FAMILY PLANNING IN ABIA STATE: A TALE OF POOR FUNDING, "USER FEES" AND TCI’S IMPACT

By Temple Tici Barrah

Family Planning has been practiced since the 16th century by the people of Djenné in West Africa when physicians advised women to space their births; every three years, rather than too many and too quickly.
Family Planning Services, offers individuals and couples the ability to anticipate and attain their desired number of children and the spacing and timing of their births.
The family planning program is usually neglected despite being a key pillar in achieving safe motherhood, maternal health, and improved quality of life for women of reproductive age and their families.
Some religious sects forbid the use of contraceptive methods other than the natural billings method.
This situation has continuously increased cases of unwanted pregnancies and abortions.
The Challenge Initiative, TCI, is an exciting new “business unusual” approach to financing, scaling up, and sustaining high-impact family planning solutions for the urban poor.
It is a three-year urban reproductive health program, funded by the Bill and Melinda Gates Foundation.
TCI is demand-driven; local governments self-select to participate and demonstrate political commitment by providing financial, material, and human resources.
In return, TCI brings technical expertise, as well as support from its challenge fund. Dr Okpara Ikechwuku, who is the Technical Support Lead Service support, revealed they saw challenges but started by training the officers before renovating the facility.

“We started from training the officer in charge, that is the OIC here, the FP Supervisor of the LGA. We trained them on that LARC. Then the second intervention was to come here and renovate the facility. We did this in what we call the 72-hour makeover, where we started working on Friday at the close of business; on Monday morning, it was commissioned”.

The 72-hour clinic makeover is an improvement in the fiscal environment of clinics or other facilities that provide family planning services based on priorities identified as part of a makeover assessment.
During the makeover, facilities are renovated, refurbished, and equipped for optimal family planning service provision.
The 72-hour Clinic Makeover is the culminating event after providers have been trained or retrained and provided materials for referrals, job aids, and communities have been mobilized.
Two communities that have benefited from TCI's 72-hour Clinic Makeover are Osaa Okea Primary Health Care Center in Obingwa local government area, and Umuola Egbelu Primary Health Care Center in Aba north local government area; both in Abia State.
Comrade Eruba Victoria Choma, the Health Authority Secretary in Obingwa Local Government, says that women come from all over the ward to Osaa Okea to access family planning services at the health facility.

“We have other facilities within this place, and this place is strictly populated. So the services, there is client flow here. But we made it in such a way that it will not be difficult for them to assess in terms of distance”.

Regina Nzuegbu speaks on the acceptability of family Family Planning Services by women in Osaa Okea community.

“The good people of Osau, I greet you. My mothers, I greet you. We are self-steady very well. Our women come for family planning services just like the government has instructed us. They said we shouldn't give birth to the number of children we can't cater for. We've been keeping to it. Those who want to get pregnant, get pregnant. Those who want family planning services, still get it 24 hours. The nurses here are doing a great job, and they are nice to us.”

The men of Osaa Okea are not left out as they also access family planning services at the health facility, one of the male leaders said:

“I myself now; if I’m having sex I use a condom so I don’t cause problems. Before now our women used to give birth to a lot of children.”

What is the process of accessing family planning services?
First, you have to visit a facility and the officer in charge, OIC would ascertain what family planning method would be most suitable for you in the privacy of the family planning unit, and then you're ushered into the family planning procedure room where the client receives the service.
The general awareness, literacy level, and acceptance of modern family planning services and their benefits is still low.

Abia State allocates 7.5% of its total budget to the health sector; half of the 15% allocation recommended by WHO.
Did you know that 2,345 women in Abia State die from childbirth and pregnancy-related causes annually? Yet, some women cannot access family planning services because of a user fee that needs to be paid!
Victoria stated that family planning services are free noting that, that consumables are usually not enough.

“It's free, actually, for the materials and the consumables we get. How do we provide for it? Because the workers here are not being given any impress. So when you get commodities, like now we're doing MIMOP, Modified Medical Outreach Program. That's what we're doing, and child health will combined. They gave us consumables. You manage it so that you use it for other services. Assuming it gets finished, what do you do?”

Ebutta Grace, the Social Mobilization Officer in the Aba North local government area explained what the user fee is:

“When you come to consumables, that's where the problem lies. When you talk about the user fee, the problem is from the consumables. TCI has provided us with good accommodation and other things that we need to work with; without the consumables how does a provider give all these services?
What I need is blood, if the blood is not there.
How can I provide it? I cannot give a user what he or she wants without cotton wool. If the cotton wool is not there, I have the commodity, I have a good building, what can I do?”

For clients to continue enjoying family planning services, the service providers require consumables.
Who shall bell the cat? Before TCI came to Abia in June 2018, family planning was not considered a high priority. Partner support for family planning was negligible when compared with other reproductive health issues and the state's family planning unit planned activities dependent on partner funds.

TCI's advocacy efforts led the Abia State government to appropriate 200 million Naira for family planning interventions in its 2019 budget; the first time in its history that the state dedicated funds to family planning.
In 2020, the government of Abia State also approved a sum of One hundred and forty-five million, seven hundred and fifty thousand Naira for family planning in its budget for that year.
However, funds have not been released all these years to support the family planning program in the state.

This year, 70 million Naira has been approved by the government for family planning in its 2021 budget.
The million-dollar question is will the Abia State government release these funds?
If released, the funds will help in training and retraining health workers on modern family planning methods, social mobilization, demand generation for family planning through the mass media, community social mobilizers and other traditional methods.
It will also help in the renovation and equipping of family planning units across the state, the purchase and supply of medical consumables for family planning service delivery, and monitoring and supportive supervision of family planning services across the state to ensure that they are provided in line with national standards, the printing of data collection tools for family planning data capture and reporting.

TCI will withdraw their support for family planning in Abia State if the government does not show commitment by releasing funds for family planning!
If they do, what happens next?