Beyond Average Effects: Facility-Level Heterogeneity in Financial Preparedness for Childbirth and Obstetric Emergencies Following Structured Public Health Education in Delta North, Nigeria

Background: Pooled intervention outcomes may conceal differences in financial preparedness across healthcare facilities. This study examined facility-level variations in financial preparation for childbirth and obstetric emergencies following structured public health education among antenatal clinic attendees in Delta North, Nigeria. Methods: A cluster-based quasi-experimental pretest–posttest comparison-group design involved 168 antenatal clinic attendees across eight public health facilities in Oshimili North and Oshimili South Local Government Areas. Four facilities received structured public health education (n = 84), while four served as comparison facilities (n = 84). Assessments occurred at baseline, immediately post-intervention and eight-week follow-up. Ten participants were lost to follow-up, yielding 158 participants and a 94.05% retention rate. Facility-specific mean changes and statistical comparisons were examined alongside pooled baseline-adjusted ANCOVA. Results: Childbirth financial preparedness improved across intervention facilities, with eight-week mean increases ranging from 2.98 to 3.66, compared with 0.09 to 0.73 in comparison facilities. Emergency financial readiness increased by 3.33–4.49 across intervention facilities, compared with 0.11–1.13 in comparison facilities. All intervention facilities demonstrated statistically significant within-facility improvements in both domains at eight weeks. Pooled ANCOVA indicated significant intervention-associated differences in childbirth financial preparedness (F(1,155) = 66.16, p < .001) and emergency financial readiness (F(1,155) = 85.85, p < .001). Conclusion: Structured public health education was associated with improvements across intervention facilities, although the magnitude of observed gains varied. Facility-responsive antenatal education may strengthen financial preparedness, but between-facility heterogeneity requires formal statistical confirmation.