Nigeria QoC

In Nigeria, approximately seven million births occur annually, and a concerning 63% of women experience home births without skilled attendance. This situation is exacerbated by both inadequate clinical and non-clinical practices, contributing to an alarming Maternal Mortality Ratio of 576 per 100,000 live births, an Under-five Mortality Rate of 128 per 1,000 live births, and a Neonatal Mortality Rate of 37 per 1,000 live births (NDHS 2013). While strides have been made in reducing the under-five mortality rate, the slow decline in maternal and neonatal mortality underscores the urgent need to enhance the quality of care, especially for mothers and newborns.

International efforts such as the Global Strategy for Women, Newborn, Children, and Adolescents Health; Universal Health Coverage; the Global agenda of Ending Preventable Maternal Mortality (EPMM); and the Every Newborn Action Plan all aim to improve the quality of care, recognizing it as a crucial step toward achieving health-related Sustainable Development Goals (SDGs).

In February 2017, Nigeria, alongside eight other African countries (Bangladesh, Cote d’Ivoire, Ethiopia, Ghana, India, Malawi, Tanzania, and Uganda), joined forces with partners to establish the Global network to improve Quality of Care for mothers and newborns. Nigeria's involvement is grounded in high-level political commitment and readiness for coordinated actions to enhance the quality of care for women and newborns.

In the same year, Nigeria established a national Maternal, Newborn, and Child Health (MNCH) Technical Working Group, which initiated the development of the first-ever National Quality Strategy for Maternal and Newborn Health (MNH). Starting with 12 states and 103 pilot sites across the six geo-political zones, this strategy laid the foundation for the broader Reproductive, Maternal, Newborn, Child, Adolescent, and Elderly Health + Nutrition framework introduced in 2020. The strategy informed the initiation of the National Quality Policy and Strategy (NQPS).

The implementation guide for Reproductive, Maternal, Newborn, Child, Adolescent, and Elderly Health plus Nutrition (RMNCAEH+N) is currently being applied across all learning sites in states implementing Quality of Care (QoC) at various levels. This involves utilizing the Leadership, Action, Learning, and Accountability (LALA) strategy along with agreed-upon indicators for Maternal and Newborn Health (MNH).

In recent years, Nigeria has maintained political and national momentum, establishing supportive governance structures for Maternal, Newborn, and Child Health (MNCH) quality of care to address the significant burden of maternal and newborn morbidity and mortality. The coordination of quality-of-care implementation has been bolstered, with the Federal Ministry of Health (FMOH) and an increasing number of partners actively engaged to accelerate progress toward achieving maternal and newborn health goals.