Assessing primary health care facilities in six prioritized Nigerian states: Linking facility readiness with service availability

BACKGROUND: Nigeria's poor health indicators have been linked to its dysfunctional Primary Health Care (PHC) facilities. Policy gaps remain in achieving sustainable and equitable provision of PHC for Nigerians. Therefore, this study examined the relationship between health facilities' readiness and service provision in Nigeria. METHODS: This was a cross-sectional assessment of 204 PHC facilities enrolled under the Basic Health Care Provision Fund program, in six prioritized states in Nigeria. The facilities were assessed for the provision of ≥80% of the three levels of primary healthcare services-Tier 1, Tier 2, Tier 3-as the outcome variables. The three tiers represent the minimum, intermediate, and comprehensive levels of essential PHC services, respectively, defined under Nigeria's Minimum Service Package. Health Facility (HF) readiness (explanatory variable) was assessed across six domains, with five of the domains disaggregated into 3 levels (poor, fair, and good). Data were analysed using Principal Component Analysis (PCA) and multivariable logistic regression model (alpha = 0.05). RESULTS: The majority (81.9%) of the HFs have a functional management committee, 54.4% have an updated BHCPF annual quality improvement plan, 81.9% have standard operating procedures. While 16.2% met the World Health Organization standard ≥2.3 Health Care Workers (HCWs)/1000 population, none met the Minimum Service Package standard for HCWs across all cadres. The proportion of facilities with good readiness in each domain was: management and finance (42.6%); Health Management Information System tools/registers, supply chain tools/registers, and guidelines (40.2%); infrastructure and utility (33.3%); tracer equipment (34.8%); and tracer drugs (29.9%). The percentage of HF that provided ≥80% services was: Tier 1 (65.2%), Tier 2 (46.6%), and Tier 3 (35.8%); while 31.9% met ≥ 80% across all the service Tiers. Common predictors of providing ≥80% across the service Tiers were tracer drugs and equipment availability. The likelihood of delivering all Tiers of services was higher in HF with fair (aOR=2.38, 95% CI = 1.92-11.14, p < 0.05) and good (aOR=3.93, 95% CI = 1.96-8.49) levels of tracer equipment readiness compared to the poor. CONCLUSION: Good PHC facility readiness supports the provision of health care services in Nigeria. Availability of tracer drugs and equipment predicts the provision of healthcare services in PHC facilities. Investment in PHC facility functionality and prioritization of funds for tracer drugs and equipment will therefore improve service availability and delivery in Nigerian public PHC facilities.