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Professor Lanre Olaniyan: Family Planning, COVID-19 Pandemic and Progress Towards Achieving the SDGs
- 1. Family Planning, COVID19 Pandemicand progress towards achieving the Sustainable Development Goals OLANREWAJU OLANIYAN HEALTH POLICY TRAINING AND RESEARCH PROGRAMME (HPTRP) DEPARTMENT OF ECONOMICS UNIVERSITY OF IBADAN IBADAN, NIGERIA
- 2. Outline Introduction Thedemography of Nigeria Family planning during emergencies Preparedness for Emergencies (Any role for FP2020, policies and programmes of government) Population structure, demographic dividend etc. In the Midst of the COVID-19 emergencies (Access issues; Quality issues; Post COVID-19 emergency activities (Implementation, Financing, New normal) Family Planning and the SDGs Policy Options What can COVID19 response learn from Family Planning programming? What can Family Planning programming learn from COVID19 response ? 2
- 3. Introduction First caseof COVID 19 in Nigeria was February 27, 2020 and it was imported The types of uncertainty, health and economic shocks associated with the illness had been unprecedented The pandemic has reminded us of Global health security Weaknesses in health systems, social protection and public services. Weakness of the economic systems and dependence on social systems the critical way in which the formal economy of developing countries including Nigeria has been sustained on the back of an informal economy and invisible and unpaid care labour. 3
- 4. 1 1 2 23 93 185 238 357 925 1,918 3,278 3,973 5,131 6,726 8,065 10,174 12,584 14,894 16,071 18,160 20,391 22,173 22,567 12,154 11,506 12,141 11,402 10,929 11,011 7,619 7,370 7,456 7,277 3,627 3,397 3,034 2,752 - 5,000 10,000 15,000 20,000 25,000 Week1 Week2 Week3 Week4 Week5 Week6 Week7 Week8 Week9 Week10 Week11 Week12 Week13 Week14 Week15 Week16 Week17 Week18 Week19 Week20 Week21 Week22 Week23 Week24 Week25 Week26 Week27 Week28 Week29 Week30 Week31 Week32 Week33 Week34 Week35 Week36 Week37 Monthly EpidemicCurve of Confirmed Cases in Nigeria, February - October 4
- 5. Introduction The healthsector of the country is one of the most affected sector by the COVID pandemic. While prompt response was initiated for different areas of the health sector by government, there re arguments on whether reproductive health and family planning has received appropriate response during the pandemic Incidentally, reproductive health is a fundamental human right; only individual adults should have the power to decide whether, when, or how often to conceive. Rights and responsibility… Family planning is at the core as it assists individuals who do not wish to become pregnant, dramatically reduces the number of unwanted pregnancies and abortions. 5
- 6. Family planningensures a balanced fertility and demographic transition in a society with attendant benefits empowering women to choose how many children they have, better health and survival of mothers and children, a reduction in poverty and a better educated population. With adequate and effective family planning, individuals take responsibility for the number of children they desire leading to birth rates fall and increase in the share of the working-age population relative to the dependent population. This puts countries at a window of opportunity to harness “demographic dividends”. Given that family planning directly shape the pace and patterns of demographic dividend, it will be used as the discussion framework in this presentation 6 Introduction
- 7. Response to COVID19 across countries had been similar… Setting up of Pandemic Task forces Lockdown of cities and settlements Closure of Schools, Markets and Businesses Travel Bans and Social distancing Personal hygiene and Community Hygiene Testing, Isolation and Quarantines Search for drugs and vaccine All these come with attendant risks and uncertainty for family planning and reproductive health 7
- 8. 26 31 38 39 41 60 57 63 63 64 53 49 52 50 37 40 34 34 0% 10% 20%30% 40% 50% 60% 70% 80% 90% 100% Europe Northern America Oceania Asia LAC Africa Ghana West Africa Nigeria Age Structure of Population by Region in 2019 Under 25 years old 26-64 years old 65 years and above Africa has the largest proportion of children and youths in the world and its share of the population at working ages (25 to 64 years) is increasing, providing an opportunity for accelerated economic growth Starting with the demography of Nigeria 8
- 9. The demography ofNigeria: Population 37,859,750 55,982,142 95,212,454 158,503,203 206,139,587 401,314,997 0 100000000 200000000 300000000 400000000 500000000 1950 1970 1990 2010 2020 2050 9
- 10. How prepared wasNigeria for the Pandemic? Nigeria has a National Pandemic Influenza Preparedness and Response Plan that was prepared in 2013. The health system preparedness for a global health shock was available, at least in a printed document. Although there was ebola but COVID is on a different scale It should be noted that neither reproductive health nor family planning was mentioned in the document Note that the Global Health Security Index, a comprehensive assessment of a country's health system capabilities, shows that most African countries are rated as least prepared. Nigeria with a score of 37.8 was ranked 96th out of the 195 countries that were assessed. Only 21 of 54 African countries are classified as being more prepared from a clinical perspective to deal with epidemic threats with international implications. The other 33 are ill-equipped and least-prepared to respond to the outbreak. Preparedness of Family planning system: Availability, distribution and supply chains 10
- 11. Preparedness: Where werewe on contraception and unmet needs? Contraceptive use allows couples to realize their full potentials, the woman can better fulfil her roles as a wife, mother, wage earner and community member. The man can better expand his roles as husband, father and family caregiver promotes small family size, improves child survival and reduces sibling competition for scarce family and maternal resources curtailing population explosion thereby reduce dependency ratio better the health indices for the country and improve socio-economic conditions. assist Africa to make progress in achieving all the sustainable development goals (SDGs) 11
- 12. 12 0 5 10 15 20 25 30 35 40 1990 2003 20082013 2018 Demand for family planning 0 5 10 15 20 25 30 North Central North East North West South East South South South West Unmet need for family planning • Approximately 45per cent of women in Nigeria are sexually active and do not want a child in the next two years. • In Nigeria, unmet need vary among geopolitical zones • Unmet need for modern contraception is also higher among unmarried sexually active adolescents What do we know about Preparedness: Contraception
- 13. Family Planning inthe Midst of the COVID-19 emergencies Restrictions on mobility make it even more difficult for young people to access high-quality, respectful, and confidential care. Limited mobility due to lockdowns increases the risk of unwanted pregnancies and unsafe abortions. Negative effect on access to many healthcare services, Negative effects on access to sexual and reproductive health services which are actually essential and lifesaving. Possibility of increased unmet need for modern contraceptives, unintended pregnancies, increased unsafe abortions, maternal and neonatal deaths and child marriages during the lockdown 13 - 5.0 10.0 15.0 20.0 25.0 30.0 0-14 15 - 34 35- 54 55 - 64 65 and above Proportion of individuals who are unable to access medical treatment
- 14. Family Planning inthe Midst of the COVID-19 emergencies (Access issues; Quality issues) Health System Issues Financing Issues Economic and General Planning Issue: Economic Sustainability plan of Government Global Goals that the government has signed into SDGs 14
- 15. 0 200 400 600 800 1000 1200 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80 84 88 Thousands Per Capita Ageprofile of Labour Income in Nigeria, 2016 Labour Income Source: Olaniyan, O., N. Olasehinde, A. Lawanson and A. Soyibo (2017) 15Why family planning is important for Nigeria’s sustainable development: Population Structure and Demographic Dividend
- 16. 0 100 200 300 400 500 600 700 800 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 68 72 76 80 84 88 Thousands Per Capita Ageprofile of Consumption Expenditure in Nigeria, 2016 Consumption Source: Olaniyan, O., N. Olasehinde, A. Lawanson and A. Soyibo (2017) 16
- 17. 0 200 400 600 800 1000 1200 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90+ Thousands PerCapita Age profile of Labour Income and Consumption Expenditure in Nigeria, 2016 Consumption Labour Income 0 500,000 1,000,000 1,500,000 2,000,000 2,500,000 3,000,000 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90+ Aggregate Age profile of Labour Income and Consumption Expenditure in Nigeria, 2016 Consumption Labor IncomeSource: Olaniyan, O., N. Olasehinde, A. Lawanson and A. Soyibo (2017) 17
- 18. Economic Lifecycle Deficit,Nigeria 2016 -2.5 -2 -1.5 -1 -0.5 0 0.5 1 0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60 63 66 69 72 75 78 81 84 87 90+ Child deficit N43.93 trillion Surplus N13.7 trillion Old Age deficit N1.63 trillion 18
- 19. (800,000.00) (600,000.00) (400,000.00) (200,000.00) - 200,000.00 400,000.00 600,000.00 800,000.00 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90+ Male Economic Lifecycle Deficitby Gender 19 (800,000.00) (600,000.00) (400,000.00) (200,000.00) - 200,000.00 400,000.00 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90+ Female The lifecycle surplus for women are really low and their deficits larger than those of male counterparts
- 20. Effects of COVID19 on Reproductive Health and Planning: Demographic Dividend Index (DDMI) for Nigeria (index = 36.4) Components of the Nigerian Demographic Dividend Index, 2018 Components of the Health and Wellbeing Pillar of the Nigerian DDMI, 2018 33.2 42.5 33.448.4 23.4 Health and Wellbeing Education and Skill Development Employment and Entrepreneurs hip Governance and Youth Participation Practical Evidence- Building on DD 16.9 39.5 18.1 32.6 48.1 34.7 54.2 Child health Reproducti ve health Adult health Health Finance Nutrition Water and Sanitation Housing Source: Olaniyan et al, 2020 Construction of Demographic Dividend Monitoring Index and Procedure for Setting up a Demographic Dividend Observatory for Nigeria 20
- 21. 16.9 39.5 18.1 16.0 48.1 34.7 54.2 Child health Reproductive health Adulthealth Health Finance Nutrition Water and Sanitation Housing HEALTH AND WELLBEING (BEFORE COVID) 16.9 27.9 18.1 16.0 48.1 34.7 54.2 Child health Reproductive health Adult health Health Finance Nutrition Water and Sanitation Housing HEALTH AND WELLBEING (AFTER 6 MONTHS OF COVID) 21
- 22. 50.0 22.5 38.1 48.5 19.7 Total Fertility Rate Adolescent Fertility Rate Skilledbirth attendant Proportion of demand for family planning satisfied Maternal mortality REPRODUCTIVE HEALTH (BEFORE COVID) 44.0 18.1 19.124.3 10.5 Total Fertility Rate Adolescent Fertility Rate Skilled birth attendant Proportion of demand for family planning satisfied Maternal mortality REPRODUCTIVE HEALTH (AFTER 8 MONTHS OF COVID) 22
- 23. 32.9 45.1 34.2 51.1 23.4 Health and Wellbeing Education and Skill Development Employment and Entrepreneurshi p Governance andYouth Participation Practical Evidence- Building on DD Demographic DIVIDEND MONITORING INDEX (Before Covid) (index = 37.4) 30.0 45.1 34.2 51.1 23.4 Health and Wellbeing Education and Skill Development Employment and Entrepreneurship Governance and Youth Participation Practical Evidence-Building on DD Demographic DIVIDEND (After months of COVID) (index = 36.0) 23
- 24. - 10.0 20.0 30.0 40.0 50.0 60.0 Total Fertility Rate Adolescent Fertility Rate Skilledbirth attendant Proportion of demand for family planning satisfied Maternal mortality Reproductive Health Health and Wellbeing DDMI DDMI before and during COVID Before COVID During COVID 24
- 25. -120 -100 -80 -60 -40 -20 0 Total Fertility Rate Adolescent Fertility Rate Skilledbirth attendant Proportion of demand for family planning satisfied Maternal mortality Reproductive Health Health and Wellbeing DDMI Percentage reduction in Components of DDM Index 25
- 26. There can beno sustainability without efficient and effective family planning • The demand for family planning will never cease as long as life continues to exist on earth • Humans want to satisfy their physiological desires and need for procreation (generational species sustainability). • At any point in time, there will always be a cohort of young adult couples who not only want to fulfil their sexual desires but also want to delay or postpone pregnancy, and so the demand for contraception will continue. • The way these are handled will determine the desired future which is sustainability and sustainable development… 26
- 27. Post COVID-19 emergencyactivities: The future is sustainability and sustainable development… “Sustainable development meets the needs of the present without compromising the ability of future generations to meet their own needs” Seen as the guiding principle for long-term global development, sustainable development consists of three pillars: economic development, social development and environmental protection” (http://www.uncsd2012.org/). 27
- 28. How do allthese fit into the Nigeria we desire: Sustainable Development Goals… • 17 Goals, 169 Targets, 230 Indicators 28
- 29.
- 30. SDGs that addressReproductive health directly Target 3.7: By 2030, ensure universal access to sexual and reproductive health- care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes Target 5.6 By 2030, ensure universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Programme of Action of the International Conference on Population and Development and the Beijing Platform for Action and the outcome documents of their review conferences 30
- 31.
- 32. 20.1 24.8 26.5 28.2 32.1 36.7 37.5 40.4 42.4 47.9 51.7 56.9 58.8 66.2 78.9 82.9 98.3 NIGERIA: PROGRESS TOWARDSACHIEVING THE 17 SDGS BY 2020 32
- 33. What do FamilyPlanning and SDGs have in common The political declaration stipulates the vision of the agenda and its underlying principles: • Universality: The goals and targets are applicable to all countries: Developing, emerging economies as well as developed countries • Integrative character of the all dimensions of sustainable development (economic, social, environmental and cultural) • Multi-stakeholder-Approach: all actors in line with their capacities have a shared responsibility to implement the agenda – shared responsibility for the outcomes! • Transformative: Sustainability shall be the new principle of all actions 33
- 34. • People • Endpoverty and hunger, in all their forms and dimensions, and to ensure that all human beings can fulfil their potential in dignity and equality and in a healthy environment • Planet • Protect the planet from degradation, including through sustainable consumption and production, sustainably managing its natural resources and taking urgent action on climate change, so that it can support the needs of the present and future generations. What can Family Planning preparedness learn from the SDG Elements 34
- 35. • Prosperity • Ensurethat all human beings can enjoy prosperous and fulfilling lives and that economic, social and technological progress occurs in harmony with nature. • Peace • Foster peaceful, just and inclusive societies which are free from fear and violence. There can be no sustainable development without peace and no peace without sustainable development. • Partnership. • mobilize the means required to implement this Agenda through a revitalised Global Partnership for Sustainable Development, based on a spirit of strengthened global solidarity What can Family Planning preparedness learn from the SDG Elements 35
- 36. Making Family Planningwork for the SDGs Digital Revolution Implementation arrangement Financing strategies Communications and outreach Partnerships 36
- 37. Digital Revolution forSustainable Development Given the new normal of social distancing and lockdowns, efficient and effective digital health solutions to reduce the burden on family planning providers is required as it will also increase access Further development of other digital government services and e- commerce Further investments in STEMS, digital skills, equity, and lifelong learning for reproductive health Accelerate the adoption of measures that support a fair transition for workers affected by the digital and technological revolution 37
- 38. Government must takethe commanding heights in the implementation… Increased role of government in key sectors (economy, health, food, social security) Develop a detailed action plan. Re-think global supply chains and dependence for strategic equipment and materials Strengthen development cooperation to support recovery plans Strengthen statistical capacity, and the availability of timely data Strengthen government capacities to anticipate and manage unforeseen disruptive events Strengthen international platforms, exchanges and transparency among scientists/researchers (open science) 38
- 39. Making Family Planningwork for the SDGs Implementation Issues Invest in health preparedness to update and upgrade healthcare systems. In the long run, large investments in health preparedness are required to update and upgrade Africa’s health care systems. No single framework can apply equally to all countries, so these transformations will need to be adapted and tailored to suit local needs and customs. Issues of supply chain and distribution of vaccines when they are eventually available for distribution. With the number of targets and indicators within the SDGs, it creates opportunities and challenges for research. Political and financial support from individual African governments is vital to achieve regulatory governance and health research capacity. Quality of health system governance including those of reproductive health and family planning 39
- 40. Financing Strategies Strengthenfinancing mechanisms for developing countries. Finance: The Elephant in the Room: The magnitude of the SDG financing challenge far exceeds the capacity of any one organisation and demands a strong partnership among governments, the private sector, and development organisations. Redirect resources to the public health sector and develop sound health emergency plans. In the short run, Countries should tap into existing resources to invest in health infrastructure for detecting, testing, confining, and treating COVID– 19 infected people. Various financing mechanisms are used for family planning. This is good also for COVID 19 response. Note that the IMF was created for global crises like this one Private creditors will need to refinance or capitalize debts falling due. What is missing is the specific Reproductive health and family planning facilities 40
- 41. Communication and Outreach There is the need to develop effective information sharing and communication: strategies. Early dissemination of accurate information on the coronavirus symptoms, prevention, and treatment can contain its spread and reduce public panic and misinformation. African governments need to engage and create an environment that a) uses results from health research, b) adapts national health policies to invest in new and better medicines, and c) makes these accessible through public health systems. The world needs urgently to learn from and to emulate the information and dissemination strategies for fighting Covid-19. Family planning programmes seems to have mastered the art of communication and dissemination to the different stakeholders well. 41
- 42. Partnership is key Governments, development partners and other stakeholders must respond in a coordinated, targeted, and rapid manner to be effective in limiting its impacts. Across the country, the response must be well-sequenced and multipronged, involving every stakeholder This can bring all the stakeholders in ways that address family planning and COVID 19 issues There are compelling advantages to having institutional partnerships so that individuals can collaborate to have a sustainable impact compared to working individually within institution. If built, maintained, and managed in an equitable fashion have the potential to generate a lasting positive impact on global health 42
- 43. Making Family Planningwork for the SDGs Ensure social protection. As part of any comprehensive response to the pandemic, governments should promote new instruments of social protection. This should include both child and maternal health protection. Family planning must also be at the core of this social protection Continuous promotion of new drugs and vaccines. Financing R&D for Covid-19 drugs and vaccines is an urgent global public good. Without global cooperation, R&D will be inadequate and duplicative. Family planning programmes can suggest optimal ways for distribution and mass uptake. While Global Fund and GAVI, the Vaccine Alliance are two exemplary institutions that serve as historical precedents, Nigerian family planning stakeholders have a lot of experience to fall back on 43
- 44. Take home points COVID 19 pandemic emergencies have affected family planning negatively in the last ten months The effects is escalated due to the structure of the pace and pattern of the country’s population and preparedness of the health system The effects of the emergency on family planning have important implications for the country’s progress in harnessing the demographic dividend as well as attaining the sustainable development goals 44
- 45. Olanrewaju Olaniyan Health PolicyTraining and Research programme (HPTRP) Department of Economics University of Ibadan Ibadan, Nigeria Tel: +234-802-325-5741 • Alternate Mail: [email protected] • Skype: Olaniyan57 • Linkedin: lanreolaniyan • Facebook: lanreolaniyan • Twitter: @Lolaniyan 45