POLICY BRIEF

POLICY BRIEF

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Key Messages

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ABOUT HERFONThe Health Reform Foundation of Nigeria (HERFON) is a non-profit, non- governmental, membership-based organization founded by a group of

reform-minded Nigerians committed to the achievement of the goal “Better Health for All Nigerians” through the reform of the way the health

services are organized and delivered in the country. With active members in all the 36 States and FCT Abuja, HERFON has remained the foremost

health sector NGO inspiring and initiating lasting positive change across a range of reform issues in the health sector, at national, state, local and

community levels in Nigeria.

Office Address: HERFON National Secretariat: 19B, Jimmy Carter Street, Asokoro, Abuja, Nigeria.

Telephone (D/L): +234-9-220-0340, +234-9-220-0341

Email: info@herfon.org

Website: www.herfon.org

Contact Details:

KADUNA STATE

Improving Funding To Address Unmet Needs For Family Planning In Kaduna State

WHY IS CHANGE NECESSARY?·FP contributes to reducing maternal mortality during childbirth by reducing the number of births, hence, the reducing the

number of times a woman is exposed to the risk of dying;·Available evidence indicates that satisfying the unmet needs of contraceptives could avert 44% of maternal deaths;·FP also ensures that families have only the desired number of children they can conveniently care for;·Furthermore, FP ensures that policy makers and administrators are better able to plan population growth and optimize the use of

resources towards developmental projects that benefit citizens.

ased on the findings of the study, the following recommendations have been made to the policy makers and decision makers in Kaduna State to ensure improved B

domestic funding for the provision of FP Services in Kaduna State.

Actions for State Governor·Prioritize and approve fund requests for provision of essential

maternal and child health services, including family planning.·Progressively increase domestic funding of FP services to

ensure sustainability.·Recognize that FP prevents maternal deaths with added

socioeconomic and demographic benefits to the state.·Be a champion for FP by harnessing the potentials and

opportunities of the office to promote FP activities. Actions for State Legislators·Ensure adequate allocation of funds for FP services in the

State's annual budget·Provide oversight to ensure funds released for FP are spent

judiciously by SMOH and SMOLG·Recognize that access to FP services is a basic health right for

citizensActions for State Ministry of Finance and Accountant-General's Office·Ensure timely release and cash backing of approved funds for FP·Build capacity of SMoH and State Primary Health Care Agency

(SPHCA) officials on how to write a compelling and evidence-based fund requisition memos for the release of funds as approved in the annual budget

·Support initiatives and plans to ensure sustainable financing for FP through innovative financing strategies including public-private partnerships

Actions for State Ministry of Health and State Ministry of LGAs

·Articulate clearly the goals, outputs and activities needed to address unmet needs for FP services to be integrated into the State's Annual Health Plans

·Prepare a detailed annual budget for FP based on actual quantification and costing of FP needs to reduce stock-outs of FP commodities

·Develop a detailed FP resource mobilization plan to improve domestic resource mobilization in the state

·Strengthen inter-sectoral coordination of FP programmes in order to harmonize resources and programmes of the stakeholders, including government and development partners.

Non-Governmental Organizations and Other Non-State Actors

·Conduct high level advocacy to the State Executive Governor, the Honorable Commissioner of Finance, the Honorable Commissioner for Economic Planning, and the State Accountant General to make a case for increased budgetary allocation and releases for health in general and FP in particular

·Sensitize policy makers and other decision makers in the state on the importance of domestic financing of FP programs and to re-orient and change their opinion that FP financing is an exclusive domain of development partners.

·Hold the Government Officials accountable for the provision of FP and other essential health services for women and children in the state.

This Publication is produced with support from the Partnership for Advocacy on Child & Family Health (PACFaH); a coalition of Nigerian CSOs committed to improving the lives of women and children in Nigeria with focus on Nutrition, Family Planning, Routine Immunization and Child killer diseases like pneumonia and diarrhea.

RECOMMENDED ACTIONS FOR POLICY MAKERS IN KADUNA STATE

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Kaduna is the third most populous

State in Nigeria

with an estimated

population of 7,915,4901;

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The average numb er of childre n per woman in Kaduna State

is 7.1 , which is higher than the national average of 5.72;

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About 20.2% of married women in the State use a child spacing method while 18.5% use modern methods of family planning with an unmet need of 5.8%3;

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In 2014, the Kaduna State Ministry of Health

(SMoH)

budgeted over N26 million

Naira

for FP

but none of the funds were

released4;

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The State Ministry for Local Government (SMoLG) budgeted 46 million Naira for FP

activities in

2014, but only

5.87% (N2.6 million

Naira) of the approved budget

was released to the 23 Local

Government Areas

in the State5.

? Legislative and executive agencies create bottlenecks and significant barriers in the process of budget allocation and releases due to poor understanding of the relevance of FP in

socioeconomic development.

? Funding for FP activities in the state is largely donor -driven. With declining donor funding, there are dangers of overdependence, lack of ownership, and poor sustainability of existing programs. Policy makers and legislators should act by ensuring adequate budgetary allocation and timely release

of funds for the provision of FP services with annual increments. There is need to institute

mechanisms for legislative oversight to ensure proper use and accountability of funds for FP.

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POLICY BRIEFPOLICY BRIEF

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aduna State is the third most populous state in Nigeria with an estimated population of 7.9 million people. Kaduna state has a fertility rate of 4.1% compared to the national fertility rate average of 5.5% and North West average of 6.7%, nevertheless Kthere is a huge gap in terms of access and uptake of FP services. Recent surveys have shown that, only 21.2% of married women

in Kaduna State use any type of FP method, while 18.5% use a modern method of FP. Maternal deaths account for 32% of all deaths among women of reproductive age group of 15 to 49 years and the current estimates show that the maternal mortality rate in the country to be 576 per 100,000 live births. FP is a proven and cost effective intervention for averting maternal deaths. Available evidence indicates that satisfying the unmet needs of contraceptive could avert 44% of maternal deaths. Thus, women are at more risk of dying due to pregnancy and childbirth if they do not have access to essential reproductive health services including FP or child spacing services.

However, more than 50% of health facilities in Kaduna State do not provide FP services, thus, limiting access to FP services. In general, the non-provision of FP services in these facilities has largely been due to poor allocation and release of funds from the state government, thus necessitating interventions by donors to increase access to family planning services. So far, provision of FP services in the state is largely donor-driven.

Donor funding for FP services is unsustainable. This is primarily because of dwindling resources from donors due to the global economic meltdown. Thus, it is important to remove barriers that mitigate against adequate allocation, release, and efficient utilization of government funding of FP programmes in Kaduna State.

Health Reform Foundation of Nigeria (HERFON) conducted a study in 2015 to track budgetary allocations and release of funding for FP. Specifically, the study assessed the regulatory and administrative barriers to adequate allocation and release of budget for FP services in Kaduna State for 2014 fiscal year. With support from the Partnership for Advocacy on Child & Family Health (PACFaH), the study included a desk review of relevant documents and a tracking tool to assess budget requests, actual budget allocations, and releases. The study also elicited responses from key stakeholders on regulatory and institutional bottlenecks that hinder the adequate allocation and release of FP resources in the state.

BACKGROUND

The study has helped in understanding the current situation of FP financing in Kaduna State. Key findings include:

Funds for the provision of FP services in Kaduna State are allocated annually to the SMoH and SMoLG. Available evidence shows that funds were allocated for FP in the annual budget for 2012, 2013 and 2014 to both the SMoH and SMoLG respectively and requisitions were made to the State Government for fund releases by both ministries. While SMoLG was able to access and subsequently release funds from the State Government for FP to

1. Poor Allocation and Release of Funds for FP Services:

the LGAs, the SMoH was not able to access funds for FP. Thus, FP programme interventions were not implemented due to lack of cash backing from the State Ministry of Finance (SMoF) which was caused by non-approval of the requests by the State Governor.Kaduna State Ministry of Health (SMoH) budgeted over N27 million Naira for FP in 2014, but no funds were released to the Ministry from the State Government. This trend of non-release of budget was also observed in the budgets for 2012 and 2013 respectively.

CURRENT SITUATION OF FP FINANCING IN KADUNA STATE

Kaduna State Ministry of Local Government (SMoLG) consistently made budgetary provision for FP for the three years under

review and there was a surge in budgetary allocation in 2014. The entire allocated amount in 2012 and 2013 were duly released by

the SMoF but there was a sharp drop in the actual amount released and as a proportion of the amount budgeted for in 2014. The

sharp drop in actual releases for 2014 was as a result of dwindling revenue base of the government. While the SMoLG budgeted

N46 million for FP in 2014, only about 5.87% (N2.7 million) of approved budget was released to 23 local government areas of the

State, as shown in the table below:

2. Executive, Bureaucratic and Legislative Bottlenecks Hamper Allocation and Release of Funds: Several agencies play important roles in the process of allocation and releases as articulated in the state appropriation and release process mapping (figure 1 and 2). Legislative and executive agencies create bottlenecks and significant barriers in the process of budget allocation and releases due to poor understanding of the merits of FP, among other factors. Bottlenecks militating against

adequate budgetary allocation for FP include: restriction of budget ceilings, intra-sectoral priorities, as well as legislative appropriation, and fiscal bottlenecks. Bottlenecks to adequate budgetary releases include inter-sectoral delays, limited requisition capacity of Ministries, Departments and Agencies (MDAs), executive bottlenecks, as well as bottlenecks at the level of SMoF and the Accountant-General's Office. Overall, the policy thrusts and priorities of the State Governor and resource availability largely determines whether funds requisitions will be approved or not, which has led to poor funding for FP services.

3. Low Capacity for Evidence-based FP Fund Requisitions by MDAs Including SMoH:

4. Poor funding Hampers Provision of FP Services in Over 50% of Facilities:

5. Over-dependence on Donors for Financing FP Services:

The various MDAs in the state are

required to send requisition memos to the office of the Governor for the release of approved budget for their programmes and

activities. However, the quality of requisition made by the MDAs was poor and lacked sound evidence. It was observed that the

capacity of MDAs including SMoH to write convincing and evidence-based fund release memos is suboptimal. To ensure adequate

funding for FP services, it is imperative for the SMoH to use empirical evidence to convince the Executive Governor on the

socioeconomic, health (reduction in maternal mortality) and demographic dividends of FP.

Although FP is part of the Essential Services and

system package being provided by the Kaduna State Government more than half of primary health care facilities in the State do not

provide FP services. Paucity of funds for the distribution and provision of FP commodities are major deterrents to provision of family

services in public health facilities.

Some of the government agencies have the notion that

development partners are responsible for financing FP interventions. In the wake of declining donor funding, this perception

presents the danger of overdependence, lack of ownership, and poor sustainability of existing programs.

There were no tools for evidence-based engagement of the executive and legislators on improved domestic financing of FP.

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13 HERFON, Tracking Allocation And Releases For 2014 Family Planning Budget And Scanning For Implementation Systems Barriers (Regulatory, Administrative) To Accessing These Services In Kaduna State, May 2015 14 HERFON, Tracking Allocation And Releases For 2014 Family Planning Budget And Scanning For Implementation Systems Barriers (Regulatory, Administrative) To Accessing These Services In Kaduna State, May 2015 15

HERFON, Tracking Allocation And Releases For 2014 Family Planning Budget And Scanning For Implementation Systems Barriers (Regulatory, Administrative) To Accessing These Services In Kaduna State, May 2015