Reframing continuity of care in Nigeria through the triple helix of collapse framework for understanding health workforce and system failure in low and middle income countries

Continuity of care is a core attribute of effective health systems and a prerequisite for achieving Universal Health Coverage (UHC). In Nigeria, persistent physician migration and workforce instability have been widely discussed as “brain drain,” yet their implications for continuity of care and system sustainability remain insufficiently conceptualized. A narrative review and conceptual synthesis were conducted using peer-reviewed literature and selected grey sources published between 2000 and 2025. Evidence relating to clinical care delivery, medical education and training, and health workforce governance was thematically analyzed to examine how physician mobility interacts with health system performance in Nigeria. The review identified a synergistic breakdown across three interdependent systems: clinical care delivery, medical education, and health workforce governance. Evidence showed that severe workforce shortages, training pipeline erosion, unsafe working conditions, and weak regulatory enforcement collectively disrupted relational, informational, and managerial continuity of care. Physician migration emerged not as an isolated workforce outcome but as a symptom of broader institutional failure that undermined patients’ access to sustained and coordinated care. This review demonstrates that disruptions in continuity of care in Nigeria reflect interconnected failures across clinical, educational, and governance domains. Addressing these challenges requires coordinated reform across all three systems. To make progress toward UHC and the Sustainable Development Goals, integrated strategies that simultaneously strengthen service delivery, workforce training, and governance structures are needed in Nigeria and similar low- and middle-income settings.