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 (NBS). 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 delivery across the country.
The survey assessed diagnostic accuracy using vignettes across five priority diseases: diarrhoea, pneumonia, malaria, postpartum haemorrhage, and asphyxia. The findings revealed stark regional disparities, with the North-East recording the highest diagnostic accuracy at 54.3%, while the South-West had the lowest at 36.7%. These numbers underscore the uneven distribution of healthcare expertise and resources across Nigeria's diverse regions.
At the state level, Zamfara recorded the highest diagnostic accuracy at 79.0%, while Osun recorded the lowest at 13.4%. Such stark differences in health worker capacity across states further emphasize the need for targeted interventions and resource allocation to address these disparities.
The survey also examined diagnostic accuracy by cadre, revealing that doctors recorded the highest diagnostic accuracy at 74.3%, followed by nurses and midwives at 56.3%. Community Health Extension Workers and other health workers performed significantly lower, at 43.7% and 32.3%, respectively. This disparity in performance among different categories of health workers suggests a need for targeted training and support programs to enhance their diagnostic skills.
In addition to diagnostic accuracy, the survey assessed adherence to clinical guidelines and the availability of essential drugs and medical equipment. While there was moderate adherence to clinical guidelines nationwide, with the North-East ranking highest at 62.9% and the South-West lowest at 46.9%, the availability of essential drugs and medical equipment was also uneven.
The availability of basic medical equipment stood at 36.9% nationally, with 34.8% in primary facilities and 76.8% in secondary facilities. This highlights major infrastructure gaps, particularly in primary healthcare facilities. The survey also revealed disparities in access to medicines, with the availability of essential drugs improving to 37.4% in 2025 from 35.0% in 2023.
In terms of infection prevention and control, the survey found that only 26.5% of facilities had long-lasting insecticidal nets or LLIN vouchers, indicating weak malaria prevention readiness. This is a critical area of concern, as malaria remains a significant public health issue in Nigeria.
The NHFS 2025 survey builds on earlier rounds conducted in 2016, 2019, and 2023, providing trend data for assessing progress and identifying persistent gaps in Nigeria's healthcare system. With 3,330 health facilities selected and visited across 36 states and the FCT, the survey offers a comprehensive assessment of service delivery and resource availability across the country's health sector.
In conclusion, the decline in diagnostic accuracy among health workers in Nigeria's public health facilities is a cause for serious concern. It underscores the need for targeted interventions, resource allocation, and training programs to enhance the quality of healthcare delivery across the country. As Nigeria continues to grapple with healthcare challenges, the findings of the NHFS 2025 survey provide valuable insights for policymakers and healthcare stakeholders to address these issues and improve the overall health outcomes for the population.
