HEALTH WORKFORCE DISTRIBUTION AND GEOGRAPHIC INEQUITIES IN NIGERIA: IMPLICATIONS FOR UNIVERSAL HEALTH COVERAGE

Abstract

The geographic maldistribution of the health workforce is among the most persistent obstacles to universal health coverage (UHC) in low-and middle-income countries. Nigeria exemplifies this challenge. Although the country carries one of the heaviest absolute workforce deficits in Africa, the deficit is compounded by a profoundly uneven spatial distribution that concentrates skilled personnel in urban and southern areas while leaving rural and northern communities critically underserved. This article examines the patterns, drivers, and consequences of health workforce maldistribution in Nigeria and considers their implications for UHC. Drawing on a national evaluation of the 2021–2025 National Human Resources for Health Strategic Plan together with published facility-level and demographic evidence, the analysis is organized around three questions: how unevenly the workforce is distributed, why the maldistribution persists, and what it means for population health. The evidence indicates that approximately 70% of doctors and 65% of nurses practise in urban settings, that Workload Indicators of Staffing Need (WISN) ratios fall below 1.0 in most surveyed rural primary care facilities, and that roughly 65% of newly trained workers are deployed to urban areas despite national policy favouring rural service. These spatial inequities are reproduced by a governance vacuum in posting and transfer, by accreditation and training capacity concentrated in the south, and by retention determinants that systematically disadvantage rural practice. Interpreting these findings through Hart’s inverse care law and the WHO framework for rural attraction and retention, the article argues that maldistribution in Nigeria is not primarily a problem of aggregate scarcity but of distributive governance, and that meaningful progress toward UHC requires deliberate, enforceable, and equity-weighted distribution policy rather than the continued expansion of undirected production.