CEmONC programme: Advancing maternal health through measurable actionsTony Ademiluyi

I write in response to a feature story by Nkechi Onyedika-Ugoeze published in The Guardian on January 9, 2025, which presented a rather bleak and overly critical assessment of the Comprehensive Emergency Obstetrics and Neonatal Care (CEmONC) programme. The article described the initiative designed to make Caesarean sections free for eligible pregnant women as a “gargantuan failure,” a characterization that overlooks the tangible progress made and the significant strides achieved in improving maternal healthcare in Nigeria.

The report highlighted concerns over delays in awareness campaigns and the programme’s rollout, raising doubts about its viability. It also suggested that the programme had yet to take off three months after its announcement. While it is true that large-scale health programmes often encounter initial hurdles, prematurely labeling CEmONC as a failure disregards the concrete evidence of its phased implementation and measurable progress. A more nuanced and balanced assessment of the programme would reveal the efforts already in motion and the milestones reached.

Launched in August 2024, CEmONC commenced operations in four health facilities located in Kano and Akwa Ibom: Aminu Kano Teaching Hospital, Murtala Mohammed Specialist Hospital, Mohammed Abdullahi Wase Specialist Hospital, and the University of Uyo Teaching Hospital. By December 2024, the programme expanded to seven additional facilities in Bauchi, Sokoto, Kebbi, and Borno States, indicative of its steady growth rather than stagnation.

These new facilities include the Federal Teaching Hospital Birnin Kebbi; Sir Yahaya Memorial Hospital, Kebbi; Maryam Abacha Women and Children Hospital; Usman Danfodio University Teaching Hospital, Sokoto; Abubakar Tafawa Balewa University Teaching Hospital; the Federal University of Health Sciences Teaching Hospital Azare, Bauchi; and the University of Maiduguri Teaching Hospital, Borno. Of these, five have already begun reporting significant progress in achieving the programme’s objectives.

Within its first four months, CEmONC recorded measurable outcomes that challenged the pessimistic narrative. Between September and December 2024, 887 claims were processed, with 706 independently verified and 663 payments disbursed. More than ₦87 million has been allocated to participating facilities to cover treatment costs for life-threatening complications during childbirth. Additionally, over 2,600 women have accessed life-saving obstetric care at pilot facilities, with 887 receiving comprehensive support that covered all associated costs. Official documents from the Federal Ministry of Health and engagements with hospital leadership confirm that financial and operational support has been extended to these hospitals, facilitating service delivery.

CEmONC is not a story of failure; rather, it is a testament to the government’s commitment to reducing Nigeria’s maternal mortality rate, which the World Health Organization estimated at 1,047 deaths per 100,000 live births in 2023. This underscores the need for targeted interventions, particularly for economically disadvantaged families who face barriers to accessing healthcare services.

Far from being an impromptu initiative, CEmONC was meticulously planned to ensure sustainability. As early as December 2023, all 36 states and the FCT were engaged through letters to their respective State Commissioners for Health, requesting data on eligible healthcare facilities. This early engagement enabled proper prioritization based on need and capacity. By the end of 2024, Memorandums of Understanding had been signed with 42 referral facilities across all six geopolitical zones, with efforts underway to onboard all 69 eligible tertiary health institutions.
The programme extends beyond financial support for Caesarean sections. A significant component of CEmONC is the upgrading of healthcare infrastructure to enhance service delivery. Currently, 40 percent of Level 1 primary health facilities are being upgraded to Level 2, allowing them to provide integrated sexual and reproductive health services, including family planning and post-abortion care. Additionally, in 2024, more than 60,000 frontline health workers received training to deliver full-scale sexual and reproductive health services, with another 60,000 set to be trained in 2025. These efforts illustrate a holistic approach to addressing maternal mortality and strengthening Nigeria’s healthcare system.

Given these achievements, the focus should not be on initial implementation challenges, which are common in large-scale interventions, but rather on the significant strides made within a short period. While constructive criticism is necessary to improve policies, assessments of programmes like CEmONC must remain fair, well-researched, and anchored in verified data.
Misinformation about public health initiatives carries real-world consequences, particularly for vulnerable populations. The media plays an essential role in holding institutions accountable and fostering public discourse. However, responsible reporting should prioritize accuracy and balance to avoid undermining confidence in life-saving initiatives. Instead of skepticism, a more constructive approach would be to highlight areas requiring improvement while acknowledging the progress made.

The CEmONC programme is designed to tackle the five leading causes of maternal mortality in Nigeria: haemorrhage, preeclampsia, sepsis, post-abortion complications, and obstructed labour. It offers a lifeline to low-income women who would otherwise struggle to afford critical obstetric care. This initiative is a commendable step by the federal government that deserves broad support from stakeholders, including the media, civil society, and healthcare professionals.
For successful implementation, public awareness about CEmONC must be intensified. Families should be informed that financial barriers should not prevent them from accessing essential maternal healthcare services.

Likewise, healthcare workers and administrators must be adequately equipped with the knowledge and resources to execute the programme effectively. The media has a vital role in this process by providing constructive feedback and raising awareness, ensuring that public discourse supports rather than hinders the initiative’s objectives.

As Nigeria strives to meet the Sustainable Development Goal of reducing maternal mortality to fewer than 70 deaths per 100,000 live births by 2030, the CEmONC programme marks a significant milestone. Rather than being dismissed as a “failure,” it should be seen as an evolving intervention with immense potential to improve maternal health outcomes. It is, therefore, in the national interest that all stakeholders, including the media, rally behind this initiative to maximize its impact.

Tony Ademiluyi, a health journalist and columnist, wrote from Lagos.