Reducing maternal mortality rates remains a critical priority for Nigeria, which has one of the highest rates globally. To address this challenge, efforts to improve access to essential health care resources and ensure the availability of vital medical products have mostly focused on strengthening public sector facilities.
But this focus has left out a substantial portion of Nigerian health facilities and users: Sixty percent of the health facilities in Lagos, Nigeria’s largest city, are private. The public-private divide makes it a challenge to ensure all health facilities in Nigeria provide the best possible care, with private sector facilities at a disadvantage in utilizing data for decision making, allocating resources, and formulating policy.
Seeing this gap, The Challenge Initiative (TCI), funded by the Gates Foundation and implemented in Nigeria by the Johns Hopkins Center for Communication Programs, has innovatively increased family planning demand and services by working directly with private sector facilities, which hadn’t been done before. TCI’s “Business Unusual” approach to technical and financial assistance gives local organizations and governments ownership in projects by having them also invest in providing services.
CCP’s TCI team found that one key to increasing demand in Lagos was training community volunteers to provide modern family planning health talks during prenatal visits and immunization drives in private clinics. Even more importantly, volunteers provide one-on-one counseling sessions with potential clients, allowing them to openly discuss an uncomfortable topic and receive referrals to take up a family planning method right away, if they chose. This one-stop shop approach increases the likelihood of uptake.
“I see the work we do in the private sector as extremely important because of the large untapped market that exists there,” says CCP’s Chidinma Eke, the TCI Technical Support Lead for Private-Sector Engagement in Lagos. “Even if the public sector health facilities were meeting all their clients’ needs, a substantial number of Nigerians wouldn’t be reached at all if we didn’t engage the private sector.”
Between May and October 2024, more than 11,000 women accessed various family planning methods in 67 private health facilities in Lagos state. Sixty percent of those referred for services received family planning services.
“This in-clinic social mobilization effectively increased uptake by enabling potential clients to make immediate decisions on family planning methods,” says CCP’s Omotunde Odanye, the State Program Manager for TCI in Lagos. “And this work has the potential to be broadly implemented across public sector health facilities and bridge service delivery gaps in Lagos and beyond.”
Meanwhile, public health facilities have requirements and systems to report their data to the government, but challenges remain with private clinic data reporting. Data collection methods for the private health facilities are inconsistent, and fewer reporting requirements have been put in place. This complicates efforts to paint an accurate picture of Nigeria’s national family planning landscape.
Ideal data collection and reporting would mean that health care providers in the private sector would gather similar data as the public sector, such as patient demographics, diagnoses, treatments, and other relevant information. That data would be submitted to the National District Health Information System (DHIS2) through online platforms, mobile applications, or even physical reports. DHIS2 could then analyze and aggregate the data, generating reports and dashboards for decision-making, policy, resource support, and programs.
TCI has supported improving data collection and reporting for private facilities, where reporting rates increased from 8 percent in September 2022 to 97.5 percent in October 2024 after coaching and supportive supervision were conducted. “In Kwara state, there are 333 private health facilities, but just one-fifth of these facilities were reporting data to DHIS2 when TCI began its work there,” says CCP’s Foluso Oyewale, the Technical Support Lead for Research, Monitoring and Evaluation in Kwara State. “With help from TCI, government and other partners were able to increase the use of data reporting systems.”
A key aspect of TCI’s model is ensuring sustainability by fostering local ownership. As TCI phases out active implementation in some states, government involvement in monitoring and supporting private health facilities through providing routine feedback and coaching shows a promising path toward long-term continuity. This level of reporting from the private sector has enhanced transparency and accountability within the health care system.
“There’s still a lot to be done,” Odanye says, “but we have made a significant difference since we started.”
Engaging with the private sector is pivotal for expanding family planning access in Nigeria, she says. “These sustainable initiatives can be replicated nationwide,” she says.
