Dr. Funmilola Olaolorun, a senior lecturer in the Department of Community Medicine, College of Medicine, University of Ibadan-Nigeria, is co-principal investigator for Performance Monitoring and Accountability 2020/Nigeria. Olaolorun who is also a Gates’ Scholar and graduate of the Johns Hopkins Bloomberg School of Public Health in this interview with CHIOMA UMEHA advocates some form of voucher system to enable the poorest of the women to afford family planning consumables and commodities. Excerpts:
What is PMA 2020 all about?
The Performance Monitoring and Accountability (PMA) 2020 is likely to help to monitor and evaluate the progress towards the goal of FP 2020, which is to reach additional 120 million women and girls in the poorest countries of the world with family planning services, those who don’t have access by the year 2020. So that is the reason PMA2020 exists, just for monitoring and evaluation so that we can track the main family planning indictor overtime in the light of the project.
From your survey, beginning from 2015 till date, do you think we are making progress; can we achieve all the goals by 2020?
We are making progress, but the progress is very slow, based on what we have seen so far. I don’t think we can reach those indicators by 2020. However, the important thing is that progress is in the right direction and the indicators that we are expected to improve such as modern contraceptive problem rate are improving. It is just about one per cent a year, but in general, you don’t expect more than a two per cent increase in a year because it takes a while for people to change their behaviour, but we have not added that two per cent. In order for it to be sustained, what we are looking for is at least two per cent in a year, we are not there yet, but we are making some progresses, it is just not enough.
Is there going to be a scale up?
There is a new project in PMA 2020 which is Performance Monitory for Action that would start later this year.
You also said there is progress, but the progress is kind of slow; the project was slow compared to the time remaining for the goal to be achieved. So what do you think the government can do, the Contraceptive Prevalence Rate (CPR) that can be used to achieve those areas?
I think for one, they need to be able to release fund at the right time. Sometimes they allocate funds for, I think it is called reproductive health commodities in our budget, but many times it takes very long time for them to release the fund.
So releasing the funds on time and then increasing the funds allocated to reproductive health facilities, it not sufficient. It not sufficient and it is delayed before it is released. So I think just ensuring that the funds are available and ensuring that they are released at the right time will go a long way. But, beyond that, I think they also need to ensure that they allocate funds for consumables, because most of the funds are used for commodities and the women are paying for consumables. Some local governments in Lagos State now have started allocating funds for consumables. So allocating more funds for consumables, more funds for commodities and developing some form of voucher system to be able to ensure that even the poorest women can afford family planning because even when consumables and commodities are available, women are still asked to pay for registration, laboratory test, including pregnancy test. So if the government can pay for that for the poorest women who cannot afford it possibly through a voucher system, I think they would have done something positive to improve the health of Nigerian women.
There are stories about implant, migrating from the hand to the stomach; how true is some of the myths and do you think it is time for Nigeria to dispel the myths?
The myths are not true, exactly the way they are myth, so I think apart from health workers, we need more people who are family planning advocates who are regular Nigerians and not necessary in the health sector, knowing what is right and what is true and sharing that with people in their communities. I think we need people who would be willing to advocate for family planning, among families, among friends, beyond health workers; people who are trusted and respected in their communities so that they can understand the ideal ways to obtain proper and correct information. Many people are getting information from the wrong sources. Implants do not migrate and the side effect of family planning is usually very few and I think that it is overhyped that family planning can be negative because in most cases, in majority of cases, it is beneficial for women.
2020 is around the corner; how would you access Nigeria in view of the commitment it made during the London summit 2012?
I don’t have the exact numbers, but I think we have made some progress, but the progress is definitely not enough. Many times the allocated funds have been delayed in being released and sometimes not the entire amount is released and even what was allocated is not sufficient in the first place. It is generally for commodities and hardly ever for consumable. So we need much more commitment, not enough has been done and we need a government that is more dedicated, not just in the reproductive health but the holistic health of Nigerians.
So if you are asked to rate Nigeria, what percentage would you apportion to the country as regards to the London summit?
I think that is a tough one because I first have to think about the criteria I am going to use to access them. But, I think in general we have a pass mark, but a very low pass. I will leave it at that, a very low pass.
You said 1/5 of Lagos women have unintended pregnancy. How do we change that narrative?
I think none of the ways is to encourage women to seek information about family planning because only 25.5 per cent of married women are reporting use of the modern method, I mean we can do better than that. Because many of them have an unmet need. And the unmet continues to be very high, that means they are all expected to be using a family planning method, but they are not because they do not want to have a baby within the next two years, yet not using a method.
Just getting people to understand that family planning is safe and available. Obtaining the right information and using the right method will reduce the proportion of women who report unintended pregnancy. So women need information and they should be able to access the services which are readily available in the State. I think that will go a long way because there are already many demand generation effort in place and the supply is good because stock out is almost non-existent in many public facilities in the State. So what women need is informwation, where to obtain the method and to be convinced that the methods are actually safe for them.
So you mentioned about some services that are paid for, in specific terms, how free is family planning?
Well, according to the government the commodities are free, but many times money is not set aside for consumables and apart from that, many women have to pay for registration. So they are actually still paying for something even if they are not paying for Commodities they still pay for registration, they pay for consumables like syringes, cotton wools and things like that and upon that they also pay for investigation like pregnancy test. So free is very relative it not completely free, they are still paying out-of -pocket for consumables, registration, pregnancy test and other tests.
Don’t you think these services should be made free?
They should be made free if it is sustainable, the problem is sustainability, because there is no point making it free for six months and not being able to go on. I think that rather than making them free, they should be some form of scale to identify those who truly cannot pay for them and make it free for them and those who can pay, can pay a token and have it subsidised, but to have it free for everyone is not a sustainable approach.