Nigeria faces N720bn maternal health funding gap as mortality remain high

Nigeria faces a N720 billion annual funding gap in maternal health, stakeholders have warned, saying the shortfall threatens efforts to reduce the country’s high rate of maternal and newborn deaths even as the country continues to record one of the world’s highest maternal mortality rates.

They noted that chronic underfunding, weak budget implementation and poor accountability continue to undermine efforts to reduce the country’s high maternal mortality rate.

The concerns were raised during a maternal health roundtable organised by Nigeria Health Watch in Abuja with the theme, “Investing in Mothers: Aligning Finance, Policy and Innovation for Improved Maternal Outcomes.”

Dayo Adeyanju, the National Lead of the Maternal and Neonatal Mortality Reduction Innovation Initiative (MAMII), presenting the funding outlook, said the National Health Sector Annual Operational Plan (AOP), covering the Federal Government, the 36 states, the Federal Capital Territory and federal Ministries, Departments and Agencies (MDAs), is estimated to cost N3.68 trillion.

According to him, development partners are expected to provide N1.25 trillion, while government funding stands at N1.70 trillion, leaving a financing gap of about N720 billion that could hamper implementation of key maternal and newborn health interventions.

Adeyanju also highlighted the burden of maternal and neonatal mortality across priority states under the Maternal and Neonatal Mortality Reduction Innovation Initiative, noting that preventable deaths continue to be driven by multiple delays in accessing quality healthcare.

He identified delays in seeking care, reaching healthcare facilities, receiving appropriate treatment, taking responsibility and coordination failures as major contributors to maternal and neonatal deaths.

He highlighted the distribution of the five delays across priority states and the Federal Capital Territory, underscoring persistent barriers to timely obstetric and newborn care in states including Sokoto, Niger, Kaduna, Bauchi, Gombe, Adamawa, Kwara, Plateau, Nasarawa and the FCT.

Also speaking, Biobele Davidson, Strategic Health Systems Lead at BudgIT Foundation, said Nigeria continues to spend far below its commitment under the Abuja Declaration, which urges African countries to allocate at least 15% of their national budgets to health.

He noted that Nigeria’s health allocations have generally remained between 3.5 and 6% of national budgets, adding that the Federal Government’s 2026 health budget of N2.51 trillion represents just 3.67% of the total 2026 budget.

Davidson said the country’s health financing system is heavily dependent on households, with between 69 and 77% of health expenditure paid directly by patients through out-of-pocket spending.

He said the high level of out-of-pocket payments poses a major barrier to antenatal care, skilled birth attendance and emergency obstetric services, particularly for poor and vulnerable women.

He further observed that although international development partners, including the World Bank and the Global Financing Facility (GFF), continue to fill critical financing gaps for vaccines and maternal health commodities, excessive reliance on donor funding leaves Nigeria’s health system exposed to external funding shocks.

According to Davidson, health insurance coverage among pregnant women also remains extremely low, with fewer than five percent of the estimated seven million Nigerian women who give birth annually enrolled in health insurance schemes.

He noted that even where governments make health budget allocations, implementation remains a major challenge. “Budget performance analysis across Nigerian states consistently shows that actual health expenditure frequently falls between 30 and 50 per cent below approved allocations,” he said.

He explained that for maternal health services, including emergency obstetric care, skilled birth attendance, antenatal drug procurement and referral transport, the execution gap means that even inadequate budgeted funds rarely reach the facilities where women need them most.

Davidson said the implementation record of the Basic Health Care Provision Fund (BHCPF) illustrates the challenge, citing delayed federal releases, inconsistent counterpart funding by states and limited capacity of health facilities to absorb available resources.

He described Nigeria’s maternal mortality ratio of about 993 deaths per 100,000 live births as one of the highest globally, noting that the country accounts for about 19 to 20% of global maternal deaths despite representing only about two percent of the world’s population.

According to him, about 82,000 Nigerian women die every year from pregnancy-related complications, with postpartum haemorrhage, eclampsia, obstructed labour and sepsis remaining the leading causes of maternal deaths.

He stressed that these conditions are largely preventable through adequate financing, stronger primary healthcare systems and timely access to quality maternal care. Davidson also identified accountability failures as a major obstacle to improving maternal health outcomes.

He cited the lack of transparency in health budget implementation at the federal, state and local government levels, noting that many states either fail to publish quarterly budget implementation reports on time or do not publish them at all.

He further alleged that diversion of local government funds by some state governments continues to deprive primary healthcare facilities of resources constitutionally meant for frontline service delivery.

While describing the 2022 Supreme Court judgment affirming local government financial autonomy as an opportunity to strengthen primary healthcare financing, Davidson said its implementation remains incomplete.

He added that accountability mechanisms built into the Basic Health Care Provision Fund, including state counterpart funding requirements and facility-level reporting, are inconsistently enforced, limiting the fund’s effectiveness in improving maternal and newborn health services.

Participants at the roundtable called for increased domestic investment in maternal health, improved budget execution, stronger accountability systems and sustained policy reforms to ensure that financial resources translate into better health outcomes for mothers and newborns across the country.