Care Plan as an Effective Service Tool to Improving Well-being of Vulnerable Households: A Case Study of Lagos and Calabar, Nigeria

INTRODUCTION

Care plans are an essential service delivery tool that improves the well-being of vulnerable households through structured coordination, empowerment, and service integration.^[1] They function as systematic procedures for identifying needs, setting goals, and implementing and monitoring interventions tailored to individual or household circumstances. Vulnerable households can be defined as those facing socioeconomic, health, or psychosocial challenges. They often struggle with fragmented services and unmet needs.^[2,3] A well-designed care plan is context-sensitive, time-bound, individualized, and family-centered, aiming to achieve measurable improvements in household well-being.

In this study, household vulnerability is defined as the inability of households to meet the minimum standards of well-being consistently over time. This condition is prevalent in low-income developing economies, where households are exposed to multiple stressors, including income instability, inflation, disease outbreaks, flooding, civil unrest, and vulnerability to economic, political, and environmental crises.^[4,5] These challenges tend to hit hardest on households and individuals who are least equipped to handle such shocks. In response, various public health and development agencies have implemented programs aimed at addressing some of the challenges contributing to household vulnerability in developing countries.^[6] Agencies, such as the World Bank, United Nations Development Programme, United States Agency for International Development (USAID), and Department for International Development, have developed and implemented packages and programs targeting the poorest of the poor in countries where households live on <$100 a day.^[7-9]

Despite these efforts, there is limited empirical evidence on the effectiveness of the care plans in reducing household vulnerability. Specifically, the extent to which care plans and the services provided, such as health referrals, educational support, food assistance, shelter improvement, and livelihood strengthening, contribute to measurable improvements remains underexplored.

This study evaluates the effectiveness of care plans in improving the well-being of vulnerable households in program communities in Lagos and Cross River states, Nigeria. The independent variable is the implementation of the care plan, while the change in the household vulnerability status over time is the dependent variable. Outcomes were quantified in terms of vulnerability score differences across eight dimensions: Health, household headship, education level, shelter and housing, food security and nutrition, livelihood means, and household income. Scores were assessed at baseline and 2 years following the execution of the care plan. This study aims to contribute to the evidence base on care planning as a valuable strategy for reducing household vulnerability and informing service provision in contexts of scarcity.

METHODS

Study Design

This study adopted a mixed-method, comparative case study design to examine the effectiveness of care plans in improving the well-being of vulnerable households in Lagos and Calabar, Nigeria. The case management process is indicated in Figure 1. Quantitative data were collected through a cross-sectional survey of selected households in both cities to assess the presence and impact of care plans on well-being indicators. Complementary qualitative data were gathered through in-depth interviews with household members and service providers to explore experiences, challenges, and perceived outcomes of care plan implementation. This design allows for both a broad analysis of patterns and an in-depth understanding of contextual factors influencing care plan effectiveness.

Figure 1:

Case Management Process: Graphic informed by Centre for International Social Work at Rutgers University’s School of Social Work and International Social Service-USA for USAID.

RESULTS

The gender distribution of the respondents in Cross River and Lagos State is shown in Tables 2 and 3, respectively. Also indicated are the Local Government Areas and the Communities.

Vulnerability Status of the Different Communities in Cross River

Figure 2 illustrates the vulnerability status of the different communities in Cross River State, presenting the baseline results for the three categories of vulnerability and those of the follow-up.

Figure 2:

Baseline and follow-up vulnerability of communities in Cross River.

Vulnerability Status of the Different Communities in Lagos State

Figure 3 shows the vulnerability status of the different communities in Lagos State, indicating the baseline results for the three different categories of vulnerability and those of the current study.

Figure 3:

Baseline and follow-up vulnerability of communities in Lagos.

DISCUSSION

The findings of the study shows the significant role care plan can play in reducing the level of vulnerability of households in Lagos and Cross River State. It has contributed immensely to the improvement of health, provision of shelter, food security, household income, means of livelihood, educational level, and general poverty reduction.

The findings of this investigation revealed that out of a total of 14 communities used for the study, 13 communities were significantly impacted by the care plan, while only one community, Waterside in the Apapa Local Government area, remained unaffected during the study period. This may be as a result of poor service delivery and access to the community, given that it was a riverine community. Poor implementation and service delivery have been reported by Brean et al.^[15] to hinder the effectiveness of care plans designed for vulnerable households and individuals, leading to poorer health and social outcomes.

All communities covered in Calabar were positively impacted. Ikot Edem Odo in Akpabuyo had the highest impact, followed by Odukpani Qua, Ikot Awatim 2, Ekorinim 1, and Obotong. In the Lagos region, highly impacted communities were Akinhanmi/Cole, Atobaje, Queens Barracks, and Oke-Koto. Communities that fell into the most vulnerable category in Calabar were the Ikot Edem Odo Community, while in Lagos, we had Keke, Oke-Koto, and Airways. These households needed urgent intervention to help them recover and meet their basic needs. The results of this study showed that many households classified as “More Vulnerable Category” during the baseline assessment improved to a “Vulnerable level,” except for the Obotong community in Calabar Local Government, where three households remained in the “More Vulnerable state.” This can be attributed to the fact that the service rendered by the implementing partner was not delivered to the target population appropriately, or the care plan was not properly documented.

It is evident that the care plan is carefully tailored to meet the needs of households following a thorough assessment. The application of care plans in helping vulnerable individuals recover has been reported by several authors. In health outcomes, the evidence of its effectiveness was reported by Boyd et al.,^[15] who demonstrated that individualized care plans for chronically ill and low-income families led to reduced hospital readmissions and better medication adherence. Similarly, interventions targeting maternal-child health in vulnerable households saw marked improvements in the quality of life and efficiency of health care for older adults with multimorbidity.^[16,17] In terms of social and economic well-being, the “Family-Centered Practice” model used in the UK and Australia integrates care plans with social support services. This model has shown success in enhancing housing stability, school attendance, and financial independence among at-risk families.^[18,19] Care planning has been shown to improve the efficiency and responsiveness of service delivery. Studies have highlighted how inter-agency care planning reduces duplication of services, improves accountability, and helps clients navigate complex systems.^[20,21] Despite the benefits of care plan, it’s implemention faces challenges and limitations, including lack of funding, insufficient staffing, poor inter-agency collaboration, inadequate training of care coordinators, resistance from clients due to stigma or a lack of trust and a “ one-size-fits-all” care plan template that fails to consider cultural, linguistic or contextual differences.^[22]

The effectiveness of the care plan is also dependent on the knowledge and the ability of the community volunteers or case managers conducting the HHVA. Studies have shown that well-trained case managers with cultural competencies and community knowledge are more likely to produce accurate assessments and develop realistic, client-centered care plans.^[20,23] Conversely, poorly trained assessors may overlook critical household vulnerabilities or fail to build trust with families – leading to fragmented or inappropriate care.^[24] It depends on the assessor’s ability and personal experience in asking the appropriate questions in a way that household members can understand and provide the right answers. Hence, continuous professional development, supportive supervision, and standardized HHVA tools can help to improve the consistency and reliability of care planning across various settings.^[25-27]

CONCLUSION AND IMPLICATIONS FOR TRANSLATION

Care plans are an essential delivery service tool that optimizes the welfare of vulnerable households through coordinated coordination, empowerment, and service integration. This study examines the effectiveness of care plan in improving the vulnerability status of Cross River and Lagos States households in Nigeria. As strong as the evidence justifies their effectiveness, challenges still exist, and adaptive strategies, adequate training, and client-centered delivery are needed. Further research needs to focus on digital innovations, cost-effectiveness, and culture-adapted models of care planning.