Identifying Gaps in Trauma System Infrastructure Across the Six Geopolitical Zones of Nigeria: A Policy-Oriented Analysis

A functional trauma system, encompassing prehospital care, triage, definitive surgical management, and rehabilitation, is essential for reducing preventable trauma mortality. Nigeria lacks a nationally coordinated trauma system, and the magnitude of infrastructure gaps across geopolitical zones has not been systematically assessed. This policy-oriented analytical study identifies and quantifies gaps in trauma system infrastructure across all six geopolitical zones of Nigeria using a cross-sectional facility survey conducted in 2022 to 2023. A total of 72 public tertiary and secondary hospitals, 12 per zone, were assessed using a structured trauma systems checklist adapted from the American College of Surgeons verification criteria. Domains assessed included prehospital care capabilities, emergency department resources, operating theatre availability, blood banking, and trauma surgery workforce. Critical deficiencies were identified in prehospital care across all zones, with fully functional ambulance services present in fewer than 20% of assessed hospitals. Designated trauma surgeons and anaesthesiologists were absent in 41% of facilities. Blood banks were non-functional in 28% of assessed hospitals. The North East and North West zones demonstrated the greatest aggregate deficits. The study provides a geographically stratified evidence base for trauma system investment priorities and recommends phased implementation of the National Trauma Registry, emergency surgical workforce programs, and prehospital care scale-up. Keywords: trauma system, infrastructure, geopolitical zones, Nigeria, policy analysis