Health Workforce Shortage a Major Challenge to Primary Healthcare Service Delivery in Urban and Rural Communities of Nigeria.

Primary healthcare (PHC) in Nigeria faces severe challenges due to significant health workforce shortages, despite existing policies aimed at mitigation. Previous research points to inadequate funding, professional emigration, and poor working conditions as critical contributors to this crisis. This study focuses on Bayelsa State, where disparities in health service access between urban and rural populations highlight an urgent need for comprehensive reform. A mixed-methods study design was employed, collecting both quantitative and qualitative data. Questionnaires were administered to healthcare workers across 24 health facilities, achieving an impressive 98% response rate. The study also included community engagement efforts to gather insights on local health service delivery. Demographics results show a slight female majority (52.1%), with most aged 31-40 (30.2%) and 56.2% holding tertiary qualifications. Most surveyed facilities (95.8%) are government-owned PHCs, many established over 20 years ago. Urban areas have better staffing, with 30.4% of facilities having Medical Officers versus only 4% in rural areas. In urban areas, 62% of respondents use health centres versus 55% in rural areas. Urban satisfaction is 71% compared to 60% rural. Urban residents are 1.6 times more likely to engage with services (P < 0.05) and show an 85.7% agreement in documenting community complaints, emphasising transparency in healthcare. The study concludes with a call for actionable recommendations addressing health workforce distributions and community engagement in health governance. Local governments, healthcare workers, and community members are encouraged to prioritise increased funding, equitable workforce distribution, and enhanced community engagement to strengthen the healthcare system. These efforts are critical for advancing towards universal health coverage and improving health outcomes in line with Sustainable Development Goal 3 (SDG3).