Nigeria’s maternal mortality ratio is the tenth highest in the world, with 576 maternal
deaths per 100 000 live births and about 40 000 maternal deaths recorded
annually (1). The uptake of antenatal care (ANC) remains low in the country: in 2013
only 61% of pregnant women accessed ANC at least once from a skilled provider.
Also, only 36% of pregnant women delivered at a health-care facility (2).
To encourage Nigerian women to access ANC and other maternal health services and increase
uptake of facility-based delivery, the national Subsidy Reinvestment and Empowerment Programme
(SURE-P) piloted a conditional cash transfer (CCT) scheme. Women are eligible to receive a cash
payment for every ANC registration in a SURE-P-supported facility and for the second through
fourth ANC visits, facility-based delivery and postnatal care/infant immunizations. However,
payments are often delayed due to the CCT’s cumbersome, paper-based reimbursement system.
Pathfinder’s m4Change2 initiative is a set of interventions that aim to address these two issues
(low uptake of health services and delayed payments) by facilitating real-time data collection and
payment verification.