Researchers assessed each facility against three service tiers: Tier 1 for minimum services, Tier 2 for intermediate services and Tier 3 for comprehensive essential primary health care. A facility was counted as providing a tier when it delivered at least 80% of the services in that tier. Of the 204 facilities, 65.2% provided at least 80% of Tier 1 services, 46.6% provided at least 80% of Tier 2 services and 35.8% provided at least 80% of Tier 3 services. The proportion meeting the 80% threshold across all three tiers was considerably lower, at 31.9%.

Readiness was evaluated across six domains, with five domains classified as poor, fair or good. The strongest good-readiness result was for management and finance, reported in 42.6% of facilities. Around 40.2% of facilities had good readiness for health management information system tools and registers, supply-chain tools and registers, and guidelines. Good readiness was less common for tracer equipment, at 34.8%; infrastructure and utilities, at 33.3%; and tracer drugs, at 29.9%. Management indicators were also uneven: 81.9% of facilities had a functional management committee and 81.9% had standard operating procedures, while 54.4% had an updated Basic Health Care Provision Fund annual quality-improvement plan. Staffing readiness showed a separate shortfall, with 16.2% of facilities meeting the World Health Organization standard of at least 2.3 health care workers per 1,000 population and none meeting the Minimum Service Package standard across all cadres.

Principal component analysis and multivariable logistic regression were used to examine the relationship between readiness and service provision, with statistical significance assessed at an alpha of 0.05. Tracer drugs and equipment availability were common predictors of providing at least 80% of services across the tiers. Compared with facilities with poor tracer-equipment readiness, facilities with fair readiness had higher adjusted odds of delivering all three tiers, with an adjusted odds ratio of 2.38 and a 95% confidence interval of 1.92–11.14. Facilities with good tracer-equipment readiness also had higher adjusted odds, with an adjusted odds ratio of 3.93 and a 95% confidence interval of 1.96–8.49. The reported results marked the fair-readiness comparison as statistically significant at p < 0.05. Because the assessment was cross-sectional, these estimates describe adjusted associations rather than causal effects or changes over time.

The study’s scope was limited to 204 Basic Health Care Provision Fund facilities in six prioritized states, so the results do not necessarily represent all public primary health care facilities in Nigeria. Within that sample, however, the analysis linked stronger readiness with more extensive service provision and identified tracer drugs and equipment as common predictors across the three service tiers. The authors concluded that investing in facility functionality and prioritizing funds for tracer drugs and equipment could improve service availability and delivery in Nigerian public primary health care facilities.

Subject of Research: Association between facility readiness and service availability in 204 Nigerian public primary health care facilities across six prioritized states

Article Title: Assessing primary health care facilities in six prioritized Nigerian states: Linking facility readiness with service availability

Article References: Fasawe, O., Abba, A., Yerima Mohammed, A., Kukoyi, C., Gulma, K. A., Abubakar, A. A., Shuaibu, A., Jamoh, B., Mahmoud, M. N., Shamsudeen, Y., Mustafa, I. A., Dangana, I. A., Yakubu, A., Sani, A., Peter, B., Oladapo, O., Mohammed, N., Umar, N., Anyanwu, L. N., & Ayo, A. S. (2026). Assessing primary health care facilities in six prioritized Nigerian states: Linking facility readiness with service availability. PLOS One, 21(10), e0360425. https://doi.org/10.1371/journal.pone.0360425

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360425

Keywords: Nigeria, primary health care, health facilities, service availability, tracer equipment, tracer drugs, facility readiness, Basic Health Care Provision Fund, Minimum Service Package, health workforce, Assessing, primary