By ODIRI UCHENUNU-IBEH, Lagos
In a bid to halt the loss of 2,300 under-five year olds and 145 women of childbearing age every single day, the federal government has restated its commitment to increase Family Planning (FP) uptake by ensuring that both commodities and consumables are available at the Primary Healthcare Centres (PHCs) across the country.
LEADERSHIP Sunday learnt that FP can reduce maternal deaths by 40 percent and government commitments to increase FP uptake can help to prevent more than a third of the total maternal deaths, saving 140,000 to 150,000 lives per year.
The Minister of Health, Prof. Isaac Adewole, said the issue of maternal health could not be addressed without tackling the issue of FP. He emphasized the need to look at education, address poverty and increase access to healthcare, adding that government was targeting 500 percent use of FP commodities in the country in the next few years.
Adewole said, “Our commitment here is that in spite of the downturn in the economy, we would continue to meet all our obligations, we will revalidate our Memorandum of Understanding (MOU) with the United Nations Population Fund (UNFPA), that obliged us to put some funds in the basket that funds FP commodities in Nigeria, we are committed under the existing MOU to put $3Million per year and for 2017 we will increase it to $4 million.”
While government is trying to meet its commitments made at the 2012 London Summit on FP by increasing Contraceptive Prevalence Rates (CPRs) from 15 percent to 36 percent by 2018, stakeholders in the health sector contended that government could only achieve that if all the 36 states were similarly committed in achieving their targets.
According to them, states will need to follow a similar process to that of the Federal Ministry of Health in creating state-level blueprints. Each State will have to engage stakeholders beyond the state ministry of health to include the state primary healthcare agencies, department of health of the ministry of local government and chieftaincy affairs, religious and traditional leaders and the private sector; set CPR objectives to contribute to reaching the national target of 36 percent and create a costed plan based on identified priorities and state level CPR objectives.
Investigation showed that states like Kwara, Plateau, Kaduna and Lagos have drafted blueprint that would guide them in increasing uptake of FP, thereby assisting the federal government to meet its 36 percent target.
Kwara state increased its FP budget by 90 percent, from US$ 10,500 (N2.1 million) in 2015 to US$ 20,000 (N4 million) in 2016. In February 2016, Advocacy Core Group Nigeria (ACGN), with support from Pathfinder International finalized the state Costed Implementation Plan (CIP) for FP.
Plateau state, in April 2016, approved a US $25,125 (N5 million) allocation for reproductive health and family planning implementation in the 2016 state health budget. The state seeks to increase the CPR from 17.4 percent to 34 percent by 2018, which would contribute to the Nigeria FP Blueprint goal to increase the country’s CPR from 15 percent to 36 percent by 2018.
Kaduna State, which has a CPR of 20 percent, expects its CPR to be raised to 46.5 percent by 2018 and to ensure that the state-adopted National FP Blueprint and FP2020 commitments are met with a CIP developed to provide direction to Kaduna State’s FP programming.
Commissioner for health, Kaduna state, Dr. Paul Dogo said the CIP “comprehensively captures and budgets for all evidence-based, high-impact FP interventions and the detailed costed activities are also tailored towards achieving the goals of improving the health and well-being of the populace through FP.”
In the same vein, Lagos state has also developed its CIP in order to increase the overall CPR for married women from 48 percent to 74 percent by 2018, thereby fulfilling the state’s share of the national blueprint goal.
According to the Lagos State’s Commissioner for Health, Dr. Jide Idris, the CIP is meant to avert 2.6 million unintended pregnancies, thereby saving the lives of 103,000 child and 8,000 maternal lives. “an approximately $91 million is needed to achieve the FP goals in the state.”
Speaking on what the state government has done so far in the last two years to achieve its FP target of 74 percent, Jide said from 2015 to 2017, the state government was able to train a total of 10 health workers drawn from the public health facilities in the state on facilitation skills through competence based teaching and practical skills to improve their capacities in Long Acting Reversible Contraceptives (LARC).
“A FP training program in collaboration with Nigeria Urban Reproductive Health Initiative (NURHI) was conducted for 200 Traditional Birth Attendants (TBAs) in 10 selected local government areas to develop TBAs interpersonal communication skills for counselling women in the reproductive age group for the need to accept FP services,” he added.
The commissioner said, over the years, the state had ensured that FP commodities were available in all health facilities, adding that the state had conducted four rounds of integrated last mile distribution pilot for malaria, FP and reproductive health commodities and a total of 443 public health facilities across 12 LGAs were supplied with FP commodities.
Jide said; Lagos State in collaboration with NURHI began a 72-hour refurbishment of 50 PHCs in order to increase uptake of FP among women and men of reproductive age in the state.
With the achievements recorded by these states, stakeholders are advocating that other states follow suit if Nigeria must achieve its 36 percent targets.
The team leader, NURHI-2, Lagos state, Dr Omasanjuwa Edun in an interview with LEADERSHIP said research had shown that FP saves lives and reduces maternal deaths by up to 40 percent.
“It helps prevent unwanted pregnancies and unsafe abortion. It has been found to promote gender equality as well as promote educational and economic empowerment. So if ten women were to die as a result of pregnancy, FP can save three to four of those women, hence Nigeria cannot afford not to meet its target of 36 percent CPR,” he added.
Despite the enormous benefits of FP services, Edun said the uptake remained low in the country and this has resulted into high rates of unwanted pregnancies, unplanned deliveries, unsafe abortions and mortalities in the country.
He said non availability and accessibility to FP services have marred the progress in country. He listed some of the challenges as weak policy environment for FP, dearth of health services providers, disproportionate number of service providers that can provide all range of methods, poor supply chain system, myth and misconception, social norms, culture, tradition, religion, and poor funding for FP services in areas like procurement of commodity to match demand, procurement of consumables, training and re-training of service providers and monitoring, evaluation and supervision.
For the 36 percent of CPR to be attained by 2018, Edun advised that all states in Nigeria must achieve their targeted goals by ensuring that FP clinics are at all PHCs in the state and that commodities and consumables are available to women and men of reproductive age at no cost.
He said there was need to create awareness of FP and contraceptive use by emphasizing on the benefits as it would help reduce misconceptions, increase access and utilization of FP services. “Males should also be educated on the benefits of FP services so as to reduce opposition from husbands,” he added.
Family planning expert, Mrs Charity Ibeawuchi, said FP is one of the most effective ways to prevent maternal, infant and child mortality.
When FP needs of women are met, she reiterated that Nigeria can prevent more than a third of her total maternal deaths per year, saving 140,000 to 150,000 lives per year