Healthcare Workers’ Knowledge and Factors Associated with Ward Health System Implementation in Andoni Local Government Area, Rivers State, Nigeria: A Cross-Sectional Study

The Ward Health System (WHS) is intended to organize primary healthcare delivery at ward level through defined service, community participation, referral and governance functions. Evidence on how consistently these functions are implemented in riverine local government areas of Rivers State remains limited. This study assessed WHS knowledge, implementation, Ward Development Committee (WDC) perceptions and factors associated with implementation among healthcare workers in Andoni Local Government Area. A quantitative descriptive crosssectional survey was conducted among 185 healthcare workers in functional primary healthcare facilities in Andoni LGA. Total enumeration was used. Data were collected with an intervieweradministered structured questionnaire covering sociodemographic and occupational characteristics, WHS knowledge, implementation conditions, WDC roles and perceived influencing factors. Data were analyzed in SPSS version 27 using descriptive statistics, chisquare tests and multivariable logistic regression. Because no respondent was classified in the poor implementation category, the multivariable outcome was dichotomized as high versus moderate implementation. Statistical significance was set at p<0.05. Mean WHS knowledge was 74.02% (SD=12.39), with 43.2% of respondents classified as having good knowledge, 48.1% fair knowledge and 8.6% poor knowledge. Knowledge was weakest for community participation (35.1% correct), maternal/newborn/child health coverage (45.9%) and referral linkage (52.4%). Mean self-reported implementation was 68.90% (SD=7.76); 64.3% of respondents reported moderate implementation and 35.7% high implementation, with none in the poor category. Implementation varied significantly by ward (F=2.60, p=0.008), with Ward 3 recording the highest mean score (76.10%) and Ward 4 the lowest (65.97%). Although 85.9% had favourable perceptions of WDC roles, reported WDC functionality was weaker (mean=2.30); 58.4% rated functionality as minimally implemented and 9.2% as not implemented. In multivariable analysis, fair rather than good knowledge (aOR=0.308, 95% CI: 0.130–0.732, p=0.008), tertiary rather than postgraduate education (aOR=0.168, 95% CI: 0.046–0.613, p=0.007), and practice in Ward 4 rather than Ward 10 (aOR=0.056, 95% CI: 0.005–0.699, p=0.025) were independently associated with lower odds of high implementation. WHS implementation in Andoni was predominantly moderate, with substantial ward-level differences. The findings support targeted strengthening of weak wards, refresher training focused on community participation, maternal/newborn/child health coverage and referral linkage, stronger WDC functionality, and ward-specific supportive supervision. Future assessments should combine worker reports with independent facility observation and routine service data.