Use of Routine Health Information to Inform Budgetary Allocations for Reproductive Health in Cross River State, Nigeria
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Author(s): Hassan A
The relevance of reproductive health (RH) and family planning (FP) for the global and national development agenda as well as socioeconomic development of communities, families, and individuals is a major issue in the sustainable development era. Negative reproductive health outcomes are common in Nigeria. The 2013 Demographic and Health Survey (DHS) showed that the total fertility rate (TFR) of 5.3 was higher than the wanted fertility rate (4.7) in Cross River State. This implies that the average number of children a woman wants is less than the number she currently has. The unmet need for family planning (30.8%) is almost twice the national average. Despite the situation, the use of modern contraceptives in the state has declined from 16.3 percent in 2008 to 14.4 percent in 2013 (NPC & ICF Macro, 2009; NPC & ICF International, 2014). The uptake of FP services has been hampered by many challenges, including contraceptive commodity stockouts and unavailability of consumables.
Government demonstrates its commitment to health by speaking out, making public declarations in favor of health, linking health to development, creating budget lines, and ensuring prompt release of budgeted funds for the purpose for which it was budgeted; and by effective and equitable delivery of quality service (Bujari & McGinn, 2013). To ensure that decisions on budgetary allocations are evidence-based, it is essential to understand the budget process. Donald and Ahmed (2013) examined the budget process in Cross River State. Despite the highly sophisticated budget process in the state, FP was not considered a critical issue by government officials and policymakers. Hence, there is no budget line for FP commodities and distribution in the state except for the support received from the United Nations Population Fund (UNFPA) (Donald & Ahmed, 2013). Also, the budget for reproductive health is placed under the budget for maternal and child health. However, not much is known about the inner workings of the budget process within the State Ministry of Health (SMOH) and the local government councils, such as the process of allocating proportions of the budget to specific items under maternal and child health, and the use of routine health information to inform such budgetary allocations. In addition, there is little documentation of the process to guide advocacy efforts.
The survey used a cross-sectional design. Both qualitative (key informant interviews [KIIs]) and quantitative (structured questionnaires) research methods were employed for the survey. The research team conducted a desk review of existing FP data in the state and Calabar Municipal LGA (Local Government Area).
The HMIS remains extremely relevant when considering budgetary allocations for RH and FP in planning, policymaking, program design, and implementation. This study revealed that budgetary allocations for program M&E are perceived as the major difference between the private and public sectors, where the private sector is seen as been more engaged in oversight functions. Training on data management is imperative in order to ensure availability of quality data for decision making by policymakers. Even though the participants have a fairly good understanding of data management, they believe they need further training as this will strengthen their capacity to understand and use data. In turn, this is an important way to enhance service delivery in the health sector because virtually nothing can be done well without data acting as the raw material for planning and appropriation.
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