A Step to Deliver on Family Planning: community based access to injectable contraceptives

One week after the Nigerian Government committed to tripling the current funding for family planning at the London Summit on Family Planning, Mrs Toyin Saraki. had the privilege to congratulate the Nigerian National Council on Health for taking a monumental step to support this commitment. On Thursday, the National Council on Health approved a task sharing policy that will allow community health extension workers to provide injectable contraceptives in communities.
Before now the country's reproductive health and family planning service protocols and guidelines allowed only doctors, nurses and midwives to provide injectable contraceptives while community health extension workers were only allowed to provide condoms and contraceptive pills in the community. This policy prevented many women in rural communities from accessing injectable contraceptives which is the preferred method. (National Demographic & Health Survey)





One can only begin to imagine the effect this policy has had on the maternal health status of women in rural communities. Approximately one out of five women who intend to limit or space their pregnancies don't have access to family planning services. This is because health workers who can provide family planning services and health facilities where women can access these services are too few and too far. Moreover, cultural, religious and gender barriers have contributed to worsening this scenario.
Hence the need for an innovation that will bring family planning services privately to the doorstep of rural women: community based access to injectable contraceptives. FHI360 piloted this innovation in 10 rural communities in Funakaye and Yamaltu/Deba Local Government Areas in Gombe state. The pilot findings showed that community health extension workers provided injectable contraceptives to women either in their homes or in the provider's homes without any report of injury or injection morbidities. More importantly, women preferred community-based access to injectable contraceptives to facility provision. These findings provided evidence for a policy change.

However, the policy change met strong opposition during the technical sessions of the National Council of Health annual meeting. As usual, professional competition among health workers and socio-cultural barriers that favor population increase threatened the approval of this policy change.
Civil society organizations, led by White Ribbon Alliance Nigeria (WRAN) and FHI360 were relentless in advocating for the new policy. After coordinating individual meetings with the Federal Ministry of Health and the State Commissioners to make the case for passage of this policy, the memo that recommended policy changes to enable community based access to injectable contraceptives was reconsidered and unanimously approved by the National Council of Health.
While we celebrate this monumental step to deliver for family planning, we urge the Federal Ministry of Health to review the curriculum for community health extension workers to ensure they are properly trained to deliver these beneficial services at the community level, and to provide guidance to State Governments on implementing this policy change. 

We also urge donors to join the Government in supporting state level implementation.