Imo State Family Planning Costed Implementation Plan (2021-2024)

[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024
IMO STATE MINISTRY OF

HEALTH
FAMILY PLANNING
COSTED IMPLEMENTATION PLAN
(2021 – 2024)
October 2020
1
CONTENTS
CONTENTS..................................................................................................................................... 2
List of figures, Charts, Boxes and Tables ..................................................................................... 4
FORWARD ..................................................................................................................................... 5
ACKNOWLEDGEMENTS................................................................................................................ 7
List of Contributors ....................................................................................................................... 8
List of Abbreviations and Acronyms ......................................................................................... 10
SECTION 1 ................................................................................................................................... 12
SITUATION ANALYSIS ................................................................................................................................. 12
Desk Review: .............................................................................................................................................. 12
1.1 Introduction: The Global Context..................................................................................................... 12
1.1.1 London Summit on Family Planning .............................................................................................. 12
1.2 The Nigeria Context .......................................................................................................................... 14
1.3 Imo State Context............................................................................................................................. 17
1.4 Imo State Family Planning Situation................................................................................................. 18
Health Facility Survey ................................................................................................................................. 33
1.5 Summary of The Findings ................................................................................................................. 33
SECTION 2 ................................................................................................................................... 37
INTEGRATED FAMILY PLANNING PLAN ...................................................................................................... 37
2.1. Goal ................................................................................................................................................. 37
2.2. Objectives ........................................................................................................................................ 37
2.3. Strategic Priorities ........................................................................................................................... 37
2.4 Structures of the Costed Implementation Plan ............................................................................... 38
2.4.1 Demand Generation and Behaviour Change Communication ...................................................... 39
2.4.2 Service Delivery ............................................................................................................................ 46
2.4.3 Commodities and Supplies ............................................................................................................ 56
2
2.4.4 Policy and Enabling Environment ................................................................................................. 61
2.4.5. Financing ...................................................................................................................................... 67
2.4.7 Supervision, Monitoring, and Coordination (SMC) ....................................................................... 72
SECTION 3 ................................................................................................................................... 78
COSTING ..................................................................................................................................................... 78
3.1 Cost Summary .................................................................................................................................. 78
3.2 Total CIP Cost by Thematic Areas and Priority Objective ................................................................ 80
SECTION 4 ................................................................................................................................... 89
PROJECTED FP METHODS MIX AND IMPACT ............................................................................................. 89
4.1 Projected FP Methods Mix ............................................................................................................... 89
4.2 Impact Assessment .......................................................................................................................... 91
SECTION 5 ................................................................................................................................... 92
Resource Mobilization and Performance Management ............................................................................ 92
5.1 Resource Mobilization...................................................................................................................... 92
5.2 Ensuring Progress through Performance Management .................................................................. 93
ANNEX A: MONITORING AND EVALUATION SUMMARY TABLE ............................................................. 93
References................................................................................................................................................ 100
3
List of figures, Charts, Boxes and Tables

Figure 1: Nigeria Method Mix 1990–2013................................................................................... 16
Figure 2: Imo State Population Pyramid.................................................................................... 17
Figure 3: South East CPR............................................................................................................ 19
Figure 4: Imo States CPR. Source: NDHS 2013........................................................................... 19
Figure 5: South East States Fertility Rates as at 2016................................................................. 20
Figure 6: Sources of FP Services by Method in Imo State........................................................ 21
Figure 7: Imo State FP method use 2013 and 2018.................................................................. 22
Figure 8: Imo State human resource capacity......................................................................... 23
Figure 9: Imo State Family Planning Training Coverage...........................................................24
Figure 10: Awareness of methods of contraceptive............................................................... 28
Figure 11: Reasons for facility visit by FP clients.................................……………………………34
Figure 12: Total budget by thematic areas.............................................................................. 79
Figure 13: Current and Projected Method Mix for Imo State.................................................. 91
Table 1: FP budgetary allocation in Imo SMoH from 2014-2018............................................. 34
Table 2: Summary total budget by thematic areas .............................................................79

Table 3: Total budget by thematic areas and by priority objectives.................................... 80
Table 4: Projected Total Users by methods and Years............................................................. 93
Table 5: Projected impact of achieving 27% CPR by 2024................................................... 93
4
FORWARD
The 2012 London Summit on Family Planning provided the platform on which
Nigeria committed to a yearly 2% incremental change in Contraceptive
Prevalence Rate for married women to achieve overall 36% in 2018.
For the realisation of the above target, the Federal Ministry of Health developed a
scale up five years costed implementation plan (CIP), which outlined activities,
cost, and resources required to achieve this.
Each State of the federation was to contribute its quota by developing its own
implementing CIPs in line with local realities, to ensure the national targets.
However, with the current National Contraceptive Prevalence Rate for modern
contraceptive at 12% (2018 NDHS), the earlier plan of 2012-2018 failed to achieve
the desired target.
In a renewed effort to achieve improved national and respective state
contraceptive prevalence rate, a national target of 27% by 2023 has been set by
the Federal Ministry of Health. With support from UNFPA and Marie Stopes
International Organisation Nigeria, Imo State Ministry of Health kickstarted the
process of developing her State Family Planning CIP while setting our CPR target
of 27% by 2024. This was followed by series of engagement meetings, interviews,
desk reviews, family planning landscape assessment, etc.
The activities in this plan are expected to produce high impact in Family Planning
needs and service delivery in Imo State. The key thematic areas of focus of the
CIP are:
• Service Access and Delivery
• Demand Creation
• Supplies, Commodities and Distribution
• Policy and Enabling environment
• Financing mechanisms
• Supervision, Monitoring and coordination
5
The Technical Team held series of meetings with Imo State Family Planning
Committee and a major stakeholder Workshop to derive activities from each
thematic area to enable the State reach its FP goals. This document is a result of
that endeavour.
Dr Mrs Damaris Osunkwo

Hon. Commissioner for Health
Owerri, Imo State.
6
ACKNOWLEDGEMENTS
Development of Imo State Family Planning Costed Implementation Plan 2021-2024 is
strategic in scaling up contraceptive prevalence rate in the state and contributing
our state quota to the national target of 27% by 2023. This sets the roadmap and
details the activities and means to achieve the targets within the timeframe.
The process of the CIP development was collaborative, involving concerted efforts of
many players who contributed technically and otherwise to ensure a robust and
achievable cost and effective and efficient plan developed.
Special mention and thanks must be extended to the Governor of Imo State,
Distinguished Senator Hope Odidika Uzodinma for his 3R innovative policies and
approach in Governance which has created an enabling environment for
strengthening of the various systems in the State, especially the health system. His
approval to enable the achievement of this document was key.
The financial support of UNFPA in producing this document is highly appreciated. The
enduring and tireless efforts of the Staff of the State Ministry of Health, especially the
Family Planning and Reproductive Health units and MSION consultant are well
appreciated.
We greatly appreciate the Hon. Commissioner for Health, Dr Damaris Osunkwo for her
support, keen interest and leadership which impacted positively on the development
of this CIP document.
Finally, all other Partners and Stakeholders quite numerous to mention who
contributed one way or the other to the achievement of this CIP are hereby
appreciated. We expect that meticulous implementation of this plan will achieve the
set targets
Dr Okeji A.C.
Director Public Health
Ministry of Health
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List of Contributors
S/N NAME ORGANISATION
CORE TEAM
1. Dr Damaris Osunkwo Hon. Comm. For Health, SMoH, Owerri
2. Dr Austin Okeji Dir. Public Health, SMoH
3. Dr George Udeji RH Coordinator, SMoH
4. Mrs H. Nnenna Oriaku FP Coordinator, SMoH
5. Dr Emereuwaonu Njoku Consultant, MSION
6. Mr Emmanuel Emesowum FP Logistics, M&E Officer, SMoH
7. Mr Onyekachi Onumara Prog. Mgr. Rural Health Foundation (Tech.

Asst. Imo FP CIP)
OTHER CONTRIBUTORS
8. Prof. S. J. Ozims Dept. Of Public Health, IMSUTH, Orlu
9. Dr Eugene Onwuchuruba Cottage Hosp. Umuowa, Ngor-Okpala
10. Mrs Chinyere Ekwugha Rural Health Foundation
11. Mr Chidi Madu Health Reporter, IBC, Owerri
12. Mr Gavas Eke PPMV, Imo State
13. Mrs Chukwueke Victoria DNS SMoH, Owerri
14. Mrs Nwachukwu Catherine FP Unit, FMC Owerri
15. Rev Fr. Justin Okoro Admin., Holy Rosary Hosp., Emekuku
16. HRH. Eze Geoffrey Okoro Chairman, Traditional Rulers, Ngor-okpala

LGA, Imo State
17. Mrs. Harbor Florence Marie Stopes Nigeria
18. Mr Geoffery Anyaegbu HSDF
19. Chioma Nnajiofor CFHI
20. Mrs Comfort Mere CHM FPAWG, Owerri
21. Pharm Uche Maduike LMCU SMoH
22. Mrs Onwukwe Vivian FP Supervisor, Okigwe Zone
23. Mrs Chukwunyere Innocentia Former Imo State FP Coordinator
24. Mrs Stella Ozims FP Supervisor, Owerri North
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25. Mr. Andy Iheagwara DPRS, SMoH
26. Amakihe George C. N DD Donor Aids & Project Coordinator,

MBEPS
27. Lovinda Onyiriagwu Assistant Projector Coordinator, MBEPS
28. Mrs Obilor Lilian C. HMIS, SMoH
29. Mrs Okeke Florence PHCC Ohaji/Egbema
30. Mrs Osuala Chiazo FP Unit IMSUTH, Orlu
31. Mrs Oranusi Ucheamaka DDNS, SMoH
32. Mrs Ugbaja Anne PHCC, Obowo LGA
33. Dr Eze Nwokoma PSI, Imo State
34. Mrs Ngozi Amaliri Edith DNS HMB, Owerri
35. Dr D. O. Anyaegbule DHS HMB, Owerri
36. Eke Ijeoma J PPFN Imo State
37. Dr Nkiruka Onyekpandu Rural Health Foundation
38. Dr Gwacham Uchenna Health Strategy & Delivery Foundation

(HSDF), Owerri
39. Mrs Egesionu Adanna Imo State PHCDA, Owerri
40. Dr Uche Odom Imo State PHCDA, Owerri
41. Lady Eziama F. I. Owerri West HOD Health
42. Dr Alaocha Frank Rep. Perm. Sec., SMoH
43. Dr Kyrian Duruewuru Chairman, NMA Imo State Chapter
44. Mrs Igwe Irene C. FP Supervisor Orsu LG
45. Dr Okere E. S. Director PHC, Imo State PHCDA
46. Dr Tony Igwe Perm. Sec. SMoH, Owerri (Rtd)
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List of Abbreviations and Acronyms

AHI Action Health Incorporated
COC Combined Oral Contraceptive Pill
CLMS Contraceptives Logistics Management System
CPR Contraceptive Prevalence Rate
CMS Coordination, Monitoring and Supervision
CTC Core Technical Committee
CIP Costed Implementation Plan
CLMS Contraceptive Logistics Management System
DHS Demographic and Health Survey
FMC Federal Medical Centre, Owerri
FGON Federal Government of Nigeria
FHAC Family Health Advocacy Coalition
FMOH Federal Ministry of Health
FP Family Planning
FPAWG Family Planning Advocacy Working Group
FPF Family Planning Financing
HCW Health Care Workers
HF Health Facility
HMIS Health Management Information System
HP+ Health Policy Plus
HTS HIV Testing Services
HWs Health Workers
IEC Information Education and Communication
IHVN Institute of Human Virology of Nigeria
IMNCH Integrated Maternal and New Born and Child
Health
IUD Intra Uterine Device
JSI John Snow Inc.
LGA Local Government Area
KAP Knowledge, attitudes and practice
LMCU Logistics Management Coordinating Unit
LMD Last Mile Distribution
LMIS Logistics Management Information System
MSION Marie Stopes International of Nigeria
MCH Maternal and child health
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MDAs Ministries, Departments and Agencies

NAPMED National Association of Patent Medicine Dealers
NBS National Bureau of Statistics
NHMIS National Health Management Information System
NSHIP Nigeria State Health investment Project
OCP Oral Contraceptive Pill

PACFaH Partnership for Advocacy for Child and Family
Health
PEE Policy and Enabling Environment
PHC Primary Health Care
PMTCT Prevention of Mother To Child Transmission
POP Progestin-Only Pill
PPIUD Post-Partum Intra Uterine Device
PSI Population Services International
RIRF Requisition Issue and Receipt Form
RRS Review and Re-supply
SDGs Sustainable Development Goals
SDPs Service Delivery Points
SFH Society for Family Health
SMoH State Ministry of Health
SOML-P4R Save One Million Lives Program for Result
SRH Sexual Reproductive Health
TFR Total Fertility Rate
UNFPA United Nations Population Fund
USAID United States Agency for International
Development
WRA Women of Reproductive Age
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SECTION 1
SITUATION ANALYSIS
Desk Review:
1.1 Introduction: The Global Context
Family planning (FP) is one of the most cost-effective ways to prevent maternal,
infant, and child mortality. It can reduce maternal mortality by reducing the
number of unintended pregnancies, the number of abortions, and the proportion
of births at high risk1. It has been estimated that meeting women’s need for
modern contraceptives would prevent about one-quarter to one-third of all
maternal deaths, saving 140,000 to 150,000 lives per year globally. Family planning
offers a host of additional health, social, and economic benefits; it can help slow
the spread of HIV, promote gender equality, reduce poverty, accelerate socio-
economic development, and protect the environment.
Among women of reproductive age in developing countries, 867 million (57%) are
in need of contraception because they are sexually active but do not want a
child in the next two years. Of these, about 222 million (26%) do not have access
to modern methods of contraception, resulting in significant unmet needs.
1.1.1 London Summit on Family Planning
On July 11, 2012, FP stakeholders worldwide assembled for the London Summit on
Family Planning. The United Kingdom (UK) government, through its Department for
International Development (DFID), and the Bill & Melinda Gates Foundation
(BMGF) partnered with the United Nations Population Fund (UNFPA) to host a
gathering of leaders from national governments, donors, civil society, the private
sector, the research and development community, and other interest groups.
12
The meeting deliberated on the renewal and revitalization of the global

commitment to ensure that women and girls, particularly those living in low-
resource settings, have access to contraceptive information, services, and
supplies.
The objective of the summit was to “mobilize global policy, financing, commodity,
and service delivery commitments to support the rights of women and girls in the
world’s 69 poorest countries to use contraceptive information, services, and
supplies without coercion or discrimination by 2021.” Doing so would prevent
staggering 100 million unintended pregnancies, 50 million abortions, 200,000
pregnancy/childbirth-related maternal deaths, and 3 million infant deaths 4
The London Summit on Family Planning committed to the following:

• Increase demand and support for family planning by removing barriers to its
access and use
• Improve supply chains, systems, and service delivery models and procure more
affordable high-quality contraceptives through better global coordination,
including new methods for expanded choices
• Improve market dynamics, including country forecasting capacities and
increased availability and quality of a range of FP methods
• Promote accountability at the global and country levels through improved
monitoring and evaluation (M&E)
• Advocate for sustained government and donor funding
Nigeria was represented at the London Summit by a team of experts led by the
Federal Ministry of Health (FMOH). At the summit, they committed to increasing
domestic funding for family planning. The Federal Government of Nigeria (FGON)
committed to disbursing an additional $8.35 million per year specifically for family
planning and reproductive health (RH), which translated to about a 300 percent
increase.
After the summit’s conclusion, the FMOH team of experts identified the following
key steps to ensure the increased uptake of FP services:
13
Support advocacy
Strengthen accountability
Improve supply chains
Increase contraceptive supply
Promote best practices
Support new innovations
Nigeria developed the National Family Planning Blueprint (Scale-Up Plan),

evolving from the commitments made at the London Summit. It provides a
roadmap for achieving the FGON’s goals for improving access to family planning
and reducing maternal mortality through a concerted national effort to scale up
family planning over five years (2013‒2018) now extended to 2021. The Blue print
also provides guidelines and encourages states to develop their state specific
family planning costed implementation plans.
1.2 The Nigeria Context

With more than 200 million people, Nigeria is the most populous country in Africa
and the seventh most populous country in the world5. Annual population growth
is 3.2 percent, and the total fertility rate is 5.3, with variations across states and
regions (NDHS, 2018). Most projections place Nigeria as the third most populous
country behind India and China by 2050. There are approximately 48 million
women of reproductive age in Nigeria and the country will have an early 7.5
million births in 2017 alone 6.
Nigeria’s Gross Domestic Product (GDP) grew consistently at above 6 percent

per year between 2001 and 2014 and experienced a decline between 2015 and
quarter 2 of 2017. There is some improvement over time as in quarters 2 and 3 of
2017; Nigeria GDP experienced a positive growth taking Nigeria out of economic
recession. However, income inequity remains a key issue in Nigeria. The top 10
percent wealth bracket in Nigeria receives more than 34 percent of the income
share, whereas the lowest 10 percent receives less than 2 percent. This pattern
14
has been relatively stable for the past 20 years. These inequities persist along
regional lines, with oil revenues concentrated in the South.
From an RH perspective, the Federal Government is charged with developing

policies, strategies, guidelines, and plans that provide direction for the Nigerian
healthcare system. However, implementation of these guidelines ultimately falls
on the State Ministry of Health (SMOH). Each SMOH is responsible for health
programme direction and coordination in its State. The State Ministry of Local
Government Affairs (SMOLGA) is responsible for hiring, managing, and paying
health workers at the primary healthcare level (as part of the civil service). Each
State also has an FP coordinator who facilitates commodity ordering and
transportation as well as advocacy. Effecting change in reproductive health
requires a concerted effort and clear alignment from the federal government
down to the LGAs.
According to the 2018 NDHS, 17 percent of married women of reproductive age

(15‒ 49) are using any contraceptive method; however, only 12 percent of
these women are using modern FP methods, an increase of 2.2 percent from
2013. This national rate has largely remained at this level since the late 1990s.
The modern method mix predominantly comprises condoms, pills, and
injectables
5 World Population Review, 2020
6 Health Policy Plus 2017: 4th National RAPID
15
Figure 1: Nigeria Modern Contraceptive Method Mix, 2015. Source: FP 2020
As part of its FP 2020 commitment, the Nigerian government had set a target of
reaching a 36% CPR by 2018 now revised down to 27 percent and extended to
2023. To achieve this goal, the government pledged additional funds starting from
2014 and several donors and non-governmental organizations (NGOs) are
currently committed to supporting FP/RH efforts in Nigeria.
16
Figure 2: Nigeria Population Pyramid. Source: NBS 2017
1.3 Imo State Context

Imo State is one of the five states in the South-East region of Nigeria. Its capital and
largest city is Owerri. The state is inhabited and populated primarily by the Igbos
and a few non-Igbo speaking indigenes. Imo state has 27 LGAs: Mbaitoli, Ngor
Okpala, Ikeduru, Owerri West, Owerri North, Owerri Municipal, Aboh Mbaise,
Ahiazu Mbaise, Ezinihitte Mbaise, Orlu, Nkwerre, Isu, Njaba, Orsu, Nwangele, Oguta,
Ohaji-Egbema, Oru East, Oru West, Obowo, Okigwe, Isiala Mbano, Ihitte Uboma,
Ehime Mbano and Onuimo. Imo State is bordered by Abia State on the East,
Anambra State on the North and Rivers State to the South. The state lies within
latitudes 4°45'N and 7°15'N, and longitude 6°50'E and 7°25'E.
The chief occupation of the local people is farming. The cash crops include oil
palm, raffia palm, rice, melon, cashew, cocoa, rubber, and maize. Consumable
crops such as yam, cassava, cocoyam and maize are also produced in large
quantities.
With an estimated population of 6,135,073 (NPC 2020 estimate) land area of

about 5,530sq.km, Imo is primarily an agricultural region and it is a producer of
17
yam, potatoes, maize and cassava in Nigeria. The state has several solid mineral
resources, including lead, crude oil, and natural gas, but few large-scale
commercial mines. The population of women of reproductive age (WRA), 15-49
years is about 1,349,715.99 (WRA is 22% of total population).
1.4 Imo State Family Planning Situation

Imo State contraceptive prevalence rate among married women (including those
co-habiting) aged 15-49 is 30.7% though significantly higher than the national
average of 17% and is the third among all the states in South East geopolitical
zone of Nigeria 7. The modern CPR according to NDHIS 2018 stands at 10.9%. Of all
current users, as high as 19.8% use traditional methods while about 2.6% either
used condoms, tablets, injections or other methods.
Figure3: South East CPR. Source 2018 NDHS Figure 4: Imo State CPR. Source 2018 NDHS
Imo State has relatively high unmet need for family planning. Of the 1,349,715.99
women of reproductive age, 283,440 (21%) married and sexually active women
18
in Imo state want family planning services but currently are not able to access it.
The total demand for family planning in Imo State stands at 51.7% (NDHS 2018).
According to National Bureau of Statistics Bulletin of 2017, Imo State fertility rate is
5.1, ranking 20th in Nigeria along with Abia and 2nd in the South East zone.
19
Figure 5: South East States Fertility Rates as at 2016. Source: NBS Bulletin 2017
1.4.1 Service Delivery
Sources of Family Planning Services: Imo State women seek FP services from both
the public and private sectors. Because intrauterine contraceptive devices
(IUCDs) and implants require trained service providers, they are usually sourced
via the public sector and the private facilities whose staff have been trained on
provision of Long Acting Reversible Contraceptives (LARC) services. Condoms
and pills are available from a wide variety of sources, including Proprietary Patent
Medicine Vendors (PPMVs), pharmacies, and private and public health clinics.
Scaling up access through the public and private sectors will increase FP uptake
in the state.
Imo State has approximately two thousand one two hundred and eighty-four
(2284) healthcare facilities made up of Public (564) and Private (1720).
(DPRS)). There are two tertiary healthcare facilities, each in the State providing
family planning services with
• Federal Medical Centre (FMC), Owerri and
20
• Imo State University Teaching Hospital (IMSUTH), Orlu
The secondary healthcare facilities include 10 State General Hospitals and Imo
State Specialist Hospital, Owerri. As at October 2020, 236 out of 564 public health
facilities provide FP services (source: Imo FP Unit records).
Traditional birth Government

attendants hospital/healthce
Government 5% ntre/post
family 5%
planningclinic Others
2% 7%
Chemist/PMS
39%
I use a non-
supply method
42%
Main source of FP services by method. Source: NARHS 2012
Figure 6: Sources of FP Services by Method in Imo State
21
FP Usage in the state: The use of any Family Planning method decreased from
34.1% in 2013 to 30.7% in 2018. However, this was largely because of decrease in
the use of traditional methods which decreased almost significantly within the
period compared with modern methods that slightly increased from 10.7% to
10.9%. Traditional methods are very unreliable and have the least couple year of
protection. More reliable methods such as implants, IUCDs and sterilization
remained almost unchanged. However, there was a marked decrease in the use
of injectables and condom male from 2013 to 2018. The use of Implants jumped
from 0% in 2013 to 1.6% in 2018, a remarkable achievement by the State. This
could be due to more aggressive mobilization in the use of implants by the State
and Partners
Figure 7: Imo State FP method use 2013 and 2018. Source: 2013 and 2018 NDHS report
22
Staff Skills and training: there are 236 facilities providing Family planning services
in Imo State. Of these 236 facilities, 217 have LARC-trained providers. The target is
to have at least one LARC-trained nurse/midwife in each of the 564 public health
facilities. So far, the State is far from achieving this target due paucity of fund and
a shortfall in the number of development partners to assist the State in capacity
building. Currently, only Marie Stopes International Organisation Nigeria (MSION)
and Rotary International are responsible for training Nurse/midwifes on LARC in
the State and the SMOH remains appreciative of that effort
Family Planning Human Resource Capacity in Imo State

564
236
217
Figure 8: Imo State human resource capacity. Source: SMOH
23
Figure 9: Imo State Family Planning Coverage. Source: SMOH
Compliance with Task Shifting/Sharing Policy: Task shifting/sharing policy has yet
to be domesticated in Imo State. There is need to train CHEWs on the provision of
modern family methods, especially the long acting and reversible
contraceptives across all rural health facilities to expand service delivery
capacity, bridge the biting capacity gap between nurses and CHEWS and to
reach more clients.
Provision of Adolescent and Youth-Friendly FP Service: Adolescent and youth-

friendly FP services are being provided by Public and Private Sectors in the state.
Each of the three Senatorial zones has Adolescent and Youth-Friendly Health
Service (AYFHS) Centres and a Focal Person. Many adolescents and youths
however still find it difficult to come to these centres to access FP services
because of misconception that only married women should access FP services.
Adolescents who seek FP services are often misconceived as being promiscuous
by the Service Providers.
FP Service Provision through the Private Sector and the Current Challenges: Private
sector health care providers such as private health facilities, CSOs, PPMVs provide
24
FP services. Most of them buy their commodities and collect high service charge.
The challenge is that most of them do not report their activities hence services
provided are not captured on HMIS (DHIS2) and state report. Some private
facilities provide services on LARC even though they do not have the necessary
training and capacity to do that hence there is urgent need to identify these
facilities and evolve a platform to standardize their skills to ensure patient safety.
Human Resource for Health Challenges: Human resource for health (HRH) is
grossly in short supply in Imo State. Some of the state’s General Hospitals have
only one State employed Medical doctor. There has been a continued
depletion of health workers due to retirement for the past 16 years without any
replacement. All State-owned healthcare facilities are currently understaffed.
1.4.2 Supplies and Consumables
The purpose of Contraceptive Logistics Management System (CLMS) is to ensure

clients are able to receive the FP method of their choice when needed through
existing Service Delivery Points (SDPs). In order to achieve commodity security of
contraceptive products, there must be a logistic system that ensures accurate
forecasting, procurement, storage, distribution and inventory management of
the contraceptive products.
Forecasting: This involves the estimation of the contraceptive products that will
be dispensed to users by a program for specific period of time in the future.
Currently, in Imo State, forecasting of contraceptive products is conducted by
Logistics Management Coordinating Unit (LMCU) in collaboration with a
Partner: Global Health Supply Chain PSM (GHSC-PSM). However, the LMCU
members need to be trained to improve on their health commodities
forecasting skills.
25
Procurement and Storage: Procurement of contraceptive products is done at the

national level and distributed to states from the Federal Central Medical Store to
the State Central Medical Store.
Distribution: The State Family Planning Coordinating Unit through her logistics
officer distributes commodities to LGA FP supervisors and focal persons in tertiary
and secondary facilities. Family Planning Providers in the public primary health
centres pick their commodities from their supervisors at the LGA warehouse. This
method, though an improvised one has a major disadvantage as commodities
do not get to the SDPs in a timely manner. The coordinating unit does not carry
out last mile distribution to the service delivery points due to lack of fund. The Bi-
monthly (2 Months) Requisition Issue and Report Form (RIRF) is generated at the
SDPs and submitted to the coordinating unit by the LGA supervisors for resupply.
The State is currently embracing the National Product Supply Chain
Management Program (NPSCMP) model of health commodities distribution.
Inventory Management: Within the logistics system, records are kept of all
transactions at each level. Stock cards or Inventory Control Cards (ICC) are used
to track movement of products, while RIRFs are used for reporting and LMD matrix
is developed using the data from RIRF on the NHLMIS platform. Stock cards are
available at the CMS but will soon be distributed to the SDPs. Besides, most health
personnel at the SDPs need training on CLMS to enable them to manage the LMIS
tools. In addition, the LMCU needs support to conduct quarterly Mentoring and
Supportive Visits (MSVs) to SDPs to provide on the job training to staff.
1.4.3 Demand Generation

Demand generation is aimed at increasing awareness of family planning services
to the population for uptake of services.
Awareness on Family Planning: According to the 2013 NDHS, contraceptive in Imo

State was very high as almost 9 out of every 10 persons were aware of a modern
26
method, Awareness of a modern method increased from 92.3% in 2008 to 99.8% in

2013. Evidence shows that increase in awareness has not really translated to
demand in FP.
Figure10: Awareness of methods of contraceptives
27
Current Demand Generation Activities in the State and How they are Addressing
the Unmet Needs: There is low level of uptake of family planning services in the
State due to misconception, religious belief and stereotyped perception of the
numerical value of children. Some partners in the past few years have made
laudable attempts to reach men and women of reproductive age with key
information on family planning and child birth spacing to influence individual and
collective actions.
However, more needs to be done to reach all eligible men and women with
quality information on family planning services.
As a strategy to increase the awareness on family planning services in the State,

Imo State Ministry of Health in collaboration with development partners have
developed workable strategies for demand generation and uptake. The
strategies include monthly outreach and in-reach activities in communities and
health facilities targeted at increasing the uptake of LARC sponsored. This has
been consistently sponsored by Marie Stopes International Organization Nigeria
(MSION) since 2015. Rotary International is currently supporting the training of 25
health workers on LARC. In June 2019, Action Health Incorporated (AHI) with fund
from UNFPA supported the training of 40 Community Health Volunteers (CHVs) on
Sayana Press injectable, part of which include demand creation. The role of
CHVs is to create awareness in the communities of six pilot LGAs about Sayana
Press Injectable contraceptive, refer clients to the nearest SDP for Family Planning
and join in the monthly Sayana Press outreach activities sponsored by UNFPA.
The Effectiveness of the Current Demand Generation Activities in Terms of

Increase in Long Acting Reversible Contraceptives Uptake: Very notable among
the milestone achievements in this regard in the State is the remarkable increase
in the use of implant contraceptives from 0% in 2013 to 1.6% in 2018. This is a
testimony to the huge effort of all the Partners and Imo State Ministry of Health.
28
IEC and BCC Tools for Demand Generation: Limited availability of IEC /BCC
materials for demand generation activities continues to be a huge challenge
towards efforts aimed at increasing the uptake of family planning Services in the
State. Implementing Partners have been responsible for the production of
IEC/BCC materials in the State which are still inadequate.
29
IMO STATE FAMILY PLANNING COST IMPLEMENTATION PLAN 2021-2024
1.4.4 Policy and Enabling Environment

As the primary responsibility bearer, the new administration in Imo State
promises to be health-friendly and has demonstrated strong political will to
move the health sector forward.
Measures taken to support FP service delivery in the State are:
• Establishment of the State Primary Health Care Development Agency

backed by legislation;
• Financial commitment to the basic health care provision fund

(BHCPF) to ensure basic minimum health package for the poor
people.
• Establishment of Imo State Health Insurance Scheme
• Financing of MNCH week Programs to ensure scale-up of FP services
However, inadequate human resources for health in the state and Local
Government health facilities, and inadequate budgetary provision for FP
and delay/or non-release of approved funds are the major challenges that
will hamper the successful implementation of the FP services in the state.
Therefore, the priority area of policy and environment focuses on

advocacy for family planning within various levels of government and the
private sector, including faith- based organizations, civil society and
private providers to ensure that the best policies are available and fully
implemented.
1.4.5 Financing
The financing of family planning in Imo State is primarily the responsibility of

the Federal, State and Local Government with the support of Development
Partners. The Federal Government is saddled with the responsibility of
procuring FP commodities and transports same from their central warehouse
to the State. A large chunk (almost 92%) of these commodities and logistics
cost is funded by donor agencies. The State Government is expected to
30
handle last mile distribution of commodities by transporting the commodities

to the SDPs, maintain an effective human resource, create demand,
maintain and coordinate the operation of the health facilities that provide FP
services. However, this is mostly funded by donors. The Local government is
expected to support service delivery and human resources as much as
possible, but this is often left for other stakeholders to handle.
The state’s investment in human resource and equipment is inadequate as

many facilities are understaffed or non-functional. This maybe because the
priority of the State Government in recent years has been in the area of
infrastructure development and free education and little has been done in
balancing this with the need for adequate human resource for health. Since
2014, there has been zero release of family planning budgetary allocation
despite the paltry sum allocated to the program.
Worthy of note is that the proposed budget (runs in millions) by the

coordinating unit always starkly differs from the final budgetary allocation
(runs hundreds of thousand) for Family Planning by the Ministry of Health. No
release of allocated funds also limits the state spending and results in making
the FP activities largely funded by out of pocket and donor funds.
However, SOML Program for Result (P4R) program is an opportunity to limit

the funding gap as it has CPR indicator as one of its major pillars.
Table 1: Family Planning budgetary allocation in Imo State Ministry of Health from 2014-
2018. Source: SMOH
Year Actual Budgetary Allocated Funding Gap

Allocation to FP Amount
Released
2018 2,000,000 0 2,000,000
2019 500,000 0 500,000
2020 500,000 0 500,000
The Development partners currently supporting the State FP intervention in
the State include UNFPA, MSION, AHI, Rotary International, and JSI. They
support the state in demand generation, Advocacy, policy and systems
strengthening, logistics, service delivery and human resource development.
31
1.4.6 Supervision, Monitoring, and Coordination
For any project to succeed there must be effective supervision, monitoring

and coordination system/strategy throughout the different levels of planning
and implementation. At this critical period when most partners are gradually
withdrawing, Government needs to look inwards and strategize on how to
be less donor-dependent.
Studies have shown that a programme not well supervised and monitored
falls short of the expected result. In Imo State, family planning programme is
done by the Reproductive Health Unit of the State Ministry of Health and this
is monitored by the Integrated Supportive Supervision (ISS) team established
by the government and supported by donor agencies. The Team monitors
health facilities on all range of health services provision, including family
planning. The platforms for supervision that are presently available are largely
driven by donor agencies and withdrawal of their support may lead to the
collapse of the coordination mechanism.
Among the development agencies implementing family planning

programmes in Imo state, only MSION, UNFPA and JSI are involved in
monitoring, supervision and coordination activities in public health
facilities.
Effective coordination of FP activities at the various levels and sectors

(public and private) will reduce to a significant level these challenges.
The current supervisory and monitoring system does not cover the private
health sector, NGOs, or PPMVS, as these sectors are yet to be properly
integrated in to the state FP service delivery system.
32
Health Facility Survey
1.5 Summary of The Findings

1.5.1 Sample Characteristics
Results show that almost all FP service providers at the hospitals and health
centers (98%) were nurses and midwifes. The FP providers were all female.
FP clients were mostly married and of the Christian religion, and the majority,
had formal education
1.5.2 Personnel, Infrastructure and Equipment

Only 25% of Public Secondary HFs (General Hospitals) had providers (nurses)
who have received training in IUCD insertion, IUCD removal and training in
implant insertion and removal. 100% of public primary HFs visited had at least
one provider (nurse) who had received training IUCD insertion, IUCD removal
and training in implant insertion and removal and contraceptives logistics
management system (CLMS). However, in reality, only 88% of Public HFs
providing Family Planning services have at least one provider (nurse) who
have received training in LARC and CLMS. In comparison, no CHEWs are
being trained in IUCD and Implant insertion or removal, largely because Imo
State has yet to implement Federal Government task shifting and task sharing
policy on long acting and reversible contraceptives (LARC) and partly, due
to the opposition from nurse/midwifes to CHEWs training. The only two Public
Tertiary HFs in the State had at least 2 providers (nurses) who had received
training in both LARC and CLMS. The 5 Private Hospitals visited had at least
one LARC-trained provider with no training on CLMS.
Results on the basic infrastructure and equipment for FP services show that
basic equipment such as tenacula, specula, uterine sound and sponge
holding devices, weighing scale, blood pressure machines, torch were
available in the FP/MCH unit of 97% of facilities visited. However, most notably
absent and lacking was Standard Sterilizing equipment in 98% of public
33
primary HFs visited as can be seen in Figure 2. However, the overall FP service
delivery environment was good in all facility types. Most hospitals and health
centers had the necessary equipment and good examination rooms for
delivering long-acting FP methods.
1.5.3 Reasons for Client Visit and Availability of FP Services

The main reason for visiting the health facility for most of the FP clients was to
obtain a re-supply of their FP method. New FP users constituted just over one
fifth (22%) of the hospitals and health centers clients. Generally, most health
facilities reported usually providing a range of short acting methods, with
injectables being the most available and the most dispensed method.
Hospitals and health centers had on average 5 different FP methods
available at the time of the survey. Of the long acting methods, Implanon
was relatively more available than the other long acting methods.
Figure 11: Reasons for Visiting FP Facilities by FP Client
34
1.6.4 Supplies and Logistics Management
Most of the facilities that reported usually providing a particular FP method

were found to also have it in stock at the time of the survey, but very few of
these facilities (especially the public facilities) also had experienced stock-
outs in the past six months. In the facilities that usually provided IUCDs, 93%
also had it in stock at the time of the survey. Of the facilities that usually
provided Implanon, it was generally found to be in stock at the time of the
survey. Overall, more than 90% of all facilities had injectables and oral
contraceptive pills in stock.
All Public HFs reported receiving theirs supplies form either the LGA
Warehouse/store or Central Medical Store which are all Government sources,
while 40% of Private hospitals received their supplies from Government
sources (LGA store & Central medical store) and 60% either from supporting
NGOs and or through market purchase.
95% of public HFs said they did not receive full quantities of contraceptives
that they ordered for in the last three months. Reason being that quantities
supplied were determined by suppliers based on quantities available in the
store.
There was absence of consumables being supplied by Government sources

in 99% of Public HFs. This absence, they said, is the major reason most the
public HFs charge clients as consumables are either bought out-of-pocket by
providers or by clients.
1.6.5 Quality of Care

Most of the FP clients reported receiving services at no cost, satisfied with
providers’ quality of care and service delivery and willingness to return to the
same facility in future. However, 30% of clients reported paying receiving
services at a cost. When asked the reason for the payment, they reported
being asked by providers to bring money for either consumables or
pregnancy test and other laboratory tests. In these cases, an average of
₦500 was paid by clients.
35
Most of the providers who had conducted IUCD and implant insertions
reported that they were comfortable with conducting insertions, but for those
who had not conducted any insertions, the lack of training was cited as the
primary reason. However, the majority of providers (including those who had
never been trained in IUCD and implant services) were interested in providing
IUCDs and implants.
Generally, most of the providers interviewed had specific influencing factors

for dispensing FP methods. These factors included: minimum and maximum
age, marital status, partner consent, and menstrual status. With the exception
of sterilization, the majority of providers were open to dispensing FP methods
to non-married clients, the main difference being that while 76% of the nurses
and health officers were open to inserting implants to unmarried women
36
SECTION 2
INTEGRATED FAMILY PLANNING PLAN
2.1. Goal
The overarching goal of the state FP CIP is to increase Imo State

contraceptive prevalence rate to 27% and also contribute to the reduction
of Imo state maternal and child mortality by the year 2024.
2.2. Objectives
By 2024, Imo State intends to accomplish the following:

• Provide accurate and comprehensive knowledge of FP methods to every
segment of the population through easily accessible channels to generate
demand and change behaviour.
• Ensure that the State Government and all the LGAs provide the funds
required for adequate FP service delivery every year.
• Ensure that every public health and 50% of private health facilities have
adequate numbers and categories of trained staff—in line with national
guidelines—to provide LARC services.
• Strengthen contraceptive logistics management systems to ensure
continuous contraceptive availability at all FP SDPs.
• Improve routine data management (including collection, collation,
reporting, and use) at all levels of the healthcare delivery system in the state
to allow for smooth tracking of FP progress
2.3. Strategic Priorities
As part of the State FP CIP development process, the SMoH, guided by the
National FP Blueprint and the contributions of key stakeholders, prioritised a
set of issues most relevant to achieving the state’s target of 27 percent CPR
37
by 2024. These issues surfaced based on existing FP/RH planning work, a

diagnosis of the FP landscape in Imo, and partner experiences working in FP
programming in the state. Based on these inputs, seven issues emerged as
priorities, including one focusing on M&E.
• FP demand generation and behaviour change communication: To

strengthen demand for FP services by developing targeted and accurate
information and delivering it through accessible communication channels
to all key segments of the population.
• FP financing: To set up standard budget lines in the state and LGA budgets
to cover FP services, commodities, consumables, and distribution all the way
to the service delivery points.
• Staff and training: To build capacity of providers, training institutions and
support the health care system in delivering high-quality FP services.
• Private sector delivery channels: To increase coverage and access to high-
quality integrated FP services and commodities through the private sector,
including faith-based organisations, private hospitals/clinics, and pharmacies
and PPMVs as appropriate for some methods.
• FP coverage in the PHC system: To improve access to high-quality
integrated FP services by the PHC system, including the provision of
counselling and delivery of all methods except tuba ligation.
• Forecasting and distribution logistics: To strengthen the state and LGA FP
structures to better coordinate and monitor all supply chain activities to
deliver commodities and consumables promptly and to efficiently use
innovative technologies (e.g., health platforms).
• Evidence-based decision making and performance management: To
improve FP knowledge and performance management (e.g., research, data
collection, collation, analysis, feedback, and use) at all levels.
2.4 Structures of the Costed Implementation Plan
The state FP CIP activities are structured around six basic areas of the health
system for family planning:
• Demand generation and behaviour change communication
38
• Service delivery
• Supplies and commodities
• Policy and enabling environment
• Financing
• Supervision, monitoring, and coordination
Across the six categories, several activities exist—some of which are further
sub-divided into sub-activities, with descriptions for costing purposes
2.4.1 Demand Generation and Behaviour Change Communication
a. Justification
Public awareness of family planning can be enhanced by increasing its

public visibility. Knowledge and demand will come from the wide
dissemination of accurate information about FP methods and their
availability, as well as the encouragement of FP use to promote the health of
women and their families. Advocates at the state and LGA levels can
increase interest in family planning within communities, producing a
supportive environment, reducing normative barriers, and mobilising
community support.
b. Strategy
The key proposed interventions aim to sustain support for family planning from
the highest policy level and promote public dialogue at all levels—from the
state through to the community—about the important role of family planning
in promoting health and supporting development. They include high-impact
demand generation activities to close the knowledge-use gap by addressing
myths and mis-information about family planning and the fear of side effects
and health concerns that impede its adoption and use.
Specific demand generation efforts will be targeted at identified high-priority

segments (e.g., adolescents/young people, unmarried women). Community
Volunteers shall be trained to help with disseminating information and linking
young people to service delivery points if and when they need the services.
39
Provision of adolescent- and youth-friendly services shall be mainstreamed

into pre-service and in-service training of healthcare providers.
c. Activities
The activities are aimed at scaling up awareness on family planning for
increased uptake of family planning services through capacity-building for
Media Reporters on Social Change Communication and Family Planning
Champions and Community Volunteers on community mobilization
strategies.
Production of Social Behaviour Change Communication and Service
delivery tools for increased awareness on family planning and quality of
family planning services.
Priority Issues:
1. Scale up awareness of family planning services in the State by 2024
2. Capacity building of family planning champions and community
Volunteers
3. Ensure availability of Family planning job aids and service delivery tools
Proposed Activities:
Priority Expecte Main Activity Sub Inputs Output Tim Resp.
Objective d Results Activities required/ Indicat elin
details Additional ors e
details
Scale up DBC1.0 DBC 1.1 DBC 1.1.1 3 facilitators, Number 2021 SMoH
awareness Increase Build the 2-day Hall, of , ,
of family d capacity of training of Accommod Media 2022 Partn
planning awarene selected select ation, Tea Reporte 2023 er
services in ss on State and State and Break, rs and
the State family Private Private Lunch, Slide trained 2024
planning owned owned Projector,
electronic electronic Public
and print and print Address
media on media System,
Social Reporters transport,
Behaviour to increase Stationery,
Change their Per diem,
Communicati knowledg honorarium
on (SBCC) in e on social
the Behaviour
40
promotion of change
family communic
planning ation for
services family
planning
(25
Participant
s)
Hall, Lunch, FP 2021 SMoH

DBC1.1.2 Public Champi ,
Inaugurati Address ons Partn
on of 135 System, Networ ers
Family Slide k
Planning projector, Inaugur
Champion transport, ated
s/Advocat Stationery
es Network
(5 per
27 LGAs)
Hall, tea Bi- 2021 SMoH
DBC 1.1.3 break, annual 2022 ,
1-day Bi- Lunch, Slide Review 2023 Partn
annual projector, Meetin and ers
Family Flip chart& gs 2024
Planning stand, Condu
Champion markers, cted
s Review Stationery,
meeting transport
for 78
members
DBC1.1.4 Hall, tea Number 2021 SMoH
1-day break, of 2022 ,
Quarterly Lunch, Quarterl 2023 partn
Review Public y And ers
meeting Address Review 2024
for 171 System, meetin
Communit projector, gs
y Flip chart conduc
Volunteers &stand, ted
(171 ward stationery,
tansport
DBC1.1.5 Transport for Number 2021 SMoH
Monthly FP of 2022 ,
Communit Community people 2023 partn
y dialogue Volunteers, reache and ers
41
on family BCC d 2024

planning Materials, through
by 171 Refreshment commu
Communit nity
y dialogu
Volunteers es
in 171 Number
Wards for of
50 session
participant held
s per ward
conduct 1- FP of 2022 ,
day Community people 2023 Partn
monthly Volunteers, reache and ers
Communit BCC d 2024
y Materials, through
Outreach Refreshment monthly
on family , Fuel Commu
planning in nity
171 Wards Outrea
for 100 ches
participant Number
s per ward of
session
held
conduct FP of 2022 ,
monthly Community people 2023 Partn
Compoun Volunteers, reache and ers
d meetings BCC d 2024
on family Materials, through
planning Refreshment compo
by 171 und
Communit meetin
y gs
Volunteers Number
in 171 of
Wards for session
50 held
participant
s per ward
DBC 1.1.8 Hall, tea Number 2021 SMoH
1-day Bi- break, of 2022 ,
annual Lunch, Religiou 2023 Partn
Sensitizatio Public s 2024 ers
n meeting Address Leaders
for 60 System, Sensitize
42
Religious projector, d
Leaders on Flip chart Number
Family &stand, of
Planning Stationery, session
(20 per transport held
each
Senatorial
Zone)
DBC 1.1.9 Scripts, Number 2021 SMoH
Production Design of Partn
of 7 Family Format, Jingles ers
Planning Fund Produc
Radio and ed
Television
Jingles in
English,
Igbo and 3
dialects
(Radio 5,
TV 2)
DBC 1.1.10 Fund for Number 2021 SMoH
Airing of 7 airing of of 2022 ,
Family Family Family 2023 Partn
Planning Planning Plannin 2024 ers
Jingles on Jingles g
Select Jingles
State and aired as
Private schedul
Radio ed
Stations in
the State
DBC 1.1.11 Hall Hire, Number 2021 SMoH
Mark Radio, of 2022 ,
Special Television Special 2023 Partn
days announcem days 2024 ers
(World ents, Tea celebra
Population Break, ted in
Day, Girl Lunch, T- the
Child, Shirts, Caps, State
Women Flex
Contracep banners,
tion day & Slide
World Projector,
Condom Public
Day) Address
System,
Stationery,
transport
43
Capacity DBC 2.0 DBC 2.1 Build DBC 2.1.1 3 facilitators, Number 2021 SMoH
building of Increase the Capacity Conduct a Hall, of 2022 ,
family in of Family 2-day Accommod Family , Partn
planning uptake Planning training for ation, Tea Plannin 2023 ers
champions of family Champions 134 family Break, g and
and planning and planning Lunch, Slide Champi 2024
community Services Community champions Projector, ons
Volunteers Volunteers on family Public trained
planning Address
and System, Flip
promotion charts&
al stand,
strategies markers,
Stationery,
transport,
per diem. 2
Batches (67
per batch)
DBC 2.1.2 3 facilitators, Number SMoH
3-day Hall, of 2021 ,
training for Accommod Commu 2022 Partn
305 ation, Tea nity ,202 ers
Communit Break, Volunte 3
y Lunch, ers and
Volunteers Projector, trained 2024
on family PAS, Flip
planning charts &
and stand,
communit markers,
y Stationery,
mobilizatio transport 5
n Batches (61
Strategies. per batch)
5 Batches
(61 per
batch)
Ensure DBC 3.0 DBC 3.1 DBC 3 1.1 Samples of Number 2021 SMoH
availability Increase Production of Print 25 BCC, of BCC & ,
of Family in the family family service & 2024 Partn
Planning quantity planning planning delivery service ers
Behaviour and behaviour BCC and tools & delivery
Change quality change service billboards, tools
Communica of Family communicati delivery detailed printed;
tion and Planning on and tools @ Quantificati billboar
Service services service 25,000 on, ds
delivery delivery tools Copies Quotation produc
44
tools each from ed &

(Client companies. mounte
Individual d at
Form, strategi
Counsellin c points
g Cards,
brochures
on
methods,
flip charts,
Referral
cards,
posters,
fliers,
stickers,
Flex
banners
(and
produce
billboards
(15) 5 per
each
senatorial
zone
Scale FP Knowled Strengthen Transportati Number 2021 SMoH
awareness ge of FP the 1. on, of in ,
and services implementati Engageme Educational school partn
knowledge increase on of the nt of State materials youths ers
among in d Family Life Ministry of reache
school among Health Education d
youths in school Education 2.
youths Programme Assessmen
t of the
implement
ation
status of
the FLHE
programm
e in Imo
State
3. Work
with SMoE
to monitor
and
supervise
the
implement
ation of
45
the FLHE
programm
e
Scale up Conduct
demand for Quartely
Family Communit
Planning y
through Outreache
community s in
outreaches churches,
market
places,
etc in
each of
the 27
LGAs
2.4.2 Service Delivery
a. Justification
The current staffing and skill levels in the public and private sectors of the
state healthcare system do not provide adequate and equitable FP services
to the population. Health care workers are concentrated in the urban
locations while there is dearth of health care workers in rural locations. It is
necessary to both bolster the current delivery system through improving skills
and deploy new FP service approaches to improve availability and
accessibility.
b. Strategy
To ensure wide availability of family planning services, it is essential to identify
the health system’s current FP service delivery capabilities and develop
modalities for updating the gaps. The core of FP service availability is ensuring
that FP health workers at each level have the appropriate training to provide
FP services.
FP training of health workers will be increased—both in general and based on
immediate scale-up needs for methods (i.e., injectables, LARCs and tubal
ligation). A training plan will be developed based on a situation analysis of
health worker skills. All partners involved in training will be coordinated by the
46
SMOH to reach training goals. Mentorship and supervision following formal

training will be a key activity of the SMOH going forward.
Integrating family planning into other health services will also be explored as
a key strategy to enhance its availability at higher-level facilities with sufficient
staff; for example, there is a need to build capacity for postpartum IUCD and
tubal ligation services in labour wards. Referral for FP services will be stressed
in the training and supervision of all healthcare workers who do not
themselves provide these services.
Several other innovative approaches to enhancing FP services availability will
be piloted, including training staff at pharmacies and PPMVs throughout the
state to provide high-quality counselling and services for those methods they
are legally permitted to provide.
In addition to these activities, innovative solutions to reach rural and under-
served populations will be employed like FP outreach services to reach hard
to reach communities.
c. Activities
The key Priorities addressed by the activities in Service delivery are promotion
of uptake of LARC services including PP-IUD; scale up of FP outreach services
and promotion of uptake of tubal ligation services. The key targets include:
• Increase the uptake of Implants from the current 21,595 users to 145,440
users by the end of December 2024;
• Increase the uptake of IUD from the current 8,098 users to 76,548 users by
the end of December 2024;
• Increase the uptake of tubal ligation services from the current 1,350 users to
22,964 by the end of Dec. 2024;
• to increase the uptake of other modern contraceptive methods by the end
of December 2024 and
• Ensure provision of quality FP services in the health facilities by the end of
December 2024.
47
Priority Issues:
1. Promotion of uptake of LARC services including PP-IUD
2. Scale up FP Service Outreaches
3. Promotion of uptake of tubal ligation services.
Priority Expecte Main Sub Inputs Output Tim Resp.
Objective d Results Activity Activities required/ Indicat elin
details
To increase SD 1.0: SD1.1: Build SD1.1.1: 5 facilitators, Number 2021 SMO
the uptake Increase the Conduct a Hall Hire, of H
of Implants d capacity of 6-Day Anatomic Master &Part
from the uptake HCWs in the Training of models, Trainers ners
current 8,098 of tertiary, 20 Master other trained
users to Implants secondary Trainers on training
76,548 users and primary LARC materials,
by the end healthcare consumable
of facilities s,
December (public and Accommod
2024; private) in ation, 2 tea
the state to breaks,
provide lunch, slide
LARC Projector,
services flip chart &
stand,
markers, Per
diem,
Transport
SD1.1.2: 7 facilitators, Number SMO
Conduct a Hall Hire, of 2021 H
6-Day Anatomic doctors &Part
Training of models, trained ners
100 other on
nurse/midwif training LARC
es and materials,
doctors (50 consumable
nurse/midwif s,
es & 50 Accommod
doctors) ation, 2 tea
from private breaks,
hospitals on lunch, slide
provision of Projector,
48
LARC flip chart &

services stand,
markers, Per
diem,
Transport
SD1.1.3: 5 facilitators, Number 2021 SMO
Conduct a Hall Hire, of H
6-Day Anatomic doctors &Part
Training of models, trained ners
30 doctors other on
from IMSUTH, training LARC
(O&G, materials,
Family consumable
Medicine & s,
Community Accommod
Medicine), ation, 2 tea
FMC Owerri, breaks,
ISSH & the lunch, slide
GHs on Projector,
provision of flip chart &
LARC stand,
services markers, Per
diem,
Transport

Conduct a Hall Hire, of & H
6-Day Anatomic Nurses/ 2022 &Part
training of models, Midwiv ners
80 Nurses/ other es
Midwives training trained
from 80 materials, on
public consumable LARC
health s,
facilities on Accommod
provision of ation, 2 tea
LARC breaks,
services in 4 lunch, slide
batches of Projector,
20 each. flip chart &
stand,
markers, Per
diem,
Transport
Conduct a Hall Hire, of , H
6-Day Anatomic CHEWS 2022 &Part
training of models, trained & ners
49
342 CHEWS other on 2023

(one from training LARC
each of the materials,
PHCs) on consumable
provision of s,
LARC Accommod
services in ation, 2 tea
11 batches breaks,
of 30 each lunch, slide
(4 Projector,
batches per flip chart &
year.) stand,
markers, Per
diem,
Transport
To increase SD 2.0: SD2.1: Build SD2.1.1: 5 facilitators, Number 2023 SMO
the uptake Increase the Conduct a Hall Hire, of & H
of IUD from d capacity of 5-Day Anatomic Nurses/ 2024 &Part
the current uptake HCWs in the training of models, midwiv ners
8,098 users of IUDs tertiary, 80 Nurses/ other es
to 76,548 secondary Midwives training trained
users by the and primary from 80 PHFs materials, on PP-
end of healthcare on provision consumable IUD
December facilities of PP-IUD s,
2024 (public and services in 4 Accommod
private) in batches of ation, 2 tea
the state to 20 each breaks,
provide PP- lunch, slide
IUD services Projector,
flip chart &
stand,
markers, Per
diem,
Transport
SD2.2: Build Conduct a 5 facilitators, Number 2023 SMO
the 5-Day Hall Hire, of , H
capacity of training of Anatomic Nurses/ 2024 &Part
HCWs in the 100 Nurses/ models, midwiv ners
private Midwives & other es and
healthcare doctors from training doctors
facilities in 100 PHFs on materials, from
the state to provision of consumable the
provide PP- PP-IUD s, private
IUD services services in 4 Accommod health
batches of ation, 2 tea sector
25 each breaks, trained
lunch, slide on PP-
Projector, IUD
50
flip chart &

stand,
markers, Per
diem,
Transport
Conduct a Hall Hire, of & H
5-Day Anatomic CHEWS 2024 &Part
training of models, trained ners
342 CHEWS other on-IUD
(one from training
each of the materials,
342 PHCs) consumable
on provision s,
of PP-IUD Accommod
services in 6 ation, 2 tea
batches of breaks,
30 each. lunch, slide
Projector,
flip chart &
stand,
markers,
Perdiem,
Transport
To increase SD3.0: SD3.1: Build SD3.1.1: 4 facilitators, Number SMO
the uptake Increase the Conduct Hall Hire, of 2022 H
of tubal d capacity of a10-Day Anatomic doctors &Part
ligation uptake doctors and Training of models, & ners
services of tubal specialist 80 doctors other Nurses
from the ligation nurses (30 from training trained
current 1,350 working in Public HFs materials, on
users to the tertiary, and 50 from consumable provisio
22,964 by secondary Private HFs) s, n of
the end of and PH on provision Accommod tubal
Dec. 2024; facilities to of mini-lap ation, 2 tea ligation
provide services in 8 breaks,
tubal batches of lunch, slide
ligation 10 each Projector,
services flip chart
&stand,
markers,
Per-diem,
Transport
Improve SD4.0: SD4.1: Build SD4.1.1: 5 facilitators, Number 2022 SMO
knowledge Improve the conduct a 6 Hall Hire, of PSE H&
and skills of d capacity of -Day training Anatomic Staff Partn
pre-service knowled tutors and of 44 tutors models, trained ers
tutors on ge and preceptors and other on
51
LARC by skills of of the 11 preceptors training LARC

2023 tutors PSE of PSE materials,
and Institutions in institutions consumable
precept the State on on LARC in s,
ors of Modern FP two batches Accommod
PSE Methods of 20 each ation, 2 tea
Institutio breaks,
ns on lunch, slide
modern Projector,
FP flip chart &
methods stand,
markers, Per
diem,
Transport
SD5.0: SD5.0: SD5.1: SD5.1.1: 5 team Number 2021 SMO
Improved improve Institutionaliz Monthly members, of field , H&
quality of FP d quality e supportive supportive Transport, visits 2022 Partn
services in of FP supervision supervision checklist, conduc , ers
the health services and and refreshment ted 2023
facilities in the mentoring mentoring Number ,
health of all visit to the of 2024
facilities trained FP 639 Health Provider
providers in facilities in s
the State the State supervis
ed and
mentor
ed
SD5.2: SD5.2.1: No cost. Number 2021 FP
Retain Advocate Leverage of , AWG
skilled to LGA on existing trained 2022 ,
providers at health platforms provide , SMO
SDPs for a managers, e.g. rs who 2023 H
period of 5 ISPHCDA, Enlarged spent &
years to ISSH and Manageme at least 2024
allow for IMSUTH to nt meeting 5 years
optimal retain since post
service trained Admin. Secs training
provision. providers for are under in the
a period of SPHCDA unit of
5 years to their
allow for posting
transferring
skills and
building FP
service
provision
capacity.
Scale up FP SD6.0: SD6.1: SD6.1.1: FP Number SMoH
52
outreach Increase Provide Conduct FP commoditie of new 2021 ,

services to d periodic quarterly s, FP 2022 SPHC
women in uptake community outreach consumable accept , DA,
hard to of FP outreach across the s, lunch and ors 2023 Partn
reach services services to 305 wards in transport followin , ers
communities increase FP the State g 2024
uptake outreac
h
services
Number
of
outreac
h
services
conduc
ted
To ensure SD7.0: SD7.1: SD7.1.1: Personnel, Quantifi 2021 SMO
availability Relevant Procure FP Conduct an transport, cation . H,
of all equipme equipment initial needs refreshment. of 2022 SPHC
relevant nt and assessment equipm DA,
equipment availabl anatomic to ent and Partn
for training e at models for determine commo ers
and clinical both training the dities
practice training equipment needed
and needs for FP at SDPs
clinical services for
sites each facility
and FP
program.
SD7.1.2: Detailed Quantit SMO
Procure quantificati y of 2021 H,
equipment, on of training , SPHC
models, commoditie equipm 2022 DA,
commoditie s, finance, ent, , Partn
s and activation commo 2023 ers
consumable of dities
s (e.g., IUD procuremen and
insertion kits, t processes, consum
plastic transportati ables
uteruses for on of procure
IUDs, or commoditie d
plastic arms s, storage,
for implants) etc.
based on
determined
needs
SD7.1.3: Detailed Quantit 2021 SMO
53
Procure quantificati y of , H,
equipment, on of equipm 2022 SPHC
commoditie commoditie ent, , DA,
s and s, finance, commo 2023 Partn
consumable activation dities & ers
s e.g. of consum
Sponge procuremen ables
holding t processes, procure
Forceps, transportati d and
Speculums, on of distribut
Tenaculum, commoditie ed to
Implant s, storage, SDPs.
insertion Kits, etc.
IUD insertion
Kits and
consumable
s
Scale up SD8.0: SD8.1: SD8.1.1: Hall, Tea Number 2022 SMO
community- Improve Establish FP- Conduct a break, of & H,
based d quality focused 2-Day non- lunch, PPMVs 2023 SPHC
distribution of short orientation residential transport, orientat DA,
of short- acting programme Annual orientation ed on Partn
acting FP s for PPMVs. orientation materials, family ers
methods services of 150 projector plannin
through rendere PPMVs on and screen, g.
PPMVs by d by short acting flip chart
2024. PPMVs methods and stand
/referral in
three
clusters one
in each
senatorial
zone (50 per
cluster)
SD8.1.2: Hall, Tea Number 2022 SMO
Quarterly break, of , H,
meetings lunch, quarterl 2023 SPHC
with PPMVs transport, y & DA,
to provide training meetin 2024 Partn
updates materials, gs held ers
and collect projector Number
reports (2nd and screen, of
year 150, 3rd flip chart PPMVs
year 300, 4th and stand, that
year 450) PAS attend
the
meetin
g
54
Scale up SD9.0: SD9.1: SD9.1.1: 3 persons, Review 2021 SMO

access of Increase Improved conduct a 7 Transport, ed H,
contraceptiv d access to days study refreshment, Report SPHC
e Services to youths’ contracepti to assess review tools, DA,
young access ve services functionality report Partn
people. to among and writing ers
contrac young contribution
eptive people s of the
services current 3
AYFHS
Centres to
contracepti
ve services
SD 9.1.2: Accommod Number 2021 SMO
Establishme ation, of 27 , H,
nt of one furniture, TV LGAs 2022 SPHC
AYFHS set, DVD, AYFHS . DA,
Center in Indoor Centres 2023 Partn
each of the games, establis , ers
remaining counselling hed 2024
24 LGAs tools,
registers,
motorcycles
etc.
SD10.1.3: 5- 4 facilitators, Number 2021 SMO
Day training Hall Hire, of H,
of 30 AYFHS Anatomic AYFHS SPCD
Focal models, FPs A,
Persons on other trained Partn
Provision of training ers
youth materials,
friendly consumable
contracepti s,
ve services Accommod
ation, 2 tea
breaks,
lunch, slide
Projector,
flip chart &
stand,
markers,
Per-diem,
Transport
To ensure SD10.0 SD10.1: SD10.1.1: Hall, Tea Number 2021 SMoH
proper Timely Establish Quarterly break, of 2022 ,
coordination submissi State, /LGA State-LGA Lunch, meetin 2023 SPHC
of FP on of FP Coordinatio FP transport, gs held & DA,
55
services and service n meetings coordinatio training Number 2024 Partn

timely reports n meetings materials, of ers
submission by with 27 projector particip
of report by service RH/FP Focal and screen, ants
2023 providers persons and flip chart submitti
5 SMoH and stand, ng
Officers PAS reports
on time
2.4.3 Commodities and Supplies
Justification
This thematic area addresses the sustainable supply of safe and quality
contraceptive commodities and related consumables. Currently, the state
receives commodities from the Federal Government thus efforts here are
aimed at ensuring that they are adequate and available to meet the needs
and choices of FP clients. The activities of this strategic priority will be
implemented in line with the FMoH Reproductive Health Commodity Security
(RHCS) Strategic Plan.
Currently, significant distribution challenges are limiting factor in ensuring the
availability of high-quality FP services at SDPs. Specific activities will be
undertaken to ensure that contraceptives are delivered to the “last mile” to
health facilities to ensure RHCS throughout the state, including rural areas.
b. Strategy
At the Federal level, supply no longer poses a significant challenge for FP
commodities, thus the focus will be on resolving distribution challenges from
state stores to the LGA stores and SDPs. A key focus will be on improving the
distribution of commodities, ensuring that the last mile of the supply chain is
strengthened.
56
c. Activities
Family planning commodities flow from Federal Central Medical Stores to
State Central Medical Stores. The State Central Medical Store will be
upgraded to meet minimum requirements for storage of pharmaceutical
products. To ensure effective distribution and reporting, the capacity of the
relevant actors such as the LMCU, LLMCU and SDP staff will be built on
Contraceptives Logistics Management System (CLMS). Furthermore,
appropriate LMIS tools will be made available for efficient and effective
management of Family planning commodities.
Priority Issues:
• Maintain constant availability of FP commodities at the HFs
• Develop the capacity of the LMCU, LLMCU members and facility staff on
CLMS.
• Ensure last mile distribution of family planning commodities.
• Ensure the availability of logistics management information system (LMIS)
tools.
• Ensure appropriate use of LMIS tools.
Priority Expecte Main Sub Activities Inputs Output Tim Resp
Objecti d Results Activity details required/ Indicat elin onsib
ve Additional ors e le
details
To CS1.0 CS1.1: 1.Disseminate Distribution Number 2021 SMO
ensure Reduce Conduct a information van hire, of - H&
consta d stock one-day to conveyors, Facilitie 2024 Partn
nt out rate bimonthly participating communica s that ers
availab of FP last mile facilities 2. tion (SMS & receive
ility of commo distribution Pick and calls), d FP
FP dities at (LMD) of pack FP Transport commo
commo SDPs, family commodities allowance dities
dities at increase planning from CMS to for State and
the last d commoditi the 6 clusters conveyors reporte
mile product es to SDPs 3. Rent and FP d
availabili distribution provider stockou
ty and vans t of
enhanc commo
ed dities in
commo their
57
dity RIRF
security
To CS2.0 CS2.1: Last Conduct a 5-
Monitoring Comple 2021 SMO
ensure Enhance Mile day post checklist, ted - H &
that d Distribution LMD vehicle hire, checklis 2024 Partn
deliver commo (LMD) monitoringdaily t, ers
y and dity Monitoring visit to transport verified
security security supported FP
allowance proof of
of and facilitiesfor delivery
commo increase participatin notes
dities at d g LMCU and (RIRF)
the last product FP unit staff,
mile availabili allowance
ty for providers
To CS3.0 CS3.1: 1. Historical Number 2021 SMO
ensure Eliminati Procure Quantificatio and current of - H&
consta on of 4000 FP n of stock status consum 2024 Partn
nt service Consumabl Consumables data for able kits ers
availab charge e kits per to be quantificati procure
ility of on year procured in on, market d and
consu clients collaboration survey proof of
mables due to with LMCU reports, delivery
at lack of 2. Submit proposal
facilitie consum proposal for writing
s and ables procurement
CMS and
increase
d service
uptake
To CS4.0 CS4.1: Printing of 10, Proposal, Quantit 2021 SMO
ensure Increase Produce 000 tally sample tools y of - H&
consta d CLMIS data cards, 1,500 for printing data 2024 Partn
nt docume tools RIRF booklets, tools ers
availab ntation 2,000 DCR printed,
ility of and booklets and delivery
CLMIS data 1,000 FP vouche
tools at reporting registers r
the
facilitie
s
To build CS5.0 CS5.1: Conduct a 5- Accommod Number 2021 SMO
the Increase Capacity day ation, hall FP - H&
capacit d building of residential hire, 2 tea provide 2024 Partn
y of FP capacit service training on breaks, rs ers
provide y of providers CLMS for 639 lunch, trained
rs in provider on CLMS FP service transport, on
PHFs on s on providers in 4 projector, CLMS
CLMS CLMS of 50 flip chart,
58
and batches perflip chart

knowled year stand
ge of markers, 2
LMIS resource
tools persons and
training
materials
To CS6.0 CS6.1: Hire a truck Truck hire, Physical 2021 SMO
meet Increase Trucking of that will commodity count, - H &
the d FP transport conveyor, verified 2024 Imple
commo capacit Commoditi commodities delivery menti
loaders,
dity y of the es from from Lagos to note ng
deman State FP CCW Owerri accommod and partn
ds of unit to Oshodi to ation and lead ers
SDPs meet CMS DSA for time
commo Owerri State
dity conveyor,
demand communica
s of SDPs
tion
and
enhanc
ed
product
security
To CS7.0 CS7.1: 1. Form a Supervision Number 2021 SMO
provide Improve Conduct combined checklists, of FP - H&
on the d data quarterly supervision personnel facilities 2024 Imple
job quality integrated team (LMCU, FP visited, menti
training and supportive comprising unit and comple ng
of data supervision FP unit, LMCU LGA ted partn
provide output, of FP and LGA FP supervisors, checklis ers
rs and enhanc facilities on supervisors vehicle hire, ts with
enhanc e the supply 2. Produce DTA for recom
e their capacit chain copies of supervision mendat
perform y of managem supervision team, SMS ions
ance provider ent checklist and calls
s for 3. Orientation
service of supervision
delivery team on the
and use of
ensure supervision
account checklist
ability 4. Rent
vehicles for
supervision
To CS8.0 CS8.1: 1. Convey a Personnel, Availabi 2021 SMO
assess Reduce Prepare FP one -day SMS and lity of - H
stock d stock Quarterly meeting of calls, venue copies 2024
59
levels out and stock status LMCU and FP renting, of QSSR

and reduced report unit to transport
expiries (or (QSSR) prepare the allowance,
of eliminati QSSR printing and
commo on) 2. disseminatio
dities expiry of Disseminate n of reports
across commo and
the dities. implement
three Increase findings of
levels d the report
of knowled
distribut ge of
ion consum
ption
rate
To CS9.0 CS9.1: 1. Send SMS SMS, chairs Copies 2021 SMO
improv Improve Conduct invitation to and table of - H
e the d data bimonthly all renting, validat 2024
quality quality participants transport ed RIRF
RIRF data
of LMIS 2. Rent chairs allowance and
data review and and tables for attend
fed into validation for the participants, ance
NHLMIS meeting meeting refreshment, sheet
platfor printing and
m photocopy
To build CS10.0 CS10.1: Conduct a 5- Accommod Availabi 2021 SMO
the Increase Capacity day ation, hall lity of - H&
capacit d CU Building of residential hire, 2 tea training 2023 Partn
y of member LMCU TOT for 20 breaks, attend ers
LMCU s on members State LMCU lunch, ance
membe CLMS on members on transport, list and
rs on and LMIS contracept CLMS projector, photo
CLMS ive flip chart,
capacity flip chart
of LMCU stand
members markers, 2
on logistics resource
managem persons and
ent system training
(CLMS) materials
To CS11.0 CS11.1: Quantificatio Historical Proof of 2021 SMO
ensure State Procure n, proposal consumptio delivery - H
uninterr ownershi 671,000 submission, n data, , lead 2024
upted p of units of call for proposal, time
supply procure Family procurement tender and
of FP ment Planning tender/bid notice, physical
commo and self- Commoditi procuremen inspecti
dities to sufficien es per year t protocols on
60
Imo cy
State in
the
event
of
paucity
donor
fund
2.4.4 . Policy and Enabling Environment
a. Justification
Although the state government is increasing efforts to domesticate federal
level FP supportive policies, additional support will be paramount in achieving
the state FP goals. There is still insufficient allocation of human and financial
resources to achieve these goals. Therefore, the priority area of policy and
environment focuses on advocacy for family planning within various levels of
government and the private sector, including faith-based organisations, civil
society and private providers to ensure that the best policies are both present
and fully implemented.
b. Strategy
To improve the enabling policy environment for family planning, government
policies and strategies will be updated as necessary to ensure that family
planning is integrated appropriately. Specific advocacy will also be
conducted to ensure that policies and guidelines for family planning promote
rather than hinder access to it, especially by under-served populations, faith-
based groups, and youths. The SMoH and partners will support advocates at
all levels who can play key role in ensuring that family planning remains in the
limelight for both policy making and domestic funding.
c. Activities
Activities that are needed to provide enabling policy environment for Family
Planning services in the state include:
• Domestication of relevant National FP policies
• Development of evidence-based advocacy materials
61
• Increase in advocacy momentum through participation in the state,

national and international FP related events and
• Increase in human resource in the health sector and funding for FP.
Priority Issues:
• Domestication of national family planning relevant policies at State and
LGA levels.
• To increase advocacy momentum through State, National and
international events.
• Increase human resources for health and FP funding
Objective d Results Activities required/ Indicat elin
details
To domesticate Availabili Domesticatio 1-day Hall, No of 2021 SMO
relevant ty of n and meeting of Stationery, AWG H,
national family relevant circulation of 30 AWG Transport, and AWG
planning FP national FP members Snacks, stakeho ,
policies in the policies policies for and Lunch lders Partn
state in the Imo State. stakeholde that ers
state rs to attende
and identify d.
LGAs and No of
review policy
relevant docum
national ents
policies for identifie
domestica d
tion.
A 3-day Hall, Number 2021 SMO
meeting of stationeries, of AWG H,
50 AWG, transport, and AWG
State and lunch stakeho ,
LGA lders Partn
stakeholde that ers
rs to attende
develop a d,
state-level Number
advocacy of
plan for policy
adoption docum
62
of relevant ents
FP policies adopte
d
A 3-day Hall, Number Qua SMO
meeting of stationeries, of AWG rter H,
30 AWG transport, and 3 AWG
and lunch stakeho 2020 ,
stakeholde lders Partn
rs to that ers
develop attende
evidence- d,
based Number
advocacy of
materials policies
for eviden
decision ced-
makers based
highlightin advoca
g annual cy
projected materia
cost, cost ls
savings, develo
impact ped
analysis
and other
benefits of
FP
To increase Partners Participation Support 5 Transport, No of 2021 SMO
advocacy hip and in State, Staff of FP Per diem, persons - H&
momentum collabor National and Unit Accommod that 2024 Partn
through ation for international Ministry of ation, attende ers,
participation in FP FP Health, Course fees d FP
State, National service conferences AWG State
and delivery and events. members nationa
international Improve and other l and
events d. relevant internati
stakeholde onal
rs to confere
attend FP nce
national and
and events
internation Networ
al ks and
Conferenc partners
es. hips
establis
hed as
a result
63
of
particip
ating in
these
events
To advocate Adequat Engage all One-day Hall, No of 2021 AWG

for increase in e relevant meeting of Stationery, AWG - s,
Human manpow Policy makers Advocacy snacks, membe 2023 Partn
Resources for er to employ all Working lunch and rs that ers
Health providin cadres of Group to transport. attende
especially as it g FP and HWs. identify d.
relates to FP other relevant Number
service health Policy of
provision. services Makers on Policy
at all recruitmen makers
levels of t of HWs identifie
health and plan d to be
care. next step advoca
on their ted
engagem
ent.
1-day Stationeries, Number 2021 SMO
advocacy lunch, of - H,
visit to 9 transport policy 2023 AWG
policy makers and
makers visited partn
(Hon. ers
Commissio
ner for
Health,
Chairmen
House
Committe
es on
Health,
establishm
ents,
Chairman
CSC, ES of
SPHCDA,
and CEO
SHMB on
manpower
situation of
the health
sector in
the State,
64
and
advocate
for the
recruitmen
t of HW
Follow up Advocacy Number 2021 AWG
visit to briefs, of - /
Hon. materials policy 2023 Partn
Commissio and makers ers
ner for transport visited
Health,
Chairmen Number
House of
Committe advoca
es on cy visits
Health, conduc
establishm ted
ents,
Chairman
CSC, ES of
SPHCDA,
and SPC,
CEO SHMB
on
manpower
situation of
the health
sector in
the State,
and
advocate
for the
recruitmen
t of HW
Advocacy Stationeries, Waivers 2021 SMO
visit to the lunch, granted - H.
Executive transport by the 2023 AWG
Governor, govern and
to obtain or partn
waiver for ers
the
recruitmen
t of HW
65
To advocate Increase Engage State Advocacy Advocacy No of 2021 SMO

for increase FP d in FP and LGAs visits to kit, advoca - H/A
funding funding Policy makers Hon. Stationery, cy visits 2023 WGs/
to increase Commissio lunch and conduc
funding for FP ner & PS transport ted
and promptly SMOH &
release Ministry of
approved Planning,
funds. ES
SPCHDA,
DPRS and
Director of
Budget on
increasing
budgetary
allocation
for FP and
prompt
release of
approved
fund.
1- Day Hall, No of SMO
Advocacy Stationery, LGA 2021 H/A
meeting snacks, policy - WGs/
with lunch and makers 2023 partn
Chairman, transport. that ers
HPM, TR, attende
and d.
Administra
tive Sec of
13 LGAs on
increasing
budgetary
allocation
for FP and
prompt
release of
approved
funds.
66
2.4.5. Financing
a. Justification
While the overall policy environment for family planning is increasingly
positive, the government’s strong policy and strategic commitment has to be
accompanied by a commensurate dedication of state, or LGA-level
financial resources.
b. Strategy
To address the limited financial commitment to family planning within the
various government budgets commensurate to need, the SMoH, CSOs and
partners will advocate for increased funding within state budgets, in addition
to funding secured from development partners and the private sector. The
SMoH will also cultivate advocates within other ministries to ensure that the
state budget includes a line item for family planning that increases over time
to meet the growing demand for FP services.
c. Activities
Imo State Ministry of Health with support of relevant partners will develop
advocacy documents and scorecards to support evidence-based
advocacy. Furthermore, annual budget tracking for allocative and
expenditure efficiency assessment will be done. Financing activities will also
target the LGA budgeting and expenditure process to expand public sector
funding and last mile distribution. Due to several competing economic needs,
the public-sector resources alone will not be able to adequately fund FP
activities, thus, the private sector through Corporate Social Responsibility
(CSR) and individual philanthropist will be mainstreamed into the funding
space of FP to minimize the gap in the State.
Priority Issues:
• Develop evidence-based advocacy materials, score card and policy briefs
to advocate for more allocations and releases of fund for FP on annual basis.
• Target Local Governments to budget adequately for FP interventions
• Increase donor and private sector commitment to FP interventions.
• Increase annual allocation to CPR pillar of SOML P4R programme
67
• Develop capacity of stakeholders and provide technical support for

budget tracking
Proposed Activities
Priority Expecte Main Activity Sub Inputs Output Timel Resp.
Objecti d Results Activities required/ Indicat ine
ve details Additional ors
details
Develo FIN 1.0 FIN 1.1 FIN1.1.1 • Hall @ Q3 SMo
p Increase Develop FP Hold a 3- hotel in Number annu H&
eviden d advocacy day Imo of ally FPA
ce- allocatio package meeting • Transport advoca WG
based n and highlighting for 20 refunds cy
advoc release annual technical • Lunch materia
acy of FP projected staff and •Refreshme ls /
materia budget costs, developm nts • briefs
ls, score potential cost ent Printing: 20 develo
card savings, partners pages per ped
and impact for person
policy analysis, Advocacy
briefs to scorecard material/
advoc and other Scorecard
ate for benefits of materials
more family developm
allocati planning and ent
ons adapt it FIN 1.2.2 Advocacy Advoca 2021, SMo
and accordingly Conduct meetings cy 2022, H&
release for the various advocacy and follow- conduc 2023, FPA
s of target to relevant ups ted 2024 WG
fund for groups. Ministries Comple
FP on and te and
annual agencies timely
basis. for timely releases
and of
complete budget
releases of ed
budgeted funds
funds
FIN 1.2 FIN 1.2.1 A Printing of Number 2021 SMo
Disseminate 1-day 300 copies of H&
the FP orientation of advoca FPA
advocacy meeting advocacy tes WG
briefs/Scorec for briefs/Score oriente
ards to advocacy card and d on
advocates groups, distribute to the use
and relevant networks advocates of the
stakeholders and for targeted FP
68
champions advocacy advoca

on the use cy
of the briefs
packages and
developed packag
. es
Target FIN2.0: FIN2.1: FIN2.1.1: Stationeries, Number 2021- SMO
LGA to FP Hold regular Developm hall, lunch, of LGAs 2022 H,
budget budget consultations ent of LGA transport, with a MOL
adequ line /advocacy FP Costed advocacy costed G&C
ately included with key Workplan materials, FP Plan A
for FP and stakeholders projector
interve released on LGA Number
ntions in LGA funding at FIN2.1.2 of LGAs
annual the LGA Advocacy with FP
budget levels for to Hon. budget
and increased Commissio line
expendit funding for FP ner for
ure LGA and Number
Chieftainc of LGAs
y matters, with
Chairman increasi
LGA ng FP
service budget
Commissio s and
ner, LGA releases
Chairmen,
and other
key
officers
Increas FIN.3.0 FIN 3.1 Hold FIN 3.1.1 One-day Number 2021- SMO
e Increase Strategic Hold three strategic of 2023 H/FP
donor d donor engagement Governme engageme Donor AWG
and support/ meetings with nt / Donor nt meeting partners
private funding major donor Agencies with Donor the
sector and agencies like Strategic Agency. state
commit secure USAID, DFID, engagem Inputs are has
ment to Private and UNFPA to ent slides, MOU's
FP Sector strengthen meetings printings, with.
interve funding funding for FP transport,
ntions. for FP in in the State. periderm,
the state lunch
through
CSR for
SME's
and
corporat
ions,
69
Individu
al
Philanthr
opist
and
other
innovativ
e
mechani
sms
FIN. 3.2
Engage the FIN 3.2.1 A one-day Number 2021- SMo
Governor Identify meeting of of 2022 H &
and his well- ministry staff individu SMoE
cabinet to set meaning with als and
up a individuals members of corpora
Corporate and FPAWG to te
Social Corporate draft bodies
Responsibility SME 's/ suggested identifie
committee corporatio names and d as FP
for health ns to serve develop the ambass
sector (with as proposal. adors
70
focus on FP ambassad Stationeries

and other ors for FP Hall, Lunch,
emergency and Transport,
health issues) develop / advocacy
comprising of submit the materials,
captains of proposal/ projector,
private sector terms of
within and reference
outside the for the
state. Non-
governme
ntal actors
committee
for Health
sector to
the
executive
Governor.
Stationeries 2021 SMo

Hall, Lunch, H&
Transport, Gov
advocacy ernm
materials, ent
projector Hous
e
FIN 3.2.3 Bi- Stationeries Number 2021 SMo
annual Hall, Lunch, of FP 2022 H
review of Transport, ambass 2023
activities advocacy adors &
of the materials, and 2024
committee projector, SMEs
that
attend
the
review
FIN 4.0 FIN.4.1 FIN 4.1.1 Stationeries Percent 2021- SMo

Increas Increase Present One-day Hall, Lunch, age 2024 H
e d in proposal of meeting to Transport, increas and
annual SOML result-based harmonize advocacy e in FP FPA
allocati funds for FP activities to proposal materials, budget WG
on to FP Technical into state projector, in the
CPR Core Group SOML SOML
pillar of (TCG) and budget P4R
SOML Programme budget
P4 R Management
71
progra Unit (PMU) of

mme SOML in the
State
Develo FIN 5.0 FIN 5.1 FIN 5.1.1 Hall, Lunch, Number 2021 SMo
p Budget Capacity Two-day Transport, trained H
capaci tracked building of workshop advocacy on
ty of and financial and for 25 materials, budget
stakeho reported program persons Stationeries, tracking
lders annually officers on projector, for FP
and Budget progra
provide tracking for mming
technic FP program IN 5.1.2. Hall, Lunch, Number Q1 SMo
al implementati One-day Transport, of annu H
support on budget advocacy people ally and
for tracking materials, that Othe
budget meeting Stationeries, attende rs
trackin projector, d the
g meetin
g
2.4.7 Supervision, Monitoring, and Coordination (SMC)
a. Justification
Effective coordination of FP activities at all levels is very important if the state
is to achieve its FP goal. Better systems are needed to improve coordination
among partners and the SMoH to ensure that activities are implemented as
needed at state level. Current challenges in supervision, monitoring, and
coordination include inadequate dedicated staffing and financial resources
at the state, LGA and Facility levels, as well as inadequate data
management.
b. Strategy
The Core Technical Committee is a forum where discussion on issues
surrounding integrated maternal, new-born and child health are held. Efforts
will be undertaken to make this group more effective and efficient by
ensuring a standardized schedule of meetings.
In recent times, the NHMIS has adopted the use of District Health Information
System (DHIS2) for reporting health related service data. All facility-based
72
information systems feed into the DHIS2. It is a database adaptive to different

levels such as the LGA, state, and national. The DHIS2 empowers health
workers at facilities and all levels to use information to improve health
services. Implementation of the state FP CIP shall be integrated into it.
Mentorship and supervision are key strategies for improving the quality of
implementation. National supervisory tools will be adapted to include key FP
quality standards, such as youth-friendly service provision. Supervisors will
receive training in conducting supportive supervision. Mentoring and
supervisory tools for family planning will be adopted as part of the training
curriculum for use in post-training mentorship sessions.
c. Activities
This section outlines activities geared towards supervision, monitoring and
coordination by increasing coordination between stakeholders in family
planning programmes, monitoring of the implementation of the CIP, ensuring
regular and timely supportive supervision of the FP services as well as ensuring
that the budgeted activities are carried as planned.
Priority Issues:
• Limited coordination of Family Planning partners and implementers in the
State
• Inadequate supervision of providers especially at LGA levels
• Non-existence of effective monitoring mechanism
• Poor Data quality from facilities
Proposed Activities
Objecti d Results Activities required/ Indicat elin
ve details Additional ors e
details
Increas SMC 1.0 SMC 1.1 SMC 1.1.1 •SMoH Hall Number Qua SMoH
e Institutio Institutionalize Hold a 1- • Transport of CTC rterl and
Coordi nalize coordination day CTC refunds membe y Partn
nation improve mechanisms meeting • Lunch, rs in 2021 ers
betwee d with monthly projector attend ,
n coordin development funded by • ance 2022
Stakeh ation partners. SMoH Refreshment ,
73
olders mechani s • Printing 2023

in sms and &
family between Stationary 2024
plannin SMoH SMC 1.2.2 •Hall @ Number Qua SMoH
g and Hold 1-day hotel in Imo of rterl and
Progra develop bi -annual • Transport private y Partn
mme in ment coordinati refunds and 2021 ers
the partners on/ review • Lunch, public- ,
State. meeting projector sector 2022
for • Printing provide ,
Selected and rs who 2023
Private Stationary attende &
Sector d the 2024
facilities review
(including meetin
PPMV's) gs
and
public-
sector
facilities
that
provide FP
services to
improve
coordinati
on
between
public and
private
facilities.
Monitor SMC 2.0 SMC 2.1 Hold SMC 2.1.1 • Hall @ Number Qua SMoH
ing of Quarterl quarterly CIP Hold a 1- hotel in of rterl and
the y CIP execution day Imo quarterl y CIP
implem Monitori meeting by quarterly • Transport y CIP 2021 Core
entatio ng CIP Core meeting to refunds meetin , Team
n of CIP meeting team and review CIP • Lunch, gs held. 2022
with a held, other performan projector Number ,
substitu and a relevant ce with • Refreshm of 2023
tion new FP stakeholders. key actors ents people &
plan to CIP and tease • Printing that 2024
prepar develop our and attende
e ed by activities Stationary d the
another Q4 2023 SMC 2.2 for next meetin
plan Develop 2021 quarter gs
before - 2025 CIP SMC 2.2.1 •Hall @ New Q4 SMoH
the end Hold a 5- hotel CIP 2021 and
of 2023 day outside Launch CIP
residential Owerri ed by Core
74
meeting in • Transport Q4 2021 Team

Q4 of 2021 refunds, per
to develop diem and
and cost Accommod
FP ation
activities • Lunch,
for 2021 - projector
2025 •
Refreshment
s
• Printing
and
Stationary
Ensure SMC.3.0 SMC 3.1 SMC 3.1.1 •Hall @ Number 2021 SMoH
regular Improve Capacity Hold a 5 hotel of &
and d FP building and days outside master 2022
Timely quality deployment training of Owerri trainers
Support of of trained 2 Master • Transport trained
ive service personnel at trainers in refunds, per
Supervi LGA level to each LGA diem and
sion of conduct making 54 Accommod
provide regular persons. ation.
rs of FP Supportive • Lunch,
service Supervisory projector
s. Visits to •Refreshme
providers nts, SOP's
under them and training
manual, 4
consultants
for
assignment
• Printing
and
Stationary
SMC 3.1.2 SSV report Number 2021 LGA
Each template, of SSV , FP
Master transport conduc 2022 Super
trainer to allowance, ted by , visor
supervise refreshment, each 2023 and
at least 5 communica master & LGA
providers tion trainer 2024 Mast
monthly allowance er
within the train
LGA and er
report
same on a
monthly
basis to
75
SMoH
SMC 3.1.3 Stationeries, Number 2021 SMoH
Organize Lunch, of ,
bi-monthly Transport, provide 2022
SSV per diem, rs/ 2023
support by accommod facilities &
the State ation visited 2024
team to
selected
LGA.
Ensure SMC. 4.0 SMC 4.1 SMC 4.1.1 Vehicle/Fuel Number 2020 SMoH
that Account Onsite visit Conduct if vehicle is of - /FP
budget ability and quarterly available quarters 2023 Advo
ed and assessment of activity already, activity Q1, cacy
activitie transpar activities to and Transport and 23,4 Grou
s are ency in ensure it is in financial refunds • financia p
carried the use line with the implement Lunch l /Oth
out as of fund CIP. ation implem ers
planne allocate assessmen entatio partn
d d for FP t to ensure n er
prog. implement assessm
ed ent is
activities conduc
are as in ted
the
approved
plan.
Improv SMC 5.0 SMC 5.1 SMC 5.1.1 Hall, Lunch, Number Qua SMoH
e Quality Conduct Adapt and Transport, of times rterl
quality data quarterly print DQA advocacy DQA is y
of data reporting DQA tools materials, conduc
reportin improve SMC 5.1.2 Stationeries ted in a
g d Conduct stationery, year
DQA in 100 projector,
facilities etc.
quarterly
SMC 5.1.3
Hold
debrief
meeting
where the
report
DQA
findings is
presented
SMC 5.1.4
Hold
76
monthly
LGA data
validation
meeting
and
provide
NHMIS
data tools
in all
facilities
providing
FP services
SMC 5.1.5
Conduct
monthly
data
validation
meetings
to ensure
FP data is
complete
and
properly
reported
77
SECTION 3
COSTING
3.1 Cost Summary
The total cost of implementing the state FP CIP over the course of four years is
estimated at ₦2,046,002,139 billion or $5,301,897 million. The costs of the CIP
were calculated using an Excel-based costing tool with methodologies
borrowed from the costing of other FP plans in some States of the Country.
The cost estimates consider total resource requirements for contraceptive
commodities, contraceptive consumables, and programme activities over
the four-year CIP period. The CIP costs were estimated based on inputs
derived from government rate documents, relevant vendors, partners
implementing
programmes, and national estimates when necessary. In addition to total
costs, the tool categorises costs by programme areas and priority objective
and thematic area per year. The CIP factors in investment costs as well as
sustainability/inflation costs over the four years. This should be considered as
only a broad costing of the Blueprint, not a budgeting tool to be used on an
activity-by-activity basis to allocate funds.
The vast majority of the cost of the plan, Naira 820,729,900 billion or 40% of the
total costs is allocated to commodities and supplies, with procurement of
contraceptives and consumables taking a larger share. This is followed by
28% for service delivery, 22% for demand generation 4% each for SMC and
PEE and 2% for financing activities.
Costs are spread over the duration of the CIP, with commodity costs
increasing over time as more women are reached.
78
Table 2: Summary total budget by thematic areas
Thematic 2021 2022 2023 2024

Total per
Areas Thematic
Area
Demand 126,599,733 106,350,533 111,000,533 111,500,533 126,599,733
Generation
Service 269,869,063 152,505,060 85,869,444 70,714,210 269,869,063
Delivery
Commodities 195,395,250 197,978,550 208,383,550 218,972,550 195,395,250
and supplies
Policy & 18,700,350 18,700,350 18,700,350 18,700,350 18,700,350
Enabling
Environment
Financing 12,346,000 9,740,500 6,500,685 4,876,345 12,346,000
Supervision 20,000,600 16,800,100 24,254,500 21,543,000 20,000,600
Monitoring &
Coordination
Total Per 642,910,996 502,075,093 454,709,062 446,306,988 2,046,002,139
Year
Policy & Financing (Fin) Supervision

Enabling 2% Monitoring &
Environment Coordination
(P&EE) (SMC) Demand Generation
4% 4% (DG)
Demand Service Delivery (SD)

Generation (DG)
22%
Commodities and
Commodities Supplies (C&S)
Service Delivery
and Supplies Policy & Enabling
(SD)
(C&S) Environment (P&EE)
28%
40%
Financing (Fin)
Supervision Monitoring &

Coordination (SMC)
Figure 12: Total budget by thematic areas
79
3.2 Total CIP Cost by Thematic Areas and Priority Objective
Table 3: Total budget by thematic areas and by priority objectives
Thematic Priority 2020 2021 2022 2023 TOTAL

Area Objective
Demand DCB 1. 81,694,47 81,694,47 81,694,473 326,777,89
creation Scale up 81,694,473 2
awareness
of family
planning
services in
the State
by 2023
DCB 2.
Capacity 24,156,060 24,656,060 25,156,060 25,656,060 99,624,240
building of
family
planning
champions
and
community
Volunteers
Service DCB 3. 20,749,200 - 4,150,000 4,150,000 29,049,200
Delivery Ensure
availability
of Family
Planning
Behaviour
Change
Communic
ation and
Service
delivery
tools
126,599,7 106,350,53 111,000,5 111,500,5 455,451,3

Sub total 33 3 33 33 32
SD1. To 96,195,240 96,195,240

increase
the uptake
of Implants
from the
80
current
21,595
users to
145,440
users by
the end of
December
2024
SD 2. To
increase 22,856,060 16,496,500 39,352,560
the uptake
of IUD from
the current
8,098 users
to 76,548
users by
the end of
December
2024
SD 3. To
increase 8,816,010 8,816,010 8,816,010 8,816,010 35,264,040
the uptake
of tubal
ligation
services
from 1350
users to
22,964 by
the end of
December,
2024
SD4.To
increase 79,145,173 57,791,450 23,190,373 20,697,555 180,824,55
the uptake 1
of other
modern
contracept
ive
methods:
injectables
to 38,274
users from
current
20,246
users; Pills
to 32,150
users from
the current
81
28,344
users and
Male
condoms
to 61,238
users from
the current
35,093
users) by
the end of
December
2024
SD 5. To
ensure that 18,500,030 7,618,256 26,118,286
tutors and
preceptors
of Pre-
service
Education
al
Institutions
in Imo
State have
updated
knowledge
and skills
on Modern
Contracep
tive
methods
including
LARC by
2023
SD 6. To
ensure 2,803,500 2,803,500 2,803,500 2,803,500 11,214,000
standardiz
ation of
skills of all
HCW that
have been
trained on
FP services
SD7. Scale
up of FP 5,570,000 5,570,000 5,570,000 5,570,000 22,280,000
Outreach
Services
SD 8. To
ensure 17,622,020 17,622,020
82
availability
of all
relevant
equipment
for training
and
clinical
practice
SD 9. Scale
up 16,020,020 16,020,020 16,020,020 16,020,020 64,080,080
community
-based
distribution
of short-
acting
methods
through
PPMVs and
informal
drug sellers
SD10.
Confirm 16,035,040 21,701,550 17,045,285 12,001,125 66,783,000
usefulness
of AYFHS
Centres
and Scale
up
availability
of AYFHS if
required.
SD 11. To
ensure 4,806,000 4,806,000 4,806,000 4,806,000 19,224,000
proper
coordinati
on of FP
providers
and timely
submission
of reports
Sub total 269,869,0 152,505,06 85,869,44 70,714,21 578,957,7

63 0 4 0 7
Commodi CS 1. To
ties and ensure 12,186,00 12,330,000 12,402,000 12,474,000 49,392,000
Supplies constant
availability
of FP
commoditi
83
es at the
last mile
Commodi CS 1. To
ties and ensure 12,186,000 12,330,000 12,402,000 12,474,000 49,392,000
Supplies constant
availability
of FP
commoditi
es at the
last mile
CS 2. To
ensure that 1,900,000 2,080,000 2,080,000 2,260,000 8,320,000
delivery
and
security of
commoditi
es at the
last mile
CS 3. To
ensure 32,000,000 36,000,000 40,000,000 44,000,000 152,000,00
constant
availability
of
consumabl
es at
facilities
and CMS
CS 4. To
ensure 4,600,000 4,600,000 4,600,000 4,600,000 18,400,000
constant
availability
of CLMIS
tools at the
facilities
CS 5. To
build the 15,377,200 11,487,300 11,787,300 12,087,300 50,739,100
capacity
of FP
providers in
PHFs on
CLMS
CS 6. To
meet the 320,000 340,000 355,000 375,000 1,390,000
commodity
demands
of SDPs
CS7. To
84
provide on 3,610,850 3,620,850 3,630,850 3,639,850 14,502,400

the job
training of
providers
and
enhance
their
performan
ce
CS 8. To
assess 422,000 434,000 442,000 450,000 1,748,000
stock levels
and
expiries of
commoditi
es across
the three
levels of
distribution
CS 9. To
improve 1,650,000 1,650,000 1,650,000 1,650,000 6,600,000
the quality
of LMIS
data fed
into
NHLMIS
platform
CS 10. To
build the 3,892,800 3,892,800
capacity
of LMCU
members
on CLMS
CS 11. To
ensure 119,436,40 125,436,400 131,436,40 137,436,40 513,745,60
uninterrupt 0 0 0 0.
ed supply
of FP
commoditi
es to Imo
State in the
event of
paucity of
donor fund
Sub total 195,395,2 197,978,55 208,383,5 218,972,5 820,729,9

50 0 50 50 00
85
Policy & PE&E 1.

Enabling Domesticat 4,855,050 4,855,050 4,855,050 4,855,050 19,420,200
Environm ion of
ent relevant FP
policy
PE&E 2.
Engage 3,598,000 3,598,000 3,598,000 3,598,000 14,392,000
policy
makers
and top
governme
nt
functionari
es with
targeted
advocacy
PE&E 3.
Improve 10,247,300 10,247,300 10,247,300 10,247,300 40,989,200
global
sharing
and
learning of
best
practice
Sub total 18,700,35 18,700,350 18,700,35 18,700,35 74,801,40

0 0 0 0
Financing FIN 1.
Develop 3,172,930 3,172,930 3,172,930 3,172,930 12,691,720
evidence- .
based
advocacy
materials,
score card
and policy
briefs to
push for
more
allocations
and
releases of
fund for FP
on annual
basis.
FIN 2.
Increase 4,864,320 3,546,740 1,052,288 178,421 9,641,769
private
sector/Non
86
-
Governme
nt Actors
and donor
agencies
funding for
FP
FIN 3.
Develop 975,330 975,330 975,330 975,330 3,901,320
performan
ce-based
activity for
SOML CPR
Pillar to
increase FP
finance
FIN 4.
Capacity 3,333,420 2,045,500 1,300,137 529,665 7,208,722
building on
budget
tracking
and
annual
budget
tracking
Sub total 12,346,00 9,740,500 6,500,685 4,876,345 33,463,53

0 0
Supervisio SMC 1.
n Increase 4,390,430 4,390,430 4,390,430 4,390,430 17,561,720
Monitorin Coordinati
g& on
Coordinat between
ion Stakeholde
rs in family
planning
Programm
e in IMO
State.
-
SMC 2. CIP
execution 2,100,040 2,100,040 2,100,040 2,100,040 8,400,160
and
preparatio
n of next
CIP by
87
2024
SMC 3.
Improve 9,000,000 6,504,040 10,802,160 9,271,500 35,577,700
supportive
supervision
mechanis
m
SMC 4.
Improve 4,510,130 3,805,590 6,961,870 5,781,030 21,058,620
quality of
data
reporting
Sub total 20,000,60 16,800,100 24,254,50 21,543,00 82,598,20

0 0 0 0
TOTAL 642,910,9 502,075,09 454,709,0 446,306,9 2,046,002,

96 3 62 88 139.00
88
SECTION 4
PROJECTED FP METHODS MIX AND IMPACT
4.1 Projected FP Methods Mix
The Imo State FP CIP’s activities are designed to enable 273,083 new users of
to access modern contraceptives between 2021 and 2024. This equates to
an increase in the CPR from 10.9 percent to 27.4 percent and significantly
contributes to reducing maternal and child death by 2024. If the projected
CPR is achieved, the state unmet FP need will drop from the current 21.0% to
8.5 % by 2024. The principle of the state FP CIP is to provide a broad choice of
FP methods to users to meet their preferences and needs.
For purposes of costing and planning, a method mix projection was

developed. Thus, these figures are meant to be directional, not stand-alone
targets. The current method mix was derived from the 2018 NDHS.
The 2021-2024 method mix was estimated based on three core assumptions:
• Use of LARCs (i.e., IUDs and implants) will grow faster than in previous years
due to increases in trained healthcare providers and improved facilities
based on the National LARC Strategy and the implementation of the task
sharing policy that allows CHEWs to provide LARC services.
• Use of injectables will also grow faster than in previous years due to a policy
change allowing CHEWs to administer injections, as well as experience from
other countries indicating that injectables are typically a preferred method
as CPR increases.
• Traditional methods will continue to grow at the same rate, but their share
of the total CPR will decrease due to higher rates of growth for modern
methods.
89
Figure 13: Current and Projected Method Mix for Imo State
The growth of each method is calculated as a linear progression, and the

trajectory for each method can be seen below.
Table 4: Projected Total Users by methods and Years
METHODS 2021 2022 2023 2024

Condom users 47,359 51,749 56,372 61,238
Injectable users 26,465 30,187 34,120 38,274
Pill users 25,072 27,312 29,670 32,150
Female sterilization 6,965 12,937 17,802 22,964
users
IUD users 23,679 40,249 57,856 76,548
Implant users 48,752 79,061 111,261 145,440
Other modern users 4,345 7,345 10,345 13,345
All traditional users 196,400 159,560 105,327 52,052
Total users 379,037 408,402 422,752 442,011
90
4.2 Impact Assessment
Achievement of the Imo State FP Plan will cumulatively avert about 110,000
unwanted pregnancies; avert 520 maternal and 4,265 child deaths. Over the
period, unmet need will drop from the current 21.0% to 8.5%.
In addition to the above, the state will save as much as $1,885,470 on
maternal and infant healthcare cost.
Table 5: Projected impact of achieving 27% CPR by 2024
Indictors 2021 2022 2023 2024 Total

Unintended 10,643 24,252 10,643 15,987 61,525
pregnancies averted
Births averted 5,233 11,925 21,511 39,876 78,545
Abortions Averted 3,831 8,731 15,749 22,234 50,545
Unsafe Abortions 3,826 8,719 15,728 24,987 53,260

Averted
Maternal deaths 39 87 151 243 520
averted
Child deaths averted 293 668 1,206 2,098 4,265
DALYs averted 27,209 61,818 111,181 189,765 389,973
Maternal & infant 241,649 550,650 993,280 1,875,437

healthcare costs 3,661,016
averted (USD)
Unmet Need 8.5%
91
SECTION 5
Resource Mobilization and Performance Management
5.1 Resource Mobilization
This document can serve as an excellent tool to mobilise adequate funding

for FP in Imo State to reach the state CPR goal. Considering that Imo State
has the third lowest CPR and also the third highest unmet need among the
South-East States of Nigeria, the costs to cover the specific contraceptive
needs for women of reproductive age would require significant investment.
Currently, the FMOH holds the responsibility for covering the costs and
providing adequate contraceptive commodities to meet the family planning
needs of women in Imo State. However, this does not guarantee sufficient
and constant supplies of commodities over the tour-year time period of the
CIP as fund for procurement and distribution may be negatively impacted
and also logistics will require strengthening. To ensure full support of the Imo
State CIP by the state government, this document should be used as an
advocacy and accountability mechanism for effective delivery of FP
intervention in the state.
A severe funding gap currently exists between allocated state funding for FP
and the projected costs. Over the past six years, released funds for FP have
consistently been zero. To address this gap, the state should fully allocate,
and release already committed FP funds to support the programme activity
costs outlined over the six years. In addition, the state may consider using the
outlined activities and associated spending requirements to advocate for
additional federal, local and donor support to fill the funding gap.
92
5.2 Ensuring Progress through Performance Management
In order to reach the 27% CPR goal of the CIP, Imo State must make a
concerted effort to fully implement the CIP in a timely fashion. In doing so, the
state and partners must remain cognisant of progress along the way through
stringently tracking the status of implementation, measuring outputs and
estimating impacts where possible.
The Family Planning CIP in Imo State is meant to serve as a living document
that can evolve over the four-year period based on measurements of
progress and feedback from implementers. High-quality, timely, and
comprehensive data collection is necessary to inform the evolution of the
plan to improve performance and institutionalisation and scale-up of best
practices. Therefore, uptake of the performance management plan (Annex
A) is encouraged for all stakeholders as a guiding tool towards progress.
To support successful implementation and achievements of CIP goals and
objectives, the following four inter-linked M&E components will be
implemented systematically:
• Routine collection of service and logistics data through the NHMIS & NHLMIS
systems respectively
• Performance review and quality improvement
• Integrated supportive supervision
• Evaluation and operations research
Imo State CIP indicators are purposely aligned with the national Performance
Management Plan to encourage harmonisation where possible with the
National Blueprint and allow the state to efficiently report feedback on
implementation progress to FMoH.
ANNEX A: MONITORING AND EVALUATION SUMMARY TABLE

No Indicator Indicators Indicator Data Level of Frequenc
No Type Source Reporting y
93
FP Modern Impact Outcome DHIS- State Annually

1 contracepti 2/NDHS/M
ve ICS/SMAR
prevalence T/NARHS
(all women)
[CPR]
Demand Generation and Behaviour Change Communication
2 D1 Percentage of women Outcome NDHS/MI state Annually
of reproductive age CS/SMART
who have heard /NARHS
about at least three
methods of family
planning
3 D2 Percentage of the Outcome DHIS- state Annually
population who know 2/NDHS/M
of at least one source ICS/SMAR
of modern T/NARHS
contraceptive services
and/or supplies
4 D3 Percentage of Outcome NDHS/NA state Annually
audience who RHS
believes that spouse,
friends, relatives, and
community approve
(or disapprove) of the
practice
5 D4 Number of targeted Output Program state Quarterly
State and local me report
multimedia FP
advocacy and
demand generation
campaigns
6 D5 Number of state, and Output Program state Quarterly
community-level FP me report
champions/advocates
, identified by type of
level (i.e., state, and
community)
7 D6 Number of key state Output Program state Annually
leaders who have me report
spoken in favour of
family planning
8 D7 Number of peer Output Program State Quarterly
educators / me report
community volunteers
trained in State
94
Service Delivery
9 SD1 Couple years of Outcome NHMIS State Quarterly

protection (CYP)
10 SD2 Percentage/total Output NHMIS State Quarterly

number of modern
method users (all
women)
11 SD3 Percentage of women Outcome NARHS/N State Annually
whose demand for DHS
contraception is
satisfied
12 SD4 Percentage of women Outcome NDHS/MI State Annually
with an unmet need CS/SMART
for contraception /NARHS
13 SD5 Number of unintended Outcome NHMIS State Annually
pregnancies averted
due to contraceptive
use
14 SD6 Number of unsafe Outcome NHMIS State Annually
abortions averted due
to contraceptive use
15 SD7 Number of maternal Outcome NHMIS State Annually
deaths averted due to
contraceptive use
16 SD8 Percentage of women Outcome Facility State Annually
who were provided assessme
with information on nt
family planning during
last visit with health
service provider
17 SD9 Number of FP trainers Output Facility State Quarterly
trained in updated assessme
pre-service training nt
curriculum.
18 SD10 Number of trainers Output Facility State Quarterly
trained in in-service FP assessme
practices nt
19 SD11 Number of training Output Facility State Quarterly
sessions conducted by assessme
trainers, nt
disaggregated by
LGAs
20 SD12 Proportion of recruited Outcome Facility State Quarterly
CHEWs trained for assessme
95
comprehensive FP nt
(emphasis on
injectables and LARCs)
training,
disaggregated by
level (LGAs)
21 SD13 Proportion/number of Outcome Facility State Quarterly
nurses and midwives assessme
trained in nt
comprehensive family
planning (emphasis on
LARC methods)
22 SD14 Number of Output Facility State Quarterly
pharmacies where at assessme
least one person has nt
been trained in FP
methods and
counselling, by level
(state and community)
23 SD15 Number of training Output Facility State Quarterly
sessions conducted for assessme
PPMVs and informal nt
drug sellers, by levels
24 SD16 Quantity of FP training Output Facility State Annually

equipment, materials, assessme
and anatomical nt
models procured and
disbursed to trainers
25 SD17 Number of new Outcome Facility State Quarterly
access points for FP assessme
service provision nt
(hospital, clinic
outreach, mobile FP
clinics, and
community venues
where FP outreaches
are conducted), by
State
26 SD18 Number of facilities at Output Facility State Quarterly
which FP equipment assessme
assessments were nt
conducted, by State
27 SD19 Number of facilities in Output Facility State Quarterly
which family planning assessme
is integrated with other nt
healthcare services
96
(i.e., sites where family

planning is integrated
with routine
immunization, HIV
counselling and
testing, prevention of
mother-to-child
transmission (PMTCT),
and STI services)
28 SD20 Number of public- Output Program State Annually
private partnerships for me report
increasing FP service
delivery, supply chain,
demand generation,
etc., by State per year
29 SD21 Proportion of identified Output Program State Annually
PHCs renovated for me report
service delivery, by
State
Supplies and Commodities
30 SC1 Percentage difference Outcome NHLMIS/FP Federal/S Annually

between forecasted Dashboar tate
consumption and d/Progra
actual consumption mme
report
31 SC2 Stock out rate of family Outcome NHLMIS State Quarterly
planning commodities
including consumables
at the health facilities
32 SC3 Percentage of Output NHLMIS State Bimonthly
flagged LMIS reports
on NHLMIS platform
33 SC4 Existence of a Output State State Annually
government budget Budget/
line item for the Program
procurement of me report
contraceptives
34 SC5 Contraceptive or Output Program State Annually
other RH commodity me report
forecasts updated at
least annually
35 SC6 Costing of forecasted Output Program State Annually
(quantified) me report
contraceptive or other
RH commodity needs
conducted and
incorporated into
97
budget planning by
SMOH and/or donors
36 SC7 Number of persons Output Program State Quarterly
trained to manage me report
and produce
commodity forecast
reports, by region or
State
37 SC8 Number of Output Program State Quarterly
commodities forecast me report
reports, by region or
State
38 SC9 Number of Output Program National/ Quarterly
procurement and me report State/Re
forecast meetings gion
conducted at
national, regional, and
state levels
39 SC10 Number of commodity Output Program State Quarterly
logistics trainings me report
conducted at
national, state, and
LGA levels
40 SC11 Number of storage Output Program State Quarterly

facilities in which me report
commodity quantity
and quality reviews
are conducted, by
region or State
Policy and Environment
41 PE1 Number of commodity Output Program State Annually
logistics trainings me report
conducted at
national, state, and
LGA levels
42 PE2 Number of storage Output Program State Annually
facilities in which me report
commodity quantity
and quality reviews
are conducted, by
region or State
Financing
43 FN1 Annual expenditure on Output Program State Annually
family planning from me report
IMO State and Local
Government domestic
98
budget
44 FN2 Annual Private Sector Output Program State Annually

funding for family me report
planning
45 FN3 Number of LGAs with Output Program State Annually

an FP budget line item me report
Supervision, Monitoring, and Coordination
46 SMC1 Capacity for Output Program State Annually

supervision, me report
coordination
management, or M&E
of family planning
47 SMC2 Number of existing Output Program State Annually
staff trained in either me report
supervision,
coordination
management, or M&E
of FP programme at
the national and state
levels
48 SMC3 Number of state- and Output Program State Annually
LGA-lev el assessments me
of staff capacity to report/OC
conduct supervision, AT report
coordination
management, or M&E
of FP programme at
the national and state
levels
49 SMC4 Number of new staff Output Program State Annually
hired to supervise, me report
coordinate, and
conduct M&E of FP
programme at the
national and state
levels
50 SMC5 Number of supervisory Output Program State Annually

visits conducted me report
51 SMC6 updating of the state Output Program State Quarterly
FP dashboard me report
52 SMC7 Annual report to CTC, Output Program State Annually
listing results for each me report
M&E indicator
99
References
1 Lule, E., R. Hasan, and K. Yamashita-Allen. 2007. “Global Trends in Fertility,
Contraceptive Use and Unintended Pregnancies.” Pp. 8–39 in Fertility
Regulation Behaviors and Their Costs: Contraception and Unintended
Pregnancies in Africa and Eastern Europe & Central Asia, edited by E. Lule, S.
Singh, and S.A. Chowdhury. “Health, Nutrition& Population Discussion Paper.
Washington, DC: World Bank. Retrieved from
www.go.worldbank.org/BZSBNC53A0
2 Singh, S., J.E. Darroch, M. Vlassof, and J. Nadeau. 2003. Adding It Up: The
Benefits of Investing in Sexual and Reproductive Health Care. New York: Alan
Guttmacher Institute. Retrieved from
www.guttmacher.org/pubs/addingitup.pdf.
3 Singh, S., and J.E. Darroch. 2012. Adding It Up: Costs and Benefits of
Contraceptive Services: Estimates for 2012. New York: Guttmacher Institute
4 Family Planning Summit 2012. “Technical Note: data sources and

methodology for calculating 2012 baseline, 2021 objectives, impacts and
costings.” Family Planning Summit Metrics Group, 2012.
5 World Population Review, 2020
6 Health Policy Plus 2017: 4th National RAPID
7 Miller R, Fisher A, Miller K, et. al. The Situation Analysis Approach to Assessing
Family Planning and Reproductive Health Services: A Handbook. 1997. The
Population Council, New York
8 2013 NDHS, 2018 NDHS. National Population Commission (NPC), Federal

Republic of Nigeria
and ICF International. 2014. Nigeria Demographic and Health Survey (NDHS)
2018.
9 Imo State Health Management Information System (HMIS), 2013-2020.
10 District Health Information System v2 (DHIS-2)
11 National Family Planning Dashboard. www.fpdashboard.com
12 Imo State Family Planning Program Reports, 2017-2020.
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[IMO STATE FAMILY PLANNING COSTED IMPLEMENTATION PLAN] 2021-2024

IMO STATE MINISTRY OF

List of figures, Charts, Boxes and Tables ..................................................................................... 4

List of Contributors ....................................................................................................................... 8

List of Abbreviations and Acronyms ......................................................................................... 10

SITUATION ANALYSIS ................................................................................................................................. 12

Desk Review: .............................................................................................................................................. 12

1.1 Introduction: The Global Context..................................................................................................... 12

1.1.1 London Summit on Family Planning .............................................................................................. 12

1.2 The Nigeria Context .......................................................................................................................... 14

1.3 Imo State Context............................................................................................................................. 17

1.4 Imo State Family Planning Situation................................................................................................. 18

Health Facility Survey ................................................................................................................................. 33

1.5 Summary of The Findings ................................................................................................................. 33

INTEGRATED FAMILY PLANNING PLAN ...................................................................................................... 37

2.1. Goal ................................................................................................................................................. 37

2.2. Objectives ........................................................................................................................................ 37

2.3. Strategic Priorities ........................................................................................................................... 37

2.4 Structures of the Costed Implementation Plan ............................................................................... 38

2.4.1 Demand Generation and Behaviour Change Communication ...................................................... 39

2.4.2 Service Delivery ............................................................................................................................ 46

2.4.3 Commodities and Supplies ............................................................................................................ 56

2.4.4 Policy and Enabling Environment ................................................................................................. 61

2.4.5. Financing ...................................................................................................................................... 67

2.4.7 Supervision, Monitoring, and Coordination (SMC) ....................................................................... 72

3.1 Cost Summary .................................................................................................................................. 78

PROJECTED FP METHODS MIX AND IMPACT ............................................................................................. 89

4.1 Projected FP Methods Mix ............................................................................................................... 89

4.2 Impact Assessment .......................................................................................................................... 91

Resource Mobilization and Performance Management ............................................................................ 92

5.1 Resource Mobilization...................................................................................................................... 92

5.2 Ensuring Progress through Performance Management .................................................................. 93

ANNEX A: MONITORING AND EVALUATION SUMMARY TABLE ............................................................. 93

List of figures, Charts, Boxes and Tables

Table 1: FP budgetary allocation in Imo SMoH from 2014-2018............................................. 34

Table 2: Summary total budget by thematic areas .............................................................79

Dr Mrs Damaris Osunkwo

1. Dr Damaris Osunkwo Hon. Comm. For Health, SMoH, Owerri

2. Dr Austin Okeji Dir. Public Health, SMoH

3. Dr George Udeji RH Coordinator, SMoH

4. Mrs H. Nnenna Oriaku FP Coordinator, SMoH

5. Dr Emereuwaonu Njoku Consultant, MSION

6. Mr Emmanuel Emesowum FP Logistics, M&E Officer, SMoH

7. Mr Onyekachi Onumara Prog. Mgr. Rural Health Foundation (Tech.

8. Prof. S. J. Ozims Dept. Of Public Health, IMSUTH, Orlu

9. Dr Eugene Onwuchuruba Cottage Hosp. Umuowa, Ngor-Okpala

10. Mrs Chinyere Ekwugha Rural Health Foundation

11. Mr Chidi Madu Health Reporter, IBC, Owerri

12. Mr Gavas Eke PPMV, Imo State

13. Mrs Chukwueke Victoria DNS SMoH, Owerri

14. Mrs Nwachukwu Catherine FP Unit, FMC Owerri

16. HRH. Eze Geoffrey Okoro Chairman, Traditional Rulers, Ngor-okpala

17. Mrs. Harbor Florence Marie Stopes Nigeria

18. Mr Geoffery Anyaegbu HSDF

19. Chioma Nnajiofor CFHI

20. Mrs Comfort Mere CHM FPAWG, Owerri

21. Pharm Uche Maduike LMCU SMoH

22. Mrs Onwukwe Vivian FP Supervisor, Okigwe Zone

23. Mrs Chukwunyere Innocentia Former Imo State FP Coordinator