Nigeria's contraceptive coverage, indicated by the modern Contraceptive Prevalence Rate (mCPR), currently stands at a mere 16.6 per cent, and has stood at an average of 17 per cent for some time.
These were the findings of the 2018 Nigeria Demographic and Health Survey (NDHS). It is worth noting that this average is below the Nigerian government's national objective to achieve an mCPR of 27 per cent by the year 2023. Coverage and other indicators provide a glimpse of the state of Nigeria's family planning sector and are largely attributed to funding.
In 2017, the Nigerian Government, through her Federal Ministry of Health committed to set aside US$4 million (N1.2 billion) annually from 2017-2020 to fund the Family Planning (FP) programmes in Nigeria. The government planned to use the set aside sum to facilitate commodity procurement and distribution to respective states.
As it stands, only N300 million of the agreed sum was awarded and released in 2019. Currently, the government is yet to release the 2020 family planning budget constituting N1.2 billion. 2020 as the final year in the allocation schedule creates a sense of urgency. Moreover, the constant delay and inconsistency in funds discharged has now created a gap of N2.1 billion. Over the past three years, although the government has tried to keep up with its end of this commitment, shortfalls have occurred, the largest being in the year 2019.
In all fairness, the year 2020 has seen a lot of challenges already. The ongoing COVID-19 global pandemic has brought on a lot of strain on the world healthcare systems, seeming to drive backwards most of the health gains made in developing countries in areas such as the fight against Malaria, HIV and Tuberculosis, and uptake of services such as family planning. With the current circumstances, the hope of covering the gap of 10.4 per cent mCPR by 2023 may be prolonged.
These fears were further driven with the recent budgetary cuts that saw the proposed expenditure on healthcare cut to almost 50 per cent. Over these past five years, government's commitments such as that of the FP funding have made this basic service available to couples at the necessary levels of care. However, the current family planning funding gap has been a significant issue of concern for various stakeholders, given its significance on the women's maternal health as well as the health of the family and the nation at large.
On that note, Premium Times Centre for Investigative Journalism (PTCIJ) in partnership with Development Research and Project Centres' (dRPC) Partnership for Advocacy in Child & Family Health at Scale (PAFAH@Scale) project held a webinar on July 3 that centred on this very concern.
The theme, "Securing the Funding Gap for Family Planning in the face of Covid-19" was aimed at openly discussing these rising uncertainties. The panel discussion featured the representative of the Federal Ministry of Health, President of the Medical Women Association of Nigeria (MWAN), the Executive Director, Association for the Advancement of Family Planning (AAFP), the First Vice President, Society of Gynaecology and Obstetrics in Nigeria (SOGON). The Managing Director/Chief Executive officer of ACIOE associates, Lawrence Anyanwu, Minnie Oseji, Ejike Oji, Habib Muhammad Saduki, and Ekenem Isichei were also in attendance. Also in attendance was one of the winners of the 120Under40 award, 2018, Hameed Adediran. The RASuDiN Programme Manager further doubled as a panel moderator.
Mr Anyanwu, the representative of FMoH, remarked that "it is true that the federal government of Nigeria committed to the contribution of a certain sum of money annually to the procurement of contraceptive commodities." He added that this is intended to support funding coming from other sources to ensure the family planning needs of Nigerians are met wholly. Presently, money for FP commodities is jointly funded by the Government, United States Agency for International Development (USAID), and United Nations Population Fund (UNFPA).
Gender imbalance in decision-making was also noted to be one of the perils that hinder access to family planning services in Nigeria. Historically, our male dominated cultures mean most women have to seek permission from their spouses and choose an agreed method of contraception. Ms Oseji further remarked on how MWAN had actively been involved in sensitisation campaigns that aimed to push for client patronage of services at the community level from this standpoint.
Mr Isichei offered some recommendations, which he suggested would tackle the family planning shortfalls. These include an evidenced-based advocacy effort at the highest level, private sector partnership, the Federal Governments' need to purchase commodities before October of each preceding year, strengthening last mile community-based distribution, strengthening the capacity of health care workers and lastly, data generation and mapping.
Overall, several important questions were raised about advocacy strategy to catalyse action from the government as well as questions on the private sector options for family planning services. Mr Orji noted that on this level, pushing for broader inclusion of FP services into the National Health Insurance Scheme (NHIS), that would ensure service provision at public and private facilities, is a sure strategy.
Mr Sadauki had also noted the continual active role played by professionals like the Obstetricians and Gynaecologists over the years in service provision. This service, in his opinion, needed to continue.
COVID-19 has no doubt brought a lot of uncertainties to a sector that had seen strong advocacy for increased funding and sustainability plans. As we enter the second half of the year, it is hoped that promised funds such as that of the government would be made available soonest to meet the growing need of FP services in the country. Mr Orji noted that this challenge was already great as the estimated cost of dealing with the ongoing pandemic runs two times over the FCT's health budget for instance, which calls for a more significant commitment towards funds to be released for services such as FP. As already seen, even designated family planning facilities are seeing low client turnout due to ongoing social challenges, which would also call for creativity such as providing commodities that can be self-administered by clients, in giving couples better access.