Structural Determinants of Oral and Maxillofacial Surgical Workforce Distribution Inequities Across Nigeria’s Geopolitical Zones: A Health Systems Analysis

The maldistribution of specialist oral and maxillofacial surgeons across Nigeria's six geopolitical zones constitutes a profound equity challenge, with the majority of practicing specialists concentrated in Southern states and a critical shortage persisting in the North East, North West, and North Central zones. This health systems analysis investigates the structural, historical, institutional, and economic determinants of this workforce distribution inequity, drawing on human resources for health theory, political economy analysis, and geographic information science. A multi-method qualitative and quantitative design was employed, incorporating mapping of current specialist distribution using data from the Medical and Dental Council of Nigeria, document analysis of training program accreditation records, secondary analysis of macroeconomic and infrastructure data by state, and in-depth interviews with 35 purposively sampled consultants, training program directors, and health system managers from all six zones. Thematic analysis was triangulated with spatial regression models relating surgeon density to health system determinants. Findings reveal that training concentration in Southern teaching hospitals, absence of residency programs in many Northern institutions, insecurity in the North East, poor infrastructure, and inadequate remuneration are the dominant structural drivers of maldistribution. Specialist licensing policies that do not incentivize rural and underserved zone posting compound the problem. The study develops a multi-level theoretical model of oral surgical workforce inequity in Nigeria and proposes a Geopolitically Targeted Workforce Development Framework as a policy prescription to address distributional injustice. Keywords: workforce distribution, oral surgery, health inequity, geopolitical zones, Nigeria.