Community leaders' perspectives on linking formal and informal health providers in Nigerian urban slums: a qualitative study.

Introduction: Poor living conditions and poverty in urban slums mean that informal health providers (IHPs) often dominate health service provision in such settings. We explored the capacity of leaders within slums to contribute to linking IHPs to formal health providers (FHPs), for improved access to quality health services in slums. Method: We purposively selected and interviewed 16 community leaders across 8 urban slums in Enugu and Anambra states in Southeast Nigeria. Transcribed interviews were then analyzed using thematic analysis aided by NVIVO. Finding: Chairpersons and local vigilante security outfits were ubiquitous across urban slum communities- coordinating and influencing actors and health activities within settlements. Oversight functions and lived experiences meant leaders had a good insight into existing community dynamics. Slum leaders acknowledged the differential roles, as well as the strengths and weaknesses of FHPs and IHPs. Linkage establishment was considered potentially useful, and leaders were willing to assist, if the existing shortcomings in FHPs were addressed. Conclusion: Despite being under-recognized, leaders in urban slums have the potential to help the realization of health goals given their grassroots influences. Leaders in urban have strategic positional knowledge and leverage that could catalyze the IHP-FHP linkage conversation and implementation towards improving access to quality healthcare services in slums.