03170nas a2200313   4500000000100000008004100001260005300042653001500095653001300110653003900123653003200162653002100194653002500215653003300240653001900273653001500292653001200307100001700319700001400336700001200350700001500362700001200377700001200389245014600401856008300547300001100630520220100641022001402842       2026                            d  c09/2026bSpringer Science and Business Media LLC10aTrichiasis10aTrachoma10aNeglected tropical diseases (NTDs)10aPost-elimination transition10a Policy analysis10aDocumentary analysis10aHealth-system sustainability10aHealth systems10aEye health10aNigeria1 aNwarienne FO1 aAkyala AI1 aGambo Y1 aAfolayan G1 aUmar ZA1 aAremu S00aAligning national policy with post-elimination reality: a documentary analysis of Nigeria’s trachoma and eye health policy frameworks, 2026  uhttps://link.springer.com/content/pdf/10.1186/s13690-026-02076-x_reference.pdf  a1 - 183 a<p><strong>Background</strong></p>

<p>Achieving disease elimination thresholds does not guarantee the long-term sustainability of health-system functions needed to preserve those gains. Nigeria has made substantial progress towards trachoma elimination, with most formerly endemic states achieving WHO elimination thresholds, creating an urgent need to ensure the sustainability of trichiasis (TT) services and post-elimination surveillance. This study assessed whether Nigeria’s national policy architecture supports this transition and identified gaps in institutionalisation.</p>

<p><strong>Methods</strong></p>

<p>A documentary analysis of six national policy documents spanning NTD programme management, trachoma, eye health, primary health care and health financing was conducted using a six-domain sustainability framework and the Policy Triangle. Provisions were extracted and rated using predefined three-point criteria; 11 of 36 document-domain combinations (30.6%) were independently double-coded (Cohen’s kappa = 0.81).</p>

<p><strong>Results</strong></p>

<p>All six domains were rated Partial; none met the criteria for Adequate. Disease-specific provisions were concentrated in the National Trachoma Action Plan, while eye-health, PHC, financing and information-system policies supplied potential receiving structures. Surveillance and service delivery showed the clearest transition pathways; governance, financing, workforce succession and commodity continuity showed weaker pathways. Policy content, context and actors were generally identifiable, but processes for transferring, financing and sustaining functions within routine systems were consistently under-specified.</p>

<p><strong>Conclusions</strong></p>

<p>Nigeria’s policy architecture provides a foundation for sustaining TT services after elimination, but not yet a coherent transition framework. The principal gap lies in institutionalisation and transition processes. Priorities include explicit ownership, costed financing, workforce succession, post-elimination surveillance-response protocols, and secured commodity continuity, specified before programme structures withdraw.</p>
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