Health
How Public Sector Strengthening Is Raising FP Uptake In Edo PHCs
How public sector strengthening is raising FP uptake in Edo PHCs
By Chidinma Ewunonu-Aluko, News Agency of Nigeria (NAN)
When Mrs Faith Ifeanyi walked into a Primary Healthcare Centre (PHC) in Edo, she was not looking for a miracle. She wanted something simpler – time.
After having two children, Ifeanyi wanted to space her pregnancies so she could care for her family and return fully to her trading business.
She eventually chose an IntraUterine Contraceptive Device (IUCD) after receiving counselling at a PHC supported by MSI Nigeria Reproductive Choices (MSIN).
“Before, I was not having time to face my business. But when I spaced my children, I was having time to trade,” she said.
For Ifeanyi, family planning became less about contraception and more about control over the rhythm of her family life.
“To other women, family planning is good. The spacing will give you time to take care of the children,” she said.
Her experience is increasingly being replicated across the state of Edo, where women who once faced limited information, unavailable commodities or providers unable to offer a full range of methods are finding more consistent services at primary healthcare centres.
For Mrs Kadijah Rabiyu, the availability of commodities and counselling made the difference.
She said she received strong support from her husband and was able to access her preferred injectable contraceptive whenever she needed it.
“The consumables and commodities were always available whenever I needed them. MSIN personnel are always available to counsel one and support,” Rabiyu said.
With the rising cost of living, she said she and her husband were conscious of the number and spacing of children they could comfortably care for.
“I didn’t want to be producing children anyhow,” she said, urging other women to consider family planning as a way of protecting their health and managing family responsibilities.
Mrs Joy Yusuf reached a similar decision for economic reasons.
With household expenses rising, she and her husband decided to create more space between their children rather than have another pregnancy before they were ready.
“This economy now is not easy, so we gave gap to take care of those ones that we have before we plan to have another one,” Yusuf said.
Her husband, she added, fully supported the decision.
“The injection method I used is good for my body and the MSIN service providers are really doing their best to attend to us,” she said.
For Mrs Yemisi Ayanda, family planning gave her control over her life and health.
Ayanda, a five-year Implant user, said she got pregnant five months after removing it.
She appreciated MSIN for providing adequate counseling and ensuring that commodities and consumables were always available.
“There is no argument. Family planning is very good. It helped me to plan my life as a woman without looking older.
“Without it, many men without self-control will just be producing children anyhow; so I really thank the service providers for the good work,” she said.
For Mrs Mary Ogbemudia, spacing her children was about protecting their wellbeing.
Ogbemudia, a three-year implant user, said she chose the method so that her children would not suffer due to poor maintenance.
“Family planning is better for married people to enjoy their marriage because not every man likes using condoms with their wives. They prefer it skin-to-skin.
“Some people believe that after doing FP one will not be able to give birth again. But I don’t believe it, because my sister and I did it and in less than three months after removing it, she became pregnant again.
“When I did it initially, I didn’t see my menstruation.
“I came to complain to the clinic and they told me that it will start flowing again. So after the fourth month, I started seeing my menses again and it’s coming out fine till now,” she said.
Mrs Joy Romanus and her husband reached a different decision.
Romanus said fear of side effects made them opt for the natural method of withdrawal instead of modern methods.
“Fear of the side effects people complain about FP made us opt for the natural method of withdrawal by agreement,” she said.
These individual decisions reflect a wider change in the way family planning is delivered in Edo.
In 2018, only 15 per cent of women in the state were using modern contraception. By 2024, the figure had risen to 19.4 per cent—a 4.4 percentage-point increase.
The News Agency of Nigeria (NAN) reports that the improvement came amid efforts by MSIN and the Edo State Ministry of Health to strengthen family planning services through the Public Sector Strengthening (PSS) model in primary healthcare centres.
According to Dr David Odiko, Director of Family Health, Edo State Ministry of Health, the PSS model is a Public-Private Partnership between government and MSIN.
“The partnership between the Ministry and MSIN provides a win-win for both parties.
“We provide a platform for them to deliver on their mandate of improving maternal reproductive health services and the data to justify their investment.
“The state benefits in health systems strengthening, capacity building, improved service delivery and improved data management,” he said.
Rather than creating a parallel service, the model works through existing government facilities, combining the supply of contraceptive commodities, training of healthcare workers, supportive supervision, demand creation and stronger data systems.
The state is also taking ownership to sustain the gains.
Odiko noted that with the governor’s approval of N150 million for FP commodities and inclusion in the state’s Annual Operational Plan, Edo is preparing PHCs to run services without partners.
“We are already budgeting for provision of commodities and we intend to advocate for yearly increase of that budget by showcasing what was made possible, maternal deaths averted, livelihoods improved,” he said.
For women like Ifeanyi, Rabiyu, Yusuf, Ayanda and Ogbemudia, the impact is ultimately measured in practical terms: whether the method they want is available, whether a trained provider can explain their options, and whether they can make decisions about pregnancy without being turned away.
At Uhunmwode Local Government Area, health workers say this shift is becoming visible in routine service delivery.
Mrs Favour Nwabor, a Health Educator in the LGA, said counselling had become central to the way women were supported to choose a method.
“We normally counsel women on the methods to know the best ones for their bodies,” she said.
Nwabor reiterated that they normally counselled the women on the different FP methods to know the best ones for their bodies.
“We tell them that natural methods such as withdrawal is 50/50, as it can still fail them. It’s not 100 per cent guarantee,” she said.
She also pointed to the availability of commodities as an important part of the change.
“Moreover, we normally get adequate support from MSI and other partners in terms of commodity supplies. We don’t always run out of stock,” Nwabor said.
For MSIN, ensuring that women do not leave facilities empty-handed is one of the central pillars of PSS.
Mrs Grace Esan, Social and Behaviour Change Officer, MSIN, Edo, said the intervention was designed to strengthen PHCs so they could continue delivering quality family planning services even after external partners withdraw.
“Our approach is not to run a parallel system. We are working inside government structures to strengthen what is already there,” she said.
“The goal is that in two to three years, the PHCs can stand on their own to deliver quality FP without waiting for partners.”
The approach addresses a familiar problem in public healthcare: training health workers without ensuring that the commodities they need are available, or supplying commodities without building the capacity to provide quality counselling and services.
Under PSS, MSIN supports four key areas—FP commodities and consumables, provider training, supportive supervision, and data and reporting.
Esan said the organisation first tackled stock-outs because availability was critical to retaining clients.
“We support with FP commodities and consumables so that when a woman walks into the PHC, the method she chooses is available. Stock-out is one of the biggest reasons women drop out, so we tackled that first,” she said.
Providers were also trained in counselling, method mix, long-acting reversible contraceptive insertion and removal, and client-centred care.
“Many providers were afraid of some methods before. After training and mentoring, their confidence has improved and they can now counsel properly and offer all methods,” Esan said.
But training, she explained, is not a one-off exercise.
“We don’t just train and go. We go back to the facilities, sit with providers, review their data, correct mistakes and encourage them. That supervision builds their skills and keeps service quality high,” she said.
Esan cited Uhunmwode LGA as one example of the change.
“Before PSS, the PHC had very low FP uptake and stock-outs were frequent. Women would come and go back empty.
“But with training, supportive supervision and regular commodity supply, the facility now offers full method mix and records steady client flow. The providers are confident as clients trust them,” she said.
The model, she added, works because it tackles both sides of the family planning equation.
“When commodities are available, providers are skilled, and communities are sensitised, uptake will rise. That is exactly what we are seeing in Edo,” Esan said.
The Edo Family Planning Coordinator, Mrs Adja Abieyuwa, said the intervention had also improved counselling and integration of family planning into routine maternal health services.
She said providers were now better equipped to offer a full method mix, conduct balanced counselling and help clients make informed decisions.
“Service delivery has shifted to routine, integrated FP in Antenatal Care, Postnatal Care, in-reach and outreach,” she said.
On what had changed in PHCs since 2018 because of PSS, Odiko said: “More facilities now have capacity to offer the full range of family planning services. The counselling process is improved.”
But the progress has not eliminated the barriers.
Abieyuwa identified commodity gaps, cultural myths, misinformation, partner or spousal refusal and fears about side effects, particularly among adolescents, as continuing challenges.
Dr Christiana Ijeghede, a retired Director of Nursing and former Principal of the State School of Midwifery, said misinformation remains particularly difficult to overcome.
“Many women believe an IUCD will travel to the brain, or that tubal ligation will prevent reincarnation,” she said.
She argued that better counselling, using basic anatomy and engaging faith and community leaders, could help dispel such beliefs.
“Every local government area should have at least a family planning personnel who is well trained,” Ijeghede said.
“When the community leaders, the religious leaders, the men and the women all understand why family planning is important, then we will see real change.”
The state also faces a more immediate operational challenge: keeping commodities available.
Odiko confirmed that stock-outs remain a concern.
“A major challenge now is stock-out of FP commodities. We couldn’t procure products last year because approval came late and we didn’t get cash back; right now we have stock-outs,” he said.
He linked some of the delays to the transition of procurement responsibilities to a new Drug Management Agency.
“Procurement has been ceded to them, and the takeover is causing delays. But we’re in the process of getting the commodities now,” Odiko said.
The Commissioner for Health, Dr Cyril Adams-Oshiomole, said more than 350 PHCs in the state currently provide family planning services either free or at significantly subsidised rates where consumables are required.
He attributed the growth in uptake to targeted programmes and partnerships, including outreaches to hard-to-reach communities and markets, peer-to-peer sexual and reproductive health education among secondary school students, and collaboration with development partners.
The state’s MCPR, he said, now stands at 19.4 per cent, above the 15 per cent national figure reported in the 2024 Nigeria Demographic and Health Survey.
He said the state was also working to domesticate the Task-Shifting and Task-Sharing policy to enable trained senior Community Health Extension Workers to provide family planning services.
Since 2022, he said, FP uptake across Edo had grown by an average of 25 per cent annually, with more than 90,000 women accessing services in 2025 and more than 20,000 in the first quarter of 2026.
Yet the numbers tell only part of the story.
For women like Ifeanyi, the significance of family planning is not captured by a percentage point increase. It is the extra time to run a business.
For Rabiyu, it is the confidence that a preferred method will be available when she needs it. For Yusuf, it is the ability to plan around the economic realities of raising children.
Their experiences suggest that when a health system makes services available, equips providers to offer informed choices and earns the trust of communities, women are more likely to use those services.
The state of Edo is now trying to make that progress sustainable.
At the 2026 Edo SHINE—State Health Investment for a Nigeria that Ensures Primary Healthcare—Summit, the state signed a PHC Sustainability Commitment.
The governor also approved N150 million for family planning commodity procurement, while FP interventions have been incorporated into the state’s Annual Operational Plan with dedicated budgeting.
On the sustainability plan if MSIN withdraws, Odiko said the state would use results to push for more funding.
“As stated earlier, we intend to showcase the work we are doing as an advocacy tool for increased funding,” he stated.
The ambition is to move from dependence on external partners towards government co-funding and institutionalise training, supervision, mentoring and commodity procurement within the state health system.
The women already using the services may be the clearest measure of whether that transition succeeds.
For Ifeanyi, the benefit is straightforward: “The spacing will give you time to take care of the children.”
For Edo’s health system, the challenge is to ensure that every woman who makes that choice finds the information, commodities and skilled provider she needs when she walks into a PHC. (NANFeatures)www.nannews.ng
Edited by Vivian Ihechu
