A Situation Assessment of Human Resources in the Public Health Sector
Health Facility Survey
Nigeria has one of the largest stocks of human resources for health (HRH) in Africa. However, great disparities in health status and access to health care exist among the six geo-political zones, and between rural and urban areas. This assessment measures the size, skills mix, distribution, and growth rate of HRH in the public health sector in Nigeria. The assessment also quantifies the increase in HRH requirements in the public health sector necessary for reaching key PEPFAR targets and the health Millennium Development Goals. The findings are based on a survey conducted in April-May 2006 in 290 public health facilities representing all levels of care (primary, secondary, and tertiary). The study data enabled us to estimate the total number of doctors, nurses, midwives, lab and pharmacy staff, and community health workers currently employed in the public sector. The distribution of health workers by level of care, and HRH availability in rural and urban areas was also quantified.Staff attrition rates, measuring the number of those leaving the public sector as percent of total staff, were determined among all staff categories. The annual growth in HRH in the public sector from new graduates was also measured.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Public Health Facilities
The survey collected information on:
- Number of staff employed in 2004, 2005, and at the time of survey (April 2006)
- Number of incoming and outgoing staff in 2005 by reason for leaving or starting work at the facility
- Types of services provided at the facility for HIV/AIDS, TB, malaria, maternal and child health, and family planning
- Number of patients seen at the facility in the three months preceding the survey for each of these services
- Which types of health staff provide each service
- Average time spent per patient-visit for each of the services related to the five focus areas
The survey focused on public health facilities representing all levels of care (primary, secondary, and tertiary).
Producers and sponsors
Partners for Health Reformplus Project
National Action Committee on AIDS
Federal Ministry of Health
State and LGA Facilities
Other Key Stakeholders
United States Agency for International Development Mission in Nigeria
Two-Stage Stratified Random Sample
A survey was conducted in 290 public health facilities representing all levels of care (primary, secondary, and tertiary). The facilities were selected using two-stage stratified sampling. First, two states were selected from each of the six geo-political zones in Nigeria, with probability of selection of each state proportional to its population size. In addition, the Federal Capital Territory of Abuja (FCT) was added to the two states selected in the North Central zone. The selected states in each zone cover between 32 and 50 percent of the zone's population and in total, the 13 states included in the sample account for 40 percent of Nigeria's population.
In the second stage of sampling, a sample of facilities at each level of care was chosen in each selected state. All Federal Medical Centers and teaching hospitals in the sampled states were selected with certainty. All other facilities were selected using systematic random sampling. A higher proportion of hospitals, compared to smaller facilities, were included in the sample in order to increase the number of facilities that have most of the data being collected. Primary care facilities include health centers, health clinics, maternities, and dispensaries. There was non-response from two facilities selected with certainty.
Sampling weights were constructed for all facilities included in the analysis. The weights were based on the probability of selection of each state, and the probability of selection of individual facilities within each state. All estimates of HRH availability, skills mix, and distribution are based on the data collected from the health facility survey, and are computed using the sampling weights.It should be stressed that these are statistical estimates based on our sample, and are subject to a certain margin of error (see Annex A of the report available as external resources).
Dates of Data Collection
Data Collection Mode
Partners for Health Reformplus Project
Data collection instrument
In each of the selected facilities, a questionnaire was administered to eligible facility managers and health staff. These were staff in charge of the services included in the survey – for example, information regarding immunizations in a hospital was obtained from the nurse in charge at the hospital’s child health clinic. The questionnaire collected information on:
1. Number of staff employed in 2004, 2005, and at the time of survey (April 2006);
2. Number of incoming and outgoing staff in 2005 by reason for leaving or starting work at the facility;
3. Types of services provided at the facility for HIV/AIDS, TB, malaria, maternal and child health, and family planning;
4. Number of patients seen at the facility in the three months preceding the survey for each of these services;
5. Which types of health staff provide each service;
6. Average time spent per patient-visit for each of the services related to the five focus areas.
Data from the survey questionnaires was entered electronically using an EpiInfo database, and all data analysis was performed using Stata v.8 software.
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.