ELIMINATING FAMILY PLANNING BARRIERS IN LAGOS STATE

In Lagos state, the targeted increase in the Contraceptive Prevalence Rate (CPR) of Family Planning (FP) uptake was from 48 to 74 percent by 2018, now revised to 2020. The achievement of that alone would have saved the lives of an additional 657 mothers and 8,500 children in 2018. In addition, the state would have saved an additional N3.5 billion (approx. $10 million) in direct healthcare expenses in 2018 if this target had been reached.

 

Many factors, however, stood as barriers to the achievement of these targets in 2018; amongst which was the out-of-pocket cost of consumables, especially at the local government supported Primary Health Centres (PHCs). Other barriers to the achievement of the 78percent prevalence rate of family planning in Lagos state also revolved around methods, choice and use of contraceptives by many females, especially, residents in hard-to-reach communities.

 

In a bid to consolidate governments’ efforts, the Lagos state FP Advocacy Working Group (LAWG), formerly known as the Public Health Sustainable Advocacy Initiative (PHSAI) was established in January 2015 with the support of Pathfinder. LAWG comprised civil society organisations, faith-based organizations, the media, and local government units for budget and reproductive health and family planning and took up the mandate of creating dedicated local budgets for family planning services. Through the application of the AFP SMART advocacy approach, LAWG set out to tackle the problem of FP consumable costs in PHCs in Lagos state; at the time there was no specific budget for FP Consumables at the State Ministry of Health, Primary Health Care Board or the Local Governments.

 

The group, therefore, employed an advocacy strategy which would involve direct communication with Health authorities within the state. In late 2015, LAWG, known as PHSAI at the time, refocused advocacy on Lagos State’s Honorable Commissioner for Health who agreed that consumables should be funded and therefore issued a policy directive mandating that family planning services in Lagos should be completely free of charge to the client. This was a win for stakeholders and advocates of family planning in the state and paved way for many more wins in subsequent years. LAWG then engaged with sole administrators of the local government areas, heads of local council development areas, medical officers of health, and chairmen of community development committees. Together they identified ways to leverage existing funds for family planning.

 

In January 2018, Nigeria Network of NGOs (NNNGO) – Partnership for Advocacy in Child & Family Health (PACFaH) @Scale (NNNGO-PAS) began actively supporting LAWG-PHSAI on advocacy to Improve FP funding in the state. Through evidence-based advocacy and strategic identification of areas which required strengthening, NNNGO-PAS has discovered the need to work innovatively using strategic alliances and networking to improve family planning. PHSAI originally sought to establish a specific local government budget for family planning consumables. NNNGO-PAS carried out strategic mapping of civil society organisations working in the FP space and directly worked with reproductive health managers of PHCs at the local government levels identify gaps in the allocation and receipt of funds for the purchase of consumables in the centres. This opened up discussions as to how best to find ways of bridging such gaps in order to mitigate problems posed by the unavailability of consumables at PHCs.

 

Between 2015 and 2018, LAWG-PHSAI embarked on meetings with key stakeholders in Lagos including policymakers in the Health Sector, Local Government executives, Community leaders and RH/FP Managers to identify ways to leverage funds for FP.

 

 

 

 

 

In 2017, the Lagos State Primary Healthcare Board for the first time in history created a specific budget line for family planning consumables in the sum N50,000,000 ($140,000). The same amount was allocated in the 2018 budget, 18 LGAs/LCDAs are now reported to be funding FP Consumables in 2018.  In addition to this, the State Budget for FP doubled from N86,740,000 ($240,944.44) in 2017 to N177,500,000 ($493,055.56) in 2018.

 

While it cannot be said that the 74 percent CPR target was achieved in the year 2018, it is safe to say that we are on the track to achieving this desired target by 2020 if partnerships are strengthened and efforts are further scaled up in the coming year. The PACFaH@Scale program is committed to maximizing the lessons learned with PHSAI by sharing with State and Local Governments throughout Nigeria.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LAGOS STATE PHCB MEETS RH/FP MANAGERS IN THE STATE

LAGOS, Nigeria– The overarching objective of the Lagos State Family Planning Costed Implementation is to increase the overall Contraceptive Prevalence Rate (CPR) from 48 per cent to 74 per cent by 2020. Achieving this target is not only an indication of Lagos State’s commitment to ensuring the achievement of the goal of the National Blueprint (36 per cent CPR), it is also a way of fore-grounding the role of Lagos State as one which sets the pace for innovation and development in the country.

 

In its bid to achieve this goal as well as provide universal coverage of quantitative and efficient primary health care centres, the Lagos state government resurrected the Primary Health Care Board, PHCB. PHCB is tasked with the responsibility of implementing health care services through community participation, intersectoral collaboration, utilize appropriate technology for health-integrated services as well as supply essential drugs and comprehensive monitoring and evaluation of the process. This is where the need to integrate healthcare providers at the local government level comes in.

 

All twenty local government areas in Lagos state have more than two-hundred and eighty-eight Primary Health Care Centres, including flagship centres which have as part of their core duties, provision of Reproductive Health and Family Planning (RH/FP) services. The idea is to take health care services into the communities in order to ease the pressure on secondary and tertiary healthcare facilities and ultimately and better serve the people at the grassroots.

 

In past months, the Lagos state PHCB has hosted RH/FP managers from the twenty LGAs in the state to meetings which aim at tackling the challenges experienced by these LGAs in the delivery of health care services especially in the area of reproductive health and family planning. These meetings which often comprise RH/FP officers from different LGAs in the state, directors and officials from the PHCB, also look into strategies on how to ensure the achievement of the state’s share of the National Blueprint goal.

 

The August edition of the monthly Family Planning (FP) Managers’ Meetings was hosted on Monday, 13th August 2018 by the Lagos State Primary Health Care Board (PHCB). In its usual fashion, it was attended by Reproductive Health/Family Planning Managers (RH/FP) and relevant Directors from the Lagos State PHCB along with the NNNGO-PAS team who provided support.

 

Data on RH/FP services carried out in PHCCs from all twenty LGAs of the state between June and July 2018 was presented and revealed that the number of women who registered with the PHCCs for antenatal care increased from 11,878 in June to 12,075 in July 2018. Of this number, there were 1, 511 deliveries in June and a decrease of 1, 328 in July. Statistics also showed that despite the gap between the number of registrations for antenatal services and delivery rate, a silver lining was the decrease in the occurrence of still-births at the PHCCs within Lagos State.

 

RH/FP managers noted the less than 10 per cent ratio of women registered for antenatal care with PHCCs to women who undergo delivery of their babies at PHCCs in the state is largely a function of the unideal health care system.  They bemoaned the dearth of adequate facilities at the PHCCs, lack of adequate community involvement which breeds ineffectiveness.

 

These challenges which pose a threat to the lives of grassroots women and their unborn children have also resorted to lack of trust in the system; on the part of the patient and their families. RH/FP managers noted that many pregnant women tend to employ the services of trusted but unskilled health caregivers or religious centres which many noted have resulted in health complications over the years. They indicated that since many grassroots women live distances away from the closest PHCCs, therefore, they often resort to undergoing home deliveries due to inability to transport themselves to the centres especially during the night when many go into labour.

 

Health care officials who manage PHCCs said, a cause for concern is the attitude of relevant authorities towards funding and provision of RH/FP consumables. Many LGAs have not received steady funding for the running of the centres while almost none of them receive imprest on RH/FP care, in recent times.

 

Barr. Ayo Adebusoye, Project Officer for NNNGO-PAS identified that the duty of Civil Society Organisations is to put pressure on stakeholders and relevant authorities, through the collective efforts of the Lagos State Advocacy Working Group, NNNGO-PAS, Pathfinder and NURHI, in order to ensure that health becomes a priority to government and adequately funded. He noted that statistics from the FP budget tracking conducted in Lagos state from January 2018 to June 2018 revealed that the Ministry of Health released forty-eight million Naira and provided FP consumables to LGAs through the Saving One Million Lives Initiative. The next step is to make enquiries into how these resources are utilized in order to advocate for more in subsequent years.  This, in his opinion, is a direction worth taking to achieve the common objective of a better health care system.

 

Oyebisi Oluseyi, Project Director of NNNGO-PAS commended the board and managers for their work while noting that it was refreshing to see such a level of commitment in the public sector. He encouraged that they be accurate in their data collection and recording in order to assist the government in identifying what requires attention and the measures to employ. This will aid the fight against maternal and infant mortality in the country while ensuring that the sustainability of resources for the coming generation is guaranteed.

REVIEWING THE COSTED IMPLEMENTATION PLAN FOR ROUTINE IMMUNIZATION IN LAGOS STATE

LAGOS, Nigeria, 10 September 2018— A fully immunized child is one who has received the complete doses of the standard six antigens – BCG, Diphtheria Tetanus Pertussis (DTP) (3 doses), polio (3 doses), and measles vaccines. Globally, there are about 19.5million un/under-immunized children with 18% of them live in Nigeria.

 

A survey conducted in 2017 using a Multi Indicator Cluster Survey (MICS) showed that only about 23% of children in Nigeria were fully immunized in the last one year leaving 77% not fully immunized. In addition, statistics from the National Immunization Coverage Survey (NICS) 2017 for Lagos State showed that 68% of children aged 12-23 months received full immunization. This implies that although RI coverage in Lagos is impressive, there is still a lot more work to be done to achieve 100% coverage with the intention of leaving no child behind.

 

Understanding the critical role civil society organisations can play in attaining the 100% coverage goal for RI in Lagos State, NNNGO-PAS, following up on a civil society mapping exercise in March 2018, organised a strategy meeting with the Lagos State Accountability Mechanism (LASAM) on Friday 21, 2018 to review the costed implementation work plan for RI in Lagos State and to identify areas for advocacy. Organising a strategy meeting at this time was therefore not simply timely, but key to ensuring effective implementation of the RI costed implementation plan in Lagos state especially as governments begin preparations for 2019 RI year.

 

“We must begin to articulate more focused areas of advocacy that would improve RI funding and coverage in Lagos State now and in the coming year-2019” said Oyebisi, B. Oluseyi, NNNGO-PAS Program Director, who noted that part of the objectives of the meeting was to engage meaningfully with government and other critical stakeholders through a technical review of the costed implementation plan for RI in Lagos State, new domestic funding schemes and conduct feasibility updates on same.

 

Ayo Adebusoye, NNNGO-PAS Programs Officer further explained that the meeting also aimed at identifying capacity gaps amongst accountability mechanisms in the State, setting the foundation for addressing identified gaps with a view to strengthening and amplifying civil society’s voice on RI issues.

 

As with many other states in the country, issues of inadequate financing for routine immunization and untimely releases is playing out strongly in Lagos, a State that prides itself as a centre of excellence. History proves that these issues have plagued reproductive health for a long time. A report released by InfoGuide Nigeria in May 2018, noted that “vaccines have always been problematic for Nigeria primarily because funds are insufficient or were not released on time”.

 

The aforementioned roadblocks to RI service provision and delivery are compounded by inadequate cold chain infrastructure, weak preventive maintenance system of cold chain systems leading to rapid and continuous breakdown, inadequate supportive supervision, weak monitoring and lack of data for action as well as the slow integration of private providers in RI service delivery.

 

Needless to say, there is an urgent need to intensify advocacy for a sustained increase in allocation to RI and timely release of such funds. Specifically, critical stakeholders must begin to tackle these issues by ensuring that governments fulfil their commitments to RI with emphasis on adequate funding.

The Nigeria Network of NGOs (NNNGO) is the first generic membership body for civil society organisations in Nigeria that facilitates effective advocacy on issues of poverty and other developmental issues. 

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