Kaduna state has gotten a waiver to procure Family Planning (FP) commodities as their demands for FP commodities increases. This makes Kaduna the first and only state with permission to directly procure family planning commodities in Nigeria.
The Executive Secretary, Kaduna State Primary Health Care Board (KPHCB), Hamza Abubakar, made this known during the Kaduna state primary health care board Reproductive Health (RH) Coordinators' review meeting held in Kaduna on Thursday, December 17, 2020.
The meeting was held to update the Local Government RH coordinators and partners on family planning programmes, logistics and issues arising from the last reporting period. The goal of the meeting was also to give the RH coordinators and partners update on antenatal care and skilled deliveries as well as Adolescent Reproductive Health (ASRH).
The quarterly RH Coordinators meeting was organised by the Global Initiative for Women and Children (GIWAC) supported by the development Research and Projects Centre (dRPC), under the Partnership for Advocacy in Child and Family Health at Scale (PACFaH@Scale). dRPC also supports the Kaduna State government on capacity building, budget analysis, and technical expertise in the health sector.
The ES, who was represented by Hamza Ibrahim Ikara, Director Disease Prevention and Control Kaduna, said the state got the waiver due to its achievements in family planning. He said the Board had been creating awareness for families to understand the benefits of having a reproductive health service.
"This is why we are training and retraining of health nurses and midwives in the state," he said, adding, "We have just concluded the training of 50 midwives and nurses on life saving skills which would improve the state's reproductive health services".
He noted that the state had activated 255 health facilities which would improve reproductive health services and family planning in Kaduna.
While speaking at a panel titled 'Direct FP commodity procurement by sub-national government, a Pioneer" to discuss Kaduna state's pioneering leadership in the family planning commodities procurement process, Kaduna State FP/RH coordinator, Hajiya Nafisa Musa Isah pointed out that the state has an estimated 2 million women of reproductive age.
She added the total fertility rate (TFR) of the State was 5.6 percent, unmet FP need was15.5%, the state's contraceptive prevalence rate (CPR) for modern methods was 13.8% while the number of Service Delivery Points (SDPs) proving family planning was 705 as at 2020.
Isah noted that Kaduna State had recorded an upward trend in modern Contraceptive Prevalence Rate (mCPR), from 2008-2015 from an 8.4% in 2008 according to Nigeria Demographic Health Survey (NDHS) to 18.5% in 2013 and 24% in 2015, according to National Nutrition and Health Survey (NNHS).
"However, the mCPR dropped from 24% in 2015 (NNHS) to 12.8% in 2018 (NNHS), revealing a decline, which the State had never experienced in the past decade," she said.
"Another survey, the Performance Monitoring & Accountability (PMA) 2020, showed similar increase in the trend of mCPR in Kaduna State, from 15% in 2015 to 16.1% in 2016 and 18.1% 2017, but also evidenced a drop to 16.7% 2018," she added.
According to the NNHS 2018, Kaduna State had the highest mCPR of 12.8% in the North West zone but was significantly lower than the national average of 17.3%.
The RH coordinator stated that a root cause analysis was conducted from November 5 to 7, 2018, to explore the possible reasons for the sharp drop in mCPR from 24% in 2015 to 12.8% in 2018.
Some of the key findings of the analysis were stock out of FP commodities, which 15.2 percent of facilities offering FP services experienced. There was also inadequate skilled manpower and only 69.8 percent of health centres were offering at least five or more modern contraceptive methods which affects the choices for women in need of the services, she explained.
"There was a high unmet need among married women in the state which increased from 27.7% in 2017 to 31.7% in 2018 and only 33.1% of the women who demanded for modern methods were satisfied in 2018," she said, adding that there was also low capacity of family planning commodities and data management at service delivery points at LGA level.
The findings were presented to the state ministry of health. The Kaduna state government in response to the findings and recommendations increased service delivery points for FP from 435 in 2018 to 711 in January 2019 to address access challenges in the state.
In addition, an official letter was written to the Federal Ministry of Health (FMOH) requesting for permission to make FP procurement at the state level and an approval was obtained in April 2019. The goal of state-level procurement is to improve the availability of family planning commodities at facilities. A 5-day national virtual training was held on the development of guidelines for purchasing FP commodities with state funds.
The process however faced some delays in the initiation of the procurement guidelines. The state must wait for FMOH to develop guidelines for state level FP commodity procurement. Other challenges included the likely reprioritization of allocated funds due to the COVID-19 pandemic.
Alhaji Bala Muhammad Tijjani, Chairman Family Health Advocate Network Initiative (FHANI), said on the panel that civil society has worked tirelessly to ensure that Kaduna state meets up all Reproductive Health targets.
"We have been partnering with the state government to ensure that they do what is required. I am delighted that Kaduna state is the first state to get a waiver to buy FP commodities and consumables," he said, adding, "Over the years, we've been keeping track, we have been keeping the drug management agency on their toes to ensure that they do the right thing by buying good quality commodities."
He said civil society groups in Kaduna have ensured accountability through advocacy, monitoring and evaluating the performances of all the agencies involved in procurement, especially the drug management agency.
He added that the CSOs rub minds and share notes in trying to ensure that FP commodities were being procured properly and distributed on time so that they meet up with the large demand of the community as well as monitor the demand.
Aminu Babangida, program officer at GIWAC-PAS said dRPC's support helped the advocacy to the state to push for the waiver. "dRPC last quarter had supported us where we advocated for the state government for state procurement of FP commodities. dRPC made that push that state procurement would serve better to avoid any stock out of commodities," he said.
Director General, Kaduna State Contributory Health Management Authority (KADCHAMA), Aliyu Saidu who represented the commissioner for Human Services and Development, Hajiya Hafsat Baba, said that the health management authority had benefit packages that captured services related to RH.
He noted that KADCHMA was advocating for the integration of all vertical programs in the state into the health insurance scheme. "We have already covered over 300,000 people. All Kaduna public servants have been captured, and only a few have not been registered," he said, then added, "We are getting the informal sector on board. So far we have reached 500 which is low but we are targeting 8.9 million people," he said.
Despite the temporal halt of the process due to COVID-19 pandemic, Kaduna state is pioneering the process for states to procure their own family planning commodities. The state ministry of health is currently awaiting guidelines for state level procurement from the FMOH. For family planning advocates such as the Partnership for Advocacy in Child and Family Health At Scale, PACFaH@Scale, this is certainly a step in the right direction.