Multisectoral Contributions to Health Security and Formal Policy Availability at the Community Level in Nigeria Examining the level of multisectoral contributions and what formal policies exist for health security at the community level in Nigeria

Enyi Ifeoma Etiaba ^* Prince Agwu Obinna E. Onwujekwe

• University of Nigeria, Nsukka, Nsukka, Nigeria

Introduction: Multisectoral collaboration (MSC) and actions at community level are one of strategies deployed in the Primary Healthcare (PHC) system for improving health and well being of the people and addressing the social determinants of health (SDH). However, there is paucity of knowledge on level of multisectoral involvement for health security at community level. This paper provides new knowledge on what multisectoral activities for health undertaken at community level and what can be done to strengthen them.,in Nigeria. Methods: A qualitative cross-sectional study of three states: Akwa Ibom, Anambra and Kano States., was guided by the Expanded Health Systems and WHO PHC Operational frameworks, which recognises collaborations between non-health sector and other societal partnerships , to contribute to community health and proposes multisectoral action as one approach to UHC respectively. Data were collected and triangulated, through 103 in-depth interviews with policymakers (health and non-health sectors), health providers, community leaders; 12 focus group discussions with community members and review of policy documents, and thematically analysed.Results:Several community and household level activities were identified as having been borne out of multisectoral actions. Most activities were initiated by health sector, and others by non-health sectors (Education, Environment, Agriculture, Security, Women Affairs, Social Welfare, Nutrition, Water, Sanitation and Hygiene-WASH), or communities. Multisectoral activities contributed to PHC activities and health security of communities, directly or indirectly, through improving one or several SDH (Water supply, housing, environment, security, food and Nutrition). However, most activities, which involved collaborative engagements with non-health sectors were not backed by any formal policies, but organically initiated and developed to support health security. Support of community leaders and groups facilitated initiation and sustenance of multisectoral activities whilst inadequate formal policy backing and funding were constraints. A multisectoral action plan for non-communicable diseases has been developed but has not been implemented and evaluated. MSC community level is important for harnessing resources outside the health sector for enhancing health security of communities. Such MSC is a powerful tool for strengthening PHC, towards UHC.. However, entrenched and sustained MSC should be undertaken through policy reforms and their implementation, through identifying, promoting, and financing MSC actions.