Too far to walk but too close to a taxi: Improving maternal and newborn health through incentivized emergency transport scheme in northern Nigeria

The burden of high maternal and child mortality is one which the Nigerian Government is working hard to overcome particularly in the northern part of the country. Majority of women in Yobe State, just like any other state in Northern Nigeria, deliver at home. Those who deliver at home often do so because of reasons related to cultural norms (not necessary to deliver in a health facility), cost, lack of transport, lack of spousal permission or due to health worker’s attitude. One of the strategies in improving maternal and neonatal health would be to reduce the barriers to accessing emergency maternal obstetric care services through functional emergency transport scheme (ETS). We report preliminary results of a community-based quasi experimental prospective pilot study on the role of financial incentives in sustaining the ETS in Yobe State, northwest Nigeria. Over 75% of women and newborns from the incentivized intervention communities benefited from ETS services compared with their counterparts. The pilot study also demonstrated its ability to transport women from hard-to-reach and impoverished rural areas to health facilities. We discuss these results in light of the existing challenges related to health service delivery and the need to scale up the pilot results.