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.