PT  - JOURNAL ARTICLE
AU  - Victor Igharo
AU  - Uduak Ananaba
AU  - Olukunle Omotoso
AU  - TrishAnn Davis
AU  - Mwikali Kioko
AU  - Clea Finkle
TI  - Innovations in Public Financing for Family Planning at Subnational Levels: Sustainable Cofinancing Strategies for Family Planning With Nigerian States
AID  - 10.9745/GHSP-D-22-00242
DP  - 2022 Dec 27
TA  - Global Health: Science and Practice
4099  - http://www.ghspjournal.org/content/early/2023/03/14/GHSP-D-22-00242.short
4100  - http://www.ghspjournal.org/content/early/2023/03/14/GHSP-D-22-00242.full
AB  - Key FindingsFrom 2018 to 2022, The Challenge Initiative (TCI) employed a cofinancing strategy in Nigeria to support states in their family planning and reproductive health (FP/RH) budget allocations and expenditures.Thirteen states accessed and used a total of 2.03 billion Nigerian naira (US$5.6 million) from the TCI Challenge Fund, a mechanism to incentivize domestic funding for FP programming.State governments demonstrated substantial improvements in their fiscal commitment and releases with a 4-year average of 78.7% release of committed resources toward FP programs.Key ImplicationsThe TCI Nigeria cofinancing model is a viable tool for building relations among key actors and improving accountability in RH financing.At the health systems level, this model can guide governments to allocate FP budgets within strategic planning frameworks for more sustainable funding.As a mechanism for mobilizing domestic resources, strengthening accountability systems, and building consensus and transparency, the model should be tested in other health and development areas beyond FP/RH.Global declines in donor funding present a substantial threat to development financing in low- and middle-income countries. In Nigeria, the resources required to achieve states’ health goals surpass existing government budgets and available donor funding, a shortfall that incentivizes efforts to expand nondonor sources of financing, including public-driven cofinancing models. The Challenge Initiative (TCI) in Nigeria implements a demand-led model wherein 13 state governments requested technical support from TCI to adapt and scale up high-impact family planning and reproductive health (FP/RH) interventions. TCI provides a blend of technical coaching and financial support through the Challenge Fund, a mechanism designed to incentivize domestic funding for FP programming. To qualify as a recipient, states must demonstrate political will, financial commitment, and potential for impact at scale. However, state financial commitments alone are insufficient to guarantee the successful implementation of health scale-up initiatives. For this reason, the TCI Nigeria cofinancing strategy builds positive relations among key actors (donors, implementers, and government) and improves accountability in FP/RH financing. Although there are several donor-led cofinancing primary health care initiatives in Nigeria, such as the Saving One Million Lives Performance for Results project and Basic Healthcare Provision Fund, little is known about the role of government in driving the process specifically for improving domestic FP/RH financing. In Nigeria, state governments, in collaboration with TCI, developed a cofinancing model that helps states meet their FP/RH financing commitments. To promote effectiveness and sustainability, this model operates within an existing state structure, the State Annual Operation Plan. TCI’s cofinancing model motivates continuous improvement in state governments’ fiscal capacity, using a framework to measure, track, and reward financial and nonfinancial state commitments. Although the model is not a replacement for existing program tracking and monitoring tools, it helps subnational governments better harness their resources to accelerate improvement in FP/RH outcomes.