Partnering for progress: Defeating maternal and child mortality in Nigeria

Hajiya A'ishatu lives in the outskirts of Tudun-Wada city in Nigeria’s Gombe State. She runs a shop out of her home selling cold drinks and other merchandise. Her older children often help with the business while her younger ones are still in school. She remembers when she gave birth to them at the Tudun Wada Primary Health Care Facility.

“I had all my children in this facility,” she says. My family is grateful for everything the doctors and nurses did for us here. They supported me throughout my deliveries and took good care of my babies. I am fortunate to see my children growing healthy and thriving. As a parent, you want the best for them.”

Hajiya’s story speaks to a broader national effort over the past few years to improve maternal and child health services across Nigeria, particularly in underserved communities. Nigeria’s levels of maternal and child mortality are among the highest in the world, with maternal mortality representing 20% of the global burden.

Through the establishment of a Basic Health Care Provision Fund the government was able to channel more resources to primary health care across the country. Financing and technical assistance from the Global Financing Facility for Women, Children and Adolescents (GFF), helped pilot this program in three states, and mobilized government resources to expand it nationwide. The efforts helped to strengthen about 900 primary health care facilities with critical infrastructure like maternity wards, medicines and skilled health workers. Deliveries, pregnancy medications and other services were provided for free, and some facilities even covered transportation expenses for midwives to reach isolated communities.

At the same time, the GFF and the World Bank supported the Nigeria State Health Investment Project to reach communities in the Northeastern region of Nigeria which has been grappling with conflict and weakened health systems, leaving many without health care. As a result, from 2014 and 2020, before the COVID-19 pandemic, safe deliveries jumped from 22% to 68% and the number of children immunized each year tripled to reach 1 million.

Adolescent health also became a priority given Nigeria’s large youth population. Through the Accelerating Nutrition Results project supported by the World Bank and the GFF in Kaduna State, adolescent girls are now accessing better information and counseling on family planning, leading to increased use of modern contraceptives. Highly trained health workers also visit communities and provide nutritional advice to families. Covering a total of 12 states in Nigeria, the project helped provide nutrition services to nearly 5 million pregnant women and over 7 million children under five and supported the treatment of children from amongst the 2.6 million affected by severe malnutrition nationally.

These efforts have empowered young women like 17-year-old Maryam Ishah, who points out the life-changing nature of accessing these services.

I learned a lot from the counselors at the health center and now I am able to share this information with my community. When I grow up, I want to be a doctor and help others take charge of their health,” Ishah says.

Challenges Persist

Despite significant strides, challenges remain. The health of women, children and youth is still underfunded. As a result, women and children, especially in areas without well-equipped health facilities and human resources are dying preventable deaths.  

Zainab Umar Ciroma, Facility in Charge in Tudun Wada, notes ongoing staff shortages and long wait times.

“We used to have more and better motivated health workers due to improved conditions and pay, but now that’s changing,” she says.

The economic downturn over recent years has exacerbated these issues, rendering health services unaffordable for many. Many women forgo their prenatal check-ups, choosing traditional healers instead. As Sumaiya Yakubu, a patient at Tudun Wada, says many women also now opt for home births to avoid costs, undermining the gains made in hospital births.

“In the past, everything used to be free which was a huge incentive for women to come in. Honestly, now so many women prefer to give birth at home because at least they don't have to pay for anything,” Yakubu laments.

A Path Forward

While the scale of the challenge is daunting, Nigeria is taking decisive steps to prioritize the health of women and children, with the support of its development partners.

Building on lessons from past initiatives, the government has unveiled the Nigeria Health Sector Renewal Investment Initiative, a bold plan designed to crash maternal and child mortality.

This initiative adopts a Sector Wide Approach (SWAp) to foster alignment among partners around national health priorities, which is crucial in a resource-constrained environment. The World Bank’s recently approved $570 million primary health care project is an example of bringing together financing from multiple partners. The new financing comprises of  $500 million from the World Bank and $70 million in grants from the GFF, with contributions from the UK’s Foreign, Commonwealth & Development Office and the Children’s Investment Foundation Fund through joint financing with the GFF. These funds will help to close critical financing gaps for provision of primary health care services and family planning commodities for the most vulnerable communities.

As Nigeria navigates this pivotal moment, the government’s commitment to collaboration and strategic investment offers a promising path toward transforming its health sector, potentially saving countless lives and ensuring the right to health for all women, children, and adolescents.