As part efforts to strengthen implementation of family planning programmes in Nigeria, the development Research and Project Centre (dRPC) is organising a one day high level meeting for developmental partners in the sector.
The meeting which would be held in Abuja on Thursday is in collaboration with the federal ministry of health and other civil society organisations.
At the forefront of the meeting deliberation is the gender analysis of FP (family planning) and reproductive health in Nigeria.
The meeting also intends to update the states on the new family planning policies and how to improve implementation.
The CSO and focal persons are also expected to appraise the new policy direction of the federal ministry of health on FP.
In spite effort to make FP services cheap and available in the country, the rate of acceptance is still very low as many sexually active women are reluctant to embrace contraceptives.
The benefits of family planning are obvious. It allows women to space child birth and replenish vital nutrients lost during the process. It also allows the organs of mothers to return to normal.
In spite of these obvious merits, 87 per cent of women in Nigeria or their partners do not use modern or traditional contraceptives.
Statistics from the 2016/17 Multiple Indicator Cluster Survey (MICS) indicate that only 11 per cent of women of ages 15 to 49, currently married or in a union, use the method in the country.
An urban city such as Lagos also has very low record of FP usage.
The event is expected to start at 9:00 a.m.
9: 10 am – It’s a beautiful sunny day here in Abuja. The temperature here at the venue for the high level meeting on FP is 25c
9:12 am – Participants are already entering into the hall.
9:20 am – The programme is about to start. The moderator, Umar Kawu, just welcomed the participants of the events. He said the workshop is to update the states in the new nation’s FP policies and policy directions and update from states on FP situation and innovations
9: 38 am – Mr Kawu said the event should start while waiting for the representative of the minister.
Currently on the high-table is Emmanuel Abanida, the Senior Technical Adviser, DRPC-PAS, he is representing the ED Judith Walker,
Also here is Fatai Aremu, a professor of political science, is a technical adviser legislative policies and advocacy, dRPC-PAS
Also present is Hajiya Sa’a Nata’ala coordinator, Family Planning Kano State and Sadauki, the deputy national president – SOGON
9: 45 am – The workshop is attended by government workers working on family planning, CSOs and journalists.
SOGON is the Society of Gynaecology and Obstetrics of Nigeria.
10:00 am – The cros section of participans at the workshop are from diverse states in Nigeria including Lagos, Kano, Abuja, Taraba and Kaduna,
10: 02 am – The event is divided into five sessions
The first panel is on gender analysis of FP policies – to be discussed by Joyce Ahmadu and Sakina Bello/Pathfinder International
The second panel is- FP financing at state level to be discussed by the representatives from the five PAS states (Kaduna, Kano, Lagos, Niger and Taraba)
There will be a tea break for about 20 mins before a paper presentation on the topic FP Financing at national level – a review of allocation and releases. The paper is to be presented by Kayode Afolabi, Director/Head-RH, Federal Ministry of Health (FMOH).
The third panel is on a new FP policies, policy direction and performance monitoring indicators. The objective is to understand new FP policies and identify performance indicators to monitor. Panelists are Adedeji Aderibigbe, University of Ilorin, GRed Izuwa (DD) FMOH and Okey Akpala/ M space
The fourth panel is FP policy implementation at state level. This would be handled by the representatives from the PAS states
The fifth and last pane is the state level innovations to address human resources for Health Gaps (Generating cross- learning to improve programme directions in bridging gaps for HRH)
10:10 am – Giving the welcome message and objectives is Mr Abanida. He said the objective of the workshop is to get people to talk about FP, especiallyy its implementation across the selected states and its implication on gender.
10:14 am – Mr Abanida said dRPC feels that their stakeholders need to get used to the FP policies
The meeting is to enable the stakeholders, CSOs, and media engage themselves in the new narration.
“We hope to employ FP policies in 2019 to 2023. FP is seen as injustice in gender inequity.” He said they intend to focus on gender equity and are hopeful that with the number of experts in the room, they will be able to come up with advocacy tools that will help improve FP in Nigeria and promote gender equality.
He said the event will help the states know what is happening at the national policy level. Before the event, we looked at the CSO landscape on FP and also found out what people know about FP
10:20 – Coming in is the representative of the minister of health, Kayode Afolabi- He is a director at the health ministry.
He will be giving the keynote speech and declaring the meeting open.
He is also going to be delivering a paper on FP financing at national level – a review of allocation and releases.
10:30 Speaking now is Mr Afolabi of the health ministry. He said FP in Nigeria is being supported by the government and the Bill and Melinda Gates Foundation.
He said FP is very important to reduce maternal and child mortality because the current rate of live birth in Nigeria is 560 per 1,000 birth.
He said this is not to good because the country can do better and FP can be used to reduce this as it will reduce the rate of unwanted pregnancies in the country.
He said FP is very necessary to save lives of the women, allow them live their lives to the fullest and also take care of the family.
He said looking at the high figure and comparing it to what has happened in the past then the country can do well.
“We need to promote availability of new contraceptive model in line with the global trend. We are trying to review the roadmap we are using in FP policies. We are also happy that the media is here because we have over 300 PHCs in the country and most of the women are not accessing it.”
Mr Afolabi is an obstetrician and Gynecologist and presently a director in the ministry of health
He said 25 per cent of maternal mortality can be prevented by contraceptives.
“We have a lot of FP commodities where they are needed. But the question is how do we achieve this? Government has done a lot, but we cannot do it alone.”
He said the minister of health, Isaac Adewole, has also commissioned a task force to look into the problem in the six highest burden state for maternal mortality.
10: 40 am – Still Speaking is Mr Afolabi. He has declared the workshop open and proceeds to presenting his paper.
He said FP financing is very important and the government has been very committed to funding the FP programme. He said the government has been releasing its counterpart fund to the FP to GFF and World Bank.
Mr Afolabi said Nigeria started implementing its FP blueprint on cost estimates for FP in 2014. He said government and stakeholders decided to improve family planning uptake. He said there has been a gradual increase in the financing of FP in the country. Investing in high impact FP intervention is a cost effective national development initiative, he said.
He showed in graphics how Nigeria has fared in the funding of FP. He said USAID has been consistent in moping up the gaps in FP Funding in Nigeria. He said the country has not been fulfilling most of its pledges as it pledged $3 million for the basket funding for FP yearly for four years. This was meant to total to $12 million. Unfortunately the fund released was only $7 million in total.
He said Nigeria will not be able to pay the backlog in the funding because the source of money generation has dried up. He said the source was the excess crude oil fund. Unfortunately, that era is over, he said.
Mr Afolabi also said tat the government is now looking inwards to raise money to sustain the FP funds.
He said the minister this year made a pledge of $4 million to FP and he has promised that the government would pay it in bulk and not in installments as it used to be.
11: 00am Mr Afolabi said the budgetary allocation to health is also very low as it is only 4 per cent of the whole budget.
He said though the budgetary allocation is reducing, the allocation to FP is increasing and this shows commitment on the path of the government. He said there are also efforts to improve domestic funding to FP and this has started with advocacy visit to the budgetary office and this is why there has been a increase.
He said some of what the government have been doing in FP are renewed MoU with UNFPA procurement for the country, zs well asincreased effort to grow sustainable domestic financing through an annual government counterpart contribution of $4 million form 2018-2021
He said they have also disbursed $56 million to the states through IDA loans and Global financing facility from 2017-2020. A BHCPF roll out as pilot in line with the NHA of 2014, which shall be funded from government Consolidated Revenue pool.
He said the government is also investing in a robust accountability system to track and report actual domestic resources expenditure at national and state levels. He said accountability is very important because that is how they can know what the government is spending especially human resource.
Mr Afolabi summited by saying all Nigerians especially the CSO needs to improve on their advocacy for more budget to health because more money to health means more to FP.
The session now is the question and answer session.
A participant from Lagos said she does not think accountability should be a problem if there is right and official channels to disburse funds. She said such is what is used in Lagos.
“There is an official channel for funds disbursement to the government and CSOs working on FP in the state,” she said.
A participant asked why the fund for FP was being increased.
Mr Afolabi said the increase in the funding was due to forecast by the federal government and development partners who work on FP in Nigeria. He said the contribution the country makes is also being released to the basket fund in Geneva and not through anyone. He said the country is setting targets that it can realise and does not want to go beyond what it can meet.
He said there are huge unmet needs of FP in Nigeria and the highest in the country is Kano. He said there are lots of women who want to use FP but cannot because of many issues such as lack of facilities, spousal disagreement, fear of the unknown, unavailability of contraceptive choices among others.
He said Lagos and Kaduna have developed a cost implementation plan.
In conclusion, Mr Afolabi said there is a need to focus on people who are currently on FP method so as to make the services always available to them before focusing on those with the unmet needs. He said Oyo State tops the chart of where contraceptive is most accepted.
11: 26 am Mr Kawu has taken over the floor. He thanked Mr. Afolabi for coming and asked him to express their gratitude to the minister of health.
11:30 am – Tea break
12:10pm – Back from tea break
The moderator says the first panel will be handled by Joyce Ahmadu. It was meant to be taken by two panelists, but the second person is unavoidably absent.
The topic is gender analysis of FP policies. It focuses on gender assessment from gender perspectives. It assesses how projects/policies address and respond to gender dynamics and inequalities (gender norms, roles and regulation) in technical programming, policies and practices
it addresses how gender affects health seeking behaviour, reproductive health care and child care.
Gender role refer to what males and females should do within the society. The role of the women includes taking care of the homes and the family and this affects their ability to seek healthcare.
They also have to seek permission to take care of their health, she says. The unequal gender base responsibility also leads to gender violence. The gender norms also affect female health seeking behavior and all these serve as barriers to women health and family planning
12:22 pm – The panel also reviews and assesses the extent to which the national child and family health health policies/pans /strategies consider and address gender norms, rules and relations in specific ways to reduce gender based health inequalities. The aim is to promote policy action to strengthen gender integration in future policy development process and extensive analytics desk review of national child and family health policies, plans and strategies.
She said understanding and analysis of gender norms is very important in order to know if the policy is gender sensitive or not
Ms Ahmadu analyses gender in family planning and reproductive health in Nigeria.
Under the gender analysis, nine national policy documents were reviewed and assessed and was been presented to the participants
Four of the documents are draft policies. These documents are the National Reproductive Health Policy (2017),Draft National Health Policy (2016),Draft National Child Health Policy (2016) ,Draft National Strategic Health Development Plan 11 (2017 – 2021),Nigeria Family Planning Blueprint (Scale Up Plan) 2014.
Other include the Nigeria Strategy for Immunisation and PHC System Strengthening (2018-2028),Draft Reproductive, Maternal, New-Born, Child Adolescent Health + nutrition Strategy (2017-2012),Implementation Guidelines for PHC Under One Roof (2018), and the National Guideline for the Implementation of Integrated Community Case Management of Childhood Illness in Nigeria (2013).
Ms Ahmadu said all the health policies in Nigeria were assessed using the WHO gender responsive assessment scale which is on a scale of one to five with one indicating that gender inequality perpetuates unbalanced norms, roles and relations.
Ms Ahmadu said they found out that while preparing most of these policies, gender consideration is not often on the menu. She said though most of the health agencies have a gender unit, the ministry of health is not often included in policy matters.
She said the ministry of women affairs is also being neglected.
she said that is not good enough as this usually affects the way the policies are fashioned and implemented.
12:25 pm – Ms Ahmadu concludes her session.
In the question and answer session, a woman from Lagos said most CSOs do not include women in their decision making
A participant said she should also cross match her finding with the SDG goals since the fifth SDG is specifically focused on gender equality. She needs to see how this is related to health maters in Nigeria
Ms Ahmadu promised to go factor in all the suggestion and that the work is an on going one which will always be shared
12 : 26 pm: The moderator has taken the floor. She thanked Ms Ahmadu for the presentation and called on the second panel.
The second panel is to take on FP financing in states. People on the panel are the five representatives from Kaduna, Kano, Lagos, Niger and Taraba
The Lagos State representative, Okanlawon Idowu, said they a distribution process which they used to distribute FP products.
She called for the need to work with the private sector.
From Taraba State, Titi Saleh said there is need more training for LAC because “some of our staff are retired and some do not know about it (FP.”
“They have approved the training but we are waiting for the financing to come so that we can do so. We have new partners in the states and we need more partners to help us in our states so that we can retrain our staff and so that the providers can be able to service the rural areas.
“We have started using Sanaya Press. It is being given to us by the federal ministry of health; but we have challenges because we do not have enough personnel to attend to rural people.”
From Niger State, the director PRS, Jummai Idris, said when she got to office she focused on improving reproductive health and she understood that FP will help in reducing maternal mortality . “The first thing I did as a director is to get coordination line in place. In 2017, we had 3.7 million and in 2018, we have almost 5.8 million and for 2019 we are proposing 9 million.”
“Niger is also one of the luck states to be implementing the Basic Healthcare Provision Funds given by the federal ministry of health. Fifty percent of this fund will be going to the contributory scheme which the state government is proposing, 49 per cent to PHC and five percent to emergencies and other health intervention.
FP will also be one of the major focus from the Basic Healthcare provision funds, she said.
The Kaduna representative – Ibrahim Bakat, Assistant Director FP- said the state has been doing well in FP, but women have been complaining about paying money to get some of the commodities.
He said the government has been consistently budgeting for FP programme in the state and most of the budget has been cashed backed.
He said before funds can be released they have to get approval of the governor if it is above N20 million.
In 2017, they budgeted N100 million for FP commodities and services. Though the fund was released, it was not cashed backed. He, however, said N113 million has been proposed for 2018 and it has been released and cash backed.
Mr Bakat said for 2019, N143 million has been budgeted for FP commodities.
The Kano State representative, the director of budget, Muktar Ado Yakassai, said FP has been largely supported by donor partners such as Dangote Foundation and Bill and Melinda Gates Foundation.
He said N1.6 million is being used to purchase of FP commodities. In 2018, we purchase FP equipment of N16 million.
In June this year, 3.3 million was used to purchased consumables. He said in July, another N3 million was used.
Mr Yakassai said the state is making efforts to improve financing of FP.
Five per cent of the state IGR will also be used to support health in the state. Kano state also said one per cent of the total grant will be given to the fund so that they can take care of the facilities.
1;55 pm – Speaking now is Mr Aderibigbe.
Mr Aderibigbe is presenting on advocacy inclusion in Nigerian family planning policy document.
He said he realised that some of the documents reviewed in spite of having lines on family planning issues, they have no mention of FP advocacy.
Mr Aderibigbe said this is despite a significant body of evidence suggesting the role of advocacy in the eventual acceptance of policies that are developed.
He said policy documents that have direct or indirect bearing on FP issues in Nigeria were used for the meta analysis. Some of the documents he said were retrieved from the internet
He said all the document which had no advocacy policies were national service documents. He also said that they found that all the documents analysed were also at national level and none was domesticated (in states).
Mr Aderibigbe said for the country to improve FP programme, there is a need to advocate to the political leaders, traditional and religious leaders.
He said with high political will, leadership and stewardship role of government at all levels as well as sustained passion by all stakeholders on improved FP, financing implementation of the FP Blueprint will be assured and more impactful.
“With effective coordination, enabling environment and funding commitments, the efforts will be rewarding. It will be easier and pleasing to reach our goal.”
Giving his presentation now is Greg Izuwa. He said globally, contraception use has shown to prevent unwanted pregnancies, reduce abortion rate and lower the incidence of death related to maternal causes
Mr Izuwa however said in most developing countries, there are high unmet needs for contraceptives. It is known that FP has the potential to reduce maternal mortality rate by 30 per cent and infant mortality rate by 75 per cent, he said.
Mr Izuwa also said the government desires for Nigeria to reach 27 per cent modern Contraceptive Prevalence Rate CPR by 2020.
He said the government through the FMOH has put in place a policy of free FP information, services and commodities to FP clients at public health facilities across the country.
“Also select private facilities are equally being supported with government’s free commodities to enable them provide FP services at subsidised fee to their clients. The action here are to promote affordability and access”.
He said the government has been doing a lot as a number of guidelines and manuals have been developed to promote strict adherence to established standards and quality of care in the provision of family planning services.
Mr Abanida rounded up the session by saying policies are not not laws as such states too can make their policies or domesticate the ones available.
This, he said, would ensure more implementation of policies.
2:40 pm – Mr Kawu has called on the next session.
The next session is moderated by Mr Abanida.
The topic of this session is state level innovation to address human resource for Health Gaps.
Muktar Gadanya, an associate professor, Bayero University Kano and FP expert, Kehinde Osinowo, director of programme ARFH; and Zainab Moukarim of Women 4 health
The first panelist, Ms Osinowo, who spoke on human capital development for health said the health human resources is negatively skewed in the rural areas.
She said the problem of human resources in the health sector in Nigeria ranges from the shortage of human resources across the health profession, brain-drain, wide gap amongst health professionals among others.
Ms Osinowo said anywhere there is shortage of staff, it is common to have challenges and death of people.
She said some of the practical ways we can resolve this problem which unfortunately is more prevalent in the rural area/ PHCs is to embark on rigorous retraining of the available staff.
She said local governments should develop in-service training, internal service training for the CHEW in the PHCs.
She said she is against the costing implementation plan because the government is just repackaging what the donors are doing or paying for.
She also advised CSOs to reduce advocacy on policies implementation but focus more on talking about training for the staff. This, she said, is very important because when the donors take away their money, Nigeria will still have something to fall back on .
“The PHC under one roof, should focus on capacity building for the workers who work there especially the CHEWS. Government at all level should institute strong orientation for all health workers. If we embrace some of the old practices when funding was not available we will be able to have skilled workers,” she said.
Ms Osinowo also emphasised that the training should be target specific. She said it should be targeted at the people who provide the services and not the top officials who would be retiring from service in no time.
“The training should be for everyone, especially the provider of services and not the top officers who would be retiring at anytime. There are also e-learning. All health providers have phones, you can use the technology to provide simple lessons on how to carry out their services,” she added.
Ms Osinowo also said the government needs to engage more with the private health sector for health development especially in FP. There should be no leakages at least the services will be used by Nigerians, she said.
3:10 pm – Speaking next is Muktar Gadanya. He said there is a need to include more women in health capacity building. He said there is a need for the government to build health schools and equip them to train more of the health workers.
He discussed the socio-economy of human resources in the country. He said we drove away all foreign health workers when we do not have the human resources to do what is needed to take ownership of the health space.
Mr Gadanya said insufficient human resources in health sector starts from the entry point, retention, graduation, employment and deployment.
He said as at the end of 2015, Nigeria was one the 75 countdown countries that accounted for 95 per cent of the world’s burden of maternal, new born and child deaths.
Mr Gadanya said the dearth of health workers is worse in the northern part of the country and this is affected by the conflict in the North-eastern part of the country.
He said the various militating factors have also affected the training institutions and how they can produce quality health resources for the health sector.
3: 45 pm – The last panelist, Zainab Moukarim, said that northern Nigeria has one of the worse health indies in Sub Saharan Africa, according to the WHO 2017. This can be attributed to the very low number of front line health workers especially in the rural area in the north, she said.
Although Nigeria has a huge pool of health work force, the geographical distribution of health worker in Nigeria is very uneven with fewer staff per person in less developed areas, she said.
She said there is a huge concentration of health worker in urban areas and tertiary health care, and the southern part of the country.
Although knowledge of contraceptives seems high in northern Nigeria, the region is reported to have a very low level uptake especially in states where two organisations – girls for health and women for health – are operating
She said they also observed that the states where the Girls 4 Health (G4H) and Women4 Health (W4H) are operational have the most unmet FP needs. This she said can be attributed to the shortage of indigenous health workers who have the understanding of the culture and value of the society and how best to communicate FP messages.
She said they have also realised that to have effective healthcare system, there is a need to train more females because of societal issues. She said most of the northern men do not allow their wives to visit the health facilities because they do not want then to be attended to by a man.
5:00 pm – The session just reconvened.
The last session is about to start. The moderator, Mr Kawu, is leading the panel. The topic for discussion by this panel is – FP policy implementation at state level.
On the panel are the representatives from the five states- Kaduna, Kano, Lagos, Niger and Taraba.
Mr Na’allah said the government of Niger State has been doing a lot to improve and implement FP through the Primary Healthcare Under One Roof.
He said the government has gotten support from donor partners to train some of its health workers in FP services. He said 255 CHEWS were trained and deployed to 255 focal PHC facilities. to be able to participate in implementing contraceptive methods.
They also trained 120 midwives and they were also deployed to health facilities in the state. He said 22 facilities have at least two midwives that oversee health services.
We are judiciously following all the aspects of the cost spent, he said.
For Taraba state, Ms Saleh said one of the problems affecting the state is the lack of funding. This, she said, has been stalling full implementation of FP programmes in the state.
She also said most of the health workers in the state have little or no knowledge on the how to administer the LAC services. She said though some of them have been trained. The training has been done by the federal government and donor partners
Ms Fini added that they have been talking to the media and partners for more advocacy about FP.
” Our FP facilities are modern, well equipped and are up to date. we also have well trained workers.
Lagos State said it has adopted the national FP working policies and also the task sharing, task shifting policy.
She however said N50 million was budgeted for FP and it has not been released. She said they have been depending on donor partners for commodities and consumables.
She, however, said Kano State has been working on advocacy and this has been done in collaboration with the traditional leaders, religious leaders and other notable people within the society.
Lastly was the representative from Kaduna, Ibrahim Bakat. He said the state has been doing quite well in FP programmes as it is one of the interest of the governor.
He said the state has also been releasing funds budgeted for FP and most of the PHCs in the state now provide the services
5:45 pm – The panel session was wrapped up by the moderator
The key issues and recommendation discussed at the workshop are:
1. Gender assessment by the first speaker- she talked about breaking discrimination that affect health.
she recommended that gender data should be given at all level.
she also called for involvement of gender stakeholders while formulating gender policies
Recommendations from the workshop include
Use of data for policy making
Domestication of TSTS policy at state level
Deal with the shortage of skills providers
Improve the perception of female education and female empowerment
6: 00 pm- the workshop was wrapped up by the moderator, Mr Kawu
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