Family planning

Leveraging the private sector to expand access to family planning – without compromising quality

By Iyadunni Olubode (Lead Writer)

The past few years have been difficult for maternal health. COVID-19 has dealt a severe blow to our healthcare system, slowing us down in our efforts to improve the quality and equity of care to help pregnant women survive and thrive.
In order to sufficiently address our country’s maternal health crisis, however, we must do more than improve care during pregnancy, labor and delivery. We also need to expand access to family planning.

Nigeria still has the highest number of maternal deaths in the world, accounting for more than 20%, the majority of which are avoidable. Meeting women’s reproductive health needs by expanding access to the full range of modern contraceptive methods is widely considered one of the most cost-effective ways to reduce maternal mortality —potentially preventing a third of all maternal deaths by empowering women to plan and space their pregnancies.

To integrate— a program that is making tremendous progress on this front — shows us how we can get there. The program demonstrates the opportunities and benefits of working with providers who are part of the informal private health sector in Nigeria, namely the Community Pharmacies (CPs) and Patent Medicine Vendors (PPMVs) that so many women already know and know about. trust, but who are often not officially taken into account. part of the health system.

For most Nigerians, local private pharmacies are their first stop when seeking primary and reproductive health care services. Photo credit: Nigeria Health Watch

For most Nigerian women, these local private pharmacies are their first stop when seeking primary and reproductive health care services. It makes sense to harness their reach as part of an overall health system strengthening strategy and leverage that reach to overcome barriers to access – misinformation, cultural biases, lack of knowledge and training of providers – who have maintained Nigeria’s lowest contraceptive prevalence rates. in the world.

In 2019, only 39% of the estimated 14 million women in Nigeria who wanted to avoid pregnancy were using some form of modern contraception, according to Guttmacher Institute data. According to the 2018 Nigerian Demographic and Health Survey, only 10.5% of women use a modern contraceptive method, with 40.8% of users getting supplies from private sector providers.

IntegratE is a collaborative effort championed by the Pharmacists Council of Nigeria, with the Society for Family Health leading the implementation, with financial support from MSD for Mothers and the Bill & Melinda Gates Foundation. Since its launch in 2017, IntegratE has focused on working with PCs and PPMVs, providing resources and training to improve the quality of family planning service delivery, first in Lagos and Kaduna in as test cases. A pathway to training and accreditation has been created for store owners – many of whom do not have formal medical training – to drive quality improvement, along with quality assurance mechanisms. Through a tiered accreditation model administered by the Pharmacists Council of Nigeria, PPMVs are trained, accredited, and licensed to offer quality family planning products and services.

Image credit: Nigeria Health Watch

Program implementers have worked with more than 1,400 KPs ​​and PPMVs in the two pilot states for four years, providing more than 200,000 women with quality family planning services and counseling, with compelling results. Clients reported a high level of satisfaction with the services received: 99.5% reported feeling respected by PPMV providers and 97% felt that confidentiality was assured.

On the provider side, 94% of PPMVs reported an increase in demand for their services as a result of their training. They felt that more people in their communities were confident in their abilities to provide family planning services. (Detailed summaries of the IntegratE project can be found here).

With IntegratE, family planning services data from PPMVs in both states is now integrated into the national health management information system, allowing policy makers to have visibility into more data for decision-making. and planning.

The project has shown that engaging the local private sector in the delivery of health services, including it in quality improvement efforts, incentivizing it to deliver quality care and certifying it for this to do, are essential steps to ensure increased and more equitable access to quality care in a mixed environment. health system.

Harnessing the reach of KPs and PPMVs is the best buy to overcome health access barriers and strengthen health systems. Photo credit: Nigeria Health Watch

There are some important lessons here. First, task shifting and sharing works. Inclusion of trained KPs and PPMVs in the national task-shifting and task-sharing policy has the potential to increase access to quality family planning and primary health care services, especially in the most remote areas. more difficult to access. Second, by integrating the local private health sector, we can increase our system’s overall capacity for universal health coverage and help accelerate progress towards reducing maternal mortality. Third, nothing substantial can be achieved without collaboration between federal, state and local government – ​​and the communities themselves. The IntegratE program has had this support from the start and will need this support to build sustainability in the future.

Transferring and task sharing works. Inclusion of trained KPs and PPMVs in the national task-shifting and task-sharing policy has the potential to increase access to quality family planning and primary health care services. Photo credit: Nigeria Health Watch

It’s time to lean on The success of Integrate— sustain the effort with continued support from policy makers and other key stakeholders and replicate the approach in other states. To do this, IntegratE, with financial support from the Bill & Melinda Gates Foundation, will better train PPMVs to meet the needs of women and support demand for their services, including digitizing training modules so that PPMVs can access distance training and equipping PPMVs with commercial and inventory management tools. Additionally, IntegratE will build the coordination capacity of key stakeholders at the national and state level to scale and sustain the program over time.

Image credit: Nigeria Health Watch

Given what we know about women’s health behaviors and preferences, armed with this new insight into maximizing engagement with the local private health sector, and what Integrate has been able to achieve to provide quality family planning services, we know that we must continue to integrate the local private sector into our mixed health system. As IntegratE expands beyond Lagos and Kaduna, state and local governments must create an enabling environment to train and accredit PPMVs to increase access to quality family planning services, by particularly in hard-to-reach and underserved areas. At the national level, we need to leverage the evidence from IntegratE to encourage a revised task sharing and task shifting policy that includes PPMVs and health trained PCs – this is a critical step to increase access quality family planning and reduce maternal mortality in this country. the country. So, I call on our decision makers to take the plunge with us to help create a world where no woman has to die giving life.

Iyadunni Olubode is the Nigerian Director of MSD for Mothers, a global maternal health initiative of Merck & Co., Inc., Kenilworth, NJ, USA. The IntegratE project is proof of concept that community pharmacists and patent medicine vendors have the capacity to provide a wider range of family planning and primary health care services than they are currently authorized by law to provide. to supply. The project is implemented by a consortium of partners led by the Society for Family Health and the Pharmacists Council of Nigeria with support from the Bill & Melinda Gates Foundation and MSD for Mothers. Other collaborators include PharmAccess, MSI, Pop Council and PPFN and the project is implemented in Kaduna and Lagos State. To learn more, visit the Integrated website.