Family planning (FP) is a highly cost-effective investment that boosts global health and empowers women. By meeting the unmet needs for FP among women, there is a significant decrease in unplanned pregnancies and abortions. As a result, this contributes to a reduction in maternal and child mortality rates and curtailing the transmission of HIV (Human Immunodeficiency Virus). These health outcomes collectively contribute to an overall improvement in the health and well-being of women, children, and families.
Over the past decade, the federal and state governments of Nigeria have budgeted significant resources to develop and implement strategies to create an effective healthcare delivery system, as evidenced by an increase in federal health budget allocations from 434 billion naira in 2018 to 1.02 trillion naira in 2021. However, this is still grossly insufficient as the allocation is contrary to the Abuja Declaration which called for the allocation of a minimum of 15% of the national budget to health. This inadequate funding is aggravated by weak governance, accountability, and policy implementation combined with limited data available for planning and decision-making.
In the range of health financing options, just like other health areas, there are existing challenges for FP financing, and this has critical implications for maternal outcomes in Nigeria.
Funding challenges are compounded because the benefits of investments in FP and development outcomes are often poorly understood by high-level stakeholders, even though it is cross cutting in the health and social development pillars within the National Strategic Development Plan.
To encourage and regularise domestic financing effectively, innovative methods are required, in addition to ensuring that donor funds are efficiently used. It is crucial for governments and donors to work together, ensuring that the available resources are strategically coordinated towards the most impactful strategies and directed at the most economically disadvantaged populations, maximising the effectiveness of investments. Existing funding gaps highlight the need to diversify funding sources beyond donors, particularly establishing long-term private sector involvement in FP financing.
Scoping mission on financing Family Planning commodities
To this end, the Private Sector Health Alliance of Nigeria (PSHAN) has conducted scoping missions on financing FP commodities in Lagos, Kano, Kaduna, Nasarawa and Bauchi states. Given the need to identify sustainable financing methods for FP, the scoping mission also aimed to recommend public-private financing models in Nigeria that have the potential for scalability by the Bill & Melinda Gates Foundation in 2023/2024, the funders of the study. The locations chosen for the scoping mission were based on the presence of key private sector investments in the health sector, the political will of the government and the Foundation’s previous investments in improving health outcomes.
Dr. Anne Adah-Ogoh, Head of Policy and Programs, at the Private Sector Health Alliance of Nigeria, in her opening remarks, spoke about the project objectives, stating “The project sought to identify one to two Public-Private Partnerships (PPP) financing models with highest potential for FP commodities in terms of feasibility, scalability, sustainability, and impact and also recommend specific implementation strategies for piloting the identified PPP sector financing model(s) for FP commodities in Nigeria”, she added.
Dr Mojisola Odeku, Senior Programme Officer, Bill and Melinda Gates Foundation, re-echoed this sentiment pointing at the foundation’s commitment to removing bottlenecks in FP financing for Nigeria.
“We need to look at how to consolidate all FP financing efforts, also strengthening the operationalisation of Nigeria’s Private Sector Strategy for Family Planning by bridging the existing evidence gaps in identifying impactful and scalable models for private sector financing involvement,” she said.
Existing PPP financing models, strengths, and potential
The team lead for the scoping mission in Lagos and Nasarawa States, Dr Gafar Alawode, outlined existing models for private sector financing for health in these states. They include;
- Catalytic financing model such as The Challenge Initiative (TCI)
- Basket funding- philanthropic financing such as The Coalition against COVID-19 (CACOVID),and Adopt-A-Healthcare-Facility-Programme (ADHFP)
- Blended Financing such as the integration of FP in health insurance benefits package, and other models such as health equity funds.
The identified catalytic financing model, it adapts the concept of “counterpart funding” where high level advocacy to stakeholders is used to secure government commitment to fund FP initiatives. It enhances transparency and accountability which are key barriers to sustainable FP financing. The model also addresses the issue of poor fiscal responsiveness, routine tracking of expenditures, and commitment from the government. Identified success factors include the existence of a robust advocacy strategy and coaching on resource mobilisation to facilitate budget fiscal responsiveness.
Another identified financing model discussed was the Integration of FP into the Lagos Health Insurance package (Ilera Eko). The model integrates private for-profit and nonprofit facilities in government-supported health insurance schemes for FP services. The model uses a blended approach by using the government health insurance scheme package to encourage private sector participation and leverages high-level stakeholder negotiations, cost subsidisation and community-based awareness to improve FP services. Identified success factors included strong private sector engagement, presence of a clear policy framework, and the involvement of Social Marketing Organisations (SMOS) to provide subsidised products. Identified challenges with this model included difficulty in facilitating private providers integration, accreditation to contracting, reimbursement issues and quality assurance.
In Bauchi State, FP delivered in the private sector is mostly commercially driven through Patent and Proprietary Medicine Vendors (PPMVs) and private clinics, with limited social marketing efforts. Several private foundations and philanthropic efforts focused on women and girls’ health and social empowerment but not specific to FP programs.
For Kaduna State, Society for Family Health (SFH) through the Integrate Project and Clinton Health Access Initiative (CHAI) through its sexual and reproductive health (SRH) programme have supported the establishment of FP hubs at the LGA to provide support to community pharmacists (CPs) and PPMVs. In addition, existing private sector (CPs and PPMVs) networks provide access to FP information and services, facilitating referrals, especially in rural underserved communities.
In Kano State, there is a rapid evolution of private sector involvement in FP, aligning with the state’s healthcare policy. The presence of the Private Health Institutions Management Agency (PHIMA) plays a pivotal role in regulating, facilitating the establishment of, and ensuring the delivery of high-quality healthcare services by all private health institutions operating in the state. The major sources of funding for FP initiatives in the state include the government (both federal and state), health basket fund, and other development partners. In addition, a robust Drug Revolving Funding (DRF) mechanism for Maternal, Newborn, and Child Health (MNCH) products is coordinated by the Kano State Drug and Medical Consumables Supply Agency (DMCSA).
Despite substantial efforts, including budget allocations and the domestication of national procurement policy guidelines, the state faces challenges in the slow domestication of guidelines specifically related to the state procurement of FP commodities. Notably, FP services are also predominantly delivered free of charge in the state.
Recommendations for optimisation of private sector financing for family planning
In Lagos State, optimising private sector financing for FP involves establishing strong relationships with private sector providers through ongoing engagements and incentivisation measures, such as tax relief, consumable/commodity support, and equipment provision. Additionally, implementing a robust accountability mechanism is crucial to attract private sector investment. Furthermore, a strategic plan should be developed and executed to engage non-health formal private institutions, encouraging them to include FP programs in their Corporate Social Responsibility (CSR) initiatives.
In Nasarawa State, efforts to enhance FP financing must involve evidence-based advocacy directed at private sector organisations. There needs to be a focus on increasing awareness through strategic social and behaviour change communication (SBCC) campaigns to emphasise the role of FP in reducing maternal mortality. Additionally, support could be provided for private sector service providers through the subsidisation of FP commodities eased by social marketing organisations such as DKT- Nigeria, Society for Family Health Access to Health Limited (SFH-Access), and MSI Reproductive Choices.
In Bauchi State, recommendations included the development of a set criterion for site selection of eligible facilities for adoption, introduction of state led procurement processes through various channels from suppliers such as DKT who can supply at subsidised rates and discussing with advocacy core groups to work to improve ideas about FP and child spacing.
For Kano State, recommendations included ensuring the integration of private sector data for evidence based informed decision making, prompt and timely payment of procured commodities and the full operation of FP procurements policy domesticated in the state and engages the private sector fully.
For Kaduna State, recommendations for optimising private sector financing for FP included provision of subsidised FP commodities, inclusion of private facilities for partners intervention and the integration of FP to Health Insurance in the state.
On a national scale in Nigeria, it is emphasised that the selection and operation of financing models for FP should be tailored to the specific needs and context of each state. The approach recognises that a one-size-fits-all strategy is not applicable, highlighting the importance of flexibility and adaptability in addressing the diverse healthcare landscape within the country. This underscores the need for a nuanced understanding of regional contexts and preferences when designing and implementing FP financing models across Nigeria.