Editor’s Note: This week’s Thought Leadership piece comes from Dr. Victor Igharo and Dr. Olukunle Omotoso from The Challenge Initiative (TCI) Nigeria, a four-year intervention supported by the Johns Hopkins School of Public Health and the Bill and Melinda Gates Institute for Population and Reproductive Health. They put a spotlight on the dire need for better family planning approaches in Nigeria and explain how this new initiative holds potential promise for sustainable gains in the family planning space.
“We started using family planning after our first child, we really wanted to space our children but then, we did not know about much about family planning. This was before NURHI came to Ilorin. We visited a family planning clinic where we were counseled on all methods of family planning. Thereafter, my wife went for some tests and decided to use injectables. When we wanted to have our second child, there was no delay after the injectable was stopped. We have three children with at least three years between them. We want to encourage people to seek for family planning advice to know the best method for them and also give birth only to the number of children you can take care of. NURHI’s awareness is making a lot of impact in the city, more people are now aware of the benefits of family planning and they are going for it.”
~ Mr. & Mrs. Bashiru, Family Planning Beneficiaries, Ilorin, under the NURHI Phase 1 intervention. NURHI ended in 2015, but The Challenge Initiative (TCI) will build on the gains of NURHI.
Investing in family planning has been identified as critical to accelerating Nigeria’s progress on 5 of the 17 Sustainable Development Goals (SDGs): People, Planet, Prosperity, Peace, and Partnership. This potential acceleration is important for several reasons, but primarily because without such an investment, the Nigerian population will rise to an estimated 398 million people by 2050. It is anticipated that just over half that number will be living in urban areas. If nothing is done about this exponential growth, by 2050 Nigeria will become the 3rd most populated nation in the world.
This growth has incredible implications for resource allocation in Nigeria, both for individuals and the nation as a whole. The pressure this would place on citizen’s budgets is likely to increase the risk of illness and deaths, as families struggle to meet competing needs with their limited resources. Family planning benefits include a reduction in unwanted pregnancies, as well as a reduction in maternal and infant mortality. The high incidence of infant mortality is often as a result of insufficient spacing of pregnancies and frequent births. Family planning is therefore essential if we are to secure the health, well-being, and independence of women and families.
The Federal Ministry of Health’s (FMoH) National Family Planning Blueprint plans to increase the Contraceptive Prevalence Rate (CPR) to 36% by 2018 across all the states in Nigeria. If all investments are made according to this blueprint, we should see an incredible reduction in the maternal and infant mortality rates in Nigeria, with maternal mortality reducing by 75% and Infant Mortality reducing by 66%. It is estimated that 1.6 million pregnancies would have been prevented by 2018. In order to achieve this type of progress in Nigeria, a lot of collaboration is required between the Federal and State Ministries of Health and other partners in the family planning space.
The Challenge Initiative
A recent initiative with exciting prospects for improving the state of family planning in Nigeria, “The Challenge Initiative,” (TCI) will use a “business unusual” model for catalyzing family planning investment.
TCI’s model will be based on several components:
- Demand-driven interest from states/cities: States that express an interest in the TCI intervention will play an active role in project design and implementation, while local and global partners will play supporting and facilitating roles.
- Quick alignment and leveraging of resources: TCI will collaborate with multilateral agencies, bilateral partners and private foundations to meet the family planning needs of the urban poor.
- Collaborative learning: TCI will ensure there is global community of practice by operating “TCI-University”- a virtual platform of learning which will exchange lessons learned and share best practices in delivering family planning and health services to model states/cities.
- Early wins and visibility: TCI will focus on accessing relevant communities of practice built around major meetings and community forums which incorporate extensive communication (pre-meeting, conference materials, post meeting) with high visibility conferences/events recognized on the global and or regional level
- Entrepreneurial spirit and approaches: TCI will incorporate new approaches, shifts basic paradigms, leverage and align financial resources and investments, and offer new models for scaling up highly effective evidence-based interventions especially with private partners.
TCI will use the Business Unusual Model of “SCALE”: Self-selection by states based on demand, Challenge fund matching mechanism, Angel Investing, Learning resources and tools, and Efficiency built into performance analytics.
TCI will specifically support improvements in:
- Supply – reducing stock outs through an informed push model supply chain, conducting screening and referrals of mothers visiting health facilities, improving quality through 72-hour clinic makeovers and improving access by making services available in close proximity to the clients
- Demand – using scientific approaches to behaviour change communication, promoting partner communication, conducting health outreaches at the community level, using mass media to reach large numbers of people
- Enabling environment – outreach to religious leaders, advocating for specific policies at local levels, and improving staff capacity.
TCI has just concluded the Expression of Interest (EOI) validation exercise for the first round of proposals. Nine (9) states have expressed interest in the Initiative so far, and 5 have met the requirements to proceed to next stage, which is a Proposal Development workshop scheduled to take place in May 2017 It is expected that at least one state will begin implementation of “The Challenge Fund” by the end of June 2017.
TCI was introduced by The Johns Hopkins Bloomberg School of Public Health (JHSPH), with support from the Bill and Melinda Gates Institute for Population and Reproductive Health. This initiative comes on the heels of the Urban Reproductive Health Initiative (URHI), which was also implemented by JHSPH and the Gates Institute. URHI was implemented in four countries between 2009 and 2015 – Nigeria, Senegal, India and Kenya.
The Nigeria Urban Reproductive Health Initiative
In Nigeria, the Nigeria Urban Reproductive Health Initiative (NURHI) tested comprehensive approaches to improving contraceptive access in 6 selected states – Federal Capital Territory (FCT), Ibadan, Ilorin, Kaduna, Benin and Zaria. The strategy adopted by the NURHI Project was successful, with the contraceptive prevalence rate (CPR) of the poorest intervention communities increasing by 11 percent.
NURHI’s model worked because NURHI reached community people through Entertainment Education, mobilized communities and created a supportive environment for family planning programs, improved quality of service and access to family planning in supported states, invested in demand generation drives uptake of family planning services and modern method contraceptive prevalence rate (mCPR), and generated demand through fun and innovative ways e.g. “Get it Together”-An Entertainment Education Program. NURHI also developed the NURHI Toolkit, a resource for program managers, communicators, implementers and program researchers to implement family planning programs. More so, NURHI used “The Concept of Ideation” which illustrates different ideational factors to predict contraceptive use.
TCI was launched in Nigeria on the 23rd February 2017 and has received the support of key stakeholders in the family planning space, including Her Excellency Aisha Buhari, wife of the President of the Republic of Nigeria. She is quoted as saying, “As a strong advocate for family planning, I am in support of all that BMGF* plans to do in Nigeria and would like to lend my support as women make up to more than 50% of the population of the country.”
One of TCI ‘s main project outcomes is to contribute to the goals of Family Planning 2020 (a global partnership supporting the reproductive rights of women and girls) and universal access to reproductive health, by 2030. According to the Copenhagen Consensus report (Post-2015 Consensus), family planning documents a significant Return on Investment (ROI) as every dollar invested in family planning guarantees a ROI of $120.
Nigeria is at the tipping point of its developmental agenda as key players are beginning to recognise the dire importance of family planning. At the launch of TCI, the Honorable Minister of State, Federal Ministry of Health, Dr. Osagie Ehanire reinforced the need for family planning initiatives to scale up using business unusual models. While emphasising that the FMoH will continue its collaboration, the Hon. Minister expressed optimism that the Challenge Initiative would bring about a turning point in the successful implementation of the National Family Planning Blueprint.
For more information on The Challenge Initiative, visit http://www.tciurbanhealth.org
*Bill and Melinda Gates Foundation (BMGF)