IN A NUTSHELL
Author's Note 

Project Aisha demonstrated that financial resilience and clinical quality are inseparable. By equipping 11 private maternal health facilities in Lagos with structured financial management systems, targeted mentorship, and peer learning, the project achieved a 50% reduction in facility-based maternal mortality — evidence that strengthening the business foundations of private facilities is a high-impact strategy for saving lives. For Nigerian states and other low-and middle-income settings grappling with fragmented private health sectors, this model offers a replicable, evidence-based pathway. The question is not whether private providers can deliver quality maternal care — it is whether health systems are willing to invest in the financial and operational foundations that make it possible

 

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  Executive Summary 

Despite investments in clinical training, maternal health outcomes in private health facilities are frequently undermined by fragile, business-driven models and weak financial oversight. In many low- and middle-income settings, private health facilities suffer from informal financial management and high out-of-pocket dependency, leading to erratic procurement of life-saving commodities and high staff turnover. When financial systems fail, the ‘clinical gain’ evaporates, leaving private health facilities unable to maintain 24/7 emergency readiness, including the blood bank supplies essential for managing obstetric emergencies.

Project Aisha, a maternal health initiative, demonstrated that financial management is an effective and underutilized approach to improving the quality of maternal health services, especially in the private sector. Implemented in Ifako-Ijaiye LGA, Lagos, the initiative targeted single-doctor-led private hospitals that serve as first-contact providers for most pregnant women.

Using an adapted Financial Management Assessment Tool (FinMAT), Project Aisha identified critical gaps in financial record-keeping, governance and staffing, internal controls, budgeting and planning, and reporting among private maternal care providers. Facilities were stratified by financial risk, enabling tailored mentorship intensity. Through structured training, continuous mentorship, supportive supervision, and integration of quality improvement principles, providers strengthened financial systems directly linked to maternal health service delivery.

Results were substantial. Average financial management scores increased from 38% at baseline to 66% at endline, with the greatest improvements observed in financial documentation, governance, and internal controls—foundational systems essential for service continuity. Strengthened financial practices were associated with fewer service disruptions, improved availability of essential maternal health commodities, better staff retention, and enhanced readiness for obstetric emergencies.

Project Aisha demonstrated that strengthened financial management is a frontline quality-of-care intervention. When private providers gain control over their finances, they are better positioned to safeguard the quality of care. Integrating financial management mentorship into maternal health quality improvement approaches offers a scalable, high-impact strategy to sustain safe motherhood gains, reduce preventable maternal deaths, and build resilient private health systems across Nigeria and sub-Saharan Africa.