Lagos and Kano have emerged as the most prepared states 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 patterns, supply systems and implementation readiness across six states.
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Presenting the findings in Abuja on Thursday, Stanley Ukpai, Director of Projects at the development Research and Projects Centre (dRPC), said both states were classified as Tier One because of strong antenatal care (ANC) utilisation, health system capacity, financing commitments, and logistics readiness.
He explained that while both states ranked highest, their strengths reflected very different health system structures.
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Lagos leads with private-sector strength
In Lagos, the researchers found that readiness for scale-up is driven largely by a strong private-sector health system and high utilisation of antenatal care services.
Private facilities account for 82.5 per cent of health service delivery in the state, making Lagos the most privately driven maternal health market among the six states assessed.
The study noted that this structure, combined with a dense network of health facilities and well-developed logistics systems, positions the state for rapid MMS expansion.
Kano’s public system
Kano’s ranking, on the other hand, is anchored in a dominant public health system and strong government commitment to maternal nutrition.
Primary healthcare centres (PHCs) account for 75.6 per cent of health facilities in the state, reflecting reliance on public service delivery for maternal health care.
Despite this, Kano matched Lagos in readiness due to sustained political commitment and significant public financing for nutrition interventions.
The state is the only one among those assessed with explicit budget lines for both Iron-Folic Acid (IFA) and MMS.
It also recorded ₦500 million in co-financing under the Community and Nutrition Financing mechanism, alongside N144 million earmarked specifically for MMS procurement.
Middle-tier and lower-tier states
Beyond Lagos and Kano, the study classified Bauchi and Imo as Tier Two states. At the same time, Niger and Bayelsa were placed in Tier Three due to structural and geographic constraints affecting service delivery.
Bauchi recorded the highest PHC dominance at 93.7 per cent, but was limited by low antenatal care coverage and dependence on donor-supported programmes.
Imo, with a 49.7 per cent PHC mix, showed a more balanced public-private system and relatively high ANC utilisation. Still, MMS access remains largely dependent on private pharmacies and retail distribution.
Niger State, with 81.2 per cent PHC dominance, faces insecurity, long travel distances and low ANC uptake, all of which limit effective supplementation coverage.
Bayelsa, with 60 per cent PHC coverage, is constrained by its riverine geography and recurring flooding, which disrupts supply chains and makes supplementation largely campaign-driven rather than routine.
Study design, scope
The assessment, conducted in 2025, was led by the Federal Ministry of Health and Social Welfare through its Nutrition Department, in collaboration with Sight and Life and dRPC.
It covered Lagos, Kano, Bauchi, Imo, Niger and Bayelsa, using a mixed-methods approach guided by a market-shaping framework that examined both demand and supply-side factors.
In total, 162 stakeholders were interviewed, including government officials, health workers, development partners, HMOs, Patent and Proprietary Medicine Vendors, facility managers and pregnant women.
70 of the respondents were pregnant women across the six states and the Federal Capital Territory (FCT).
Seven million pregnancies, rising anaemia burden
Mr Ukpai said Nigeria’s maternal nutrition challenge is anchored in a large and persistent burden, with about seven million pregnancies recorded annually.
Drawing on the 2024 Nigeria Demographic and Health Survey (NDHS), he noted that maternal anaemia affects about 50 per cent of pregnant women, translating to roughly 3.5 million cases annually.
He said this dual burden highlights both a public health urgency and a significant market opportunity for maternal supplementation interventions.
Shift towards MMS
Nigeria’s transition from IFA to MMS is supported by global evidence and recommendations from the World Health Organisation (WHO).
The federal government first endorsed MMS through a ministerial directive in 2021 and later reinforced the policy through the National MMS Roadmap 2025–2029.
The roadmap targets 40 per cent coverage in the initial phase and 60-70 per cent by 2039.
According to Mr Ukpai, MMS provides broader nutritional benefits and is generally better tolerated than IFA because it causes fewer side effects, including nausea.
However, he warned that successful scale-up would depend on sustainable financing, strong consumer demand and reliable supply systems.
“Scale will only work if the market works,” he said.
Financing gaps persist
The study identified three major financing channels: domestic public funding, donor support and Drug Revolving Fund systems.
Federal allocations for MMS increased from N20 million in 2024 to N172.6 million in 2025, while donor commitments to maternal nutrition exceeded $100 million.
At the state level, financing varied significantly. Kano maintained dedicated budget lines for both IFA and MMS, while Bauchi allocated N600 million for MMS in its 2025 budget.
Researchers noted that although IFA remains the dominant supplement, there is currently no dedicated federal budget line for its procurement.
They warned that long-term sustainability would depend on stronger domestic financing as donor support declines.
Low awareness, supply constraints
Despite widespread acceptance of maternal supplementation, awareness of MMS remains low among pregnant women.
Among the 70 women interviewed, many could not identify the supplements they received during antenatal visits.
About 40 per cent reported receiving IFA, while roughly 35 per cent said they did not know the name of the supplement they were taking.
Researchers found that awareness was significantly higher among women who received proper counselling during ANC visits.
More than 60 per cent of respondents earned less than N30,000 per month, and most relied on out-of-pocket healthcare spending.
Although MMS was generally preferred because of its broader nutritional benefits and fewer side effects, affordability remained a major barrier.
Frequent stockouts also forced many women to buy supplements from private pharmacies or discontinue use altogether.
On the supply side, the report found that MMS availability remains heavily dependent on imports, government procurement and donor-supported distribution.
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More than 10 MMS brands are currently available in Nigeria, most of them imported.
Local manufacturers cited weak demand guarantees and competition from imported products as major barriers to domestic production.
Recommendations
The study recommended dedicated MMS budget lines at national and state levels, improved procurement systems, stronger supply chains and incentives for local manufacturing.
It also proposed a phased rollout strategy that prioritises high-readiness states such as Lagos and Kano while strengthening weaker systems in lower-tier states.
