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.
