Maternal Mortality and Nigeria’s Health Workforce Crisis: Legislative Pathways for Health System Recovery

Abstract

Nigeria, Africa's economic powerhouse, grapples with persistently high maternal mortality driven by profound health workforce deficits, critical shortages of skilled midwives, nurses, and obstetricians; under-funding of Healthcare system, economic constraints; nutritional deficiencies; stark state-level disparities; and ineffective retention amid mass "japa" emigration. Accounting for 28.3% of global maternal deaths (8,200 annually, MMR 1,047/100,000 live births), with only 43% of births by skilled providers (39% in facilities, 59% at home), these gaps worsened by underfunding, rural infrastructure deficits, and weak oversight fuel preventable haemorrhage, sepsis, and eclampsia deaths, derailing SDG 3; In view of this, the following propose targeted legislative reforms are urgently needed.  National Assembly may wish to intensify oversight the implementation of the appropriations Act elevating health spending from 5% to the Abuja Declaration of 15% target, ring-fencing funds for maternal commodities like blood products and magnesium sulphate, as prioritized in the 2025 Safe Motherhood Strategy.  Lawmakers may wish to enact legislation that enforces competitive salaries, hazard pay, rapid promotions, and training bonds to halt "japa" emigration of health workers, aiming for WHO 1:1,000 doctor ratio amid the current 40,000 workforce gap.  Legislators may consider reforming the National Health Insurance Authority (NHIA) to fully subsidize maternal and neonatal services under the NHIS, eliminating out of-pocket payments (over 70% of current costs) and funding emergency transport in insecure regions.