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Rethinking Family Planning: Takeaways from the 5th NFPC 2018

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“If you fail to plan, plan to fail” – Benjamin Franklin
Family planning allows communities to shape their futures and use resources effectively. This has spill over effects for the nation’s economy, productivity, and well-being. Today, a Nigerian woman has an average of 5.5 children in her lifetime compared with her counterpart in neighbouring Ghana who has four. This has vast implications for Nigeria, in terms of its population, but more critically in terms of its economic growth and development.

The Nigeria Family Planning Conference 2018 (NFPC 2018) was convened to deliberate the contextual nuances around family planning and chart roadmaps for more progress in Nigeria’s family planning agenda.

The 5th edition of the conference held from 3rd – 6th December 2018, centred around “Investment, Innovation, and Inclusiveness,” three critical keys Minister of Health Professor Isaac Adewole said were important to “unlock the extremely beneficial contributions of family planning to Nigeria’s ambitions of reaping all of its potentials.” He delivered the keynote address on behalf of Nigeria’s Vice President Professor Yemi Osinbajo.

Professor Isaac Adewole presents a keynote address on behalf of Vice President Professor Yemi Osinbajo at the opening ceremony of NFPC 2018. Photo credit: Nigeria Health Watch

Key takeaways from the NFPC 2018 include:

1. Government must invest more funds into family planning services: Family planning has been established as the best buy for national development, with every $1 investment saving governments up to $6 according to UNFPA. It has also been shown to be one of the best safeguards against maternal mortality. Yet, funding for family planning in Nigeria continues to be largely donor-driven. Professor Oladapo Ladipo, Co-Founder of the Association for Reproductive and Family Health (ARFH), pushed for more advocacy to government at all levels to invest more, stressing the need for more innovation in financing strategies at all levels of governance. Nigerians should demand improved investment and budgeting for family planning from the government. At the women’s pre-conference, Ifeyinwa Omowole, President, Nigeria Association of Women Journalists, told attendees that ahead of the 2019 presidential elections, they should, “ask the candidates seeking for your votes how they plan to keep women alive and healthy”.

2. Money is needed, but accountability on how it is spent is critical:
Dr Ibrahim Kana said the problem however is not money, but how to spend the money. Kana, who leads the World Bank’s Saving One Million Lives Program for Results (SOML-PforR), advocated for strict monitoring of the use of funds to deliver on some of the indicators. One such indicator is the Contraceptive Prevalence Rate (CPR), which the SOML-PforR uses to decide on disbursement of funds to states through its programme.

3. It is important to expand service provision to reach the right people: 
Dr Olumide Okunola of the World Bank made a case for the Federal Government’s task shifting and task sharing policy, noting that it is not compulsory for a doctor or nurse to render family planning services. For significant and sustained progress to be made in the uptake of family planning services, there is a need to involve other cadres of health care workers like Community Health Extension Workers (CHEWS) and Patent and Proprietary Medicine Vendors (PPMVs). It is almost impossible to reach the required coverage of family planning services, while keeping the delivery of these services in the exclusive purview of doctors and nurses.

4. Can health insurance come to the rescue?
Dr Sylvester Akande, a Senior Health Finance Advisor at Integrated Health Program Nigeria proposed health insurance as an innovative strategy to fund family planning services in Nigeria.
He painted the picture of a state that budgets 13% of its total expenditure on health. This amounts to 9.5 billion Naira and a health expenditure per capita of N1900 ($6) on every individual, which he said is far less than the WHO recommended spending of $86 per person. If the state succeeds in their proposed N8500 premium by only 30% of the population, a total sum of 13.52 billion would be generated to spend on health, an amount far higher than the budget for health.

The 5th Nigeria Family Planning Conference provided an opportunity for stakeholders to share best practices, success stories, lessons learned and opportunities for further improvement. Photo credit: Nigeria Health Watch

The conference also provided opportunities to learn what different approaches were being employed at the state and community levels to improve family planning uptake.

1. A mix of approaches from Anambra State:

Dr. Uchechukwu Onyejieme, Director of Public Health, Anambra State Ministry of Health shared how the 72-hour clinic makeover championed by The Challenge Initiative (TCI) is working to change the discourse on family planning in the state. The state is also working to involve traditional and religious rulers and adopt the task shifting and task sharing policy. “In Anambra state, whenever you mention family planning, religion always comes into the discussion. We involved religious leaders to be part of our advocacy to help address some of their issues around family planning in the state,” Onyejieme said at a side session organised by Development Research and Project Centre (dRPC).

2. Leveraging traditional and religious institutions:
Leveraging on the role of traditional and religious institutions to advance family planning in the country is crtical if Nigeria is to make significant progress. The Christian Health Association of Nigeria (CHAN) which owns 400 clinics, includes family planning services in its range of health services. Dr. Edward Egede of CHAN said this contributes to achieving universal health coverage. He added that the Catholic Church supports the traditional family planning method and is proactive in encouraging members to adopt it. For Umar Sanni Jabbi, the Sarkin Yakin Gagi, Sokoto, low uptake of family planning services in the North is as a result of ignorance, and this is where traditional rulers, who are community gatekeepers, can play important roles. He connected the significant improvement in family planning uptake in Sokoto State, notably the increased use of misoprostol, to the involvement and ownership of advocacy by traditional rulers. He advised Civil Society Organisations to work on building community ownership for sustenance of family planning programs.

Umar Sanni Jabbi, the Sarkin Yakin Gagi, Sokoto said traditional ruler are gatekeepers of communities and  they play important roles to advance family planning. Photo credit: Nigeria Health Watch

3. The media as a family planning partner:
Another panel session at the side event deliberated meaningful ways the media can help improve family planning uptake in the country. The need for media practitioners to effectively communicate family planning beyond a health issue was emphasised by Adaobi Ezeokoli, Editor in Chief at Nigeria Health Watch. She said when journalists understand that family planning is also a development, social, economic and political issue, they will craft better narratives and increase the awareness of and need for political buy-in for family planning investment. Rubby Rabiu, a journalist from Daily Trust, passionately called for the inclusion of the media from the onset of family planning programme design, in lieu of calling them only for press conferences. She noted that this will help them develop more passion and ownership for the cause.

“It’s important for journalists to communicate family planning as not only a health issue but a development issue’ – Adaobi Ezeokoli. Photo credit: Nigeria Health Watch

What can we do better?
The 6th Nigeria Family Planning Conference will take place next year. What indices will change by then? What learnings from the 5th edition are we going to put to effective use? What new progress are we going to share? How many more women and girls will have access to quality contraceptives information and services?

Nigeria had committed to achieving a contraceptive prevalence rate of 36% by the year 2018 during the 2012 London summit where the FP2020Global goal was agreed on. By the middle of 2017, Nigeria’s CPR was still less than 20% and taking into cognizance current realities, Nigeria rebased its CPR target to 27%. Should we aspire higher or strive to achieve the already set target?

Eze Onyekpere, Executive Director at Centre for Social Justice said Nigeria may not be getting expected outcomes in family planning because of low targets. “We are getting poor results because we have low aspirations. Where is 27% a pass mark in the world?” he asked during a plenary session on Accountability and Family Planning in Nigeria.

Family planning is a tool to tap into Nigeria’s potential demographic dividend. Dr. Ejike Oji, NFPC Local Organising Chair, painted a dire picture if Nigeria does not invest in Family Planning. “In 12 years, Nigeria has added 58 million people to its population. As we continue to increase in this alarming rate, we will be increasing the number of poor people in our country with resources not increasing accordingly,” he said.

While the theme of this year’s family planning conference speaks to the multi-sector, multi-pronged approach that is needed to advance family planning in Nigeria, the question now is “Are we going to implement the solutions we always talk about?” What will change in 2020, when we gather for the 6th Nigeria Family Planning Conference? The hope is that Nigerian women will have better access to family planning services in their communities, and the Nigerian government, on all levels, will release the funds necessary to take advantage of the best-buy that family planning is for the nation’s development.

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