Understanding the Sustainability of Free Maternal and Child Health Services: Perspectives From Costing Studies in Jigawa and Kaduna States, Nigeria

Understanding the Sustainability of Free Maternal and Child Health Services: Perspectives from Costing Studies in Jigawa and Kaduna States, Nigeria

Erin Lee, Xi Cheng, Geir Lie, Benson Obonyo and Elaine Baruwa.

Northwest Nigeria has some of the highest maternal and child mortality rates in the country.  The Partnership for Transforming Health Systems Phase II (PATHS2), funded by the Department for International Development, started work towards achieving Millennium Development Goals 4 and 5 in Jigawa and Kaduna States by supporting maternal and child health programs that provide free services to pregnant women and children under 5.  The aim of this study is to conduct a program assessment and cost analysis of free maternal and child health (FMCH) programs from the perspective of the State Ministry of Health in order to improve the planning, financing, delivery, and sustainability of FMCH services. 

Cost data were collected from primary and secondary level health facilities.  A modified version of the World Health Organization Mother-Baby Package was used to calculate unit cost estimates.  These estimates in turn were used to understand the underlying cost drivers associated with delivering FMCH services.  A classic ‘structure-process-outcome' model was adopted to assess program quality and equity.  Interviews with key stakeholders provided qualitative information about processes of care associated with the programs. 

Preliminary results suggest that differences in unit cost estimates exist between the states.  Unit cost estimates for maternal health services at primary health care facilities range from $13.98 to $72.31 in Jigawa, while in Kaduna unit cost estimates range from $1.69 to $34.99.  Personnel and drugs account for more than 80% of the costs. 

Specific cost information is critical for scale up and sustainability of FMCH programs.  Findings from the study will provide policymakers with the necessary evidence to advocate for continued funding of these programs.