Using the workload indicators of staffing need method to determine the staffing requirements for primary healthcare service delivery in Nigeria

# Background Weak health governance mechanisms and inequitable distribution of health investments exist in Nigeria, and this is negatively affecting the health system, and health workforce availability and performance. This is evident at the primary level of care and necessitates the need to ensure that staffing levels are informed by workloads. # Methods This study applied the workload indicators of staffing need (WISN) method to determine the staffing requirements for nurses, midwives, community health officers (CHO), community health extension workers (CHEWS), and junior community health extension workers (JCHEWS). It was conducted in 11 purposefully selected primary-level health facilities in two local government areas in Cross River State, Nigeria. # Results Eighteen health service activities were identified for the primary level of care across the life course. Whilst nurses, midwives, CHO and CHEWS perform all the activities, the JCHEWS performed 10 of these functions. The staffing requirement findings for the facilities in Calabar Municipal indicated that there were staffing shortages for nurses and midwives in 4 of the 5 sampled facilities, three facilities had sufficient or excess numbers of CHO/CHEWS, and 4 facilities had sufficient or excess numbers of JCHEWS. In Calabar South local government area, the calculated requirement showed a cumulative shortage of 5 nurses/midwives and 26 CHO/CHEW, and appropriate staffing of JCHEWS in 4 facilities. # Conclusions The results of this study illustrate the staffing needs of nurses, midwives, CHO, CHEWS and JCHEWS in the sampled facilities and indicate the need for using evidence for staffing decisions. This is pertinent considering it ultimately contribute to improvements in service delivery and health indices. The evidence from the application of the WISN tool and the scale-up of its application has the potential of contributing to the achievement of national goals as well as universal health coverage and sustainable development goals