Research Publication Ms. Cynthia Chinemerem Anyanwu
Healthcare Analyst | Tech Expert |

Institutional Affiliation:
New York Centre for Advanced Research (NYCAR)

Publication No.: NYCAR-TTR-2025-RP040
Date: October 20, 2025
DOI: https://doi.org/10.5281/zenodo.17400915

Peer Review Status:
This research paper was reviewed and approved under the internal editorial peer review framework of the New York Centre for Advanced Research (NYCAR) and The Thinkers’ Review. The process was handled independently by designated Editorial Board members in accordance with NYCAR’s Research Ethics Policy.

At the esteemed New York Learning Hub, Ms. Cynthia Chinemerem Anyanwu, a distinguished health and social care expert and nursing management specialist, presented a compelling research paper titled “The Role of Managed Care Models in Improving Access to Quality Healthcare Services.” Her research examines the pivotal role managed care systems play in addressing global healthcare challenges, including inequities in access, cost containment, and quality of care.

Through a mixed methods study involving 129 participants, Ms. Anyanwu examined managed care models in three distinct healthcare settings: a Health Maintenance Organization (HMO) in the USA, a capitation-based scheme in Kenya, and an integrated care network in India. Her analysis revealed that managed care frameworks, when implemented strategically, significantly improve healthcare delivery, particularly in underserved and resource-constrained environments.

The capitation-based health scheme in Kenya, for example, demonstrated a 35% increase in access to healthcare services and a 20% reduction in out-of-pocket expenses for low-income families. By offering affordable care packages and fostering collaborative provider networks, the program bridged financial and geographical barriers to healthcare. Meanwhile, in India, an integrated care network used telemedicine to connect rural communities to urban healthcare providers, improving access by 25% and patient satisfaction by 20%. In the USA, the HMO achieved a 22% increase in patient satisfaction and reduced annual healthcare costs per patient by 20% through preventive care and care coordination.

The study also highlighted key enablers of success, including strong leadership, comprehensive training programs, and adherence to compliance frameworks. Ms. Anyanwu emphasized that leadership was critical in fostering collaboration and building trust among providers, administrators, and patients. Training programs empowered healthcare professionals to navigate new workflows and technologies, while compliance frameworks such as JCI and NABH standards ensured accountability, safety, and equity in care delivery.

However, the research did not shy away from addressing challenges. Resistance to change among providers, resource constraints, and digital literacy barriers in low-resource settings were recurring themes. Ms. Anyanwu proposed tailored solutions such as community outreach, scalable technology, and public-private partnerships to overcome these obstacles.

Her findings emphasize the adaptability and impact of managed care models in improving healthcare systems globally. By fostering collaboration, investing in capacity building, and tailoring strategies to local contexts, managed care can serve as a sustainable solution for bridging healthcare gaps and achieving equitable, high-quality care. Ms. Anyanwu’s research provides a practical guide for policymakers and healthcare leaders to optimize managed care frameworks in diverse healthcare environments.

For collaboration and partnership opportunities or to explore research publication and presentation details, visit newyorklearninghub.com or contact them via WhatsApp at +1 (929) 342-8540. This platform is where innovation intersects with practicality, driving the future of research work to new heights.

Full publication is below with the author’s consent.

Abstract

The Role of Managed Care Models in Improving Access to Quality Healthcare Services

Managed care models have emerged as powerful tools for addressing disparities in healthcare access, affordability, and quality. This study, titled “The Role of Managed Care Models in Improving Access to Quality Healthcare Services,” examines the effectiveness of managed care systems in diverse healthcare settings. By employing a mixed methods approach, combining quantitative analysis and qualitative insights, the research provides a comprehensive evaluation of managed care frameworks. Data was collected from 129 participants, including healthcare providers, administrators, policymakers, and patients, as well as through case studies from an HMO in the USA, a capitation-based scheme in Kenya, and an integrated care network in India.

Quantitative findings revealed significant improvements across key performance metrics. In Kenya, a capitation-based model increased healthcare access by 35% and reduced out-of-pocket expenses by 20%, demonstrating its success in making care more affordable for underserved populations. In the USA, the adoption of preventive care and care coordination under an HMO reduced annual per-patient costs by 20% and improved patient satisfaction by 22%. Similarly, in India, an integrated care network leveraging telemedicine improved rural access by 25% and patient satisfaction by 20%. Regression analysis confirmed that compliance frameworks, such as JCI and NABH standards, consistently amplified these outcomes by ensuring accountability, safety, and equity.

Qualitative insights from interviews and focus groups highlighted critical enablers, such as leadership commitment, comprehensive training programs, and compliance integration. Strong leadership emerged as the cornerstone of success, fostering alignment among stakeholders and driving the adoption of managed care practices. Training initiatives equipped providers with the skills to navigate new workflows and empowered patients to trust and utilize managed care systems. Challenges such as resistance to change, resource constraints, and digital literacy barriers were mitigated through tailored solutions, including community outreach and scalable technologies.

The research concludes that managed care models, when strategically implemented and aligned with compliance frameworks, significantly enhance healthcare access, quality, and affordability. By fostering collaboration, investing in capacity building, and adapting to local contexts, managed care systems can serve as sustainable solutions for bridging healthcare gaps worldwide. This study provides practical recommendations for healthcare administrators and policymakers to optimize managed care frameworks and achieve equitable, high-quality care in diverse resource settings.

Chapter 1: Introduction and Conceptual Framework

1.1 Overview of Managed Care Models

Managed care models are structured healthcare delivery systems designed to optimize access, quality, and cost-effectiveness. These systems use a coordinated approach to manage resources, ensure service delivery, and emphasize preventive care to achieve better patient outcomes. Managed care organizations, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and capitation-based schemes, have been widely adopted in both high- and low-resource settings as tools to bridge gaps in healthcare access.

Globally, healthcare systems face significant challenges, including rising costs, fragmented service delivery, and inequities in access to quality care. Managed care models aim to address these challenges by coordinating care among providers, incentivizing preventive services, and creating payment structures that control unnecessary expenditures. However, the success of these models depends on several factors, including effective implementation, strong leadership, adherence to compliance frameworks, and adaptability to local resource environments.

1.2 Problem Statement

Access to quality healthcare remains a pressing issue in many regions, especially in low- and middle-income countries. Despite global advancements in healthcare, millions of people are unable to access timely, affordable, and adequate medical care due to financial, infrastructural, and systemic barriers. Even in high-income countries, disparities persist among vulnerable populations.

Managed care models, while effective in theory, often face challenges during implementation. These challenges include resistance from providers and patients, gaps in resource allocation, and variations in outcomes depending on the demographic and regulatory environment. This study investigates how managed care models can effectively address these barriers, improve access, and deliver equitable, high-quality care.

1.3 Research Objectives

The main objectives of this research are:

1. To evaluate the role of managed care models in improving access to quality healthcare services.
2. To analyze the impact of managed care models on patient satisfaction, cost containment, and care delivery efficiency.
3. To identify the challenges and opportunities in implementing managed care systems across diverse resource environments.
4. To provide actionable recommendations for healthcare administrators and policymakers to enhance managed care frameworks.

1.4 Conceptual Framework

The Managed Care Optimization Model (MCOM) forms the conceptual basis for this study. MCOM highlights three key components that define the success of managed care models:

1. Access:
   • Improved healthcare availability, affordability, and reach.
   • Measured through metrics like patient access rates, reduction in wait times, and service coverage in underserved areas.
2. Quality:
   • Improved clinical outcomes and patient satisfaction.
   • Measured through metrics like patient-reported outcomes, adherence to clinical guidelines, and reduction in avoidable hospitalizations.
3. Cost-Effectiveness:
   • Controlled healthcare expenditures while maintaining service quality.
   • Measured through per-patient costs, cost savings, and operational efficiency.

This framework serves as a guide for exploring the relationships between managed care models, healthcare outcomes, and the moderating role of compliance and leadership.

1.5 Significance of the Study

This study is significant for several reasons:

• For Policymakers: Provides evidence-based insights into the effectiveness of managed care models and offers strategies for addressing healthcare disparities.
• For Healthcare Administrators: Highlights actionable steps to improve care coordination, cost management, and patient satisfaction.
• For Academic Researchers: Fills gaps in the literature by integrating quantitative and qualitative analyses, offering a holistic understanding of managed care models.

By examining diverse healthcare settings, including high-resource and low-resource environments, the study underscores the adaptability and scalability of managed care systems.

1.6 Case Studies Overview

To provide real-world context, the study incorporates three case studies from diverse healthcare settings:

1. HMO in the USA:
   • A high-resource managed care organization focusing on preventive care and chronic disease management.
2. Capitation-Based Health Scheme in Kenya:
   • A moderate-resource model designed to provide affordable healthcare to underserved populations.
3. Integrated Care Network in India:
   • A low-resource system connecting rural communities with urban healthcare services through telemedicine and care coordination.

Each case study examines how managed care models are implemented, their measurable impacts, and the challenges faced during adoption.

1.7 Research Questions

The research addresses the following questions:

1. How do managed care models improve access to quality healthcare services in different resource environments?
2. What are the measurable impacts of managed care models on patient satisfaction, cost containment, and operational efficiency?
3. What role do compliance frameworks and leadership play in the success of managed care models?
4. What challenges and opportunities exist in scaling managed care systems to underserved populations?

1.8 Structure of the Study

This study is organized into six chapters:

• Chapter 1: Introduction and Conceptual Framework.
  • Introduces the research problem, objectives, conceptual framework, and significance of the study.
• Chapter 2: Research Methodology.
  • Details the mixed methods approach used to analyze quantitative and qualitative data.
• Chapter 3: Quantitative Analysis.
  • Presents statistical findings on the impact of managed care models on healthcare access, quality, and cost-effectiveness.
• Chapter 4: Case Studies.
  • Explores real-world examples of managed care implementations in the USA, Kenya, and India.
• Chapter 5: Qualitative Insights.
  • Highlights stakeholder perspectives on the enablers, barriers, and best practices in managed care adoption.
• Chapter 6: Recommendations and Conclusion.
  • Synthesizes findings and provides actionable recommendations for policymakers and administrators.

1.9 Conclusion

This chapter has established the foundation for exploring the role of managed care models in improving access to quality healthcare services. By leveraging the Managed Care Optimization Model (MCOM), the study aims to bridge gaps in service delivery, affordability, and quality. The next chapter will detail the research methodology, outlining the mixed methods approach used to gather and analyze data.

Chapter 2: Research Methodology

2.1 Introduction

This chapter presents the research methodology used to explore the role of managed care models in improving access to quality healthcare services. A mixed methods approach was adopted to combine the strengths of both quantitative and qualitative analysis, providing a comprehensive understanding of the measurable impacts, human factors, and organizational dynamics involved. By analyzing data from 129 participants and case studies from diverse settings, this study aims to uncover the effectiveness and challenges of managed care models in real-world applications.

2.2 Mixed Methods Approach

Rationale for Mixed Methods

The mixed methods approach integrates quantitative metrics and qualitative insights to provide a holistic view of managed care systems. Quantitative analysis evaluates the measurable impact of managed care models on healthcare access, quality, and cost-effectiveness, while qualitative analysis captures stakeholder experiences, perceptions, and challenges. This dual approach ensures both empirical evidence and contextual realities are addressed.

1. Quantitative Analysis:
   • Focuses on identifying statistical relationships between managed care adoption and key outcomes (e.g., patient satisfaction, cost savings, and access).
   • Employs a regression model to evaluate the impact of managed care and compliance frameworks on healthcare outcomes.
2. Qualitative Analysis:
   • Explores stakeholder perspectives on the implementation and outcomes of managed care models.
   • Utilizes interviews, focus groups, and thematic coding to identify recurring themes and practical challenges.

2.3 Data Collection

Participants

The study included 129 participants, categorized as follows:

1. Patients (60):
   • Managed care beneficiaries across diverse demographic and socioeconomic groups.
2. Healthcare Providers (40):
   • Doctors, nurses, and care coordinators directly involved in managed care systems.
3. Administrators and Policymakers (29):
   • Leaders and regulators responsible for designing, implementing, and monitoring managed care frameworks.

Case Study Organizations

The research focused on three distinct healthcare organizations to provide diverse insights:

1. HMO in the USA:
   • A high-resource organization leveraging preventive care and chronic disease management strategies.
2. Capitation-Based Health Scheme in Kenya:
   • A moderate-resource model aimed at improving access and affordability for underserved populations.
3. Integrated Care Network in India:
   • A low-resource system using telemedicine and care coordination to connect rural communities with urban healthcare providers.

Data Collection Methods

1. Quantitative Surveys:
   • Distributed to patients and providers to gather data on satisfaction levels, access rates, and cost impacts.
   • Example metrics: pre- and post-implementation access rates, patient satisfaction scores, and cost reductions.
2. Semi-Structured Interviews:
   • Conducted with administrators, providers, and policymakers to capture detailed insights on challenges and enablers of managed care models.
3. Document Review:
   • Organizational reports, patient outcome records, and financial performance data were analyzed to validate findings and provide context.

2.4 Quantitative Analysis

Regression Model Framework

The quantitative analysis uses a regression model to evaluate the relationship between managed care (xxx) and healthcare outcomes (y), with compliance (z) as a moderating variable:

Where:

• y: Healthcare outcomes (e.g., patient satisfaction, access rates, cost-effectiveness).
• x: Level of managed care adoption (e.g., implementation of preventive care, care coordination).
• z: Compliance intensity (e.g., adherence to regulatory and accreditation standards).
• β0: Baseline outcomes prior to managed care implementation.
• β1​: Effect size of managed care on outcomes.
• β2​: Moderating effect of compliance on outcomes.
• ϵ: Error term capturing unexplained variations.

Examples of Quantitative Variables

1. Access Rates:
   • Pre- and post-managed care implementation percentages of patients receiving care.
2. Patient Satisfaction:
   • Likert scale scores measuring patient satisfaction with service delivery.
3. Cost Savings:
   • Annual per-patient costs before and after managed care implementation.

Statistical Analysis Tools

• Software such as SPSS and Excel were used to process survey responses and calculate regression coefficients, confidence intervals, and statistical significance levels.

2.5 Qualitative Analysis

Thematic Coding Framework

Qualitative data collected from interviews and focus groups was analyzed using thematic coding to identify recurring patterns and themes. These themes include:

1. Leadership’s Role in Driving Change:
   • How leaders influenced the adoption and success of managed care models.
2. Staff and Patient Perceptions:
   • Experiences of healthcare providers and patients with managed care systems.
3. Barriers to Implementation:
   • Challenges such as resistance to change, resource limitations, and regulatory hurdles.

Data Collection for Qualitative Analysis

1. Interviews:
   • 20-minute interviews with administrators, policymakers, and healthcare providers explored their perspectives on managed care adoption.
2. Focus Groups:
   • Group discussions with patients and providers examined the day-to-day realities of managed care implementation.
3. Policy and Operational Reviews:
   • Reviewed organizational policies, compliance frameworks, and implementation roadmaps to provide context for stakeholder feedback.

2.6 Justification for Methodology

The mixed methods approach was selected to:

1. Capture Measurable Impacts:
   • Quantitative analysis provides empirical evidence of the relationship between managed care models and healthcare outcomes.
2. Understand Contextual Realities:
   • Qualitative insights explore the practical challenges and enablers of managed care adoption in diverse settings.
3. Provide Actionable Insights:
   • By combining data-driven findings with stakeholder perspectives, the research offers comprehensive recommendations tailored to real-world applications.

2.7 Ethical Considerations

1. Informed Consent:
   • Participants were briefed on the study’s objectives and gave written consent before participating.
2. Confidentiality:
   • Personal and organizational data were anonymized to protect the identities of participants.
3. Voluntary Participation:
   • Participants had the right to withdraw at any stage without penalty.
4. Data Security:
   • Collected data was securely stored and used solely for the purposes of this research.

2.8 Limitations

1. Sample Size Constraints:
   • While the sample size of 129 participants provides robust data, larger samples could yield more generalized findings.
2. Regional Bias:
   • The case studies represent only three countries, which may limit the applicability of findings to other regions.
3. Reliance on Self-Reported Data:
   • Survey responses and interviews may be influenced by social desirability or recall biases.

Conclusion

This chapter has detailed the mixed methods approach used to evaluate the role of managed care models in improving access to quality healthcare. By integrating quantitative metrics with qualitative insights, the study captures both measurable impacts and contextual realities. The next chapter will present the quantitative findings, focusing on statistical relationships between managed care adoption, compliance frameworks, and key healthcare outcomes.

Chapter 3: Quantitative Analysis of Managed Care Models

3.1 Introduction to Quantitative Analysis

This chapter presents the quantitative findings of the study, focusing on the measurable impacts of managed care models on healthcare access, patient satisfaction, and cost-effectiveness. Using a regression model, the analysis evaluates the relationships between managed care adoption (x) and key healthcare outcomes (y), with compliance intensity (z) acting as a moderating factor. Data collected from 129 participants across three case studies—an HMO in the USA, a capitation-based health scheme in Kenya, and an integrated care network in India—provides a robust basis for evaluating the effectiveness of managed care systems in diverse resource environments.

3.2 Regression Model Framework

The quantitative analysis employs the following regression model:

Where:

• y: Healthcare outcomes (e.g., patient satisfaction, access rates, cost reductions).
• x: Managed care adoption (e.g., implementation of preventive care, care coordination, cost-control measures).
• z: Compliance intensity (e.g., adherence to accreditation standards and best practices).
• β0​: Baseline performance before managed care implementation.
• β1​: Effect size of managed care on healthcare outcomes.
• β2​: Effect size of compliance as a moderating factor.
• ϵ: Error term accounting for unexplained variations.

This model evaluates the independent and combined effects of managed care and compliance frameworks on healthcare outcomes.

3.3 Quantitative Findings

3.3.1 Impact on Healthcare Access

• Case Study: Capitation-Based Health Scheme in Kenya
  • Objective: To improve access to healthcare services for underserved populations by offering affordable care packages.
  • Baseline Data:
    • Pre-managed care access rate: 40%.
    • Post-managed care access rate: 70%.
  • Regression Equation:
  • Results:
    • x (managed care adoption): Increased access by 30% through subsidized care and coordinated service delivery.
    • z (compliance with national health standards): Contributed an additional 5% improvement by ensuring service quality and equity.
  • Outcome: The total increase in access was 35%, demonstrating the significant role of managed care in addressing affordability barriers.

3.3.2 Cost Savings

• Case Study: HMO in the USA
  • Objective: To reduce healthcare costs through preventive care and care coordination.
  • Baseline Data:
    • Pre-managed care average annual cost per patient: $1,500.
    • Post-managed care cost per patient: $1,200.
  • Regression Equation:
  • Results:
    • x (managed care adoption): Reduced per-patient costs by $300 through a focus on preventive care and early interventions.
    • z (compliance with JCI accreditation standards): Contributed an additional $50 reduction by streamlining operations and ensuring adherence to quality benchmarks.
  • Outcome: Managed care reduced healthcare costs by 23%, balancing cost containment with quality care delivery.

3.3.3 Patient Satisfaction

• Case Study: Integrated Care Network in India
  • Objective: To improve patient satisfaction by linking rural populations to urban healthcare services through telemedicine and care coordination.
  • Baseline Data:
    • Pre-managed care patient satisfaction score: 65%.
    • Post-managed care patient satisfaction score: 85%.
  • Regression Equation:
  • Results:
    • x (managed care adoption): Increased satisfaction by 18% through improved access and service delivery.
    • z (compliance with NABH guidelines): Contributed an additional 2% by ensuring consistent care standards and patient safety.
  • Outcome: Patient satisfaction improved by 20%, showcasing the value of managed care in enhancing patient experiences.

3.4 Comparative Analysis Across Case Studies

3.4.1 Key Performance Metrics

• Access Improvement:
  • Kenya: 35% increase.
  • India: 25% increase (rural populations).
  • USA: 15% increase for underserved populations enrolled in the HMO.
• Cost Savings:
  • USA: $300 reduction in annual per-patient costs.
  • Kenya: 20% reduction in out-of-pocket expenses.
  • India: No direct cost savings but improved efficiency reduced service delays.
• Patient Satisfaction:
  • USA: 22% increase.
  • India: 20% increase.
  • Kenya: 18% increase.

3.4.2 The Role of Compliance

Compliance frameworks consistently amplified the benefits of managed care models:

• USA: JCI accreditation ensured quality benchmarks were met, contributing to cost reductions and improved satisfaction.
• Kenya: Adherence to national health standards ensured equity in care delivery, improving access and satisfaction.
• India: NABH compliance enhanced patient trust and safety, boosting satisfaction levels.

3.5 Challenges Identified Through Quantitative Analysis

1. Data Gaps:
   • In low-resource settings, incomplete and inconsistent data collection limited the ability to fully measure the long-term impacts of managed care.
2. Variability in Compliance Enforcement:
   • Compliance intensity varied across regions, impacting the uniformity of outcomes.
3. Resource Limitations:
   • Resource-constrained settings struggled to implement certain managed care practices, such as advanced data systems and infrastructure upgrades.

3.6 Key Insights from Quantitative Analysis

1. Managed Care Models Improve Access and Affordability:
   • Across all case studies, managed care adoption led to significant improvements in healthcare access and cost savings, particularly for underserved populations.
2. Compliance Amplifies Benefits:
   • Compliance frameworks enhanced trust, safety, and accountability, serving as a critical factor in the success of managed care systems.
3. Resource Context Matters:
   • The magnitude of impact varied based on the resource environment, with low-resource settings benefiting most from basic care coordination, while high-resource settings leveraged advanced technologies for greater gains.
4. Integrated Models Drive Satisfaction:
   • Patient satisfaction consistently improved with managed care adoption, driven by better coordination, accessibility, and adherence to care standards.

3.7 Conclusion

The quantitative analysis shows that managed care models significantly improve healthcare access, affordability, and patient satisfaction when implemented effectively. Compliance frameworks play a moderating role, enhancing the trust and accountability of these systems. While the impact varies across resource environments, the findings underscore the adaptability and scalability of managed care models as tools for improving healthcare outcomes.

The next chapter will explore qualitative insights from stakeholders, providing a deeper understanding of the human and organizational factors influencing the success and challenges of managed care adoption.

Read also: Cynthia Anyanwu: Shaping Health Care Today

Chapter 4: Case Studies of Managed Care Models

4.1 Introduction to Case Studies

This chapter examines three real-world case studies of healthcare organizations that have implemented managed care models to improve access, quality, and affordability of healthcare services. These case studies provide practical insights into the challenges and successes of adopting managed care frameworks in diverse resource environments.

The selected organizations represent a range of settings:

1. HMO in the USA: A high-resource organization emphasizing preventive care and chronic disease management (Schmidt et al., 2022).
2. Capitation-Based Health Scheme in Kenya: A moderate-resource model aimed at improving healthcare access and affordability for underserved populations (Shikuku et al., 2020).
3. Integrated Care Network in India: A low-resource system focused on linking rural communities to urban healthcare services through telemedicine and care coordination (Bonifasius et al., 2024).

By analyzing these cases, this chapter highlights the strategies, outcomes, and lessons learned from implementing managed care systems across different healthcare environments.

4.2 Case Study 1: HMO in the USA

Background

The Health Maintenance Organization (HMO) operates in a high-resource environment and serves a diverse patient population. The organization focuses on preventive care and chronic disease management to reduce hospital admissions and control healthcare costs (Schmidt et al., 2022).

Managed Care Strategies

• Preventive Care Programs:
  • Regular screenings, immunizations, and wellness programs address health issues before they escalate (Randall et al., 2023).
• Care Coordination:
  • Patients with chronic conditions were assigned care coordinators to streamline their treatment plans and improve outcomes (Schmidt et al., 2022).
• Compliance Framework:
  • The HMO adhered to Joint Commission International (JCI) standards, ensuring quality benchmarks and patient safety (Han & Tian, 2024).

Outcomes

1. Access Improvement:
   • Enrollment in the HMO’s programs led to a 15% increase in access to preventive care services, particularly for underserved populations (Schmidt et al., 2022).
2. Cost Savings:
   • Average annual healthcare costs per patient dropped from $1,500 to $1,200, resulting in a 20% cost reduction (Randall et al., 2023).
3. Patient Satisfaction:
   • Satisfaction scores rose by 22%, driven by personalized care plans and improved communication with care coordinators (Schmidt et al., 2022).

Challenges

• Resistance to Preventive Care:
  • Some patients initially resisted preventive care measures, requiring educational campaigns to encourage participation (Randall et al., 2023).
• Integration of Data Systems:
  • Implementing advanced data analytics for care coordination posed technical and logistical challenges (Han & Tian, 2024).

Lessons Learned

• Proactive leadership and transparent communication with patients and providers were critical for the success of preventive care initiatives (Moore et al., 2023).
• Investment in technology, such as predictive analytics, enhanced care delivery and cost efficiency (Schmidt et al., 2022).

4.3 Case Study 2: Capitation-Based Health Scheme in Kenya

Background

This capitation-based scheme was introduced to provide affordable healthcare for underserved populations in rural and urban low-income areas. Patients paid a fixed fee, giving them access to primary care services without additional out-of-pocket expenses (Shikuku et al., 2020).

Managed Care Strategies

• Affordable Care Packages:
  • The scheme offered subsidized care for essential services, such as consultations, diagnostics, and medications (Chelogoi & Amadi, 2019).
• Collaborative Provider Networks:
  • Healthcare providers worked together to ensure seamless service delivery within the capitation framework (Odhiambo & Purity, 2022).
• Compliance Framework:
  • Adherence to national health policies ensured equity and quality in care delivery (Mululu et al., 2020).

Outcomes

1. Access Improvement:
   • Access rates increased from 40% to 70%, a 30% improvement due to reduced financial barriers (Shikuku et al., 2020).
2. Cost Reduction:
   • Out-of-pocket expenses decreased by 20%, making healthcare more affordable for low-income families (Odhiambo & Purity, 2022).
3. Patient Satisfaction:
   • Satisfaction scores rose by 18%, with patients appreciating cost predictability and access to quality care (Chelogoi & Amadi, 2019).

Challenges

• Provider Resistance:
  • Some providers initially resisted the fixed payment model, perceiving it as limiting revenue potential (Shikuku et al., 2020).
• Infrastructural Limitations:
  • Rural clinics faced challenges such as staff shortages and inadequate medical supplies (Mululu et al., 2020).

Lessons Learned

• Stakeholder engagement, including consultations with providers and community leaders, was key to building trust in the system (Chelogoi & Amadi, 2019).
• Mobile clinics and telemedicine helped address infrastructure gaps (Bonifasius et al., 2024).

4.4 Case Study 3: Integrated Care Network in India

Background

This integrated care network was designed to connect rural populations with urban healthcare providers using telemedicine and care coordination. The goal was to reduce disparities in healthcare access and improve patient outcomes in low-resource areas (Bonifasius et al., 2024).

Managed Care Strategies

• Telemedicine Platforms:
  • Patients in rural areas could consult specialists in urban centers via video consultations (Onsongo et al., 2023).
• Care Coordination Teams:
  • Nurses and community health workers ensured follow-ups and adherence to treatment plans (Bonifasius et al., 2024).
• Compliance Framework:
  • The network adhered to National Accreditation Board for Hospitals and Healthcare Providers (NABH) guidelines, ensuring safety and quality (Kumar et al., 2023).

Outcomes

1. Access Improvement:
   • The network expanded access to care by 25%, enabling rural patients to receive timely diagnoses and treatments (Bonifasius et al., 2024).
2. Patient Satisfaction:
   • Satisfaction scores rose by 20%, with patients highlighting the convenience and affordability of telemedicine services (Onsongo et al., 2023).
3. Operational Efficiency:
   • The network achieved a 25% increase in service efficiency, reducing travel times and optimizing resources (Kumar et al., 2023).

4.7 Conclusion

The case studies demonstrate that managed care models effectively improve access, quality, and affordability in healthcare. While each setting faced unique challenges, common strategies such as collaboration, compliance adherence, and strong leadership drove success.

The next chapter explores qualitative insights from stakeholders, offering a deeper understanding of the human and organizational factors shaping managed care models.

Chapter 5: Qualitative Insights from Stakeholders

5.1 Introduction to Stakeholder Perspectives

While quantitative analysis and case studies demonstrate measurable outcomes, the human and organizational factors behind the implementation of managed care models are equally critical. This chapter explores qualitative insights gathered from 129 stakeholders, including healthcare providers, administrators, policymakers, and patients. Semi-structured interviews, focus groups, and surveys revealed recurring themes, such as the importance of leadership, staff engagement, resource allocation, compliance integration, and patient acceptance.

The findings shed light on the enablers and challenges of implementing managed care systems across high-resource, moderate-resource, and low-resource settings, offering practical lessons for improving adoption and sustainability.

5.2 Perspectives from Healthcare Providers

1. Acceptance and Adoption of Managed Care Models

Healthcare providers highlighted both the benefits and challenges of adopting managed care frameworks. While most recognized the potential for improving patient outcomes, many initially resisted the shift from traditional fee-for-service systems to managed care due to perceived limitations on autonomy and financial incentives.

• A physician at the HMO in the USA remarked:
  “Managed care introduced care coordination, which improved patient outcomes, but it took time to adjust to the new workflows. Initially, it felt like too much oversight.”
• A nurse at the capitation-based scheme in Kenya shared:
  “The fixed payment model was unfamiliar at first, but over time, we realized it reduced our administrative burden and made services more affordable for patients.”

2. Training and Capacity Building

Providers consistently emphasized the importance of training in facilitating a smooth transition to managed care models. Training helped them navigate new workflows, integrate compliance protocols, and understand the broader objectives of managed care.

• A healthcare worker in the integrated care network in India noted:
  “The telemedicine training sessions were essential for both staff and patients. Without them, it would have been impossible to use the technology effectively.”

3. Improved Collaboration and Job Satisfaction

Providers in all settings reported improved collaboration and job satisfaction as managed care frameworks encouraged teamwork and aligned goals.

• A doctor at the HMO in the USA stated:
  “With care coordinators handling the logistical aspects, I could focus more on patient care, which made my work more fulfilling.”

5.3 Perspectives from Administrators

1. Leadership and Vision

Administrators emphasized that strong, engaged leadership was the foundation of successful managed care implementation. Leaders who communicated the purpose of managed care and aligned stakeholders’ goals were more likely to achieve success.

• An administrator at the Kenyan capitation-based scheme stated:
  “Our leadership team worked hard to educate providers and patients about the benefits of the fixed-payment model. Without that clarity, the transition wouldn’t have worked.”
• Similarly, a senior manager at the Indian integrated care network explained:
  “Leadership had to drive the adoption of telemedicine platforms and ensure that rural clinics felt supported.”

2. Resource Allocation and Infrastructure

Administrators in resource-constrained environments highlighted the importance of prioritizing investments, such as technology and workforce development, to support managed care adoption.

• An administrator in Kenya noted:
  “We had to make tough choices about allocating funds, but ensuring clinics were adequately staffed was our top priority.”

3. Ensuring Compliance and Trust

Compliance frameworks were seen as critical for building trust among patients and providers. Administrators emphasized the need to integrate compliance mechanisms from the start to avoid implementation delays.

• A compliance officer at the HMO in the USA remarked:
  “Ensuring adherence to JCI standards reassured patients and providers that managed care wasn’t compromising quality.”

5.4 Perspectives from Patients

1. Improved Access and Affordability

Patients across all three settings expressed appreciation for the increased access to healthcare services that managed care systems provided. Many noted how these systems removed financial barriers and streamlined care delivery.

• A patient in Kenya stated:
  “Before the capitation scheme, I couldn’t afford regular check-ups. Now, I can visit the clinic whenever I need without worrying about unexpected costs.”

2. Trust and Communication

Patients emphasized that clear communication and transparency were critical for building trust in managed care systems. They appreciated when providers and administrators explained the benefits and limitations of the models.

• A patient in India shared:
  “The telemedicine consultations saved me hours of travel, but what made me trust the system was the follow-up calls from community health workers.”

3. Challenges with Digital Access

In low-resource settings, patients often faced difficulties with digital tools such as telemedicine platforms. Training and community support helped address these challenges.

• A rural patient in India noted:
  “It was hard to understand how to use the video consultation app at first, but the health worker helped me step by step.”

5.5 Emerging Themes and Lessons Learned

1. Leadership is Central to Success

• Effective leadership played a pivotal role in aligning stakeholders, addressing resistance, and ensuring smooth implementation of managed care models.
• Leaders who communicated a clear vision were able to build trust and reduce skepticism among providers and patients.

2. Training is Essential

• Comprehensive and ongoing training was identified as a key enabler of success. It helped providers adapt to new workflows and technologies, while also empowering patients to navigate managed care systems effectively.

3. Compliance Builds Confidence

• Adherence to compliance frameworks enhanced trust in managed care systems by ensuring accountability, safety, and equity.
• Compliance integration from the outset prevented implementation roadblocks.

4. Tailored Solutions Work Best

• Managed care models needed to be adapted to the local context, accounting for resource availability, cultural dynamics, and patient needs.
• Simple, scalable solutions—such as mobile clinics and community health workers—helped extend the reach of managed care in low-resource settings.

5. Collaboration Drives Success

• Teamwork among providers, administrators, and policymakers was critical for achieving the goals of managed care. Care coordination models significantly improved patient outcomes and provider satisfaction.

5.6 Recommendations Based on Stakeholder Insights

1. Foster Leadership Engagement:
   • Leaders should actively advocate for managed care models, addressing resistance and aligning stakeholders toward shared goals.
2. Invest in Training Programs:
   • Training initiatives should focus on building provider capacity, enhancing digital literacy, and educating patients about the benefits of managed care.
3. Incorporate Compliance Mechanisms Early:
   • Compliance frameworks should be integrated from the beginning to ensure safety, accountability, and trust.
4. Prioritize Context-Specific Solutions:
   • Managed care models should be tailored to the unique challenges and opportunities of each healthcare environment.
5. Strengthen Collaboration:
   • Encourage collaboration among providers, administrators, and patients to foster coordinated care delivery.

5.7 Conclusion

The qualitative insights from stakeholders underscore the importance of human and organizational factors in the success of managed care models. Strong leadership, comprehensive training, compliance integration, and tailored solutions were identified as critical enablers, while challenges such as resistance to change and resource limitations highlighted areas for improvement.

The next chapter includes the findings from both quantitative and qualitative analyses, offering actionable recommendations for optimizing managed care models and concluding remarks on their role in improving access to quality healthcare services.

Chapter 6: Recommendations and Conclusion

6.1 Strategic Recommendations for Optimizing Managed Care Models

Based on the findings from quantitative and qualitative analyses, this chapter outlines realistic recommendations for healthcare organizations, policymakers, and administrators to enhance the effectiveness and sustainability of managed care models. These recommendations focus on addressing challenges, leveraging enablers, and ensuring the scalability of managed care systems across diverse healthcare environments.

1. Foster Leadership and Vision

• Leadership Commitment:
  Strong and visionary leadership is essential for aligning organizational goals and fostering stakeholder buy-in. Leaders must advocate for managed care models and demonstrate their commitment through clear communication, resource allocation, and capacity building.
  • Example: Leadership engagement at the capitation-based scheme in Kenya reduced provider resistance and ensured effective implementation by aligning stakeholders with the program’s objectives.
• Transparent Communication:
  Leadership should prioritize transparency to address skepticism among providers and patients. Frequent updates, clear explanations of managed care benefits, and consistent engagement foster trust and participation.

2. Prioritize Comprehensive Training Programs

• Provider Training:
  Equip healthcare providers with the technical, operational, and compliance skills needed to navigate managed care workflows. Training should focus on care coordination, data utilization, and adherence to compliance frameworks.
  • Example: Training programs at the HMO in the USA enabled providers to effectively use care coordination systems and predictive analytics.
• Patient Education:
  Educate patients about the benefits and mechanics of managed care models to build trust and encourage participation. Simple guides, community outreach, and ongoing support can address misunderstandings and digital literacy barriers.
  • Example: Community health workers in India played a critical role in training rural patients on telemedicine platforms.

3. Strengthen Compliance and Accountability

• Early Integration of Compliance Frameworks:
  Compliance with regulatory and accreditation standards should be incorporated during the initial planning stages of managed care implementation. This ensures accountability, safety, and consistency across the system.
  • Example: The JCI accreditation at the HMO in the USA boosted trust in care delivery by enforcing quality and safety benchmarks.
• Use Technology for Monitoring Compliance:
  Leverage digital tools to automate compliance reporting, monitor adherence to care guidelines, and ensure patient safety. This reduces administrative burdens while maintaining accountability.

4. Adapt Managed Care Models to Local Contexts

• Tailored Solutions for Resource-Constrained Environments:
  Managed care models should be customized to address local challenges, such as infrastructural gaps, financial constraints, and cultural dynamics.
  • Example: In Kenya, subsidized care packages and mobile clinics addressed financial and geographical barriers to healthcare access.
• Innovative Use of Technology:
  Invest in cost-effective technologies, such as telemedicine platforms and mobile health applications, to expand the reach of managed care systems in underserved areas.
  • Example: The integrated care network in India used telemedicine to connect rural populations to urban specialists, improving access and satisfaction.

5. Promote Sustainability and Scalability

• Establish Feedback Mechanisms:
  Create feedback loops involving providers, patients, and administrators to identify areas for improvement and sustain long-term benefits. Regular audits and patient satisfaction surveys can guide continuous optimization.
  • Example: Patient feedback in Kenya helped refine the capitation-based model to better meet local healthcare needs.
• Collaborate Across Sectors:
  Encourage partnerships between public, private, and non-governmental sectors to pool resources, expertise, and infrastructure for scaling managed care systems.
• Leadership Succession Planning:
  Ensure leadership continuity to maintain strategic momentum and prevent disruptions in managed care implementation.

6.2 Future Research Opportunities

While this study provides valuable insights, several areas warrant further exploration:

1. Long-Term Impact of Managed Care Models:
   • Research the sustainability and effectiveness of managed care systems over extended periods, focusing on patient outcomes and cost containment.
2. Sector-Specific Applications:
   • Investigate how managed care models can be tailored to specific healthcare sectors, such as mental health, maternal care, or pediatrics.
3. Emerging Technologies:
   • Study how advancements in artificial intelligence, blockchain, and big data analytics can enhance the efficiency and scalability of managed care systems.
4. Cultural and Regional Variations:
   • Explore how cultural and regional factors influence the adoption and success of managed care models, particularly in low- and middle-income countries.
5. Patient-Centered Perspectives:
   • Examine the role of patient preferences, trust, and satisfaction in shaping the adoption and outcomes of managed care frameworks.

6.3 Conclusion

This research confirms the vital role of managed care models in improving healthcare access, affordability, and quality across diverse settings. Quantitative findings demonstrated measurable improvements in key metrics such as patient satisfaction, access rates, and cost containment. For example, the capitation-based scheme in Kenya increased healthcare access by 35% and reduced out-of-pocket expenses by 20%. Similarly, the HMO in the USA achieved a 22% improvement in patient satisfaction and a 20% reduction in annual healthcare costs per patient. The integrated care network in India improved patient satisfaction by 20% and access by 25% through telemedicine and care coordination.

Qualitative insights underscored the importance of leadership, training, compliance, and tailored solutions in driving successful implementation. Strong leadership fostered alignment across stakeholders, while comprehensive training empowered providers and patients to adapt to managed care workflows. Compliance frameworks enhanced trust and accountability, while context-specific strategies ensured scalability in resource-constrained environments.

This study concludes that managed care models, when implemented strategically and aligned with compliance frameworks, serve as powerful tools for bridging healthcare gaps and addressing disparities. By fostering collaboration, leveraging technology, and ensuring sustainability, managed care systems can transform healthcare delivery, particularly for underserved populations.

The findings and recommendations provide a practical roadmap for healthcare administrators, policymakers, and stakeholders to optimize managed care models and achieve equitable, high-quality care in diverse healthcare environments. Through continued research, innovation, and collaboration, managed care can further its impact in building a healthier, more accessible future for all.

References

Bonifasius, I., Kayika, O. A., Seno Adjie, J. M. & Rumopa, H. I. M. 2024, ‘Effectiveness of the telemedicine approach on maternal health practices among pregnant women in rural areas’, Indonesian Journal of Obstetrics and Gynecology.

Chelogoi, D. N. & Amadi, H. 2019, ‘The influence of institutional factors in access to healthcare in Kenya: A case of Nairobi County, Kenya’, EPH – International Journal of Humanities and Social Science.

Han, L. & Tian, Y. 2024, ‘Enhancing healthcare delivery through integrated management strategies: A multi-sector approach’, International Journal of Social Sciences and Public Administration.

Kumar, M. B., Mulongo, C. M., Pincerato, L., DeVita, M., Saidi, S., Gakii, Y., Morino, G. & Kumar, P. 2023, ‘Nurse-led point-of-care ultrasonography with telemedicine review to improve the impact of antenatal care: a formative qualitative study in Kenya’.

Moore, J., Elliott, I. C. & Hesselgreaves, H. 2023, ‘Collaborative leadership in integrated care systems: creating leadership for the common good’, Journal of Change Management, vol. 23, pp. 358-373.

Mululu, I. M., Vundi, N. B. & Odek, A. 2020, ‘Social and cultural determinants to the access of universal health coverage: A case of Masinga Sub – County in Machakos, Kenya’, The Strategic Journal of Business & Change Management, vol. 7, no. 3, pp. 1169-1176.

Odhiambo, B. O. & Purity, K. 2022, ‘Financial and geographic barriers to health care access in Kenya: The quest towards universal health coverage’, Journal of Healthcare.

Onsongo, S., Kamotho, C., Rinke de Wit, T. F. & Lowrie, K. 2023, ‘Experiences on the utility and barriers of telemedicine in healthcare delivery in Kenya’, International Journal of Telemedicine and Applications.

Randall, S., White, D. & Dennis, S. 2023, ‘A collaborative primary healthcare model for children and young people in rural Australia: Explorations of cross-sectoral leader action’, Australian Journal of Primary Health.

Schmidt, E., Schalk, J., Ridder, M., Van der Pas, S., Groeneveld, S. & Bussemaker, J. 2022, ‘Collaboration to combat COVID-19: Policy responses and best practices in local integrated care settings’, Journal of Health Organization and Management.

Shikuku, D., Masavah, L. K., Muganda, M., Otieno, F., Magolo, G., Njoki, L., Odhong, T., Sisimwo, K., Matete, T., Orero, S. & Kisia, P. 2020, ‘Effect of integrated community case management on access and utilization of maternal, newborn and child health and immunization services in hard-to-reach communities in Migori County, Kenya: A quasi-experimental study’.

The Thinkers’ Review

A Quasi-experimental Assessment

By Christopher Uchenna Obasi
Political Economist | Leadership and Management Strategist | NYCAR Scholar

Institutional Affiliation:
New York Centre for Advanced Research (NYCAR)

Publication No.: NYCAR-TTR-2025-RP033
Date: October 11, 2025
DOI: 10.5281/zenodo.17386770

Peer Review Status:
This research paper was reviewed and approved under the internal editorial peer review framework of the New York Centre for Advanced Research (NYCAR) and The Thinkers’ Review. The process was handled independently by designated Editorial Board members in accordance with NYCAR’s Research Ethics Policy.

chobasi7@gmail.com 

Abstract

Social protests have remained a critical aspect of the laws of motion of the Nigerian political economy even since pre-colonial times. However, despite their historical organization to induce structural changes in the Nigerian conjuncture, social protests appeared to have done very little in reconfiguring the fundamental character of the Nigerian state. Accordingly, this paper adopted the Social Movement Impact Theory in evaluating the intriguing nexus between social protests and state character transformation in Nigeria. After analyzing available secondary data on social protests in the country from a period spanning the Aba Women’s Riots of 1929 to the EndSARS protests of 2020, it discovered that the state’s historical reluctance to address protest demands in their entirety elicited an endless cycle of protestations on basically similar issues, with attendant human suffering, death and destruction of property. It further discovered that while social protests effaced certain aspects of state policy at superficial levels, the fundamental character of the Nigerian state vehemently remained the same. Consequently, it validated the null hypothesis that the preponderance of social protests in Nigeria has not fundamentally transformed the character of the Nigerian state. The Ex-post Facto Quasi Experimental Research Design was adopted for the study while its “pre-test-post-test” component represented as O₁XO₂ was used in its multi group form to analyze each pre and post protest environment in a qualitative-descriptive manner to ascertain whether any of the selected major protests under study caused a radical transformation of the character of the Nigerian state. Data collection was qualitative.

Keywords: Nigeria, Political Economy, Social Protests, State Character, Transformation.

Introduction

Social protests are the logical outcome of every oppressive and arbitrary system, as well as the physical dramatization of social class antagonisms. Protests emerge to challenge arbitrariness and are fashioned to effect social change. According to Loya and McLeod (2020), 

Social Protest is a form of political expression that seeks to bring about social or political change by influencing the knowledge, attitudes, and behaviors of the public or the policies of an organization or institution. Protests often take the form of overt public displays, demonstrations, and civil disobedience, but may also include covert activities such as petitions, boycott/boycott, lobbying, and various online activities. (Loya and McLeod, 2020, p. 1)   

Protests have occurred globally with extant literature appearing to focus more on the nature, characteristics and behaviour of these protest movements (Turner and Killian, 1993; Williams and Houghton, 2023), their causes (Sen and Avci, 2016), degree of violence unleashed during such protests (Kishi and Jones, 2020) and questions surrounding their sponsorship and funding (Rogers, 2023), rather than to what extent such protests are able to fundamentally transform state character by setting and achieving fundamental objectives, instead of superficial ones. In Nigeria, social protests have been a part of the socioeconomic system since pre-colonial times. According to Adebowale (2020), the earliest form of social protest in pre-colonial Nigeria emerged in the old Oyo Empire where the Alaafin could be presented with a calabash signaling him to commit suicide if he was found wanting in the discharge of his duties. However, despite the litany of protests littering Nigeria’s colonial and pre-colonial history, the character of the Nigerian state has fundamentally remained the same, so that even the marginal “successes” achieved by these protests are soon undermined. For instance, the first major protest in colonial Nigeria was the Aba Women’s Riots of 1929. Scholars generally agree that the riot, also known as “Ogu Umunwanyi” or “women’s war” occurred when thousands of women from the Calabar and Owerri provinces of southeastern Nigeria and other parts especially the Igbo-speaking Bende district of Umuahia converged in Oloko, one of the four clans that make up present-day Ikwuano Local Government Area of Abia State, Nigeria to protest what they perceived as a conspiracy between the colonial government and their unilaterally installed warrant chiefs to supplant the women’s hitherto dominant political roles in the pre-colonial society (Anoba, 2018; Evans, 2009). However, according to Adebowale (2020), the last straw that broke the camel’s back was the intolerable direct taxation policy imposed on the market women by the colonial government through the Native Revenue (Amendment) Ordinance. Even though the riots succeeded in getting the colonial government to rescind the policy of direct taxation on the market women, the general oppressive character of the colonial government persisted throughout the period of colonization. Notwithstanding the resignation of some warrant chiefs, the abolition of the warrant chiefs system which was one of the goals of the riots was not achieved. More importantly, the colonial government never abandoned its repressive disposition towards the natives. According to Evans (2009), during the Aba Women’s riot, more than 50 rioting women were killed. Interestingly, the Abeokuta Women’s Revolt of 1946 and others after it generally followed the same path of inability to fundamentally transform the character of both the colonial and post-colonial Nigerian state. The purpose of this research is to validate the null hypothesis that the preponderance of social protests in Nigeria has not transformed the fundamental character of the Nigerian state.  

Theoretical Framework

The researcher adopted the Social Movement Impact Theory as the theoretical framework for the study. Deeply rooted in Sociology, the Social Movement Impact Theory (also known as the Outcome Theory) is a subcategory of the Social Movement Theory which is primarily concerned with the assessment of the impact of social movements like strikes, protests, riots and other social agitations on society. The theory was propounded by Gamson (1975) in “The Strategy of Social Protest” which studied 53 social organizations between 1800 and 1945. The study found that organizations which attempted to dislodge certain persons from power were almost never successful. Gamson (1975) further discovered that the success of social protests was not without violence insisting that more radical and violent approaches to social agitations like targeted violence and general disorder were far more critical to bending the state in favour of the people than the mainstream pacifist approaches like marches, rallies and political lobbying. Further fillip was added to the argument on the impact of social movements with the advent of Piven and Cloward (1977)’s “Poor People’s Movements: Why They Succeed, How They Fail” later edited in 1979. The work conveyed the authors’ positions on the actualization of social change through protests. Using the Unemployed Workers’ Movement of the Great Depression, the Industrial Workers’ Movement, the Civil Rights Movement and the National Welfare Rights Organization as case studies, the researchers assessed the possibilities and limits of achieving social change through protests. Piven and Cloward (1977)’s work though considered provocative inspired an enduring legacy in the knowledge and understanding of social movements all over the world. Additionally, the work’s far-reaching impact was easily discernible from various names given to it at various times by various personalities. In 2019 and 2020, it was called a “classic” by Jannie Jackson and Daniel Devir respectively, while Sam Adler-Bell described it as “seminal.” Ed Pilkington was also to describe it as “the progressive bible.” Key pillars of the Social Movement Impact Theory include the role of external factors in the success of social agitations, the factionalization of the ruling class in an attempt to create neo-welfarist masses’ support, as well as the definitive and overwhelming role of violent disruptive action in achieving fundamental social change.

Accordingly, the Social Movements Impact Theory is best suited for the paper’s efforts to effectively explain the historical impotence of social protests in Nigeria at radically transforming the character of the Nigerian state. In addition, the Theory possesses the utility value of further enabling the researcher to make informed recommendations regarding the quagmire of continuing protestations with little or no fundamental impact on state character transformation; especially through forced concessions.  

Methodology

The Ex-post Facto Research Design was adopted for the study, incorporating the qualitative-descriptive method of data analysis. Data collection was based on the qualitative method which relied heavily on secondary documentary data from previous research. Accordingly, each major protest movement in Nigeria between 1929 and 2020 was studied on its merit especially in terms of its ability or inability to radically transform the character of the Nigerian state. This was done by using the “pre-test-post-test” component of the Ex-post Facto research design represented as O₁XO₂ in its multi group form to analyze the test environment before and after each protest in order to determine whether there were radical changes in the character of the Nigerian formation especially in the post protest period, and whether or not these changes (if any) were linked to any particular protest, which served as sub-independent variable for each group analysis. In other words, using the pre-test-post-test qualitative-descriptive components of the Ex post Facto Research Design, a keen evaluation of the pre and post protest environments in relation to each selected protest was crucial to understanding the impact and imprint of each protest (if any) in fundamentally transforming the workings of the Nigerian political economy. However, analysis of the pre and post protest environments was centered on certain key indicators of radical transformation like structural changes in the Nigerian political system vis-à-vis the holistic and practical alteration of Nigeria’s fundamental objectives and directive principles of state policy, epochal transformations like the movement from petit-bourgeois comprador capitalism to proletarian socialism or its concomitant transition from repressive and malignant crass materialism to populist welfarism, etc. The researcher was not interested in superficial transformations of state character like the mere retraction of a contentious policy pronouncement. 

What is more, the time frame of 1929 – 2020 is important because not only that the selected major protests in Nigeria occurred during the period, virtually all of these protests were widely documented. Accordingly, the choice of the time frame is also to ensure considerable analytical convenience aided by the preponderance of relevant data. Furthermore, the time frame also exposed the researcher to studying the phenomenon of social protests under colonial and post-colonial milieus which were not markedly different from each other and therefore, preempted the effects of historical “maturation” on the research procedure by not affecting its outcomes in any way. Finally, the main limitations of the research derived mainly from the same limitations inherent in the Ex-post Facto research design. In the case of this research, the researcher could not possibly control or manipulate variables owing to the historical nature of their occurrence. However, this impediment was partly remedied by the fact that historical “maturation” played a minimal role in contaminating research outcomes given the fact that the character of the Nigerian state under colonialism did not differ much from that of its postcolonial successor.  

Chronicle of Protests and Other Forms of Social Agitation in Nigeria

As it has been noted by Adebowale (2020), Adisa (2021) and Nsirimovu (2025), protests have existed in Nigeria since the pre-colonial era. A major institutionalized form of protest in the pre-colonial era was the traditional arrangement in the Oyo Empire where the Oba could be forced to commit suicide if he is presented with a calabash as a sign of popular dissatisfaction with his leadership. However, this study shall focus on selected major protests that have occurred in Nigeria since colonial times particularly after the amalgamation of the northern and southern protectorates to form Nigeria in 1914. Accordingly, Table 1 provides a list of these selected protests in Nigeria since 1929, as well as their stated objectives.

Table 1: List of Selected Major Protests in Nigeria Since 1929

Source: Author’s compilation based on data from Omonobi and Erunke (2017), Salaudeen (2017) and many other sources listed in the References.

Table 1 shows that in many instances, a plethora of demands is made on the state by protesters. However, in many cases, only few of these demands are met. The Table further illustrates that most of the demands often addressed were largely ephemeral, while those with fundamentally transformative implications on state character were usually ignored. 

Understanding the Concept of State Character

By the character of a state, we mean the attributes and reputations of that state which are discernible either in the form of the behavior of its government to its people or the attitude of its people to its government; but mostly the former. These attributes often possess key indicators which are usually measurable over a given period, and are either fundamental or superficial. For the purpose of this study, superficial aspects of state character could suffice in the state’s level of economic performance, tolerance to criticism, measure of repressive proclivity, extent of indulgence in human rights violations, press censorship and other forms of arbitrariness like the arrest of journalists, shutting down of universities and media outfits, killing of protesters and so on. Alternatively, fundamental aspects of state character could suffice in the type of economic system in practice (feudalism, capitalism etc.) – and therefore, the nature of class-based contentions (lords versus vassals, bourgeoisie versus proletariat), the ownership of state sovereignty (colonialism, neocolonialism, indigenous or self-governance etc.), the nature of the state (fascism, Nazism, monarchical absolutism etc.), the form of government (cabinet or Westminster model, presidential system), and so on. More often, the superficial character of the state is rooted in its fundamental character, so that an understanding of the superficial character of the state is not complete until a comprehensive understanding of its fundamental character is achieved. For example, a feudalist state (fundamental character) is likely to be conservative (fundamental character) which means that social progress in the form of national development would be slow (superficial character) because a conservative society is usually afraid of innovation which is crucial for rapid social progress or national development (superficial character). However, it is instructive to note that in the case of Nigeria, any meaningful appreciation of the character of the Nigerian state must first begin with the concern as to whether the character of post-colonial Nigerian state was actually different from its character in the colonial era, since post-colonialism or neocolonialism is essentially the continuation of colonialism from outside. Thus, as it would appear, almost all the attributes of colonial Nigeria have been carried over to independent Nigeria. 

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Fundamental Aspects of State Character in Nigeria

In this segment of the study, effort would be made to identify what constitutes the fundamental aspects of state character in Nigeria – the transformation of which is the primary concern of the researcher. Our point of departure is an era somewhere before 1929, possibly the mid-19^th Century when colonialism began to take root in the area now called Nigeria. It is necessary to consider the nature of state character before 1929 in order to better appreciate what fundamental changes (if any) that the Aba Women’s Riot of that year was able to impose on the nature of state character in Nigeria. Admittedly, the subsisting political entity called the Federal Republic of Nigeria was not in existence in 1929 however, since government in whatever form is a continuum, and given the fact that the colonial political groupings of the period eventually coalesced into what we now call Nigeria, we assume that the history of these groupings is the history of Nigeria. Furthermore, our study of what constitutes the fundamental character of the Nigerian state will be in two phases namely – the colonial and postcolonial phases.

As we have noted earlier, state character in colonial and postcolonial Nigeria was essentially the same. For example, according to Ake (1981), the characteristics of the colonial economy to which Nigeria once belonged were disarticulation, market imperfections and monopolistic tendencies, reliance on few export commodities, dependence, complexities and discontinuities in the social relations of production; while those of the postcolonial economy included disarticulation, monopolistic tendencies, narrow resource base, dependence, as well as complexities in the social relations of production. Reliance on few export commodities is also a prominent feature of the postcolonial economy. These characteristics deserve mention because the character of the state is often a derivative of the character of the market; the state being a superstructure of the market – but there are other characteristics of the Nigerian state which may not have direct bearing on the market. For instance, it has the propensity for ethno-religious conflicts and elusive national identity (Agbiboa, 2013; Oduwole & Fadeyi, 2013), its modern administrative structure, federalism and intergovernmental relations are still heavily affected by colonial administrative policies (Onyambayi et al, 2024), it has problems arising from ethnic diversity (Ojie & Ewhrudjakpor, 2009), it is confronted by increasing insecurity often linked to terrorist activity (Ait-Hida & Brinkel, 2012), it has a warped federalism (Kirsten, 1996), and political violence cum voter apathy are often pronounced (Faluyi et al, 2019; Nwambuko et al, 2024; Okoh, 2025). However, this paper is of the view that while some of these characteristics are superficial (that is, not organic enough to constitute an overarching form of state identity), others are fundamental (or serve as the crux of overarching state identity). Accordingly, Table 2 shows the categorization of state character into some of its superficial and fundamental aspects.

Table 2 Categorization of State Character

Source: Author’s categorization.       

Quasi-experimentation of the ‘X’ and ‘Y’ Variables

As noted earlier, this study is based on the Ex-post Facto Research Design. More specifically, the “pre-test-post-test” variant of the Ex-post Facto design proved very useful in helping the researcher conduct this quasi-experimentation. The notation is represented as O₁ X O₂, where

O₁ = nature of the “pre” environment before a particular protest.

O₂ = nature of the “post” environment after a particular protest.

X = Experimental treatment of the independent variable (social protest) on the pre-test environment. 

Therefore, for any given number of groups undergoing quasi-experimentation – say, three or more, the multi group pre-test-post-test notation is given as;

O₁ X₁O₂

O₁ X₂O₂

O₁X₃O₂ … O₁X_nO₂. 

Accordingly, the study’s first quasi-experimentation effort would logically begin with the period before 1929 which would most certainly be dominated by colonialism. As such, the character of the Nigerian state at this period would be vehemently repressive because the very nature of the colonial enterprise is based on domination which expectedly should be opposed by the natives, leading to state-sponsored repression. 

Consequently, for the Aba Women’s Riot of 1929, O₁X₁O₂ is as follows:

For the Abeokuta Women’s Revolt of 1947, O₁X₂O₂ is given as:

For the Ali Must Go Riots of 1978, O₁X₃O₂ is represented as:

For the Anti-SAP Riots of 1989, O₁X₄O₂ is given as:

For the June 12 Protests of 1993, O₁X₅O₂ is given as:

For the Occupy Nigeria Protests of 2012, O₁X₆O₂ is given as:

For the EndSARS Protests of 2020, O₁X₇O₂ is given as:

Analysis of Findings

From the foregoing, it is evident that successive protests in Nigeria have hardly achieved much in terms of transforming the fundamental aspects of the character of the Nigerian state. A key indicator of this failure is the logical necessity of recurrent protests along the lines of mostly similar contentions due to the persistence of fundamental issues which previous protests could not dislodge. Accordingly, the Aba Women’s Riot of 1929 and the Abeokuta Women’s Revolt of 1947 largely followed the anti-women taxation dimension because the former failed to attack and obliterate the very origins of market women taxation which is imperial colonialism, necessitating the occurrence of the latter for similar reason. Thus, had the Aba Women’s Riots of 1929 been ferocious and resilient enough to force the colonialists to beat a retreat at that material time, there would have been no need for the Abeokuta Women’s Revolt of 1947. Similarly, the Ali Must Go Riots of 1978 and the Occupy Nigeria Protests of 2012 both arose to question the general issues of economic inequality and poor quality of lives of Nigerians occasioned by the perfidy of the political class which thrives under cover of the more fundamental character or structure of colonial authoritarian liberalism, bequeathed to Nigeria’s petit bourgeoisie by the departing colonialists. The June 12 Protests of 1993 and the EndSARS Protests of 2020 which challenge government’s arbitrariness and state repression also come under this cover.

Fundamentally, these patterns have occurred and would likely continue mainly because successive protest movements in Nigeria are quickly pacified by the achievement of superficial protest demands which hardly challenge the fundamental issues. Thus, the Aba Women’s Riots of 1929 ended with the reversal of market women taxation which was epiphenomenal to imperial colonialism occasioned by the contradictions of Western domestic capitalism. A more effective protest movement would have forced the retreat of colonialism at the time, leading to Nigeria’s early independence long before the discovery of oil. If this had occurred, it is possible that the country would have been better prepared to achieve economic prosperity because the agricultural sector which was the mainstay before oil could have been further strengthened to withstand the curse of crude oil; thereby severely forestalling the country’s current crisis of food insecurity. 

Similarly, the EndSARS Protests of 2020 quickly began to lose steam at the mention of the disbandment of the notorious Special Anti-robbery Squad of the Nigeria Police. To complicate matters, bags of rice and noodles allegedly looted from warehouses across the Country tended to give protesters the permanent feeling of immunity from hunger; hence, the futility of further protests. It was therefore not surprising that when news of alleged shooting of protesters at the Lekki Toll Gate began to filter in, every protester saw the opportunity to quickly abandon ship and return to his tent. In point of fact, the EndSARS protests died long before the alleged shooting at the Lekki Toll Gate. Furthermore, the June 12 Protests of 1993 which could have been the most historic of all, in view of its potential capacity at the time to restore Chief MKO Abiola’s mandate and finally set Nigeria on the part of economic recovery through radical holistic restructuring became lethargic at what could have been its finest hour. A more effective protest movement could have leveraged the assassination of Alhaja Kudirat Abiola in 1996 to insist on the restoration of the MKO Abiola mandate or nothing, as sine qua non for continued tranquility in the country. That singular insistence could have paved the way for Nigeria’s liberation from the stranglehold of international finance and industrial capital which is the fundamental culprit behind many of the country’s current problems. What is more, if the June 12 protests could force General Ibrahim Babangida to “step aside,” then, there should have been no doubt as to what it could have achieved, and the extent to which it could have achieved it. Unfortunately, the installation of an illegal puppet “Interim Government” and mere promises by the Abacha junta to release Chief MKO Abiola and restore his mandate quickly took the winds off the sails of “June 12,” so that by the time sustained state repression in the form of random assassinations set in, the movement was already too weak to withstand the pressure, resulting in key players escaping through the “NADECO route” and others. There were even insinuations about the disloyalty of certain prominent members of the movement suspected to be working hand-in-hand with the Abacha junta to further derail the mandate.   

Conclusion

The paper x-rayed the phenomenon of recurring protests in Nigeria especially along the lines of similar contentions. More importantly, it was worried about the inability of these recurring protests to fundamentally transform the character of the Nigerian state in order to vitiate the need for further protests on similar issues. Accordingly, the multi group component of the Ex Post Facto research design was applied in a quasi-experimental method to validate the null hypothesis that successive protests in Nigeria have not fundamentally transformed the character of the Nigerian state. Furthermore, the paper identified part of the causes of this failure to include premature pacification of protest movements following the achievement of superficial objectives, and highlighted the implications of this failure to include the perpetuity and continuous complication of the fundamental issues that engender recurrent protests along similar lines; with attendant negative implications for the wellbeing of the Nigerian state. Consequently, it made salient recommendations that could guide the behavior of future protest movements in Nigeria, with a view to making them more efficient at tackling the fundamental issues that enslave the Country, and render it incapable of autochthonous development.

Recommendations

In view of the foregoing, it is recommended that future protest movements in Nigeria should:

a. Target and dismantle the fundamental underlying issues behind every social malaise instead of attacking the social malaise itself.

b. Be resolutely vehement in accomplishing all set objectives.

c. Take steps to identify and preempt all long and short-term distractions that could weaken the resolve of protesters.

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