Community Midwifery Programme Evaluation in Rural Northern Nigeria: Coverage, Quality, and Outcome Metrics

Community midwifery programmes have been implemented in northern Nigeria to extend skilled birth attendance to rural communities with the lowest facility delivery rates, yet their coverage, quality, and impact on maternal health outcomes have not been systematically evaluated. This study evaluates the community midwifery programme in rural communities of Yobe and Niger States, North East and North Central Nigeria respectively. Programme data from 2020 to 2023 were extracted from State Primary Health Care Development Agency records, covering midwife deployment, deliveries conducted, complication referral rates, maternal death rates, and community coverage indices. Structured interviews were conducted with 20 deployed community midwives and 15 community health committee leaders. Community midwife deployment reached 62 percent of targeted villages in Yobe and 74 percent in Niger. The proportion of women attending four or more antenatal contacts with community midwives increased from 22 to 41 percent during the programme period. Facility delivery referral rates improved significantly in communities with resident community midwives. However, community midwife attrition reached 28 percent per year due to poor remuneration and accommodation deficits. Programme outcome metrics show modest but meaningful maternal health gains. Professional recommendations include competitive community midwife remuneration packages, adequate accommodation provision, and programme scale-up funded through the Basic Health Care Provision Fund. Keywords: community midwifery, rural northern Nigeria, skilled birth attendance, programme evaluation, maternal health