Facilitators and Barriers to Systematically Scaling-up Family Planning Task-Shifting and Task-Sharing of Contraceptive Implants in Cross River State, Nigeria

In Nigeria, a shortage in human resources for health—fewer than two nurses and doctors per 1,000 people, with a notable lack of skilled birth attendants—contributes to poor health and development outcomes.

In 2014, recognizing the potential to mitigate the impact of this shortage and improve accessibility and cost effectiveness within the health system, Nigeria adopted its new Task Shifting and Task Sharing Policy for Emergency Obstetric and Newborn Care Services In Nigeria (TSTS). This policy would make contraceptive services previously delivered by physicians, nurses, and midwives—namely the provision of implant and injectable contraceptives in addition to short-acting, nonclinical family planning methods—available through community health extension workers (CHEWs), who reside and work in their communities and provide basic components of primary health care.

With technical support from E2A and Pathfinder International Nigeria, Cross River State (CRS) operationalized the National Family Planning (FP) TSTS Policy through the Saving Mothers, Giving Life (SMGL) Initiative. SMGL, which aims to accelerate reduction of maternal and neonatal morbidity and mortality, was implemented from 2015 to 2019 in partnership with the government of CRS. Through SMGL, the Evidence to Action (E2A) Project and Pathfinder International provided technical support, conducted operations research, and supported the development of a strategic scale-up plan to adopt the national FP TSTS policy within CRS. This brief addresses the barriers and facilitators E2A identified to scaling up the state’s TSTS policy to allow CHEWs to provide implants.