Governments, particularly at the sub-national level, have been urged to take greater ownership of reproductive health initiatives in light of dwindling donor support for programmes aimed at improving health outcomes.
Public health experts and stakeholders from across the country stressed the urgent need for sustainable domestic financing to close access gaps, especially for women and young people.
They expressed concern over Nigeria’s persistent underinvestment in family planning, citing a 97% drop in budgetary allocation over the past year and a contraceptive prevalence rate that remains stagnant at 15%.
This was highlighted on Thursday during a high-level sexual and reproductive health and rights (SRHR) policy dialogue hosted by Nigeria Health Watch (NHW) in Abuja, which focused on closing equity and access gaps in reproductive health services, particularly for women and girls, amid mounting economic challenges and declining donor support.
NHW Managing Director, Vivianne Ihekweazu, while noting the aim of the dialogue is to explore strategic approaches that address the equity and access issues that so many young girls and women face across Nigeria, pointed out that despite being a nation of over 200 million people, Nigeria continues to under-invest in reproductive health, particularly family planning services.
“Last year alone, there was a 97% drop in the budget allocated to sexual and reproductive health. This has a real-life impact, especially at the primary care level, where the commodities women and girls’ needs simply aren’t available,” she lamented.
She explained how the shortage leads to unplanned pregnancies, stripping women of the autonomy to decide how many children to have.
“The modern contraceptive prevalence rate in Nigeria is just around 15%, while the unmet need for family planning services stands at about 20%. That tells us clearly, we have serious gaps to close.
“Unmet needs and unplanned pregnancies deny women the agency to control their lives. Beautiful roads are meaningless if our health systems fail,” she said, urging State governments to take ownership as donor funding declines.
Ogun State Commissioner for Health, Dr. Oluwatomi Coker, shared how her State is navigating the challenges by integrating a dedicated family planning budget line into its operational plan, leveraging the Basic Healthcare Provision Fund (BHCPF), and gradually transitioning from donor dependence to self-reliance.
She credited the ‘Business Unusual’ approach introduced by The Challenge Initiative (TCI) for guiding the state toward sustainable financing.
“We’ve integrated this into our annual operational plans and state budgets. This allows us to know exactly what is needed, and then we mobilise resources domestically,” she said.
Dr. Coker said Ogun leverages the BHCPF State budget releases, and even spending thresholds, adding, “We make use of the Commissioner’s and Executive Secretary’s approval limits to plug any immediate gaps.”
On donor dependence, she noted, “Initially, partners like TCI covered most of the cost. But we’ve steadily increased the state’s share. In 2023 and 2024, we procured our commodities with support from UNFPA, and we plan to do so again this year.
“Part of the profits from our Drug Management Agency’s drug sales also go into the family planning basket fund.”
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Highlighting progress in capacity building, she said, “Our team can now forecast, report, and manage public funds. Local governments pre-position funds to support family planning, and traditional leaders help drive grassroots demand.
“We’re on the right trajectory, but political will is still key.”
Dr. Binyerem Ukaire, Director of Family Health at the Federal Ministry of Health and Social Welfare, who delivered the keynote address, however, noted that the Federal government has not been complacent about addressing the issue while acknowledging that Nigeria has historically relied on external partners for up to 80% of family planning funding.
Noting that recent donor cuts have exposed vulnerabilities, she added, “Thanks to the leadership of the Health Minister and support from President Tinubu, we’ve mobilised $200 million to maintain supply chains”.
Resources from the BHCPF, the Gavi Health Systems Strengthening (HSS) fund, and the Global Financing Facility (GFF), according to her, have further boosted the country’s capacity.
States like Lagos now have dedicated family planning budget lines, while initiatives such as Medicaid’s PVAC have secured an additional
$6 million for logistics and procurement, she explained.
She added that many policies need updating to reflect current realities, saying, “Our focus is now on implementation, ensuring services are integrated across schools, communities, and health facilities”.
The panellists who discussed ‘Addressing Policy Implementation and Funding Gaps for SRHR Impact’ shared the same sentiment, as Pharm. Aminu Bashir, Permanent Secretary of Kano State’s Ministry of Health, shared the State’s success in establishing a Health Trust Fund that allocates a fixed portion of state and local revenue to reproductive health.
According to him, Kano has introduced a N500 million budget line for family planning and partnered with the Gates Foundation in a tripartite funding structure.
“Embedding family planning into our Annual Operational Plan ensures better alignment and sustained access,” he said.
Dr. Taiwo Johnson, Director of TCI Nigeria, emphasised that Nigeria requires $45 million annually for contraceptives, but only 62% of that is funded, largely by donors. Stock-outs affect up to 70% of health facilities in some states.
“Ogun, Kaduna, and Lagos have shown how institutionalising high-impact practices can drive local ownership and improve access,” he said.
Mal. Ghali Dambazau Talle, from the Federal Ministry of Education, stressed the importance of youth-friendly, age-appropriate sexuality education.
Through the Family Life and HIV Education (FLHE) curriculum, schools are equipping adolescents with the knowledge to make informed decisions, he added, revealing that a recent partnership between the Health and Education Ministries now ensures better integration of services in schools.
