Primary health care facilities in the Yaba Local Council Development Area of Lagos State, Nigeria, removed all user fees for family planning services in November 2016 – making family planning services completely free. Yaba is the first locality to follow through on the government of Nigeria’s commitment at the 2012 London Summit on Family Planning to provide free family planning services to all Nigerians.
The state’s Honorable Commissioner for Health first issued a policy directive in January 2016, mandating that family planning services should be completely free of charge to the client. Though family planning commodities are already free nationwide, out-of-pocket costs for consumables remain a barrier for family planning uptake. These costs particularly affect highly effective long-acting methods, such as IUDs and implants, which require consumables for proper provision.
The directive was issued as a result of efforts from the Lagos State family planning advocacy working group: the Public Health Sustainable Advocacy Initiative (PHSAI). The directive abolished fees usually charged for health care consumables such as gloves, surgical blades, and other supplies. However, the State Ministry of Health did not allocate any additional funds to support this directive, which impeded its implementation.
Determined to implement the new directive, PHSAI spent months reaching out to key stakeholders with support from Advance Family Planning local partner Pathfinder International, the Nigerian Urban Reproductive Health Initiative, and other partners. They engaged with sole administrators of the local government areas, heads of local council development areas, medical officers, and chairmen of community development committees to take actionable steps towards creating a budget for family planning in the Lagos state’s local budget for family planning. The PHSAI also worked with these stakeholders to identify ways to leverage existing funds for purchasing family planning consumables at the primary health care centers.
Eight months of sustained advocacy helped implementation unfold. The Medical Officer of Health in Yaba directed the four primary health care centers within his jurisdiction to allocate funds for family planning consumables from the monthly funds given to them. All of the centers have complied, allocating between US $32—64 per month. This led to family planning consumables being provided, along with full services to clients, free of charge since November 2016.
This success will likely be a catalyst—already a few other local council development areas in Lagos State are discussing to follow suit. There are anecdotal reports suggesting more clients are taking advantage of the free services. The PHSAI will continue to advocate with local government and local council development areas in Lagos to secure funding for consumables throughout the states.