Centre for Communication and Social Impact’s maiden webinar titled “Influencing Sexual and Reproductive Health Behaviour in the COVID19 pandemic” had an amazing line up of speakers, bringing together different perspectives on family planning/childbirth spacing and the future of sexual and reproductive health.
Dr Kayode Afolabi, M.B.B.S F.W.A.C.S (O&G)
Director & Head, Reproductive Health Division, Dept of Family Health, Federal Ministry of Health, Abuja.
Topic: The impact of the COVID-19 pandemic on Family Planning activities from the perspective of the Federal Ministry of Health
Q: Thank you for the enlightening session. Please what can the government do to make consumables available to make family planning truly free?
It is good to know that the Federal Ministry of Health is making conscious efforts to keep family planning commodities in circulation across the country in spite of the pandemic. However, family planning providers are charging as high as 3,000 Naira in some places because they take the advantage of the loophole that the government does not supply consumables. Cost has been a barrier to the uptake of family planning for a lot of women.
Response: The Federal Government of Nigeria is still committed to its policy of free family planning information, services and commodities across all public sector health facilities in Nigeria. Every family planning service provider in any public health facility is expected to comply with this policy and serve FP Clients without charging them any fees. Non-compliance is an offence.
The issue of lack of consumables has however, been a recurring challenge because of the non or infrequent procurement of consumables by Governments at Federal, State and LGA levels. At the Federal level, the procurement of the contraceptives is being prioritized due to the high level of funding gap being experienced in the implementation of our Annual Procurement Plan to meet our FP contraceptive commodities’ need. As soon as funding improves, consumables would be captured and procured as part of future procurement plans. States are being encouraged to include consumables for FP Service provision in their procurements for healthcare delivery interventions in general and in particular, the Free Maternal and Child Health Programmes being implemented by many States. The SOML, the BHCPF Programmes and other State-specific programmes can serve as sources of funding.
Q: One major challenge with accessing Family Planning commodities has been excessive billing by service providers – even when commodities are free. What is FMoH doing to handle this challenge at every level?
Response: The FMOH is engaging with relevant stakeholders especially at the community level (Ward Development Committees and Facility Health Committees, etc.) to ensure that service providers comply with the provisions of the free commodity policy. Also, increased availability of contraceptive commodities including consumables is being pursued to reduce or avoid stocks that some providers might use as excuse to charge for providing FP services. SERVICOM Guidelines have long been disseminated and are expected to health facilities and other Government institutions to enable consumers of services including FP clients to ensure they are not exploited. Supportive Supervision Visits are equally being used to monitor and address issues related to charging user-fees for services that are meant to be free.
Q: The reduction in FP services uptake is huge, do you think we are doing enough at Federal, State, LGA and community levels to reverse this trend?
Response: Yes, we are doing enough but a lot still needs to be done to reverse the declining uptake of RH/FP services across the country. The Nigeria Family Planning Blueprint which has been revised and now covering the 2019-2020 period has a robust Demand Generation Component and this is being complimented with the National FP Communication Plan and Logo. These are being used to drive interventions to educate Nigerians on the benefits of family planning; address myths and misconceptions about family planning; engage with religious, community and opinion leaders to enhance sustenance of RH/FP service uptake. Also, additional health facilities are being capacitated to provide family planning services; the Task Shifting and Task Sharing Policy has been revised and is being disseminated to ensure a broad pool of healthcare workers are supported with capacity building for skills to provide quality health services including FP. Integration of services is also being pursued. Outreaches and community-based service delivery interventions are equally being prioritized.
Q: The uptake of FP commodities dropped during this pandemic. What is the way forward? What measures are being put in place to protect clients from covid-19 while assessing FP commodity?
Response: Yes, uptake of FP services dropped during the COVID-19 Pandemic due to a number of reasons including
- The initial restriction of movement affected the ability of service of providers and FP clients to get to health facilities to either provide of access FP services.
- FP service delivery including last mile distribution of commodities was not initially prioritized by Governments due to major focus on COVID-19 Pandemic Response
- Available FP Guidelines were lacking in protocols for safety of both providers and clients thereby negatively impacting service delivery and uptake.
To address these challenges, a number of steps are being taken and some of these include:
- The Family Health Department has ensured that key FP programme interventions are included in the Government COVID-19 Response Plan. This is helping to ensure that FP Service Providers are included in the distribution of PPEs and other supplies; Job Aids, Protocols/Guidelines issued by NCDC and other relevant institutions of Government.
- The Health Promotion Division of the Family Health Department has, on behalf of the FMOH being collaborating with relevant Stakeholders to disseminate messages to Nigerians on safety measures to be observed or taken while accessing health services including family planning
- The Department is also engaging with stakeholders for the development and subsequent implementation of the Family Health Department’s specific RMNCAEH+N Action Plan on sustainability of services in the face of COVID-19 Pandemic
Q: How can we support commodity distribution to the PPMVs to avoid overcharging the youths?
Response: There is presently, a Guideline on involvement of PPMVs in the provision of family planning services and other health services as appropriate. There is also the Guideline on the supply of Government contraceptive commodities to private Service Delivery Points (SDP) including PPMVs to enable them provide quality and affordable FP services to FP clients as a way of increasing access to access by Nigerians of reproductive age. Based the mentioned Guidelines, the Reproductive Health Division in collaboration with Partners begin series of capacity building for qualified PPMVs on family planning service delivery as appropriate. This is to be followed with supply of contraceptives after appropriate user-fees would have been agreed with them. Periodic supportive supervision will also be prioritized.
Q: Dr. Afolabi mentioned that maternity units are being attached to Isolation centers… This is impressive but I hope the full package to cover all SRH needs are also provided.
Response: Priority here is on ensuring the availability of appropriate facilities for the care of COVID 19 infected pregnant women to enhance their chances of safe delivery and reduce or completely avoid mortalities.
Q: A lot of people in the communities are afraid to go to the health facilities for FP services, especially in Lagos State where some PHCs were converted to Isolation centers. What is the government doing to address this? Can the services be taken to the people by CHIPS agents and CHEWS?
Response: Yes, CHIPS, CHEWS and other Community-Based Distribution Agents/Outlets are being utilized for sustenance of health services including RH/FP. Community Outreaches for RH/FP Services are being adopted.
Q: Dr. Kayode, please what is the vital information to handle the ongoing argument on a child that was born with an IUD coil in his hands?
Response: This is part of the Myths and Misconceptions being addressed with some of the contents of the National Family Planning Communication Plan. Presently, there is on-going effort at increasing awareness on family planning especially in the communities through radio and television as well as other media. Proper counselling of FP clients at the SDPs is made compulsory in order to give correct information on the various family planning methods to enable the clients make informed choice every time.
Dr Saratu Olabode-Ojo
Technical Director Programs, JHCCP/NURHI 2 project
Topic: What sexual and reproductive health activities entailed prior to the pandemic and what is the future of sexual and reproductive health in light of the pandemic.
Q: How is NURHI targeting the out of school adolescents to access SRH services during this pandemic?
Response: NURHI 2 seeks to ensure that young people, who are frequent users of social media, are exposed to correct information about life and family planning. NURHI 2 thus uses platforms like Facebook, Twitter and Instagram to reach out of school adolescents with information/resources about SRH services and directions to primary healthcare facilities that are youth-friendly for services. The three main areas of focus are ensuring that the life planning information they receive is accurate, inspiring discussion in an engaging, attention-grabbing way using elements such as hash tags, influential bloggers, competitions and quizzes and, finally creating a safe space where young people can ask questions and receive correct information without judgement.
Q: What are your communication plans for farmers to allow them to access information on FP since most of them are hardly at home?
Response: NURHI 2 engages household members in the home during mobilization activities and urges them to discuss the information they have received with members who are unavailable at the time of the mobilization activity. Also, NURHI promotes FP information using radio which is the most accessible means of information in Nigeria.
Q: Thank you NURHI for the fantastic work in Kaduna. I’m not too sure if you had specific intervention targeting adolescents in Kaduna? If you did, what was it and what are the outcomes of the intervention and what are the sustainability plans?
Response: NURHI 2 engaged NYSC corps members at their orientation camp through the CPET program, and through the Go Men Go radio programme broadcast by the Kaduna NYSC Editorial Board CDS group. The team also instituted Life Planning for Adolescent and Youth (LPAY) ambassadors who promoted reproductive health information and services through their networks and often engaged in social mobilization activities. These LPAY ambassadors were then added to the NURHI 2 established capacity building group on WhatsApp aimed at providing a mutually beneficial platform for the ambassadors, youth led/focused organizations, State Adolescents and Youth Health Desk Officers, and NURHI 2 staff to engage, learn, and share experiences towards increasing young people’s knowledge and skills on reproductive health and development. The platform provides training on different life skills ranging from reflective writing, storytelling, advocacy, family planning, social media, leadership, etc.
FP service providers in NURHI implementation LGAs are trained to provide youth-friendly services. In addition, NURHI used the Human Centred Design approach to develop interventions that promotes client-provider interactions and allows providers to reflect on the consequences of their actions if clients including adolescents are denied FP services. This has led to more providers offering FP services in a professional manner and not allow biases prevent service provision regardless of the client.
Q: Will there be a 3rd phase of the NUHRI project? What other organizations are working together to make FP a norm in Nigeria?
Responses: Other organizations working to promote family planning use in Nigeria are: The Challenge Initiative, Post Pregnancy Family Planning, Breakthrough Action Nigeria, Society for Family Health and FHI360, JHPIEGO, Marie Stopes, Post Pregnancy Family Planning,
Q: The reduction in FP services uptake is huge, do you think we are doing enough at Federal, State, LGA and community level to reverse this trend?
Response: At the moment, members of the public may be reluctant to visit a health facility for fear of COVID-19, however, government at all levels can reinforce that the Health facilities are safe and accessible during this time; reminding people to take the necessary COVID-19 precautions when leaving their homes and reassuring them that health facilities are sanitized throughout the day to reduce the spread. Community/religious leaders can also serve as advocates to further reinforce the safety of healthcare facilities and COVID-19 preventive measures. Government at all levels should sustained funding for FP services for commodities distribution to the Last Mile, availability of consumables and PPEs, using virtual platforms to conduct regular on the job trainings so providers are updated and provide quality FP services, ensuring availability of PPE to supervisors who conduct supportive supervision.
Q: What strategies did NURHI put in place to ensure that services provided by the PPMVs were captured in the state DHIS?
Response: NURHI Trained PPMVs on IPCC and referral so clients are referred to supported healthcare facilities for FP method administration.
Q: Over the years, it has been proven that PPMVs have become a necessary group that we must work with especially in the hard to reach terrain but the headache is how did you work with them, monitoring and ensuring that they adhere to the national guidelines and not overshoot as they always do?
Response: NURHI worked closely with the PMV association, NAPPMED, in selecting registered members to work with and these selected PMVs were trained on Interpersonal Communication and Counselling (IPCC) and referral. Potential clients are counselled by these PMVs and are referred to facilities closest to them. NURHI also supported their facilities with SBC materials and developed Information leaflets which had FP methods on them with the list of our NURHI 2 High volume sites as an addendum to this information leaflets to serve as a source of referral to any of NURHI High volume sites.
Q: Great work that NURHI is doing especially in Lagos State! I however want to also stress the need for the government to expedite actions in ensuring that family planning services are added to the benefit package in the Lagos State Health Insurance Scheme. This can go a long way in expanding coverage and improving access to FP services in the State. This has been made possible in Anambra State and Lagos State can follow suit. Thank you.
Response: There are other BMGF funded projects working to address this issue in Lagos State.
Q: Can you share more on your experience on how you were able to train PPMV during this pandemic?
Response: PPMVs were trained in clusters and in groups in halls that contained not more than 20-25 participants to ensure social distancing
Margaret Bolaji-Adegbola
Founder, Stand With A Girl Initiative
Topic: The impact of the COVID19 pandemic on family planning activities from the perspective of young people
Q: What are some of the youth friendly services you would recommend?
Response: Health facilities providing youth friendly services must effectively attract adolescents and youth, responsively meet their needs, and succeed in retaining them for continuing care. These facilities should offer wide range of youth friendly services on puberty-related concerns, sexual violence, contraceptives, STIs including HIV, mental health disorders, substance use, nutritional problems, violence, and injuries.
Q: I am wondering if a call in centre will be an option to reach out to young people?
Response: This is a great option for young people. It will ease the challenge of mobility while ensuring confidentiality.
Q: How can private public relationships be strengthened in this period of pandemic to give youth access to FP?
Response: Public-Private Partnership is essential to ensure young people have access to quality family planning information and services. Public health facilities need to liaise with Patent and Proprietary Medicine Vendors (PPMVs) to ensure contraceptives are available and clients are referred to health facilities accordingly. PPMVs’ capacity must be strengthened to provide youth friendly balanced counseling.
Q: Has your organization trained health caregivers assisting at the facility level on confidential information management?
Response: SWAG Initiative makes advocacy to the government to ensure health providers are trained on youth friendly service provision. A key component of these training is ensuring that all health facility staff (clinical and non-clinical) are welcoming and offer confidentiality. SWAG continues to partner with the government to ensure that the Nigeria National Standards & Minimum Service for Adolescent and Youth Friendly Health Services is domesticated and implemented at the State and Local Government levels.
Q: Please provide more information on HOW salt is applied by the young people as contraceptive – is it through drinking or what?
Response: Due to lack of adequate and accurate sexual and reproductive health information, young people continue to result to crude means to determinate pregnancies (unsafe abortions). These are dangerous to their health and in some cases, cause their lives. This is a misconception, its is unscientific and unacceptable.
Q: With closure of schools, (and no plan on re-opening soon); how do we hope to address the SRH needs of youths and adolescents. How can methods like DMPA-SC be pushed out to meet their needs at this time?
Response: The use of traditional and new media to ensure young people have access to SRH information is key. We continue to support the government to accelerate its effort in ensuring that DMPA-SC is available for use.
Q: Where are the youth friendly centers located in different states and how accessible is it to youths?
Response: While youth friendly centres are good spots for young people, making health care facilities youth health Initiative (NURHI) and The Challenge Initiative (TCI) supported States (Kaduna, Lagos, Oyo, Edo, Niger, Ogun and Plateau) to train service providers on youth friendly service provisions.
Some youth friendly health centres some states (Lagos, Oyo and Kaduna) include;
- Hello Lagos LASUTH, Oba Akinjobi way, LASUTH Complex Ikeja.
- Hello Lagos Youth friendly center, Oko-awo Lagos Island LGA
- Hello Lagos Youth friendly Center, Ogudu
- PHC Alimosho Youth friendly center, Onilu village Ikotun-Igando
- Agege Youth Friendly Center, Sango PHC, Agege LGA
- Youth friendly Center, Akere PHC-Ajeromi-Ifelodun LGA
- Youth Friendly Center, University of Ibadan. 08055310155
- Association for Reproductive and Family Health (ARFH) House, 0802 354 2889
- Youth Friendly Center, Barau Dikko Hospital 08099606363
- Youth Friendly Center, Comprehensive Health Care Center, Jaji. 08099301112
- Youth Friendly Center, Gwamna Awan General Hospital. 08023760691
- Youth Friendly Center, PHC, Sabon Tasha. 08028449947
- General Hospital Kawo. 08094734834
- PHC, Makera 08036597576.
Q: How do we continuously address some of these misconceptions you alluded to in your presentation by young people on sexual and reproductive health?
Response: To dispel these myths and misconceptions, we need to ensure young people have access to accurate information on family planning. Engaging bloggers and social media influencers are some ways to ensure they pass accurate information. Parents, teachers, religious and traditional leaders, and other caregivers should not shy away from the responsibility of giving correct information on sexual and reproductive health to young people. The Family Life and HIV Education (FLHE) offer in school must be updated to reflect current SRH realities and should be implemented in schools.
Q: How can someone use salt and over dose antimalarial to prevent pregnancy?
Response: We strongly discourage the use of any crude means and unscientific alternatives even during COVID-19. This is dangerous to health and may lead to death of the user. We must inform young people rightly and make services accessible to them.
Dr. Shittu Abdu-Aguye
Deputy Project Director, Breakthrough Action, Nigeria (BA-N)
Topic: How to adapt family planning promotion activities to the COVID19 pandemic (Case of BA-N)
Q: For Dr Shittu’s presentation, I think we need to also take into consideration patent medicine vendors, the spiritual wellness home, and the traditional birth attendant who are the first point of contact with the people in the country since the people did not want to go to the hospital
Response: Patent medicine stores – especially where the proprietors who have been trained on counseling and provision of some modern FP methods – are a recognized source of services and clients are duly encouraged to uptake methods there. As stated during the presentation, PPMVs may even be more accessible than other providers during the COVID-19 outbreak. Spiritual wellness homes and traditional birth attendants should refer clients in need of FP services to recognized service delivery points or providers – PPMVs, pharmacies, health facilities, community distributors etc.
Q: Thank you, Dr Shittu, for the presentation. Where FP services were free before COVID-19 pandemic, will out-of-pocket purchases not limit the usage of FP commodities?
Response: FP commodities were free before and during the COVID-19 outbreak at government owned health facilities and a few private facilities supported by the government in certain locations. The service costs are usually attributed to ‘consumables’ when they are not available. Efforts are being made by Federal and State governments to ensure the availability of consumables and FP service provision with no out-of-pocket payments
Adenike Ayodele
Program Officer, Centre for Communication and Social Impact
Topic: Using SBCC to promote healthy sexual and reproductive health behaviours. How CCSI is deploying SBCC approaches to safe guard the reproductive rights of women and girls
Q: Thank you Adenike, kindly give more information about the self- administered contraceptive picture you shared and what method? Thanks
Response: DMPA-SC (Depot Medroxyprogesterone Acetate) is a convenient, safe and easy-to-use method of contraception. It comes in a pre-filled, injection device and is very effective at preventing unintended pregnancy.
DMPA-SC is a reversible, short-acting method of contraception that is re-injected every 3 months (13 weeks). DMPA-SC can be used privately as most women can self-inject at home after being trained by a health provider.
The instructional video on self-injection for DMPA-SC can be accessed at the link below:
Q: For Ayodele. Pls, are you in partnership with farmers associations to help in your activities on FP
Response: CCSI partners with a number of associations across the different states where we work. As described during the webinar, at the core of our approaches are partnerships with government and community structures. These partnerships give us access to many of these groups within the different communities, including associations of farmers, tailors, barbers, hairdressers, meat sellers etc.
As highlighted by this question, CCSI will explore intentional engagement of the Farmer’s association, working through the community and government partnership model.
Q: How do we ensure compliance/ FP method continuation during this Pandemic especially to rural dwellers with poor access to technology or FP services?
Response: CCSI works with community volunteers resident in the different intervention areas, including rural areas and hard-to-reach communities. These volunteers continue to educate community members on the benefits of FP and where to access services during the pandemic.
Some projects CCSI supports provide services in the communities and hard-to-reach areas through community resource persons and PPMVs (Patent and Proprietary Medicine Vendors). These service delivery channels provide methods such as DMPA-SC that the client can self-inject, thus reducing the number of visits to health facilities.
This multi-pronged approach means that the communities have local solutions for getting information and services even if access to technology is limited.