Nigeria

Nigeria’s rapidly increasing population has created pressure on the capacity of its health system. High birth rates are accompanied by high rates of under-5 mortality. Uptake of family planning services is low while unmet need is very high. The private sector is the preferred source of contraceptives and diarrhea treatment for most women.

  • 41%
    of caregivers access diarrhea treatment in the private sector
  • 19%
    of under-5 mortality is due to diarrhea
  • 27%
    of women in urban areas and 9% in rural areas use contraceptives
  • 65%
    of the population seek health services from the private sector

With the largest population and economy in Africa, over 62% of Nigeria’s 170 million people live in extreme poverty. The country has one of the highest maternal mortality ratios in the world at an estimated 576 deaths per 100,000 live births. A contributing factor to Nigeria’s poor maternal health status is the country’s relatively high fertility rate. Nigeria’s total fertility rate remains high at 5.5. The contraceptive prevalence rate is 15% due to opposition to use, method-related concerns, and lack of accurate knowledge about contraceptive methods. Unmet need is high, with 16% of women reporting that they are not using contraception, but wish to postpone their next birth or stop childbearing altogether. 

More than 240,000 children under the age of 5 die annually in Nigeria due to diarrhea, representing 19% of Nigeria’s under-5 mortality. Currently, effective treatment for acute pediatric diarrhea—the use of zinc along with low-osmolarity oral rehydration salts (ORS)—is not reaching children in need. 

The private sector is the preferred source of contraceptives for most women in Nigeria and a major source of health care for caregivers seeking treatment for childhood illnesses. Over 50 percent of rural Nigerians routinely to turn to private health facilities to meet their basic health needs.  SHOPS Plus works to improve family planning, reproductive health, and child health outcomes in Nigeria by expanding access to and use of priority products and services by leveraging the potential of the private sector. The project focuses on increasing the availability of products, improving the capacity of service providers, increasing demand for and use of services, and supporting an enabling environment for private sector participation in policy dialogue with the public sector. The project will also expand existing child health interventions focused on diarrhea management in Kebbi and Benue States.

Program Components

Build the Capacity of Private Provider Associations

SHOPS Plus will continue to work closely with the Association of General and Private Medical Practitioners of Nigeria and the Association of General Private Nursing Practitioners to ensure the sustainability of private provider activities. Project staff will build the capacity of these associations by mentoring and coaching staff on organizing family planning trainings, facility monitoring, and proper data recording and submission to the government. The project will also work with the associations to ensure that family planning trainings are fully integrated into their professional development programs and offered to members in the future.

Disseminate a National Guideline on Private Provider Access to Free Public Sector Commodities

SHOPS Plus is drafting a set of national guidelines that outline the necessary steps and processes for the public and private sectors to scale up private provider access to public sector family planning commodities. SHOPS Plus will facilitate the government’s adoption of the guidelines and disseminate them to all stakeholders. The project is expanding the public-private partnership model of linking private facilities to free public sector commodities in Kaduna and Lagos States. The guidelines articulate the process for implementing this model. They will serve as a useful resource to replicate the model in other parts of the country.

Increase Access to ORS and Zinc for Diarrhea Treatment

SHOPS Plus implements an evidence-based four-pronged approach to improve diarrhea treatment for children under 5. This approach includes creating a favorable enabling environment by partnering with local authorities; increasing knowledge of and demand for oral rehydration solution (ORS) and zinc among private providers and caregivers; building the capacity of private drug shops, proprietary patent medicine vendors, and other private providers; and ensuring access to quality supplies of ORS and zinc through partnerships with local manufacturers.

Increase Private Provider Access to Free Public Sector Family Planning Commodities

SHOPS Plus collaborates with the federal and state ministries of health in Lagos and Kaduna States to increase private sector access to free public sector family planning commodities. The project trains providers on long-acting methods (specifically Implanon and post-partum IUD insertion) to expand the range of methods offered in participating facilities. SHOPS Plus will then conduct routine supervisory monitoring visits to ensure quality service provision.

Strengthen Commodity Supply and Linkages

SHOPS Plus is strengthening the existing supply chain for priority health products to ensure efficiency and sustainability. The project facilitates private providers’ access to free government family planning commodities. SHOPS Plus will conduct training workshops for private providers on local government authority procurement procedures, data reporting, and recordkeeping requirements to ensure that facilities can accurately track and forecast commodity stocks.