This review is a DFID annual review of two projects that have been combined: the DFID-funded Programme for Reviving Routine Immunisation in Northern Nigeria (PRRINN) project and the Norwegian-funded Maternal, Neonatal, and Child Health (MNCH) project.

Particular successes include:

• the basket fund in Zamfara state demonstrating that funds can be transparently managed there
• the appreciation expressed by the state governments of Zamfara and Jigawa for capacity building elements of the project, demonstrating their willingness to participate in the process of transparent government
• human resource audits with fulltime HR units established within each State Ministry of Health, demonstrating real progress in HR planning in all states
• costing of the Minimum Service Package (MSP) in each state
• posting of 96 midwives per state through the Midwife Service Scheme (MSS)
• increasing demand for routine immunisation and a programme survey indicates a doubling of routine immunisation rates for the four states (albeit from a very low base)

The biggest problems remain:

• tracking the release and expenditure performance of budgets at every level (federal to state to LGA)
• an overly complex health architecture across Nigeria
• a lack of trained health personnel, particularly midwives