Health workers' diagnostic accuracy in Nigeria's public health facilities has been on a downward spiral, according to the National Health Facility Survey (NHFS) released by the National Bureau of Statistics. The survey, conducted in collaboration with the Federal Ministry of Health and Social Welfare and supported by the World Bank, revealed a concerning decline in diagnostic accuracy from 56.2% in 2023 to 46.1% in 2025. This trend is particularly alarming, as it highlights a potential breakdown in the quality of healthcare services across the country.
The survey's findings are even more striking when broken down by region and state. The North-East, which recorded the highest diagnostic accuracy at 54.3%, still lags behind the national average. In contrast, the South-West, with the lowest accuracy at 36.7%, underscores the stark regional disparities in clinical performance. Within states, Zamfara stands out with a remarkable 79.0% diagnostic accuracy, while Osun's abysmal 13.4% accuracy is a cause for grave concern. These disparities suggest that health worker capacity varies significantly across Nigeria, with secondary health facilities performing better (68.1%) than primary facilities (44.6%).
The survey also examined diagnostic accuracy by cadre, revealing a concerning trend. Doctors, who are expected to be the most competent, recorded the highest accuracy at 74.3%. However, nurses and midwives, who are often the primary point of contact for patients, managed only 56.3%. This disparity highlights a potential issue with the distribution of responsibilities and the quality of training across different cadres of health workers. Community Health Extension Workers and other health workers performed even worse, with accuracy rates of 43.7% and 32.3%, respectively.
The survey's findings extend beyond diagnostic accuracy to clinical guideline adherence. The North-East, which led in diagnostic accuracy, also ranked highest in guideline adherence at 62.9%. Conversely, the South-West, with the lowest diagnostic accuracy, recorded the lowest adherence at 46.9%. This trend suggests that while some regions may excel in one area, they may struggle in others, indicating a need for a more holistic approach to healthcare improvement.
One of the most concerning aspects of the survey is the low adherence to physical examination guidelines nationwide, at just 31.0%. The North-East, with 46.1%, and the South-West, with 24.4%, are particularly lagging in this area. This suggests that health workers are not consistently following established clinical protocols, which could have significant implications for patient care and health outcomes.
The survey also shed light on the availability of essential drugs and basic medical equipment. While there has been some improvement in essential drug availability, from 35.0% in 2023 to 37.4% in 2025, primary facilities still lag behind secondary facilities. The availability of basic medical equipment stands at 36.9% nationally, with primary facilities at 34.8% and secondary facilities at 76.8%. This highlights major infrastructure gaps that need to be addressed to ensure that health workers have the necessary tools to provide effective care.
Infection prevention and control indicators revealed a mixed picture. While most facilities have safety boxes, waste containers, hand-washing units, and gloves, only 26.5% have long-lasting insecticidal nets or LLIN vouchers. This indicates weak malaria prevention readiness and a need for improved infection control measures to protect both patients and health workers.
The NHFS 2025 survey is a comprehensive assessment of Nigeria's healthcare system, building on earlier rounds conducted in 2016, 2019, and 2023. It provides valuable trend data for assessing progress and identifying persistent gaps. With 3,330 health facilities selected and visited across 36 states and the FCT, the survey ensures a comprehensive evaluation of service delivery and resource availability. However, the declining diagnostic accuracy and other concerning findings suggest that Nigeria's healthcare system is facing significant challenges that require urgent attention and action.
In my opinion, the survey's findings are a wake-up call for the Nigerian government and healthcare stakeholders. The declining diagnostic accuracy and other issues highlighted in the survey indicate a systemic problem that needs to be addressed. It is crucial to invest in training and support for health workers, improve infrastructure and resource availability, and ensure consistent adherence to clinical guidelines. Only through a comprehensive and coordinated approach can Nigeria's healthcare system be strengthened and the quality of care for its citizens be improved.
