Nigerian Government commits to family planning. Will they deliver?
Co-authored by Tonte Ibraye, White Ribbon Alliance Nigeria National Coordinator and Bridget Nwagbara, FHI360 and White Ribbon Alliance Nigeria member
One week after the Government of Nigeria committed to increase family planning services, the National Council on Health is now meeting to discuss a policy that could help to make this commitment a reality. The item on the agenda is a task-sharing policy that would allow community health extension workers to provide family planning services at the community level.
Currently in Nigeria, the contraceptive prevalence rate (percentage of married women utilizing contraceptives) is 15%. However, an additional 20% of married women want to avoid or postpone pregnancy are not using any form of contraception. There are many challenges to accessing family planning services in Nigeria, both cultural and logistical.
The task-sharing policy on the agenda this week is based on the results of a 2008-2010 pilot study in a Northeastern state of Nigeria. The pilot demonstrated the feasibility and benefits of allowing community health extension workers and junior community health extension workers to provide injectable contraceptives at the community and household level. Injectable contraceptives are a preferred method of contraception in Nigeria, but were previously only administered at health facilities. This policy seeks to enable health extension workers to administer family planning services beyond the facilities in order to reach rural populations and women who may not be able to access family planning counseling and services.
While this policy appears to be a simple solution contributing to meeting the unmet need for family in Nigeria, it has become contentious particularly with Health Professional Associations. Higher cadre health workers perceive that such task-sharing could reduce their relevance and have expressed concern about injection safety and insufficient levels of training.
The pilot study in Gombe State showed greater contraceptive protection was delivered at the community level than the facility level. In fact community based provision was preferred at the community level because it provided greater privacy and convenience. The pilot in Gombe also found that community health extension workers were able to safely provide injections and dispose of waste. Though these findings are supported by numerous studies from Uganda, Ethiopia, Kenya and Bangladesh, the socio-political dynamics of the health care system in Nigeria continue to threaten the adoption of a policy that would contribute to Nigeria’s goal of increasing contraceptive prevalence and reducing the unmet need for family planning services.
Longstanding tensions between various cadres of health workers are a major obstacle to improving health policy in Nigeria. When adequately regulated, task-sharing provides an opportunity to reduce the workload of overburden health workers and system and to serve the ever growing health needs of the large Nigerian populace. We recognize that all cadres of health workers must be part of this solution and we welcome health professionals to join White Ribbon Alliance Nigeria in advocating for a policy that will help to meet the needs of Nigeria’s women and girls.
Last week, the Government of Nigeria made a commitment to increase contraception prevalence rate to 38% by 2018; to increase family planning spending from $3million annually to $ 8.5million; and to develop complementary budgets for delivery family planning services. The National Council on Health has the opportunity to move from commitments to action and to demonstrate that the Government of Nigeria is serious about meeting the needs of its citizens.