Beyond Aid Is Not a Financing Plan: What Sustainable Women’s and Maternal Health Funding Must Look Like in Nigeria

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Nigeria’s maternal health challenge is not simply about whether sufficient funding is available. It is also about how resources are raised, allocated and translated into essential services for women, particularly those living in poor and underserved communities.

Discussions at the 2026 World Health Summit in Berlin brought this challenge into focus. Across several sessions, a compelling message emerged for Nigeria: moving beyond aid must mean building a more resilient, country-led financing system, not abandoning international support or shifting the burden of healthcare onto households.

The urgency is evident in Nigeria’s own data. The 2024 Nigeria Demographic and Health Survey found that only 43% of live births occurred in health facilities, while 46% were assisted by a skilled provider. Meanwhile, out-of-pocket payments accounted for 71.9% of current health expenditure in 2023, according to the World Health Organization’s (WHOs) Global Health Expenditure Database. These figures reveal the challenge of ensuring that essential maternal services are accessible, affordable and available when needed.

Domestic responsibility, international partnership

During the session The Moment is Now: Unlocking New Capital for Women’s Health Beyond Aid, Ghana’s Minister of Health, Kwabena Mintah Akandoh, articulated a principle that should resonate with Nigerian policymakers: “When external resources declined, our responsibility to our people does not decline with them.”

A key lesson from Ghana’s experience is that expanding access to health facilities does not automatically translate into better maternal outcomes. Women may reach health facilities and still face preventable complications if skilled personnel, essential medicines, blood supplies, and emergency obstetric care are unavailable.

This distinction matters for Nigeria, where financing decisions must account for the entire continuum of maternal care, from antenatal services and skilled birth attendance to emergency interventions and postnatal follow-up. According to Akanoh, financing alone cannot save mothers, it takes political leadership, functioning health systems and accountability.  The discussion also demonstrated that domestic financing need not be the only source of investment.

 Bangladesh announced a €250 million agreement with the European Investment Bank to support women’s health, including maternal care, obstetric and newborn services, and women’s cancer care. Germany also committed €3.4 million to support technical assistance for implementation.  The significance lies in understanding how government leadership, development finance and technical partnerships can work together to strengthen national health systems, not in replicating Bangladesh’s arrangement wholesale. For Nigeria, these examples reinforce the need to move towards sustainable financing for the full continuum of maternal care.

As Birgit Pickel, Germany’s Director-General for Sustainable Development and Climate at the Federal Ministry for Economic Cooperation and Development, stressed during the discussion, development cooperation should “complement not replace domestic financing and wider investment.” For Nigeria, the transition beyond aid should not become an abrupt withdrawal of external resources, particularly where these support essential commodities, reproductive health services, frontline workers and vulnerable populations.

From financing commitments to saved lives

The session “Transforming the Future: Ending Preventable Maternal and Child Deaths” co-hosted by the Global Financing Facility, focused on country-led primary health care investment to improve women’s, children’s and adolescents’ health and nutrition. It reinforced the importance of integrating proven interventions into strong primary healthcare systems. Financing must support the entire continuum of care, from antenatal services and skilled delivery to emergency obstetric care, newborn services and postnatal follow-up.

For Nigeria, this means that innovative finance should complement, rather than distract from, investments in health workers, essential commodities, reliable referral systems and functional primary healthcare facilities.

Blended finance and private-sector partnerships may help mobilise additional capital for suitable investments, including local production of health commodities and infrastructure. However, such arrangements require clear public-interest safeguards. Commercial returns must not take precedence over affordability, equitable access or the needs of women who cannot pay. The ultimate test is whether women receive quality care without facing financial hardship.

Nigeria’s next steps should be practical: protect funding for essential maternal and newborn services; improve the execution and transparency of health budgets; expand effective financial protection for poor and vulnerable women; and align external support with country-led priorities and measurable outcomes.

Government, development partners, civil society and communities must also be able to track whether resources are reaching underserved populations and improving service availability.

Beyond aid should therefore be understood not as financing health alone, but as strengthening the institutions, partnerships and accountability mechanisms that sustain care.

Nigeria does not need to choose between domestic responsibility and international solidarity. It needs a financing compact in which domestic resources provide a stronger foundation, external support remains predictable and strategically aligned, and every investment is judged by its contribution to equitable, affordable care.

The measure of success will not be how much aid Nigeria replaces. It will be whether more women survive childbirth, more newborns receive timely care, and fewer families are pushed into financial hardship when seeking essential health services.

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