Family planning is not a priority for Nigerian government in 2018

Nigerian officials speak a lot about population control but 2018 budget shows family planning is not a priority

On July 11, Nigeria joined the rest of the world in celebrating the World Population Day, an event which seeks to focus attention on the urgency and importance of population issues.

Currently the world’s seventh most populous country, various stakeholders have described Nigeria’s population outlook as a crisis that needs urgent attention.

In 2017, Senator Ben Murray Bruce drew public attention to the country’s rapidly growing population and the need for urgent intervention to ensure better provision for the citizens.

International organizations, basing their opinions on epidemiological data, also observed a dangerous trend in Nigeria. For instance, from 2008-2011, 5.8 million babies were born in Europe. In contrast, Nigeria produced 30.4 million babies within this same period.

Family planning and use of contraceptives

To address the challenge of Nigeria’s rapidly exploding population, Nigerian government under the President Muhammadu Buhari, has identified family planning and the use of contraceptives as vital ways of controlling population growth in Nigeria. But the government has admitted that its efforts are not producing desired results.

Nigeria’s health minister, Prof. Isaac Adewole, revealed that Nigeria’s  modern Contraceptive Prevalence Rate is only at 16.0% which is low. It also suggested that it could be difficult for the country to achieve the goal of a contraceptive prevalence rate of 27% mCPR by 2020, according to the country’s Family Planning 2020 Commitment which is just 2 years away.

According to the minister, unmet needs for family planning in Nigeria is high.

“It is estimated that 12.7% of women who wish to delay or prevent a pregnancy are not using any form of family planning method. These are clear indications that the country is yet to fully harness the benefits of family planning, despite the scale-up in interventions,” Adewole said.

Budgetary allocation for family planning is lowest since 2016

The incumbent administration’s first full budget was for 2016. For family planning, a total of N797.41 million was set aside for family planning and contraceptives-related expenses. In 2017, the amount rose to over N966 million. But for 2018, Nigeria is only planning to spend a total of N500 million on family planning as counterpart funding for the procurement of contraceptives.

According to the approved version of the Nigerian budget that was passed by the Nigerian lawmakers, the only item attributable to family planning is the sum of NGN500,000,000 which is for the improvement of family planning services through contraceptives use in interventions and counterpart funding.

This is the lowest counterpart funding the country is making in 3 years and it is almost half of what it paid in 2017 as co-funding for the procurement and national distribution of contraceptive commodities. It is also lower to the amount budgeted in 2016 as counterpart fund for the procurement and national distribution of contraceptive commodities.

By definition, a budget is a financial plan for a defined period of time, usually a year. It may also include planned sales volumes and revenues, resource quantities, costs and expenses, assets, liabilities and cash flows.

Missing family planning budgetary items

In 2016 and 2017, Nigeria’s budget featured items focusing on the training of family service providers, last mile distribution of contraceptive commodities, support for state government in the development of costed implementation plan for the Nigeria family planning blueprint, and reproductive health training of community health extension workers on family planning methods across the country’s geopolitical zones.

Comparing the previous budgets suggested that training of healthcare officials is the worst hit by the slash in Nigeria’s budgetary allocation for family planning.

After the counterpart contribution for the procurement of contraceptives, the next item that had attracted budgetary allocation in 2016 and 2017 was the training of healthcare workers, particularly community health extension workers, CHEWS.

In 2016, more than half of the budgetary allocation for family planning in Nigeria excluding counterpart contribution was for the training of health workers. In 2017, the proportion rose to 72%. It is not on the list for 2018.

Without an additional source of funding or training arrangement in the light of the outlook, what this suggests, according to budget experts, is that the Nigerian government will not be sponsoring any training of health workers on any aspect of family planning.

“While there can be slight changes in the expenses of the health ministry within the purview of the budget, it will be extremely hard for the minister to pool large funds from other budgeted expenses for family planning,” a budget expert told healthnews.africa

‘This is not new’

A review of Nigeria’s previous commitment to family planning revealed that while its population is rapidly expanding, the country is not fulfilling any of the promises it has made in the past.

In 2014, Nigeria promised to train at least 3,700 community health workers (CHWs) to deliver the range of contraceptives, particularly long-acting and reversible methods (LARMs) and support task shifting so CHWs in rural areas can provide multiple methods. This has not been fulfilled.

The country also promised to provide an additional US $8.35 million annually for the procurement of reproductive health commodities. Available budget data indicated the commitment was not fulfilled either.

Best and worst scenario

Those familiar with operations of the health ministry told healthnews.africa that the best outcome is for donor organization to step in and fill the vacuum created by Nigeria’s budgetary oversight.

“Family planning in Nigeria is largely reliant on international organizations and it will not be unusual for them to extend their support to the training of health professionals and provide support to state governments,” a source said.

Another source added that the health minister could get funds to finance the training exercises among others, adding that the worst scenario is unlikely.

“The worst that can happen is for those training exercises to be suspended this year. There have been all sorts of training. This year, those that have been trained can also train others. The ministry cannot sponsor all workers for family planning training,” the source added.

Scaling up with less funds

The scenario presented by the Nigerian budget is opposite to the picture being painted by the health minister who recently unveiled 3 new documents to guide the scale-up of family planning in Nigeria.

The minister noted that the documents would improve decision making in the health sector particularly in the area of family planning.

One of the documents is the National Depot Medroxyprogesterone Acetate (DMPA-SC) Accelerated Introduction and Scale-Up Plan 2018 – 2022; another is on National Guidelines on Safe Termination of Pregnancy for Legal Indication.

The minister mentioned that the document was developed to ensure that contraceptive information and services reached women and adolescent girls who might have wanted to avoid pregnancy, space or limit child birth. He added that it also provides the modalities for coordinating the activities of various stakeholders involved in introducing and scaling up Depot Medroxyprogesterone Acetate which is a highly effective injectable contraceptive that affords privacy and has a convenient dose schedule of four times per year, making it appealing to many users, especially adolescents.

The minister also noted that the health ministry wants to set up a platform that would promote more timely and cost-effective delivery of family planning commodities and other health commodities in such a way that more Nigerian women are reached with the right products where they live and work.

To achieve this, the ministry is aiming to deploy the Global Family Planning Visibility and Analytical Network/National Logistics Management Information System (NAVISION). But without donors supporting this project, the ministry will not be able to legally finance it since there is no budgetary provision for the venture.

Who is to blame?

A cross section of family planning experts that spoke to healthnews.africa put the blame on those involved in the development of the health ministry’s health budget.

On February 26, 2018, health minister Adewole blamed the federal government’s inability to plan and coordinate health service delivery on weak governance, poor human resource capacity and inefficient core processes.

He also admitted that his ministry has been unable to demonstrate expected results and ensure value for money in the delivery of health services. He made the remarks while at a retreat aimed at strengthening the health ministry’s budget process and the capacity of the Department of Health Planning, Research & Statistics, which was organised in collaboration with Bill and Melinda Gates Foundation, and Health Systems Consults Ltd in Abuja.

According to the health minister, a review of the budget formulation, execution, and monitoring practices within the ministry was a desideratum.

Less than one month later, Nigeria’s president mounted pressure on all ministers including Adewole to defend their budgets within a week. The budget of the health ministry and 12 others were defended within 2 days.

But in May 2018, about 2 months after the budget was defended, an announcement was made that indicated the priority of the lawmakers.

Chairman, Senate Committee on Health, Senator Lanre Tejuoso, revealed the National Assembly included funding for the Basic Healthcare Provision Fund (BHCPF) in the 2018 Appropriations Bill.

“The Senate Committee on Health through the Technical Advisory Group (TAG) to the Legislative Network on Universal Health Care (UHC) held series of sensitization, capacity building and media parleys to galvanize support towards implementation of the BHCPF and reiterate the commitment of the National Assembly towards the cause,” he said in a statement.

For Tejuoso, his dream is for Nigeria’s health care system to become a model for other African countries; he also wants Nigeria to become a reputable destination for medical tourism. But with a rapidly expanding population and lesser amount of money available to scale up efforts, family planning advocates told healthnews.africa that the senator’s dream cannot come to pass anytime soon.