By Bashir Aliyu
In April, a coalition of civil society groups, government officials and journalists gathered at the Nigeria Union of Journalists press centre in Kano for what was billed as a routine media parley on maternal health. What came out of that room was less routine. The Kano State Led Accountability Mechanism, a monitoring group known as KanSLAM, told reporters that money the state government had set aside for maternal, newborn and child health had still not reached the facilities meant to spend it. Pharm. Maimuna Yakubu Muhammad, the group’s co-chair, put it plainly: funds allocated by government must be released promptly and used strictly for what they were meant for.
The figure at the centre of that complaint is familiar to anyone who has followed Kano’s health budget this year. The state’s 2026 appropriation, signed into law in January, set aside ₦2 billion for free maternal and child healthcare services, part of a wider ₦214.8 billion health sector package that included ₦91.36 billion for the Ministry of Health and ₦12.9 billion for the Primary Health Care Management Board. On paper, it is a serious commitment. KanSLAM itself credited the state with meeting the Abuja Declaration benchmark of allocating 15 percent of the budget to health in 2026, a target most Nigerian states miss. But the group’s warning was that allocation is not the same thing as delivery, and that the gap between the two is where women in labour and newborns in distress end up paying the price.
That gap has a paper trail of its own. A separate review by The Whistler newspaper found that a N90.6 billion health allocation in Kano was only 4.6 to 12 percent utilised in capital terms, meaning most of the physical work the money was meant to fund, from new health centres to equipment procurement, did not happen at anything close to the pace planned. The state’s population, estimated at more than fifteen million, is the largest in Nigeria, and its rural areas carry a disproportionate share of home births without a skilled attendant present.
Kano is not an isolated case. In neighbouring Jigawa, the Jigawa Maternal Accountability Forum, a coalition that includes civil society organisations, health professionals and traditional and religious leaders, presented its second-quarter 2026 budget performance review in August and found something more specific and, in its own way, more damning. Under the Jigawa State Primary Healthcare Development Agency, ₦500 million had been approved for family planning. As of the end of June, the Forum reported, zero naira of it had been spent, not in the first quarter, not in the second. The state’s overall 2026 health sector budget of roughly ₦80.15 billion had seen only ₦27.49 billion, about a third, spent by the same point in the year. JiMAF co-chair Isah Mustapha warned that the slow pace of implementation could undermine efforts to reduce maternal, newborn and child mortality, the very outcomes the money was supposed to protect. According to the campaign’s review of the state budget, there has historically been no clearly visible, dedicated line for maternal and childbirth spacing services in Jigawa at all, a gap that campaigners say makes it nearly impossible for communities to know what has been funded, let alone hold anyone accountable for spending it.
In Kaduna, the picture is layered differently. The state has for several years allocated at least 15 percent of its budget to health, and in July its Ministry of Health convened stakeholders to review the Free Maternal and Child Healthcare policy first introduced in 2006. The review, presented by the Kaduna State Primary Health Care Board, did not sugarcoat what it found: inadequate financing, a lack of life-saving medicines, drug procurement bottlenecks, outdated policy provisions and weak management structures. Perhaps most tellingly, the review acknowledged that beneficiaries still pay for some services despite the policy’s promise of free care. According to the campaign brief, ₦2.5 billion has been allocated for mothers and babies in Kaduna without being released; that specific figure could not be independently verified through public budget documents at the time of writing and should be treated as a claim requiring further confirmation, though it sits comfortably alongside a state-commissioned review that already concedes the free-care promise is not being kept in full.
Lagos presents a variation on the same theme. The campaign brief cites an approved ₦89 million for family planning that has not been released; Lagos’s own health allocation for 2026 stands at roughly ₦339 billion within a total state budget of ₦4.44 trillion, and the state currently runs about 340 primary health centres, nearly half of which health officials say need upgrading. A state family planning funding line of a few million naira (a figure this small could not be independently confirmed against the 2026 appropriation and needs verification) would be a fraction of a fraction of that health budget, yet family planning at the primary care level is precisely where women decide whether and when to have another child.
Gombe, which the campaign brief says allocated ₦51.8 billion to health without a visible line for maternal and childbirth spacing services, has in fact been cited in a recent peer-reviewed account of its own health reforms as having raised its health share from single digits toward the 15 percent Abuja target. The state’s full 2026 budget was signed into law at ₦617.95 billion. Whether a dedicated, trackable line for maternal and newborn health exists within that figure is something JiMAF-style scrutiny has not yet been applied to in Gombe the way it has in Kano and Jigawa, a gap in the public record itself.
None of this happens in a vacuum. Nationally, out-of-pocket spending accounted for close to 71 percent of Nigeria’s total health expenditure in 2023, among the highest shares in the world, while the federal health budget for 2025 came to about 5.18 percent of total spending, far short of the 15 percent African governments promised each other at Abuja in 2001. When a state budget line goes unreleased, it is rarely absorbed painlessly elsewhere in the system. It is absorbed, more often, by the woman told to buy her own gloves.
What accountability groups in Kano and Jigawa are asking for is not complicated: publish what has been budgeted, release it on schedule, and let communities track what happens next. Whether Kaduna, Lagos and Gombe face the same scrutiny may depend on whether journalists and civil society in those states start asking the same pointed questions KanSLAM and JiMAF have already put on the record.
## SOURCES AND REFERENCES
1. Nigeria Info FM (Lagos). “Delayed Release of Health Funds Puts Women, Children at Risk in Kano, KanSLAM.” April 11, 2026. https://www.
2. Leadership Newspaper. “Kano Government To Spend N214.8bn For Health Sector Repositioning In 2026.” March 4, 2026. https://leadership.
3. The Whistler Newspaper. “Kano’s Health Budgets Meet Threshold, But Execution Is Abysmal.” June 8, 2026. https:
4. The Guardian Nigeria (Features/Health). “JiMAF Faults Slow Health Budget Implementation In Jigawa.” August 7, 2026, reporting the Jigawa Maternal Accountability Forum’s 2026 Q2 Health Sector Budget Performance Review. https://
5. Voice of Nigeria. “KADMAM Seeks Implementation of Free Maternal Healthcare Policy.” July 16, 2026, Kaduna State Primary Health Care Board review of the Free Maternal and Child Healthcare (FMCH) Policy. https://von.gov.ng/
6. Eagle Online. “Lagos unveils decade-long primary healthcare financing plan.” May 7, 2026. https://
7. AllAfrica / Lagos House of Assembly. “Breaking News: Lagos State House of Assembly Approves ₦4.44 Trillion Budget for Year 2026.” https:/
8. Habu Dahiru et al. “Transforming the health system in Gombe State: accomplishments, challenges and the next frontier.” Pan African Medical Journal, January 30, 2026. https://www.
9. Voice of Nigeria. “Gombe Governor Signs 2026 Budget Into Law.” https://von.gov.ng/
10. Commonwealth Fund. “Nigeria” (international health policy profile), citing WHO/Global Health Expenditure Database. Updated 2026. https://www.
11. Centre for Journalism Innovation and Development (CJID). “Out-of-Pocket and Out of Reach: Why Nigeria’s Health Insurance Coverage is not working.” June 27, 2025. h
