Severe workforce gaps threaten primary healthcare delivery in Zamfara despite multi-billion naira recruitment plan
By Aminu Abubakar
Zamfara State’s healthcare system is facing a critical workforce crisis, with newly compiled data revealing massive shortfalls in both primary and secondary health facilities—gaps that experts warn could significantly undermine service delivery, worsen health outcomes, and stall progress toward universal health coverage if not urgently addressed.
The findings by the Zamfara State Ministry of Health were drawn from a comprehensive human resources for health gap analysis, highlighting deep structural weaknesses in the state’s healthcare workforce planning, including under-recruitment, uneven distribution of personnel, and longstanding underinvestment in health systems. While authorities have outlined an ambitious five-year recruitment and funding plan, the scale of the deficit raises questions about feasibility, funding sustainability, and implementation capacity.
A System Under Strain
Globally, the health workforce—comprising doctors, nurses, midwives, and other essential personnel—remains the backbone of any functional healthcare system. Their availability, distribution, and efficiency directly determine the quality and accessibility of care. In low- and middle-income settings like Nigeria, however, persistent shortages and systemic inefficiencies continue to strain service delivery.
Zamfara State exemplifies these challenges. Located in Nigeria’s North-West region, the state has a population spread across 14 Local Government Areas, with a significant proportion residing in rural and hard-to-reach communities. These demographics place additional pressure on an already overstretched health system, particularly at the primary healthcare (PHC) level, which serves as the first point of contact for most residents.
Stark Primary Healthcare Deficit
Data from the state’s primary healthcare system reveal a staggering workforce gap. Out of the 13,504 personnel required to adequately staff PHC facilities, only 2,648 are currently available, leaving a deficit of 10,856 workers. This represents a shortfall of over 80 percent, pointing to a near-collapse of frontline healthcare delivery capacity.
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Key cadres such as Community Health Extension Workers (CHEWs) and Junior Community Health Extension Workers (JCHEWs), who are essential for grassroots service delivery, are among the most affected. For instance, while 2,067 CHEWs are required, only 698 are in place, leaving a gap of 1,369. Similarly, JCHEWs show an even wider disparity, with 3,634 required personnel compared to just 198 available—a deficit of 3,436.
Other critical support roles are also severely understaffed. Pharmacy technicians, laboratory technicians, and medical records officers all show significant shortages, undermining the efficiency of diagnosis, treatment, and data management systems. Even basic operational roles such as health attendants, security personnel, and maintenance staff are insufficient, further weakening facility functionality.
Secondary Facilities Also Hit Hard
The crisis is not limited to primary care. Secondary health facilities in the state are also grappling with acute workforce shortages. Of the 7,102 personnel required across various technical and clinical roles, only 2,223 are currently employed, leaving a gap of 4,879 workers.
Medical doctors are among the most critically affected, with only 69 available out of the 708 required, resulting in a deficit of 639 physicians. This shortage severely limits the state’s capacity to provide specialized and referral care.
Nurses and midwives, who form the backbone of patient care, also face a shortfall of 2,574, with only 622 available out of the 3,196 needed. Similar gaps exist among laboratory scientists, radiology technicians, biomedical engineers, and pharmacists, indicating systemic deficiencies across nearly all professional categories.
Structural and Systemic Challenges
The workforce shortages in Zamfara are symptomatic of broader systemic issues affecting healthcare delivery in low-resource settings. These include limited training capacity, inadequate recruitment and retention strategies, and the migration of skilled health workers to more developed regions and countries.
Additionally, disparities in workforce distribution between urban and rural areas exacerbate inequities in access to care. Rural communities, which often bear the highest disease burden, remain the most underserved.
Demographic shifts are compounding the problem. An increasing population, coupled with a growing burden of non-communicable diseases and ageing populations, is placing additional demand on already limited healthcare resources.
Ambitious but Costly Recruitment Plan
In response to these challenges, state health authorities have developed a five-year recruitment and deployment plan aimed at gradually closing the workforce gap between 2026 and 2030. The plan proposes phased recruitment, starting with 15 percent of required personnel in 2026, increasing incrementally to achieve full staffing by 2030.
The financial implications of this plan are substantial. For primary healthcare alone, the total annual gross salary for required personnel is estimated at over ₦12.7 billion. The phased recruitment plan outlines expenditures running into billions of naira annually, with allocations increasing as more personnel are absorbed into the system.
Similarly, the secondary healthcare recruitment plan projects total annual salary costs exceeding ₦10.5 billion, with incremental spending tied to recruitment targets across different cadres.
While the plan demonstrates a clear commitment to addressing workforce gaps, concerns remain about the state’s fiscal capacity to sustain such levels of expenditure, particularly in the face of competing budgetary demands.
Questions Over Implementation
Despite the clarity of the data and the structured recruitment roadmap, significant gaps remain in terms of implementation strategy. Analysts note that recruitment alone may not resolve the crisis unless accompanied by broader reforms in training, retention, and workforce management.
For instance, the plan emphasizes continuous professional development and training, including digital skills and emergency response capacity. However, details on how these programs will be funded, monitored, and evaluated remain unclear.
Moreover, the success of the recruitment drive will depend heavily on the state’s ability to attract and retain skilled workers, particularly in rural areas where conditions are often less favourable. Without incentives such as improved working conditions, housing, and career progression opportunities, newly recruited staff may be unwilling to remain in underserved locations.
Implications for Health Outcomes
The consequences of these workforce gaps are far-reaching. Inadequate staffing leads to increased workload for existing personnel, reduced quality of care, longer waiting times, and ultimately poorer health outcomes. High morbidity and mortality rates, particularly among vulnerable populations, are often linked to such systemic deficiencies.
The gaps also pose a significant barrier to achieving universal health coverage, a key objective of Nigeria’s health policy framework. Without sufficient human resources, even well-funded health programs may fail to deliver intended outcomes.
The Road Ahead
As Zamfara State moves forward with its recruitment plan, the scale of the challenge underscores the need for a coordinated and sustained response.
Addressing the workforce crisis will require not only increased funding but also strategic investments in training institutions, policy reforms, and stronger health system governance.
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Stakeholders emphasize that bridging the gap is not merely a matter of numbers but of building a resilient and responsive healthcare system capable of meeting the needs of the population.
Over time, it has been urged that while the outlined plan provides a roadmap for progress, its success will hinge on political will, financial commitment, and the effective translation of policy into action.
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