Imo State Family Planning Costed Implementation Plan (2021-2024)

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

IMO STATE MINISTRY OF HEALTH

FAMILY PLANNING COSTED IMPLEMENTATION PLAN (2021 – 2024)

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

October 2020

CONTENTS CONTENTS..........................................................................................................................................2 List of figures, Charts, Boxes and Tables........................................................................................4 FORWARD..........................................................................................................................................5 ACKNOWLEDGEMENTS....................................................................................................................7 List of Contributors............................................................................................................................8 List of Abbreviations and Acronyms.............................................................................................10 SECTION 1.........................................................................................................................................12 SITUATION ANALYSIS.................................................................................................................................12 Desk Review:.............................................................................................................................................12 1.1 Introduction: The Global Context....................................................................................................12 1.1.1 London Summit on Family Planning.............................................................................................12 1.2 The Nigeria Context.........................................................................................................................14 1.3 Imo State Context............................................................................................................................17 1.4 Imo State Family Planning Situation................................................................................................18 Health Facility Survey................................................................................................................................33 1.5 Summary of The Findings................................................................................................................33 SECTION 2.........................................................................................................................................37 INTEGRATED FAMILY PLANNING PLAN......................................................................................................37 2.1. Goal................................................................................................................................................37 2.2. Objectives.......................................................................................................................................37 2.3. Strategic Priorities..........................................................................................................................37 2.4 Structures of the Costed Implementation Plan...............................................................................38 2.4.1 Demand Generation and Behaviour Change Communication......................................................39 2

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 2.4.2 Service Delivery...........................................................................................................................46 2.4.3 Commodities and Supplies...........................................................................................................56 2.4.4 Policy and Enabling Environment................................................................................................61 2.4.5. Financing.....................................................................................................................................67 2.4.7 Supervision, Monitoring, and Coordination (SMC).......................................................................72 SECTION 3.........................................................................................................................................78 COSTING....................................................................................................................................................78 3.1 Cost Summary.................................................................................................................................78 3.2 Total CIP Cost by Thematic Areas and Priority Objective.................................................................80 SECTION 4.........................................................................................................................................89 PROJECTED FP METHODS MIX AND IMPACT.............................................................................................89 4.1 Projected FP Methods Mix..............................................................................................................89 4.2 Impact Assessment..........................................................................................................................91 SECTION 5.........................................................................................................................................92 Resource Mobilization and Performance Management............................................................................92 5.1 Resource Mobilization.....................................................................................................................92 5.2 Ensuring Progress through Performance Management...................................................................93 ANNEX A: MONITORING AND EVALUATION SUMMARY TABLE..............................................................93 References...............................................................................................................................................100

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

List of figures, Charts, Boxes and Tables Figure 1: Nigeria Method Mix 1990–2013................................................................................... 16 Figure 2: Imo State Population Pyramid.................................................................................... 17 Figure 3: South East CPR............................................................................................................ 19 Figure 4: Imo States CPR. Source: NDHS 2013........................................................................... 19 Figure 5: South East States Fertility Rates as at 2016................................................................. 20 Figure 6: Sources of FP Services by Method in Imo State........................................................ 21 Figure 7: Imo State FP method use 2013 and 2018.................................................................. 22 Figure 8: Imo State human resource capacity......................................................................... 23 Figure 9: Imo State Family Planning Training Coverage...........................................................24 Figure 10: Awareness of methods of contraceptive............................................................... 28 Figure 11: Reasons for facility visit by FP clients.................................……………………………34 Figure 12: Total budget by thematic areas.............................................................................. 79 Figure 13: Current and Projected Method Mix for Imo State.................................................. 91 Table 1: FP budgetary allocation in Imo SMoH from 2014-2018............................................. 34 Table 2: Summary total budget by thematic areas .............................................................79 Table 3: Total budget by thematic areas and by priority objectives.................................... 80 Table 4: Projected Total Users by methods and Years............................................................. 93 Table 5: Projected impact of achieving 27% CPR by 2024................................................... 93

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

FORWARD The 2012 London Summit on Family Planning provided the platform on which Nigeria committed to a yearly 2% incremental change in Contraceptive Prevalence Rate for married women to achieve overall 36% in 2018.

For the realisation of the above target, the Federal Ministry of Health developed a scale up five years costed implementation plan (CIP), which outlined activities, cost, and resources required to achieve this.

Each State of the federation was to contribute its quota by developing its own implementing CIPs in line with local realities, to ensure the national targets.

However, with the current National Contraceptive Prevalence Rate for modern contraceptive at 12% (2018 NDHS), the earlier plan of 2012-2018 failed to achieve the desired target.

In a renewed effort to achieve improved national and respective state contraceptive prevalence rate, a national target of 27% by 2023 has been set by the Federal Ministry of Health. With support from UNFPA and Marie Stopes International Organisation Nigeria, Imo State Ministry of Health kickstarted the process of developing her State Family Planning CIP while setting our CPR target of 27% by 2024. This was followed by series of engagement meetings, interviews, desk reviews, family planning landscape assessment, etc.

The activities in this plan are expected to produce high impact in Family Planning needs and service delivery in Imo State. The key thematic areas of focus of the CIP are: 

Service Access and Delivery



Demand Creation



Supplies, Commodities and Distribution



Policy and Enabling environment



Financing mechanisms 5

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 ï‚·

Supervision, Monitoring and coordination

The Technical Team held series of meetings with Imo State Family Planning Committee and a major stakeholder Workshop to derive activities from each thematic area to enable the State reach its FP goals. This document is a result of that endeavour.

Dr Mrs Damaris Osunkwo Hon. Commissioner for Health Owerri, Imo State.

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

ACKNOWLEDGEMENTS Development of Imo State Family Planning Costed Implementation Plan 2021-2024 is strategic in scaling up contraceptive prevalence rate in the state and contributing our state quota to the national target of 27% by 2023. This sets the roadmap and details the activities and means to achieve the targets within the timeframe.

The process of the CIP development was collaborative, involving concerted efforts of many players who contributed technically and otherwise to ensure a robust and achievable cost and effective and efficient plan developed.

Special mention and thanks must be extended to the Governor of Imo State, Distinguished Senator Hope Odidika Uzodinma for his 3R innovative policies and approach in Governance which has created an enabling environment for strengthening of the various systems in the State, especially the health system. His approval to enable the achievement of this document was key.

The financial support of UNFPA in producing this document is highly appreciated. The enduring and tireless efforts of the Staff of the State Ministry of Health, especially the Family Planning and Reproductive Health units and MSION consultant are well appreciated.

We greatly appreciate the Hon. Commissioner for Health, Dr Damaris Osunkwo for her support, keen interest and leadership which impacted positively on the development of this CIP document.

Finally, all other Partners and Stakeholders quite numerous to mention who contributed one way or the other to the achievement of this CIP are hereby appreciated. We expect that meticulous implementation of this plan will achieve the set targets

Dr Okeji A.C. Director Public Health 7

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 Ministry of Health

List of Contributors S/N

NAME

ORGANISATION CORE TEAM

1.

Dr Damaris Osunkwo

Hon. Comm. For Health, SMoH, Owerri

2.

Dr Austin Okeji

Dir. Public Health, SMoH

3.

Dr George Udeji

RH Coordinator, SMoH

4.

Mrs H. Nnenna Oriaku

FP Coordinator, SMoH

5.

Dr Emereuwaonu Njoku

Consultant, MSION

6.

Mr Emmanuel Emesowum

FP Logistics, M&E Officer, SMoH

7.

Mr Onyekachi Onumara

Prog. Mgr. Rural Health Foundation (Tech.

Asst. Imo FP CIP) OTHER CONTRIBUTORS

8.

Prof. S. J. Ozims

Dept. Of Public Health, IMSUTH, Orlu

9.

Dr Eugene Onwuchuruba

Cottage Hosp. Umuowa, Ngor-Okpala

10.

Mrs Chinyere Ekwugha

Rural Health Foundation

11.

Mr Chidi Madu

Health Reporter, IBC, Owerri

12.

Mr Gavas Eke

PPMV, Imo State

13.

Mrs Chukwueke Victoria

DNS SMoH, Owerri

14.

Mrs Nwachukwu Catherine

FP Unit, FMC Owerri

15.

Rev Fr. Justin Okoro

Admin., Holy Rosary Hosp., Emekuku

16.

HRH. Eze Geoffrey Okoro

Chairman, Traditional Rulers, Ngor-okpala LGA, Imo State

17.

Mrs. Harbor Florence

Marie Stopes Nigeria

18.

Mr Geoffery Anyaegbu

HSDF

19.

Chioma Nnajiofor

CFHI

20.

Mrs Comfort Mere

CHM FPAWG, Owerri

21.

Pharm Uche Maduike

LMCU SMoH

22.

Mrs Onwukwe Vivian

FP Supervisor, Okigwe Zone

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

23.

Mrs Chukwunyere Innocentia

Former Imo State FP Coordinator

24.

Mrs Stella Ozims

FP Supervisor, Owerri North

25.

Mr. Andy Iheagwara

DPRS, SMoH

26.

Amakihe George C. N

DD Donor Aids & Project Coordinator, MBEPS

27.

Lovinda Onyiriagwu

Assistant Projector Coordinator, MBEPS

28.

Mrs Obilor Lilian C.

HMIS, SMoH

29.

Mrs Okeke Florence

PHCC Ohaji/Egbema

30.

Mrs Osuala Chiazo

FP Unit IMSUTH, Orlu

31.

Mrs Oranusi Ucheamaka

DDNS, SMoH

32.

Mrs Ugbaja Anne

PHCC, Obowo LGA

33.

Dr Eze Nwokoma

PSI, Imo State

34.

Mrs Ngozi Amaliri Edith

DNS HMB, Owerri

35.

Dr D. O. Anyaegbule

DHS HMB, Owerri

36.

Eke Ijeoma J

PPFN Imo State

37.

Dr Nkiruka Onyekpandu

Rural Health Foundation

38.

Dr Gwacham Uchenna

Health Strategy & Delivery Foundation (HSDF), Owerri

39.

Mrs Egesionu Adanna

Imo State PHCDA, Owerri

40.

Dr Uche Odom

Imo State PHCDA, Owerri

41.

Lady Eziama F. I.

Owerri West HOD Health

42.

Dr Alaocha Frank

Rep. Perm. Sec., SMoH

43.

Dr Kyrian Duruewuru

Chairman, NMA Imo State Chapter

44.

Mrs Igwe Irene C.

FP Supervisor Orsu LG

45.

Dr Okere E. S.

Director PHC, Imo State PHCDA

46.

Dr Tony Igwe

Perm. Sec. SMoH, Owerri (Rtd)

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

List of Abbreviations and Acronyms AHI COC CLMS CPR CMS CTC CIP CLMS DHS FMC FGON FHAC FMOH FP FPAWG FPF HCW HF HMIS HP+ HTS HWs IEC IHVN IMNCH IUD JSI LGA KAP LMCU LMD LMIS MSION MCH MDAs NAPMED NBS 10

Action Health Incorporated Combined Oral Contraceptive Pill Contraceptives Logistics Management System Contraceptive Prevalence Rate Coordination, Monitoring and Supervision Core Technical Committee Costed Implementation Plan Contraceptive Logistics Management System Demographic and Health Survey Federal Medical Centre, Owerri Federal Government of Nigeria Family Health Advocacy Coalition Federal Ministry of Health Family Planning Family Planning Advocacy Working Group Family Planning Financing Health Care Workers Health Facility Health Management Information System Health Policy Plus HIV Testing Services Health Workers Information Education and Communication Institute of Human Virology of Nigeria Integrated Maternal and New Born and Child Health Intra Uterine Device John Snow Inc. Local Government Area Knowledge, attitudes and practice Logistics Management Coordinating Unit Last Mile Distribution Logistics Management Information System Marie Stopes International of Nigeria Maternal and child health Ministries, Departments and Agencies National Association of Patent Medicine Dealers National Bureau of Statistics

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 NHMIS NSHIP

National Health Management Information System Nigeria State Health investment Project

OCP PACFaH

Oral Contraceptive Pill Partnership for Advocacy for Child and Family Health Policy and Enabling Environment Primary Health Care Prevention of Mother To Child Transmission Progestin-Only Pill Post-Partum Intra Uterine Device Population Services International Requisition Issue and Receipt Form Review and Re-supply Sustainable Development Goals Service Delivery Points Society for Family Health State Ministry of Health Save One Million Lives Program for Result Sexual Reproductive Health Total Fertility Rate United Nations Population Fund United States Agency for International Development Women of Reproductive Age

PEE PHC PMTCT POP PPIUD PSI RIRF RRS SDGs SDPs SFH SMoH SOML-P4R SRH TFR UNFPA USAID WRA

SECTION 1

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

SITUATION ANALYSIS Desk Review: 1.1 Introduction: The Global Context Family planning (FP) is one of the most cost-effective ways to prevent maternal, infant, and child mortality. It can reduce maternal mortality by reducing the number of unintended pregnancies, the number of abortions, and the proportion of births at high risk1. It has been estimated that meeting women’s need for modern contraceptives would prevent about one-quarter to one-third of all maternal deaths, saving 140,000 to 150,000 lives per year globally. Family planning offers a host of additional health, social, and economic benefits; it can help slow the spread of HIV, promote gender equality, reduce poverty, accelerate socioeconomic development, and protect the environment.

Among women of reproductive age in developing countries, 867 million (57%) are in need of contraception because they are sexually active but do not want a child in the next two years. Of these, about 222 million (26%) do not have access to modern methods of contraception, resulting in significant unmet needs.

1.1.1 London Summit on Family Planning On July 11, 2012, FP stakeholders worldwide assembled for the London Summit on Family Planning. The United Kingdom (UK) government, through its Department for International Development (DFID), and the Bill & Melinda Gates Foundation (BMGF) partnered with the United Nations Population Fund (UNFPA) to host a gathering of leaders from national governments, donors, civil society, the private sector, the research and development community, and other interest groups.

The meeting deliberated on the renewal and revitalization of the global commitment to ensure that women and girls, particularly those living in lowresource settings, have access to contraceptive information, services, and supplies.

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 The objective of the summit was to “mobilize global policy, financing, commodity, and service delivery commitments to support the rights of women and girls in the world’s 69 poorest countries to use contraceptive information, services, and supplies without coercion or discrimination by 2021.” Doing so would prevent staggering 100 million unintended pregnancies, 50 million abortions, 200,000 pregnancy/childbirth-related maternal deaths, and 3 million infant deaths

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The London Summit on Family Planning committed to the following: • Increase demand and support for family planning by removing barriers to its access and use • Improve supply chains, systems, and service delivery models and procure more affordable high-quality contraceptives through better global coordination, including new methods for expanded choices • Improve market dynamics, including country forecasting capacities and increased availability and quality of a range of FP methods • Promote accountability at the global and country levels through improved monitoring and evaluation (M&E) • Advocate for sustained government and donor funding Nigeria was represented at the London Summit by a team of experts led by the Federal Ministry of Health (FMOH). At the summit, they committed to increasing domestic funding for family planning. The Federal Government of Nigeria (FGON) committed to disbursing an additional $8.35 million per year specifically for family planning and reproductive health (RH), which translated to about a 300 percent increase.

After the summit’s conclusion, the FMOH team of experts identified the following key steps to ensure the increased uptake of FP services:  Support advocacy  Strengthen accountability  Improve supply chains  Increase contraceptive supply 13

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024  Promote best practices  Support new innovations Nigeria developed the National Family Planning Blueprint (Scale-Up Plan), evolving from the commitments made at the London Summit. It provides a roadmap for achieving the FGON’s goals for improving access to family planning and reducing maternal mortality through a concerted national effort to scale up family planning over five years (2013‒2018) now extended to 2021. The Blue print also provides guidelines and encourages states to develop their state specific family planning costed implementation plans.

1.2 The Nigeria Context With more than 200 million people, Nigeria is the most populous country in Africa and the seventh most populous country in the world5. Annual population growth is 3.2 percent, and the total fertility rate is 5.3, with variations across states and regions (NDHS, 2018). Most projections place Nigeria as the third most populous country behind India and China by 2050. There are approximately 48 million women of reproductive age in Nigeria and the country will have an early 7.5 million births in 2017 alone 6.

Nigeria’s Gross Domestic Product (GDP) grew consistently at above 6 percent per year between 2001 and 2014 and experienced a decline between 2015 and quarter 2 of 2017. There is some improvement over time as in quarters 2 and 3 of 2017; Nigeria GDP experienced a positive growth taking Nigeria out of economic recession. However, income inequity remains a key issue in Nigeria.

The top 10 percent wealth bracket in Nigeria receives more than 34 percent of the income share, whereas the lowest 10 percent receives less than 2 percent.

This pattern has been relatively stable for the past 20 years. These inequities persist along regional lines, with oil revenues concentrated in the South.

From an RH perspective, the Federal Government is charged with developing policies, strategies, guidelines, and plans that provide direction for the Nigerian healthcare system. However, implementation of these guidelines ultimately falls 14

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 on the State Ministry of Health (SMOH). Each SMOH is responsible for health programme direction and coordination in its State. The State Ministry of Local Government Affairs (SMOLGA) is responsible for hiring, managing, and paying health workers at the primary healthcare level (as part of the civil service). Each State also has an FP coordinator who facilitates commodity ordering and transportation as well as advocacy. Effecting change in reproductive health requires a concerted effort and clear alignment from the federal government down to the LGAs. According to the 2018 NDHS, 17 percent of married women of reproductive age (15‒ 49) are using any contraceptive method; however, only 12 percent of these women are using modern FP methods, an increase of 2.2 percent from 2013. This national rate has largely remained at this level since the late 1990s.

The modern method mix predominantly comprises condoms, pills, and injectables 5 World

Population Review, 2020

6 Health Policy Plus 2017: 4th National RAPID

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

Figure 1: Nigeria Modern Contraceptive Method Mix, 2015. Source: FP 2020

As part of its FP 2020 commitment, the Nigerian government had set a target of reaching a 36% CPR by 2018 now revised down to 27 percent and extended to 2023. To achieve this goal, the government pledged additional funds starting from 2014 and several donors and non-governmental organizations (NGOs) are currently committed to supporting FP/RH efforts in Nigeria.

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

Figure 2: Nigeria Population Pyramid. Source: NBS 2017

1.3 Imo State Context Imo State is one of the five states in the South-East region of Nigeria. Its capital and largest city is Owerri. The state is inhabited and populated primarily by the Igbos and a few non-Igbo speaking indigenes. Imo state has 27 LGAs: Mbaitoli, Ngor Okpala, Ikeduru, Owerri West, Owerri North, Owerri Municipal, Aboh Mbaise, Ahiazu Mbaise, Ezinihitte Mbaise, Orlu, Nkwerre, Isu, Njaba, Orsu, Nwangele, Oguta, Ohaji-Egbema, Oru East, Oru West, Obowo, Okigwe, Isiala Mbano, Ihitte Uboma, Ehime Mbano and Onuimo. Imo State is bordered by Abia State on the East, Anambra State on the North and Rivers State to the South. The state lies within latitudes 4째45'N and 7째15'N, and longitude 6째50'E and 7째25'E. The chief occupation of the local people is farming. The cash crops include oil palm, raffia palm, rice, melon, cashew, cocoa, rubber, and maize. Consumable crops such as yam, cassava, cocoyam and maize are also produced in large quantities.

With an estimated population of 6,135,073 (NPC 2020 estimate) land area of about 5,530sq.km, Imo is primarily an agricultural region and it is a producer of 17

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 yam, potatoes, maize and cassava in Nigeria. The state has several solid mineral resources, including lead, crude oil, and natural gas, but few large-scale commercial mines. The population of women of reproductive age (WRA), 15-49 years is about 1,349,715.99 (WRA is 22% of total population).

1.4 Imo State Family Planning Situation Imo State contraceptive prevalence rate among married women (including those co-habiting) aged 15-49 is 30.7% though significantly higher than the national average of 17% and is the third among all the states in South East geopolitical zone of Nigeria 7. The modern CPR according to NDHIS 2018 stands at 10.9%. Of all current users, as high as 19.8% use traditional methods while about 2.6% either used condoms, tablets, injections or other methods.

Figure3: South East CPR. Source 2018 NDHS

Figure 4: Imo State CPR. Source 2018 NDHS

Imo State has relatively high unmet need for family planning. Of the 1,349,715.99 women of reproductive age, 283,440 (21%) married and sexually active women 18

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 in Imo state want family planning services but currently are not able to access it.

The total demand for family planning in Imo State stands at 51.7% (NDHS 2018).

According to National Bureau of Statistics Bulletin of 2017, Imo State fertility rate is 5.1, ranking 20th in Nigeria along with Abia and 2nd in the South East zone.

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 Figure 5: South East States Fertility Rates as at 2016. Source: NBS Bulletin 2017

1.4.1 Service Delivery Sources of Family Planning Services: Imo State women seek FP services from both the public and private sectors. Because intrauterine contraceptive devices (IUCDs) and implants require trained service providers, they are usually sourced via the public sector and the private facilities whose staff have been trained on provision of Long Acting Reversible Contraceptives (LARC) services. Condoms and pills are available from a wide variety of sources, including Proprietary Patent Medicine Vendors (PPMVs), pharmacies, and private and public health clinics.

Scaling up access through the public and private sectors will increase FP uptake in the state.

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 Imo State has approximately two thousand one two hundred and eighty-four (2284) healthcare facilities made up of Public (564) and Private (1720).

(DPRS)). There are two tertiary healthcare facilities, each in the State providing family planning services with • Federal Medical Centre (FMC), Owerri and • Imo State University Teaching Hospital (IMSUTH), Orlu The secondary healthcare facilities include 10 State General Hospitals and Imo State Specialist Hospital, Owerri. As at October 2020, 236 out of 564 public health facilities provide FP services (source: Imo FP Unit records).

Figure 6: Sources of FP Services by Method in Imo State

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 FP Usage in the state: The use of any Family Planning method decreased from 34.1% in 2013 to 30.7% in 2018. However, this was largely because of decrease in the use of traditional methods which decreased almost significantly within the period compared with modern methods that slightly increased from 10.7% to 10.9%. Traditional methods are very unreliable and have the least couple year of protection. More reliable methods such as implants, IUCDs and sterilization remained almost unchanged. However, there was a marked decrease in the use of injectables and condom male from 2013 to 2018. The use of Implants jumped from 0% in 2013 to 1.6% in 2018, a remarkable achievement by the State. This could be due to more aggressive mobilization in the use of implants by the State and Partners

Figure 7: Imo State FP method use 2013 and 2018. Source: 2013 and 2018 NDHS report

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 Staff Skills and training: there are 236 facilities providing Family planning services in Imo State. Of these 236 facilities, 217 have LARC-trained providers. The target is to have at least one LARC-trained nurse/midwife in each of the 564 public health facilities. So far, the State is far from achieving this target due paucity of fund and a shortfall in the number of development partners to assist the State in capacity building. Currently, only Marie Stopes International Organisation Nigeria (MSION) and Rotary International are responsible for training Nurse/midwifes on LARC in the State and the SMOH remains appreciative of that effort

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

Figure 8: Imo State human resource capacity. Source: SMOH

Figure 9: Imo State Family Planning Coverage. Source: SMOH

Compliance with Task Shifting/Sharing Policy: Task shifting/sharing policy has yet to be domesticated in Imo State. There is need to train CHEWs on the provision of modern family methods, especially the long acting and reversible contraceptives across all rural health facilities to expand service delivery 25

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 capacity, bridge the biting capacity gap between nurses and CHEWS and to reach more clients.

Provision of Adolescent and Youth-Friendly FP Service: Adolescent and youthfriendly FP services are being provided by Public and Private Sectors in the state.

Each of the three Senatorial zones has Adolescent and Youth-Friendly Health Service (AYFHS) Centres and a Focal Person. Many adolescents and youths however still find it difficult to come to these centres to access FP services because of misconception that only married women should access FP services.

Adolescents who seek FP services are often misconceived as being promiscuous by the Service Providers.

FP Service Provision through the Private Sector and the Current Challenges: Private sector health care providers such as private health facilities, CSOs, PPMVs provide FP services. Most of them buy their commodities and collect high service charge.

The challenge is that most of them do not report their activities hence services provided are not captured on HMIS (DHIS2) and state report. Some private facilities provide services on LARC even though they do not have the necessary training and capacity to do that hence there is urgent need to identify these facilities and evolve a platform to standardize their skills to ensure patient safety.

Human Resource for Health Challenges: Human resource for health (HRH) is grossly in short supply in Imo State. Some of the state’s General Hospitals have only one State employed Medical doctor. There has been a continued depletion of health workers due to retirement for the past 16 years without any replacement. All State-owned healthcare facilities are currently understaffed.

1.4.2 Supplies and Consumables The purpose of Contraceptive Logistics Management System (CLMS) is to ensure clients are able to receive the FP method of their choice when needed through 26

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 existing Service Delivery Points (SDPs). In order to achieve commodity security of contraceptive products, there must be a logistic system that ensures accurate forecasting, procurement, storage, distribution and inventory management of the contraceptive products.

Forecasting: This involves the estimation of the contraceptive products that will be dispensed to users by a program for specific period of time in the future.

Currently, in Imo State, forecasting of contraceptive products is conducted by Logistics Management Coordinating Unit (LMCU) in collaboration with a Partner: Global Health Supply Chain PSM (GHSC-PSM). However, the LMCU members need to be trained to improve on their health commodities forecasting skills.

Procurement and Storage: Procurement of contraceptive products is done at the national level and distributed to states from the Federal Central Medical Store to the State Central Medical Store.

Distribution: The State Family Planning Coordinating Unit through her logistics officer distributes commodities to LGA FP supervisors and focal persons in tertiary and secondary facilities. Family Planning Providers in the public primary health centres pick their commodities from their supervisors at the LGA warehouse. This method, though an improvised one has a major disadvantage as commodities do not get to the SDPs in a timely manner. The coordinating unit does not carry out last mile distribution to the service delivery points due to lack of fund. The Bimonthly (2 Months) Requisition Issue and Report Form (RIRF) is generated at the SDPs and submitted to the coordinating unit by the LGA supervisors for resupply.

The

State

is

currently

embracing

the

National

Product

Supply

Chain

Management Program (NPSCMP) model of health commodities distribution.

Inventory Management: Within the logistics system, records are kept of all transactions at each level. Stock cards or Inventory Control Cards (ICC) are used 27

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 to track movement of products, while RIRFs are used for reporting and LMD matrix is developed using the data from RIRF on the NHLMIS platform. Stock cards are available at the CMS but will soon be distributed to the SDPs. Besides, most health personnel at the SDPs need training on CLMS to enable them to manage the LMIS tools. In addition, the LMCU needs support to conduct quarterly Mentoring and Supportive Visits (MSVs) to SDPs to provide on the job training to staff.

1.4.3 Demand Generation Demand generation is aimed at increasing awareness of family planning services to the population for uptake of services.

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 Awareness on Family Planning: According to the 2013 NDHS, contraceptive in Imo State was very high as almost 9 out of every 10 persons were aware of a modern method, Awareness of a modern method increased from 92.3% in 2008 to 99.8% in 2013. Evidence shows that increase in awareness has not really translated to demand in FP.

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

Figure10: Aware

methods of con

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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 Current Demand Generation Activities in the State and How they are Addressing the Unmet Needs: There is low level of uptake of family planning services in the State due to misconception, religious belief and stereotyped perception of the numerical value of children. Some partners in the past few years have made laudable attempts to reach men and women of reproductive age with key information on family planning and child birth spacing to influence individual and collective actions.

However, more needs to be done to reach all eligible men and women with quality information on family planning services.

As a strategy to increase the awareness on family planning services in the State, Imo State Ministry of Health in collaboration with development partners have developed workable strategies for demand generation and uptake. The strategies include monthly outreach and in-reach activities in communities and health facilities targeted at increasing the uptake of LARC sponsored. This has been consistently sponsored by Marie Stopes International Organization Nigeria (MSION) since 2015. Rotary International is currently supporting the training of 25 health workers on LARC. In June 2019, Action Health Incorporated (AHI) with fund from UNFPA supported the training of 40 Community Health Volunteers (CHVs) on Sayana Press injectable, part of which include demand creation. The role of CHVs is to create awareness in the communities of six pilot LGAs about Sayana Press Injectable contraceptive, refer clients to the nearest SDP for Family Planning and join in the monthly Sayana Press outreach activities sponsored by UNFPA. The Effectiveness of the Current Demand Generation Activities in Terms of Increase in Long Acting Reversible Contraceptives Uptake: Very notable among the milestone achievements in this regard in the State is the remarkable increase in the use of implant contraceptives from 0% in 2013 to 1.6% in 2018. This is a testimony to the huge effort of all the Partners and Imo State Ministry of Health.

31

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024 IEC and BCC Tools for Demand Generation: Limited availability of IEC /BCC materials for demand generation activities continues to be a huge challenge towards efforts aimed at increasing the uptake of family planning Services in the State. Implementing Partners have been responsible for the production of IEC/BCC materials in the State which are still inadequate.

32

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

1.4.4 Policy and Enabling Environment As the primary responsibility bearer, the new administration in Imo State promises to be health-friendly and has demonstrated strong political will to move the health sector forward.

Measures taken to support FP service delivery in the State are: • Establishment of the State Primary Health Care Development Agency backed by legislation; 

Financial commitment to the basic health care provision fund (BHCPF) to ensure basic minimum health package for the poor

 

people.

Establishment of Imo State Health Insurance Scheme Financing of MNCH week Programs to ensure scale-up of FP services

However, inadequate human resources for health in the state and Local Government health facilities, and inadequate budgetary provision for FP and delay/or non-release of approved funds are the major challenges that will hamper the successful implementation of the FP services in the state.

Therefore, the priority area of policy and environment focuses on advocacy for family planning within various levels of government and the private sector, including faith- based organizations, civil society and private providers to ensure that the best policies are available and fully implemented.

1.4.5 Financing The financing of family planning in Imo State is primarily the responsibility of the Federal, State and Local Government with the support of Development Partners. The Federal Government is saddled with the responsibility of procuring FP commodities and transports same from their central warehouse to the State. A large chunk (almost 92%) of these commodities and logistics cost is funded by donor agencies. The State Government is expected to

33

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 handle last mile distribution of commodities by transporting the commodities to the SDPs, maintain an effective human resource, create demand, maintain and coordinate the operation of the health facilities that provide FP services. However, this is mostly funded by donors. The Local government is expected to support service delivery and human resources as much as possible, but this is often left for other stakeholders to handle.

The state’s investment in human resource and equipment is inadequate as many facilities are understaffed or non-functional. This maybe because the priority of the State Government in recent years has been in the area of infrastructure development and free education and little has been done in balancing this with the need for adequate human resource for health. Since 2014, there has been zero release of family planning budgetary allocation despite the paltry sum allocated to the program.

Worthy of note is that the proposed budget (runs in millions) by the coordinating unit always starkly differs from the final budgetary allocation (runs hundreds of thousand) for Family Planning by the Ministry of Health. No release of allocated funds also limits the state spending and results in making the FP activities largely funded by out of pocket and donor funds.

However, SOML Program for Result (P4R) program is an opportunity to limit the funding gap as it has CPR indicator as one of its major pillars.

Table 1: Family Planning budgetary allocation in Imo State Ministry of Health from 2014-

2018. Source: SMOH

Allocated Amount Released 2018 2,000,000 0 2019 500,000 0 2020 500,000 0 The Development partners currently supporting the Year

Actual Budgetary Allocation to FP

Funding Gap

2,000,000 500,000 500,000 State FP intervention in

the State include UNFPA, MSION, AHI, Rotary International, and JSI. They support the state in demand generation, Advocacy, policy and systems strengthening, logistics, service delivery and human resource development.

34

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

1.4.6 Supervision, Monitoring, and Coordination For any project to succeed there must be effective supervision, monitoring and coordination system/strategy throughout the different levels of planning and implementation. At this critical period when most partners are gradually withdrawing, Government needs to look inwards and strategize on how to be less donor-dependent.

Studies have shown that a programme not well supervised and monitored falls short of the expected result. In Imo State, family planning programme is done by the Reproductive Health Unit of the State Ministry of Health and this is monitored by the Integrated Supportive Supervision (ISS) team established by the government and supported by donor agencies. The Team monitors health facilities on all range of health services provision, including family planning. The platforms for supervision that are presently available are largely driven by donor agencies and withdrawal of their support may lead to the collapse of the coordination mechanism.

Among the development agencies implementing family planning programmes in Imo state, only MSION, UNFPA and JSI are involved in monitoring, supervision and coordination activities in public health facilities.

Effective coordination of FP activities at the various levels and sectors (public and private) will reduce to a significant level these challenges.

The current supervisory and monitoring system does not cover the private health sector, NGOs, or PPMVS, as these sectors are yet to be properly integrated in to the state FP service delivery system.

35

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

Health Facility Survey 1.5 Summary of The Findings 1.5.1 Sample Characteristics Results show that almost all FP service providers at the hospitals and health centers (98%) were nurses and midwifes. The FP providers were all female.

FP clients were mostly married and of the Christian religion, and the majority, had formal education

1.5.2 Personnel, Infrastructure and Equipment Only 25% of Public Secondary HFs (General Hospitals) had providers (nurses) who have received training in IUCD insertion, IUCD removal and training in implant insertion and removal. 100% of public primary HFs visited had at least one provider (nurse) who had received training IUCD insertion, IUCD removal and training in implant insertion and removal and contraceptives logistics management system (CLMS).

However, in reality, only 88% of Public HFs

providing Family Planning services have at least one provider (nurse) who have received training in LARC and CLMS. In comparison, no CHEWs are being trained in IUCD and Implant insertion or removal, largely because Imo State has yet to implement Federal Government task shifting and task sharing policy on long acting and reversible contraceptives (LARC) and partly, due to the opposition from nurse/midwifes to CHEWs training. The only two Public Tertiary HFs in the State had at least 2 providers (nurses) who had received training in both LARC and CLMS. The 5 Private Hospitals visited had at least one LARC-trained provider with no training on CLMS. Results on the basic infrastructure and equipment for FP services show that basic equipment such as tenacula, specula, uterine sound and sponge holding devices, weighing scale, blood pressure machines, torch were available in the FP/MCH unit of 97% of facilities visited. However, most notably absent and lacking was Standard Sterilizing equipment in 98% of public

36

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 primary HFs visited as can be seen in Figure 2. However, the overall FP service delivery environment was good in all facility types. Most hospitals and health centers had the necessary equipment and good examination rooms for delivering long-acting FP methods.

1.5.3 Reasons for Client Visit and Availability of FP Services The main reason for visiting the health facility for most of the FP clients was to obtain a re-supply of their FP method. New FP users constituted just over one fifth (22%) of the hospitals and health centers clients. Generally, most health facilities reported usually providing a range of short acting methods, with injectables being the most available and the most dispensed method.

Hospitals and health centers had on average 5 different FP methods available at the time of the survey. Of the long acting methods, Implanon was relatively more available than the other long acting methods.

Figure 11: Reasons for Visiting FP Facilities by FP Client

37

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

1.6.4 Supplies and Logistics Management Most of the facilities that reported usually providing a particular FP method were found to also have it in stock at the time of the survey, but very few of these facilities (especially the public facilities) also had experienced stockouts in the past six months. In the facilities that usually provided IUCDs, 93% also had it in stock at the time of the survey. Of the facilities that usually provided Implanon, it was generally found to be in stock at the time of the survey. Overall, more than 90% of all facilities had injectables and oral contraceptive pills in stock.

All Public HFs reported receiving theirs supplies form either the LGA Warehouse/store or Central Medical Store which are all Government sources, while 40% of Private hospitals received their supplies from Government sources (LGA store & Central medical store) and 60% either from supporting NGOs and or through market purchase.

95% of public HFs said they did not receive full quantities of contraceptives that they ordered for in the last three months. Reason being that quantities supplied were determined by suppliers based on quantities available in the store.

There was absence of consumables being supplied by Government sources in 99% of Public HFs. This absence, they said, is the major reason most the public HFs charge clients as consumables are either bought out-of-pocket by providers or by clients.

1.6.5 Quality of Care Most of the FP clients reported receiving services at no cost, satisfied with providers’ quality of care and service delivery and willingness to return to the same facility in future. However, 30% of clients reported paying receiving services at a cost. When asked the reason for the payment, they reported being asked by providers to bring money for either consumables or pregnancy test and other laboratory tests. In these cases, an average of ₌500 was paid by clients.

38

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 Most of the providers who had conducted IUCD and implant insertions reported that they were comfortable with conducting insertions, but for those who had not conducted any insertions, the lack of training was cited as the primary reason. However, the majority of providers (including those who had never been trained in IUCD and implant services) were interested in providing IUCDs and implants.

Generally, most of the providers interviewed had specific influencing factors for dispensing FP methods. These factors included: minimum and maximum age, marital status, partner consent, and menstrual status. With the exception of sterilization, the majority of providers were open to dispensing FP methods to non-married clients, the main difference being that while 76% of the nurses and health officers were open to inserting implants to unmarried women

39

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

SECTION 2 INTEGRATED FAMILY PLANNING PLAN 2.1. Goal The overarching goal of the state FP CIP is to increase Imo State contraceptive prevalence rate to 27% and also contribute to the reduction of Imo state maternal and child mortality by the year 2024.

2.2. Objectives By 2024, Imo State intends to accomplish the following: • Provide accurate and comprehensive knowledge of FP methods to every segment of the population through easily accessible channels to generate demand and change behaviour.

• Ensure that the State Government and all the LGAs provide the funds required for adequate FP service delivery every year.

• Ensure that every public health and 50% of private health facilities have adequate numbers and categories of trained staff—in line with national guidelines—to provide LARC services.

• Strengthen contraceptive logistics management systems to ensure continuous contraceptive availability at all FP SDPs. • Improve routine data management (including collection, collation, reporting, and use) at all levels of the healthcare delivery system in the state to allow for smooth tracking of FP progress

2.3. Strategic Priorities

40

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 As part of the State FP CIP development process, the SMoH, guided by the National FP Blueprint and the contributions of key stakeholders, prioritised a set of issues most relevant to achieving the state’s target of 27 percent CPR by 2024. These issues surfaced based on existing FP/RH planning work, a diagnosis of the FP landscape in Imo, and partner experiences working in FP programming in the state. Based on these inputs, seven issues emerged as priorities, including one focusing on M&E. 

FP demand generation and behaviour change communication: To strengthen demand for FP services by developing targeted and accurate information and delivering it through accessible communication channels to all key segments of the population.

• FP financing: To set up standard budget lines in the state and LGA budgets to cover FP services, commodities, consumables, and distribution all the way to the service delivery points. 

Staff and training: To build capacity of providers, training institutions and support the health care system in delivering high-quality FP services.

• Private sector delivery channels: To increase coverage and access to highquality integrated FP services and commodities through the private sector, including faith-based organisations, private hospitals/clinics, and pharmacies and PPMVs as appropriate for some methods.

• FP coverage in the PHC system: To improve access to high-quality integrated FP services by the PHC system, including the provision of counselling and delivery of all methods except tuba ligation.

• Forecasting and distribution logistics: To strengthen the state and LGA FP structures to better coordinate and monitor all supply chain activities to deliver commodities and consumables promptly and to efficiently use innovative technologies (e.g., health platforms).

• Evidence-based decision making and performance management: To improve FP knowledge and performance management (e.g., research, data collection, collation, analysis, feedback, and use) at all levels.

41

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

2.4 Structures of the Costed Implementation Plan The state FP CIP activities are structured around six basic areas of the health system for family planning: • Demand generation and behaviour change communication • Service delivery • Supplies and commodities • Policy and enabling environment • Financing • Supervision, monitoring, and coordination Across the six categories, several activities exist—some of which are further sub-divided into sub-activities, with descriptions for costing purposes

2.4.1 Demand Generation and Behaviour Change Communication a. Justification Public awareness of family planning can be enhanced by increasing its public visibility. Knowledge and demand will come from the wide dissemination of accurate information about FP methods and their availability, as well as the encouragement of FP use to promote the health of women and their families. Advocates at the state and LGA levels can increase interest in family planning within communities, producing a supportive

environment,

reducing

normative

barriers,

and

mobilising

community support.

b. Strategy The key proposed interventions aim to sustain support for family planning from the highest policy level and promote public dialogue at all levels—from the state through to the community—about the important role of family planning in promoting health and supporting development. They include high-impact demand generation activities to close the knowledge-use gap by addressing myths and mis-information about family planning and the fear of side effects and health concerns that impede its adoption and use.

42

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 Specific demand generation efforts will be targeted at identified high-priority segments (e.g., adolescents/young people, unmarried women). Community Volunteers shall be trained to help with disseminating information and linking young people to service delivery points if and when they need the services.

Provision of adolescent- and youth-friendly services shall be mainstreamed into pre-service and in-service training of healthcare providers.

c. Activities The activities are aimed at scaling up awareness on family planning for increased uptake of family planning services through capacity-building for Media Reporters on Social Change Communication and Family Planning Champions

and

Community

Volunteers

on

community

mobilization

strategies.

Production of Social Behaviour Change Communication and Service delivery tools for increased awareness on family planning and quality of family planning services.

Priority Issues: 1. Scale up awareness of family planning services in the State by 2024 2. Capacity building of family planning champions and community Volunteers 3. Ensure availability of Family planning job aids and service delivery tools

Proposed Activities: Priority Objective

43

Expecte d Results

Main Activity

Sub Activities details

Inputs required/ Additional details

Output Indicat ors

Tim elin e

Resp.

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 Scale up awareness of family planning services in the State

DBC1.0 Increase d awarene ss on family planning

DBC 1.1 Build the capacity of selected State and Private owned electronic and print media on Social Behaviour Change Communicati on (SBCC) in the promotion of family planning services

DBC 1.1.1 2-day training of select State and Private owned electronic and print media Reporters to increase their knowledg e on social Behaviour change communic ation for family planning (25 Participant s) DBC1.1.2 Inaugurati on of 135 Family Planning Champion s/Advocat es Network (5 per 27 LGAs)

3 facilitators, Hall, Accommod ation, Tea Break, Lunch, Slide Projector, Public Address System, transport, Stationery, Per diem, honorarium

Number of Media Reporte rs trained

Hall, Lunch, Public Address System, Slide projector, transport, Stationery

FP 2021 SMoH Champi , ons Partn Networ ers k Inaugur ated

Hall, tea DBC 1.1.3 break, 1-day Bi- Lunch, Slide annual projector, Family Flip chart& Planning stand, Champion markers, s Review Stationery, meeting transport for 78 members

44

Biannual Review Meetin gs Condu cted

2021 , 2022 2023 and 2024

2021 2022 2023 and 2024

SMoH , Partn er

SMoH , Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 DBC1.1.4 1-day Quarterly Review meeting for 171 Communit y Volunteers (171 ward

Hall, tea break, Lunch, Public Address System, projector, Flip chart &stand, stationery, tansport DBC1.1.5 Transport for Monthly FP Communit Community y dialogue Volunteers, on family BCC planning Materials, by 171 Refreshment Communit y Volunteers in 171 Wards for 50 participant s per ward DBC1.1.6 Transport for conduct 1- FP day Community monthly Volunteers, Communit BCC y Materials, Outreach Refreshment on family , Fuel planning in 171 Wards for 100 participant s per ward

45

Number of Quarterl y Review meetin gs conduc ted

2021 2022 2023 And 2024

SMoH , partn ers

Number of people reache d through commu nity dialogu es Number of session held

2021 2022 2023 and 2024

SMoH , partn ers

Number of people reache d through monthly Commu nity Outrea ches Number of session held

2021 2022 2023 and 2024

SMoH , Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 DBC1.1.7 conduct monthly Compoun d meetings on family planning by 171 Communit y Volunteers in 171 Wards for 50 participant s per ward DBC 1.1.8 1-day Biannual Sensitizatio n meeting for 60 Religious Leaders on Family Planning (20 per each Senatorial Zone) DBC 1.1.9 Production of 7 Family Planning Radio and Television Jingles in English, Igbo and 3 dialects (Radio 5, TV 2) DBC 1.1.10 Airing of 7 Family Planning Jingles on Select 46

Transport for FP Community Volunteers, BCC Materials, Refreshment

Number of people reache d through compo und meetin gs Number of session held

2021 2022 2023 and 2024

SMoH , Partn ers

Hall, tea break, Lunch, Public Address System, projector, Flip chart &stand, Stationery, transport

Number of Religiou s Leaders Sensitize d Number of session held

2021 2022 2023 2024

SMoH , Partn ers

Scripts, Design Format, Fund

Number 2021 SMoH of Partn Jingles ers Produc ed

Fund for airing of Family Planning Jingles

Number of Family Plannin g Jingles

2021 2022 2023 2024

SMoH , Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 State and Private Radio Stations in the State DBC 1.1.11 Mark Special days (World Population Day, Girl Child, Women Contracep tion day & World Condom Day)

Capacity building of family planning champions and community Volunteers

47

DBC 2.0 Increase in uptake of family planning Services

DBC 2.1 Build the Capacity of Family Planning Champions and Community Volunteers

DBC 2.1.1 Conduct a 2-day training for 134 family planning champions on family planning and promotion al strategies

aired as schedul ed

Hall Hire, Radio, Television announcem ents, Tea Break, Lunch, TShirts, Caps, Flex banners, Slide Projector, Public Address System, Stationery, transport 3 facilitators, Hall, Accommod ation, Tea Break, Lunch, Slide Projector, Public Address System, Flip charts& stand, markers, Stationery, transport, per diem. 2 Batches (67 per batch)

Number of Special days celebra ted in the State

2021 2022 2023 2024

SMoH , Partn ers

Number of Family Plannin g Champi ons trained

2021 2022 , 2023 and 2024

SMoH , Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

Ensure availability of Family Planning Behaviour Change Communica tion and Service delivery tools

48

DBC 3.0 Increase in the quantity and quality of Family Planning services

DBC 3.1 Production of family planning behaviour change communicati on and service delivery tools

DBC 2.1.2 3-day training for 305 Communit y Volunteers on family planning and communit y mobilizatio n Strategies.

5 Batches (61 per batch)

3 facilitators, Hall, Accommod ation, Tea Break, Lunch, Projector, PAS, Flip charts & stand, markers, Stationery, transport 5 Batches (61 per batch)

Number of Commu nity Volunte ers trained

DBC 3 1.1 Print 25 family planning BCC and service delivery tools @ 25,000 Copies each (Client Individual Form, Counsellin g Cards, brochures on methods, flip charts, Referral cards, posters, fliers, stickers, Flex banners (and

Samples of BCC, service delivery tools & billboards, detailed Quantificati on, Quotation from companies.

Number 2021 SMoH of BCC & , & 2024 Partn service ers delivery tools printed; billboar ds produc ed & mounte d at strategi c points

202 SMoH 1 , 2022 Partn ,202 ers 3 and 2024

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 produce billboards (15) 5 per each senatorial zone Scale FP awareness and knowledge among in school youths

49

Knowled ge of FP services increase d among in school youths

Strengthen the implementati on of the Family Life Health Education Programme

Transportati 1. on, Engageme Educational nt of State materials Ministry of Education 2.

Assessmen t of the implement ation status of the FLHE programm e in Imo State 3.

Work with SMoE to monitor and supervise the implement ation of the FLHE programm e

Scale up demand for Family Planning through community outreaches

Conduct Quartely Communit y Outreache s in churches, market places, etc in each of the 27 LGAs

Number 2021 SMoH of in , school partn youths ers reache d

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

2.4.2 Service Delivery a. Justification The current staffing and skill levels in the public and private sectors of the state healthcare system do not provide adequate and equitable FP services to the population. Health care workers are concentrated in the urban locations while there is dearth of health care workers in rural locations. It is necessary to both bolster the current delivery system through improving skills and deploy new FP service approaches to improve availability and accessibility.

b. Strategy To ensure wide availability of family planning services, it is essential to identify the health system’s current FP service delivery capabilities and develop modalities for updating the gaps. The core of FP service availability is ensuring that FP health workers at each level have the appropriate training to provide FP services.

FP training of health workers will be increased—both in general and based on immediate scale-up needs for methods (i.e., injectables, LARCs and tubal ligation). A training plan will be developed based on a situation analysis of health worker skills. All partners involved in training will be coordinated by the SMOH to reach training goals. Mentorship and supervision following formal training will be a key activity of the SMOH going forward.

Integrating family planning into other health services will also be explored as a key strategy to enhance its availability at higher-level facilities with sufficient staff; for example, there is a need to build capacity for postpartum IUCD and tubal ligation services in labour wards. Referral for FP services will be stressed in the training and supervision of all healthcare workers who do not themselves provide these services.

Several other innovative approaches to enhancing FP services availability will be piloted, including training staff at pharmacies and PPMVs throughout the state to provide high-quality counselling and services for those methods they are legally permitted to provide.

50

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 In addition to these activities, innovative solutions to reach rural and underserved populations will be employed like FP outreach services to reach hard to reach communities.

c. Activities The key Priorities addressed by the activities in Service delivery are promotion of uptake of LARC services including PP-IUD; scale up of FP outreach services and promotion of uptake of tubal ligation services. The key targets include: • Increase the uptake of Implants from the current 21,595 users to 145,440 users by the end of December 2024; • Increase the uptake of IUD from the current 8,098 users to 76,548 users by the end of December 2024; • Increase the uptake of tubal ligation services from the current 1,350 users to 22,964 by the end of Dec. 2024; • to increase the uptake of other modern contraceptive methods by the end of December 2024 and • Ensure provision of quality FP services in the health facilities by the end of December 2024.

Priority Issues: 1. Promotion of uptake of LARC services including PP-IUD 2. Scale up FP Service Outreaches 3. Promotion of uptake of tubal ligation services.

Proposed Activities: Priority Objective

51

Expecte d Results

Main Activity

Sub Activities details

Inputs required/ Additional details

Output Indicat ors

Tim elin e

Resp.

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 To increase the uptake of Implants from the current 8,098 users to 76,548 users by the end of December 2024;

52

SD 1.0: Increase d uptake of Implants

SD1.1: Build the capacity of HCWs in the tertiary, secondary and primary healthcare facilities (public and private) in the state to provide LARC services

SD1.1.1: Conduct a 6-Day Training of 20 Master Trainers on LARC

5 facilitators, Hall Hire, Anatomic models, other training materials, consumable s, Accommod ation, 2 tea breaks, lunch, slide Projector, flip chart & stand, markers, Per diem, Transport SD1.1.2: 7 facilitators, Conduct a Hall Hire, 6-Day Anatomic Training of models, 100 other nurse/midwif training es and materials, doctors (50 consumable nurse/midwif s, es & 50 Accommod doctors) ation, 2 tea from private breaks, hospitals on lunch, slide provision of Projector, LARC flip chart & services stand, markers, Per diem, Transport

Number 2021 SMO of H Master &Part Trainers ners trained

Number SMO of 2021 H doctors &Part trained ners on LARC

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

53

SD1.1.3: Conduct a 6-Day Training of 30 doctors from IMSUTH, (O&G, Family Medicine & Community Medicine), FMC Owerri, ISSH & the GHs on provision of LARC services

5 facilitators, Hall Hire, Anatomic models, other training materials, consumable s, Accommod ation, 2 tea breaks, lunch, slide Projector, flip chart & stand, markers, Per diem, Transport

Number 2021 SMO of H doctors &Part trained ners on LARC

SD1.1.4: Conduct a 6-Day training of 80 Nurses/ Midwives from 80 public health facilities on provision of LARC services in 4 batches of 20 each.

5 facilitators, Hall Hire, Anatomic models, other training materials, consumable s, Accommod ation, 2 tea breaks, lunch, slide Projector, flip chart & stand, markers, Per diem, Transport

Number 2021 SMO of & H Nurses/ 2022 &Part Midwiv ners es trained on LARC

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 SD1.1.5: Conduct a 6-Day training of 342 CHEWS (one from each of the PHCs) on provision of LARC services in 11 batches of 30 each (4 batches per year.)

To increase the uptake of IUD from the current 8,098 users to 76,548 users by the end of December 2024

SD 2.0: Increase d uptake of IUDs

SD2.1: Build the capacity of HCWs in the tertiary, secondary and primary healthcare facilities (public and private) in the state to provide PPIUD services

SD2.2: Build the capacity of HCWs in the private healthcare facilities in the state to provide PPIUD services

54

5 facilitators, Hall Hire, Anatomic models, other training materials, consumable s, Accommod ation, 2 tea breaks, lunch, slide Projector, flip chart & stand, markers, Per diem, Transport SD2.1.1: 5 facilitators, Conduct a Hall Hire, 5-Day Anatomic training of models, 80 Nurses/ other Midwives training from 80 PHFs materials, on provision consumable of PP-IUD s, services in 4 Accommod batches of ation, 2 tea 20 each breaks, lunch, slide Projector, flip chart & stand, markers, Per diem, Transport Conduct a 5 facilitators, 5-Day Hall Hire, training of Anatomic 100 Nurses/ models, Midwives & other doctors from training 100 PHFs on materials, provision of consumable PP-IUD s, services in 4 Accommod

Number of CHEWS trained on LARC

2021 , 2022 & 2023

SMO H &Part ners

Number 2023 SMO of & H Nurses/ 2024 &Part midwiv ners es trained on PPIUD

Number 2023 SMO of , H Nurses/ 2024 &Part midwiv ners es and doctors from the private health

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 batches of 25 each

SD2.1.2: Conduct a 5-Day training of 342 CHEWS (one from each of the 342 PHCs) on provision of PP-IUD services in 6 batches of 30 each.

To increase the uptake of tubal ligation services from the current 1,350 users to 22,964 by the end of Dec. 2024;

SD3.0: Increase d uptake of tubal ligation

SD3.1: Build the capacity of doctors and specialist nurses working in the tertiary, secondary and PH facilities to provide tubal ligation services

SD3.1.1: Conduct a10-Day Training of 80 doctors (30 from Public HFs and 50 from Private HFs) on provision of mini-lap services in 8 batches of 10 each

Improve

SD4.0:

SD4.1: Build

SD4.1.1:

55

ation, 2 tea breaks, lunch, slide Projector, flip chart & stand, markers, Per diem, Transport 5 facilitators, Hall Hire, Anatomic models, other training materials, consumable s, Accommod ation, 2 tea breaks, lunch, slide Projector, flip chart & stand, markers, Perdiem, Transport 4 facilitators, Hall Hire, Anatomic models, other training materials, consumable s, Accommod ation, 2 tea breaks, lunch, slide Projector, flip chart &stand, markers, Per-diem, Transport 5 facilitators,

sector trained on PPIUD

Number 2023 SMO of & H CHEWS 2024 &Part trained ners on-IUD

Number SMO of 2022 H doctors &Part & ners Nurses trained on provisio n of tubal ligation

Number 2022 SMO

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 knowledge and skills of pre-service tutors on LARC by 2023

Improve d knowled ge and skills of tutors and precept ors of PSE Institutio ns on modern FP methods

the capacity of tutors and preceptors of the 11 PSE Institutions in the State on Modern FP Methods

conduct a 6 -Day training of 44 tutors and preceptors of PSE institutions on LARC in two batches of 20 each

SD5.0: Improved quality of FP services in the health facilities

SD5.0: improve d quality of FP services in the health facilities

SD5.1: Institutionaliz e supportive supervision and mentoring of all trained FP providers in the State

SD5.1.1: Monthly supportive supervision and mentoring visit to the 639 Health facilities in the State

SD5.2: Retain skilled providers at SDPs for a period of 5 years to allow for optimal service provision.

SD5.2.1: Advocate to LGA health managers, ISPHCDA, ISSH and IMSUTH to retain trained providers for a period of 5 years to allow for transferring skills and building FP

56

Hall Hire, Anatomic models, other training materials, consumable s, Accommod ation, 2 tea breaks, lunch, slide Projector, flip chart & stand, markers, Per diem, Transport 5 team members, Transport, checklist, refreshment

No cost.

Leverage on existing platforms e.g.

Enlarged Manageme nt meeting since Admin. Secs are under SPHCDA

of PSE Staff trained on LARC

Number of field visits conduc ted Number of Provider s supervis ed and mentor ed Number of trained provide rs who spent at least 5 years post training in the unit of their posting

H& Partn ers

2021 , 2022 , 2023 , 2024

SMO H& Partn ers

2021 , 2022 , 2023 & 2024

FP AWG, SMO H

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

Scale up FP outreach services to women in hard to reach communities

To ensure availability of all relevant equipment for training and clinical practice

57

SD6.0: Increase d uptake of FP services

SD7.0: Relevant equipme nt availabl e at both training and clinical sites

SD6.1: Provide periodic community outreach services to increase FP uptake

SD7.1: Procure FP equipment and anatomic models for training

service provision capacity.

SD6.1.1: Conduct FP quarterly outreach across the 305 wards in the State

SD7.1.1: Conduct an initial needs assessment to determine the equipment needs for FP services for each facility and FP program.

SD7.1.2: Procure equipment, models, commoditie s and consumable s (e.g., IUD insertion kits, plastic uteruses for IUDs, or plastic arms for implants)

FP commoditie s, consumable s, lunch and transport

Number of new FP accept ors followin g outreac h services

SMoH 2021 , 2022 SPHC , DA, 2023 Partn , ers 2024

Number of outreac h services conduc ted Personnel, Quantifi 2021 SMO transport, cation .

H, refreshment. of 2022 SPHC equipm DA, ent and Partn commo ers dities needed at SDPs

Detailed quantificati on of commoditie s, finance, activation of procuremen t processes, transportati on of commoditie s, storage, etc.

Quantit y of training equipm ent, commo dities and consum ables procure d

2021 , 2022 , 2023

SMO H, SPHC DA, Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

Scale up communitybased distribution of shortacting methods through PPMVs by 2024.

58

SD8.0: Improve d quality of short acting FP services rendere d by PPMVs

SD8.1: Establish FPfocused orientation programme s for PPMVs.

based on determined needs SD7.1.3: Procure equipment, commoditie s and consumable s e.g.

Sponge holding Forceps, Speculums, Tenaculum, Implant insertion Kits, IUD insertion Kits and consumable s SD8.1.1: Conduct a 2-Day nonresidential Annual orientation of 150 PPMVs on short acting methods /referral in three clusters one in each senatorial zone (50 per cluster) SD8.1.2: Quarterly meetings with PPMVs to provide updates and collect reports (2nd year 150, 3rd year 300, 4th

Detailed quantificati on of commoditie s, finance, activation of procuremen t processes, transportati on of commoditie s, storage, etc.

Quantit y of equipm ent, commo dities & consum ables procure d and distribut ed to SDPs.

2021 , 2022 , 2023

Hall, Tea break, lunch, transport, orientation materials, projector and screen, flip chart and stand

Number 2022 SMO of & H, PPMVs 2023 SPHC orientat DA, ed on Partn family ers plannin g.

Hall, Tea break, lunch, transport, training materials, projector and screen, flip chart and stand,

Number of quarterl y meetin gs held Number of PPMVs that

2022 , 2023 & 2024

SMO H, SPHC DA, Partn ers

SMO H, SPHC DA, Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

Scale up access of contraceptiv e Services to young people.

SD9.0: Increase d youths’ access to contrac eptive services

SD9.1: Improved access to contracepti ve services among young people

year 450)

PAS

SD9.1.1: conduct a 7 days study to assess functionality and contribution s of the current 3 AYFHS Centres to contracepti ve services SD 9.1.2: Establishme nt of one AYFHS Center in each of the remaining 24 LGAs

3 persons, Review Transport, ed refreshment, Report review tools, report writing

2021 SMO H, SPHC DA, Partn ers

Accommod ation, furniture, TV set, DVD, Indoor games, counselling tools, registers, motorcycles etc.

4 facilitators, Hall Hire, Anatomic models, other training materials, consumable s, Accommod ation, 2 tea breaks, lunch, slide Projector, flip chart & stand, markers, Per-diem, Transport

2021 , 2022 .

2023 , 2024

SD10.1.3: 5Day training of 30 AYFHS Focal Persons on Provision of youth friendly contracepti ve services

59

attend the meetin g

Number of 27 LGAs AYFHS Centres establis hed

SMO H, SPHC DA, Partn ers

Number 2021 SMO of H, AYFHS SPCD FPs A, trained Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 To ensure proper coordination of FP services and timely submission of report by 2023

SD10.0 Timely submissi on of FP service reports by service providers

1.

SD10.1: Establish State, /LGA Coordinatio n meetings

SD10.1.1: Quarterly State-LGA FP coordinatio n meetings with 27 RH/FP Focal persons and 5 SMoH Officers

Hall, Tea break, Lunch, transport, training materials, projector and screen, flip chart and stand, PAS

Number of meetin gs held Number of particip ants submitti ng reports on time

2021 2022 2023 & 2024

Commodities and Supplies

Justification This thematic area addresses the sustainable supply of safe and quality contraceptive commodities and related consumables. Currently, the state receives commodities from the Federal Government thus efforts here are aimed at ensuring that they are adequate and available to meet the needs and choices of FP clients. The activities of this strategic priority will be implemented in line with the FMoH Reproductive Health Commodity Security (RHCS) Strategic Plan.

Currently, significant distribution challenges are limiting factor in ensuring the availability of high-quality FP services at SDPs. Specific activities will be undertaken to ensure that contraceptives are delivered to the “last mile� to health facilities to ensure RHCS throughout the state, including rural areas.

b. Strategy At the Federal level, supply no longer poses a significant challenge for FP commodities, thus the focus will be on resolving distribution challenges from state stores to the LGA stores and SDPs. A key focus will be on improving the distribution of commodities, ensuring that the last mile of the supply chain is strengthened.

60

SMoH , SPHC DA, Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

c. Activities Family planning commodities flow from Federal Central Medical Stores to State Central Medical Stores. The State Central Medical Store will be upgraded to meet minimum requirements for storage of pharmaceutical products. To ensure effective distribution and reporting, the capacity of the relevant actors such as the LMCU, LLMCU and SDP staff will be built on Contraceptives

Logistics

Management

System

(CLMS).

Furthermore,

appropriate LMIS tools will be made available for efficient and effective management of Family planning commodities.

Priority Issues: • Maintain constant availability of FP commodities at the HFs • Develop the capacity of the LMCU, LLMCU members and facility staff on CLMS. • Ensure last mile distribution of family planning commodities.

• Ensure the availability of logistics management information system (LMIS) tools.

• Ensure appropriate use of LMIS tools.

Proposed Activities: Priority Objecti ve

Expecte d Results

Main Activity

To ensure consta nt availab ility of FP commo dities at the last mile

CS1.0 Reduce d stock out rate of FP commo dities at SDPs, increase d product availabili

CS1.1: Conduct a one-day bimonthly last mile distribution (LMD) of family planning commoditi es to SDPs

61

Sub Activities Inputs details required/ Additional details 1.Disseminate Distribution information van hire, to conveyors, participating communica facilities 2. tion (SMS & Pick and calls), pack FP Transport commodities allowance from CMS to for State the 6 clusters conveyors 3. Rent and FP distribution provider

Output Indicat ors

Tim elin e

Resp onsibl e

Number 2021 SMO of H& Facilitie 2024 Partn s that ers receive d FP commo dities and reporte d stockou

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

To ensure that deliver y and security of commo dities at the last mile To ensure consta nt availab ility of consu mables at facilitie s and CMS

To ensure consta nt availab ility of CLMIS tools at the facilitie s To build the capacit y of FP

ty and enhanc ed commo dity security CS2.0 Enhance d commo dity security and increase d product availabili ty CS3.0 Eliminati on of service charge on clients due to lack of consum ables and increase d service uptake CS4.0 Increase d docume ntation and data reporting

CS5.0 Increase d capacit 62

vans

t of commo dities in their RIRF

Conduct a 5day post LMD monitoring visit to supported FP facilities

Monitoring checklist, vehicle hire, daily transport allowance for participatin g LMCU and FP unit staff, allowance for providers CS3.1: 1.

Historical Procure Quantificatio and current 4000 FP n of stock status Consumabl Consumables data for e kits per to be quantificati year procured in on, market collaboration survey with LMCU reports, 2. Submit proposal proposal for writing procurement

Comple 2021 SMO ted H & checklis 2024 Partn t, ers verified proof of delivery notes (RIRF)

CS4.1: Produce CLMIS data tools

Printing of 10, Proposal, 000 tally sample tools cards, 1,500 for printing RIRF booklets, 2,000 DCR booklets and 1,000 FP registers

Quantit y of data tools printed, delivery vouche r

CS5.1: Capacity building of service

Conduct a 5day residential training on

Number 2021 SMO FP H& provide 2024 Partn rs ers

CS2.1: Last Mile Distribution (LMD) Monitoring

Accommod ation, hall hire, 2 tea breaks,

Number 2021 SMO of H& consum 2024 Partn able kits ers procure d and proof of delivery

2021 SMO H& 2024 Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 provide rs in PHFs on CLMS

y of provider s on CLMS and knowled ge of LMIS tools

To meet the commo dity deman ds of SDPs

CS6.0 Increase d capacit y of the State FP unit to meet commo dity demand s of SDPs and enhanc ed product security To CS7.0 provide Improve on the d data job quality training and of data provide output, rs and enhanc enhanc e the e their capacit perform y of ance provider s for service delivery and ensure account ability

63

providers on CLMS

CLMS for 639 FP service providers in 4 of 50 batches per year

lunch, transport, projector, flip chart, flip chart stand markers, 2 resource persons and training materials CS6.1: Hire a truck Truck hire, Trucking of that will commodity FP transport conveyor, Commoditi commodities loaders, es from from Lagos to accommod CCW Owerri ation and Oshodi to DSA for CMS Owerri State conveyor, communica tion

trained on CLMS

CS7.1: Conduct quarterly integrated supportive supervision of FP facilities on supply chain managem ent

Number 2021 SMO of FP H& facilities 2024 Imple visited, menti comple ng ted partn checklis ers ts with recom mendat ions

1. Form a combined supervision team comprising FP unit, LMCU and LGA FP supervisors 2. Produce copies of supervision checklist 3. Orientation of supervision team on the use of supervision checklist 4. Rent vehicles for

Supervision checklists, personnel (LMCU, FP unit and LGA supervisors, vehicle hire, DTA for supervision team, SMS and calls

Physical count, verified delivery note and lead time

2021 SMO H & 2024 Imple menti ng partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

To assess stock levels and expiries of commo dities across the three levels of distribut ion

To improv e the quality of LMIS data fed into NHLMIS platfor m To build the capacit y of LMCU membe rs on CLMS

To ensure uninterr upted

CS8.0 Reduce d stock out and reduced (or eliminati on) expiry of commo dities.

Increase d knowled ge of consum ption rate CS9.0 Improve d data quality

CS10.0 Increase d CU member s on CLMS and LMIS

CS11.0 State ownershi p of 64

supervision CS8.1: 1. Convey a Prepare FP one -day Quarterly meeting of stock status LMCU and FP report unit to (QSSR) prepare the QSSR 2.

Disseminate and implement findings of the report

CS9.1: Conduct bimonthly RIRF data review and validation meeting

1. Send SMS invitation to all participants 2. Rent chairs and tables for the meeting

CS10.1: Capacity Building of LMCU members on contracept ive capacity of LMCU members on logistics managem ent system (CLMS) CS11.1: Procure 671,000 units of

Conduct a 5day residential TOT for 20 State LMCU members on CLMS

Quantificatio n, proposal submission, call for

Personnel, SMS and calls, venue renting, transport allowance, printing and disseminatio n of reports

Availabi 2021 SMO lity of H copies 2024 of QSSR

SMS, chairs and table renting, transport allowance for participants, refreshment, printing and photocopy Accommod ation, hall hire, 2 tea breaks, lunch, transport, projector, flip chart, flip chart stand markers, 2 resource persons and training materials Historical consumptio n data, proposal,

Copies of validat ed RIRF and attend ance sheet

2021 SMO H 2024

Availabi 2021 SMO lity of H& training 2023 Partn attend ers ance list and photo

Proof of delivery , lead time

2021 SMO H 2024

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 supply of FP commo dities to Imo State in the event of paucity donor fund

procure ment and selfsufficien cy

Family Planning Commoditi es per year

2.

procurement tender/bid

tender notice, procuremen t protocols

and physical inspecti on

. Policy and Enabling Environment

a. Justification Although the state government is increasing efforts to domesticate federal level FP supportive policies, additional support will be paramount in achieving the state FP goals. There is still insufficient allocation of human and financial resources to achieve these goals. Therefore, the priority area of policy and environment focuses on advocacy for family planning within various levels of government and the private sector, including faith-based organisations, civil society and private providers to ensure that the best policies are both present and fully implemented.

b. Strategy To improve the enabling policy environment for family planning, government policies and strategies will be updated as necessary to ensure that family planning is integrated appropriately. Specific advocacy will also be conducted to ensure that policies and guidelines for family planning promote rather than hinder access to it, especially by under-served populations, faithbased groups, and youths. The SMoH and partners will support advocates at all levels who can play key role in ensuring that family planning remains in the limelight for both policy making and domestic funding.

c. Activities Activities that are needed to provide enabling policy environment for Family Planning services in the state include: 65

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 • Domestication of relevant National FP policies • Development of evidence-based advocacy materials • Increase in advocacy momentum through participation in the state, national and international FP related events and • Increase in human resource in the health sector and funding for FP.

Priority Issues: • Domestication of national family planning relevant policies at State and LGA levels.

•

To

increase

advocacy

momentum

through

State,

National

and

Inputs required/ Additional details Hall, Stationery, Transport, Snacks, Lunch

Output Indicat ors

Tim elin e

international events.

• Increase human resources for health and FP funding

Proposed Activities: Priority Objective

Expecte d Results

Main Activity

Sub Activities details

To domesticate relevant national family planning policies in the state

Availabili ty of relevant FP policies in the state and LGAs

Domesticatio n and circulation of national FP policies for Imo State.

1-day meeting of 30 AWG members and stakeholde rs to identify and review relevant national policies for domestica tion.

66

Resp.

No of 2021 SMO AWG H, and AWG, stakeho Partn lders ers that attende d.

No of policy docum ents identifie d

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

To increase advocacy momentum through participation in State, National and international events

67

Partners hip and collabor ation for FP service delivery Improve d.

Participation in State, National and international FP conferences and events.

A 3-day meeting of 50 AWG, State and LGA stakeholde rs to develop a state-level advocacy plan for adoption of relevant FP policies

Hall, stationeries, transport, lunch

A 3-day meeting of 30 AWG and stakeholde rs to develop evidencebased advocacy materials for decision makers highlightin g annual projected cost, cost savings, impact analysis and other benefits of FP Support 5 Staff of FP Unit Ministry of Health, AWG members and other relevant

Hall, stationeries, transport, lunch

Transport, Per diem, Accommod ation, Course fees

Number of AWG and stakeho lders that attende d, Number of policy docum ents adopte d Number of AWG and stakeho lders that attende d, Number of policies eviden cedbased advoca cy materia ls develo ped

2021 SMO H, AWG, Partn ers

Qua rter 3 2020

SMO H, AWG, Partn ers

No of 2021 SMO persons H& that 2024 Partn attende ers, d FP State nationa l and internati

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 stakeholde rs to attend FP national and internation al Conferenc es.

To advocate for increase in Human Resources for Health especially as it relates to FP service provision.

68

Adequat e manpow er providin g FP and other health services at all levels of health care.

Engage all relevant Policy makers to employ all cadres of HWs.

One-day meeting of Advocacy Working Group to identify relevant Policy Makers on recruitmen t of HWs and plan next step on their engagem ent.

1-day advocacy visit to 9 policy makers (Hon. Commissio ner for Health, Chairmen House Committe es on Health,

onal confere nce and events Networ ks and partners hips establis hed as a result of particip ating in these events Hall, Stationery, snacks, lunch and transport.

No of 2021 AWG AWG s, membe 2023 Partn rs that ers attende d.

Number of Policy makers identifie d to be advoca ted

Stationeries, lunch, transport

Number 2021 SMO of H, policy 2023 AWG makers and visited partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 establishm ents, Chairman CSC, ES of SPHCDA, and CEO SHMB on manpower situation of the health sector in the State, and advocate for the recruitmen t of HW Follow up visit to Hon. Commissio ner for Health, Chairmen House Committe es on Health, establishm ents, Chairman CSC, ES of SPHCDA, and SPC, CEO SHMB on manpower situation of the health sector in the State, and advocate for the recruitmen t of HW Advocacy visit to the

69

Advocacy briefs, materials and transport

Number 2021 AWG of / policy 2023 Partn makers ers visited Number of advoca cy visits conduc ted

Stationeries, lunch,

Waivers 2021 SMO granted H.

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

To advocate for increase FP funding

70

Increase d in FP funding

Engage State and LGAs Policy makers to increase funding for FP and promptly release approved funds.

Executive Governor, to obtain waiver for the recruitmen t of HW Advocacy visits to Hon. Commissio ner & PS SMOH & Ministry of Planning, ES SPCHDA, DPRS and Director of Budget on increasing budgetary allocation for FP and prompt release of approved fund.

1- Day Advocacy meeting with Chairman, HPM, TR, and Administra tive Sec of 13 LGAs on increasing budgetary allocation for FP and prompt release of approved funds.

transport

by the 2023 AWG govern and or partn ers

Advocacy kit, Stationery, lunch and transport

No of 2021 SMO advoca H/AW cy visits 2023 Gs/ conduc ted

Hall, Stationery, snacks, lunch and transport.

No of SMO LGA 2021 H/AW policy Gs/ makers 2023 partn that ers attende d.

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

2.4.5. Financing a. Justification While the overall policy environment for family planning is increasingly positive, the government’s strong policy and strategic commitment has to be accompanied by a commensurate dedication of state, or LGA-level financial resources.

b. Strategy To address the limited financial commitment to family planning within the various government budgets commensurate to need, the SMoH, CSOs and partners will advocate for increased funding within state budgets, in addition to funding secured from development partners and the private sector. The SMoH will also cultivate advocates within other ministries to ensure that the state budget includes a line item for family planning that increases over time to meet the growing demand for FP services.

c. Activities Imo State Ministry of Health with support of relevant partners will develop advocacy

documents

advocacy.

Furthermore,

and

scorecards

annual

budget

to

support

tracking

for

evidence-based allocative

and

expenditure efficiency assessment will be done. Financing activities will also target the LGA budgeting and expenditure process to expand public sector funding and last mile distribution. Due to several competing economic needs, the public-sector resources alone will not be able to adequately fund FP activities, thus, the private sector through Corporate Social Responsibility (CSR) and individual philanthropist will be mainstreamed into the funding space of FP to minimize the gap in the State.

Priority Issues: 71

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 • Develop evidence-based advocacy materials, score card and policy briefs to advocate for more allocations and releases of fund for FP on annual basis.

• Target Local Governments to budget adequately for FP interventions • Increase donor and private sector commitment to FP interventions.

• Increase annual allocation to CPR pillar of SOML P4R programme • Develop capacity of stakeholders and provide technical support for budget tracking

Proposed Activities Priority Objecti ve

Expecte d Results

Main Activity

Sub Activities details

Develo p eviden cebased advoc acy materia ls, score card and policy briefs to advoc ate for more allocati ons and release s of fund for FP on annual basis.

FIN 1.0 Increase d allocatio n and release of FP budget

FIN 1.1 Develop FP advocacy package highlighting annual projected costs, potential cost savings, impact analysis, scorecard and other benefits of family planning and adapt it accordingly for the various target groups.

FIN1.1.1 Hold a 3day meeting for 20 technical staff and developm ent partners for Advocacy material/ Scorecard materials developm ent FIN 1.2.2 Conduct advocacy to relevant Ministries and agencies for timely and complete releases of budgeted funds FIN 1.2.1 A

FIN 1.2

72

Inputs required/ Additional details  Hall @ hotel in Imo • Transport refunds • Lunch •Refreshme nts • Printing: 20 pages per person

Output Indicat ors

Timel ine

Resp.

Q3 Number annu of ally advoca cy materia ls / briefs develo ped

SMoH & FPA WG

Advocacy meetings and followups

Advoca cy conduc ted Comple te and timely releases of budget ed funds

2021, 2022, 2023, 2024

SMoH & FPA WG

Printing of

Number 2021

SMoH

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 Disseminate the FP advocacy briefs/Scorec ards to advocates and relevant stakeholders

Target LGA to budget adequ ately for FP interve ntions

FIN2.0: FP budget line included and released in LGA annual budget and expendit ure

73

FIN2.1: Hold regular consultations /advocacy with key stakeholders on LGA funding at the LGA levels for increased funding for FP

1-day orientation meeting for advocacy groups, networks and champions on the use of the packages developed .

FIN2.1.1: Developm ent of LGA FP Costed Workplan FIN2.1.2 Advocacy to Hon. Commissio ner for LGA and Chieftainc y matters, Chairman LGA service Commissio ner, LGA Chairmen, and other key officers

300 copies of advocacy briefs/Score card and distribute to advocates for targeted advocacy

of advoca tes oriente d on the use of the FP advoca cy briefs and packag es Stationeries, Number 2021hall, lunch, of LGAs 2022 transport, with a advocacy costed materials, FP Plan projector Number of LGAs with FP budget line Number of LGAs with increasi ng FP budget s and releases

& FPA WG

SMO H, MOL G&C A

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 Increas e donor and private sector commit ment to FP interve ntions.

FIN.3.0 Increase d donor support/ funding and secure Private Sector funding for FP in the state through CSR for SME's and corporat ions, Individu al Philanthr opist and other innovativ e mechani sms

74

FIN 3.1 Hold Strategic engagement meetings with major donor agencies like USAID, DFID, and UNFPA to strengthen funding for FP in the State.

FIN 3.1.1 Hold three Governme nt / Donor Agencies Strategic engagem ent meetings

One-day strategic engageme nt meeting with Donor Agency.

Inputs are slides, printings, transport, periderm, lunch

Number 2021of 2023 Donor partners the state has MOU's with.

SMO H/FP AWG

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 Stationeries Hall, Lunch, Transport, advocacy materials, projector

FIN 4.0 Increas Increase e d in annual SOML allocati funds for on to FP CPR pillar of SOML P4 R progra mme Develo p capaci ty of stakeho lders and provide technic al support for budget trackin g

FIN 5.0 Budget tracked and reported annually

75

FIN.4.1 Present proposal of result-based FP activities to Technical Core Group (TCG) and Programme Management Unit (PMU) of SOML in the State FIN 5.1 Capacity building of financial and program officers on Budget tracking for FP program implementati on

2021

SMoH & Gove rnme nt Hous e SMoH

FIN 3.2.3 Biannual review of activities of the committee

Stationeries Hall, Lunch, Transport, advocacy materials, projector,

Number of FP ambass adors and SMEs that attend the review

2021 2022 2023 & 2024

FIN 4.1.1 One-day meeting to harmonize proposal into state SOML budget

Stationeries Hall, Lunch, Transport, advocacy materials, projector,

Percent age increas e in FP budget in the SOML P4R budget

20212024

SMoH and FPA WG

FIN 5.1.1 Two-day workshop for 25 persons

Hall, Lunch, Transport, advocacy materials, Stationeries, projector,

2021

SMoH

IN 5.1.2.

One-day budget tracking meeting

Hall, Lunch, Transport, advocacy materials, Stationeries, projector,

Number trained on budget tracking for FP progra mming Number of people that attende d the meetin g

Q1 annu ally

SMoH and Other s

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

3.

Supervision, Monitoring, and Coordination (SMC)

a. Justification Effective coordination of FP activities at all levels is very important if the state is to achieve its FP goal. Better systems are needed to improve coordination among partners and the SMoH to ensure that activities are implemented as needed at state level. Current challenges in supervision, monitoring, and coordination include inadequate dedicated staffing and financial resources at the state, LGA and Facility levels, as well as inadequate data management.

b. Strategy The Core Technical Committee is a forum where discussion on issues surrounding integrated maternal, new-born and child health are held. Efforts will be undertaken to make this group more effective and efficient by ensuring a standardized schedule of meetings.

In recent times, the NHMIS has adopted the use of District Health Information System (DHIS2) for reporting health related service data. All facility-based information systems feed into the DHIS2. It is a database adaptive to different levels such as the LGA, state, and national. The DHIS2 empowers health workers at facilities and all levels to use information to improve health services. Implementation of the state FP CIP shall be integrated into it.

Mentorship and supervision are key strategies for improving the quality of implementation. National supervisory tools will be adapted to include key FP quality standards, such as youth-friendly service provision. Supervisors will receive training in conducting supportive supervision. Mentoring and supervisory tools for family planning will be adopted as part of the training curriculum for use in post-training mentorship sessions.

c. Activities This section outlines activities geared towards supervision, monitoring and coordination by increasing coordination between stakeholders in family 76

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 planning programmes, monitoring of the implementation of the CIP, ensuring regular and timely supportive supervision of the FP services as well as ensuring that the budgeted activities are carried as planned.

Priority Issues: • Limited coordination of Family Planning partners and implementers in the State • Inadequate supervision of providers especially at LGA levels • Non-existence of effective monitoring mechanism • Poor Data quality from facilities

Proposed Activities Priority Objecti ve

Expecte d Results

Main Activity

Sub Activities details

Increas e Coordi nation betwee n Stakeh olders in family

SMC 1.0 Institutio nalize improve d coordin ation mechani sms between

SMC 1.1 Institutionalize coordination mechanisms with development partners.

SMC 1.1.1 Hold a 1day CTC meeting monthly funded by SMoH

77

Inputs required/ Additional details •SMoH Hall • Transport refunds • Lunch, projector • Refreshment s • Printing and Stationary

Output Indicat ors

Tim elin e

Resp.

Number of CTC membe rs in attend ance

Qua rterl y 2021 , 2022 , 2023 & 2024

SMoH and Partn ers

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 plannin g Progra mme in the State.

SMoH and develop ment partners

Monitor ing of the implem entatio n of CIP with a substitu tion plan to prepar e another plan

SMC 2.0 Quarterl y CIP Monitori ng meeting held, and a new FP CIP develop ed by Q4 2023

78

SMC 2.1 Hold quarterly CIP execution meeting by CIP Core team and other relevant stakeholders.

SMC 1.2.2 Hold 1-day bi -annual coordinati on/ review meeting for Selected Private Sector facilities (including PPMV's) and publicsector facilities that provide FP services to improve coordinati on between public and private facilities.

SMC 2.1.1 Hold a 1day quarterly meeting to review CIP performan ce with key actors and tease our activities for next quarter

•Hall @ hotel in Imo • Transport refunds • Lunch, projector • Printing and Stationary

Number of private and publicsector provide rs who attende d the review meetin gs

Qua rterl y 2021 , 2022 , 2023 & 2024

SMoH and Partn ers



Number of quarterl y CIP meetin gs held.

Number of people that attende d the meetin gs

Qua rterl y 2021 , 2022 , 2023 & 2024

SMoH and CIP Core Team

   

Hall @ hotel in Imo Transport refunds Lunch, projector Refreshm ents Printing and Stationary

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 before the end of 2023

Ensure regular and Timely Support ive Supervi sion of provide rs of FP service s.

79

SMC.3.0 Improve d FP quality of service

SMC 2.2 Develop 2021 - 2025 CIP

SMC 2.2.1 Hold a 5day residential meeting in Q4 of 2021 to develop and cost FP activities for 2021 2025

SMC 3.1 Capacity building and deployment of trained personnel at LGA level to conduct regular Supportive Supervisory Visits to providers under them

SMC 3.1.1 Hold a 5 days training of 2 Master trainers in each LGA making 54 persons.

•Hall @ hotel outside Owerri • Transport refunds, per diem and Accommod ation • Lunch, projector • Refreshment s • Printing and Stationary •Hall @ hotel outside Owerri • Transport refunds, per diem and Accommod ation.

• Lunch, projector •Refreshme nts, SOP's and training manual, 4 consultants for assignment • Printing and Stationary

New Q4 CIP 2021 Launch ed by Q4 2021

SMoH and CIP Core Team

Number 2021 SMoH of & master 2022 trainers trained

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

Ensure that budget ed activitie s are carried out as planne d

SMC. 4.0 Account ability and transpar ency in the use of fund allocate d for FP prog.

SMC 4.1 Onsite visit and assessment of activities to ensure it is in line with the CIP.

Improv e quality of data

SMC 5.0 Quality data reporting

SMC 5.1 Conduct quarterly DQA

80

SMC 3.1.2 Each Master trainer to supervise at least 5 providers monthly within the LGA and report same on a monthly basis to SMoH SMC 3.1.3 Organize bi-monthly SSV support by the State team to selected LGA. SMC 4.1.1 Conduct quarterly activity and financial implement ation assessmen t to ensure implement ed activities are as in the approved plan.

SMC 5.1.1 Adapt and print DQA tools

SSV report template, transport allowance, refreshment, communica tion allowance

Number of SSV conduc ted by each master trainer

2021 , 2022 , 2023 & 2024

LGA FP Super visor and LGA Mast er traine r

Stationeries, Lunch, Transport, per diem, accommod ation

Number of provide rs/ facilities visited

2021 SMoH , 2022 2023 & 2024

Vehicle/Fuel if vehicle is available already, Transport refunds • Lunch

Number of quarters activity and financia l implem entatio n assessm ent is conduc ted

2020 2023 Q1, 23,4

Hall, Lunch, Transport, advocacy materials,

Number Qua SMoH of times rterl DQA is y conduc

SMoH /FP Advo cacy Grou p /Oth ers partn er

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 reportin g

81

improve d

SMC 5.1.2 Conduct DQA in 100 facilities quarterly SMC 5.1.3 Hold debrief meeting where the report DQA findings is presented SMC 5.1.4 Hold monthly LGA data validation meeting and provide NHMIS data tools in all facilities providing FP services SMC 5.1.5 Conduct monthly data validation meetings to ensure FP data is complete and properly reported

Stationeries stationery, projector, etc.

ted in a year

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

SECTION 3 COSTING 3.1 Cost Summary The total cost of implementing the state FP CIP over the course of four years is estimated at â‚Ś2,046,002,139 billion or $5,301,897 million. The costs of the CIP were calculated using an Excel-based costing tool with methodologies borrowed from the costing of other FP plans in some States of the Country.

The cost estimates consider total resource requirements for contraceptive commodities, contraceptive consumables, and programme activities over the four-year CIP period. The CIP costs were estimated based on inputs derived from government rate documents, relevant vendors, partners implementing programmes, and national estimates when necessary. In addition to total costs, the tool categorises costs by programme areas and priority objective and thematic area per year. The CIP factors in investment costs as well as sustainability/inflation costs over the four years. This should be considered as only a broad costing of the Blueprint, not a budgeting tool to be used on an activity-by-activity basis to allocate funds.

The vast majority of the cost of the plan, Naira 820,729,900 billion or 40% of the total costs is allocated to commodities and supplies, with procurement of contraceptives and consumables taking a larger share. This is followed by

82

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 28% for service delivery, 22% for demand generation 4% each for SMC and PEE and 2% for financing activities.

Costs are spread over the duration of the CIP, with commodity costs increasing over time as more women are reached.

Table 2: Summary total budget by thematic areas Thematic Areas Demand Generation Service Delivery Commodities and supplies Policy & Enabling Environment Financing Supervision Monitoring & Coordination Total Per Year

83

2021

2022

2023

Total per Thematic Area 126,599,733 106,350,533 111,000,533 111,500,533 126,599,733 269,869,063 152,505,060 85,869,444

2024

70,714,210

269,869,063

195,395,250 197,978,550 208,383,550 218,972,550 195,395,250 18,700,350

18,700,350

18,700,350

18,700,350

18,700,350

12,346,000 20,000,600

9,740,500 16,800,100

6,500,685 24,254,500

4,876,345 21,543,000

12,346,000 20,000,600

642,910,996 502,075,093 454,709,062 446,306,988

2,046,002,139

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

Figure 12: Total budget by thematic areas

3.2 Total CIP Cost by Thematic Areas and Priority Objective Table 3: Total budget by thematic areas and by priority objectives

Thematic Area Demand creation

84

Priority Objective DCB 1.

Scale up awareness of family planning services in the State by 2023 DCB 2.

Capacity building of family planning champions and

2020

2021

2022

2023

TOTAL

81,694,47

81,694,47

81,694,473 326,777,89 81,694,473 2

24,156,060 24,656,060

25,156,060 25,656,060 99,624,240

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

Service Delivery

community Volunteers DCB 3.

Ensure availability of Family Planning Behaviour Change Communic ation and Service delivery tools

Sub total SD1. To increase the uptake of Implants from the current 21,595 users to 145,440 users by the end of December 2024 SD 2. To increase the uptake of IUD from the current 8,098 users to 76,548 users by the end of December 2024

85

20,749,200

126,599,7 33

-

106,350,53 3

4,150,000

4,150,000

29,049,200

111,000,5 33

111,500,5 33

455,451,33 2

96,195,240

96,195,240

22,856,060 16,496,500

39,352,560

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 SD 3. To increase 8,816,010 8,816,010 the uptake of tubal ligation services from 1350 users to 22,964 by the end of December, 2024 SD4.To increase 79,145,173 57,791,450 the uptake of other modern contracept ive methods: injectables to 38,274 users from current 20,246 users; Pills to 32,150 users from the current 28,344 users and Male condoms to 61,238 users from the current 35,093 users) by the end of December 2024

86

8,816,010

8,816,010

35,264,040

23,190,373 20,697,555 180,824,55 1

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 SD 5. To ensure that tutors and preceptors of Preservice Education al Institutions in Imo State have updated knowledge and skills on Modern Contracep tive methods including LARC by 2023 SD 6. To ensure standardiz ation of skills of all HCW that have been trained on FP services SD7. Scale up of FP Outreach Services SD 8. To ensure availability of all relevant equipment for training and clinical practice SD 9. Scale up community -based 87

18,500,030

7,618,256

2,803,500

2,803,500

2,803,500

2,803,500

11,214,000

5,570,000

5,570,000

5,570,000

5,570,000

22,280,000

17,622,020

16,020,020 16,020,020

26,118,286

17,622,020

16,020,020 16,020,020 64,080,080

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 distribution of shortacting methods through PPMVs and informal drug sellers SD10.

Confirm usefulness of AYFHS Centres and Scale up availability of AYFHS if required.

SD 11. To ensure proper coordinati on of FP providers and timely submission of reports Sub total Commodi ties and Supplies

Commodi ties and Supplies

88

CS 1. To ensure constant availability of FP commoditi es at the last mile CS 1. To ensure constant availability of FP commoditi es at the last mile CS 2. To ensure that

16,035,040 21,701,550

17,045,285 12,001,125 66,783,000

4,806,000

4,806,000

4,806,000

4,806,000

19,224,000

269,869,0 63

152,505,06 0

85,869,44 4

70,714,21 0

578,957,77

12,186,00

12,330,000

12,402,000 12,474,000 49,392,000

12,186,000 12,330,000

12,402,000 12,474,000 49,392,000

1,900,000

2,080,000

2,080,000

2,260,000

8,320,000

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 delivery and security of commoditi es at the last mile CS 3. To ensure constant availability of consumabl es at facilities and CMS CS 4. To ensure constant availability of CLMIS tools at the facilities CS 5. To build the capacity of FP providers in PHFs on CLMS CS 6. To meet the commodity demands of SDPs CS7. To provide on the job training of providers and enhance their performan ce CS 8. To assess stock levels and 89

32,000,000 36,000,000

40,000,000 44,000,000 152,000,00

4,600,000

4,600,000

4,600,000

4,600,000

18,400,000

15,377,200 11,487,300

11,787,300 12,087,300 50,739,100

320,000

340,000

355,000

375,000

1,390,000

3,610,850

3,620,850

3,630,850

3,639,850

14,502,400

422,000

434,000

442,000

450,000

1,748,000

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 expiries of commoditi es across the three levels of distribution CS 9. To improve the quality of LMIS data fed into NHLMIS platform CS 10. To build the capacity of LMCU members on CLMS CS 11. To ensure uninterrupt ed supply of FP commoditi es to Imo State in the event of paucity of donor fund Sub total Policy & Enabling Environm ent

90

1,650,000

1,650,000

1,650,000

1,650,000

3,892,800

6,600,000

3,892,800

119,436,40 125,436,400 131,436,40 137,436,40 513,745,60 0 0 0 0.

195,395,2 50

PE&E 1.

Domesticat 4,855,050 ion of relevant FP policy PE&E 2.

Engage 3,598,000 policy makers and top governme nt functionari es with

197,978,55 0

208,383,5 50

218,972,5 50

820,729,90 0

4,855,050

4,855,050

4,855,050

19,420,200

3,598,000

3,598,000

3,598,000

14,392,000

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 targeted advocacy PE&E 3.

Improve global sharing and learning of best practice Sub total Financing

91

FIN 1.

Develop evidencebased advocacy materials, score card and policy briefs to push for more allocations and releases of fund for FP on annual basis.

FIN 2.

Increase private sector/Non Governme nt Actors and donor agencies funding for FP FIN 3.

Develop performan ce-based activity for SOML CPR Pillar to

10,247,300 10,247,300

10,247,300 10,247,300 40,989,200

18,700,35 0

18,700,350

18,700,35 0

18,700,35 0

74,801,400

3,172,930

3,172,930

3,172,930

3,172,930

12,691,720 .

4,864,320

3,546,740

1,052,288

178,421

9,641,769

975,330

975,330

975,330

975,330

3,901,320

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 increase FP finance FIN 4.

Capacity building on budget tracking and annual budget tracking Sub total Supervisio n Monitorin g& Coordinat ion

SMC 1.

Increase Coordinati on between Stakeholde rs in family planning Programm e in IMO State.

3,333,420

2,045,500

1,300,137

529,665

7,208,722

12,346,00 0

9,740,500

6,500,685

4,876,345

33,463,530

4,390,430

4,390,430

4,390,430

4,390,430

17,561,720

SMC 2. CIP execution and preparatio n of next CIP by 2024 SMC 3.

Improve supportive supervision mechanis m SMC 4.

Improve quality of data reporting Sub total

92

2,100,040

8,400,160

2,100,040

2,100,040

2,100,040

9,000,000

6,504,040

10,802,160 9,271,500

35,577,700

4,510,130

3,805,590

6,961,870

5,781,030

21,058,620

20,000,60

16,800,100

24,254,50

21,543,00

82,598,200

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 0 TOTAL

642,910,9 96

502,075,09 3

0

0

454,709,0 62

446,306,9 88

2,046,002, 139.00

SECTION 4 PROJECTED FP METHODS MIX AND IMPACT 4.1 Projected FP Methods Mix The Imo State FP CIP’s activities are designed to enable 273,083 new users of to access modern contraceptives between 2021 and 2024. This equates to an increase in the CPR from 10.9 percent to 27.4 percent and significantly 93

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 contributes to reducing maternal and child death by 2024. If the projected CPR is achieved, the state unmet FP need will drop from the current 21.0% to 8.5 % by 2024. The principle of the state FP CIP is to provide a broad choice of FP methods to users to meet their preferences and needs.

For purposes of costing and planning, a method mix projection was developed. Thus, these figures are meant to be directional, not stand-alone targets. The current method mix was derived from the 2018 NDHS. The 2021-2024 method mix was estimated based on three core assumptions: • Use of LARCs (i.e., IUDs and implants) will grow faster than in previous years due to increases in trained healthcare providers and improved facilities based on the National LARC Strategy and the implementation of the task sharing policy that allows CHEWs to provide LARC services.

• Use of injectables will also grow faster than in previous years due to a policy change allowing CHEWs to administer injections, as well as experience from other countries indicating that injectables are typically a preferred method as CPR increases.

• Traditional methods will continue to grow at the same rate, but their share of the total CPR will decrease due to higher rates of growth for modern methods.

94

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

Figure 13: Current and Projected Method Mix for Imo State

The growth of each method is calculated as a linear progression, and the trajectory for each method can be seen below.

Table 4: Projected Total Users by methods and Years

METHODS Condom users Injectable users Pill users Female sterilization users IUD users Implant users Other modern users All traditional users Total users

95

2021 47,359 26,465 25,072 6,965

2022 51,749 30,187 27,312 12,937

2023 56,372 34,120 29,670 17,802

2024 61,238 38,274 32,150 22,964

23,679 48,752 4,345 196,400 379,037

40,249 79,061 7,345 159,560 408,402

57,856 111,261 10,345 105,327 422,752

76,548 145,440 13,345 52,052 442,011

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

4.2 Impact Assessment Achievement of the Imo State FP Plan will cumulatively avert about 110,000 unwanted pregnancies; avert 520 maternal and 4,265 child deaths. Over the period, unmet need will drop from the current 21.0% to 8.5%.

In addition to the above, the state will save as much as $1,885,470 on maternal and infant healthcare cost.

Table 5: Projected impact of achieving 27% CPR by 2024

Indictors Unintended pregnancies averted Births averted

2021 10,643

2022 24,252

2023 10,643

2024 15,987

Total

5,233

11,925

21,511

39,876

78,545

Abortions Averted

3,831

8,731

15,749

22,234

50,545

Unsafe Abortions 3,826 Averted Maternal deaths 39 averted Child deaths averted 293

8,719

15,728

24,987

53,260

87

151

243

520

668

1,206

2,098

4,265

DALYs averted

61,818

111,181

189,765

389,973

550,650

993,280

1,875,437

Maternal & healthcare averted (USD) Unmet Need

96

27,209 infant 241,649 costs

61,525

3,661,016 8.5%

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

SECTION 5 Resource Mobilization and Performance Management 5.1 Resource Mobilization This document can serve as an excellent tool to mobilise adequate funding for FP in Imo State to reach the state CPR goal. Considering that Imo State has the third lowest CPR and also the third highest unmet need among the South-East States of Nigeria, the costs to cover the specific contraceptive needs for women of reproductive age would require significant investment.

Currently, the FMOH holds the responsibility for covering the costs and providing adequate contraceptive commodities to meet the family planning needs of women in Imo State. However, this does not guarantee sufficient and constant supplies of commodities over the tour-year time period of the CIP as fund for procurement and distribution may be negatively impacted and also logistics will require strengthening. To ensure full support of the Imo State CIP by the state government, this document should be used as an advocacy and accountability mechanism for effective delivery of FP intervention in the state.

A severe funding gap currently exists between allocated state funding for FP and the projected costs. Over the past six years, released funds for FP have consistently been zero. To address this gap, the state should fully allocate, and release already committed FP funds to support the programme activity costs outlined over the six years. In addition, the state may consider using the outlined activities and associated spending requirements to advocate for additional federal, local and donor support to fill the funding gap.

97

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

5.2 Ensuring Progress through Performance Management In order to reach the 27% CPR goal of the CIP, Imo State must make a concerted effort to fully implement the CIP in a timely fashion. In doing so, the state and partners must remain cognisant of progress along the way through stringently tracking the status of implementation, measuring outputs and estimating impacts where possible.

The Family Planning CIP in Imo State is meant to serve as a living document that can evolve over the four-year period based on measurements of progress and feedback from implementers. High-quality, timely, and comprehensive data collection is necessary to inform the evolution of the plan to improve performance and institutionalisation and scale-up of best practices. Therefore, uptake of the performance management plan (Annex A) is encouraged for all stakeholders as a guiding tool towards progress.

To support successful implementation and achievements of CIP goals and objectives,

the

following

four

inter-linked

M&E

components

will

be

implemented systematically: • Routine collection of service and logistics data through the NHMIS & NHLMIS systems respectively • Performance review and quality improvement • Integrated supportive supervision • Evaluation and operations research Imo State CIP indicators are purposely aligned with the national Performance Management Plan to encourage harmonisation where possible with the National Blueprint and allow the state to efficiently report feedback on implementation progress to FMoH.

ANNEX A: MONITORING AND EVALUATION SUMMARY TABLE No Indicator No FP Modern

98

Indicators Impact

Indicator Type Outcome

Data Source DHIS-

Level of Reporting State

Frequenc y Annually

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 1

2

3

4

5

6

7

8

contracepti 2/NDHS/M ve ICS/SMAR prevalence T/NARHS (all women) [CPR] Demand Generation and Behaviour Change Communication D1 Percentage of women Outcome NDHS/MI state of reproductive age CS/SMART who have heard /NARHS about at least three methods of family planning D2 Percentage of the Outcome DHISstate population who know 2/NDHS/M of at least one source ICS/SMAR of modern T/NARHS contraceptive services and/or supplies D3 Percentage of Outcome NDHS/NA state audience who RHS believes that spouse, friends, relatives, and community approve (or disapprove) of the practice D4 Number of targeted Output Program state State and local me report multimedia FP advocacy and demand generation campaigns D5 Number of state, and Output Program state community-level FP me report champions/advocates , identified by type of level (i.e., state, and community) D6 Number of key state Output Program state leaders who have me report spoken in favour of family planning D7 Number of peer Output Program State educators / me report community volunteers trained in State

99

Annually

Annually

Annually

Quarterly

Quarterly

Annually

Quarterly

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 Service Delivery 9

SD1

Couple years of protection (CYP)

Outcome

NHMIS

State

Quarterly

10

SD2

Output

NHMIS

State

Quarterly

11

SD3

Outcome

NARHS/N DHS

State

Annually

12

SD4

Outcome

Annually

SD5

Outcome

NDHS/MI CS/SMART /NARHS NHMIS

State

13

State

Annually

14

SD6

Outcome

NHMIS

State

Annually

15

SD7

Outcome

NHMIS

State

Annually

16

SD8

Outcome

Facility assessme nt

State

Annually

17

SD9

Output

Facility assessme nt

State

Quarterly

18

SD10

Output

Quarterly

SD11

Facility assessme nt Facility assessme nt

State

19

State

Quarterly

20

SD12

Percentage/total number of modern method users (all women) Percentage of women whose demand for contraception is satisfied Percentage of women with an unmet need for contraception Number of unintended pregnancies averted due to contraceptive use Number of unsafe abortions averted due to contraceptive use Number of maternal deaths averted due to contraceptive use Percentage of women who were provided with information on family planning during last visit with health service provider Number of FP trainers trained in updated pre-service training curriculum.

Number of trainers trained in in-service FP practices Number of training sessions conducted by trainers, disaggregated by LGAs Proportion of recruited CHEWs trained for comprehensive FP

Facility assessme nt

State

Quarterly

100

Output

Outcome

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

21

SD13

22

SD14

23

SD15

24

SD16

25

SD17

26

SD18

27

SD19

101

(emphasis on injectables and LARCs) training, disaggregated by level (LGAs) Proportion/number of Outcome nurses and midwives trained in comprehensive family planning (emphasis on LARC methods) Number of Output pharmacies where at least one person has been trained in FP methods and counselling, by level (state and community) Number of training Output sessions conducted for PPMVs and informal drug sellers, by levels Quantity of FP training equipment, materials, and anatomical models procured and disbursed to trainers Number of new access points for FP service provision (hospital, clinic outreach, mobile FP clinics, and community venues where FP outreaches are conducted), by State Number of facilities at which FP equipment assessments were conducted, by State Number of facilities in which family planning is integrated with other healthcare services (i.e., sites where family

Facility assessme nt

State

Quarterly

Facility assessme nt

State

Quarterly

Facility assessme nt

State

Quarterly

Output

Facility assessme nt

State

Annually

Outcome

Facility assessme nt

State

Quarterly

Output

Facility assessme nt

State

Quarterly

Output

Facility assessme nt

State

Quarterly

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024 planning is integrated with routine immunization, HIV counselling and testing, prevention of mother-to-child transmission (PMTCT), and STI services) Number of publicOutput Program private partnerships for me report increasing FP service delivery, supply chain, demand generation, etc., by State per year Proportion of identified Output Program PHCs renovated for me report service delivery, by State Supplies and Commodities

28

SD20

29

SD21

30

SC1

Percentage difference Outcome between forecasted consumption and actual consumption

31

SC2

32

SC3

33

SC4

34

SC5

35

SC6

Stock out rate of family planning commodities including consumables at the health facilities Percentage of flagged LMIS reports on NHLMIS platform Existence of a government budget line item for the procurement of contraceptives Contraceptive or other RH commodity forecasts updated at least annually Costing of forecasted (quantified) contraceptive or other RH commodity needs conducted and incorporated into budget planning by 102

State

Annually

State

Annually

Annually

Outcome

NHLMIS/FP Federal/S Dashboar tate d/Progra mme report NHLMIS State

Output

NHLMIS

State

Bimonthly

Output

State Budget/ Program me report

State

Annually

Output

Program me report

State

Annually

Output

Program me report

State

Annually

Quarterly

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

36

SC7

37

SC8

38

SC9

39

SC10

40

SC11

41

PE1

42

PE2

43

FN1

103

SMOH and/or donors Number of persons trained to manage and produce commodity forecast reports, by region or State Number of commodities forecast reports, by region or State Number of procurement and forecast meetings conducted at national, regional, and state levels Number of commodity logistics trainings conducted at national, state, and LGA levels

Output

Program me report

State

Quarterly

Output

Program me report

State

Quarterly

Output

Program me report

National/ State/Re gion

Quarterly

Output

Program me report

State

Quarterly

Number of storage Output Program facilities in which me report commodity quantity and quality reviews are conducted, by region or State Policy and Environment Number of commodity Output Program logistics trainings me report conducted at national, state, and LGA levels Number of storage Output Program facilities in which me report commodity quantity and quality reviews are conducted, by region or State Financing Annual expenditure on Output Program family planning from me report IMO State and Local Government domestic budget

State

Quarterly

State

Annually

State

Annually

State

Annually

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

44

FN2

Annual Private Sector funding for family planning

Program me report

State

Annually

45

FN3

Number of LGAs with Output Program an FP budget line item me report Supervision, Monitoring, and Coordination

State

Annually

46

SMC1

Output

Program me report

State

Annually

47

SMC2

Output

Program me report

State

Annually

48

SMC3

Output

Program State me report/OC AT report

Annually

49

SMC4

Capacity for supervision, coordination management, or M&E of family planning Number of existing staff trained in either supervision, coordination management, or M&E of FP programme at the national and state levels Number of state- and LGA-lev el assessments of staff capacity to conduct supervision, coordination management, or M&E of FP programme at the national and state levels Number of new staff hired to supervise, coordinate, and conduct M&E of FP programme at the national and state levels

Output

Program me report

State

Annually

50

SMC5

Output

Annually

SMC6

State

Quarterly

52

SMC7

Program me report Program me report Program me report

State

51

Number of supervisory visits conducted updating of the state FP dashboard Annual report to CTC, listing results for each M&E indicator

State

Annually

104

Output

Output Output

IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024

References 1 Lule, E., R. Hasan, and K. Yamashita-Allen. 2007. “Global Trends in Fertility, Contraceptive Use and Unintended Pregnancies.” Pp. 8–39 in Fertility Regulation Behaviors and Their Costs: Contraception and Unintended Pregnancies in Africa and Eastern Europe & Central Asia, edited by E. Lule, S. Singh, and S.A. Chowdhury. “Health, Nutrition& Population Discussion Paper.

Washington, DC: World Bank. Retrieved from www.go.worldbank.org/BZSBNC53A0 2 Singh, S., J.E. Darroch, M. Vlassof, and J. Nadeau. 2003. Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. New York: Alan Guttmacher Institute. Retrieved from www.guttmacher.org/pubs/addingitup.pdf.

3 Singh, S., and J.E. Darroch. 2012. Adding It Up: Costs and Benefits of Contraceptive Services: Estimates for 2012. New York: Guttmacher Institute 4 Family Planning Summit 2012. “Technical Note: data sources and methodology for calculating 2012 baseline, 2021 objectives, impacts and costings.” Family Planning Summit Metrics Group, 2012.

5 World Population Review, 2020 6 Health Policy Plus 2017: 4th National RAPID 7 Miller R, Fisher A, Miller K, et. al. The Situation Analysis Approach to Assessing Family Planning and Reproductive Health Services: A Handbook. 1997. The Population Council, New York 8 2013 NDHS, 2018 NDHS. National Population Commission (NPC), Federal Republic of Nigeria and ICF International. 2014. Nigeria Demographic and Health Survey (NDHS) 2018.

9 Imo State Health Management Information System (HMIS), 2013-2020.

10 District Health Information System v2 (DHIS-2) 11 National Family Planning Dashboard. www.fpdashboard.com 12 Imo State Family Planning Program Reports, 2017-2020.

105