97% of PHCs in 16 states fail national staffing standards – Report

A new assessment of 1,480 Primary Healthcare Centres (PHCs) across 16 Nigerian states has found that 97 per cent failed to meet the national minimum staffing requirement, raising fresh concerns about the capacity of the country’s frontline health facilities to provide essential services.

The PHC Operational Capability Report, produced by Orodata Science and Civic Tech, assessed facilities across 277 local government areas in Nigeria’s six geopolitical zones.

The assessment, conducted between October 2023 and June 2025, examined staffing, infrastructure, equipment, electricity, water supply and accessibility using the CheckMyPHC Digital Scorecard.

According to the report, only three per cent of the facilities assessed met the national minimum staffing requirement, while 11 of the 16 states had no assessed PHC that met the standard.

What the staffing standard requires

The national PHC framework recognises adequate staffing as essential to the delivery of quality primary healthcare.

The National Primary Health Care Development Agency’s (NPHCDA) Ward Minimum Health Care Package, developed with the World Health Organisation (WHO), outlines minimum manpower requirements for ward-level PHCs.

For a PHC, the proposed workforce includes a community health officer, public health nurse, three community health extension workers, six junior community health extension workers and four nurse/midwives, with a medical assistant listed as optional.

The same framework recommends that basic essential obstetric care centres be adequately staffed with four midwives or nurse/midwives to provide 24-hour coverage for maternal and newborn care.

Against this staffing framework, the Orodata assessment found that only three per cent of the facilities surveyed met the national minimum requirement.

The report said the shortage was particularly concerning because about 75 per cent of the assessed PHCs were located in rural communities, where such facilities often serve as the first and sometimes only formal source of healthcare for residents.

Staffing gaps, other deficiencies

The staffing problem was not isolated.

The assessment found that many of the facilities struggling to meet staffing requirements were also dealing with inadequate infrastructure and unreliable basic utilities.

According to the report, 40 per cent of the PHCs had broken ceilings or leaking roofs, while 38 per cent operated without electricity.

Water supply was another major concern, with 39 per cent of the facilities relying on unsafe water sources.

Orodata said the deficiencies were interconnected, with poor infrastructure, inadequate staffing, unreliable electricity and water supplies, limited equipment and accessibility barriers often occurring within the same facilities.

The report said the combination could increase risks for patients while placing additional pressure on the health workers available at the facilities.

Newborn care faces major equipment gaps

The assessment also exposed gaps in the capacity of PHCs to respond to complications during childbirth.

It found that 75 per cent of the facilities lacked essential neonatal resuscitation equipment.

Such equipment is required to support emergency interventions for newborns experiencing complications during or immediately after delivery.

The report said the absence of essential newborn-care equipment, alongside staffing shortages and other infrastructure deficiencies, could limit the ability of facilities to provide safe maternal and newborn services.

Accessibility was also a major concern.

According to the assessment, 66 per cent of the PHCs lacked provisions for persons with disabilities and people with mobility challenges.

State-level differences emerge

While the overall findings showed widespread deficiencies, the severity varied across the states assessed.

The report identified Kano and Sokoto as having particularly serious gaps in safe water, reliable electricity and essential newborn-care equipment.

In Gombe, 80 per cent of the assessed PHCs lacked accessibility provisions for persons with disabilities and people with mobility challenges.

The assessment also sought to establish how residents viewed the services provided by their local facilities.

It found that 51 per cent of surveyed community members rated services at their local PHCs as poor.

PHC challenges

The findings are consistent with concerns documented by PREMIUM TIMES in a recent investigation into rural PHCs in Osun State.

The investigation found that despite government investments in the health sector and efforts to revitalise primary healthcare facilities, challenges including inadequate staffing, deteriorating infrastructure, limited equipment and gaps in essential services persisted at some rural facilities.

At one of the facilities visited by PREMIUM TIMES, a single health worker was responsible for attending to pregnant women, children and other patients, while also responding to emergencies outside normal working hours. The facility also lacked a functional laboratory and had inadequate delivery equipment.

The investigation further found that some patients had to travel outside their communities for basic services because the facilities could not provide them.

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Coordinated interventions

Orodata said improving PHCs would require coordinated interventions beyond isolated renovations.

It urged state governments to develop facility-specific plans with clear targets, responsibilities, resources and timelines, alongside regular monitoring.

The organisation also recommended repairs to damaged infrastructure, provision of safe water and reliable electricity, solar or hybrid power systems, recruitment and retention of health workers, and essential neonatal resuscitation equipment for PHCs offering delivery services.

The assessment involved facility visits, direct observation, interviews with health workers and community members, photographs, GPS coordinates and facility records.

Orodata said its CheckMyPHC Digital Scorecard was based on NPHCDA minimum standards and inclusion requirements, and urged authorities to use verified facility-level evidence to guide resource allocation and interventions.