*Launch self-care, community-oriented self-injection acceleration projects

By Joseph Erunke, ABUJA

NIGERIA’s quest to enhance its health system with self-care for sexual, reproductive and maternal health and rights has been boosted with the launch of two safe self-care and injection acceleration projects.

The projects,Self-Care Accelerator Project (S-CAP) and Community-Oriented DMPA-SC/Self-Injection Acceleration in Nigeria (CODSAiN) Project, are being funded by the Bill and Melinda Gates Foundation have implementation period from December, 2022 to November 2023 and 2023 to 2026, respectively.

While John Snow Incorporated (JSI) is the implementing partner for Self-Care Accelerator Project (S-CAP); Association for Reproductive and Family Health is implementing CODSAiN.

The initiatives are targeted at safe self-administration of some medicines, self-diagnosis and improvement in health awareness and literacy in the country.

Giving an overview of the Self-Care Accelerator Project (S-CAP) at the launch of the projects in Abuja,Dr Adewole Adefalu, Country Coordinator John Snow incorporated, explained that,”Self-care will empower women and men, families, and communities to carry out effective health actions, with or without support from health care providers.”

He recalled that:”Nigeria was one of the first countries to adapt the WHO’s Consolidated Guideline on Self-Care Interventions for Health: Sexual and Reproductive Health and Rights which provides a people-centered, evidence-based normative guidance to support individuals, communities and countries with quality health services and self-care interventions. “

“In 2021, the Federal Ministry of Health developed the National Guideline on Self-Care for Sexual, Reproductive and Maternal Health, which provides national direction on the integration of Self-care interventions for SRMH into the Nigerian health system as well as its implementation.

” Since then, there have been concerted efforts to disseminate the National Guideline and Self-Care Demand Generation Strategy while providing orientation at national and sub-national levels,”he said.

According to Dr Adefalu,”The project will employ the key principles of coordination, adaptive learning, and practical outputs to:Accelerate and institutionalize a national self-care agenda in Nigeria;Identify policy and regulatory bottlenecks for self-care scale up;Advance the national self-care subcommittee work plan and identify lessons for self-care scale up in additional geographies.”

The target audience of the project,he said,are,” National and state level policymakers, program managers, health workers, donors, and civil society organizations responsible for making decisions related to the delivery or promotion of self-care interventions.”

“Other target audiences include product developers, manufacturers, communities, and all individuals affected by the recommendations in the National Guideline on Self-Care for Sexual, Reproductive and Maternal Health,”he added.

According to him, the key message in initiating the project is,”The scale up and use of self-care interventions as outlined in the National Guideline on Self-Care for Sexual, Reproductive and Maternal Health has the potential to boost Nigeria’s modern contraceptive prevalence rate, result in cost-savings and accelerate progress towards achieving universal health coverage.”

He spoke further:” Self-care will empower women and men, families, and communities to carry out effective health actions, with or without support from health care providers. The value proposition with self-care lies in the opportunity to support healthcare systems.

“When fully introduced, self-care reduces the burden on healthcare providers, limiting their role to initiating, educating and supporting individuals who are more empowered to take effective health action.

“This innovation includes interventions that are targeted at safe self-administration of some medicines, self-diagnosis and improvement in health awareness/literacy.

“Self-care offers a paradigm shift, empowering individuals and communities and saving the bludgeoning healthcare cost. The dwindling health investments and competing public health cost makes self-care the solution for the future in Nigeria and many African countries. John Snow Inc. will, through this BMGF-funded grant, work with the government to lead the coordination of the scale up of self-care in Nigeria.

“Our role is to support the government at all levels to unlock all policy bottlenecks to full scale up interventions with the self-care product portfolio, lead stakeholder coordination and provide technical assistance to all ongoing efforts to fully integrate this innovation into the sexual reproductive and maternal health systems in Nigeria.”

Speaking on the Community-Oriented DMPA-SC/Self-Injection Acceleration in Nigeria (CODSAiN) Project, Dr Kehinde Osinowo, Chief Executive Officer, Association for Reproductive and Family Health (ARFH),noted that,”ARFH reaches 1million Nigerian women with family planning methods DMPA-SC & Self-injection.”

She said:”Nigeria has been reported to be the most populous country in Africa representing about 20% of the African continent. According to the postulation of the UN population projection, Nigeria is on the verge of becoming the third most populous country by 2050 with its current population growth rate if no strategic population and fertility management is embraced. Family planning (FP) is the nexus of Population and fertility management planning.”

She explained that:” The Nigeria Demographic Health Survey (NDHS) 2018, shows that Nigeria’s modern contraceptive prevalence rate (mCPR) is 12%, requiring concerted efforts to increase the CPR to 27% in line with Nigeria FP 2030 agenda.”

“Association for Reproductive and Family Health (ARFH) in a bid to support the government to scale up family planning uptake introduced and implemented the Resilient and Accelerated Scale-up of DMPA-SC Self -Injection (RASuDiN) project.
DMPA Subcutaneous and Self-Injection have the potential to expand access and acceptability with the unique option to self-inject. The project was implemented through the project communities and facilities across 10 project states cut across 217 LGAs).

“Resilient Accelerated Scale-up of DMPA-SC Self-Injection in Nigeria (RASuDiN) project, was implemented from 2018 to 2022 in ten states (Anambra, Delta, Enugu, Kwara, Lagos, Niger, Ogun, Oyo, Plateau, and Rivers) using strategies such as advocacy/stakeholder engagement, demand generation, capacity building of service providers & the health systems, service delivery both at the community & facilities and evidence-based research,”she said.

She explained that,”The project recorded huge success as it surpassed the project targets among which were: the provision of family planning services through DMPA-SC uptake of over 1,000,000 with several beneficiaries being able to self-inject themselves without the assistance of health care workers thereby reducing the workload at the primary health centers (PHCs)”

She said:”The project used the “transform, enable and optimize’’ lens to expand the acceptance of the DMPA-SC Self-injection in the 10 states. Through the project’s demand generation strategy, a total of 900,381 people were reached with FP messages during social mobilization activities over four years project implementation period. Of this number reached, 198,387 people (22%) were referred for services, and of the number referred, 67% cumulatively completed referrals across the 10 project states, with approximately 8 out of every 10 people referred completed referrals in Year 4.

“This project demonstrates the feasibility to reduce the unmet need of family planning through the use of Community Health Extension Workers (CHEWS) to reach women and girls in Hard-To-Reach Areas (HTRAs) where they live and work.

“In view of the achievement recorded on the project, the Federal Ministry of Health approved the extension of the innovation to four (4) new additional states (Gombe, Kano, Nasarawa, and Yobe. The new project is titled Community Oriented DMPA-SC/Self Injection Acceleration in Nigeria (CODSAiN).

“In alignment with the strategy of the Federal government of Nigeria’s FP 2030 agenda, the CODSAiN project aims to reduce the unmet needs and missed opportunities for Family Planning through community scale-up of DMPA-SC and Self-Injection (SI) as a self-care measure and within the broader contraceptive method mix.

“Association for Reproductive and Family Health (ARFH), a non-governmental organization will continue to collaborate with other partners to strategically implement innovative projects that will promote the good health of all Nigerians.”