Editor’s Note: The Nigerian Urban Reproductive Health Initiative (NURHI) project commenced in 2009 to address gaps in access to family planning services in six Nigerian cities, targeting “urban poor” communities. The program has run for five years. On September 29, the project will hold an event to share with partners and beneficiaries the lessons they have learnt, the impact it has made, as well as best practices and tools to help others who are working on similar issues. In this week’s blog we continue our series highlighting innovative projects in the health sector by describing NURHI’s work and the role it has played in the improvement of family planning services in Nigeria.
The average woman in Nigeria will give birth to about 6 children in her lifetime. Fewer than one out of every five married women use family planning. Nigeria has one of the highest fertility rates, and this shows little sign of decline. At the same time, Nigeria also has a high maternal mortality rate, with 545 maternal deaths per 100,000 live births, which makes it second only to India in the absolute number of maternal deaths per year. Nigeria is projected to be the third most populous country in the world by 2050. These statistics point to two key concerns: our population is growing faster than the resources to provide, and too many women are still dying due to complications at child birth.
Increasing access to family planning has long been recognised as one of the main methods of reducing both poverty and maternal and child mortality. However, the concept of family planning is still unpopular in many communities in Nigeria. Strong religious and cultural beliefs perpetuate the myths and misconceptions that surround family planning practices, as many believe that children are a gift from their creator, which of course they are, and suggest therefore that the issue of giving birth should not be ‘controlled’ or interfered with, which, if interpreted to the extreme will be completely unmanageable for any society.
To address this developmental challenge, an innovative project, the Nigerian Urban Reproductive Health Initiative (NURHI) has over the past five years worked to reduce barriers to family planning use and increase the percentage of women of child bearing age who are practicing, or whose sexual partners are practicing any form of contraception in Nigerian cities.
What has NURHI done?
NURHI’s goal at inception was to increase the proportion of women (or their partners) among the total population of child bearing age using modern contraception methods by at least 20 percentage points in six Nigerian cities – Abuja, Ibadan, Ilorin, Kaduna, Benin City and Zaria. The project implemented innovative approaches to address both the supply and demand of family planning services. Through its various interventions, it managed to increase the use of modern contraceptive methods by an average of 11%, with increasing use recorded in every state. The largest increase was seen in Zaria, albeit from a low base.
NURHI’s success in this difficult area can be attributed in large part to its approach of seeing family planning through the eyes of the consumer, the family and community, while responding to the needs of the poorest and most vulnerable in the cities.
NURHI documentary on its innovative family planning interventions, “Turning the Tide”
How did NURHI “Turn the Tide”?
To achieve this, NURHI initiated a public-private partnership initiative called the Family Planning Providers Network, a network that brought together family planning service providers from both the clinical and non-clinical sectors (doctors, pharmacies, nurses and patent medicine vendors) regardless of whether they were public or private service providers. The initiative was the first of its kind in the country. Members of the FPPN make referrals at different levels to promote effective service delivery. At the same time, NURHI trained, retrained and provided distance learning to health workers who provided family planning services. They also initiated the innovative “72-hour clinic makeovers”, where a selected clinic with a large number of patients that provided family planning was renovated within 72 hours, between close of work on Friday and resumption of duties on Monday.
To generate demand for family planning services, NURHI put together a campaign titled “Get-It-Together”. The campaign had three main approaches. NURHI used radio, television and behavioural change materials (leaflets, posters, fact sheets) to spread messages on the importance of family planning in each of the cities. Another approach was a radio program that included a drama, tailored to each city’s context and predominant language. People could call in live and ask questions or make comments during the show.
NURHI also promoted family planning through young people in the communities, mostly local artisans such as hair dressers, who were trained to talk to their clients and communities about family planning practices and refer people to family planning centres.
Advocating for better family planning policies
Nigeria already has excellent policies and strategic plans to guide reproductive health and family planning programming. In fact, one objective of the Integrated Maternal, Neonatal and Child Health Strategy was a 50% increase in contraceptive prevalence by 2012. However, before 2009 government at all levels were not able to effectively implement these policies. As a result family planning programs were largely funded by external donors.
To ensure access to and support for family planning services for the urban poor, NURHI advocated primarily at the state and local government levels. The project constituted groups known as Advocacy Core Groups in each city to help promote family planning advocacy, and at the national level put together the National Family Planning Action Group (FPAG). Today, state and local governments have committed increased budgetary support and funding for family planning, media reporting on family planning issues has increased, and community leaders are more vocally supportive of family planning in all the cities in which NURHI has intervened.
NURHI has created a website, www.nurhitoolkit.org, to showcase its intervention as well as share its resources with others who are working in the field. The program is sponsored by the Urban Reproductive Health Initiative (URHI), which was created by the Bill and Melinda Gates Foundation to promote innovative family planning programs in four countries – India, Nigeria, Kenya and Senegal, particularly among the urban poor. For all of us, a Nigeria where “barriers to family planning use are eliminated, particularly among the urban poor,” is one step closer to reality.