How State Government Poor Funding Impacts on Family Planning Services in Akwa Ibom State
October 11, 2024
Street Children rescued in Akwa Ibom State
By Ekemini Simon
Idaraobong Utibe, a 25 year old girl from Ikot Ikere in Ibesikpo Asutan is a mother of six. She became a mother at a teenage age of 16 and consequently dropped out of school from class 2 at senior secondary school level.
Idaraobong’s boyfriend who makes ends meet as a motorcyclist is the only breadwinner of the family and he struggles to provide life’s essentials for the children.
Idaraobong says there are days she and her children feed only once a day due to the fact that the family is large and have little resources to grapple with. The lack of adequate nutrition for the family has left the children malnourished.
But she says the birth of the six children were beyond her choice despite having unprotected sex.
Idaraobong recalls that all her pregnancies were unplanned and she now wished she never had more than three children to help her manage the resources at her disposal thus giving them quality life.
Yet, she is unsure that her sixth child would be her last since she still lives with her boyfriend and is yet to uptake any of the family planning services.
Asked why she did not access contraceptives as a means to controlling the number of children she wished to bring to the world, Idaraobong said she heard from some women who use some contraceptives that it often cause bleeding and will make its users potential patients for cancer hence the reason she has continued to avoid it.
Idaraobong’s situation is similar to Imaobong Udeme (Name Changed) who resides in Uyo. At 32 years of age, she has seven children. She said after the fourth child, she had wanted to uptake family planning but this was vehemently resisted by her husband for fears that family planning will make her grow weightier beyond his admiration and also cause her other health complications that may stress him. Yet, her continuous pregnancy has put her life at risk ” Right from the first three months of the pregnancy of my seventh child, I practically stayed in the hospital. His birth almost cost me my life. After serious labour of hours in which I lost strength and thought I would die, I was operated on for my baby to be delivered with blood clot problem”, she recalls. Her experience made her arrive at resolution to go behind her husband’s back and uptake family planning.
However, she went to a health facility for the family planning services but was told she had to pay N2,500 for an implant to be administered to her. Unfortunately for her, she could not afford the money and had to return home without the service. Now, Imaobong is pregnant with her eight child.
The Federal ministry of Health has identified the health implications expressed by Idaraobong and Imaobong as part of the myths and misconceptions held by many about family planning uptake. However, both are just a few who are fortunate to survive the stress of many child births. They reflect the story of many women in Akwa Ibom State who are within the reproductive age but face serious challenges accessing family planning (FP) services due to its funding gaps in the State. These funding gaps are not without its consequences.
For instance, the Federal Ministry of Health in its 2021 Publication on Roadmap for Sustainable Financing of Family Planning Commodities in Nigeria notes that limited access to family planning prevents women from safely spacing their pregnancies, fuels unsustainable population growth, and puts the health of women and children at risk.
According to the World Health Organization (WHO), Family Planning is the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. Some of the family planning services available include; implants, injectables, condoms, Intrauterine Contraceptive Device (IUC) and pills.
According to the Nigeria Multiple Indicator Cluster Survey 2021 Report, the fertility rate among women aged 15-49 in Akwa Ibom State stands at 4 per 100 women. This figure indicates the average number of children a woman in this age group is likely to have during her lifetime. Nevertheless, many like Imaobong have doubled the number.
However, the report notes that high fertility rates can pose challenges to maternal and child health, as well as socio-economic development.
Interestingly, the report states that the adolescent birth rate in Akwa Ibom is measured at 42 births per 1,000 girls aged 15-19. The report highlights that high adolescent birth rates can have adverse consequences, including increased risks to young mothers and their children’s health and well-being.
Yet unplanned births also have an impact on children below age 5. The report noted that in Akwa Ibom State, Under-5 mortality, an essential indicator of child health, is reported at 49 deaths per 1,000 live births while Maternal Mortality Rate is approximately 520/100,000 live births, significantly higher than the global target of less than 70 to 100,000 births.
Mirroring the Multi indicator Cluster report for Akwa Ibom State, BudgIT Foundation in its 2023 State of States report, recommended that addressing the highlighted issues in Akwa Ibom State requires comprehensive sexual education and accessible family planning services. But is family planning really accessible in Akwa Ibom State and what is the level of State government commitment to its accessibility?
How Akwa Ibom State is faring on Family Planning Services
While the Nigerian Government provides contraceptives and other family planning commodities at no cost through family planning basket fund, state governments are responsible for getting the products to the clinics, pharmacies and other health facilities where people can access them.
According to the Family Planning Coordinator of Akwa Ibom State, Mrs. Enobong Eshiet the intervention made by the State government include; domestication of task sharing and task shifting policy, provision of warehouse for family planning commodities and employment of adhoc staff by the Akwa Ibom State Primary Healthcare Development Agency to ease staff attrition in the health sector.
However, with donor agencies withdrawing from funding family planning, more is expected from States. States are also expected to contribute to the central basket fund for family planning. Be that as it may, Akwa Ibom State is yet to join States like Rivers, Delta, Gombe and Adamawa to contribute to the basket fund, and this has negatively affected the quantity of contraceptives given to the State.
The Family Planning Coordinator says , out of 501 Public Health Facilities in Akwa Ibom State, 446 provide family planning services but among this, 385 provide long acting reversible contraceptive services. Where does the State get its contraceptives from? Eshiet says these contraceptives are given to the State by the Federal Ministry of Health from the Basket fund. Failure of the State to contribute to the basket fund limits to a reasonable extent its access to the commodities from the Federal Government.
” Since we are yet to contribute to the basket fund, only States that have contributed are prioritized. There is a gap between quantity order and quantity supply. If we request for 100, they will give us 40″, the Family Planning Coordinator explains.
Due to inadequate contraceptives, findings show that many health centers do not have all the available family planning services thus limiting the right of patients to choose their preferred choice of family planning commodity.
This experience defeats the practicability of the theme for 2024 world contraceptives day marked on Thursday, September 26, 2024 “A Choice for all, Freedom to Plan, Power to Choose”.
Yet, to administer some of these contraceptives, some consumables are needed. They include examination gloves, surgical gloves, Jik, povidone antiseptic, 2ml /5ml syringes, injection needle, cup plaster, elastoplast, gas/kg or Kerosene and Lidocaine injection.
Others are surgical blade, Cotton wool(500gm), Detergent (medium), Liquid soap, Serviette, Pad(Comfit), and Water for injection. Yet, findings show that these consumables have not been provided by the State government to these Health facilities making patients to bear the cost.
According to one Officer-in-Charge of a Facility in Uyo who pleaded anonymity for fear of retribution , since the government does not provide the consumables, they are left with no choice but use their money to purchase the consumables and make those who come for family planning services to bear the cost for the consumables even though the family planning commodities are without charge. The Officer-in-Charge said lack of funding for these consumables by the Akwa Ibom State Government is what leaves health care providers across facilities in the State with no choice but to charge between N2,000 to N3,000 depending on the family planning services rendered.
What is more, there is an urgent need for social mobilizers for community sensitization on dispelling myths and misconceptions such as the ones expressed by Idaraobong and Imaobong.
According to the Family Planning Coordinator in Akwa Ibom, the State largely depends on partners for this.
Moreover, checks into the Audited Financial Statements and Budget Performance Reports between 2015 and 2023 show that the Government of Akwa Ibom State has not made budgetary releases for family planning services in the last eight years. The failure of Akwa Ibom State Government to fund family planning has made the State to depend almost totally on Family Planning implementing Partners and Donor Agencies for family planning services.
Effort of FP Implementing Partners in Akwa Ibom State
The key implementing Partners supporting family planning in Akwa Ibom State include the Federal Ministry of Health (FMOH), United Nations Population Fund, The Challenge Initiative, MSI Reproductive Choices, Society for Family Health, and Planned Parenthood Federation of Nigeria.
On the support given by the FMOH, the Family Planning Coordinator lists them to include support for long haul distribution of family planning commodities, training of master trainers for FP, formulation of guidelines/policy for family planning services, provision of National Health Management Information System Tools (NHMIS) and Coordination of National Health Logistics Management Information System (NHLMIS).
For the UNFPA, they have assisted the State with the procurement of family planning commodities, support long haul distribution of family planning commodities, 72 hour make over of family planning unit in health facilities,
Advocacy/demand generation/Social Behaviour Change Communication, capacity building of health care workers on FP Services and the Support of Youth media advocate.
Also, the MSI Reproductive Choices have assisted the State on Capacity building of health care workers on family planning services in 100 Health facilities,
quality technical Assessment/supportive supervision to all Marie Stopes facilities, supplies of consumables to Marie Stopes supported facilities, and Conduct In-reach/Out-reach activities in MSI Supported facilities/communities.
For the PPFN, their support includes demand generation, out-reach activities on family planning and partnering with UNFPA for 72 hour make over in selected health facilities. in 2023/2024.
The Family Planning Coordinator says so far PPFN has made over 93 family planning units in the State by refurbishing, provision of tile, partitioning, provision of equipment, drug cabinet and consumables within 72 hours on weekends.
The Society for Family Health has also done its intervention for the State. This is through their partnership with Marie Stopes International to train two master trainers and 50 health workers on Depot medroxyprogesterone acetate subcutaneous self-injection (DMPA SC SI), a long-acting contraceptive that can be injected by the patient at home.
They have intervened on demand generation/social behavioural change communication of women reproductive age on self-injection of DMPA SC as self care intervention.
What is more, the Challenge Initiative (TCI) has also been a significant partner in the State.
They have implemented FP services in 10 LGAs of the State. They support In-reach activities in the 10 LGAs.
TCI has intervened by providing services on demand generation/social behavioral change communication using 60 social mobilizers and health promotion officers which they have employed to carry out neighborhood campaigns in order to offer insight into different methods of family planning and also address concerns by patients.
Other intervention by TCI includes data quality assessment, validation, monitoring and evaluation,training of Family Planning providers on Adolescent and Youth Sexual and Reproductive Health/Family Planning services and training/ support to the media on reportage on Family Planning.
Be that as it may, the over-reliance on partners to provide for about all the services on family planning in the State with the Government of Akwa Ibom State yet to release funding to the national casket fund for family planning coupled with the failure to release funds for FP services in the State budget, one wonders what will happen when the partners exit the State at the expiration of their projects especially as many are already on the verge of packing their bags?
The Family Planning Coordinator in the State says the State is often impacted negatively anytime a partner leaves since there are huge funding gaps on the part of the State.
” We have some organizations that backed out and when they leave, we always feel the gap. This is because FP services tend to be more Partner dependent. We have a budget for Family Planning but we don’t get the releases”, she shared.
Eshiet however said that to address the concerns, the Primary Healthcare Development Agency had constituted an advocacy group to key State Actors in the State including the Governor and the Speaker with a plan to inform them on the need for budgetary releases for family planning services. “We believe that our Governor with the ARISE agenda will look at these concerns”, she expressed optimism.
Yet, with the huge funding gaps staring at the State Government, will the government wake up to its responsibility in funding family planning thus helping in reducing the risks of teenage pregnancy, unplanned pregnancy, and unsafe abortions? The answer lies in government future spending priorities.
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