In March 2020, as Nigeria spiralled into a lockdown on account of the coronavirus pandemic, Gift’s life was spiralling out of control.
She had missed her period and resorted to a cocktail of drugs and tales she had heard could remedy her situation. None worked. Sent out of home, she moved in with her boyfriend.
“I was so afraid that this one mistake might end me,” she recalls.
“I stopped work, all the things I thought about for my future were on hold. We didn’t have enough between the two us, and now we had an extra mouth to feed, clothe, take care of.”
In January 2021, she was delivered of a baby boy and the couple visited a clinic in Bwari area council of Abuja.
“We don’t want such a mistake to happen again. It was not pleasant,” the 22-year-old says.
The visit wasn’t pleasant either: the contraception option they wanted was not available.
They are right back where they started—vulnerable and risking another unplanned pregnancy.
Availability of contraceptive commodities is impacting access for millions of women who need them to prevent unwanted pregnancies—and the country isn’t providing them fast enough.
Gift’s boyfriend only in April introduced her to his family for the first time in preparation for a union. Even among married women, up to nine in 10 have knowledge of contraception but only half of them get to actually use any.
The unmet need among them is estimated at 19%—that’s 19 in 100 women who want to prevent unplanned pregnancies but have no means of doing so.
Nigeria is able to provide the commodities through two means—through budget allocation and through counterpart funding shored up by donors.
Budget figures for procuring commodities have flagged over time, flatlining in 2019.
Counterpart funding—in which donors match whatever the government of Nigeria provides—has also taken a hit.
“Over the past year, there is a shift in funding gaps. Priorities in funding are changing,” says Effiom Effiom, country director of Marie Stopes Nigeria. “Donors are rethinking their funding mechanism.”
The Federal Executive Council approves release of funds for procurement of contraceptive commodities.
A total $4 million a year would be needed from 2017 to 2020.
From 2017, releases matched appropriation.
In 2020, N1.2 billion was appropriated, but just N324 million was released.
Nigeria still has 47.8% of that pledge—$8.3 million—to pay out of the $16million total.
Nigeria’s public revenue compared to gross domestic product is among the lowest in the world, according to the World Bank. And its fiscal revenues continue to decline, despite a record trend of being low.
Proponents of family planning have been asking for years where Nigeria can get such money. Attention is increasingly turning to alternative sources for financing family planning.
“We need to shift emphasis—from relying on billions from donors to unlocking trillions that may exist domestically through better use of resources, harnessing local planning and eliminating corruption,” says Emmanuel Lufadeju, cofounder of Rotary Action Group for Reproduction, Maternal and Child Health.
It is an argument he maintained in a recent policy dialogue on domestic resource mobilization for sustained family planning services, hosted by Nigeria Health Watch.
Show the money
Family planning financing is looking toward a host of sources. The Basic Health Care Provision Fund gets 1% of consolidated revenue fund, and one move is to demand an increase because family planning will be part of services offered.
Corporate social responsibility fund from companies are also in the cross hairs. Another move being propounded is tax incentives—offering tax cuts to companies, if they invest in family planning services in cash or kind.
Sin tax is coming up on the radar—making producers of unhealthy items as tobacco and sugary drinks pay a tax for the “sin” of their products. And considering the impact of such products on health, tax from such products will be earmarked for health care.
“It is not just about accumulating resources but spending accountability,” says Ejike Oji, who chairs a technical management committee at Association for Advancement for Family Planning.
“It is about increasing the quantum of money and the effective use of resources. The National Family Planning Blueprint must be funded fully for us to get what we want.”
The blueprint comes down to making Nigeria among countries to reap early demographic dividend. That means ensuring the prevalence rate of modern contraceptives rises from 12% to 27%, at the cost of N252 million, according to the National Family Planning Blueprint.
Assuming the rate grows at 3% every year, it would result in reduced total fertility rate to 4, from 5.3. That fertility rate means contraceptive prevalence rate must grow by 24.5%. The total cost of achieving this is around $412 million.
“Where will this money come from?” asks Olumide Okunola, a senior health specialist with the World Bank.
“We have not spent much on health and we don’t want to spend much.
“The financing discussion doesn’t end at the revenue level. There many parts…how do you pool, how do you purchase and what are you purchasing?”
Targeting corporates not an end
The health sector should be looking to couch its asks to corporate Nigeria in new ways, but it comes with a caveat.
“Domestic mobilization is a good indicator of sustainability, but not an end in itself,” says Ulla Mueller, representative of the UN Population Fund in Nigeria.
But the money still has to come in, and the private sector is looking particularly good to pitched.
“We need to prepare convincing argument that they will be spending wisely,” says Lufadeju.
“Not just in cash but also in kind. They can adopt a primary health centre, provide equipment. We need to marshal good points. Oil and gas, communications, banking are areas we can tap into, and they have corporate social responsibility money we can tap.”
Corporate Nigeria thrives on value for buck, and that requires a fine toothcomb to prepare the wining pitch, says Effiom.
“Thinking what matters to the private sector and making a strong business case why they need to fund family planning is the way,” he says of how family planning should be seen.
“Think of reducing maternal death. Family planning is the cheapest way to reducing maternal death. A lot of them are worried about maternal death. Healthy child spacing to ensure women are alive to support their husbands. It supports the wealth we want to see in Nigeria. We have been seeing family planning the wrong way.”
Gift had been seeing family planning the wrong too. With one unwanted pregnancy and the resulting baby to deal with, preventing another and living her dreams is an existential need.
For her, her family, and country. If only the health centre has what she needs.