The study aimed to determine performance and compare gaps in maternal and newborn health (MNH) services in urban and rural
areas of Osun State, Nigeria, to inform decisions for improved services. This study involved 14 urban and 10 rural-based
randomly selected PHC facilities. Using a Performance Needs Assessment framework, desired performances were determined by
key stakeholders and actual performances measured by conducting facility survey. Questionnaire interview of 143 health workers
and 153 antenatal clients were done. Performance gaps were determined for the urban and rural areas and compared using Chisquare
tests with SPSS version 17. PHC facilities and health workers in Osun State, Nigeria, were found to have significant gaps
in MNH service performance and this was worse in the rural areas. Root cause of most of the performance gaps was poor
political will of local government authorities. Improved government commitment to MNH is needful to address most of the gaps.