Occupational health remains a marginal aspect of health service delivery in Nigeria, despite a workforce that is greatly informal and unprotected by existing occupational safety and health structures. With an estimated 80-93% informal sector employment in Nigeria, the occupational health infrastructure, which was largely targeted in the Factories Act (Cap F1, LFN 2004) and the National Policy on Occupational Safety and Health (2006), has been developed and adapted for the formal sector. Further, the health workforce is extremely dispiriting due to density of physicians, estimated at 0.29-0.36 per 1,000 population, and a projected shortfall of tens of thousands physicians across the country by 2030. By contrast, the primary health care (PHC) is the most widespread locus where the health system meets the population including working people, and a platform on which basic functions of occupational health can be provided without parallel systems and structures. This paper aims to examine the evidence basis for integration of BOHS through a narrative literature review with a policy analysis, drawing on literature from countries around the world where the integration of BOHS has been explored and experiences from four countries and regions purposively selected to reflect diverse models of health financing and service delivery: Finland, Brazil, Thailand, and Southern African Development Community (SADC). It then compares the existing occupational health policy framework in Nigeria with the WHO/ILO delivered policy framework, explores the challenges for integration by the absence of workforce, funding, education programs, and data collections, both at the national and subnational level, and reviews an emerging subnational example, the first and only occupational health policy implemented at the PHC level in Oyo State, Nigeria, which demonstrates that integration is administratively possible. The review concludes with policy, workforce, service delivery, information systems and research recommendations which are proposed to enable Nigeria shift from being a purely and exclusively formal sector based approach to occupational health to a truly national approach, and to build the case for Universal Health Coverage, as well as a phased implementation plan to this development.

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