The USAID Saving Mothers Giving Life program in Nigeria is a five-year activity implemented under Pathfinder’s Evidence to Action Project cooperative agreement, with the goal of reducing the maternal mortality rate by 25 percent and the neonatal mortality rate by 35 percent in health facilities (HFs).

The project carried out in Cross River State, aimed to reduce the three areas of delays (3-Ds) to receiving timely and quality evidence-based and respectful obstetric and neonatal care: delay in recognizing the need to seek care and making the decision to do so; delay in reaching services; and delay in receiving timely quality care.

The evaluation focused on answering questions on access, quality of care, linkages between local government and HFs, gender integration, and sustainability. The project increased the use of antenatal care, delivery in HFs, and contraceptive use as well as reduced maternal and neonatal deaths in HFs. It strengthened emergency obstetric and neonatal care by task shifting and strengthening capacity of health workers. The project developed community-based emergency transport and discouraged deliveries by traditional birth attendants (TBAs) by paying them to refer women to HFs. The project supported mentoring and supportive supervision through the engagement of retired midwives and volunteers from professional medical associations.

Recommendations include:

  • Decrease dependence on TBA cash payments.
  • Build capacity in state government to manage interventions that address the 3-Ds.
  • Continue trainings, mentoring, and supportive supervision.
  • Pay greater attention to gender equality from project design through implementation.
  • Strengthen local government’s capacity to raise revenue in support of reducing the 3-Ds.

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