Reported maternal and child health (MCH) outcomes in Nigeria are amongst the worst in the world, with Nigeria
second only to India in the number of maternal deaths. At the national level, maternal mortality ratios (MMRs)
are estimated at 630 deaths per 100,000 live births (LBs) but vary from as low as 370 deaths per 100,000 LBs in
the southern states to over 1,000 deaths per 100,000 LBs in the northern states. We report findings from a
performance based financing (PBF) pilot study in Yobe State, northern Nigeria aimed at improving MCH
outcomes as part of efforts to find strategies aimed at accelerating attainment of Millennium Development Goals
for MCH. Results show that the demand-side PBF led to increased utilization of key MCH services (antenatal
care and skilled delivery) but had no significant effect on completion of child immunization using measles as a
proxy indicator. We discuss these results within the context of PBF schemes and the need for a careful
consideration of all the critical processes and risks associated with demand-side PBF schemes in improving
MCH outcomes in the study area and similar settings.