Parallel 7 - Oral Session 4 (053 – 056)

Background/Objectives
During COVID-19, resources for health funds were diverted to mitigate the impact of the pandemic, which led to a deprioritisation of other health service delivery areas, including reproductive health services. For example, The Lagos family planning (FP) funds expended in 2020 represented 6.3% of the total FP budget allocation to the Ministry of Health (MoH) and Primary Health Care Board (PHCB), which led to reduced FP service delivery outputs.
E4A provides technical support to build and strengthen capacity of the Lagos State Accountability Mechanism (LASAM)- a multistakeholder platform that brings together government, civil society organisations, the media and implementing partners - to analyse and simplify data that policy-makers can use in their planning and decision-making processes to improve RMNCAH and FP service outcomes.
Methods
E4A built LASAM's capacity to analyse health budget performance as well as service delivery data on RMNCAH and FP. This enabled LASAM to present the evidence in easily accessible scorecards to identified key stakeholders in targeted advocacy efforts (in-person and use of social media). LASAM also used the this evidence to engage in the State's 2021 budget planning processes. 
Results
The 2021 scorecard shows a significant increase in FP expenditure from 6.3% in 2020 to 70.1% in 2021. The facilities providing FP services that experienced FP commodity stock outs reduced from 1.0% in 2020 to 0.7% in 2021 while the public health facilities providing FP services increased from 85.8% in 2020 to 89.5% in 2021. In addition, facilities providing FP services through health workers that are trained in using the Commodity Logistics Management System increased from 10.36% in 2020 to 67.7% in 2021.
Conclusions
Building partnerships to amplify voices on evidence-based advocacy creates a platform for holding policy stakeholders accountable for delivering on their FP promises and for taking actions that improve health outcomes for targeted beneficiaries.

Background: In February 2020, Nigeria reported its index COVID-19 case which began the cycle of transmission within Nigeria. In response, the presidential task force provided guideline for the prevention and management of the pandemic used across sectors, enforced compliance, and declared a lock-down on March 30, 2020 to curb the spread of the virus. COVID-19 disrupted the health system, strained the health workforce, disrupted the supply chain, service delivery. Marie Stopes ensured last mile distribution of commodities, and provided clinical support and built resilience in the front-line health workers. As a result, 2,343 public health facilities, 168 community-based delivery Network of Marie Stopes Ladies; 221 social franchise; 3 MSION centres of excellence and 23 mobile outreach teams remained operational to meet the rising need for sexual and reproductive health services. Data reporting rate was comparable (87% before COVID 19 and 88% during the lock-down).
Method: A pre and post lockdown assessment of service delivery in Marie Stopes supported health facilities was carried out using the service statistics reported by reported for three months before the lockdown (December 2019 to Feb 2020) and three months during the lock-down (March 2020 to May 2020) was retrieved from MSI database for routine data. The data was analyzed and the proportions were compared. The impact of the services delivered was analyzed using MSI Impact2 model
Results: 772, 628 clients accessed family planning services during the lock-down compared to 634,000 three months prior. The mix of FP methods utilized included permanent, long-acting reversible and short-term methods. This is estimated to have averted 793,601 unintended pregnancies, 3,968 maternal death, 19,781, child deaths, 279, 538 unsafe abortions.
Conclusion: Sustaining the delivery of family planning service in uncertain times requires cohesive system strengthening for emergency preparedness, effective partnership, and resilience building.

Background: Globally, the emergence of the Covid -19 pandemic comes with great cost to all sectors of human endeavors. Among its impacts in Nigeria is inadequate attention to some basic health needs, including family planning, as a result of the huge diversion of health resources, including manpower to cater for Covid-19 responses. Lock down associated with the pandemic responses gave rise to increased cases of unintended pregnancies and a rise in reported cases in many facilities in Adamawa State of Nigeria. The desire and request for abortion services among married women equally rose. This study seeks to evaluate the effectiveness of the integration of SRH services with Covid-19 responses as a means of sustaining increased access to Family Planning uptake.
Method: The MSION team collaborated with Adamawa State Primary Health Care Development Agency (ASPHCDA) across Wards and facilities in 14 LGAs. Orientation of staff and other community volunteers on the strategy of SRH integration with Covid-19 responses was done. Formation of the team at Ward levels for reaching community stakeholders also took place. A minimum of 100 community stakeholders including men and women were targeted for special awareness on SRH & Covid -19. Demand creation and direct FP service provision was deployed on daily basis.
Result: Over 100 Family planning services were rendered daily per ward, with an average of 600 women reached per week for FP service uptake. The MSION team increased performance over the team's internally set targets for the state.
Outreach Team Service Target: 9,300.8 services; Team Achieved: 11,385 services (122%)Couple Years of Protection (CYPs) Target: 36,528; Team Achieved: 38,323CYPs. (105%) (Period of May -December, 2020).
Conclusion: Integration of relevant programs is a sustainable approach to sustaining and increasing uptake of family planning services, even in crisis periods like Covid-19
Keywords: Integration; Covid-19, CYPs 

Background/objectives
We examined the effect of the COVID-19 pandemic on Family Planning(FP) service provision and clients' FP service access in selected Primary Health Care (PHC) facilities in India, Nigeria and Tanzania. Findings from Nigeria are presented.
Materials and methods
A mixed methods study was conducted in six rural/peri-urban and urban Local Government Areas (LGAs) in Kano, Kwara and Oyo states. One PHC per LGA was purposively selected in each state. Qualitative data were obtained through in-depth interviews(IDIs) and focus group discussions(FGDs) with female clients and their partners, FGDs with community women and IDIs with two healthcare providers per PHC. Quantitative methods involved assessment of infrastructure and review of FP records (August 2019 to April 2022) in the PHCs. Quantitative data were analysed using descriptive statistics. Thematic analysis was used for qualitative data.
Results 
Eighty-two IDIs and 20 FGDS were conducted. Disruptions to essential FP service provision experienced included limited FP services, changes in service delivery schedules and stockout. Disruptions were mainly attributed to COVID-19-control movement restrictions, deployment of staff to provide COVID-19 relief, insufficient commodities, and reduced clientele. Disruptions were mitigated by conducting limited outreaches to sensitize community members about modifications in service delivery, task shifting and role relegation and client referral to other facilities. Clients expressed frustrations about difficulties encountered with accessing FP during the pandemic. These were due to movement restrictions, closure of facilities, prolonged wait-times, changes in procedures for accessing care and commodity stockout, especially injectables. Record review revealed a drop in clientele which was more marked in the rural PHCs compared to the urban PHCs. 
Conclusions
Family planning services were significantly affected by the COVID-19 pandemic. Measures to ensure FP services continue during epidemics should be implemented to prevent major reversals in gains in contraceptive prevalence rates made over the years.