nigeria’s fp accomplishments · 2020. 3. 4. · nigeria government fp funding status (national) 4...
TRANSCRIPT
Nigeria’s FP Accomplishments
Dr. Kayode Afolabi – Director, Reproductive Health, FMOH
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Some key accomplishments
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29 states have costed implementation
plans
or are in the process of implementing CIPs
22 states have operationalized/
implemented TSPs
87.5% of hospitals in Lagos have DMPA-
SC in stock, September 2019
14,276 total health workers trained 52.1% (14,831 of 28,449)
of facilities provide FP as of January 2020
Nigeria’s commitments towards FP2020
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Source: FP2020 website, AFP website
2012: Past FP2020
commitments2018-2020: Progress2017: Additional FP2020 commitments
Nigeria commits to train community
health extension workers (CHEWs)
and support task shifting so CHEWs in
rural areas can provide multiple
methods
Expand implementation of Task-Shifting Policy to include
patent medicine vendors and community resource
individuals to improve access to FP services in difficult to
reach areas among disadvantaged populations
Nigeria will allocate $8.35 million
annually for the procurement of
reproductive health commodities
Increase annual allocation for contraceptives to $4 million
Nigeria will use social marketing to
mitigate socio-cultural barriers to
family planning use
Partner with all stakeholders and gatekeepers to reduce
socio-cultural barriers to use of FP services
Remove regulatory barriers and take to scale access to new
contraceptive methods such as DMPA-SC injections
Invest in a robust accountability system that tracks and
reports domestic resource FP expenditures at national and
state levels
Ensure the provision of age-appropriate sexual &
reproductive health information to youth through the Family
Life Health Education Curriculum and youth-friendly services
in health facilities and other outlets
Christian and Islamic Perspective on Reproductive Health
and FP launched and disseminated.
FMoH National Health Accounts included FP as subset of
RH expenditures to be implemented and tracked in 2018
DMPA-SC now included in EML. Guidelines on DMPA-
SC Introduction and Scale up is finalized and will be
disseminated in Abuja.
Planning to address this through the creation of a multi-
sectoral platform with the Ministry of Budget & National
Planning and Governor's forum.
UNFPA and FMoH signed a MOU for $4 million from
2018 to 2020.
Nigeria government FP funding status (national)
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2015
$1.7M allocated:
for FP
[National, FY2015]
funds not released
when budgeted
Source: Grantee websites and documentation; *All conversions to USD if not converted in grantee documentation were converted at the 12/14/17 rate
2016
$2.2M allocated:
for FP
[National, FY2016]
$2,756 released:
for FP
$3M + $1M committed: for FP
[FY2016]
$1M released:
for FP
2018
$_M allocated:
for FP
[National, FY2018]
$4M pending
release: for FP
(service-wide vote)
Committed Allocated Released Funds promised but not released
2017
$2.9M allocated:
for FP
[National, FY2017]
funds not released
when budgeted
In 2019, the government FP allocation was cut by 90% compared to the 2018 allocation, but $4M of funds are pending release for FP from FMOH.
2019
$0.8M allocated:
for FP
[National, FY2019]
Most states are engaged in the TSP process
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Source: Grantee documentation, grantee monthly updates
Lagos
BayelsaRivers
Imo
Abia
Akwa
Ibom
Bauchi
Plateau
Taraba
Benue
EnuguEbonyi
Anambra
Delta
Edo
Kogi
Oyo
Ogun
Osun Ekiti
Niger
Sokoto
KebbiZamfara
Katsina
Kano
YobeJigawaBorno
Kadun
a
FCT
Cross
River
Adamawa
Ond
o
Kwara
Gombe
Kadun
a
Nasarawa
TSP as of December 2019
Lagos
BayelsaRivers
Imo
Abia
Akwa
Ibom
Bauchi
Nasarawa
Plateau
Taraba
Benue
EnuguEbonyi
Anambra
Delta
Edo
Kogi
Oyo
Ogun
Osun Ekiti
Niger
Sokoto
KebbiZamfara
Katsina
Kano
YobeJigawaBorno
Kadun
a
FCT
Cross
River
Adamawa
Ond
o
Kwara
Gombe
Kadun
a
TSP as of December 2017
TSP adopted/operationalized TSP draft validated TSP draft completed Advocacy work ongoing for TSP
Twenty-two states have adopted or operationalized the policies.
CIPs have significantly scaled up from 2016-19
CIP completed (BMGF deep investment state) CIP completed CIP scaled by other donors CIP started
CIPs as of December 2016 CIPs as of October 2019
Source: Grantee documentation
Akwa
Ibom
Lagos
Bayelsa Rivers
ImoAbia
Akwa Ibom
Bauchi
Nasarawa
Plateau
Taraba
Benue
Enugu
EbonyiAnambra
Delta
Edo
Kogi
Oyo
Ogun
Osun Ekiti
Niger
Sokoto
KebbiZamfara
Katsina
Kano
YobeJigawaBorno
Kadun
a
FCT
Cross
River
Adamawa
Ond
o
Kwara
Gombe
Kadun
a
While most states in Nigeria have a CIP, 14 states have CIPs that have already expired or will expire in 2020.
CIP expired in 2019 CIP will expire in 2020
Strong access to a variety of methods in public facilities
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We see an increase in public facilities offering FP in Kaduna, while access in Lagos has remained stable. Kaduna still has lower levels of access compared to Lagos.
Source: PMA2020 data (R1-R5 Kaduna & Lagos)
54.8%
25.0%
60.3%
28.6%
64.8%
25.0%
75.0%
20.0%
76.0%
22.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Public Private
R1/2014 R2/2015 R3/2016 R4/2017 R5/2018
90.6%
66.7%
94.0%
43.8%
92.7%
43.8%
92.5%
53.9%
93.2%
38.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Public Private
R1/2014 R2/2015 R3/2016 R4/2017 R5/2018
Percent of facilities offering at least five
modern contraceptive methods, Kaduna
Percent of facilities offering at least five
modern contraceptive methods, Lagos
We see generally high levels of access to modern contraceptive methods through PPMVs/drug shops in both Lagos and Kaduna.
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PPMVs increasingly offer modern methods
Source: PMA2020 data (R1-R5 Kaduna & Lagos)
63.8%69.5%
64.4%
75.7%79.2%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PPMV
R1/2014 R2/2015 R3/2016 R4/2017 R5/2018
Percent of PPMVs offering modern FP methods, Kaduna
76.2%
90.0% 90.6%100.0%
89.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PPMV
R1/2014 R2/2015 R3/2016 R4/2017 R5/2018
Percent of PPMVs offering modern FP methods, Lagos
Expanding method choice: Availability of DMPA-SC
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DMPA-SC in stock, Lagos
Health Center Hospital, Public
Pharmacy
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DMPA-SC in stock, Kano
Health Center Hospital, Public
Pharmacy
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DMPA-SC in stock, Ogun
Health Center Hospital, Public
Pharmacy
Source: PMA Agile (R1-R6)
The national roll-out of DMPA-SC is apparent in facility stock data, particularly among health centers and public hospitals.
DMPA-SC national roll-out
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More facilities dispense DMPA-SC (5,429 out of 13,928 FP facilities as at Dec ‘19) and relative increasing proportion of SC (15% as at Dec ‘19) in injectable product mix.
Source: NHLMIS
Increasing proportion of DMPA-SC (Green) in injectable product mix Jul 2018 to Dec 2019
Increasing facilities reporting DMPA-SC consumption
Women are more informed about their FP usage
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62.4%
54.3%
72.2%74.0%67.6%
82.6%
Informed about sideeffects
Told what to do ifexperiencing side effects
Informed about othermethods
Indicators of Informed choice among married users: Nigeria
2013 2018
Source: DHS
Since 2013 there is shifting of social norms
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Source: DHS
23.3%
35.2%
Married women (aged 15-49)
Women not using a method and say they intend to use in the future
2013 2018
18.3%
12.0%
24.2% 24.3%
Women Men
Nigerians who don’t want more children, national level
2013 2018
Increasing intention to use FP among all women and youth
13Source: PMA2020 data (R1-R5 Kaduna & Lagos)
32.9%38.5% 37.1%
44.6% 46.6%33.8%
42.0% 42.0%47.2%
51.5%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
R1/2014 R2/2015 R3/2016 R4/2017 R5/2018
All Women Youth
Intention to use by age, youth
15-24 vs. all women, Kaduna
47.4% 50.4% 51.7%56.9% 55.8%
48.9%52.5%
58.2% 60.9% 63.3%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
R1/2014 R2/2015 R3/2016 R4/2017 R5/2018
All Women Youth
Intention to use by age, youth
15-24 vs. all women, Lagos
Nigerian mCPR growth over the years
3.8%
8.9% 8.9%
10.5%11.1%
10.5%
3.5%
8.6%8.2%
9.7% 9.8%
12.0%
1990 1995 2000 2005 2010 2015 2020
Nigeria All Nigeria Married
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Women’s mCPR has increased steadily since 1990.
Source: DHS
Several states doubled (or more) their mCPR
State 2013 2018
Kano 0.5% 5.6%
Jigawa 0.6% 3.9%
Adamawa 3.5% 18.2%
Zamfara 1.3% 6.7%
Gombe 4.0% 16.2%
Yobe 0.5% 1.7%
Sokoto 0.7% 2.1%
Borno 1.8% 5.4%
Katsina 1.1% 3.3%
Kebbi 1.2% 3.2%
Bauchi 2.1% 5.2%
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Source: DHS
While some states increased mCPR, several decreased
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Top ten states with increased mCPR (by % difference)
State 2013 2018
Kano 0.5% 5.6%
Jigawa 0.6% 3.9%
Adamawa 3.5% 18.2%
Zamfara 1.3% 6.7%
Gombe 4.0% 16.2%
Yobe 0.5% 1.7%
Sokoto 0.7% 2.1%
Borno 1.8% 5.4%
Katsina 1.1% 3.3%
Kebbi 1.2% 3.2%
Bottom ten states with decreased mCPR (by % difference)
State 2013 2018
Nasarawa 16.3% 14.3%
Ondo 20.4% 17.7%
Osun 31.6% 27.0%
Edo 19.1% 15.0%
Ogun 21.5% 16.6%
Delta 16.8% 12.9%
Kaduna 18.5% 13.7%
Abia 15.6% 10.8%
Kwara 27.7% 17.1%
Bayelsa 10.1% 3.3%
Source: DHS
Method mix continues to shift
14.1%
51.1%48.6%
29.2%
11.4%5.8%4.3% 2.9%
2013 2018
Percentage distribution of modern method users by method type, Kaduna
Implants Injectables Pills Condoms
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1.1%
15.5%17.4%10.7%
24.6%
16.9%
39.0%
23.8%
2013 2018
Percentage distribution of modern method users by method type, Lagos
Implants Injectables Pills Condoms
Implant use is steadily increasing in both states, while the share of injectables and pills is declining. In Kaduna implants are now the most popular method.
Source: DHS (2013 & 2018), among married modern contraceptive users
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