Building a Resilient Public Health Workforce in Nigeria: Strategic Approaches to Workforce Planning, Leadership Development, and Health Security Preparedness

Nigeria faces a critical shortage of health workers, with a density of 1.95 per 1,000 population, well below the WHO threshold of 4.45. This study assessed the resilience of Nigeria's public health workforce and identified strategic approaches to strengthening workforce planning, leadership development, and health security preparedness. A convergent parallel mixed-methods design was employed. A cross-sectional survey of 384 health workers across Nigeria's six geopolitical zones was conducted from March to August 2024, using a structured questionnaire measuring three resilience domains: workforce planning, leadership development, and health security preparedness. Fifteen key informant interviews with senior policymakers and health leaders provided qualitative depth. Data were analyzed using descriptive statistics, ANOVA, correlation analysis, multiple linear regression, and thematic analysis. The overall workforce resilience score was 2.69 +/- 0.45 (moderate level), with 91.4% of respondents scoring in the low-to-moderate range. Domain scores were: workforce planning (2.54 +/- 0.54), leadership development (2.62 +/- 0.54), and health security preparedness (2.79 +/- 0.56). Multiple regression analysis showed all three domains were significant predictors of overall resilience (R-squared = 0.558, p < 0.001), with workforce planning as the strongest predictor (beta = 0.416, p < 0.001). Resilience was positively correlated with job satisfaction (r = 0.491, p < 0.001) and negatively correlated with intention to leave (r = -0.373, p < 0.001). No significant differences were found across geopolitical zones, gender, or work setting. Qualitative analysis identified six key themes: brain drain and retention crisis (92% of key informants), implementation and governance challenges (88%), workforce planning deficits (85%), financing constraints (82%), leadership development gaps (78%), and health security preparedness weaknesses (74%). Nigeria's public health workforce demonstrates moderate resilience with significant deficits across all measured domains. Strategic investments in workforce planning infrastructure, leadership development programs, and sustained health security preparedness are urgently needed. The findings provide evidence-based recommendations for the implementation of Nigeria's National Policy on Health Workforce Migration and alignment with the IHR 2024 amendments and National Action Plan for Health Security.