Advocacy for Children With Surgical Diseases in Nigeria: National Policy Status, Gaps, and Solutions.

Introduction: An estimated 1.7 billion children, mostly in low- and middle-income countries, lack access to surgical care. Increased focus on, and investment in, children's surgery requires the deliberate and strategic inclusion of children's surgery in healthcare policies. Here we evaluate the status of children's surgical diseases in Nigeria's healthcare policies.

Methods: Key Nigerian policy documents referring to child and adolescent health were identified and analyzed using Collins' 8-step framework for health policy analysis. The search for evidence (3rd step in Colin's framework) included a combination of directed (DCA) and conventional content analysis (CCA). DCA was based on 4 categories (workforce, service delivery, infrastructure and financing) obtained from the surgical systems development framework developed by the Lancet Commission on Global Surgery.

Results: Seven policy documents with child and adolescent health contents were reviewed: the National Child Health Policy (NCHP), National Policy on Development of Adolescents and Young People in Nigeria (NPDAYPN), Nigeria Every Newborn Action Plan (NENAP), Community Health Influencers Promoters and Services Programme (CHIPS), National Surgical Obstetrics Anaesthesia and Nursing Plan (NSOANP), National Guidelines for Comprehensive Newborn Care (NGCNC) and National Strategic Health Development Plan (NSHDP). Only the NSOANP had surgeons involved in its development, comprehensively addressed children's surgical conditions across all categories, and included surgical stakeholders in its implementation.

Conclusion: Children's surgery is not prioritized for specific inclusion within Nigeria's healthcare policies. There is a need for greater collaboration and integration into key healthcare policies. Prioritizing deliberate and strategic inclusion of children's surgery will ensure unmet surgical needs is addressed.