Nigeria, one of the most dangerous countries in the world to be born in, is beginning to record early gains from a federal emergency care programme aimed at reducing maternal and newborn deaths.
Two years ago, the government, through the National Health Insurance Authority (NHIA), commissioned Comprehensive Emergency Obstetric and Neonatal Care (CEMONC) services across public maternity hospitals at the secondary and tertiary levels of care.
Efunbo Dosekun, a senior paediatrician and chief executive officer of OUTREACH Medical Services, during a media webinar on “How CEMONC Is Reducing Maternal & Newborn Deaths in Nigeria”, said early results from the programme are already significant.
Dosekun said Nigeria currently ranks among the four worst countries globally for newborn survival, with one in every 25 Nigerian newborns dying.
Dosekun added that the country ranked second-highest worldwide when maternal and neonatal deaths are combined.
Despite these grim statistics, she said an important national intervention introduced by the federal government is beginning to change outcomes.
She said neonatal deaths, particularly among premature and critically ill newborns, are declining in facilities offering the service.
Vulnerable families are also being protected from catastrophic out-of-pocket spending during emergencies, while early referrals by birthing practitioners are increasing, helping to prevent avoidable deaths.
“These are quiet but meaningful gains,” Dosekun said, noting that many of the improvements remain largely outside public awareness.
Preventable causes still driving newborn deaths
Dosekun said the leading causes of newborn deaths in Nigeria remain prematurity, birth asphyxia, sepsis, severe jaundice, birth trauma and anaemia, stressing that most of these deaths are preventable with timely intervention.
She warned that jaundice, if not properly monitored and treated, can worsen rapidly, leading to death or permanent brain damage.
Caregivers must avoid unsafe practices such as exposing babies to sunlight and instead take affected newborns immediately to health facilities where bilirubin levels can be measured, she advised.
“There are established clinical charts that guide clinicians on when specialised phototherapy or more advanced treatment is required,” she said, adding that delayed care remains a major contributor to poor outcomes.
She noted that Sepsis continues to claim thousands of newborn lives annually and must be tackled decisively if Nigeria is to make meaningful progress in reducing neonatal mortality.
Birth complications and the first 60 seconds
Another major challenge is birth-related complications, especially in babies who fail to cry at birth and later develop brain inflammation or injury, a condition known as hypoxic-ischaemic encephalopathy (HIE), Dosekun said.
She explained that HIE is closely linked to the quality of obstetric care during labour and delivery and can only be reduced through improvements in perinatal care, covering pregnancy, labour, delivery and the immediate post-birth period.
According to her, all birth attendants, including nurses, midwives and traditional birth attendants, must be trained in basic newborn resuscitation.
She highlighted the Helping Babies Breathe programme, now being implemented in teaching hospitals across Nigeria, which trains birth attendants on what to do within the first 60 seconds if a baby does not cry at birth.
“In about 99 percent of cases, these simple steps can restore breathing,” Dosekun said, adding that such training should be scaled nationwide and made mandatory for anyone conducting deliveries in Nigeria.
She also stressed that babies who have been resuscitated should be followed up in secondary-level facilities, not just primary health centres, as many develop seizures that can be effectively managed with prompt treatment.
Prematurity and gaps in neonatal capacity
Dosekun identified preterm birth as another major contributor to newborn deaths, noting that much of its prevention and management depends on appropriate obstetric care.
Mothers in preterm labour should receive intravenous steroids to help mature the baby’s lungs, and preterm deliveries should ideally take place in hospitals with functional neonatal units, she said.
After birth, newborns, especially premature babies, must be kept warm, with Kangaroo Mother Care, Dosekun stated, adding that newer low-cost devices designed for low-resource settings are also helping to improve temperature control and breathing support.
Despite these advances, she said Nigeria’s health system remains overstretched. Delays occur at home, during referral, and within hospitals, often with fatal consequences. Bed space for neonatal care, particularly in government facilities, remains grossly inadequate.
Even in states with dedicated Maternal and Child Centres, she said the number of neonatal beds is insufficient for Nigeria’s rapidly growing population, underscoring the need for collaboration with the private sector.
Government response and scaling CEMONC
Dosekun said quality neonatal care is expensive worldwide, and Nigeria is no exception. To prevent financial barriers from delaying care, the Federal Government has committed to covering emergency obstetric and neonatal services for vulnerable families under the CEMONC programme.
“Over the past three years, emergency obstetric care has helped ensure that mothers can access life-saving interventions such as caesarean sections. Three months ago, the programme was extended to newborn care,” she said.
To address capacity gaps, the government launched a pilot programme accrediting selected public and private hospitals across different geopolitical zones to provide Level II neonatal care.
According to Dosekun, her hospital group has been accredited in Lagos, allowing vulnerable families to access emergency neonatal services at facilities in Lekki and Festac, alongside other government centres.
She said the pilot phase is aimed at identifying challenges, improving training, refining systems and developing sustainable models for nationwide expansion, noting that early results are promising but awareness remains low.
A system-wide approach needed
Dosekun said reducing newborn deaths requires a fully integrated system linking community awareness, primary care, secondary care and referral hospitals.
Families, traditional birth attendants, community and religious leaders, she said, must be able to recognise danger signs such as poor feeding, fever, jaundice, breathing difficulty or failure to cry at birth and ensure immediate referral.
Emergency transport systems, coordinated referral platforms, and better data collection are also critical to sustaining progress.
If Nigeria commits to early referral, adequate funding, workforce training and expansion of mid-level neonatal care over the next four years, the country can achieve a remarkable reduction in newborn deaths,” she said.
She described the CEMONC initiative not just as a health policy intervention, but as a national survival effort with real implications for Nigerian families.
“Most newborn deaths are preventable. With the right systems in place, Nigeria can build a future where babies survive, thrive and grow into productive adults,” Dosekun said.
The road ahead
Most newborn deaths in Nigeria are avoidable with early recognition and swift response. Warning signs such as poor feeding, fever, jaundice, breathing difficulty or failure to cry at birth require immediate referral to well-equipped facilities.
A fully integrated system, linking communities, primary care centres, secondary hospitals and referral facilities, is essential.
Strengthened ambulance services, digital referral platforms, and improved data tracking will also be key to sustaining progress.
“If Nigeria invests consistently in community education, workforce training, mid-level neonatal care and early referral over the next four years, the country can achieve a dramatic reduction in newborn deaths.
“For doctors on the frontline, the stakes are clear. This is not just health policy. It is a national survival story, about giving Nigerian babies a fair chance to live, grow and thrive,” Dosekun advised.
Dosekun called on the private sector to play a stronger and more deliberate role in closing Nigeria’s neonatal care gaps, saying government efforts alone cannot meet the scale of demand.
She said private hospitals, diagnostic centres, medical device manufacturers and health financiers must be integrated into the national emergency care framework to expand bed capacity, reduce referral delays and improve access to specialised newborn services.
According to her, structured public–private partnerships would help decongest public hospitals, bring care closer to communities and prevent avoidable deaths, especially in urban centres where facilities are overwhelmed.
She stressed that without active private-sector participation, Nigeria risks reversing recent gains and leaving thousands of vulnerable newborns without timely, life-saving care.
