Family Planning In Abia State: A Tale of Poor Funding, "User Fees" and TCI’s Impact

Family planning has been practiced for centuries. Records show that as far back as the 16th century, the people of Djenné in West Africa understood its importance, with physicians advising women to space their births every three years to prevent frequent pregnancies.

Today, family planning services provide individuals and couples with the ability to determine the number of children they want, as well as the timing and spacing of pregnancies. Yet, despite its central role in safe motherhood, maternal health, and improved quality of life for women, family planning remains one of the most neglected programs across many communities.

Some religious groups continue to discourage the use of contraceptives, insisting on only the natural Billings method, which has contributed to rising cases of unwanted pregnancies and unsafe abortions.

TCI’s “Business Unusual” Approach

The Challenge Initiative (TCI), funded by the Bill and Melinda Gates Foundation, is a three-year urban reproductive health program designed to strengthen access to high-impact family planning solutions for low-income urban populations.

Unlike traditional programs, TCI is demand-driven. Local governments self-select to participate and demonstrate political commitment by providing financial, human, and material resources. In return, TCI supports them with technical expertise and its challenge fund.

Dr. Okpara Ikechwuku, the Technical Support Lead for Service Support, explained that the programme began by addressing service delivery challenges at the facility level.

“We started from training the officer in charge, that is, the OIC here, the FP Supervisor of the LGA. We trained them on that LARC. Then the second intervention was to come here and renovate the facility. We did this in what we call the 72-hour makeover, where we started working on Friday at the close of business; on Monday morning, it was commissioned.”

The 72-Hour Clinic Makeover

The 72-hour makeover is an intensive renovation and refurbishment of health facilities based on needs identified during an assessment. When it is completed, clinics are equipped and prepared to offer optimal family planning services. It typically comes after providers have been trained and communities mobilized.

In Abia State, two facilities have already benefited: Osaa Okea Primary Health Care Centre in Obingwa and Umuola Egbelu Primary Health Care Centre in Aba North.

Comrade Eruba Victoria Choma, Health Authority Secretary in Obingwa, said the improved Osaa Okea facility now attracts clients from across the ward.

“We have other facilities within this place, and this place is strictly populated. So, the services, and there is a client flow here. But we made it in such a way that it will not be difficult for them to assess in terms of distance.”

Women in the community have also embraced the services. Regina Nzuegbu spoke about their growing acceptance.

“The good people of Osau, I greet you. My mothers, I greet you. We are very well. Our women come for family planning services just like the government has instructed us. They said we shouldn't give birth to the number of children we can't cater for. We've been keeping to it. Those who want to get pregnant, get pregnant. Those who want family planning services still get them 24 hours. The nurses here are doing a great job, and they are nice to us.”

Men are not left out. A male community leader shared his own experience.

“I myself now; if I’m having sex, I use a condom so I don’t cause problems. Before now, our women used to give birth to a lot of children.”

How Residents Access Services

Accessing family planning begins with a visit to a health facility. The officer in charge first determines the most suitable method for the client in a private counselling session. Afterwards, the client is directed to the procedure room to receive the service.

Despite improved facilities, the level of awareness and acceptance of modern family planning remains low.

The Funding Problem

Abia State currently allocates 7.5 percent of its budget to health, half of the 15 percent recommended by the World Health Organization. The consequences are severe. Every year, 2,345 women in Abia State die from pregnancy and childbirth-related complications.

Even more worrying is that some clients still struggle to access family planning services due to user fees tied to medical consumables.

Although the services themselves are free, consumables such as cotton wool, gloves, syringes, and antiseptics are often insufficient. This forces facilities to charge small fees to cover the gap.

Victoria explained:

“It's free, actually, for the materials and the consumables we get. How do we provide for it? Because the workers here are not being given any impression. So when you get commodities, like now we're doing MIMOP, Modified Medical Outreach Program. That's what we're doing, and child health will be combined. They gave us consumables. You manage it so that you use it for other services. Assuming it gets finished, what do you do?”

In Aba North, the Social Mobilization Officer, Ebutta Grace, expressed similar concerns.

“When you come to consumables, that's where the problem lies. When you talk about the user fee, the problem is with the consumables. TCI has provided us with good accommodation and other things that we need to work with; without the consumables, how does a provider give all these services?

What I need is blood, if the blood is not there.

How can I provide it? I cannot give a user what he or she wants without cotton wool. If the cotton wool is not there, I have the commodity, I have a good building, what can I do?”

Advocacy, Budgets, and the Unanswered Question

Before TCI entered Abia State in June 2018, family planning had never been a government priority. Activities depend largely on donor funds.

TCI’s advocacy pushed the state government to budget 200 million Naira for family planning in 2019, followed by 145.75 million Naira in 2020; however, these funds were never released.

In the 2021 budget, 70 million Naira was approved, but the key question remains:

Will the Abia State government finally release the funds? If released, the funds would be used for:

The training and retraining of health workers, community and mass media sensitization, renovating and equipping family planning units, procuring essential consumables, monitoring and supervision, and providing data tools and reporting materials.

TCI warns that without visible government commitment, its support to Abia may be withdrawn.

What happens next?

Family planning saves lives. It empowers families, reduces maternal deaths, and improves community well-being. Abia State has made progress through TCI’s support, but sustainability depends on government action.

If the approved funds are released, the gains made so far can be strengthened and expanded. If not, access to family planning services may decline, and the state’s maternal mortality burden may continue to rise.

For now, all eyes are on the government of Abia state to decide the future of family planning in the state.