Improving access to quality health care depends on an effective health system that enables the promotion, prevention and reduction of premature and avoidable deaths. However, providing access to essential health services, especially family planning (FP), requires a sustained financial commitment. The 2018 Nigeria Demographic Health Survey (NDHS) showed a modern contraceptive prevalence rate of 13%. The Nigerian government aimed to expand access by recommitting to fund family planning to achieve a modern contraceptive prevalence rate (mCPR) of 27% among all women by 2024. This commitment was announced during the launch of Nigeria’s Family Planning Master Plan 2020-2024.
Family Planning Allocations in Nigeria’s National Budgets
A trend analysis of national budgets from 2017 to 2022, carried out by the Development Research and Projects Center (dRPC) shows that Nigeria has met its commitment of 1.2 billion naira for the allocation and full releases for FP in 2018 and 2020, but failed to meet its commitment in 2017, 2019 and 2021, allocating and releasing N917 million, N300 million and N809 million in 2017, 2019 and 2021 respectively. There is no budget line for family planning in the 2022 budget. In the past, family planning funds atypically came from department-wide votes to fill shortfalls. This may be an avenue to fund family planning in 2022, if there is no competing national need, however, it is not sustainable. There is a family planning funding gap in Nigeria, which has implications for the unmet FP needs of Nigerians.
In the past, family planning funds atypically came from department-wide votes to fill shortfalls. This may be an avenue to fund family planning in 2022, if there is no competing national need, however, it is not sustainable. There is a family planning funding gap in Nigeria, which has implications for the unmet FP needs of Nigerians.
Working with the Private Sector: Key to Providing Sustainable Financing for Family Planning in Nigeria
The private sector has been identified as a critical contributor to family planning adoption in Nigeria. The private sector can work with government to close FP funding gaps and expand access to family planning in Nigeria. NDHS data from 2018 indicated that more than 50% of contraceptive needs met came from private sector providers. According to Sustaining Heath Outcomes through the Private Sector (SHOPS) Plus, a 2018 NDHS secondary analysis of modern contraceptive use found that the private sector is critical in driving modern contraceptive uptake through its ability to provide range of different contraceptive methods.
A 2018 WHO Family Planning Funding Brief noted that “greater integration of the public and private sectors in service delivery, pooled procurement, and strategic purchasing will lead to more efficient and higher per capita spending with more consistent investments. – reaching populations in low-income countries requires an integrated approach to strengthening health systems in order to progress towards universal health coverage”. This shows that the private sector can, through social franchising, help expand access to quality family planning products and services.
Private and Public Sector Funding for Family Planning
At the 2022 Annual Scientific Conference of the Association of Public Health Physicians of Nigeria (APHPN), during a plenary session on the topic “The Efficiency and Effectiveness of Private and Public Sector Funding for Family Planning “, the tiered accreditation model was explored in detail, with a focus on the potential impact of adopting the public-private partnership model for financing family planning in Nigeria, and its possible role. in shaping Nigeria’s capacity to achieve the FP2030 goal to achieve a future where women and girls everywhere have the freedom and ability to lead healthy lives, make their own informed decisions about the contraceptive use and childbearing, and equal participation in society.
According to Pharmacist Emily Olalere, Director of Pharmacy Practice at the Pharmacists Council of Nigeria (PCN), the organization has a mandate to train and regulate Patented and Proprietary Medicine Vendors (PPMVs) and other pharmacy technicians. pharmacy to provide extended family planning services in difficult areas. to reach communities. The prioritization system has been developed in accordance with the Federal Ministry of Health (FMoH) Task Shifting and Sharing Policy (TSTS), however, the two systems have been merged to facilitate the delivery of planning services and products family in targeted communities.
In an effort to demystify the need for community pharmacists (CPs) and PPMVs to provide expanded family planning services in hard-to-reach communities, Pharmacist Bolaji Oladejo, State Program Manager, IntegratE Project, Society for Family Health explained: “Sexual activities are happening everywhere regardless of location, and we have PPMV residing in local communities and rural villages. They are frequented by locals. Pharmacist Oladejo added that the IntegratE partnership has trained over 500 PCs and over 600 PPMVs in Lagos and Kaduna between 2017 and 2021.
Regarding the role of government, Pharmacist Ibrahim Ahmed Babashehu, Director of Planning, Research and Statistics, PCN, said that the federal government has taken on the mandate through the Pharmacists Council of Nigeria to provide quality stewardship to guide the business of CPs and PPMVs. to ensure that their services are in line with government-approved guidelines and help ensure that Nigerians have access to better quality health care, regardless of where they are.
A proven model of public-private partnership for financing family planning in Nigeria
The IntegratE project provides evidence that KPs and PPMVs have the capacity to provide a broader range of family planning services than currently permitted by law. However, for KPs and PPMVs to be able to provide expanded family planning services, regulations governing their operations must be enforced to ensure professionalism and quality control and ensure fairness to providers and users. final. The Pharmacists Council of Nigeria strives to meet these regulatory needs. This is implemented through the facilitation of a 3-tier accreditation system.
This tiered accreditation model was piloted in collaboration with the PCN, FMoH and Society for Family Health (SFH), with capacity building and social accountability support from the dRPC [email protected] program. From 2017 to 2021, the IntegratE project successfully designed and implemented the 4-year pilot in Lagos and Kaduna States. The IntegratE project is an initiative co-funded by the Bill and Melinda Gates Foundation (BMGF) and MSD for Mothers. The vision of the project is to increase service delivery for combination contraceptives and primary health care among community pharmacists and patent and patent medicine vendors in Lagos and Kaduna States.
Recommendations for action
The plenary session concluded with the following action and policy recommendations:
To provide expanded family planning services and products to rural and hard-to-reach areas, the inherent potential of the private sector must be harnessed. Based on evidence provided by the IntegratE project, CPs and PPMVs can assume the role of primary providers of family planning services, if they are trained, regulated, and remunerated, and through this group, the rate of unneeded satisfied with family planning services can reduce.
It is time to migrate the data collected by private sector providers to the National Health Management Information System (NHMIS). Once this goal is achieved, relevant data can be translated into information that can be used to inform policy and provide evidence of increased sustainability and impact.
The public sector – government at the national, state and local levels – must collaborate with the private sector to ensure that technical, material and structural resources are pooled to accelerate action in the implementation and sustainability of programs that provide expanded quality family planning services and products to meet growing demand in local, rural, and hard-to-reach communities. Currently, the Federal Government, through the Pharmacists Council of Nigeria, provides guidelines for the operation of private sector providers, however, much more needs to be done to increase investment in family planning by dramatically increasing funds allocated to family planning at the national level. budget.
Beyond family planning, the private and public sector implementing partners of the IntegratE project are on track to scale up activities to provide expanded family planning services and primary health care in more countries. States of Nigeria. The federal government must ensure that it maintains an enabling environment for private sector providers to effectively and efficiently contribute to increased reach and, therefore, meet the demand for family planning and other primary health care services.
This is a call to policymakers to finalize and roll out the updated TSTS policy that allows health-trained PCs and PPMVs to perform more duties than they are currently authorized to do. . This has the potential to dramatically improve access to primary health care for Nigerians, especially underserved populations, and expand services and supplies through these retail channels in a way which guarantees quality and durability.