Infrastructure, service delivery, and staffing gaps in primary health care facilities in Lagos State, Nigeria: a state-wide assessment.

In this study, we conducted a state-wide assessment of infrastructure, service delivery and staffing to assess compliance with national recommended guidelines. We surveyed 279 (88%) of the 319 existing primary health care centers (PHCs) across the six health districts (HDs) in Lagos State using pretested electronic field forms. Data was analyzed using descriptive statistics, and chi-square test was used to ascertain significant differences in compliance across the HDs. Significance differences were established at p < 0.05. For infrastructure quality, 37% of the PHCs had access to service rooms, (range 31-50%, p = 0.05), 56% had functional toilets (range 48-72%, p = 0.07), 23% had staff accommodation (range 11-46%, p = 0.001) and 51% were over-burdened (range 18-68, p = 0.001). By service delivery, 65% had staff stations (range 50-75, p = 0.058), 59% had delivery rooms (range 43-78%, p = 0.009), 61% had maternity wards (range 48-86, p = 0.003), 53% had in-patient wards (range 40-62%, p = 0.14). By staffing, 48% had medical officers (range 33-57%, p = 0.16), 26% had nurse/midwives (range 20-34, p = 0.002), 29% had community health workers (range 18-36%, p = 0.011), 46% had health assistants (range 36-67%, p = 0.078), and 62% had laboratory technicians (range 44-75%, p = 0.12). Findings demonstrate critical gaps in infrastructure, service delivery, and staffing across Lagos State PHCs, and should guide investments in upgrading PHC facilities and strengthen workforce deployment in Lagos State.