The typical way one usually begins an article on maternal and newborn health in Nigeria is to confront the reader with numbers. Stark, uncomfortable numbers that remind us how far the country still has to go. This article will not be any different, yet very direct.
In 2023, Nigeria accounted for well over one quarter (28%) of all global maternal deaths. This is an estimated total of 75,000 women dying in childbirth in a year, which works out at one death every seven minutes. Recent WHO report places the maternal mortality ratio at over 1,047 deaths per 100,000 live births. About 45% of all births are attended by a skilled health provider with only about 43% of births taking place in a health facility(NDHS 2023). Behind each of these numbers is a woman, a family, and a community whose lives are permanently altered by a loss that, in many cases, could have been prevented.
The tragedy of maternal death has enormous consequences, not only for families but also for society in general. Yet despite years of policies, programs, and investments, progress remains uneven.
The Layers of Delay
For many Nigerian women, accessing quality maternal health services is not a single decision but a journey marked by multiple delays. From the delay in deciding to seek care, to the delay in reaching care, and then the delay in receiving appropriate care once she arrives at a facility.
It is at this point of receiving care that the health system is expected to respond swiftly and competently. This is where infrastructure, supplies, and most importantly, people (health workers), matter.
Across many facilities, especially at the primary healthcare level, basic equipment and essential commodities are often unavailable or unreliable. But even when a woman makes it to a facility that has basic infrastructure such as beds, essential medicines, and electricity, the outcome still depends on the health workers on duty. Their numbers, their skills, and their ability to work together under pressure can mean the difference between life and death.
This is where Nigeria’s health workforce challenge becomes impossible to ignore.
The Human Face of Human Resources for Health
Human resources for health (HRH) is one of the core building blocks of any health system. It includes doctors, nurses, midwives, community health workers, and all the people whose skills and decisions shape health outcomes.
To understand what this looks like in practice, let’s consider a fictional but familiar scenario.
It is 8pm in a rural PHC. A young midwife is alone on duty. A woman arrives in labor, bleeding heavily. The midwife knows, in theory, what should be done due to previous training, but without regular practice, supportive supervision, or a team to work with, she lacks confidence in her ability to handle this complication.
This is not a scenario of incompetence. It is one of a system that places impossible demands on too few people.
Nigeria faces a severe shortage of healthcare workers, particularly at the primary healthcare level where most women first seek care. The health worker-to-population ratio remains far below WHO recommendations of 17 per 10,000 patients with current doctor to patient ratio standing at 2.9 per 10,000 patients. Population growth continues to outpace workforce expansion, and the ongoing emigration of skilled professionals (Japa Syndrome) continues to further worsen the situation. The result is overstretched staff, burnout, and high turnover, especially in rural and underserved areas.
But the challenge is not only about numbers.
When Training Does Not Translate to Care
Over the years, Nigeria has invested heavily in the recruitment and training of skilled birth attendants and other health workers. Yet gaps persist, particularly around skill retention, confidence, and real-world application. Many frontline workers have attended multiple trainings but still struggle during emergencies.
This is partly because of how training has traditionally been delivered.
Conventional training models often rely on off-site workshops, classroom lectures, and one-time events. There are little opportunities for follow-up, practice, or mentorship. Knowledge fades, skills decline and staff transfers and attrition further weaken continuity.
Recognizing this gap has pushed policymakers and partners to rethink how health workers are trained and supported.
A Shift in Direction at the National Level
In recent years, the Federal Ministry of Health has taken important steps toward strengthening the maternal, newborn, and child health workforce through more sustainable and integrated approaches. Equally important has been the shift in how training is delivered.
From One-Off Workshops to Learning on the Job
Evidence increasingly shows that traditional training offsite group-based training (TRAD) methods alone are not enough to change practice. In response, Nigeria has begun to adopt low-dose, high-frequency (LDHF) training models, particularly for reproductive, maternal and newborn health, which has been seen to be more effective in improving health care workers skills and retention
Low-dose, high-frequency training focuses on short, targeted learning sessions delivered repeatedly over time. Rather than pulling health workers away from their facilities, training happens on site, in familiar environments, using the equipment and space they work with every day.
Simulation-based training has become a key part of this approach. Simple, low-cost simulation corners are being established within facilities, allowing health workers to rehearse emergency scenarios such as postpartum hemorrhage, eclampsia, or newborn resuscitation. Practicing these scenarios repeatedly builds muscle memory, confidence, and speed.
Because the training happens within the facility, entire teams can participate. Nurses, midwives, community health workers, and supervisors learn together, strengthening communication and coordination.
Training Teams, Not Just Individuals
One of the most promising developments in recent years has been the introduction of team-based emergency response tools, such as PROMPT-style checklist approaches adapted for local use.
These tools recognize that maternal emergencies are rarely managed by one person alone. They require clear roles, rapid communication, and shared understanding under pressure. Checklist-based training helps teams practice how to respond together, step by step, during high-stress situations.
Instead of relying on memory alone, health workers learn to use structured prompts that guide actions, reduce errors, and encourage collaboration. Over time, this builds a culture of teamwork rather than hierarchy or hesitation. This approach and it’s effectiveness is still being tested in Nigeria, but has been found to work in some similar settings in Zimbabwe, Africa
When combined with simulation and frequent practice, these approaches have the potential to improve not only technical competence but also the confidence and morale of frontline staff.
Why This Matters Now More Than Ever
With recent uncertainty around foreign aid and donor funding, Nigeria faces a critical moment. While external support has played an important role in advancing maternal and newborn health, the current landscape highlights the urgency of building systems to the last mile that can endure beyond donor cycles.
Strengthening the health workforce through locally embedded, cost-effective training models offers a pathway toward sustainability. These approaches are less expensive than repeated large workshops, reduce service disruption, and build capacity within the system itself.
They also align with the realities of Nigeria’s health system, where primary healthcare centers are the backbone of service delivery. By focusing on the skills, confidence, and retention of frontline workers, particularly at the PHC level, the country can make meaningful progress toward improving the quality of maternal care.
Looking Forward
Reducing maternal mortality in Nigeria will require more than policies and statistics. It will require sustained investment in the people who stand at the frontlines of care, often under the most challenging conditions.
By rethinking how we train, support, and retain the maternal health workforce, Nigeria has an opportunity to close the gap between knowledge and practice, between facility access and quality care. The shift toward integrated programming, on-site simulation, and team-based learning is a step in the right direction.
The challenge now is scale, consistency, and commitment, ensuring that every effort and resource deployed continues to yield impact long after support is ends. Because when a woman walks into a health facility in labor, she deserves more than good intentions. She deserves a skilled, confident team ready to act.
And the strength of that team begins long before she arrives.