Nigeria should declare emergency in health sector — Country director, Pathfinder

COUNTRY Director, Pathfinder International, Nigeria, Dr Amina Aminu Dorayi says in this report by SADE OGUNTOLA that Nigeria’s declaration of an emergency on stopping the death of mothers and children, should extend to family planning services and other aspects of health to revert Nigeria’s bad health indices in 2022.

IS the budgeting for family planning in Nigeria satisfactory? What would you advocate?

Based on the Abuja declaration, at least 15 per cent of the national budget is supposed to be allocated to health. We have not met that both at the national and sub-national levels. If we have not even met this requirement for health in the budget, how can we meet the family planning budget?

Unfortunately, family planning has not been captured as we think it should be captured in the country’s budget.  With the national budget not capturing family planning, our sub-national budgets may not also capture family planning. This means a lot for our women and for the work that we do because lack of family planning is a bane of development.

There are a lot of benefits in putting resources into the delivery of family planning services. It will automatically reduce maternal and child mortalities. Those health indices are high in this country.

We’re not happy with the current state of the budget for health, in general, and with regard to reproductive health and family planning. As Professor Muhammad Fathalia, a past president of the International Federation of Obstetricians and Gynecologists said, we believe that every nation that wants to progress must put the health and well-being of its women and girls at the forefront through its policies, budgeting and its implementation.

 

Much has not been achieved with family planning, so what do you think can be done differently besides what is already ongoing to make this happen? 

We can classify what should be done in various ways; what should be done by policymakers, Civil Society Organisations (CSOs), media and also the communities that we serve. The policymakers need the information to make them realise and recognise the importance of good family planning, sexual reproductive health and health in general. We hope they do the needful in ensuring that the needed resources and policies are put in place.

Civil Society organisations should never be tired of advocacy and that is the bane of the USAID-sponsored Advanced Family Planning project. We should continue to say it whether they want to hear it or not. The media needs to continue putting it out there in the face of the public and holding the policymakers accountable.

Now, the Advanced Family Planning in the life of the project had been able to support communities and other CSOs to bring family planning to the national agenda. We have made statements with family planning. Two, we created a crop of advocates in different states that we support and also at the national level to understand what family planning is. We have built that capacity, so even at the expiration of the project, the crop of advocates are still continuing this advocacy work.

On budget advocacy, specifically, we have been able to get some resources set aside for family planning in many states. Nasarawa, Kaduna and Gombe states are good examples that put resources aside for the training of health workers and commodities for family planning. And most importantly, through the train-the-trainer programme for media organisations, including the social media, we will also be able to leave capacity to train future journalists ahead to improve on advocacy for family planning and reproductive health.

We cannot say that we have got to the state that we want, so we are open to change, ideas and innovations to be able to get to where we want. I think that one of them will be social media advocacy and using young people. Even the policymakers are on social media and most of them do not want to be called out that this is what they are doing.

 

What are the challenges faced in increasing uptake of family planning and Nigeria’s attainment of the Family Planning (FP) 2030 commitments?

Family planning is a bit different from pregnancy and delivery because unlike pregnancy and delivery, you don’t see it. Also, it is a bit challenging for people to understand the importance of family planning because they are physically healthy. Due to culture and even the way they interpret religion, people think that they must have so many children. So, for family planning, the issue is about both supply and demand. This is why, for me, making sure that basic education is mandatory for everyone, especially young girls, is important to reduce early marriage and drive up our contraceptive prevalence rate.

Secondly, women and girls need to know the importance of family planning or child spacing in their lives. Even if you are averse to planning your family for health or traditional reasons, now you would do so for economic reasons. Family planning is beyond health matters; it is beyond child spacing which many people term it to be. It is holistic for human capital development for Nigeria.  Nigeria will continue going round in circles if we continue to adopt family planning as a health issue.

 

Will you, therefore, recommend the declaration of emergency on family planning in Nigeria?

Definitely. Currently, Nigeria has declared an emergency on maternal health. If we have to get to the root of the matter, we also need to declare an emergency on family planning, which is directly linked to maternal mortality and child mortality. If we feel we are in an emergency situation for maternal mortality, we should go back to the root of the matter and address family planning and education as a holistic sector. This is very important.

 

So, how many children will you recommend for every family?

Family planning is voluntary. There is no cohesion in family planning: what we are doing is to inform people of the benefits of family planning. We need to leave the information out there so that people make informed decisions. So I’m not in a position to recommend any number of children for anybody.

 

There is a new campaign for body autonomy which is being amplified. How do you see this in the light of family planning policies?

This campaign should have taken place a long time ago because girls have a right to their bodies and they understand these rights. It is for the benefit of children, women, girls and families.  Body autonomy is not questionable: an individual owns his or her own body and nobody has the right to disturb that right.

 

People had expressed worry that while tackling COVID-19, Nigerian policymakers neglected other public health issues that are emerging, like family planning. What will you say on that?

COVID-19 has really been an eye-opener to the problems in our health systems; we need to tackle COVID-19, including others health issues like family planning holistically. If our health system is strong, COVID-19’s impact would not be that much. We also need to look at both the financing across the board and the availability and remuneration of human resources in the health system. Do we have enough health workers at the community level, which is primary healthcare? That is where our problems lie. About 70 per cent of the population receives care from primary healthcare facilities. But are we having the quality of care in those facilities?

Most of the commodities utilised, especially for the treatment or management of COVID-19, are not new. If our supply chain is strong, there will be no need to even do a separate thing for COVID-19. So basically, we need to look at the health system in a holistic manner, looking at the supplies, the human resources and the finances. That is why we should very much take health as an emergency, not just only one aspect of health. Health is supposed to be declared an emergency in Nigeria.

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