Non-communicable diseases (NCDs) are now the leading cause of morbidity and mortality globally, with low- and middle-income countries LMICs bearing a disproportionate burden. There are 38 million deaths annually attributable to NCDs, accounting for 68% of all deaths worldwide.1 Cardiovascular diseases, cancers, chronic respiratory diseases , diabetes mellitus and other groups of NCDs increasingly coexist with infectious disease challenges, straining an already fragile health system.2,3 Despite decades of epidemiological and clinical research identifying effective prevention and treatment strategies, population-level outcomes remain suboptimal.4 This gap between evidence and practice underscores the urgent need to rethink NCD care through implementation research, which examines how proven interventions can be delivered effectively in real-world settings.5
Most NCD research in Nigeria has focused on epidemiology, defining prevalence, risk factors, and disease trends. While valuable for policy planning, these insights rarely translate into improved outcomes without practical delivery strategies. The next frontier is shifting from epidemiology to home- and community-based clinical trials, where interventions are evaluated under real-life conditions. Such approaches are critical in settings where facility access is limited, follow-up is inconsistent, and medication cost and availability constrain treatment.6
A major barrier to effective NCD care is poor access to essential medicines. In hypertension and diabetes mellitus, drug affordability has reached crisis levels; the Diabetes Association of Nigeria has recently called for a state of emergency in diabetes care7. High out-of- pocket expenditure undermines treatment adherence and ultimately leads to preventable complications, which are then captured by conventional research only when patients present to tertiar y hospitals. 8 Implementation research offers an opportunity to identify context-specific strategies to improve medicine availability, affordability, and long-term adherence.