Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4...

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Nigeria’s FP Accomplishments Dr. Kayode Afolabi – Director, Reproductive Health, FMOH 1

Transcript of Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4...

Page 1: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

Nigeria’s FP Accomplishments

Dr. Kayode Afolabi – Director, Reproductive Health, FMOH

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Page 2: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 3: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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.

Page 4: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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]

Page 5: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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.

Page 6: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

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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

Page 8: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 9: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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.

Page 10: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 11: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 12: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 13: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 14: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 15: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 16: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 17: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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

Page 18: Nigeria’s FP Accomplishments · 2020. 3. 4. · Nigeria government FP funding status (national) 4 2015 $1.7M allocated: for FP [National, FY2015] funds not released when budgeted

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