Evaluation of the Effectiveness of Community Health Extension Workers in Delivering Primary Care Services in Nasarawa State, North Central Nigeria

Community health extension workers serve as critical frontline health providers in Nigeria's primary healthcare system, yet the effectiveness of their service delivery in under-resourced North Central states remains inadequately evaluated. This study evaluates the effectiveness of community health extension workers in delivering primary healthcare services in selected local government areas of Nasarawa State. A mixed-methods cross-sectional evaluation design is applied, involving 280 community health extension workers surveyed across twelve primary healthcare facilities and 600 community members interviewed from corresponding catchment areas. Quantitative instruments measure service output indicators including immunisation coverage, antenatal contacts, malaria case management, and health education sessions conducted. Qualitative data from focus group discussions with community members assess perceived quality and acceptability. Data are analysed using SPSS, with descriptive analysis and chi-square tests applied. Findings from the 2023 Nigerian Health Management Information System indicate that community health extension workers in Nasarawa State deliver over 60 percent of primary care contacts in rural communities but face critical supply chain and supervisory gaps. The Donabedian Quality of Care Model guides the evaluation of structure, process, and outcome indicators. Findings will inform Nasarawa State's Primary Health Care Development Agency on incentive structures, task redistribution, and training refreshment. Keywords: community health extension workers, primary healthcare, service effectiveness, Nasarawa State, North Central Nigeria.