The women who access family planning services at Okeolola Primary Healthcare Centre (PHC) in Oyo town, Oyo State have a local name for their preferred family planning method. It's called "alapa" and refers to the implant family planning method. "Apa" translates to "arm" in Yoruba and because the implants are inserted in the arm, demand for it has increased as well as demand for other family planning methods.
Demand for family planning information and services has not always been widespread in Oyo state. Oyo state has a modern Contraceptive Prevalence Rate (mCPR) of 24%, according to the last NDHS conducted in 2013. In the past few years, this has changed remarkably as people now talk about family planning, request for information and eventually take up a method. The efforts put into raising awareness about family planning seems to be paying off, as the 2017 Multi-Indicator Cluster Survey (MICS) shows an increase in the state's mCPR to 30%. Oyo state now has the highest modern contraceptive rate in the country, higher than the national average, which is 10.8%, according to the same survey.
Executive Secretary of the Oyo State Primary Health Care Board, Dr. Waheed Abass, said a multi-pronged approach led to this improvement. This included consistent communication about family planning benefits and the support of partners like Marie Stopes International Organisation of Nigeria (MSION) and Nigeria Urban Reproductive Health Initiative (NURHI). He said the government took steps to improve family planning uptake because of its numerous benefits. "Family planning can reduce maternal mortality by 30%. It is one intervention you are sure that if you get right, our mothers and women of reproductive age will not die while trying to bring lives into this world," he said.
One of the family planning partners active in the state is MSION often referred to as Marie Stopes Nigeria. They started operations in the state in 2013 and worked to support efforts by the state government to improve family planning uptake.
Leveraging the private sector and generating demand for FP services
MSION started a social franchise initiative that recruited 34 private health facilities under the Bluestar Healthcare Network. Staff of facilities in the network are trained to strengthen clinical capacity, including supportive supervision and branding for increased visibility to ensure adherence to operational standards of MSION's social franchise.
Demand generation is a key component of MSION strategy says Mr. Abimbola Faloye, the South West Regional Manager. It involves recruitment and training of community-based mobilisers who visit communities to educate them on the benefits of family planning. This is matched with quality service delivery at the facilities supported by the organisation.
Christ Hope Hospital & Maternity located in Ibadan is one facility that has maintained the high standard stipulated under the franchise. For Mrs. Oshoko Anna Oluwakemi, Director of Nursing Services, the Blue Star network significantly changed her practice as a family planning provider after attending an intensive training conducted by MSION in Benin city in 2014. She and her team gained more confidence in educating community members about the need to adopt modern family planning methods. Her facility, which struggled to provide services to an average of three family planning patients monthly prior to joining the network, now attends to over 30 patients monthly. When they conduct outreaches to markets and distant communities, they attend to over 60 patients.
Thirty-four-year-old Olanike Oladejo said the first time she heard about family planning services was in 2015 when a mobiliser attached to Christ Hope visited her. She had just had a baby and decided to take an option to space her next pregnancy. After informing her husband and learning about the different family planning options, she opted for Implanon in October 2015. It was a hitch-free experience and when the couple decided to have another baby, she removed the implant in May 2018 and conceived in June.
Strengthening the public sector for sustainability
MSION also extended its interventions to public institutions through an initiative called Public Sector Strengthening (PSS). The initiative started in 2014 with the training of four master trainers who in turn trained 100 frontline health workers. MSION took this step because of the value they place on capacity building. Their training strategy include being proactive with supportive supervision, providing continuous coaching and mentoring to service providers. This ensures providers deliver high-quality service and develop confidence over time. The supervisors also ensure that facilities adhere to infection prevention and control (IPC) protocols.
The family planning unit of the State Hospital Oyo located in Oyo town, a 55km drive from the capital city, is bustling. Over 20 women have come to access services within 30 minutes. Most are there either for counselling, to receive services or for post-family planning check-ups. Majority said that being able to provide a quality life for their families was the reason they wanted to access family planning.
Thirty-one-year old mother of three, Mrs. Opeyemi Olaniyi, accessed family planning for the first time in 2010 after giving birth to her first child. She was initially sceptical, but with her husband's persuasion, she opted for an IUCD commonly called 'Copper T'. When she was ready to have another child, she removed the IUCD and conceived within the same month. After delivery, she inserted an implant for three years until she was ready for her third child. She became pregnant the same week the implant was removed. She gave birth two months ago and is currently using another family planning method. "Family planning has helped me in so many ways. For example, my first child is 8 years, my second child is 4 years old and I just gave birth to another child two months ago, so I have four years interval for my children," she said.
Faloye said the most profound impact of MSION interventions in the state is contributing to the increase of the state's CPR to 30% as shown in the 2017 Multiple Indicator Cluster Survey. From 2016 till date, MSION has successfully recorded a total of 86, 439 client visits (22,721 outreach, 47,394 PSS, and 16, 324 social franchise client visits)
Sustaining gains and overcoming challenges
For ES Oyo state PHC Board, Dr. Waheed Abass, a greater achievement for the state is that family planning is more commonly spoken about, and most people are aware of its benefits. "By the time we are able to make family planning something that everyone talks about, and it becomes a household name, then we don't have any problem," he said.
The state government is also taking ownership of the initiatives from partners such as MSION by building more staff capacity. One hundred new frontline health workers have been trained on LARC between 2017 and 2018 with a commitment made to invest in supportive supervision activities. Funds for supportive supervision will be accessed from a family planning budget line which has been maintained in the state budget for the past three years.
The state faces occasional stockout of consumables. Family planning commodities are procured and distributed from the Federal to the state, and Dr. Abass said stakeholders are advocating that consumables should also be distributed accordingly and at the same time as commodities. This is yet to happen. When consumables are not available, health workers could use it as an excuse to charge unauthorised fees for family planning services and this can be a barrier to access. Another major challenge is the high cost of consistent media engagement. Various media outlets are used to target different demographics with family planning messaging and this is expensive. Dr. Abass hopes the Oyo State Social Health Insurance Scheme and the World Bank's Saving One Million Lives Initiative (SOML) will provide funds to continue to improve family planning services in Oyo state.
Still, it is clear that Oyo state has put in place a proactive approach to ensure that both demand for and supply of family planning services continue to increase. By working with partners in the family planning space, the state is able to broaden its distribution of family planning services. Maintaining a line item in its budget for family planning and additional staff capacity building shows that the state is taking steps towards sustainability and good governance in family planning. Other states struggling with increasing their mCPR, especially those with the lowest rates, can learn from the processes that Oyo has put in place.
Do you know organisations working to improve access to family planning services in states? We would love to hear from you. Share with us in the comment section below.