Strengthening Social Welfare Policies and Services: A Path to Improving Basic Healthcare Services in Nigeria

Background

Public health social work in Nigeria is growing, even as the profession of social work grapples with issues of identity, relevance, and legitimacy, with some scholars debating whether it is a standalone profession. This debate has been fueled, in part, due to the lack of a legal framework for practice. However, in 2022, the Nigerian government passed the National Council for Social Works Bill into Law, addressing this need. Amidst these discussions, primary healthcare delivery, in which social work can play a key role, is faced with a weak system, a lack of human resources, and complex political, socioeconomic, and cultural challenges. This paper uses primary and secondary sources to examine how connecting social work education and practice to indigenous forms of knowledge can improve primary healthcare delivery in Nigeria, an essential step for achieving health equity.

Method

Multiple methods were used to examine and argue the need to strengthen public health social work in Nigeria. To identify social work roles, we examined national health policies, including the National Health Act of 2014 and the National Social Protection Policy. For secondary sources, we synthesized relevant literature tracing the development of social work in the health sector, providing context for its relevance. To describe the need for strengthening social work education, we conducted desk review of graduate-level curricula. Finally, we interviewed and held discussions with N=10 social work professionals, academic experts, and representatives from government ministries and NGOs to gather insights on how current structures are shaping social work practice in the health sector. These data were analyzed and synthesized to identify recommendations for improving social work education and practice.

Results

Analyzing multiple sources, we found that the social work profession in Nigeria has transformed from a filial practice rooted in community responsibility during the pre-colonial era to a hybrid practice with roles for both community members and social work professionals during the colonial era. Throughout the colonial era and today, we saw a heavy reliance on foreign educational training materials, international philanthropy, and multi-lateral organizational approaches. Interviews with interlocutors indicate that this reliance has diminished the profession’s relevance in the health sector, as primary healthcare services are locally and communally determined. Given these findings, we contend that recent policies calling for integrating social services in healthcare delivery are an opportunity for the social work profession to integrate local knowledge into education and practice. These changes will recenter a local "social" in social work, enabling the profession to improve its perceived legitimacy and help achieve health equity in Nigeria.

Conclusions and Implications

Though the quest for legitimacy remains contested in Nigeria, the profession should leverage the new constitutional legitimization to strengthen its role in the primary healthcare enterprise, where social work has historically played a significant informal role. Additionally, by contextualizing and recentering social work education and training to fit local context, knowledge, and needs, social workers will develop a critical understanding of Nigeria’s social policy landscape and how to support better policy change that drives health equity in Nigeria.