Lagos and Kano States have been identified as the most prepared for the large-scale rollout of Multiple Micronutrient Supplements (MMS) for pregnant women in Nigeria, according to a new market landscaping and segmentation study.
The assessment examined financing capacity, demand trends, supply chain systems, and implementation readiness across six selected states.
Strong System Readiness in Two Leading States
Presenting the findings in Abuja, Director of Projects at the Development Research and Projects Centre (dRPC), Stanley Ukpai, said both Lagos and Kano were classified as Tier One states due to strong antenatal care utilisation, financing commitments, health system capacity, and logistics readiness.
He noted, however, that the two states demonstrated different structural strengths in maternal healthcare delivery.
Lagos Driven by Private Sector Capacity
According to the study, Lagos State’s readiness is largely supported by a robust private healthcare system and high antenatal care uptake.
Private health facilities account for about 82.5 per cent of service delivery in the state, making Lagos the most privately driven maternal health market among the states assessed.
Researchers said this extensive private-sector participation, combined with a dense network of health facilities and strong logistics systems, positions Lagos for rapid MMS scale-up.
Kano Anchored on Public Health Investment
In contrast, Kano State’s high ranking is driven by a predominantly public healthcare system and sustained government investment in maternal and child health programmes.
Primary healthcare centres account for about 75.6 per cent of health facilities in the state, reflecting reliance on public service delivery for maternal care.
Despite its structure, Kano matched Lagos in overall readiness due to strong political commitment and dedicated financing for nutrition interventions.
The state is the only one among those assessed with specific budget allocations for both Iron-Folic Acid (IFA) and MMS, alongside ₦500 million in co-financing under community nutrition programmes and an additional ₦144 million earmarked for MMS procurement.
Mid- and Low-Tier States Identified
Beyond the top-performing states, the study classified Bauchi and Imo as Tier Two states, while Niger and Bayelsa were placed in Tier Three due to structural and geographical constraints.
Bauchi recorded the highest proportion of primary healthcare facilities at 93.7 per cent but was limited by low antenatal care coverage and heavy reliance on donor-supported interventions.
Imo State showed a more balanced public-private health system and relatively strong antenatal care utilisation, though access to MMS remains largely dependent on private distribution channels.
Niger State faces challenges including insecurity, long travel distances, and low utilisation of antenatal services, while Bayelsa is constrained by its riverine geography and frequent flooding, which disrupt supply chains and limit routine service delivery.
Study Scope and Methodology
The assessment was conducted in 2025 by the Federal Ministry of Health and Social Welfare in collaboration with Sight and Life and dRPC.
It covered Lagos, Kano, Bauchi, Imo, Niger, and Bayelsa States, using a mixed-methods approach based on a market-shaping framework assessing both supply and demand dynamics.
A total of 162 stakeholders were interviewed, including government officials, health workers, development partners, health insurance representatives, pharmacy operators, facility managers, and pregnant women. Seventy of the respondents were pregnant women drawn from the six states and the Federal Capital Territory.
Maternal Health Burden Remains High
Ukpai said Nigeria continues to face a significant maternal nutrition burden, with an estimated seven million pregnancies recorded annually.
Citing the 2024 Nigeria Demographic and Health Survey (NDHS), he noted that about 50 per cent of pregnant women suffer from anaemia, translating to approximately 3.5 million cases each year.
He said the figures underscore both a public health challenge and a major opportunity for maternal nutrition interventions.
Transition from IFA to MMS
Nigeria’s adoption of Multiple Micronutrient Supplements is supported by global evidence and recommendations from the World Health Organisation.
The Federal Government approved MMS in 2021 and subsequently developed a National MMS Roadmap (2025–2029), targeting 40 per cent coverage in the initial phase and up to 60–70 per cent by 2039.
Ukpai noted that MMS offers broader nutritional benefits and is generally better tolerated than iron-folic acid supplements due to fewer side effects.
However, he stressed that successful scale-up will depend on sustainable financing, strong demand generation, and reliable supply systems.
Financing and Supply Gaps
The study identified three main funding sources for MMS: domestic public financing, donor support, and drug revolving fund mechanisms.
Federal allocations rose from ₦20 million in 2024 to ₦172.6 million in 2025, while donor commitments to maternal nutrition exceeded $100 million.
At the state level, financing remained uneven, with Kano and Bauchi making dedicated budget provisions for MMS procurement.
Researchers warned that long-term sustainability would depend on stronger domestic financing, especially as donor support declines.
Awareness and Access Challenges
Despite increasing adoption, awareness of MMS among pregnant women remains low.
Many respondents were unable to identify the supplements they received during antenatal visits. About 40 per cent reported receiving iron-folic acid supplements, while 35 per cent said they were unaware of the type of supplement provided.
The study found that awareness was higher among women who received adequate counselling during antenatal care visits.
Most respondents earned below ₦30,000 monthly and relied heavily on out-of-pocket healthcare spending.
Frequent stockouts and limited availability in public facilities often forced women to purchase supplements from private pharmacies or discontinue use.
Supply Constraints and Local Production Barriers
The report noted that MMS supply in Nigeria remains heavily dependent on imports and donor-supported distribution systems.
More than 10 MMS brands are currently available in the country, most of which are imported.
Local manufacturers cited weak demand guarantees and competition from imported products as key barriers to domestic production.
Recommendations
The study recommended the establishment of dedicated MMS budget lines at both national and state levels, improved procurement systems, stronger supply chain management, and incentives for local manufacturing.
It also proposed a phased rollout strategy that prioritises high-readiness states such as Lagos and Kano, while strengthening health systems in lower-performing states to support nationwide scale-up.
