5th Biennial Family Planning Conference Abuja

 

5th Biennial Family Planning Conference Abuja. Advocates for Innovations, Inclusiveness and Investment in Family Planning.  5th December, 2018.

dRPC PAS organised a side session to engage government, civil society organisations and new state actors on innovations, Inclusiveness and investment in family planning in Nigeria.

In attendance were a mix of government delegates, media and new state champions in FP. About 96 participants (delegates 45, media 23 and 28 panelists). The meeting was convened with the first panel at 9:45 am. With the discussion on sub national innovations for FP service delivery – what’s working.

The panel of the first session included the representative of the Commissioner of Health Anambra State, Onyejumbe Uchechuckwu; the Commissioner of Health in Borno State, Salisu Kwayabura; and Ebenezer Apake, director public health representing commissioner of health in Taraba State

Dr Joe Akabuike, Anambra State commissioner for health.

Director public health, Ebenezer Apake, representing the commissioner for health, Taraba State.

She asks what are the challenges, the successes and what needs to be done to join the world in the forefront. There is a need to remove the barrier to child spacing and improve the imperative of FP in Nigeria. She said this is very important because this is is what will project the nation forward. The panel moderator, Mrs Makanjuola asks the commissioner of health in Taraba State on family planning programme in the state.

Mrs. Makanjuola.

The representative of the commissioner noted that the state has been having problems with commodity shortage and workmanship. He said this limits the progress of the state in FP programmes. Mr Apake said the state government has been training health workers on the delivery of FP to people. He also said the terrain of the area has also been a hindrance to FP. In Borno State, however, the commissioner said FP materials have been available but getting people to use them was the main challenge. He also sighted that insurgency displacing individuals presented a unique opportunity as the IDP camps brought an opportunity to reach about one third of the population. The change in nomenclature to child spacing instead of FP to increase buy ins.

But now we are getting some shortage of supplies, that means people are starting to take it, he said.

He said there is also documentation of impact.

10;20 am Mr Kwayabura said FP implementation in Borno State has been supported by international donors who are working in the insurgency-affected region of the country.

He said before the insurgency, there has been little or no programme and usage of FP in the state. However, with the insurgency, there has been a change in the access and usage as many international donors work in the IDP camps and many of them are also advocating for FP.

10 25 a.m. The commissioner for health in Anambra State said there has been little or no challenges in the state as to accessing and budgeting for FP.

He said the state has a separate budget line for FP and it is not lumped up in the state health budget like other states. He also added that the state has budgeted to procure vehicles for the distribution of consumables.

Speaking on the challenges, he said the state had a challenge with clearing some of the consumables from NAFDAC as it seized it despite a letter from the ministry of health which asked for the release of the consumables.

He said the consumables were released only some few months to the expiry date.

Mr Uchechukwu also added that the state has constituted a technical working committee for FP to make sure FP takes centre stages in public health in the state.

Speaking on religious activities and the effect they have on the people, he said the government has been talking to religious leaders especially the Catholics who do not believe in the modern form of contraceptives. He said this has led to tremendous improvement.

Mrs Makanjuola appraised the effort of the Anambra State Government and said more needs to be done about NAFDAC and its activities especially when it comes to consumable for the people by the government.

She said it is unacceptable that the agency seizes drugs and only released when it is about to expire

The representative of the Niger State health commissioner came in during the presentation of the Anambra state

Mustapha Jibril, commissioner of health Niger State.

The representative, Yahaya Na’Uzo, the executive secretary PHCDA Niger State, joins the panel.

Mrs Makanjuola asked Mr Na’Uzo to tell the house what has been working in Niger State.

Mr Na’Uzo said the need for FP in Niger State is very high. He said Niger State has a high fertility rate and they are producing children as much as they can but they are working on it.

He said there is no clear-cut difference between the indices in the rural and urban centre. He said some of the people in the rural areas also seem to respond more to the idea of imbibing FP than those in the urban centres.

Mr Na’uzo also said the state has an accountability problem both internally and externally. There is no way or mechanism to show if they are doing the right things or what was promised.

“Though we have NGOs working in the state, their actions have not transcended to clear-cut achievement. There is also poor workmanship as most of the health workers are not available to provide the services needed.”

He said they are trying to improve these using data-driven report. He said there are some NGOs that they cannot translate their works to success. He said they are trying to improve on this.

FP is very dear to the state and we are trying to control the explosion of the population from the state, he said.

We are taking our advocacy to the communities and we are trying to make the people own the programme. We are also trying to introduce incentives to make people interested, he said.

10:40 am – The panellists are being asked questions on their presentations.

Some of the questions raised are on data and how they are handled?

They also asked on tax shifting and tax sharing in Borno State and how is it assisting with FP implementation in the state.

For Niger State, one of the participants asked for the government of Niger to enforce FP as one of the services of the PHCs in the state.

Mr Na’Uzo said there are incentives for good attitudes, especially for the health workers and NGOs; for both the providers and receivers. He said the incentives will not only be money but also ceremonies. He said the incentives are for behavioural change. He said they will also enforce punishment for those who default.

He said data are also available but they just want people to know the real situation of things in the country.

For Borno state, the commissioner said they need a lot of capacity building for traditional birth attendants and health workers to be able to translate the right information to the people. He said this is very important because the health workers need to know what services to render.

Mr Kwayabura said FP concentration in the IDP is very important irrespective of the fact that most of them may have lost their families or children. He said as compared to the news that there is a proliferation of child birth in the camps, there is no significant difference with what is available in the towns. He said by July the insurgency will clock ten years meaning that there is a need for a long-term measures to sustaining FP in the state.

For Borno State, the commissioner said they would need a lot of capacity building for traditional birth attendance and health workers to be able to translate the right information to the people.

He said this is very important because the health workers need to know what services to render.

Mr Kwayabura said family planning concentration in IDPs is very important, irrespective of the fact that most of them may have lost their families or children.

He said compared to the news that there is a proliferation of child birth in the camps, there is no significant difference with what is available in the towns. He said by July the insurgency will be ten years, meaning that there is a need for a long term measure to sustaining family planning in the state.

All the commissioners said they have statistics on FP programmes in their states.

The Anambra official said FP is beyond the state ministry of health as it is done in collaboration with health workers, NGOs and the government. He said this is important because of the plans to incorporate FP services into private and religious-based health care service providers. He said the state is planning to establish three sexual assault development centres in the senatorial parts of the state because of the high rate of rape and cultism. This, he said, would cater for the vulnerable.

All the commissioners said they have statistics on FP programmes in their states.

The Anambra official said FP is beyond the state ministry of health as it is done in collaboration with health workers, NGOs and the government. He said this is important because of the plans to incorporate FP services into private and religious-based health care service providers. He said the state is planning to establish three sexual assault development centres in the senatorial parts of the state because of the high rate of rape and cultism. This, he said, would cater for the vulnerable.

11:14 am –

The panellists left for their seats and the next panellists are being called.

The new session is on the role of the media in FP/maternal health space in Nigeria.

On the panel are Azeezat Olaoluwa (health desk TVC), Ada Ezeokoli (Managing Director, Health watch) Rabi Abdallah (manager health, Nigeria Television Authority and Sam Eferaro (health online).

On Anambra State, the commissioner said family planning is beyond the state ministry of health as it is done in collaboration with health workers, NGOs and the government.

He said this is important because of the plans to incorporate family planning services into private and health based health care service providers. H

The commissioner, speaking on the vulnerable, said the state is planning to establish three sexual assault development centre, in the senatorial parts of the state because of the high rate of rape and cultism.

This, he said, would cater for the vulnerable.

Speaking on Traditional Birth Attendants (TBAs), Mrs Olaoluwa said most women still patronise traditional birth attendants and traditional FP health providers.

She said there is no regulation on the Traditional FP providers. She said many women abandon most of the modern FP methods saying they do not work for them or they make them fat

She said this has affected the effort in promotion of FP. She said the women trust the traditional FP providers and believe that their methods work. She said the lack of research and regulation on the practice of this people is not helping matters as there is no concrete evidence on their activities.

Speaking on media’s role in FP and the difficulty in reporting it, she said the media has been having challenges because there has not been much information of FP. She said there is more concentration on advertorials and jingles which they believe is not enough to sell FP.

Panelist on the role of media family planing health space in Nigeria.

She said the media need to understand the concept to also report it. She said this needs to be looked into if there is going to be an improvement in FP reporting.

Ms Ezeokoli said there is a need for reporters to be able to communicate on issues around FP in a way that makes sense. She said this is a bit difficult because reporters need to be able to break down the scientific language relevant materials are written in.

Ms Ezeokoli, Managing Director, Health Watch.

She said there is also a shortage of data.

Ms Ezeokoli said FP is more than child spacing, but more on demographic, economic and social development.

She said because most of the FP stories are NGO events, they do not really tell the story.

Unless government begins to include youth population not just as target population but also as advocates, there is a problem and reporters need to get those voices, she said.

She said nowadays reporters have to chase sources around for information and they end up not getting the right report/information they need.

The traditional /cultural and religious barriers are also problems in getting reports out. Ms Abdallah said getting relevant health professional to get the right information on maternal and reproductive health is very difficult.

She said there is a need for the government and NGOs to know that the media is a key partner in the role to change the narratives. We need the right information to be able to help us get involved as much as possible, she says.

She said though NGOs are saying there is an improvement in FP budgetary allocations, a lot of the funds are not released. She said the media needs to be conversant with what they are doing as that is the only way the can make government accountable.

11: 45 am – The panelists finished their presentation.

The moderator allows for questions from the audience.

A question was asked on gender inequality in media reports and how should it be tackled.

Another participant asks about reports on the assessment by HIV/AIDs patients and persons with disabilities of FP programmes.

Sani Umar said unfounded rumour and titles given to news often cause setbacks in the propagation of FP in the country.

He said fake news circulated on social media especially WhatsApp and Facebook have affected the success of FP.

Ms Olaoluwa said though the country is often said not to have data, most reporters quote the authorities in the sector, National Bureau of Statistics and the demography Multiple Cluster Indication Survey.

She also said the religious part also affects FP as the Catholics believe only in the traditional method.

She said most contraceptives are designed for women so this makes the reporter talk more about women than men, though there are some products for men.

On statistics, one of the panellists said Nigeria does not have reliable statistics.

He also said there is a need to train reporters on how to relate FP to other things attached to it especially on FP and agriculture.

Talking on the media and the type of headlines used, a panelist said the media needs to write sensation headlines because they are a business and need to sell their products.

12;30 – Talking about gender in FP, Ms Ezeokoli said some men are getting involved in the campaign on FP but most of the products are not available to them. She said there is also a need to strengthen the PHC services to bring FP knowledge and services to the rural areas.

12:43 – The moderator has broken the panel and called for a tea break while the panellists return to their seats.

The next session is to reconvene by 1:10 p.m.

1:10 p.m. It is time for the third session.

The panel is titled: Follow the money – investment tracking platforms the open government partnership (OGP) and other CSO platforms for tracking FP budgets

On this panel are Halima Ben Umar (co-chair OGP Kano), Mustapha Jumare (co-chair OGP Kaduna); co-chair Bayelsa, Stanley Ochono; CSO focal person , OGP Abuja, Yisa Saaid; OGP Niger CSO representative, Sirajo Saidu; Director General, OGP Niger State; and Ayo Adebosuye, secretary General NNNNGO.

The moderator of the panel is Enyantu Ifenne.

Ms Ifenne said there is a need to know what the government is doing to finance health especially reproductive health and FP in the respective states. She said there is a need to remove many layers to families accessing health.

She listed reasons women give birth to many children to infant mortality, cultural practices, and lack of access to FP.

1:15 a.m. Speaking on the state of open government partnership in Kano, Mrs Umar said it is still a new policy as most of the CSOs in the state were not aware of such.

She said though they were aware of the budget for health they never focused on each budgetary item. She said the partnership with dRPC opened their eyes to what to look for.

She said most health CSOs in the state never had targeted interest in some areas of health, but today they have been scrutinizing the budget and there has been a change.

Speaking on the openness of budget in Kaduna State, Mr Jumare said Kaduna State is the only state in Nigeria that is operating full open government partnership as the budget is open to everyone for scrutiny.

He said the governor has formed a policy were people can be part of the budget planning and can also monitor the release of the money for each sector. He said this has allowed citizen participation in government.

He said there are also open lines were citizens and CSOs can track the progress of the government.

Speaking on the activities in Abuja, the CSO focal person, Stanley Ochonu, said the government has started to operate open government partnership and this is evident in the activities being done.

He said the government has so opened up the process that you can track proposed budget and appropriated budget and the breakdown.

He said the website also provides a platform to allow people participate in budget by allowing them give feed backs to what has been done in the area and what they would like to be budgeted for their area in the next government.

Speaking on Niger, Mr Saaid said the government is yet to fully implement the Open Government Partnership. He said the governor is trying to follow in the footstep of the Kaduna state counter part and has been encouraging citizens participation. He said they have been doing so through town hall meetings.

Lastly in Lagos State, Mr Adebusoye said the tracking of budget, money appropriated and released and execution is a very herculean task. This, he said, is because the government is not open to giving necessary information needed to for tracking.

During the question session, there were questions on how Kano State CSOs have been able to get involved in budget planning and the tracking. Mrs Umar said the tracking has been done through CSO advocacy. She said Kano State cannot have FP on its budget because of the sensitive nature of the topic and as such there place it with reproductive health.

She said they also have problems with the release of funds.

For Niger state, they said the government has been encouraging CSOs and community associations to deliberate on issues that affect the communities and talk about their priorities which are supposed to be presented to the LGAs.

The OGP is used to confirm what the government said they want to do, the official said.

Mr Ochonu said the Open budget progress and open budget procurement can solve the problem of tracking the projects and knowing how much was released and how much spent.

Mrs Ifenne said advocacy is an art and a science, a methodology of what is being done to get a response to from the government. She said there is a need for a documentation of models used where things are working and what can be done in places where things are not working.

She said people seem to be locked up in the money budgeted, but seem to forget the release and the conceptualization of things that are being implemented and how they impact on the people they were budgeted for.

Many CSOs from the various states said most of the budget of FP is not usually released on time despite being budgeted.

In Kano, they said each MDG must have a functional website as this is part of what they are using to track. Mrs Umar said it is very important if all states can key into the OGP. She also said donors no longer have the right to tell them what they want to do under OGP. She said they have opened up the programmes in the state and they tell the donor what they want and not the other way round.

2:22 The third session is over and the fourth session about to start.

The moderator calls to the stage the panellists for this section tagged: Inclusion model, new state and non-state actors championing FP/Maternal health

The panel is being moderated by Habu Galadima, a professor of political science and the director of research at the National Institute for Policy and Strategic Studies, NIPSS.

On the panel is Musa Umar (NIPSS); Elijah Muhammed, Registrar Pharmaceutical Council of Nigeria; Halima Mukkadas, former commissioner for health in Bauchi State, and a monarch, Umar Sanni Jabbi, the Sarkin Yakin Gagi, Sokoto

Others are Nkiru David, National Institute for Medical Research; Fatima Aliyu Youth Activities and Edward Egede, Christian Health Association.

The moderator, Mr Galadima, said this session is important because it discusses the new players in FP as most people have been entering the space and it no longer just belongs to the state.

Mr Umar from NIPSS said the agency has been given the mandate to research into universal health care funding by the president. He said NIPSS has been one of the top government research agencies, also serves as an NGO and has been working with dRPC in the training and capacity building of so many NGOs.

Mr Umar said the funding for the research has been approved by the president and all the findings will be presented at the Federal Executive Council next year.

The research will involve studies in 18 states and some countries outside the country.

We have done lots of researches as concerning FP with dRPC. Our roles as regards FP in NIPSS, all our findings, are reported straight to the government, he says.

Also speaking on the topic, Mrs Mukkadas said based on their close relationship with the government, they find it easy to go in to meet them for advocacy and for the tracking of the budget.

She said her tenure as health commissioner in Bauchi State had a high release of the budget of 78 per cent. She said though there has been an increase in the figure, there has been no full releases. She said last year, there was only 38 per cent of the budget released although the money almost equals when it was released at 78 per cent.

She said the role of CSOs has given them the opportunity to take issues to the government from the communities and direct it to the government. She said they have fora where they meet with the political office holders.

2;46 Speaking now is the Sarkin Yakin, Mr Umar, who said traditional rulers are the gatekeepers of the community. He said the lack of effective FP is based on lack of knowledge. He said there has been an improvement in the outreach of FP especially with the rollout of misoprostol.

He said CSOs need to work on building community ownership so that the people can sustain the FP programme. He said 150 million was budgeted for FP in the state and there have been tremendous releases. He said even Sokoto is also positioned

Speaking on the topic, Ms Nkiru said there is a need to focus more attention on the youth because there has been a big gap in covering adolescent FP in the country. She said as a medical doctor, she has always been concerned about the unmet gaps in FP product and services for unmarried women. She said even among her HIV patients, there has been a huge gap. She lamented the dearth of knowledge among young unmarried adolescent.

She said a lot of unmarried young adolescents come down with unplanned pregnancy which they can either lose or when they don’t it is a cycle of poverty.

She said the idea of calling FP child spacing programme is wrong and misleading especially for young unmarried women populations. She said it should not be called child spacing but should be called FP for the unmarried. How many youth-friendly clinics do we have in the country? she asks, saying there is a need to have such. Speaking on the missing link in FP advocacy in Northern Nigeria, Ms Aliyu said there is a need to understand the language of the people and speak in a way that the will trust and understand her. She said it is often better if the advocates are women based within the community.

She, however, lamented that most of the participants are adults as there is no youth involved. She said there is a need to include the youth because they are the most affected population. She said until this is done there will be a lot of gaps that will not be filled.

The Christian Health Association (CHAN) representative, Mr Egede, said the Catholics have been active in the health services. He said the church has always been a supporter of the traditional family planning method and has been doing much to encourage its people to use it.

The moderator has moved to the question and answer session

A participant asked how the government can develop the human resource for FP in the rural areas because there is a long gap in the human resource for FP.

A gynaecologist also said they should not forget the introduction of FP for newly married adolescents.

 

The moderator said there are lots of faces to FP and there is a need for inclusion in order to achieve the desired result.

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