INSTITUTIONAL GOVERNANCE, SERVICE DELIVERY CAPACITY, AND SAFE MOTHERHOOD OUTCOMES IN NIGERIA

Abstract

Improving maternal health remains a critical development priority in Nigeria, where high maternal mortality and stillbirth rates persist despite national policies and interventions. This study was anchored on Principal–Agent Theory, which posits that health system outcomes are influenced by the alignment—or misalignment—between principals (government and hospital authorities) and agents (healthcare personnel), with governance mechanisms, accountability, and incentives shaping agent performance. The study examined the relationship between institutional governance, human resource management, service delivery capacity, and safe motherhood outcomes across tertiary hospitals and primary healthcare centres (PHCs) in Nigeria. A multi-stage sampling technique selected healthcare personnel and maternal patients from six states representing Nigeria’s geopolitical zones, yielding 314 respondents. Data were collected using structured questionnaires and analyzed with descriptive statistics and chi-square tests. Findings revealed weak leadership and administrative capacity, inadequate human resource governance, insufficient service delivery, and poor coordination across health system levels. Mean scores ranged between 2.3 and 2.8, reflecting staff perceptions of delays, poor supervision, insufficient staffing, and limited availability of essential drugs and equipment. Chi-square results indicated that governance and service delivery factors significantly affected maternal outcomes (p < 0.05), contributing to high maternal mortality, stillbirths, and low service coverage. The study highlights the need for strengthened governance, accountability, and incentive structures to align agent performance with maternal health objectives and advance SDG 3 in Nigeria.