Social Determinants of Nursing Workforce Distribution in Nigeria: A Geospatial and Policy Analysis

Background: Severe nursing workforce maldistribution in Nigeria, characterised by urban concentration and rural deprivation, is a significant driver of health inequities. Understanding the social determinants underlying this distribution pattern is essential for evidence-based workforce policy. Aim: This study examined the social determinants of nursing workforce distribution in Nigeria using geospatial and policy analytical methods. Methods: A secondary data analysis study used national health workforce registry data, census data, and state-level health expenditure records. Geospatial mapping using ArcGIS documented nurse distribution patterns across all 36 states. Multilevel regression identified state-level social determinants. Policy analysis examined nursing workforce policies and their implementation across three geopolitical zones. Results: Nurse density varied from 0.4 per 1,000 population in Yobe State to 3.2 per 1,000 in Lagos State. Social determinants associated with higher nurse density included urban residence proportion, state health expenditure per capita, and secondary school enrolment rates. Policy analysis revealed absent enforcement of rural posting policies and inadequate rural incentive schemes. Conclusion: Nursing workforce maldistribution in Nigeria is socially determined and policy-addressable. Differentiated rural retention strategies, geographically targeted training investments, and enforceable rural deployment frameworks are recommended for comprehensive nursing workforce planning. Keywords: nursing workforce distribution, geospatial analysis, social determinants, Nigeria, health policy.