…FG supporting States to make services available — Dr. Afolabi
…FG, States must synergise to ensure availability –Dr. Orji
There is shortage of Family Planning (FP) services in some states of Nigeria, even though the demand for the services has increased dramatically, our investigation has revealed.
Family planning services, according to the World Health Organisation (WHO), are services that allow people to attain their desired number of children, if any, and to determine the spacing of their pregnancies.
Family planning is achieved through the use of contraceptive methods and the treatment of infertility.
Findings in some sampled Primary Healthcare Centres (PHCs) in the two States of Nasarawa, Niger and the Federal Capital Territory (FCT), have shown that the turnout of women in search of the family planning services has increased, especially, since the ease of COVID-19 lockdown.
Our investigation revealed that in most of the facilities visited, the demand for the services went down during the peak of the COVID-19 lockdown, but went up again, especially, since the beginning of 2021.
At a PHC in Masaka, one of the largest suburbs in Karu Local Government Area of Nasarawa State, the Officer in Charge of family planning in the facility, who pleaded anonymity, disclosed that the turnout of women before the COVID-19 pandemic was impressive.
She, however, revealed that the turnout of women nosedived and dropped to almost zero during the COVID-19 period.
Running through her record book, the Officer in Charge said: “In 2021, the turnout of women seeking for family planning services increased considerably even more than the previous years. This is surprising to us.
“On the average, we provide services to 15 women who come to the clinic per day for family planning services. When you calculate that in one month, you will discover that it is not a small number.”
On the availability of services, she said: “The services are free when commodities from Marie Stopes (a non governmental organization) are available, but when they are not, in order to meet the demand, we do buy from pharmacies and sell to women at N1,000 per head. Marie Stopes has been supplying us with commodities
“Karu Local Government also supports us too, but with all that, the commodities are not available because of the influx of women who come demanding for the services.”
The Officer in Charge, however, appealed to the Nasarawa State government and the federal government to make the services available so that they can meet the needs of women who come for them.
“We are appealing to the both States and the Federal government to provide us with more commodities because the demand is high”, she added.
In a PHC in another suburb in Karu Local Government Area of Nasarawa state- Nyanya Gwandara, the situation is almost the same.
A staff member of the PHC who also pleaded not to be named, said that the demand for family planning services continues to increase on a daily basis.
“We have an average of 50 women in our register every month-January to May, 2021.
“In 2020, because of the COVID-19, the turnout was very low. As low as five women in a month,” she explained.
She, however, disclosed that the supply of family planning commodities from the local government is not always enough.
According to her: “We always augment the government efforts by purchasing from reputable pharmacies for onward sale to the women with no profit.
“In case of those who need injectables, we charge them 50 naira more to cover for the cost of buying syringe.
“We, therefore, called for more commodities from the government and the private sector to meet the demand gap.”
The nurse, however, explained that the 50-persons attendance on a monthly basis excludes the women who come to the facility already pregnant and they were turned down.
“In order to prevent unwanted pregnancies, the government needs to make effort in supplying the commodities to PHCs in good time,” she appealed.
On the other hand, at a PHC in Nyanya, a major satellite town in the FCT, the commodities were available as seen by our reporter, but the demand supersedes the supply.
“You can see this commodities, we got them few days ago, but they are almost finished. The quantity given to us is not much, therefore, because of high demand, we always run short of commodities,” the nurse in charge said.
On why she thinks women seek for the services more than before, the nurse said: “Its is like most couples don’t want to give birth to many children again, may be due to the economic situation in the country.”
At a PHC in Suleja, a major town in Niger State, our reporter discovered that women across the major religions came seeking for the services.
“You see, it is not true that women of a particular religion don’t seek for the family planning services. As you can see the women here, they cut across all religions.
“Our challenge here is that the commodities are not always enough. The quantity we have is almost finished and we have to go back to the local government headquarters to order for more. This will take some time before we get another supply. That is why we always devise some means of assisting the women access the services.
“We appeal that the government at both the state and the federal to ensure that the commodities are enough because, the demand is going higher and higher each day,” the nurse who confided on our reporter said.
Speaking to our correspondent, a family planning specialist, Dr. Ejike Orji, advised the federal and state governments to ensure that family planning commodities are available in every nook and cranny of the country.
“My advice is that the government should take action to make sure that commodities are brought in and supplied to states and the states should make sure they do their own part and ensure they distribute the commodities and supplies to the facilities where women go for these services.
“It is not just the commodities alone, even the supplies. Eventually, they should also train the workers because family planning is a very specialize service.
“Different women need different services. Training of the people who will counsel the patient and give them the services is equally important,” he said.
On why he thinks the demand for the family planning commodities increased in recent times, Dr. Orji said: “The reason is that there has been a lot of demand generation activity by the CSOs and even government.
“The government has launched their communication plan and strategy and the Green Dot initiative. Wherever you see the Green Dot, you know that family planning commodities are there free.
“Our association, the Association for the Advancement of Family Planning, successfully advocated for federal government putting money in buying commodities and also making family planning services free in public hospitals nationally.
“There are also a lot of international development partners who are doing a lot of demand generation activities.
“The federal government through the health promotion department is also doing demand generation. All these things have increased the awareness for family planning services, but the problem is that they are not getting the services.”
Responding to question on the possible reasons the commodities are in short supply, Dr. Orji explained that: “I know that the United Nation Population Fund (UNFPA) buys for us, do the economics of scale and get the best for us. That money was supposed to be given to UNFPA one year before now. For example, the commodities we will use next year, we supposed to have given UNFPA the money, if we don’t give the money now, then it will cause problem in the supply chain. These are some of the things that cause the problems.
“There are also a lot of logistics problems. Even though the commodities might be in the ware house, it could be a problem to deliver it to the states and from the states to the hospitals that will use them.
“Logistic chain issues are also bedeviling the system. Also the pandemic further worsened the delivery of goods and services across the world not only in Nigeria.”
On his part, the Director, Reproductive Health of the Federal Ministry of Health, Dr. Kayode Afolabi, however, said that the Federal Government through the Federal Ministry of Health is doing its best to ensure availability of family planning commodities in the country.
He was, however, quick to say that state governments have their role to play in the supply chain.
According to him, even though he has not received any report of shortage of family planning commodities from the states, it is a shared responsibility between all tiers of government to make sure that the commodities are available at the health facilities across the country.
“It is a shared responsibility for commodities to be available at service delivery points in PHCs.
“The Federal Government through the Federal Ministry of Health, makes the family planning commodities available at the states level right in the state store. It is expected that the states will ensure the distribution of these commodities from the state store to all their service delivery points at the PHCs.
“If the challenge is that they do not have family planning commodities at the state level, then you could make inquiry on that from the federal level. If the problem is that they do not have the commodities at the PHCs, it is the responsibility of the state to ensure that.
“Once we are able to deliver family planning commodities free of charge to the state stores, it is the responsibility of the state through the ministry of health at the state and the Primary health care system at the state level to ensure the distribution of the commodities to the facilities.”
Speaking on the nature of support the federal government renders to the states, Dr. Afolabi said: “So, if the federal government could deliver family planning commodities to the states and the states have challenges, we realise that we need to provide some leadership and coordinate their last mile distribution effectively and one of such support is to conduct the last mile distribution with them.
“Officers from the federal ministry will join service providers at the state level and from different local governments. That will check up their data and provide them with the commodities that have been supplied to the state.
“We did that in 2011 and 2017. As we were doing so, we were preparing the state to take over that responsibility which is there own.
“We build their capacity and we advocate to the state for a budget line for family planning through which they could get funding for last line distribution activities.
“We also build their capacity on data gathering at the level of the facility to local government and the state because this is what will guide us to supply them and the whole country in general.
“Another area where we provide support for them on their last line distribution is on capacity building for FP coordinators. Each state has a FP coordinator.
“We periodically build their capacity and conduct technical review on their activities so that whatever challenges they have, we proffer solution to them and the one that they cannot really handle on their own, we conduct advocacy with their state principal right from the state primary health agency down to the state ministry of health.
“We are developing a national guideline for all states in such a way that they will be able to identify their responsibility along their programme of national family planning scale up plan. They will also be able to support procurement of FP commodities by their own states in which some of the states have indicated interest.
“We are providing layers support for States in such a way that FP planning programme in the whole country is effective and efficient.”
It then becomes obvious that concerted efforts need to be intensified across board to meet the demands of these women who have taken a great step to seek FP services and products. Besides, this will encourage others to join the campaign for family planning and sustain a healthy socio-economic lifestyle for those who may then become increasingly satisfied with the sermons preached to them by experts.
