By Waliyat Odemakin
The structure of the health sector in Nigeria is all-encompassing as it addresses healthcare at different levels for the delivery of efficient, affordable and qualitative services. It starts from the Primary to Secondary and ends at the Tertiary level. Usually, the functionality of each level depends largely on the availability of required fund, human, mental and material resources.
In the process of achieving standard in healthcare delivery, several efforts have been made by the Federal, State and Local Governments to strengthen the health system for the people to access essential services at all the levels. In such instances, different health bills, strategic plans and framework, policies, programmes among others have been put in place, some implemented while some somersaulted.
In the same vein, the Public Private Partnership (PPP) initiative which postulates collectivity of fund, ideas and logistics are also incorporated to fast-track development in all sectors of the economy and in time memorial continue to receive the support of Donor agencies and Development Partners. Regarding the Health system strengthening, partners such as the World Health Organization (WHO), United Nations Children Fund (UNICEF), United Nations Population Agency (UNFPA), World Bank to mention but a few, as well as Non-Governmental Organizations (NGOs), Civil Society Organizations and philanthropists have contributed immensely, and unarguably is assisting the country health system to a great extent particularly in Polio Eradication, Malaria prevention, Improved Reproductive Health, combating HIV/AIDS, Logistics Management, Capacity Development, Drug Distribution and so on.
In recent times, many health projects and programmes have been halted due to poor funding and at times, inability of the Government to consistently release counterpart funds. Aside from this, in situations where partners were involved, the timeline for the expiration of which partners’ project would last becomes an issue. In this regard, the continuity in the provision of such health services to the people sometimes are put to stop nor deficiently managed which is wreaking havoc to different levels of healthcare in the country.
In the area of Reproductive health for instance, the Family Planning outcomes in particular have remained poor due to some hindering factors that include; inadequate number and poor distribution of skilled clinical service providers, religious and cultural misconceptions, poor supply chain management systems, poor demand creation practices, poor funding of the Family Planning programme across the country among others. Whereas the implication of these to a large extent according to the recent National Demographic Survey (NDHS) 2018 has led to; high Maternal Mortality Ratio of 576/100,000 (10th highest in the world), high fertility rate of 5.5, low health service coverage as Ante–Natal stands at 61 percent, delivery with skilled attendance at 38 percent, Low uptake of Modern Contraceptive Prevalence Rate (MCPR) of 10 percent with high unmet need of 16 percent.
Having established the fact that family planning is a key preventive health intervention in addressing reproductive health issues, such as reducing maternal mortality and child morbidity ratio, as well as improving adolescent reproductive health, records also has it that childbirth spacing services contributed to overall improvement in the health status of Nigerians as healthy families makes a healthy nation and society. Basically on this premise, the continued efforts by the Federal Government in its implementation of ‘Free FP commodities ‘since 2011 has been a pragmatic one alongside the support and commitment of development partners in advancing family planning. These, in a way, are assisting States to achieve an increase in demand for FP information, services, and supplies by Nigerians of reproductive age across the country.
Really, it is often said that the best help is self-help. However, consistent smart investment into FP implementation by the Federal, State and Local Governments should be the focal point now to scale-up the delivery of quality and affordable family planning programmes. It requires the need to look inward for the sustainability of the existing workable environment which would make family planning activities thrive, most especially in achieving the Nigeria Family Planning Blueprint of 27 percent by end of year 2020 towards actualizing Global Family Planning 2020 (FP2020) initiative, with the aim to support women and girls from developing countries to access free FP services.
Ogun State in its contribution to make this a success, can harness available advantages which are not too far to grab in order to fulfill its input to the blueprint as it targets 46percent by the end of year 2020. The attainment of 32.1 percent so far has published by the recent National Demographic Health Survey (NDHS 2018), and is attributed to concerted effort of the State Government through the State Primary Healthcare Development (OGPHECADEB) in the implementation of some programmes such as capacity building for family planning providers, community resource persons, community volunteers as well as outreaches, neighbourhood campaign to increase demand at facilities while dialogue and regular supportive supervision are established to proffer solution to any identified issues arising from facilities at the same time ensure effective service delivery in facilities. The coordinated activities of (UNFPA), Marie Stopes International Organization of Nigeria (MSION), Pathfinder International, Nigeria, Nigerian Urban Reproductive Health Initiative (NURHI), Society for Family Health (SFH) and The Challenge Initiative (TCI) among others in the area trainings, Facility make-over, Behavioral Communication Change (BCC) and several other interventions can cannot be over-emphasized.
In the same vein, the emergence of Family Planning Advocacy Working Group (FP-AWG) which was formed with the support of USAID/FH+ Project metamorphosed to Family Health Initiative Ogun (FAHIO), on the mission to provide leadership, technical direction support for a changing and sustaining Family Planning landscape in the State has provided opportunities for the State to develop some important strategic framework that could be best described as partnership that works.
By and large, these frameworks have brought about policy actions that have increased investment in FP in Ogun State. Among such is the creation of a budget line for family planning where funds are sourced conveniently to carry out FP activities in the State. This has manifested in the procurement and distribution of consumables to the high volume health facilities as adaptors of Family Planning services were able to access quality services free.
In a related development, the group has influenced the domestication and operationalization of the National Task Shifting and Task Sharing Policy to addressing the shortage of health personnel in order to allow the Community Health Extension Workers (CHEWS) among other relevant cadre provide inject able contraceptives in communities having being properly trained. It is noteworthy to also mention that Ogun State has developed a Family Planning Coasted Implementation Plan and Adolescent Reproductive Health Strategic frameworks as influenced by FAHIO and these achievements have earned the state appreciable and positive health indicators among its peers in the country.
With reference to the good work of relevant stakeholders to better the whole lot of families through the uptake of the best fit Long Acting Reversible Contraceptives (LARC) for respective clients, it is high time to begin to look inward and tap the available opportunities around. However, State and Local governments, relevant Ministry, Departments and Agencies (MDAs) Legislative and Judiciary arms should not relent in its investment drive to ensuring prompt release of fund with priority and adequate focus on family planning in the yearly budgeting as well as good policy environment with consideration to its most cost- effective significance in the prevention of maternal mortality and child morbidity. At this juncture, it is pertinent to mention that much attention should be focused on the existing Family Planning Costed Implementation Plan (FP-CIP) in the State which defines the priorities, activities, and associated costs required to reach the FP goals and objectives of the State.
For the Advocacy groups ,Non- Governmental Organization (NGOs), Community Based Organizations (CBOs), Faith Based Organization (FBOs) among others, working to ensure healthier wellbeing of the family should explore and source grant advantage in the delivery of their missions at improving access to family planning services with multiplying positive effects on reproductive health indices generally .In this direction , they will be doing the state good to mobilize resources in form of grant towards the implementation of their SMART objectives that will sustain the achievements recorded so far. But it is expedient to take cognizance of essential processes in accessing grants which at times may look frustrating. Findings should be intensified by the respective groups to know ways of writing acceptable proposals, presentation of financial management policy and organization policy & manual.
The private organizations in their contributions to support the state should devote a share of allocated funds for the Corporate Social Responsibility (CSR) to family planning projects and activities. This in a way tends to fast-track development on issues surrounding it. Meanwhile, the commitment of Community, Traditional and Religious leaders at the same time would have a changing effect particularly on the myths and misconceptions on family planning among the people. Philanthropists and well- meaning individuals are not left out in this crusade based on the fact that their response to family planning needs in health facilities in their respective community would assist government to reduce the health care costs incur on maternal and infant ill health and deaths thereby promote economic growth and above all improve quality of life.
Odemakin, Is an Information Officer in the Ogun Ministry of Information & Strategy, Oke-Mosan, Abeokuta, Ogun State