2025-2029 child-survival action plan", "mapping_group": "time_and_reform", "mapping_id": "candidate-mapping:NGA:time-reform:formal-policy-and-plan-records", "source_projection_ids": [ "country-improvement-source:NGA:national-health-policy-2016", "country-improvement-source:NGA:second-national-strategic-health-development-plan-2018-2022", "country-improvement-source:NGA:child-survival-action-plan-2025-2029" ], "support_state": "candidate_supported", "target_slot": "formal-2016-policy-and-2025-plan-records", "target_view": "reforms", "typed_fields": { "boundary": "These formal records do not establish realised completion, coverage, institutional operation or outcomes.", "formal_record": "The three sources record a 2016 national policy, a 2018-2022 national strategy and a 2025-2029 child-survival action plan." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Federal Ministry of Health, National Health Policy 2016 and Second National Strategic Health Development Plan 2018-2022; Federal Ministry of Health and Social Welfare, Nigeria Child Survival Action Plan 2025-2029.", "country_ids": [ "NGA" ], "coverage_domains": [ "authoritative_review", "governance", "government_responsibilities", "networks", "primary_care", "referral_design", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "Roles and responsibilities", "institution": null, "locator": { "description": "National Health Policy PDF pages 47-54; NSHDP II PDF pages 18, 53 and 63; NCSAP PDF pages 10 and 39-40." }, "material_id": "material:9ee42890fe1309d346417a92", "notes": [ "Do not convert formal policy, strategic or planned activity into a claim of nationwide implementation, improved accountability, facility functionality, referral performance or outcomes." ], "origin": "candidate-analytical-mappings", "period": "Formal records published 2016, 2018 and 2025", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "842b28d53412f0a521eb2db5d4f0c1eddb10bf8520e43c776807996c0f8306bd" }, "statement": "The mapping records three formal policy and planning documents without treating them as proof of completed reform effects.", "tags": [], "territory": "Nigeria", "title": "Formal policy and plan records retain implementation boundary", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://extranet.who.int/countryplanningcycles/sites/default/files/public_file_rep/NGA_Nigeria_National-Health-Policy_2016-.pdf" }, { "kind": "source_reference", "source": "Second National Strategic Health Development Plan 2018-2022", "url": "https://extranet.who.int/countryplanningcycles/sites/default/files/public_file_rep/NGA_Nigeria_Second-National-Strategic-Health-Development-Plan_2018-2022.pdf" }, { "kind": "source_reference", "source": "Nigeria Child Survival Action Plan 2025-2029", "url": "https://health.gov.ng/wp-content/uploads/2025/07/Nigeria-Child-Survival-Action-Plan.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "Observed mixed-methods PHC case study with separately bounded childbirth-referral data-source analysis", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:NGA:relationships-networks:observed-phc-secondary-referral-linkages", "source_projection_ids": [ "country-improvement-source:NGA:ncd-phc-case-study-2023", "country-improvement-source:NGA:childbirth-referral-data-sources-study-2021" ], "support_state": "candidate_supported", "target_slot": "case-study-phc-secondary-linkages", "target_view": "referrals", "typed_fields": { "boundary": "Neither source establishes a national network, referral completion rate, counter-referral rate or bypass rate.", "observed_linkage": "All thirteen case-study PHC facilities had linkage with at least one secondary facility for patient referral.", "scope": "The linkage finding covers thirteen PHC facilities in four states; 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PLOS Global Public Health, 2023; Radovich E, et al. BMC Health Services Research, 2021.", "country_ids": [ "NGA" ], "coverage_domains": [ "facility_data", "hospital_organization", "networks", "observed_referral", "patient_flows", "primary_care", "referral_design", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "All PHC facilities had linkage", "institution": null, "locator": { "description": "Ojo et al., XML Findings section; Radovich et al., XML Abstract, Methods and Results." }, "material_id": "material:d2690fbfb96efbd4ee68e6fc", "notes": [ "Do not generalize thirteen facility links to all Nigerian facilities or infer completed referral, counter-referral, transport availability or national patient-flow performance. The childbirth study does not supply a single national referral metric." ], "origin": "candidate-analytical-mappings", "period": "Studies published 2021 and 2023", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "research_literature" ], "source_system": null, "source_version": { "detected_media_type": "text/xml", "response_sha256": "4bf441ed730672799e78b3f8a25090dc6c1b3793fca9173c5ef8f2de360a88a1" }, "statement": "The PHC study supports a place-bounded referral-linkage observation; the childbirth study reinforces that referral measures depend on their data source and scope.", "tags": [], "territory": "Thirteen PHCs in four states; separately scoped national, state and city childbirth-referral data", "title": "Observed PHC-secondary links in a bounded case study", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://www.ebi.ac.uk/europepmc/webservices/rest/PMC10021956/fullTextXML" }, { "kind": "source_reference", "source": "Critical comparative analysis of data sources toward understanding referral during pregnancy and childbirth: three perspectives from Nigeria", "url": "https://www.ebi.ac.uk/europepmc/webservices/rest/PMC8420846/fullTextXML" } ] }, { "analytical_mapping": { "mapping_basis": "Observed urban-slum consumer referral study", "mapping_group": "delivery_and_referrals", "mapping_id": "candidate-mapping:NGA:delivery-referrals:urban-slum-referral-observation", "source_projection_ids": [ "country-improvement-source:NGA:urban-slum-referral-study-2025" ], "support_state": "candidate_supported", "target_slot": "observed-urban-slum-referral-proportion", "target_view": "referrals", "typed_fields": { "boundary": "This is not a national referral, bypass, completion or counter-referral rate.", "observed_result": "The survey reports that 7.4% of 1,025 participants received referrals from primary healthcare sources.", "scope": "Eight urban slums in Enugu and Anambra states." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Ezeh A, et al. 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"country-improvement-source:NGA:primasys-case-study-2017" ], "support_state": "candidate_supported", "target_slot": "no-provider-autonomy-score-from-selected-sources", "target_view": "autonomy", "typed_fields": { "boundary": "The selected source does not establish a current categorical financial, workforce, procurement, capital, operations or service-mix autonomy score for primary-care facilities or hospitals.", "reported_context": "The 2017 case study describes tier autonomy and authority." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization, PRIMASYS case study from Nigeria, 2017.", "country_ids": [ "NGA" ], "coverage_domains": [ "autonomy", "decision_rights", "governance", "hospital_organization", "primary_care", "reform_history" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "substantial autonomy and exercise considerable authority", "institution": null, "locator": { 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[ { "kind": "url", "source": "not supplied", "url": "https://iris.who.int/server/api/core/bitstreams/719f400d-ce34-4f63-86e8-8bd091069d35/content" } ] }, { "analytical_mapping": { "mapping_basis": "WHO PRIMASYS reported public-private context", "mapping_group": "actors_and_functions", "mapping_id": "candidate-mapping:NGA:actors-functions:public-private-context-boundary", "source_projection_ids": [ "country-improvement-source:NGA:primasys-case-study-2017" ], "support_state": "candidate_supported", "target_slot": "reported-public-private-provider-context", "target_view": "public-private", "typed_fields": { "boundary": "It does not supply a nationally current market share or ownership denominator.", "reported_context": "The case study describes a largely public-sector-driven system with substantial private-sector service provision." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization, PRIMASYS case study from Nigeria, 2017.", 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"country-improvement-source:NGA:bhcpf-project-implementation-completion-report-2022", "country-improvement-source:NGA:ondo-phc-synergy-case-study-2013" ], "support_state": "candidate_supported", "target_slot": "reported-federal-state-local-service-tiers", "target_view": "functions", "typed_fields": { "boundary": "This reported arrangement is not a current legal authority matrix or proof that all tiers operate identically.", "corroborating_context": "The World Bank materials provide dated reported context on shared PHC financing and a historically bounded Ondo collaboration case.", "reported_roles": "The 2017 WHO case study reports federal stewardship and tertiary provision, state control of secondary hospitals, and local-government primary-health-care responsibility." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization, PRIMASYS case study from Nigeria, 2017; World Bank, BHCPF ICR, 2022; Atim and Bhatnagar, 2013.", "country_ids": 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The Ondo case is not a national finding." ], "origin": "candidate-analytical-mappings", "period": "Reported sources published 2013, 2017 and 2022", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "a96a59d4d43a0faa052ac02e09bb9ab5f74c24b621b0f69960d10c306850b2d7" }, "statement": "The linked sources support dated reported tiered organisation context; they do not establish current decision rights or observed national patient flows.", "tags": [], "territory": "Nigeria; Ondo findings remain separately bounded", "title": "Reported federal, state and local service organisation", "urls": [ { "kind": "url", "source": "not supplied", "url": 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"candidate_supported", "target_slot": "reported-policy-and-tier-responsibilities", "target_view": "decisions", "typed_fields": { "boundary": "It does not enumerate contemporary approval, staffing, procurement, capital or service-mix rights by actor.", "reported_decisions": "The case study reports federal policy and standards functions, while describing state and local-government resource-allocation authority." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "World Health Organization, PRIMASYS case study from Nigeria, 2017.", "country_ids": [ "NGA" ], "coverage_domains": [ "authoritative_review", "autonomy", "decision_rights", "governance", "government_responsibilities" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "substantial autonomy and exercise considerable authority", "institution": null, "locator": { "description": "PDF physical pages 7-8, Constitution of Nigeria and Federal responsibilities 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