Context
Nigeria faces one of the highest maternal and neonatal mortality rates globally, accounting for 12% of all maternal deaths, stillbirths, and neonatal deaths. Between 2000 and 2020, while many countries progressed in reducing mortality, Nigeria remained among the few with persistently high rates. Critical challenges include inadequate healthcare access, low skilled birth attendant density, and financial barriers to care.
To address this crisis, the Nigerian government launched the Maternal Mortality Reduction Innovation Initiative (MAMII) in November 2024. MAMII prioritises life-saving interventions for women and newborns, using both supply and demand-side strategies to strengthen healthcare services in the 172 most affected local government areas.
Investing in midwifery education to reduce perinatal mortality
Midwives are essential in reducing maternal and newborn mortality, capable of delivering up to 90% of life-saving interventions when working in supportive environments. Universal midwifery care, including emergency obstetric and newborn services, could prevent over 60% of maternal and neonatal deaths.
However, midwifery education in low- and middle-income countries remains underfunded, affecting the quality of training and care. Key challenges include outdated curricula, inadequate clinical teaching, and a shortage of skilled educators.
Objectives
This project, funded by the Gates Foundation, aims to address these challenges by improving midwifery training, enhancing healthcare service delivery, and supporting the NMCN in its role as the leading body for advancing midwifery education and practices to reduce maternal and newborn morbidity and mortality in the country.
The project will generate evidence to showcase the impact of the Gates Foundation’s investment, support advocacy for scaling midwifery education, and promote midwifery-led service delivery. Digital technology, partnerships, and institutional capacity strengthening will serve as key enablers for scalability, sustainability, and maximizing impact.
Our Role: Driving Progress in Maternal and Neonatal Health
LSTM’s Emergency Obstetric and Quality of Care Unit (EmOQoC) partners with the National Primary Health Care Development Agency (NPHCDA) the lead agency for MAMII implementation. Acting as an operational extension of NPHCDA, LSTM plays a pivotal role in strengthening healthcare delivery systems and scaling evidence-based maternal and neonatal care interventions.
Key responsibilities include:
- Enhancing NPHCDA’s capacity to monitor progress in over 2,600 healthcare facilities supported by the Basic Health Care Provision Fund (BHCPF).
- Supporting the integration of maternal and neonatal innovations into pre-service midwifery education.
- Establishing robust data collection, analysis, and feedback systems to inform adaptive decision-making and track programme outcomes.
- Conducting operational studies to refine midwifery practices and delivery models for improved care quality.
- With a focus on collaborative monitoring and learning, LSTM facilitates strategic partnerships, enabling the effective implementation and evaluation of MNCNH innovations across 33 states in Nigeria.
Implementation Research and Monitoring Success Criteria
Success will be achieved if, by the end of three years:
- Enhanced Monitoring Capacity: NPHCDA effectively monitors inputs, outputs, and outcomes in BHCPF-supported facilities.
- Midwifery Education Improvements: NMCN evaluates the integration of MNCNH innovations into pre-service midwifery education, strengthens systems, and produces a report with lessons learned to guide nationwide scale-up.
- MNCNH Scale-Up Mechanisms: LSTM establishes robust systems to track and scale MNCNH interventions, strengthening service delivery under MAMII.
- Documented Lessons: LSTM captures and shares insights from implementing maternal health projects to inform scaling and future programme designs.
- Strategic Guidance: LSTM supports NPHCDA in achieving MAMII objectives through rapid feedback loops and adaptive decision-making.
- System Evaluation: LSTM evaluates and recommends improvements to NPHCDA’s monitoring systems for enhanced functionality.
Implementation research team
The evaluation team will be led by Professor Charles Ameh from the Liverpool School of Tropical Medicine, with Professor Olaide Edet , University of Calabar, Associate Professor Muhammad Awwal Ladan, Bayero University Kano, and Dr Halima Musa-Abdul, senior Midwifery researcher from the Ahmadu Bello University Zaria.
LSTM researchers on the team include Dr Alice Norah Ladur, Dr Fiona Dickinson, Dr Sarah White, Mr Christopher Murray and Dr Hauwa Mohammed. Programme management support will be provided by a team based in the UK, Mr Tim Garner and Ms Felicia Ohl and in Nigeria Ms Adacha Bello.
NOIPolls will provide comprehensive data collection support for the health facility baseline and periodic monitoring of intervention across 33 states in Nigeria. NOIPolls has extensive experience in conducting large-scale surveys, managing high-quality data collection processes, and leveraging its network for health-focused monitoring and evaluation. The team will be led by Dr. Chike Nwangwu.
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