Diagnostic accuracy among clinical health workers in Nigeria’s public health facilities has dropped significantly, according to the 2025 National Health Facility Survey (NHFS) released by the National Bureau of Statistics in Abuja. The report shows accuracy fell from 56.2 percent in 2023 to 46.1 percent in 2025, raising concerns about the quality of healthcare delivery and clinical decision-making nationwide.
The survey assessed diagnostic performance using vignettes across five priority diseases: diarrhoea, pneumonia, malaria, postpartum haemorrhage, and asphyxia. Results revealed sharp regional disparities. The North-East recorded the highest diagnostic accuracy at 54.3 percent, while the South-West had the lowest at 36.7 percent. At the state level, Zamfara achieved 79.0 percent, while Osun lagged at 13.4 percent, underscoring wide differences in health worker capacity.
Performance varied across facility types. Secondary health facilities recorded 68.1 percent accuracy, compared to 44.6 percent in primary facilities. Doctors achieved the highest diagnostic accuracy at 74.3 percent, followed by nurses and midwives at 56.3 percent. Community Health Extension Workers scored 43.7 percent, while other health workers recorded 32.3 percent.
Adherence to clinical guidelines was moderate but uneven. The North-East again ranked highest at 62.9 percent, while the South-West recorded the lowest at 46.9 percent. Borno led at the state level with 70.2 percent compliance, while Osun had the lowest at 41.3 percent. Physical examination adherence was particularly weak, averaging 31.0 percent nationwide.
Drug availability showed slight improvement, rising to 37.4 percent in 2025 from 35.0 percent in 2023. Secondary facilities reported 60.6 percent availability compared to 36.2 percent in primary facilities. Edo recorded the highest state-level availability at 57.3 percent, while Katsina had the lowest. Regionally, the South-West led at 42.3 percent, while the North-West trailed at 31.0 percent.
Medical equipment availability remained limited, with only 36.9 percent of facilities adequately equipped. Secondary facilities fared better at 76.8 percent, compared to 34.8 percent in primary facilities. Several states, including Bauchi, Borno, Ebonyi, Gombe, Jigawa, Ondo, Sokoto, Katsina, and the FCT, reported full equipment availability, while Osun recorded just 9.1 percent.
Infection prevention and control indicators showed mixed results. Safety boxes were available in 82.0 percent of facilities, waste containers in 51.0 percent, hand-washing units in 74.1 percent, and gloves in 79.9 percent. However, only 26.5 percent of facilities had long-lasting insecticidal nets or vouchers, highlighting weak malaria prevention readiness.
The survey, conducted by the National Bureau of Statistics in collaboration with the Federal Ministry of Health and Social Welfare and supported by the World Bank, covered 3,330 health facilities across Nigeria’s 36 states and the Federal Capital Territory. A nominal sample of 90 facilities per state was included, covering public primary and secondary facilities as well as private institutions.
The 2025 NHFS builds on earlier rounds conducted in 2016, 2019, and 2023, providing trend data to track progress and identify persistent gaps in Nigeria’s healthcare system. While improvements were noted in drug supply and equipment availability, the report highlights declining diagnostic accuracy, uneven adherence to clinical guidelines, and significant disparities across regions and states.
Overall, the findings underscore the urgent need for targeted interventions to strengthen clinical capacity, improve adherence to standards, and address infrastructure gaps. The report provides policymakers with critical evidence to guide reforms aimed at enhancing healthcare delivery and ensuring more equitable access to quality services across Nigeria.
