By 2012, Community Health and Research Initiative had conducted two analytical projects in Kano, Bauchi, and Sokoto state where maternal mortality rates are high (>1000 maternal deaths per 100,000 live births). The first entailed an analysis of state‐level budgets to compare allocations to health in relation to other development sectors. The findings showed that the health budget in Kano was less than those of the Ministries of Education and Agriculture. It was also below the 15% commitment made by African governments in the regional Abuja Health Declaration. A second project, the National Midwifery Service Scheme (MSS) Budget Analysis in Kano, compared financial commitments made by different levels of government to actual monthly allowances for midwives. Information was gathered through interviews with midwives to understand if they received the money and, if so, where it came from. This project also includes a comparison of budget allocations and service provision within health facilities where MSS is being implemented. Both activities are aimed at promoting efficient and transparent use of the limited amount of existing funds according to regulations under the new Free Maternal and Child Health Policy.

To address the maternal mortality situation, the state government passed the Safe Motherhood Law and in 2010 launched the Integrated Health Records Card Programme. It also established the Community Health Insurance Scheme and launched the Malaria Free Kwara Campaign. All these were to help reduce the maternal mortality rate and contribute to the achievement of millennium development goal 5 - Improve Maternal health. The law allocated N2.5 million for family planning under the reproductive health budget line. Reports have stated that due to competing needs of other reproductive health services, the budgeted family planning funds were absorbed by other programmes and never disbursed for family planning purposes.

A pilot study was conducted to determine which incentives the volunteer drivers would like, and to assess whether these affected their performance levels, and ultimately the sustainability of the emergency transport scheme. According to HPI and DAI, some of the key messages included: (1) Incentives, both cash and in-kind, were associated with higher performance among drivers involved in a transport scheme for women in need of emergency maternal health care. Incentives tested ranged from fuel vouchers, free vehicle servicing vouchers, and cash vouchers linked to distances traveled. (2) The average cost of the incentives per safe delivery or maternal death averted was $9.33. If the women’s families had paid for these trips, the average cost would have been much higher at between $30 and $49, depending on the state. (3) Some incentives worked better than others. The selection of incentives should be based on what drivers want, and the process to obtain them needs to be simple and accessible. (4) The provision of incentives did not appear to undermine the spirit of voluntarism among the drivers. Further research is needed into the long-term effects of incentives on volunteer activity.

The PHCUOR was initiated with support from DFID funded projects- Partnership for Transformation of Health Systems (PATHS 2005-2008) and Partnership for Reviving Routine Immunization in Northern Nigeria: Maternal Newborn and Child Health Initiative (PRINN-MNCH 2008-2014), became a national policy agenda following its endorsement by the 56th National Council on Health (NCH) in May 2011. The Council in its 58th Session in 2013 further approved the national guidelines and the policy document, for implementation, through its Resolution 29. The guidelines identify a conceptual framework for implementing the policy which consists of nine specific domains- Governance, Legislation, Minimum Service Package, Repositioning, Systems Development, Operational Guidelines, Human Resources, Funding Sources & Structure and Office Setup-and outlines specific steps and approaches involved in establishing a functional SPHCDA/B. a 2015 scorecard of the program noted that, in spite of the adoption of the Policy by the NCH, progress with implementation has been slow with States making varying degrees of progress on each domain.

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