Poor funding is the major reason Nigeria failed to meet the pledge it made in 2012 to achieve a modern contraceptive prevalence rate (MCPR) of 27 per cent among women by 202O, health experts have said.
The family planning (FP) 2020 goal was to enable 120 million additional women and girls of reproductive age, globally, to have access to contraceptives by the year 2020.
At the dawn of the deadline, the FP 2020 target indicators show that Nigeria has only 12 per cent MCPR for women in the country.
FP advocates say the government continuously failed to meet its counterpart funding commitment for the goal thereby hindering progress.
PREMIUM TIMES had reported how no money was budgeted for counterpart funding in the 2019 FP budget.
But apart from poor budgetary allocations, several other challenges are hampering the delivery, acceptance and use of contraceptives.
A coalition of health advocacy groups are now taking the lead in confronting several obstacles hindering the progress of family planning initiatives in Nigeria.
Nigeria Family Planning Conference 2020 (NFPC)
Health minister Osagie Ehanire at the 2020 biennial Nigeria Family Planning Conference (NFPC) held in Abuja last December announced the extension of the 2020 target to 2024.
“This target once again has been rebased to 27 per cent by the year 2024 to allow more time for ongoing efforts to yield results, given the changing realities and emerging challenges, including those imposed by the COVID-19 Pandemic,” the minister said.
The Advancement of Family Planning (AAFP) in partnership with the health ministry and a cross-section of development partners organized the 6th NFPC held between December 7 and 11, 2020.
AAFP is a national coalition of FP advocates that evolved into a civil society organisation that has been driving FP agenda in Nigeria for years.
The theme of the event was ‘Post FP2020 Agenda and Safeguarding Investments in Emergencies: Adaptation, Innovation, Resilience’.
Last Tuesday, a report and a communique detailing the outcome and recommendations from the NFP conference was released.
The report highlighted various gaps and obstacles that could scuttle the 2024 target.
It also underscored efforts and the role of AAFP and other supporters such as the Development Research and Project Centre (dRPC)/PACFAH@scale project in improving FP services.
DRPC Accountability Network
While funding has shrunk, FP advocates believe both donor and local funding commitments that have been released for FP have not yielded commiserate results. From 2017 to 2020, there was only a two per cent increase in MCPR.
To ensure adequate use of budgetary releases for FP, the DRPC set up an accountability network in several states to track the progress of initiatives and how funds are spent.
Stanley Ukpai, DRPC/PACFAH@scale program officer, at the launch of the NFPC report, shared how the accountability network was set up and how it operates.
“One of our major focus is to hold government to account in terms of utilization of funds for FP.
“What we did was that in 2019, we partnered with the National Primary Health Care Development Agency (NPHCDA) to train local CSOs on tracking and monitoring budgetary releases for FP.
“In holding government to account, it makes sense that civil societies are prepared at the state level to become accountability platforms”, he explained.
Mr Ukpai said the network was initially set up in Kano, Kaduna, Niger, and Lagos State with the aim of expanding to other states.
He said out of the process, scorecards on how money was used were produced.
Scorecard and other DRPC/PACFAH@scale interventions
Ejike Orji, the AAFP Technical Management Committee chairman, further shared how DRPC supported the development of the scorecards that helped to understand the true situation on the ground.
“The scorecards showed there were a lot of stockouts in the FP sites. While funding was inadequate, the releases were not consistent with the timing,” Mr Orji explained.
“The DRPC/PACFAH@scale funded the recruitment of staff for tracking of budgets and monitoring the CSO accountability network in the states.”
The official said the DRPC is a major sponsor of the AAFP, including payment of office accommodation for the former. “Their support has been core. “DRPC/PACFAH@scale supported us to chart a new part for the association till 2025,” he noted.
Mr Orji said data is important in improving FP reach and services. He said the AAFP goal is to come to the one-stop shop for FP data.
“Data is so key in FP. We should have some level of data consensus.”
Family planning and COVID-19
Due to the COVID-19 pandemic, Nigeria experienced a further decline in funding for FP, the report noted, further widening the gap of meeting the 2024 target.
Realities of COVID-19 hindered the responses expected from various advocacy efforts and resulted in gains being lost.
Nigeria largely depends on grants for its FP interventions, a situation President Muhammadu Buhari had described as a “frightening prospect if we sit idly by and expect handouts from so-called development partners”.
As a result of the economic downturn caused by weeks of lockdowns in the COVID-19 pandemic era, many donor funds are no longer coming as every country faces its own COVID-19 nightmare.
The negative effects of the COVID 19 pandemic escalated due to the structure of the pace and pattern of the country’s population and preparedness of our health system, according to Olanrewaju Olaniyan, Department of Economics, University of Ibadan.
“The effects of these emergencies on family planning have important implications for the country’s progress in harnessing the demographic dividend as well as attaining the sustainable development goals,” he said.
The report highlighted how resources for FP2024 target should be mobilised amid COVID-19 through networking and improved technology.
The NFPC report focused on improving access and awareness to FP services among young people.
Four areas we need to focus on if there will be a paradigm shift in FP for young people, according to Segun Fatusi, Vice-Chancellor, Ondo State University, are:
1) ensuring that we have adolescent responsive FP services; 2) integration of services to expand the reach to young people and also reach the unreached; 3) improving social accountability and 4) build community, social and stakeholder support into the agenda of family planning for young people.
The report made the following recommendation for improvement of FP services in Nigeria:
1. Federal government should support state governments to strengthen the capacity of Primary Health Care (PHC) facilities across the country by training healthcare workers on youth friendliness through the provision of Minimum Package of Service Standard in all PHCs.
2. The National Health Insurance Scheme should fully integrate family planning services
3. Prioritize the inclusion of AYSRH including contraception services in the State annual operational plans and cost implementation plans while ensuring adolescent and youth-focused interventions in states where the family planning unmet need among young people is high and increasing; as well as invest in Post pregnancy family planning programs for first-time teenage mothers and married adolescents.
4. Integrate young people into the state Reproductive Health/Family Planning Technical Working Group to ensure meaningful engagement of Adolescents and Young People (AYP) in program design, implementation, and evaluation at all levels. Also, improve efforts to establish Adolescents Health and Development Technical Working Groups in all 36 States while ensuring compliance with the Adolescent Health and Development Technical Working Group Operationalization Guide which made clear provisions for a young person to be part of the leadership.
5. Incorporate FP services into the national emergency preparedness strategy
6. Women empowerment ventures should include FP components or at least partner with FP entities
7. Support poverty alleviation activities in communities where Interfaith organisations implement activities.
8. Strengthen multi-sectoral collaborations to harness the multiple investment across all sectors involved in AYP programs to identify, accelerate, and sustain efforts as we look beyond the FP2020 commitment.
9. Government should be more deliberate in mobilizing domestic resources for achieving the goal of 27% mCPR by 2024.
10.Contextualize FP interventions targeted at persons with disabilities and other vulnerable groups through inclusive planning and implementation, strategic communication, innovative funding, capacity building and Public Private sector partnerships.
Provider Bias could be an impediment and should be tackled. Values clarification must be reinforced in training programmes. Providers should be professional in their manner of service delivery and also need to be supported in addressing the issues of provider bias, especially towards young people, the report stated.
It also highlighted the need for an aggregated FP data source and collaborative partnerships among partners to avoid the duplication of efforts and increase efficiency.
Contextualization of research especially for younger adolescents between 10 and 14 age group.
Research into contraceptive commodities among the population, its effectiveness, and responses.
Strengthen media advocacy to ensure FP is brought to the fore amidst the RMNCH and issues.
Integrate FP into cross-sectoral issues and expand the role of the media to hold policy makers accountable.
The report stated that there is a need to Recognise the critical role, willingness and continued support of the traditional and religious leaders and there is a need to continue to strengthen partnerships with these leaders towards promoting active leadership in addressing cultural norms and myths on family planning and childbirth spacing.
Explore and utilise opportunities to develop the capacity to role model, advocate, sensitise and mobilise the hinterlands to accept FP as a lifestyle and a social norm.
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