Costed Family Planning Plan for FCT 2020-2024

Costed Implementation Plan for Family
Planning for the
Federal Capital Territory (FCT)
(2020
Planning for the
Federal Capital Territory (FCT)
(2020 – 2024)

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Contents
List of Boxes ..................................................................................................................................vii
Table of Figures..............................................................................................................................vii
ACKNOWLEDGEMENTS .........................................................................................................ix
LIST OF CONTRIBUTORS.........................................................................................................x
SECTION ONE: INTRODUCTION.....................................................................................................1
1.1 Global Context............................................................................................................................1
1.2 Family Planning 2020 and Sustainable Development Goals ........................................................2
1.3 Nigeria’s context.........................................................................................................................2
2.1 Brief on Federal Capital Territory. ..............................................................................................7
2.2 Thematic analysis of Family Planning situation ..........................................................................8
2.2.1 Behaviour Change Communication and Demand Creation................................................8
2.2.2 Service Delivery and Access...........................................................................................10
Type of training ................................................................................................................................10
Year...................................................................................................................................................10
Category of personnel trained..........................................................................................................10
Number trained ................................................................................................................................10
Sponsor .............................................................................................................................................10
2009 ...................................................................................................................................................10
Nurses/Midwives................................................................................................................................10
30 10
FCTA.................................................................................................................................................10
2011 ...................................................................................................................................................10
Nurses/Midwives................................................................................................................................10
31 10
NURHI...............................................................................................................................................10
2011 ...................................................................................................................................................10
Doctors and Nurses/ Midwives ...........................................................................................................10
6 10
NURHI...............................................................................................................................................10
2011 ...................................................................................................................................................10
Nurses/ Midwives...............................................................................................................................10
79 10
UNFPA ..............................................................................................................................................10
2011 ...................................................................................................................................................10
CBDs .................................................................................................................................................10

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30 10
UNFPA ..............................................................................................................................................10
2012 ...................................................................................................................................................10
30 10
UNFPA ..............................................................................................................................................10
2011&2012 ........................................................................................................................................10
Nurses/Midwives...............................................................................................................................10
31 10
NURHI...............................................................................................................................................10
2013 ...................................................................................................................................................10
Doctors &Nurses...............................................................................................................................10
26 10
NURHI...............................................................................................................................................10
2012 ...................................................................................................................................................10
FP Supervisors..................................................................................................................................10
10 10
NURHI...............................................................................................................................................10
2012 ...................................................................................................................................................10
FP Providers.....................................................................................................................................10
37 10
NURHI...............................................................................................................................................10
2012 ...................................................................................................................................................10
Clinical and non- clinical providers ....................................................................................................10
54 10
NURHI...............................................................................................................................................10
2013 ...................................................................................................................................................10
Clinical Service providers...................................................................................................................10
21 10
UNFPA ..............................................................................................................................................10
2014 ...................................................................................................................................................10
Nurses/Midwives...............................................................................................................................10
24 10
UNFPA & ..........................................................................................................................................10
ARFH.................................................................................................................................................10
Private Doctors.................................................................................................................................10
SHOPS Plus, UNFPA, Rotary ............................................................................................................10

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Public and private Nurses & Midwives ...........................................................................................10
SCHEWs in public and private HFs................................................................................................10
M&E Officers ...................................................................................................................................10
2.2.3 Contraceptive commodities and supplies ........................................................................12
2.2.4 Policy and Environment..................................................................................................13
2.2.5 Family Planning Financing.............................................................................................15
2.2.6 Coordination and Partnership Management.....................................................................16
2.2.7 Research, Monitoring, Data Management and Evaluation...............................................18
SECTION THREE: INTEGRATED COSTED FAMILY PLANNING IMPLEMENTATION PLAN 21
3.1 Justification for the CIP ............................................................................................................21
3.2 Vision, Goal and Strategic Objectives.......................................................................................23
3.2.1 Vision.............................................................................................................................23
3.2.2 Goal ...............................................................................................................................23
3.2.3 Strategic Objectives........................................................................................................23
3.3 Strategic Priorities ....................................................................................................................23
SECTION FOUR: STRUCTURE OF THE COSTED IMPLEMENTATION PLAN ..........................27
4.1 Pillar 1: Behaviour Change Communication & Demand Generation (BDG)..............................27
4.1.1 Justification....................................................................................................................27
4.1.2 Overview of the Pillar.....................................................................................................28
4.1.3 Main Activities...............................................................................................................28
4.2 Pillar 2: Service Delivery and Access........................................................................................30
4.2.1 Justification....................................................................................................................30
4.2.2 Overview of the pillar.....................................................................................................30
4.2.3 Main activities................................................................................................................31
4.3 Pillar 3: Contraceptives Security and Supplies ..........................................................................32
4.3.1 Justification:...................................................................................................................32
4.3.3 Broad Activities..............................................................................................................33
4.4 Pillar 4: Policy and Enabling Environment................................................................................33
4.4.1 Justification....................................................................................................................33
4.4.3 Main Activities...............................................................................................................34
4.5 Pillar 5: Family Planning Financing..........................................................................................35
4.5.1 Justification....................................................................................................................35
4.5.3 Broad Activities..............................................................................................................37

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4.6 Pillar 6: Coordination and Partnership Management..................................................................37
4.6.1 Justification....................................................................................................................37
4.6.3 Main Activities...............................................................................................................39
4.7 Pillar 7: Research, Monitoring, data management and evaluation..............................................39
4.7.1 Justification....................................................................................................................39
4.7.3 Main Activities...............................................................................................................40
SECTION FIVE: COSTING, PROJECTED METHOD MIX AND IMPACT ....................................42
6.1 CIP Cost Summary ...................................................................................................................42
6.2 Rationale and cost elements ......................................................................................................43
6.2.1 Assumptions...................................................................................................................43
6.2.2 Method Mix....................................................................................................................44
6.3 Impact of CIP Implementation..................................................................................................47
SECTION SIX: THE PATH FORWARD...........................................................................................50
7.1 Stakeholders’ Participation .......................................................................................................50
7.2 CIP Financing and Resource Mobilisation ................................................................................51
7.3 Ensuring Progress through Performance Management...............................................................53
7.4 Operationalisation of the CIP....................................................................................................54
ANNEXES.........................................................................................................................................58
ANNEX 1: ACTIVITY FRAMEWORK ............................................................................................58
Pillar 1: Behaviour Change Communication &Demand Generation ................................................58
Pillar 3: Contraceptives and Supplies..............................................................................................82
Pillar 4: Policy and Enabling Environment .....................................................................................88
Pillar 5: Family Planning Financing (FPF)......................................................................................96
Pillar 6: Coordination and Partnership Management .....................................................................103
Pillar 7: Research, Monitoring, Data Management and Evaluation................................................111
ANNEX 2: CIP Results Framework .................................................................................................115
Pillar 1: Behaviour Change Communication/Demand Generation.................................................115
Pillar 2: Service Delivery and Access ...........................................................................................117
Pillar 3: Contraceptives safety and supplies ..................................................................................120
Pillar 4: Policy and Enabling Environment ...................................................................................121
Pillar 6: Coordination and Partnership Management .....................................................................124
Pillar 7: Research, Monitoring, Data management and evaluation.................................................126

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List of Boxes
Box1: FCT Health Profile……………………………………………………………………………………6
Box 2: Training and beneficiaries……………………………………………………………………………9
Box 3: Challenges facing FP access in FCT…………………………………………………………………10
Box 4: FP financing in FCT and Area Councils……………………………………………………………..14
Box 5: Highlights of Local and International Agencies/Project support to FP in FCT……………………...16
Box 6: Contraceptive prevalence (assuming CPR decreases/increases linearly and annually…..…………..40
Box 7: Service uptake requirements based on projected mCPR and usage by method……………………...40
Box 8: Contraceptives requirements based on projected mCPR and usage by method……………………..40
Box 9: Projected mCPR new acceptors by methods, unmet needs, traditional methods and women
not using FP………………………………………………………………………………………….41
Box 10: Stakeholders’ participation in implementing the CIP………………………………………………44
Table of Figures
Figure 1: Sustainable Development Goals.......................................................................................1
Figure 2: Sources of FP by methods (%).........................................................................................5
Figure 3: Exposure for FP messages ...............................................................................................7
Figure 4: FP Uptake in FCT in 2019 ...............................................................................................9
Figure 5: Illustration of challenges to LMD of contraceptives in FCT...........................................12
Figure 6: Decision on Family Planning.........................................................................................14
Figure 7: Data flow and M & E Structure......................................................................................17
Figure 8: Vision, Goal and Pillars of FCT-FP Response................................................................20
Figure 9: FCT Family Planing Costed Implementation Plan by Pillars..........................................38
Figure 10: FCT-FP Cost by percentage .........................................................................................38
Figure 11: Estimated total population and WRA (2020-2024) ...................................................... 39
Figure 12: CIP Impact……………………………………………………………….…………….. 43
Figure 13: Cost Distribution by Pillars……………………………………………………………. 45

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PREFACE
It was noted that, despite efforts, progress on enabling women and girls to access contraception
were stalled as over 200 million women and girls in developing countries who wanted to delay or
avoid becoming pregnant did not have access to modern methods of contraception. For many of
these women, the inability to choose and access family planning would cost them their lives.
Avoiding unintended pregnancies is known to reduce the number of unsafe deliveries and unsafe
abortions – two of the main causes of maternal deaths hence action was needed urgently.
Therefore, In July 2012 The UK Government and the Bill & Melinda Gates Foundation, with the
support of UNFPA and other partners hosted the London Summit on Family Planning. The
Summit was to seek a range of policy, financing and delivery commitments from developing
countries, donors, the private sector and civil society that together would enable an additional 120
million women in the world’s poorest countries to have access to modern methods of family
planning by 2020. Nigeria renewed its commitment to further improve child and maternal health
through resources support for improving family planning (FP) services.
FCT, as an integral part of Nigeria, has achieved some increase in the state’s contraceptive
prevalence rate (CPR) with the current efforts, however, we need to significantly accelerate our
progress to meet our targets and contribute to National and Global aspirations while maintaining a
commitment to supporting the rights of women and girls to decide freely, for themselves, whether,
when, and how many children they want to have. We cannot achieve this goal as a government
alone.
Therefore, this FCT Family Planning Costed Implementation Plan (CIP) is a detailed roadmap for
achieving our goals and emanates from our responsibility for and the necessity to improve maternal
and child health and survival in the FCT Abuja. It details the progress we have made, what we are
committed to doing, and how we will collaborate with partners to achieve these laudable goals.
We need a coalition of committed public and private sectors partners to continue to join hands with
us to achieve the goals of this laudable plan, which has been modeled to avert more than 700,000
child deaths. Almost 1,000 maternal deaths and 1.6million unintended pregnancies will be averted
by achieving the CPR goal of 30% between now and the end of 2024. We need to have multi-sector
collaboration with clear accountability mechanisms to ensure that we are actually delivering on our
commitments.
I appreciate all our stakeholders who throughout the process of finalizing the FCT CIP provided
significant inputs to ensure that the plan represents the best interests of all women and residents of
Abuja. The FCT FP Technical Working Group, consisting of FCT PHCB officials, Development
Partners, Implementing Partners, and advocates, advised the entire CIP development process.
As a Government, we are committed to this effort, and I want to thank all those, especially
UNFPA, who have contributed to the realization of the FCT Family Planning Costed
Implementation Plan.
I know that with sustained passion and commitments we can achieve the targets as agreed and set
in this plan.
DR. IWOT Ndaeyo
Ag. Executive Secretary (FCT PHCB)

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ACKNOWLEDGEMENTS
The FCT Primary Health Care Board (FCT PHCB) on behalf of the Federal Capital Territory
Authority (FCTA) is extremely grateful to the United Nations Population Fund (UNFPA) for both
the technical and financial support provided to the development of the 5-year FCT Costed
Implementation Plan CIP) for Family Planning. This support is a strong demonstration of UNFPA
to the social and economic well-being of residents of the Federal Capital Territory but most
especially women and children. With this plan, FCT is moving in the direction of a more organized,
strategic and systematic approach to increasing access of all eligible persons to quality family
planning information and services working with other stakeholders, the outcome of which is
reduced maternal morbidity and mortality.
We acknowledge the role played by the International Cooperation Unit, FCT Economic Planning
and Research in contributing to the process that produced this plan. It’s a demonstration of team
work and synergy between two Governmental agencies. We are equally grateful to our stakeholders
from public, private and NGO sectors as well as communities for participating actively and
contributing ideas that produced a CIP which we consider innovative, expansive and result based.
We are extremely optimistic that we will commit to the implementation of this plan individually
and collectively, addressing areas that fall within our areas of focus. We expect all stakeholders and
partners to align their programmes and responses to family planning in the FCT with the Costed
Implementation Plan to strengthen our collective effort and common goal of increased
contraceptive prevalence rate to achieve reduction in maternal morbidity and mortality
Finally, our immense gratitude goes to the Consultant, ’Yemi Osanyin and his team for the
hardwork, the organised and systematic approach adopted in guiding the process. The process was
not only about producing a plan but also the capacity of participants that was either built or
strengthened in planning and programming.
We call on our stakeholders and partners not to see the plan as an end but a means to an end. It is
important that we work together to operationalize this plan in a vigorous manner, doing more than
we have been doing to achieve the goal of the plan
Director,
Primary Health Care
FCT Primary Health Care Board

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LIST OF CONTRIBUTORS
S/N NAMES Position & Organisation Thematic Area Worked
1 Dr. Ndaeyo Iwot Ag ES,FCT PHCB Family Planning Financing
2 Dr. RuqayyatWamako Director PHCB Policy & Enabling Environment
3 Mrs. Momoh Mariam Family Planning Coordinator Coordination and Partnership
4 Muhammad A. Lawal Director EPRS Family Planning Financing
5 Mrs. Ajoke Alao Data Officer[Family Planning] Contraceptives & Supplies
6 Evelyn Max Egba Npower FP Coordinating Unit Family Planning Financing
7 Victoria Aleoghena Education Secretariat Family Planning Financing
8 Fatigun Olusegun FCT/UNFPA Programme Coordinator Policy & Enabling Environment
9 Dr. Dan-Gadzama M and E Officer PHCB Research, Monitoring & Evaluation
10 Mrs. Kanu Felicia Provider, Luingi Barracks Service Delivery and Access
11 Mrs. Daghuje Florence School of Midwifery, Gwagwalada Service Delivery and Access
12 Mrs. Attah Elizabeth Deputy FP Coordinator Coordination and Partnership
13 Iyabo Balogun Area council FP/RH Coordinator Research, Monitoring & Evaluation
14 Mrs. Eniola Awoniyi Provider Family Health Clinic Area 2 Service Delivery and Access
15 Mosunmola Adefila Npower FP Coordinating Unit BCC/Demand Generation
16 Pharm Peter Ibrahim Pharmacist PHCB Policy & Enabling Environment
17 Peter Alfa Budget Officer PHCB Policy & Enabling Environment
18 Mrs. Carol Ibrahim PRS Family Planning Financing
19 Hajia Halima Gero LMCU Coordinator Contraceptives & Supplies
20 Mrs. Munirat Usman Provider Nyanya General Hospital Family Planning Financing
21 Dr. M.O.D Abonyi Chairman AGPMPN Coordination and Partnership
22 Dr. Joachim Chijide FP/RHCS Specialist, UNFPA Research, Monitoring & Evaluation
23 Dr. Ismail A. Mohammed SHOPS Plus USAID Coordination and Partnership
24 Shafa Ahmed Salihu Community Health Practitioner BCC/Demand Generation
25 HakeematAliyu NTA BCC/Demand Generation
26 Miss Rita Anene Program Officer, PPFN Service Delivery and Access
27 Dr. Isah Vasta Director PRS PHCB Research, Monitoring & Evaluation
28 Mr Eze Josephat Secretary AGPNP Family Planning Financing
29 Omolewa Yemisi Education Secretary BCC/Demand Generation
30 Hajara Onubaiye Family Planning Coordinating Unit Policy & Enabling Environment
31 Emilene Anakhuekha FCT Focal Person, UNFPA Coordination and Partnership
32 Dr. Hadley Ikwe FP Analyst, UNFPA BCC/Demand Generation

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ABBREVIATIONS
AGPMPN – Association of General Private Medical Practitioners of Nigeria
AGPNPN - Association of General Nursing Practitioners of Nigeria
AMAC – Abuja Municipal Area Council
ARFH – Association for Reproductive and Family Health
BAN - Breakthrough Action Nigeria
BCC/DG – Behaviour Change Communication/Demand Generation
CBD – Community Based Distribution
CHEWs – Community Health Extension Workers
CIP - Costed Implementation Plan
CLMS – Contraceptive Logistics Management Supply
CPM - Coordination and Partnership Management
CPR – Contraceptive Prevalence Rate
mCPR – Modern Contraceptive Prevalence Rate
CSOs – Civil Society Organisations
DALYs - Daily Adjusted Life Years
DCR – Daily Consumption Register
DFID – Department for International Development
FBOs – Faith Based Organisations
FCT/A – Federal Capital Territory Administration
FCT-SACA – FCT Agency for the Control of AIDS
FGN - Federal Government of Nigeria
FHC – Family Health Clinic
FLHE – Family Life and HIV Education
FMOH – Federal Ministry of Health
FPF - Family Planning Financing
GHSCM-PSM- Global Health Supply Chain-Procurement &Supply Management Program
HCT – HIV Counselling and Testing
HHSS – Health and Human Services Secretariat
IPCC – Interpersonal Communication and Counselling
LARC – Long Acting Reversible Contraceptives
LMCU - Logistics Management Coordinating Unit
LMD - Last Mile Distribution
MDGs – Millennium Development Goals
MEC – Medical Eligibility Criteria
M&E – Monitoring and Evaluation
MIS – Management Information System
MMR - Maternal Mortality Ratio
MNCH – Maternal and Neo-natal Child Health
NANNM – National Association of Nigerian Nurses and Midwives
NAWOJ - National Association of Women Journalist
NDHS – Nigeria Demographic and Health Survey
NHLMIS - National Health Logistics Management Information System
NGOs – Non Governmental Organisations
NMA – Nigeria Medical Association
NOA - National Orientation Agency

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NPHCDA – National Primary Health Care Development Agency
NRHCS – National Reproductive Health Commodity Security
NURHI – Nigerian Urban Reproductive Health Initiative
NURTW - National Union of Road Transport Workers
OPDs - Organisation of Persons with Disability
PAC – Post Abortion Care
PEE - Policy & Enabling Environment
PHC – Primary Health Care
PHCB – Primary Health Care Board
PNC – Post Natal Care
PPFN – Planned Parenthood Federation of Nigeria
PPIUD – Post Partum IUD
PPMVs – Proprietary and Patient Medicine Vendors
RIRF – Requisition, Issue & Return Forms
RMDE - Research, Monitoring, Data Management and Evaluation
SDGs - Sustainable Development Goals
SDPs – Service Delivery Points
SFH – Society for Family Health
SHOPS Plus - Strengthening Health Outcomes through the Private Sector
SRH - Sexual and Reproductive Health
UNFPA – United Nations Population Fund
WRA - Women of Reproductive Age

SECTION ONE: INTRODUCTION
1.1 Global Context
Global Maternal Mortality Ratio (MMR)
and 214 million Women of Reproductive Age (WRA), especially among young, poor and
unmarried female population who want to avoid pregnancy are not using any modern contraceptive
method due to limited awareness and inadequate access
unmet need is compounded by a growing population, cultural, traditional and religious beliefs, and
a dearth of quality and accessible family planning (FP) services.
as one of the most cost-effective and beneficial investmen
needs by providing quality FP to women who do not wish to become pregnant, reduc
of unwanted pregnancies and abortions among women and young girls. This in turn decrea
maternal and child mortality, the spread of HIV while it increases women empowerment, thus,
improving the overall health and well
On July 11, 2012, a global community of FP stakeholders
family planning to deliberate on the renewal and revitalization of the global commitment to ensure
that women and girls, particularly those living in low resource settings have access to contraceptive
information, services and supplies. It was held wit
Development (DFID), and Bill and Melinda Gates Foundation in partnership with United Nations
additional 120 million women and girls in developing co
without discrimination and coercion by 2020. The Summit was held in
ensuring 120 million additional women and girls in the world’s 69 poorest countries have access to
effective family planning information and services by the year 2020. The achievement of this goal
would prevent 100 million unintended pregnancies, 50 million abortions, 200,000
pregnancy/childbirth-related maternal deaths, and 3 million infant deaths.
As an outcome of this commitment, a global partnership ‘Family Planning 2020’ (FP2020) was
formed to support the rights of women and girls to decide freely, whether, when, and the number of
Figure 1: Sustainable Development Goals
SECTION ONE: INTRODUCTION
atio (MMR) declined in 2017 from 342 to 211 per 100
method due to limited awareness and inadequate access to contraceptives. This high MMR and
s compounded by a growing population, cultural, traditional and religious beliefs, and
a dearth of quality and accessible family planning (FP) services. Family planning is globally known
effective and beneficial investments in global health. Addressing unmet
needs by providing quality FP to women who do not wish to become pregnant, reduc
of unwanted pregnancies and abortions among women and young girls. This in turn decrea
improving the overall health and well-being of women, children, and their families.
a global community of FP stakeholders came together at the London Summit on
the renewal and revitalization of the global commitment to ensure
information, services and supplies. It was held with support from the Department for Int
Population Fund (UNFPA). The
Summit was attended by
stakeholders worldwide
including leaders from national
governments, donors, civil
society, the priva
research and development
community and other interest
groups. The objective
mobilise global policy,
financing, commodity and
service delivery commitments
to support the rights of
llion women and girls in developing countries of the world to use contraceptives
without discrimination and coercion by 2020. The Summit was held in pursuit of the goal of
ng information and services by the year 2020. The achievement of this goal
related maternal deaths, and 3 million infant deaths.
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per 100 000 live births
to contraceptives. This high MMR and
s compounded by a growing population, cultural, traditional and religious beliefs, and
Family planning is globally known
ddressing unmet
needs by providing quality FP to women who do not wish to become pregnant, reduces the number
of unwanted pregnancies and abortions among women and young girls. This in turn decreases
being of women, children, and their families.
came together at the London Summit on
the renewal and revitalization of the global commitment to ensure
h support from the Department for International
Population Fund (UNFPA). The
Summit was attended by
stakeholders worldwide
including leaders from national
nts, donors, civil
society, the private sector, the
research and development
and other interest
he objective was to
mobilise global policy,
financing, commodity and
service delivery commitments
to support the rights of
untries of the world to use contraceptives
pursuit of the goal of
ng information and services by the year 2020. The achievement of this goal

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children they want to have. In July 2017, it was confirmed that 38.8 million additional women and
girls in the 69 focus countries were using a modern method of contraception than in 2012, when
FP2020 was launched. This successfully prevented 84 million unintended pregnancies, 26 million
unsafe abortions, and 125,000 maternal deaths. African countries account for almost 50% of the
additional users of contraception with 16 million additional women and girls using a modern
method of contraception in the FP2020 countries of Africa when compared to 2012 resulting in
increased contraceptive prevalence rate from 19.5% to 23.4%.
1.2 Family Planning 2020 and Sustainable Development Goals
FP2020 is aligned and committed to extending the lifesaving benefits of modern contraception in
contributing to the achievement of the Sustainable Development Goals (SDGs). Contraceptive
access is directly or indirectly mainstreamed in the SDGs, and FP2020’s goal of reaching 120
million women and girls, and is a critical benchmark on the global path to universal access by
2030. The SDGs 2030 Agenda includes targets and references to gender equality and women’s and
girls’ empowerment and sexual and reproductive health and reproductive rights. The SDGs make
specific references to family planning in Goal 3 on health and Goal 5 on gender equality and
women’s empowerment (Table 1).
However, about 13 of the 17 goals (especially goals 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 13, 14 and 16) are
linked to family planning either directly or indirectly. For instance, it will be impossible to end
poverty and hunger, ensure quality education for all, promote sustained economic growth, achieve
good health, ensure good life on land, achieve responsible consumption and ensure peace and
justice, without ensuring that every woman has access to quality family planning services.
Countries of the World have used their multi-year FP Costed Implementation Plans (CIPs) to
strengthen their response and advocate for the implementation of both the SDGs and FP2020
commitments. Similarly, The FGN has been implementing programmes aimed at achieving the
previous MDGs and now SDGs alongside other nations of the world through its Blueprint and CIPs
by individual states.
1.3 Nigeria’s context
According to the 2006 National Population census Nigeria had 140million people with a growth
rate of 3.2% making Nigeria one of the most populous and fastest growing population in the World.
In 2015, with an estimated population of slightly above 182 million, the United Nations ranked
Nigeria as the seventh most populous country, and one of the fastest growing populations in the
world. By 2018, the population was estimated to have increased to 198million (National
Population Commission, 2018), implying an addition of 58million people to the population size in
only a period of 12 years (2006 to 2018). This indicates that Nigeria recorded a 29% increase in its
population in less than 15 years and with urban the population growing at an average annual growth
rate of about 6.5%, without commensurate increase in social amenities and infrastructure.
The total population figure shows that Nigeria remains the most populous country in Africa. The
2018 World population prospect predicts that by 2050, Nigeria will become the third most
populated country in the world, with the likelihood of the population hitting the 379 million mark.
Today, Nigeria has one of the highest MMR in the world despite harbouring only 2% of the world’s

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population. The current maternal mortality ratio of 512 per 100,000 live births1
(NDHS 2018),
though it is a significant decrease from 576 per 100,000 in 2013, however, this figure is still a
source of concern to the Government of Nigeria and the various development partners working in
Nigeria. Also, the high Infant and the Under-five mortality rate of 69 and 128 deaths per 1000 live
births respectively have attracted attention to Nigeria and reinforced the need to do more for the
population in terms of increasing access to health services and reducing inequity in the health
system.
It is also not surprising that other socio-economic indicators are unacceptably poor. For instance,
poverty, under-employment and unemployment have grown significantly. In absolute figure and
with increased population growth, about 90 million persons are poor in Nigeria2
. Family Planning
is one of the most potent responses to slowing down population growth, thus improving quality of
life of the people, most especially women. With high total fertility rate (TFR) of 5.3, Nigeria’s
population is likely to hit 379 million by 2050, becoming the third most populous country on earth.3
It would take only about 30 years for population of Nigeria to double itself. The current fertility and
mortality patterns have resulted in a young population structure, where more than 40% of the
current population are children under the age of 15 years. There is no doubt that low level of family
planning uptake is a major factor in the fertility pattern and population growth rate. According to
2018 NDHS, the contraceptive prevalence rate (CPR) and mCPR among married women in Nigeria
are 17% (from 15%) and 12% (from 10%) respectively and, 37% and 28% respectively among
unmarried sexually active women. Also, the survey indicated that unmet need for contraceptives
among married women is 19% (from 16 in 2013) and 48% among sexually active unmarried
women (from 35.3% in 2013). This shows that there is still a huge unmet need for family planning
among both married and unmarried sexually active women in Nigeria
Following the July, 2012, London Summit on Family Planning, the Federal Government of Nigeria
(FGON) made a commitment of providing an additional $8.35 million per year specifically for
Family Planning and Reproductive Health. As part of its FP 2020 commitment4
, the Nigerian
government in the National Health Strategic Plan set a target of reaching 36% CPR by 2018 from
16% in 2013 which the government and several donors and nongovernmental organisations
(NGOs) expressed commitment to at that time. To actualize the resolution at the summit and the
goal of FP 2020, Nigeria adopted and launched its first National Family Planning Blueprint (Scale
Up Plan) in November 2014. The Blueprint provides a road map for achieving the FGON’s goal of
improving access to FP and reducing maternal mortality. A follow up to this was the July 11, 2017
Family Planning Summit in London, UK where Nigeria reiterated its commitment to family
planning stating that the Government of Nigeria in collaboration with its partners and private sector
pledge to achieve a more realistic modern contraceptive prevalence rate (mCPR) of 27% among all
women by 2020 considering that the previous 36% was too ambitious. This it promises to do by
ensuring sustainable financing for the National Family Planning Programme, improve availability
1
NDHS 2018
2
World Bank Africa poverty report
3
2018 World population prospect
4
Family Planning 2020 Commitment, 2017

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of services and commodities, taking measures that improve access and create the enabling
environment for sexual and reproductive health services across Nigeria, and contribute to improved
preparedness and response where humanitarian crises occur and build partnerships to improve
access. The critical actions to accomplish the commitments are
 Approval of the Federal Executive Council to Federal Ministry of Health (FMoH) to renew the
Memorandum of Understanding with UNFPA which will ensure provision of US$4million
annually from 2017 to 2020 for procurement of contraceptives for the public sector (an increase
from the US$3 mil committed from 2011 to 2014).
 The Federal Ministry of Health commits to ensuring the disbursement of US$56 million to the
States through the International Development Assistance (World Bank) loans and Global
Financing Facility from 2017 to 2020. The FMoH is working with State governments, donors
and other stakeholders programme including health insurance programs through the Basic
Health Care Provision Fund (BHCPF) to make family planning expenses by households to be
reimbursable in the public and private sectors.
 Nigeria also plans to realize the health financing goals laid out under the National Strategic
Health Development Plan II (2018 – 2022), the institutionalization of the support for primary
health services provided by the Subsidy Reinvestment and Empowerment Program (SURE P)
and meet or exceed the Abuja Declaration health financing commitments.
 Nigeria stands by the commitment to achieving the goal of a contraceptive prevalence rate of
27% mCPR by 2020 based on the FP Country Implementation Plan (revised 2019-2023
national FP blue print); by investing in increasing the number of health facilities providing FP
services in the 36 States + FCT from 9,500 as at 2016 to 20,000 by 2020 and to reach the target
of 13.5 million current users of family planning by 2020
 Reforming and expanding the Task-Shifting policy implementation to include Patent Medicine
Vendors (PPMBVs) and Community Resource Persons (CORPs) to expand access in hard to
reach areas and amongst disadvantaged populations. Deliberate efforts to be made to scale up
access to new contraceptive methods including Depot Medroxyprogesterone Acetate (DMPA)
Sub Cutaneous injection (DMPA-SC) in the public and private sectors including removal of
regulatory barriers that impede access.
 Continue to invest in and expedite the transformation of the public health sector Last Mile
Distribution (LMD) of health commodities using integrated informed pull models through
involvement of the private sector capacity for optimization of transportation, haulage and
tracking of commodities using electronic logistics management solutions.
 Invest in working with local and international NGOs, CSOs, FBOs, Traditional and Religious
leaders as well as other Government line ministries and parastatals to address socio-cultural
barriers and limitations to family planning services in communities.
 Leveraging community structures such as Ward Development Committees around the 10,000-
functional primary health care centres to promote Behavioural Change Communication
messages to foster positive perceptions about family planning.
 Working with the Ministry of Youth and Ministry of Education to ensure that age appropriate
information on sexual reproductive health is provided to young people though implementation
of the Family Life Health Education Curriculum in and out of schools including investments in
provision of youth friendly services in traditional and non-traditional outlets

In Nigeria, family planning services are availa
Sterilisation and LARC methods while private sector and
more of the short term methods including E
public perception that private clinics
response to the revised National Family
Care Board is developing its 5-year Costed Implementation Plan for Family Planning (2020
2024) with the aim of making FCT’s response to be more organised, systematic, focused and
result-driven, with government leading and assuming greater ownership of
is to provide a road map for the FCT to contribute significantly to the National CPR target of 27%
The process of developing the plan involved all stakeholders involved in FP response in the Federal
Capital Territory.
5
Family Planning 2020 Commitment, 2017
0
20
40
60
80
100
0
75 79
93
Private
Figure 2: Sources of FP by methods (%)
In Nigeria, family planning services are available through public and private sectors
public sector being the
lead (5
the private sector’s
contribution is equally
significant (41%)
especially in the
provision of some
methods. Other
sources account for the
5% remaining
2018).
analysis shows that
this role varies by
method
type.Figure
that the public sector
provides more of the
while private sector and Private Medicine Stores (
including Emergency Contraceptives. This might be as a result of
clinics do not have trained providers for LARC.
amily Planning Blueprint (2019-2023), the FCT Primary Health
year Costed Implementation Plan for Family Planning (2020
driven, with government leading and assuming greater ownership of the response. The plan
is to provide a road map for the FCT to contribute significantly to the National CPR target of 27%
81 80
67
74
51
61
34
Public PMS
5 | P a g e
ble through public and private sectors, with the
public sector being the
lead (54%), however
the private sector’s
contribution is equally
significant (41%)
especially in the
provision of some
methods. Other
sources account for the
% remaining (NDHS
.A deeper
analysis shows that
this role varies by
method
Figure 2 shows
that the public sector
provides more of the
Private Medicine Stores (PMS) provide
. This might be as a result of
. In aligning its
2023), the FCT Primary Health
year Costed Implementation Plan for Family Planning (2020 --
the response. The plan
is to provide a road map for the FCT to contribute significantly to the National CPR target of 27%5
.

7 | P a g e
SECTION TWO: SITUATION ANALYSIS OF FCT FAMILY PLANNING LANDSCAPE
2.1 Brief on Federal Capital Territory.
The Federal Capital Territory (FCT) was created on 5th February 1976 to be managed by the Federal Capital
Territory Authority (FCTA). The population of the FCT according to 2006 population census was
1.406,239.However, according to World Population Report, this is estimated to have grown to 3,095,118 in
2019, representing an increase of 1,688,879; which is more than double of the 2006 figure, over a 13 year
period. Though this increase may be attributed largely to migration, the contribution of high fertility rate of
4.8 cannot be discountenanced especially in rural areas.
The FCTA has the responsibility for planning and developing theFCT. The law establishing it vested the
ownership, control and governance of the territory in the hands of the Federal Government. The FCT covers
an area of 8,000 sq. km. Prior to 1996, the FCT had four Area Councils, namely Abaji, Gwagwalada, Kuje
and Municipal. In 1996, two additional Area councils were created, namely Kwali (from Gwagwalada) and
Bwari (from Abuja Municipal Area Council). The President is vested with the power to govern the FCT, a
power that is often delegated to the Minister of the FCT in the Presidency and constitutionally, it has one
Senatorial seat and two House of Representatives constituencies. In place of Ministries and Commissioners,
the FCT Administration is organised around Secretariats headed by Secretaries and these include Education,
Health, Social Services, Legal, Agriculture and Transport. The Health Secretariat is responsible for
coordinating the implementation of health programs and delivery of health including family planning
services in the FCT.
The FCT Administration is committed to increasing access to quality health services and improving quality
of life of the resident which explains investment in developing health infrastructure, staffing and capacity
building for health staff, provision of
required supplies and construction and
renovation of health facilities. The FCT
Administration has also put in place
relevant policies and strategic plans to
sharpen the focus of interventions as well
as chart a new direction for health care
delivery in FCT. The Primary Health Care
Development Board was thus created to
ensure coordination of planning,
budgetary provision and monitoring of all
primary healthcare services in the Federal
Capital Territory and also advice the
Minister of Federal Capital Territory and
Area Council health authorities in the
Federal Capital Territory on any matter
regarding primary healthcare services in
the Federal Capital Territory. However,
available indices (Box 1) show that the
desired result has not been obtained. For instance, maternal, infant and under-5 mortality and fertility rate in
FCT are still high. In addition about one-third (36.5%) of pregnant women still deliver at home where family
planning information, counselling and services are not available, talked about and provided. Also
contraceptive rate is low while unmet need for FP is high. In addition, Doctor Population and Doctor Patient
Box 1: FCT Health profile
NDHS 2013 and
others
NDHS 2018 &
Others
Total Population (est.) 1,406,239 (NPC
2006)
3,564,250 (WPR)
MMR 93/100,000 live
births
Not available
IMR 75/1000 live births 46/1000 live births
CMR 157/1000 live births 30/1000 live births
Neo-natal Not Available 27/1000 live births
U-5 Not Available 75/1000 live births
Post-natal Not Available 20/1000 live births
Total Fertility Rate 4.5 4.3
Preferred fertility rate 3.8 3.9
CPR (All methods) 25.2 23.9
CPR (Modern) 20.6 20.3
Unmet needs 19.7 19.1
Birth Intervals (< 24
months
22.1% 21.5%
Place of Delivery (of
babies)
 Total = 69.1%
 Public = 48.9%
 Private = 20.2%
 Home = 30.9%
 Total = 63.2%
 Public = 46.9%
 Private = 16.2%
 Home = 36.5%

ratio is very low (1:3,001 and 1:1,261), Nurse Patient Population is low, showing
resources for health, FCT has 37 Medical Doctors, 1,129 Nurses/Midwives, 122 Community Health
Extension Workers and 89 Consultants
the health sector in FCT affects both the v
population.
The table in Box 1 above further shows a Total Fertility Rate (TFR) of 4.
fertility rate among women according to 201
wanted fertility increased by 0.1, a figure that also do not show any significant difference. All the same, it
indicates that while many men will like to have more than four (4)
have less than 4 children, but there is inadequate support for them to accomplish this. The reasons might be
lack of awareness of family planning services, lack of knowledge of where to get the services or lack of
facilities that provide family planning services considering that less than
provide FP in the FCT. The inability of all the facilities to provide FP services in the FCT are due to
inadequate infrastructure, human resources and financial resources
is restricted. This partly explains the low contraceptive rate and the inability of the system to meet the family
planning needs of 19.1% of married women who desire to have family planning services
first attempt at having a coordinated and expansive approach to family planning was in 2015 when a family
planning blueprint for FCT was first developed with support from the Nigerian Urban Reproductive Health
Initiative (NURHI Project). This 5-year Costed Imp
United Nations Population Fund (UNFPA) is the second attempt being made to chart a new path for family
planning service delivery in the FCT and consolidate the gains of the past 5 years.
2.2 Thematic analysis of Family Planning
2.2.1 Behaviour Change Communication
In Nigeria, awareness and knowledge of any family planning method is
showing 94%,98% and 99.1% among
likely to be the trend in
the FCT with more than
90% in each category
demonstrating awareness
and knowledge of family
planning. A review of
the report equally shows
that women and men
have been exposed to
family planning
messages using a mix of
approaches. These
include radio and
televisionmessages, use
of posters, mobile
phones, and social media
and to some extent newspapers (Figure
while posters also have some rating. Equally showing som
especially among women. Unlike NDHS 2013
0
5
10
15
20
25
Figure 3: Exposure for FP messages
ratio is very low (1:3,001 and 1:1,261), Nurse Patient Population is low, showing 1:478. On human
Extension Workers and 89 Consultants that have been trained on LARC. The inadequate human resources in
the health sector in FCT affects both the volume and quality of services available and accessible to the
further shows a Total Fertility Rate (TFR) of 4.3 whereas wanted (preferred)
fertility rate among women according to 2018 NDHS is 3.9. Though TFR dropped by insignificant 0.2
men will like to have more than four (4) women on the other hand
there is inadequate support for them to accomplish this. The reasons might be
ily planning services considering that less than 50% of public health facilities
inability of all the facilities to provide FP services in the FCT are due to
inadequate infrastructure, human resources and financial resources, thus access to family planning services
. This partly explains the low contraceptive rate and the inability of the system to meet the family
women who desire to have family planning services
t attempt at having a coordinated and expansive approach to family planning was in 2015 when a family
year Costed Implementation Plan for Family Planning supported by
planning service delivery in the FCT and consolidate the gains of the past 5 years.
analysis of Family Planning situation
Change Communication and Demand Creation
nowledge of any family planning method is very high among women and men,
and 99.1% among women, men and sexually unmarried sampled(NDHS 201
(Figure 2). Television and radio rank very high among men and women
Equally showing some significance are mobile phones and social media
especially among women. Unlike NDHS 2013 where more men claimed to have been exposed to family
24.2
21.7
5.3
7 5.8
15.9
3.6
2.2
14.5
17.9
5.2
1.7 1.7
20.8
3.7
0.2
Women Men
: Exposure for FP messages
8 | P a g e
1:478. On human
The inadequate human resources in
olume and quality of services available and accessible to the
whereas wanted (preferred)
y insignificant 0.2,
on the other hand will prefer to
there is inadequate support for them to accomplish this. The reasons might be
0% of public health facilities
inability of all the facilities to provide FP services in the FCT are due to
family planning services
. This partly explains the low contraceptive rate and the inability of the system to meet the family
women who desire to have family planning services but unable. The
t attempt at having a coordinated and expansive approach to family planning was in 2015 when a family
lanning supported by the
reation
very high among women and men,
NDHS 2018). This is
radio rank very high among men and women,
e significance are mobile phones and social media
exposed to family
2.2 2.9
0.2 1.2

9 | P a g e
planning messages compared with women, the reverse is the case as revealed by 2018 NDHS. While 24.2%,
21.7%,15.9%, 7% and 5.8% of women reported exposure to FP messages via radio, TV, posters mobile
phone and social media respectively. The percentage is significantly lower among men showing radio
(14.2%), TV (17.9%) and posters (20.8%) while access through mobile phone and social media is equally
low compared with women. This survey also reported that more men compared with women do not receive
family planning messages via any of these media. Despite the claim of access to child spacing and limiting
information, a high proportion (21.5%) of women will observe less than 24 month birth intervals (NDHS
2018) compared with 22.1% in 2013 (NDHS 2013). Also while less than 50% of women will attend ANC at
health facilities and 63.2% of pregnant women will deliver at health facilities. These findings shows that
radio, TV, posters, phone and social media are veritable sources through which many women and some men
can be reached and as such these channels should be explored. In addition, considering that 36.8% of births
take place at home means that the response should look beyond clinics and targets agents of home deliveries
such as TBAs and community midwives. Equally, since about 60% of men and women are not exposed to
FP messages through the sources mentioned in Figure 1, it will be beneficial if the response will identify and
leverage on those unknown sources which may include but not limited to friends, neighbours, FP users,
outreach by health workers etc.
Federal Capital Territory was one of the five (5) project sites under the first phase of the Nigerian Urban
Reproductive Health Initiative (NURHI 1) between 2010 and 2015. This project deployed and used massive
multi-dimensional demand creation strategy to promote family planning in the FCT. The slogan of the
project was Know (about family planning), Talk (about family planning) and Go (for family planning). A
radio programme titled “Second Chance” sponsored by the Project was also aired by Wazobia FM between
2013 and 2014 complemented by series of jingles and discussion programs on radio, production and
distribution of posters, use of bill boards and flyers. These posters were not only posted in health facilities
but also in public places such as local food joints and residential buildings especially in rural areas. The
project also trained and deployed trained community mobilisers who conducted community outreach
activities and refer eligible persons to service delivery outlets.
Still under the NURHI 1 project, the FP Units at FCT and Area Council levels undertook key community
mobilisation activities directed at different male groups (e.g. commercial motor drivers), religious and
traditional leaders within the community. Through town hall meetings and dialogue sessions, political,
religious and community leaders were adequately engaged to support family planning by helping to remove
all the barriers in the way of acceptance and uptake of family planning by women.Building on the NURHI 1
project in a few other states including the FCT is the Breakthrough for Action (BAN) project, which is
igniting collective action and encouraging people to adopt healthier behaviours in favour of using modern
contraceptive methods, sleeping under bed nets and testing for HIV. The project harnesses the demonstrated
power of communication—from mass media to community outreach to user-driven social media
campaigns—to inspire long-lasting change. No doubt these projects made some impact in increasing
awareness and driving the demand for family planning.
In spite of these efforts, demand for family planning has not significantly increased for a number of reasons
that are strongly connected with misconceptions and myths, wide spread misinformation and negative
perception of family planning, religious factors and male resistance despite documented evidence of a
significant percentage of men interviewed (NDHS 2018) that reported receiving FP messages through the
traditional media. Rural communities in FCT are more disadvantaged when access to FP information and
awareness is measured compared with urban communities. This is due to the fact that there is no expansive
communication strategy for family planning and neither is there a structure to drive family planning in the

0
5000
10000
15000
20000
25000
30000
35000 30034
3959 5007 2655
16409
31292
Figure 4: FP uptake in FCT in 2019
rural communities. There is therefore the need to re
service delivery in FCT for greater effectiveness and impact.
sensitization and awareness creation, t
behaviour change in favour of family planningas a critical health service that improves the health and quality
of life of mothers, children and family generally.
2.2.2
care providing family planning services has increased. For instance, while only 29.2% of existing facilities
(791) in 2012 were providing FP services (FCT Bulletin), the percentage has increased to 46.2% in 2019;
however, their spread between urban and rural areas is unknown. While this may have marginally increased
uptake, majority of women still lack access to
Box 2: Training and beneficiaries
Type of training Year Category of
personnel trained
FP Refresher training 2009 Nurses/Midwives
Family Planning
Refresher training
2011 Nurses/Midwives
Training of Master
trainers
2011 Doctors and Nurses/
Midwives
CLMS training 2011 Nurses/ Midwives
Training in Community
Based Distribution of FP
2011 CBDs
FP Technology update 2012
Training of Long acting
reverse contraceptives
(LARC)
2011&20
12
Nurses/Midwives
Post Partum IUD
Training
2013 Doctors
Supportive Supervision
training for FP
Supervisors
2012 FP Supervisors
Monitoring and
Evaluation training
2012 FP Providers
IPCC training 2012 Clinical and non
clinical providers
Training on syndromic
management of STIs
2013 Clinical Service
providers
Training of Trainers on
LARC for CHEWs
2014 Nurses/Midwives
LARC Private Doctors
Public and private
Nurses &
Midwives
SCHEWs in public
and private HFs
Dash board and data
management
M&E Officers
31292
12936
8553
1295 368
Figure 4: FP uptake in FCT in 2019
There is therefore the need to re-energize the BCC/DG strategy for family planning
service delivery in FCT for greater effectiveness and impact. This strategy must go beyond
to the approach that increases knowledge and enable attitudinal and
change in favour of family planningas a critical health service that improves the health and quality
children and family generally.
Service Delivery and Access
2.2.2.1. Family Planning Uptake
In the FCT, modern methods of
family planning services are
available in public and private
health facilities including
occasional outreach
however, a few clients rely on
pharmacies and private drug s
while a few others also still rely on
traditional methods. Over the years,
the number of public health
facilities especially primary health
uptake, majority of women still lack access to family planning services. This position is validated by
Contraceptive Prevalence Rate of
23.9% (all methods),
modern methods and a high unmet
need of 19.1% and 76.1% not using
family planning.
2018).These figures except unmet
need do not compar
with findings in 2013 NDHS.
According to available data from
FCT FP Unit, only 90,159 women
of the estimated 7
Reproductive Age (a mere 1
in FCT used family planning, with
only 26,426 as new acceptors. The
source also shows
Depo,Microgynon, Implanon and
Jadellewere the most popular
methods in that order. Though
considered low, however, it is a
great improvement compared with
previous years and the marginal
increase may have been assisted by
integration of FP into other services
in the FCT such as HIV,
raining and beneficiaries
Category of
personnel trained
Number
trained
Sponsor
Nurses/Midwives 30 FCTA
Nurses/Midwives 31 NURHI
Doctors and Nurses/
Midwives
6 NURHI
Nurses/ Midwives 79 UNFPA
30 UNFPA
30 UNFPA
Nurses/Midwives 31 NURHI
Doctors &Nurses 26 NURHI
FP Supervisors 10 NURHI
FP Providers 37 NURHI
Clinical and non-
clinical providers
54 NURHI
Clinical Service
providers
21 UNFPA
Nurses/Midwives 24 UNFPA &
ARFH
Private Doctors SHOPS
Plus,
UNFPA,
Rotary
Public and private
Nurses &
Midwives
SCHEWs in public
and private HFs
M&E Officers
10 | P a g e
strategy for family planning
This strategy must go beyond mere
the approach that increases knowledge and enable attitudinal and
change in favour of family planningas a critical health service that improves the health and quality
2.2.2.1. Family Planning Uptake
In the FCT, modern methods of
family planning services are
available in public and private
health facilities including
outreach activities,
however, a few clients rely on
pharmacies and private drug stores
while a few others also still rely on
traditional methods. Over the years,
the number of public health
facilities especially primary health
family planning services. This position is validated by
Contraceptive Prevalence Rate of
% (all methods), 20.3%
modern methods and a high unmet
and 76.1% not using
family planning. (NDHS
These figures except unmet
need do not compare favourably
with findings in 2013 NDHS.
According to available data from
only 90,159 women
784,135 Women of
Reproductive Age (a mere 11.4%)
in FCT used family planning, with
only 26,426 as new acceptors. The
o shows that Noristerat,
icrogynon, Implanon and
were the most popular
methods in that order. Though
considered low, however, it is a
great improvement compared with
previous years and the marginal
increase may have been assisted by
into other services
in the FCT such as HIV,

11 | P a g e
Immunization and Maternal and Child Health. In FCT there are 390 family planning service providers
expected to provide services to all eligible persons using facility based approach. This number is grossly
inadequate, a development that has spurred the implementation of the Task Shifting policy of the Federal
Government by training more Senior Community Health Extension Workers (SCHEWs) in Long Acting
Reversible Methods including injectables.
Over the years, international development partners and others have invested in capacity development in both
the public and private health sectors for the delivery of Family Planning services in the FCT. The training
included general family planning technology update, CLMS, LARC and PPIUD, supportive supervision,
Monitoring and Evaluation, IPCC, community
mobilisation, syndromic management of STIs,FP
dashboard and data management. These training were
supported by NURHI 1, UNFPA, SHOPS Plus and Rotary
International. The training had to a large extent
strengthened human capacity in FCT for the delivery of
quality FP services. The FCT also uses coaching,
mentoring and post training follow up visit to further
strengthen capacity for FP service delivery. About 3 of
such visits to 326 FP providers were made in 2019. The
training for CBD Agents by UNFPA in 2011 is an
indication that CBD approach in FP service delivery may
have been introduced but the approach could not be
sustained. There also exists in FCT a referral system at
the community level which is actively driven by the social
mobilisers with community members referred to FP
facilities. This system is monitored with the use of
approved referral slips. The private health sector has also
been involved in family planning service provision with
support from SHOPS and SHOPS Plus projects.
In FCT, only the School of Midwifery exists for the
training of high level midwives with family planning
already integrated into its curriculum and taught in the second year of the 3 year midwifery programme.
Some of the Tutors have benefited from donor (SHOPS Plus) supported training in LARC in 2018. On the
delivery of adolescent and youth friendly services, there is no public health facility in the FCT that provides
such service, except Planned Parenthood Federation of Nigeria (PPFN). A critical analysis of the delivery of
family planning services in the FCT reveals a lot of inadequacies and challenges (demand and supply
factors) including but not limited to a number of demand and supply factors highlighted in Box 2. The last
time consumables were supplied to facilities was 2011. It is therefore important that a strategy for service
expansion and coverage (to the point of over-saturation) is designed and implemented in the next 5 years if
significant increase in contraceptive prevalence is expected. For instance, the integration, capacity building
and availability of contraceptives for community midwives and home delivery providers and the private
sector into FCT family planning response is strategically pursued considering that these outlets deliver
babies for 30.9% of the population of women of reproductive age that require such services.
Box 3: Challenges facing FP access in FCT
 Poor infrastructure/equipment in the facilities,
 inadequate family planning unit spaces in most
facilities, thereby compromising privacy and
confidentiality
 Poor Commodity supply,
 Transfer of trained FP providers to other units.
 No funding for family planning
 Men and women in FCT have some negative
perception about family planning - it is a means of
reducing their population,
 Weight gain by some women and fear of delayed
return to fertility
 Religious beliefs that interferes with free choice
(Catholic believe only in natural method of family
planning).
 Fear of side effects,
 Hidden cost of family planning services – paying
for consumables,
 Provider’s attitude and lack of counselling skills by
providers,
 Competition among wives to have more children
and religious beliefs
 Poor access to family planning facilities, (distance,
cost of transportation, bad road) cost of
consumables
 Paying for consumables by clients which negates
free contraceptives policy

12 | P a g e
2.2.2.2 Adolescent sexual and reproductive health
In FCT, there is evidence of sexual activities among adolescents and young people (ages 15-19), especially
girls with attendant consequences of unwanted pregnancy and recourse to induced abortion. For instance,
NDHS 2018 reported that 4.8% of females had their first sexual experience before age 15 while a larger
percentage (28.5%) had their first sexual experience before age 18 compared with a low percentage among
their male counterpart which shows 0.9% before age 15 and 10.4% before age 18. These sexual activities
have implications for total fertility within the FCT. According to NDHS (2018), 8.9% of girls ages 15 – 19
have had a live birth, while 10.6% have begun child bearing. In addition, adolescent birth rate in the FCT is
39/1000 live births which may have significantly contributed to high fertility rate of 4.3 within the FCT.
Knowledge of family planning among adolescents and young people is quite high at a national average of
67% and 64% respectively for any method and modern methods, however, contraceptive use though picking
up is still considered low for reasons being but not limited to lack of appropriate facilities for young people,
bias of providers and stigmatization. This is also the situation in FCT as there is no specific data on
knowledge and use of contraceptives among young people. In FCT, contraceptive prevalence rate among
sexually active unmarried female (where young people belong) is 37% while mCPR is 28%. These rates are
higher compared with married women (2018 NDHS). As reported earlier, most of these persons may have
obtained the services (mostly short term methods) through the private sector and Patent Medicine Stores
(PMS), Pharmacy and Chemists
In FCT (PHCB), there is no structure and Desk Officer for coordination of ASRH interventions; however,
there exists the adolescent sexual and reproductive health strategic plan, but not being implemented. There
are no designated facilities for adolescents and young people to access SRH/FP services, except in the clinic
being managed by Planned Parenthood Federation of Nigeria (PPFN). However, it is important to note that
some providers across PHCs/FP Service Delivery Points across FCT have been trained in the provision of
youth friendly SRH services. The FLHE programme in public secondary schools in the FCT is an avenue
for reaching in-school adolescents with SRH information, the coverage and wide reach is unclear while
almost no intervention exists to inform and educate the out-of-school with SRH education. In the Plan
period, FCT will review social communication strategy for SRH to include the adolescents and young
people while also re-organising its health system to enable access of young people to services in a friendly
environment.
2.2.3 Contraceptive commodities and supplies
The Federal Ministry of Health with support from the United Nations Population Fund (UNFPA) through its
Central Store in Lagos provides contraceptives to Federal Capital Territory through the Axial Warehouse,
from where distribution is made to all the facilities across the 6 Area Councils using the Last Mile
Distribution System on bi-monthly basis. Contraceptives Distribution in the FCT is already integrated into
the Central Logistics Management System under the coordination of a Logistics Management Coordinating
Unit (LMCU). Availability of adequate stock of contraceptives is a major requirement for undisrupted and
sustainable family planning services by eliminating stock-out, especially in all Service Delivery Points.
There is a system of determining requirements for all service delivery points on 4-monthly forecasting and
projection done by the Family Planning Unit using consumption data from all SDPs. This is then forwarded
to FMoH to inform the quantity sent to FCT on 2-monthly basis.
Family planning services are captured on National Health Logistics Management Information System
(NHLMIS) tool which enables data collection on contraceptives usage and helps in planning for Last Mile
Distribution Order with support from GHSC-PSM (Global Health Supply Chain – Procurement Supply
Management).This results to visibility of FP data on commodities supply thus facilitating tracking as well as

13 | P a g e
preventing wastages and expiration of commodities. Training on Contraceptives Logistics Management
System (CLMS) has been on-going in FCT over the years supported by UNFPA and GHSC-PSM. In 2011
for instance, 79 FP Service Providers were trained by UNFPA while over 230 were trained by GHSC-PSM
in March 2018. In addition, Monitoring and Evaluation Officers in the Area Councils were also trained on
the use of National Health Logistics Management Information Systems (NHLMIS) tool for proper data
entry. All these have strengthened capacity in contraceptives management and data collection especially at
Service Delivery Points.
In addition to contraceptives are consumables which are expected to be provided by the Government at FCT
and Area Council levels. The FCT Administration had in few instances procured and supplied consumables
and needed equipment when fund was available to enable access to free FP services in line with the free
Contraceptives Policy of
the Federal Government. It
is on record that the last
supplies of consumables to
enable free provision of FP
services was in 2011. In
FCT, there are still a
number of challenges
militating against the full
functionality and
effectiveness of existing
contraceptives and supplies
management system all of
which may have caused
service disruption in
facilities especially those existing in hard to reach areas. These include late distribution, inadequate supplies,
inaccessible SDPs, attrition of trained staff and late transmission of report online due to poor internet
coverage. There is also the challenge associated with non-availability of consumables at SDPs, a
development that has introduced hidden cost as clients have to pay for the consumables used in the process
of providing them the service required. The effects of stock-out are lack of access, client frustration and loss
of confidence, high drop-out or discontinuation rate, dissatisfied providers and decline in contraceptive
uptake and prevalence rate. A major threat to contraceptive supply and distribution in the FCT is its donor
dependence, a development that may disrupt and cause a set-back for FP service delivery in the event of the
withdrawal of international funding. The inserted diagram (Figure 5) illustrates the challenges militating
against LMD of contraceptives and implications on service delivery and clients. There is therefore the need
for a more innovative, resilient and sustainable approach in responding to them in the CIP period to remove
barriers associated with stock-out of commodities. For instance what approaches are required to reach the
hard to reach areas and inadequate supplies of commodities and how can the government take over and
assume full ownership of the Last Mile Distribution after donor funding?
2.2.4 Policy and Environment
The Federal Ministry of Health has rolled out a number of policies and plans whose provisions addressed
specific issues at the state level including Federal Capital Territory. These included the National Health
Policy; National Policy on Population and Sustainable Development; National Strategic Health
Development Plan; National Reproductive Health Policy; National Free Contraceptives policy; National
Sexual and Reproductive Health Policy for Persons with Disability; the National Adolescence Health Policy
Figure 5: Illustration of challenges to LMD of Contraceptives in FCT

14 | P a g e
and Strategic Plan; National Task Shifting and Sharing Policy; National HIV&AIDS Strategic Framework
and National Family Planning Blueprint (Revised). A number of these policies and plans are also being
replicated and domesticated at state/FCT level to address priorities and unique needs of the people.
Consequently, the FCT Administration has also enunciated and adopted a number of policies and plans for
health development in the FCT. These include the FCT Strategic Health Development Plan (SHDP) 2018-
2022; FCT Public Private Partnerships Policy; and Task Shifting/Task Sharing (TSTS) Policy for the health
sector. These plans have specific interventions for family planning. For instance, the TSTS policy is being
implemented considering that SCHEWs in the FCT are being trained to provide LARC services, thus
expanding access to LARC services in most SDPs at the PHC level. For the other plans and policies, their
level of implementation is unknown and as such the impact they have on family planning service delivery
specifically could equally not been determined. In addition, though there is no specific legislation on health
in the FCT, there are a number of national laws including the National Reproductive Health Commodity
Security Strategy Act which has impacted on the delivery of family planning services with availability of
free contraceptives at all SDPs. The implementation of this Act has increased demand, uptake and use of
modern contraceptives in the FCT.
The National Health Act (2014) is also expected to impact positively on the delivery of family planning
services when it is fully implemented. In FCT, political commitment to family planning is evolving but more
still needs be done. For instance, political commitment is strongly linked with availability and adequacy of
infrastructure and amenities for quality health care delivery, full ownership of the response to family
planning and availability of consumables. In the present circumstance, most health facilities are not
conducive to service delivery including family planning, consumables are not available to support service
provision, human resources are inadequate, basic amenities (water, power supply etc.) are inadequate, while
the response is still heavily donor dependent. For instance, Reproductive Health including family planning is
almost at zero level funding in the FCT despite the fact that the FCT Strategic Health Development Plan
(2018-2022) makes provisions for family planning and adolescent health. Furthermore, the plan has the
target of increasing contraceptive prevalence rate from 15% to 43% by 2021 and also achieve 50% reduction
in unmet needs for FP among all females of reproductive age. In addition, there are specific targets relating
to adolescent reproductive health in the plan while some costs were also indicated. However, there are no
specific activities defined for the achievement of these objectives, but some generic and non-specific
interventions.
During NURHI 1 Project, advocacy activities were pursued with intensity and with the aid of advocacy kits
developed, the efforts resulted in some positive response to family planning by a few Area Councils. The
project also facilitated the establishment of an Advocacy Core Group to engage at all levels of decision
making, but most especially policy and funding (FCTA and Area Councils). This group was trained in
advocacy, budget and expenditure monitoring and tracking for family planning and also received support to
carry out advocacy activities. The effort of this group yielded some positive results especially at the Area
Council level. For instance, AMAC and Bwari Area Councils demonstrated acceptance of FP Programme by
creating separate budget lines, allocating and releasing funding accordingly. In addition, religious leaders
were adequately mobilised and engaged to support family planning which yielded some positive dividends.
It is required that a lot needs be done to build on, consolidate and sustain the achievements recorded through
a re-energised Family Planning Advocacy Working Group and a well-articulated and effective advocacy
strategy.

15 | P a g e
At the community level, especially in rural areas, there are still widely held religious beliefs that are resistant
to the use of family planning and
modern contraceptives in particular. In
addition, negative socio-cultural
practices, low status of women and
their inability to take decisions on
FPand negative disposition of the men
towards family planning are other
factors that militate against uptake and
use of family planning. Though about
one third (31.3%) of married women
using and not using family planning
reported taking the decision alone,
however, 58.5% of married and using
and 52.0% married but not using
reported it to be a joint decision (Wife and Husband) while 10.3% of married and using and 15.5% of
married but not using reported that the decision rested with their husbands6
. These findings still show that
men are critical in the decision making process regarding the use of family planning by their partners. The
religious, traditional and community leadership is dominated by men and their stand on family planning is a
strong factor in acceptance or rejection by women. Specifically, due to inadequate knowledge and
understanding of family planning among men, coupled with low spousal communication on reproductive
health, men are a major factor to demand and use of FP services by women. This is fuelled by desire to have
more children, especially male children, thereby increasing fertility rate to 4.3 whereas preferred fertility rate
among women is 3.8. In addition, all decision making platforms (family, community, politics, policy,
legislation, religion etc.) are dominated by men, a development that makes engagement with the men at all
levels very compelling.
2.2.5 Family Planning Financing
In FCT health programs and services including family planning are funded through annual budget allocation
in addition to financial support from local and international development agencies. Though fund has not
been available for family planning through
the regular budget allocation, however, there
has been some funding support from Save
One Million Lives (SOML) and BHCPF. In
FCT, there is a budget code (22040105) for
Reproductive Health (where family planning
is expected to draw fund from). At FCT level,
between 2010 and 2014, there has been no
fund for family planning but from 2016 to
2019, N5m was allocated annually to
Reproductive Health but there has been no
release due to inadequate resources to fully fund the budget. This development has made family planning
activities and service delivery to be heavily dependent on international development partners’ support. Some
opinions have it that availability of donor support has given impetus to government neglect of this
6
NDHS 2018
Box 4: FP financing in FCT and Area Councils
Agency/
Department
2010 2011 2012 2013 2014
FCT-HHSS 0 0 0
FCT-PHCDB 0 0 0
AMAC 0 80,000 0 0 8m
Bwari AC 700,000 1.7m 4.9m 7m 5.7m
Abaji 0 0 0
Gwagwalada 0 0 0
Kuje 0 0 0
Kwali 0 0 0
Figure 6: Decision on Family Planning

16 | P a g e
component of health in annual resource allocation. The effect of this development is that areas of family
planning not covered by donor assistance receive no attention.
At the Area Council level, some funding efforts were noticeable in 2 Area Councils (AMAC and
Bwari) between 2010 and 2014. This was strongly linked with the NURHI 1 project with very
strong advocacy component at FCT, Area Councils and Community levels. For instance, AMAC
provided the sum of 80,000 in 2011 and N8m in 2014, Bwari on the other hand provided N700,000,
N1.7m, N4.9m, N7m and N5.7m in 2010, 2011, 2012, 2013 and 2014 respectively. There was no
evidence that the other 4 Area Councils provided any fund for family planning. There is no
information to prove if this funding is sustained till date in the 2 Area Councils, and perhaps if the
other Area Councils in the FCT have also made any effort at providing any form of funding for
family planning. The FCT Strategic Health Development Plan (2018-2022) indicated costs against
each pillar and intervention area with Reproductive Health accounting for 20.1% and adolescent
health 2.7% over a 5-year period. However, there is no information to show how much of the fund
has been made available as detailed in the plan. The major issue that has bedeviled the adolescent
and school health services have been that of non-release of fund. The annual budgetary allocation
to the unit in 2016, 2017, 2018 and 2019 was N5M. Despite the allocation, less than 20% was
released and utilized annually.
The implication of this inadequate government funding scenario is that, there has been a wide
funding gap for family planning in the FCT and this explains heavy reliance on international
development agencies. On resource mobilisation, there is no known strategy adopted by FP
stakeholders in FCT to mobilise resources for family planning as donor support to family planning
in FCT has been at the discretion of the agencies and providing such funding. It is therefore
important for the FCTA as well as the Area Councils to be more pro-active and strategic in taking
ownership of the response by way of direct fund allocation to family planning while still leveraging
on funding from international development partners and to the extent possible, the private business
sector.
2.2.6 Coordination and Partnership Management
Effective coordination is required for a high impact family planning response considering its
capacity for providing direction and ensuring that available resources (human, material and
financial) are adequately harnessed, deployed, managed and maximized. The availability of the
required leadership and functional management systems are drivers of a multi-disciplinary or multi-
sectoral response to programme such as family planning. At FCT and Area Council levels, family
planning units exist to coordinate all the activities and been provide the required leadership and
direction despite all the challenges being experienced.
Some of the roles and responsibilities of the Units include facilitating training of providers;
coordination of input of all actors; coordinating the implementation of related policies and plans;
documentation; supervision and monitoring; projecting and ordering for contraceptives and other
supplies; provision of required supplies, interacting with and coordinating input of the partners into
the response; resource management; use of data for planning and decision making; and linking with
national coordinating structure. Within the Board is a team headed by the FP Coordinator and

17 | P a g e
supported by other staff such as Deputy RH/FP Coordinator, Logistics Officer and Monitoring and
Evaluation Officer. At the
Area Council level are the
Family Planning
Supervisors, while
coordination at the Service
Delivery Points is led by the
FP Service Provider. The
Logistics Officer ensures
availability of contraceptives
while the M&E Officer is
responsible for data
collection, analysis and
utilization. The Board in
November 2018 inaugurated
the Family Planning
Technical Working Group
(FPTWG) to support the FP
Unit in coordinating the
input of all partners and
stakeholders into the
response. The Group
provides oversight in
shaping the response,
technical input, quality
assurance and translating
policies to action.
The operations of the Unit
has been negatively affected
largely by several factors
including lack of required
financial resources,
inadequate human resources and weak logistics support resulting in non-implementation of planned
activities such as monitoring and supervision, linking effectively with stakeholders, documentation
and engaging for more enabling environment for FP in the FCT. This is also the situation at the
Area Council level. In addition, there is also no structure to effectively coordinate the adolescent
and youth component of the response. Coordination of the response has also been hampered by the
fact that not all the players respond to the demands and requirements of the regulatory authority.
Some of the partners prefer unilateral actions without linking and aligning with the priorities and
requirements of the response. This is because the Board (Family Planning Unit) has not established
a functional system for coordinating the input of these partners. For instance, no platform exists for
continuous consultations, interactions, information sharing and progress monitoring
Box 5: Highlights of Local and International Agencies/project
support to FP in FCT
Agency Types of support
UNFPA  Renovation of FP clinics
 Procurement of contraceptives
 Training of providers in syndromic management of STIs
 Support to cluster review meetings and re-supply of FP
commodities
 Supply of female condoms
 Support to strengthen coordination
SFH  Supply of condoms
 Training of Doctors, Nurses and Lab Scientists) in STIs and RTI
from 4 health facilities in each area council.
Ipas  Training of clinical service providers on post abortion care
 Provision of MVA kits at the facilities where training was done in
Bwari AC.
ARFH  Training of Trainers for select Nurses/Midwives on injectables (as
part of Task shifting policy)
NURHI
Project
(1)
 Comprehensive Training for FP service providers (6-weeks)
 Contraceptive update/refresher training for Doctors and
Nurses/Midwives
 Training on LARC
 Training on Post-Partum IUD
 Training on Supportive Supervision and Monitoring and Evaluation
for FP Supervisors and Providers
 Training on Contraceptives Logistics Management and Supplies
 IPCC Training for non-clinical providers (CHEWs, community
mobilisers and PMVs)
 Training on RAPID presentation
 Renovation of selected FP clinics (72 hour makeover of FP clinics)
 Comprehensive BCC/DC activities including strategic media
engagement
 Support to Advocacy
 Supply of opportunity stock
PPFN  FP service delivery through its clinic
Private
Health
Sector
 Clinical services provision
 FP promotion and referral of clients
 Sales of contraceptives
SOPS
Plus
 Capacity building for private health sector to provide FP services
and facility equipment support
SOML  Support to capacity building, logistics and data management,
GHSC-
PSM
 Support to Contraceptives Logistics Management System (CLMS)
and Last Mile Distribution of FP commodities
DKT  Social franchise of family planning commodities
JHCCP –
BAN
 Social and Behavioural Change Communication for FP

Costed Family Planning Plan for FCT 2020-2024

Costed Family Planning Plan for FCT 2020-2024

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