Published in PLOS One on 2026-04-03, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Martin Njoku, Charles Nwafor, Chinwe Eze, Okechukwu Ezeakile, Anthony Meka, Ngozi Ekeke, Iyama Francis, Daniel Egbule, Joseph Chukwu, Charles Esekhaigbe, Chijioke Osakwe, Edmund Ndudi Ossai, Chibuike Agu, Grace Bernard-Asadu, Chukwuma Anyaike, Clement Adesigbin, Obioma Chijioke-Akaniro, Tunde Ojo, Daniel C. Oshi, Beatrice Kirubi, Jacob Creswell, Ngozi Murphy-Okpala
Source: PLOS One • DOI 10.1371/journal.pone.0345182
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The concept of integrated service delivery was the focus for the envisaged essential health care under one roof. Despite being the central focus of essential health under one roof and a crucial principle of primary health care, relatively little is known about community perceptions on integrated service delivery in low-and middle income countries. This study was designed to examine community perspectives on integrated service delivery for tuberculosis (TB), mental health (MH) and substance use disorder (SUD) in Nigeria.
This was a community-based cross-sectional study design using qualitative data collection methods. Data was obtained from the participants using a pre-tested focus group discussion (FGD) guide. Data was collected from three states in Nigeria including Anambra, Enugu and Nasarawa states. Twelve FGDs were conducted among 116 participants who were beneficiaries of the integrated service delivery for TB/MH/SUD and their relatives. There were four FGDs in each state. The discussions were conducted separately for patients and relatives and for male and female participants. QDA Miner Lit v2.0.6 was used in the thematic analysis of data.
Almost all the participants perceived the three disease entities as being linked to one another hence it may not be the best to manage each condition in isolation thus supporting the integrated approach. The participants noted the positive provider attitude of the healthcare workers involved in the program. They were of the opinion that integrated service delivery (ISD) has improved the awareness of the three disease entities among the populace. Most of the participants expressed their willingness to patronize integrated service delivery at the community level from trained lay health workers. This willingness to patronize was predicated on the approval of the program by the government.
Positive provider attitude of health service providers will be a good boost to efforts to improve health service delivery in Nigeria including integrated service delivery. Government has a key role to play in community acceptance of health service delivery programs. The program increased the awareness of the three diseases among the people. Thus, increasing the community awareness of TB, mental health and substance use disorders should be prioritized. Adopting the integrated service delivery approach will be of value. Consideration should be made on the use of lay health workers for the delivery of such services at the community level especially in rural areas. There is a need to incorporate community perspectives on the value, benefits, barriers and acceptability of integrated service delivery into policies guiding TB/MH/SUD integration in Nigeria.
Background
The World Health Organization (WHO) defines integration of health services as ‘the management and delivery of health services so that clients receive a continuum of preventive and curative services according to their needs over time and across different levels of the health system’ [1]. The concept of integrated service delivery was the focus for the envisaged “essential health care under one roof”. It was also the main reason for the attention paid to primary health care (PHC) in the 1980s [1]. It is regarded as the approach of combining services of multiple interrelated diseases in such a way as to increase overall efficiency of the health system and at the convenience of the patients. This may explain why ‘Pillar one of the WHO End TB Strategy’ focuses on integrated patient-centered care and prevention including action on TB and comorbidities [2].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Martin Njoku, Charles Nwafor, Chinwe Eze, Okechukwu Ezeakile, Anthony Meka, Ngozi Ekeke, Iyama Francis, Daniel Egbule, Joseph Chukwu, Charles Esekhaigbe, Chijioke Osakwe, Edmund Ndudi Ossai, Chibuike Agu, Grace Bernard-Asadu, Chukwuma Anyaike, Clement Adesigbin, Obioma Chijioke-Akaniro, Tunde Ojo, Daniel C. Oshi, Beatrice Kirubi, Jacob Creswell, Ngozi Murphy-Okpala. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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