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Victor Igharo is the Nigeria program manager of The Challenge Initiative (TCI), a Bill and Melinda Gates Foundation-funded program working in the area of improving access to family planning and childbirth spacing services to women towards achieving Family Planning 2020 across 4 hubs of the world: Kenya, India, Senegal and Nigeria
What does The Challenge Initiative (TCI) seeks to achieve?
The Challenge Initiative (TCI) is about a new approach which we call business unusual, it seeks to achieve three key things: ensure sustainable investment in family planning; secondly, we want to ensure governments take ownership of family planning programs, as against the current sole dependence on donor funding and thirdly, we want to see the replication of models that have worked.
It is currently being implemented in four hubs across the world including Nigeria. We have the Indian hub which covers India; we have the East African hub in Kenya; we have the Senegal hub which covers francophone West Africa and the Nigerian hub which covers Nigeria.
Since 2009, the Nigerian Urban Reproductive Health Initiative (NURHI) – with funding from Bill and Melinda Gates Foundation (BMGF) – has implemented family planning (FP) programs in various states of Nigeria whose outcome has shown that the least contraceptive prevalence rate (CPR) change achieved in the poorest areas where NURHI worked was 11%.
When you compare 11% over a five year period to about 0.6% regional average in sub Saharan Africa and 0.7% national average in Nigeria you will realize that there is a significant shift in family planning programming as a result of these models.
So, TCI wants to scale-up these models using a cost-effective approach while ensuring that in the process of the scaling up of the models Nigerian states can actually take ownership of the process and decide for themselves which intervention work and which will not work within their varied geographical areas. So, this is overall the concept of TCI which we call business unusual.
TCI is among others, seeking to ensure states in Nigeria take complete ownership of funding for FP and childbirth spacing programming. Do you have any specific targets you are seeking to achieve in terms of ensuring access to reproductive healthcare for women in Nigeria, as an initiative?
TCI itself do not have any target rather it aligns itself with targets the national and states FP and childbirth spacing programs seek to achieve. In Kano for example, the state seeks to achieve 17% CPR by 2018 and if you look at where the state is now at 0.6%, you will realize that a huge leap needs to happen. So, TCI’s work in Kano is aligned with the state’s FP/childbirth spacing agenda.
Also TCI is contributing to the realization of Nigeria’s national FP/childbirth spacing blueprint which seeks to achieve 36% CPR by 2018. At the global level, the FP2020 agenda is seeking to ensure all women and girls have universal access to FP services by 2020. So, TCI doesn’t have its own specific agenda instead it aligns itself to the global, national and states’ agenda.
What are the socioeconomic benefits Nigeria stands to gain if it ensures all Nigerian women have access to family planning/childbirth spacing services?
Family planning has been identified as the best investment in women’s health globally, according to the 2016 report of Copenhagen Consensus Centre; it shows that for every one dollar invested in FP, there is 120 dollars return which means that compared to other key interventions in women’s health, investment in FP has the capacity to yield up to 1400% returns.
Moreover, FP has direct bearing on other key health indices, for example, it contributes to reducing maternal mortality by as much as 25%, it also contributes significantly toward reducing child mortality and has direct link with reducing HIV prevalence and ensuring adolescent and reproductive health. So, FP helps in improving other health outcomes that are not necessarily directly linked to childbirth spacing but have link with generally improving maternal and child health.
Secondly, FP will help in achieving the Sustainable Development Goals, talking about women empowerment, ending poverty and sustainable environment they all have links with FP. The fact is that when women are empowered to decide how many children they want to have, when they want to have them in a manner that will help their healthy wellbeing, they are better empowered to be economically sustainable. As such, benefits of FP are very far-reaching.
TCI will be implemented in Nigerian states like Kano, which is the country’s most populous state yet has very low Contraceptives Prevalence Rate, how do you hope the Initiative will help improve its CPR?
We are very optimistic about Kano state because Kano shows all the potential to increase its CPR, looking at the 2016 FP2020 report, Kano has an excess of 36% unmet needs which means a lot of women are still not accessing FP and childbirth spacing services which means if we are able to get more women access FP and childbirth spacing services that will significantly increase Kano’s CPR.
Now, if you also look at Kano’s Total Fertility Rate (TFR), it has a TFR of about 6.8% against the northwest regional average of 6.7%, which means if we are able to influence Kano, with its huge population, it will have significant impact on the regional and the national averages. So, Kano is really a key intervention state and also a key area of focus for improving FP and childbirth spacing indices in Nigeria.