Background: Contraceptive funding in Nigeria is heavily donor dependent (87%) with government contributing about 13% over the last ten years. Annual contraceptive funding requirement increased from ~$15M (2013) to ~$28.5M (2021) resulting in a 500% funding gap increase ($2m to $12.1m). Without diversified funding options like domestic resource mobilization, the funding gap is likely to increase as donors transition towards country self-sufficiency.
Methodology: Clinton Health Access Initiative (CHAI) supported the Federal Ministry of Health (FMOH) identify fiscal bottlenecks and determine requisite interventions towards long-term domestic financial sustainability for contraceptive procurement. The fiscal space analysis (FSA) was conducted in 2021 at the federal level and two states of Kaduna and Lagos using quantitative and qualitative approaches as well as predictive financial modelling to understand the FP commodities financing landscape in Nigeria.
Results: Inadequate federal government health allocation of ̃4% over the last five years which is below the recommended 15% of annual budget, unfavorable macro-fiscal environment, low revenue mobilization and high levels of debt servicing. FSA recommendations towards domestic resource mobilization include: Mainstreaming demographic dividend and human capital development as essential components of the economic and sustainable development agenda; Advocating for reprioritization of FP funding at national and state levels through adoption of 1% of current health budgets as the benchmark for government FP investment; Strategic engagement of the private sector; Strategic catalytic investment on FP by donors; and Generating increased political support for FP.
Conclusion: Earmarked funds available for health do not currently prioritize FP commodities financing and will require a multi-sectoral reprioritization. Although efficiency savings may not offer significant levels of additional fiscal space, ensuring an efficient system is very crucial to safeguarding the limited resources and enhancing the results produced. It also ensures that when additional funding is accrued, the full impact will be realized.
