A maternal death is a preventable loss for a woman, her family, and her community. Yet Nigeria’s challenge is to commit to preventing these deaths and to ensure that funding, the health workforce, medicines, transport, and emergency care are available when women need them.
Nigeria’s maternal health services face linked financing problems, including insufficient public allocations, delayed or incomplete releases, and gaps between approved plans and the resources available to frontline facilities.
Systemic Gaps Undermine Maternal Health Services
These systemic gaps undermine the availability and quality of maternal services, hindering progress toward achieving the country’s maternal health goal in line with the Sustainable Development Goals (SDG) Target 3.1, which aims to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.
Maternal Health Roundtable Tackles Financing Challenges
Nigeria Health Watch, in collaboration with the Maternal and Neonatal Mortality Reduction Innovation Initiative (MAMII), convened the Maternal Health Roundtable, themed “Investing in Mothers: Aligning Finance, Policy and Innovation for Improved Maternal Outcomes.”
Participants included representatives of federal health and finance ministries and agencies, the World Bank, the United Nations Population Fund, the Nigeria Governors’ Forum, civil society, and the private sector. They examined barriers to maternal health financing and discussed ways to strengthen domestic funding, accountability, and the delivery of proven interventions.
Nigeria has evidence for many interventions that can prevent maternal deaths. The continuing challenge is to fund, deliver, and monitor those services reliably while using maternal death surveillance to identify where the system is still failing.
Between 2000 and 2020, Ethiopia reduced maternal mortality by over 70% through sustained investments in primary healthcare and the expansion of its Health Extension Program.
Reducing Maternal Mortality Requires Sustained Coordination
Reducing maternal mortality requires sustained coordination across government and a clear approach to financing, said Nigeria Health Watch’s Managing Director, Vivianne Ihekweazu. “Reducing maternal mortality is possible if there is sustained effort, working across multiple departments and ministries. It is not just the health sector; it is also financing. How are we financing these programmes?”
Nigeria’s Maternal Health Programs and Initiatives
Budgets alone do not save lives. Nigeria has introduced several maternal and child health programmes, including the Midwives Service Scheme and Saving One Million Lives. The Federal Government of Nigeria also launched the Maternal Mortality Reduction Innovation Initiative (MAMII) in 2024 under the broader Nigeria Health Sector Renewal Investment Initiative (NHSRII) to accelerate reductions in maternal and newborn deaths through coordinated action across all levels of government.
MAMII targets 172 high-burden Local Government Areas (LGAs) across 33 states that account for more than half of maternal deaths in Nigeria. “The country actually knows the problem and wants to solve it,” Dr Dayo Adeyanju, the national lead of MAMII, noted during his presentation.
According to Dr Adeyanju, the 2025 National Health Sector Annual Operational Plan (AOP) estimates that implementing priority health interventions will require approximately ₦3.68 trillion. Government financing accounts for about ₦1.6 trillion, development partners have donated at least ₦1.25 trillion, but a financing gap of more than ₦720 billion remains.
This trend is reflected in the federal budget itself. Nigeria allocated approximately ₦2.48 trillion to the health sector in the 2025 Appropriation Act, representing about 5.2% of the national budget. An approved allocation does not show how much money was released, spent, or converted into services. The result is that health facilities remain without essential medicines, emergency obstetric equipment, and trained personnel, despite policy commitments and approved appropriations.
MAMII’s Service Package and Implementation Challenges
Yet, as Dr Adeyanju stressed, investment must be directed towards interventions proven to save mothers’ lives. MAMII’s service package combines primary-level emergency care, community identification and referral, full emergency care, and transport for obstetric emergencies.
Across the 172 MAMII priority LGAs, 91% now have functional BEmONC services. However, only 26% have functional CEmONC facilities, while 26% have recruited community-based health workers to connect women with services before complications arise.
Nigeria still relies heavily on out-of-pocket spending; this means many women might delay seeking care, arrive late at facilities, or deliver outside the formal health system altogether because the cost of care is simply unaffordable.
Dr Biobele Davidson, the Lead of Strengthening Health Systems at BudgIT, added that inadequate public financing shifts the burden directly onto families. “A lot of times women will say, ‘I didn’t go to the hospital because I was asked to pay for this, and I don’t have money for it,’” she said.
Sustainable Solutions for Maternal Mortality Crisis
To address the maternal mortality crisis, sustainable domestic resource mobilisation must be institutionalised. Governments at the national and sub-national levels should increase budgetary allocations for maternal health, expand financial protection through health insurance, and ensure that allocated funds are released and used transparently.
The roundtable also considered how to ensure that allocated funds produce reliable, good-quality services. Performance-based payments may support this goal, but only when indicators reward quality and equity as well as service volume, and when results are independently verified.
Dr Olumide Okunola, Senior Health Specialist at the World Bank, challenged policymakers to move beyond national commitments and focus on practical investments at the local level. He noted that while Nigeria has significant financing opportunities, including over US$1.5 billion available to states through performance-based financing mechanisms, these resources can only be unlocked when states meet critical health system requirements. The barrier, therefore, is no longer a lack of funding but the political will, accountability, and leadership needed to translate available resources into functioning health services.