Resource availability, students’ perceived quality, and functionality of school health centers in selected south-south Nigerian states: a public–private comparative study

Background: School health centres are expected to provide accessible, safe, and responsive care for learners during school hours, yet implementation in Nigeria remains uneven despite policy provisions for school health services. This study assessed resource availability, students' perceived quality, and the functionality of school health centres in selected South-South Nigerian states. Methodology: A comparative cross-sectional baseline assessment was conducted between March and June 2012 across 30 secondary schools in three South-South Nigerian states, with five public and five private schools selected per state capital. The analytic sample comprised 2,843 senior secondary students and 31 school health-centre managers or responsible officers. Data were collected using structured questionnaires and a structural checklist. Public-private differences were examined using chi-square tests and crude binary logistic odds ratios at p < 0.05. Results: School health centres were available in 16/30 (53.3%) schools: 6/15 (40.0%) public and 10/15 (66.7%) private schools. The association between school ownership and centre availability was not statistically significant (χ² = 2.143, df = 1, p = 0.143; OR = 3.00, 95% CI: 0.68–13.31). Private schools recorded higher checklist-derived resource scores for drugs and consumables, 23/35 (65.7%) versus 7/30 (23.3%); equipment, 20/35 (57.1%) versus 7/30 (23.3%); health personnel, 19/35 (54.3%) versus 7/30 (23.3%); and funding, 18/35 (51.4%) versus 6/30 (20.0%). Students’ perceived quality was significantly associated with school ownership across all six domains (p < 0.001), with private-school students showing higher odds of positive perception for material resources (OR = 4.55, 95% CI: 3.73–5.55), physical location/facilities (OR = 5.92, 95% CI: 4.47–7.83), and overall quality of care (OR = 3.60, 95% CI: 2.97–4.37). Functionality was constrained by gaps in personnel, supplies, equipment, funding, documentation, privacy, operating procedures, and treatment spaces. Conclusion: School health-centre readiness was uneven, and availability did not guarantee functionality. Strengthening school health centres requires joint education and health sector action to establish minimum functional standards, improve public-school readiness, monitor private-school compliance, strengthen referral linkages, and routinely assess students’ experience of care.