Nigeria: Putting Family Planning First – Lessons from Zimbabwe for Lagos State

Like many countries in sub-Saharan Africa, Nigeria continues to face challenges in meeting the health needs of its population, particularly in the area of ​​sexual and reproductive health. Despite cuts in funding from international development partners for family planning (FP) services and the revision of Nigeria’s Family Planning Master Plan (Extension Plan): 2014-2018 to Nigeria’s Family Planning Master Plan 2020- 2024 currently revised, incorporating issues that have emerged since the initial plan was developed, there is no budget line for FP services and products in Nigeria’s 2022 budget. Considering that Nigeria is expected to become the third most populous country in the world by 2050, with an estimated population of over 400 million due to its annual growth rate of 2.6%, this calls into question the Continued commitment of the country to close the huge gaps in access to FP across the country.

Increasing funding and demand for FP services and products is essential because without it, FP services and products will not be demanded and made accessible. Recognizing the consequences of limited access to FP services, Nigeria Health Watch recently organized a policy dialogue to intensify conversations on the different ways Nigeria can improve its domestic resource mobilization for FP services. Speakers of the #FundFPNaija dialogue presented a business case for increasing private sector participation in financing FP services, highlighting potential benefits such as lower taxes for participating organizations, reduction in maternal mortality, increased income generation and health financing through earmarked taxes and efficient management of resources. Nigeria’s Family Planning Master Plan 2020-2024 has already highlighted that 80% of modern contraceptives are provided by the private sector.

Family planning in a new Lagos

Each year, September 8 is dedicated to World Contraception Day (WCD), to recognize the rights of couples and individuals to freely and responsibly decide the number and spacing of their births. In its pursuit of excellence in women’s health and empowerment, the Lagos State Ministry of Health and Lagos State Government, supported by the Post-Pregnancy Family Planning Project, the ‘Association of Former Students of the National Institute (AANI) -PACFaH @ Scale project (PAS) The project and other civil society organizations commemorated CMB 2021 with a policy dialogue on the theme “Family planning in a new Lagos: a catalytic pillar for women’s empowerment and socio-economic development ”. During the political dialogue, the First Lady of Lagos State, Her Excellency Dr Ibijoke Sanwo-Olu, said that despite the benefits of FP, it is disheartening to know that for many women the right to decide when or having children is hampered by the lack of access to a modern and safe method of contraception, because “many women in Lagos who wish to delay or avoid pregnancy are not currently using any form of modern contraception and our goal is is to reach these women, ”she added.

The business of women’s health

The return on investment of spending to increase access to contraception produces incredible benefits, both in terms of well-being, socio-economic impact and development for the state, which is why over the course of Over the past 18 months, the Lagos State government has ordered four modern day nurseries. centers for optimal service delivery.

Prof. Adesegun Fatusi, in his presentation, noted that contraceptive prevalence has gradually increased in Lagos but unevenly among different groups. With an annual CPR of 1.38% for the period 2014-2020, male condoms and implants remain the most widely used modern contraception. Fatusi pointed out that the use of traditional contraceptives is higher than for modern contraceptives, as around 68% of users seek contraceptives from local vendors. “People are using FP, but they are not using the most effective method,” he said. According to Professor Fatusi, the private sector, especially through community pharmacies (CPs) and patented and proprietary medicine vendors (PPMVs), are key access points for modern contraceptives for more than 65% of users to Lagos.

This is an important access point that the government can target for financial incentives to also improve the provision and access to FP services. The IntegratE project, a 4-year project funded by MSD for Mothers and implemented by a consortium led by the Society for Family Health (SFH) with the Federal Ministry of Health, piloted a 3-tier accreditation system, led by the Pharmacy Council of Nigeria (PCN) to test a task shifting model in Lagos and Kaduna. The objective was to allow increased access to FP products and services, particularly in rural areas where the informal private sector was already an important source for FP services.

The example of Zimbabwe

As the African continent continues to grapple with family planning challenges, there is an economic benefit if developing countries maintain investments in FP services, which could lead to a substantial decrease in unwanted pregnancies. For every dollar invested in contraceptive services, there is a savings of $ 3 in the cost of maternal, newborn and abortion care.

Zimbabwe, Botswana and Kenya were the first countries in sub-Saharan Africa to experience a fertility transition from 6.7 to 4.0 births per woman between 1984 and 2015. Over the past two decades, the Modern contraceptive prevalence (mtcp) for Zimbabwe has been estimated at 67 percent for all methods among married women and currently stands out as one of the highest in sub-Saharan Africa. Zimbabwe’s FP model is an outstanding African achievement that should be adopted by other countries.

Although Lagos State is not a country, it is similar in size to Zimbabwe and can adopt many structures present in their FP model. As the state prepares to achieve a comprehensive development agenda through access to FP, it can incorporate the following three approaches from the Zimbabwean model.

The Zimbabwean government has ensured the availability of FP services through a wide range of delivery points. The government has maintained and strengthened its FP service delivery programs from the tertiary hospital to community platforms in the public and private sectors. Mobile clinics, field health workers, health centers, private doctors, private hospitals / clinics have been deployed with the aim of reducing access to the provision of FP services. They have shown that the correct and ethical use of modern contraception has major social and life implications.

Zimbabwe’s ability to achieve an above-average CPRt for sub-Saharan Africa is a testament to the government’s desire to create an enabling environment that has helped FP programs thrive. Showing political will, the government of Zimbabwe has become a signatory to several international and regional conventions, including the International Conference on Population and Development and the Abuja Declaration, to which Nigeria is also a signatory. In addition, the government also revised the Marriage Law, and in 2016, a law was passed to raise the legal age of marriage from 16 to 18 for both boys and girls.

Finally, to help the government and partners to better understand the country’s budgetary needs in terms of FP over a given period, the government of Zimbabwe has defined the financial resource needs. Thus, FP financing gaps were identified, allowing the government and donor partners to strengthen their commitments through more targeted resource mobilization for the needs of the FP program over a period of 5 years.

Final thoughts

While the long-term goal of the World Contraception Day policy dialogue was to promote gender equality and the empowerment of women through the provision of unhindered access to FP, we must not lose sight of the complexity of FP and ensure that women’s voices are heard and that women and girls can choose and negotiate their sexual and reproductive health needs.

For Zimbabwe, successful FP also meant improved health services contributing to a drop in the infant mortality rate from 960 deaths per 100,000 live births in 2010 to 614 deaths per 100,000 live births in 2014. In Nigeria, the under-five mortality rate is 132 per 1,000 live births, meaning that about one in ten Nigerian children never reach the age of five. It is crucial that health care services are strengthened to improve the health of women and children.

Family planning should become an urgent national priority and governments at all levels should put their money where their mouth is in ensuring that FP programs and services are well funded in budget 2022 and beyond. Efforts should be made to ensure the full implementation of Nigeria’s FP master plan in health facilities by ensuring that there are properly trained service providers and adequate equipment and infrastructure to support the delivery of health care. services. In addition, the Ministry of Health should lead the implementation of the National Family Planning Communication Plan (NFPCP) to increase demand for family planning. The unmet need for contraceptives in young single users should be addressed and counseling services should provide non-judgmental care.

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