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.

These systemic gaps undermine the availability and quality of maternal services, and hinder progress toward achieving the country’s maternal health goal to reduce maternal mortality 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.

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.

Maternal mortality in Nigeria

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, expansion of its Health Extension

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?”

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.

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, comprehensive emergency care, and transport for obstetric emergencies:

• Functional Basic Emergency Obstetric and Newborn Care (BEmONC) facilities;
• Community-Based Health Workers who identify pregnant women early and link them to care;
• Comprehensive Emergency Obstetric and Newborn Care (CEmONC) centres capable of handling complications; and
• Rural Emergency Service and Maternal Transport (RESMAT) system to rapidly transport women during obstetric emergencies.

Across the 172 MAMII priority LGAs, 91% now have functional BEmONC services. However, only 26% have functional CEmONC facilities, while 24% 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.

To address our 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.

Performance-based financing and accountability

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.2

Senator Ibrahim Oloriegbe, Chairman of the Governing Council of the National Health Insurance Authority, called for stronger legislative oversight of maternal-health spending. He also urged civil society organisations to work with lawmakers to strengthen lawmakers’ understanding of maternal health priorities and to scrutinise budget execution.

He further urged civil society organisations to build legislators’ capacity to understand maternal health priorities and to work in partnership to strengthen oversight. Beyond funding and workforce investment, reducing maternal mortality requires sustained political commitment, effective oversight, and accountability to ensure investments translate into better outcomes for mothers.

Innovation cannot remain trapped in pilot projects

Some maternal health innovations have shown promise in specific settings, but moving from a pilot to routine services requires evidence of benefit, a costed delivery model, government ownership, trained staff, reliable infrastructure and a plan for long-term funding.

For Iyadunni Olubode, Country Director for MSD for Mothers, the issue is not a lack of evidence; rather, it is ensuring that proven interventions become embedded within routine health systems.

MSD for Mothers has invested in innovations ranging from digital tools for maternal death surveillance systems to quality improvement initiatives that strengthen respectful maternity care. Across these interventions, she noted, the objective has always been catalytic investment rather than permanent donor funding.

“Our funding must be catalytic; we are funding to demonstrate the efficacy of solutions, provide evidence for advocacy, with the expectation that those who are accountable will fund and operationalise solutions that are found to be successful.”

As development assistance becomes increasingly constrained, donors are placing greater emphasis on domestic ownership and co-financing. WHO similarly highlights the importance of domestic resource mobilisation and country ownership in sustaining health gains in low-income countries.

On her part, Muriel Mafico, Nigeria’s Representative for UNFPA, acknowledged that development partners have helped generate valuable innovations, but many remain fragmented. “We should now transition from fragmented innovations to large-scale, nationally owned, nationally driven and sustainable innovations,” she noted, highlighting digital transformation as a strategic opportunity, while cautioning that scaling digital health also requires investments in health worker digital literacy, interoperability between platforms and strong data governance.

Speaking from the subnational perspective, Dr Oyebanji Filani, Commissioner for Health and Human Services in Ekiti State, noted that health leaders must learn to speak the language of political leadership. “For example, if the governor is focused on rehabilitating roads and believes that’s the most significant thing, then everything you do in the health sector must find a way to connect to that priority.”

The pathway forward

Nigeria has policies and evidence to guide many maternal-health interventions. The challenge is to fund the full pathway of care; ensure facilities can deliver it safely and use data to identify where women still encounter delays or poor-quality services.

• The Federal Ministry of Finance, the Budget Office of the Federation and relevant planning authorities should work with the Federal Ministry of Health and Social Welfare to cost maternal-health priorities, protect funding in annual budgets and publish releases and expenditure against those priorities.
• State governments should cost and implement their Annual Operational Plans, publish quarterly maternal-health spending and service-readiness data, and ensure that designated facilities have trained staff, essential medicines, blood, equipment, power and functioning referral and transport arrangements.
• The National Assembly and State Houses of Assembly should scrutinise budget releases and expenditure, require regular reporting on maternal-health commitments, and follow up on findings from audits and facility-readiness assessments.

The roundtable’s central test is whether financing commitments become dependable care. That means money released on time, facilities able to provide emergency obstetric and newborn care, skilled workers available around the clock, and referral transport that can get women to the right level of care.

The government should publish progress on these commitments, including where services remain unavailable and what is being done to close the gaps. Maternal-health investment should be judged by whether women can obtain safe, timely and affordable care, not by the size of an allocation or the number of pilots launched.