BACKGROUND:
Informal health providers (IHPs) play a critical role in delivering care to underserved populations in Nigeria’s urban slums, yet their limited integration into formal health systems is exacerbated by weak documentation practices. Strengthening record-keeping is central to improving continuity of care, surveillance, and accountability

METHODS:
A qualitative design was employed using 36 in-depth interviews with Patent and Proprietary Medicine Vendors, Traditional Birth Attendants, and Traditional Bone Setters across four urban slum communities. Data were collected during supportive supervision visits and analyzed thematically, guided by a constructivist paradigm to capture contextual and behavioral influences on documentation practices.

RESULTS:
Five major themes emerged. Providers reported difficulties in capturing accurate patient identifiers due to reluctance or mistrust from clients. Household-assisted documentation, particularly involving children as scribes, was a common coping strategy among providers with low literacy. High workload and competing responsibilities created tensions between timely documentation and service delivery, often leading to omissions. Referral documentation was inconsistently applied, with frequent breakdowns in feedback loops from formal health facilities. Supportive supervision was identified as an enabling factor, improving the accuracy and consistency of record-keeping.

CONCLUSIONS:
Despite targeted interventions, substantial barriers to documentation remain among informal providers, underscoring the need for multipronged strategies. Actionable priorities include community engagement to build trust, development of context-sensitive tools to reduce workflow burden, introduction of digital referral tracking systems, and institutionalization of supportive supervision within primary healthcare structures. Addressing these challenges will strengthen the integration of informal providers into health information systems and enhance the quality, continuity, and equity of care in resource-limited urban settings.