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••• FEDERAL MINISTRY OF HEALTH, NIGERIA
•• NATIONAL
•• FAMILY PLANNING/REPRODUCTIVE HEALTH
POLICY GUIDELINES
••-.
... AND
STANDARDS OF PRACTICE
••
••

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(REPRINT)
•.. 1.;·
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FEDERAL MINISTRY OF HEALTH, NIGERIA

•' NATIONAL
•' FAMILY PLANNING/REPRODUCTIVE HEALTH

•' POLICY GUIDELINES

• j
AND
STANDARDS OF PRACTICE
• !

•'
•'
$ ~

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REPRINTED APRIL 2005

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5 3 Distributed by COMPASS with funding from USAID/Nigeria

This material, origina lly produced under the VISION Project, was adapted
E- ~
 • j
t:OREWORD

• ) In line with the International Conference o n Population and Devel­

opment (ICPD) Programme of Action the Federal Ministry of Health

• J developed the Re-productive Health (RH) Policy and Strategic

Framework, which gave directio ns for RH implementation in

• l Nigeria. Subsequently, the Guide to Family Planning Practice in

Nigeria was formulated to provide step-by-step instructions on
1•
• l quality family planning and RH service provision.

• l The FP/RH Standards of Practice is a po licy document that high

• :J
lights key Family Planning Methods and other related reproductive
health component services, as well as services tha t con be

• J
rendered a t every level and location, to specify roles and
responsibilities for the different cad res of service provider, and

• J
define their limitations .

• J This document will also enhance provider-client interaction as well

as stimulate collaboration among and within a ll levels of ca re

• :) through effective referrals .

• J The Standards of Practice is a very crucial tool for all Programme

Planners, Managers, Supervisors, Service Providers and Tra ine rs at
• J all levels .

•• 3 It is my hope that the use of this document w ill improve the qua lity

• 3
of RH/FP Service and enhance community access to services of all
levels of health core delivery.

• 3

• :J

• ~ r.

•
Director
:) DCDPA

• ~
Federal Ministry of Health Abu ja .

•
Nigf!l'ia Nc11at•al FP!RH Servic,. f'Diicy and Standar-ds
3
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Foreword
TABLE OF CONTENTS

iv
.... .,,
~ ") 4.0 Human Resource Development ..............................22

5.0 Management Information System...........................24

Contributors
Introduction
Acknowledgements
v
vi
• ., ., 6.0·... Quality Assurance ................................. .............26

Abbreviations
ix
• ., 7.0 Financial Resources ........ ............. .... .............. ..... 27

•
X
8.0 Supervision, Monitoring, Evaluation and Research .....28

SECTION ONE: FAM ILY PLANNING/REPRODUCTIVE • .,~

SECTION TWO: FAMILY PLANNING/REPRODUCTIVE
HEALTH SERVICE POLITY
•.. HEALTH SERVICE STANDARDS
1.0 Reproductive Health Service Policy .. ... .............·........ 1

1.1 Family Planning ...................... .................. l .. ~

~
9.0 BCC Methods, Channels and Materials ...................29

1.2 Prevention and Management of Unsafe

Abortion and Post-abortion Care .................. A • ~
10.0 Information for Clients seeking FP/RH Services ....., .... 31

1:3 Prevention and Management of Reproductive • ~ 11 .0 Family Planning Methods and Services ....................33

Tract Infections including ST1s/HIVIAIDS ..........6

• ~ 12.0 History Taking and Physical Examination ..................34
1.4 Prevention and Management of Infertility.........9
• ~
13.0 Family Planning I RH Basic Laboratory ~e~ts ...............36
1.5 Prevention and Management of Cancers of
the Female and Male Reproductive Systems... 11 • .)
14.0 Eligibility Criteria for fdmily Planning Methods... . ........3 7
1.6 Responding to Concerns about Menopause I • :)

Andropause ... ......................................... 13

• ~
15.0 Client Screening ................................................44

2.0 Behavioural Change Communication .................... 15 • ~ 16.0 Follow-up Visits .................................................45

3.0 Training of Reproductive Health Service Providers ..... i 9 • ~ 17.0 Client Screening: Special Considerations ............; ....46

• _)
Nigeria National FP/RH Service Policy and Standards

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Nig!!f'io National FP/RH Service Policy and Standards

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18.0 Post-abortion Services .... .......... .......... .............. .48 ·
• :J

19.0 Prevention and Management of RTis including • )

•
Task Force Members Mrs. Mary Hasson
STis/HIV/AI0$.•........................ ............... ..........49 j Mrs. Rocheol Adediji Mrs. lbidunni Jolaoso
Mrs. Abimbolo AdeJbulugbe
20.0 Infertility Prevention and Management.•...................51
• .J Prof. Adeyemi 0 . A ekunle
Dr. Pe ju Adenusi
Dr. Susan Konu
Mrs . Kofo Kolowole

21.0 Prevention and Management of Reproductive • ~ Dr. A.A. Adetunji

Dr. Nike Adeyemi
Dr. Josiah Mutihir
Mrs. Beatrice C. Nwibechukwu
Tract Cancers .......................................... ............ 53
• ~
Dr. Mrs. Bisi Aisien
Mrs. Yemisi Akinkunmi
Chimere Nwugo
Dr. Moji Odeku

22.0· Responding to Concerns about Menopause/

• l
Mrs. Stella Akinso
Dr. M .S. Amaeshi
Prof. O.A. Ojengbede
Mrs. Grace Oluwotoye

Andropause ............................................ .. .·. :... ... 59 • ]

Mrs. Cecilia N nonyelum Anumbo
Mrs. Irene Anya ji
Mrs. Yemisi Ayoola
Dr. linus Onoh
Mrs. Bimpe Owolobi

23.0 Functions of RH Service Providers ..........................•61 • ] Dr. Magoji Dachi

Dr. Akinremi Dodo
Mrs. Moji Oyelom i
Mrs. Salome Sombo

• 3 Dr. Bunmi Dosumu

Mrs. O.A. Folile
Dr. Babotunde Segun
Dr. Joe Taylor
24.0 Training Requirements for RH Ser¥ice Providers......... 63
• ~
Dr. Adesegun Fotusi
Mrs. M.O. Honid u
Mrs. Julie Thompson
Mrs. Bisi Tugbobo
25.0 Ust of Requirements-'for Effective Training Centres ...... 67
• ~ Devel opme nt Partners

26.0 logistics Standards for Health Facilities ..................69 • !

John Hopkins U niversity Hea lth Communications Project
Engender Health
Intra Health
27.0 Management Information Systems•............. .......... 73 •' PSI
CED PA

28.0 Supervision, Monitoring, Evaluation and Rese€1rch ...... 75 • '3 Pathfinder

UNF PA

• Editing a nd Formatting
Deadlines Nig . ltd

• ] 34 M cNeil Road,
Sabo, Yaba.

• ! Secret ariat and Logistic Stoff

Mr. Bobotunde 0. Ahmed

•' Mrs. Adesolo Adesonwo

• ...' ISBN - 978 062 224 - 1

Nigeria Natianal FP/RH Service Policy and Standards

IV •. c Nigeria Notional FP/RH Service Policy and Standards

v

• ·•..,
 • ] The FP/ RH Standards of Practice hove been developed to provide

BACKGROUND
II ~ I j: t •l •l•I!i j [•] ~I

In 1999, a civilian administration was sworn in after 20 years

of military rule duri ng which the health and socio -economic
status of Nigeria hod deteriorated.
·-
• ~
~
a clear understanding of the philosophy and intent of the RH
pol icy with a ,.view to defining loca tion-specific roles a nd
responsibi lities for the different cadres of service providers . In
doing this, key fami ly pla nning methods and othe r related
• ~ reproductive health component services hove been highlighted
in consonance with Notional RH and Population goals and

Consequently, the government, through the Federal Ministry of • j targets.

Health, other M inistries, Porostotols and Agencies embarked •• _j This document should help providers to appreciate the lim its of
on a radical remodelling of the health co re delivery system.
The remodelling was done in line with the 1994 International • "1
thei r provided skills and services, enhance provider-client
interaction, stimulate col laboration between and within levels
Conference on Population and Development (ICPD) Programme
o f Action, which aimed a t providing integrated Reproductive
Health services and ensuring quality o f core . In this regard, the
•.. l ]
o f core through effective referral, thereby promoting quality of
FP/RH services .

Notional Policy on Population for Sustainable Deve lopment

was reviewed. ••· )

")
STRUCTURE OF THE
FAM ILY PLANNING/REPRODU CTIVE HEALTH SERVICE
POLICY GUIDELINES AND STANDARDS
To specifically address reproductive health issues, a Reproductive
Health (RH) Policy was developed . This gave government policy .. . ~
Th is Policy and Standards of Practice (SOP) document is laid
out in two sections for ease of referencing a nd utilisation. Section
directions and a vision bound by goa ls, objectives and targets.
The policy statements provide gu idance for programme/project
development a nd services provided by those working in the
•.. )

3
One identifies the spectrum of family planning methods available
and provided in Nigeria as well as related RH services. Such
identified services ore prevention of unsafe abortio n and its
area of Family Planning "/ Reproductive Hea lth w ith in the health
core delivery system. complications, prevention and treatment ol reproductive tract
• · "')

••.
infections including HIV, care services for infertility, comm on

JUSTIFICATION
Following the development of the RH Policy, the Guide to Fa mily
• !I
")
cancers of the reproducti ve systems and me nopause/
ondropouse.

Pla nning Practice in Nigeria was formulated to provide step­
by-step instructions on provid ing fami ly plann ing services.
However, no guidelines were provided to specify the types of
core to be provided by the diffe rent cadres of providers and at
each level of health core within the RH Core delivery system.
It also specifies the services that can be provided at each level of
)
health ca re, the cadre of service providers at each level, and
• 3 those eligible for each specific service. In summary, section one
identifies who provides what services, at which level of care
• ~

•
Nigeria Na tional FP/RH Service Policy ond Standards Nigeria Notional FP/RH Service Policy and Stond6rds

vi ~ v ii
~ ~

II ~ i i: t • l •liies i [•l ~ I
BACKGROUND
In 1999, a civilian administration was sworn in after 20 years
of mil itary rule during which the health and socio-economic
status of Nigeria hod deteriorated .
Consequently, the government, through the Federal M inistry of
Health, other M inistries, Porostotols and Agencies embarked
• j
on a radical remodel ling of the health core delivery system.
The remodelling was done in line with the 1994 International • ]
Conference on Population and Development (ICPD) Programme
of Action, which aimed at providing integrated Reproductive •1
Health services and ensuring quality of core. In this regard, the
Notional Policy on Population for Sustainable Development
• STRUCTURE OF THE
was reviewed. • · 1
• . j
To specifically address reproductive health issues, a Reproductive
..• .
Health (RH) Policy was developed. This gave government policy
directions and a vision bound by goals, objectives and targets.
The policy statements provide guidance for programme/project
•.
development a nd services provided by those working in the
area of Family Planni ng'/ Reproductive Heallh w ithin the health
..
core delivery system.
JUSTIFICATION
Following the development of the RH Policy, the Guide to Family •·
•
Planning Practice in Nigeria was formulated to provide step­
by-step instructions on p roviding fam ily planning services.
H owever, no guidelines were provided to specify the types of
· care to be provided by the different cadres of providers and at • ~
each level of health core within the RH Core del ivery system.
Nigeria N otional FP/RH Service Policy and Standards
vi
•
...
~ - ~
l
The FP/RH Standards of Practice hove been developed to provide
a clear understanding of the philosophy and intent of the RH
policy with a ,.view to defining location -s pecific roles and
responsibi lities for the different cadres of service providers. In
doing this, key family planni ng methods and othe r related
reproductive health component services hove been highlighted
in consonance with Notional RH and Population goals and
targets.
This document should help providers to appreciate the limits of
the ir provided skills and services, enhance provid er-clie nt
interaction, stimulate collaboration between and within levels
] of core through effective referra l, thereby promoting quality of
FP/RH services .
FAMILY PLANNIN G/REPRODUCTIVE HEALTH SERVI CE
POLICY G UIDELI NES AND STANDARDS
This Policy and Standards of Practice (SOP) document is laid
')
out in two sections for ease of referencing and util isation. Section
) One identifies the spectrum of family planning methods available
and provided in Nigeria as well as related RH services. Such
) identified services are prevention o f unsafe abortion and its
complications, prevention and treatment of. reproductive tract
)
infections including HIV, care services for infertility, common
:J ca ncers of th e reproductive sys tems and menopause/
-)
ondropause.
It also specifies the services that can be provided at each level of
j
hea lth care, the cadre of service providers at each level, and
those eligible for each specific service. In summary, section one
identifies who provides what services, at which leve l of ca re
)
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Nigeria Not ional FP/RH Service Policy and Stond6rds
VII
and for whom the services ore intended.
Finally, this section sets out the modofi ties for tra ining, humon
resources development and distribution, as well as supervision,
monitoring and evaluation.
Section Two prescribes the minimum leve l of implementation
fo r each method o f FP and the re la ted components of RH
discussed in Section One . These hove been provided in a
tabu lar format to sup po rt a clear understanding of the
recommendations.
~ Jl
U3 a~ t•l'll! 3•X91M3 ~ i fl
~ ~ On behalt of the Federal Ministry o f Health, 1 wish to ex­
p ress our gratitude to lntraHealth for their i nvaluable
~ _) tech~nical. and financial support towards the development
of th 1s Pol1cy Gu ideline. In particular, we acknowledge the
~ _j
rentless effort and commitment of Professor Marcel
~ :J Vekemans, Dr. Boniface Sebikali and Mrs. Sara Stratton
The invaluable contributions o f Dr. Joe Taylor and Profes~

WHO MAY USE THE DOCUMENT

•.. ~

1
sor O ladosu O jengbede, the consultants who worked wi th
FMO H to develop the Gu id~lines, are high ly appreciated.

The guidelines set o ut in the SOP are written for use by those
who participate in FP/RH service deljyery a t all le ve ls of
health care including within the com mu nity. These include
programme planners and managers, service managers and
• 1.J Our sincere thanks also go to Dr. 0. Adenusi, Prof. Adeyemi
0. Adekunle, Dr. Ade A ~detunji, Dr. Susan Kanu and
• Mrs. I Jo laaso who worked with the consultants.

supervisors, service providers and trainers at all level s in

• ]
Special thanks to members of the Standards of Practice
pre-service and in-service traini ng programmes.
• j ~ask Force Team who reviewed the document and Deod­
lmes Advertising for editing the document.
HOW TO USE THE DOCUMENT
• 3
Programme Managers shall use the guidelines to determine
N ational Service Ta rgets for Fam i ly Planning and related • ~
Fina !ly, we thank all the Programme Managers a nd Service
Prov1ders that participated in the field-testing for their in­
ccmpcnents in Reproductive Health, set service objectives and
• j valuable contributions.

•
identi fy the requi1ed resou rces including categories ond numbe1s
of staff to be trained for specific service components . Service ]

•
Providers shall use the guidelines to identify types of services to
be provided at each level and how to organise these to meet ~

~
the prescribed standards. Training Programme Planners shall
use the guidelines to set training targets and priorities, identify fi ]
required resources and prepare train ing strategies that respond
to service needs and service standa rds. The guidelines shall
be used to mon itor and evaluate service availability, accessibility,
•
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l
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Consultant Special Grade l
Head, Reproductive Health Division
-· ·a lity and uti lisation.

• ]
Nigeria Notional FP/RH Setvice Policy and Standards

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Nigeria Notional FP/RH Service Policy ond Standards
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AIDS
rn :t! Jwr.at·ltr.J
Acquired Immunodeficiency Syndrome
•
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OB/GYN
ORS
Obstetrics and Gynaecology
Oral Rehyd ration Solution
BCC Behavioural Change Communication PAP Papan icolaou
CBD Community Based Distribution ~ j PCV Packed Cell Volume
CHEWs- Community Health Extension Workers PHC Primary Health Core
CHOS Community Health Officers ta :) PHN Public Health Nurse
coc Combined Oral Contraceptive PHY Physician
CYP Couple Year Protection ~ ~ PID Pelvic Inflammatory Disease
DCDPA Deparlment o f Community Development and PLWHA People Living With HIV/ AIDS

FLE
FMO H
Population Activities
Family Life Education
Federal M inistry o f Health
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PMTCT
PPIUD
PSA
Prevention of Mother to Child Transmission
Post-parlum IUD
Prostate Specific Antigen
FP
Hb
Fami ly Planning
Haemoglobin • ~

J
PS I
RH
RTI
Population Services International
Reproductive Hea lth
HIV
I CPO
Human lmmunodefiency Vi rus
International Conference on Population
and Development
"
~ ]
RVF
SOP
Reproductive Tract Infection
Recto Vaginal Fistula
Service Delivery Point
IEC Information, Education and Communication SOP Standards of Practice
IUD
IV
LAM
LGA
Intra-Uterine Device
Intravenous
Lactational Amenorrhoea Method
Loca l Government Area
..._.
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SPEC
STI
TBA
TV
Specialist
Sexually Transmitted Infection
Traditional Birth Attendant (Trai ned)
Television
LNG Levonorgestrel VCT Volu ntary Counselli ng and Testing
LT Laboratory Technician
._. j VCR Video Casselle Recorder
M&E Monitoring and Evaluation VHW Voluntary Health Worker
MIS Management Information System ti j VSC Voluntary Surgical Contracepti;n
MVA Manual Vacuum Aspiration WF Vesi co-Vag inal Fistula
MW Midwife ~ ]
NAFDAC National Agency for Food and Drug
~ ]
Administration and Control
NERDC- N igerian Educational Research and ~ J
Development Council
NGO
NHMIS
Non-Governmental Organisation
Notional Health Management Information System •.. ]

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Nigeria National FP/ RH Service Policy and Standards

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Nigeria National FP/RH Service Policy and Standards
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 ~ 11 1.0 REPRODUCTIVE t-IEALTH SERVICE POLICY
~ · ~
1.1 FAMILY PLANNING
~ · ~
The aims of family planning ore to:
It : ~ • Provide information to individuals and couples to enable
~ ~ them to freely and respons ibly decide the number and
spacing o f their children
~ ~
• Provide affordable and accessible contraceptive services
~ ~ and make available o full range of safe and effective
SECTI O N O N E methods
~ ~
• Provide informat ion on child bearing and support the
~ · ~ institution of marriage

II · ~ • Assist couples as well as ind ividuals who desire to hove

~ ! :. children

All ind ividuals a nd couples ore eligible for family planning

~ · !I services .
In view of the increasing problems associated wit h adolescent
• · fl sexua lity and teenage pregnancies in N igeria, it is considered

·~ ·· ~~
appropria te tha t sexually active a d olescents who seek

.
~ · ~
~
contraceptive services shall be counselled onp. served where
o ppropriote.
In the case of the mental ly cha llenged, the decision to use family
planning services shall be mode by such persons as parents,
guard ians or pa rt ners in consul tation wi th trained service
providers.
.. ~

~ ~

• · r~
The services shall include:

• BCC - Behavioural Change Communication

Nf'
Nigeria Notional FP/RH Service Policyond Standards
Nigeria Notional FP/RH Service Policy ond Standards

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 ~ 11 New contraceptives and contraceptive methods shall be
• Counselling
approved and registered by the National Agency for Food and
• Provision of contraceptives
~ ~ Drugs Administration and Control (NAFDAC) before being used
Management of side effects and complications
• in Nigeria .
• Referral ~ 11
At the various delivery points, the following service providers
Contraceptive services shall be offered to: ~ Jl
shall provide contraceptive services:
• Prevent pregnancies fi! jl
• Community Level: CBDs, trained TBAs, CHEWs, Patent
• Delay child-bearing Medicine Dealers and Pharmacists
t! Jl
•
•
•
Space births
End child-bearing where desirable
Prevent RTI including STI/HIV/ A IDS
.. ]I
•
•
Hea lth Post: CHEWs, Nurses, Midwives
Basic Health Centres and Maternity Homes: CH EWs,
Nurses, Midwives, Community Health Officers (CHOs)

The following family planning methods shall be mode available ··~

~ · )I
• Comprehensive Health Centres CHEWs, Nurses,
M idwives, CHOs and Phys icians
in Nigeria • General Hospitals: CHEWs, Nurses, Midwives, CHOs,
I! ~ Physicians and Specialists (obstetrics/gynaecology)
Te mporary M ethods • Specialist/Tertiary Hospita ls: M idwives, Physicians
Short Term I! ]I and Specialists (obstetricians/gynaecologists)
• Condoms
~ · ~ The d ifferent services shall be mode avai lable at al l leve ls of the
•
Spermicides
health system based on the category of staff and infrastructure
• Diaphragms ~ · jl
Oral Contraceptive Pills
•
Lactational Amenorrhoea Method (LAM)
• ... )I
at each level of core .
• Community Level: Behavioural Change Communication,
counselling, condoms provision, spermis:ides, re-supply
•
Natural Family Planning
I! · ~ of oral contraceptives and lactational amenorrhoea
Long Term method
~ ~
• lnjectobles • Health Post: BCC, counselling, condom provision,
• Intra Uterine Device (IUD) ~ )I spermicides, LAM, re-supply o f oral contraceptives
• lmp).!Jnls • Basic Hea lth Centre : BCC, co unselling , condom
.. • I
•.,. I' ~ ]I provision, spennicides, LAM, oral contraceptives, IUD
Permane nt M e thods 1
• Comprehensive Health Centre: BCC, cou nselling,
• Bilatera i•,Tubal ligation ~ · ~
condoms , d iaphragms, spermicides, LAM, oral
• Vasectomy I! ~. contraceptives, IUD, injectables, implants, permanent
Nig eria No tiona l FP/RH Service Policy and Standards
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Nigeria Notional FP/RH Service Policy and Standards

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 (tubal ligation, Vasectomy) contraception, and infer! ~ jl complications of unsafe abortion
management • Manage and/or refe r abortion complications
• General Hospital: oi l of the above plus manageme E )I
The target g roups shall include
of complications • Men and women
~ 11
• Speciolis!/Tertio ry: as in general hospital plus • Adolescents
adva nced management of infertility II! :JI The strategies shall include
A variety of service del ivery approaches shall be used to make ~ ·~ • Clinic-based
family planning services accessible, available a nd affordable to • Community - based
all eligible individuals a nd couples. Such approaches shall be: ~ :~ • Outreach
I
• Clin ic based se rvices ~ ·~ The activities shall be

• Communi ty based services

I • Education on dangers of unsafe abortion
~ · ~ • Fami ly planning counselling and services
• Outreach services
I'
I • Recognition and management of abortion complications
· ~
Clients shall be referred to a highe r level of service delivery whe re • Linkages with other RH services
services required are not provided at the lower level or whe re
II: !I • Referra l
management of complications and side effects o re beyond the
competence of the service provider(s) .
• ·)) I

At each level, the services a nd providers shall include:

I! · ~
1.2 PREVENTION AND MANAGEMENT OF • Community Level
UNSAFE ABORTION AND POST-ABORTION CARE
Abortion is the loss of pregnancy before the foetus is viable. An
abortion is unsafe when performed either by pe rsons locking
..
~

~
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!!I
!I
Services: FP counselli ng, education on dangers of
unsafe abortion, postabortion, FP services, referral
Providers: CBDs, TBAs, C HEWs, Patent Medicine
Dea lers, Pharmacists
necessa ry skills o r in on environment locking minimal medical t Health Post
standards or both . ~ · ~ Services: Same as for community level

Services for unsafe abortion and post-abortion core have ... ~

•
Providers: CBDs, CHEWs
Basic Health Centre Level
the followings aims: Services: Same as for community plus management o f
~ !I
• Prevent unwonted pregnancies through family p lanning complications
counselling and services ~ ~ Providers: CHEWs, Nurses, Midwives, CHOs, Physicians
• Create public awareness o n the dangers and
• ~

•·
Nigeria Natio nal FP/ RH Service Policy and Standards Nigeria National FP/RH Service Policy and Standards
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E ~
 f! • JI • Pregnant women
• Comprehensive Health Centre Sex workers
~ · )I • Neonates (eye core)
Services: Same as for Basic Health Centre plus
management of complicat ions, includ ing surgery • Children with H IV
~ ·
Providers: CHEWS, Nurses, Midwives, PHN-C HO, and
The fo ll owing activities shal l be provided:
Physicians t! jl
• BCC (Behavioural Change Communication) including
~ ji counselling
• General Hospital • Client screening
Services: Some as for Comprehensive Health Centre
~ · ~ • Syndromic diagnosis and treatment
Providers : Nurses, Midwives, Physicia ns and O bstetricians,
Laboratory diagnosis and definite treatment
Laboratory Technicians t! · ~ • Partner notification
• lrnmunisation (Hepatitis B)
• Specialist I Tertiary Hospital ~ · ~
• Follow-up care
Services: Some as at General Hospita l.
~ · ~ • Management of long term complications
Providers : N urses, M idwives, Physicians, Obstetricians
I • Core and support for peo ple living with HIV/AIDS
and Laborato ry Scientists ~~~ (PLW HA)
The service del ivery strateg ie s sha ll include :
The logist ics support including BCC mat erials, MVA kit, ~ · ~
I Prevention
contraceptives and equipment whic h sha ll be pro v ided as ~ · )I • Advocacy

~~ '~ ~~
appropriate for each level. • Mass-media campaigns
• Enter-educate (Enterta inment Education}
• Interpersona l comm un ication
• Fami ly Life Educatio n
1.3 PREV ENT I ON AND MANAGEMENT OF
REPRODUCTIVE TRACT INFECTIONS ~~ ~ • Promotion of condoms
• Provision of condoms
INCLUDIN G STis, HIV/ AIDS ~ Jl
The a im of STis servi ces is to: E )i M a nage ment of cases
• Prevent and manage RTis including STis, HIV/AIDS • Compliance w ith service standards
~ · )I • Use of treatment protocols/guidelines
The target group shall inclu d e • Referral of cases
• All sexually active men and women
t! !II The following services shall be provided at the d ifferent levels
• Adolescents f! ~ of the health care delivery system:
Nigeria N o tional FP/RH Service Policy and Standards Nigeria Notional FP/RH Service Policy and Sta ndards
~ !I
6 7
·E )I
 t! : jl Technicians, CH Os (N urse Midwives) plus Specialists,
• Community Resea rchers and HIV/AIDS counsellors
Services: Counselling including Prevention of Mother- ~ · :t t Specialist I Tertiary
To-Chi ld Transmission (PMTCT), BCC, promotion and Services : As in the General Hospital plus specialist
~ :t
sale of condoms, and vaginal foaming tablets, follow- core
up and referral t! · ]) Providers: Nurses, M idwives, Pharmacy Technicians,
Provide rs: TBAs, Patent Med icine Dealers, CHEWs and PHN -CHOs and Specialists
Pharmacists ~ j}
Appropriate logistic supporl shall be provided at all levels for
~ ill the prevention and management of STis, including HIV/AIDS.
• Health Post
Services: BCC/ counselling, PMTCT, promotion and ~ · ]I
1.4 PREVENTION AND MANAGEMENT OF INFERTILITY
sale of condoms, spermicides, LAM,and re-supply of
I! ~ The aims o f this service component ore :
oral contraceptives
Providers: CBDs, TBAs, CHEWs Preve ntion of inferlility
Ji · ]l t

• Treatment of inferlility
• Basic H ealth Centre 1! · 11
Services: As in the health post plus syndromic The target g ro u ps shall include:
management of ST!s, counselling for PMTCT ~ ·. 11
Providers: CHEWs, Nurses, Midwives, Pharmacy
1! · 11 • Persons in the-reproductive age group
technicians, and CHOs • Patients with RTis
~ · ]I • lnferlile couples
• Comprehensive Health Centre • lnfe rl ile individuals
Services: As in the Basic Health Centre plus laboratory ~ · lt
diagnosis and management of STI's, epidemiologica l The a c t iv iti es to be unde rtake n shall incJu d e:
survei llance and Volu ntary Counselling & Testing (VCT) ~ · 11 Prevention
Providers: CHEWs, Nurses, Midwives, Pharmacy • Advocacy
Techn icians, CHOs, Laboratory Technicians and
E 11 • Multi -media channels
Physicians ~ 11 • Mass-med ia campaigns

• G en eral Hospital E 11 • Interpersonal communication

Services: As in comprehensive hea lth center plus reference • BCC

laboratory I! )I • Counselling
• Family life education
Providers: C H EWs, Nurses, Midwives, Pharmacy
~ 11 • Promotion of condoms
Nigeria National FP/RH Service Policy and Standards Nigeria National FP/RH Service Policy and Standards
~ · 11
8 9
E ~
 • Treatment of RTI (syndromic and etiologic) ~ · JI
• General Hospital
Manage ment ~ :1 Services: As in the comprehensive plus specialised
• Counselling investigations and some other treatments such as
E ~
• Clinical exam ination insemination, adoption
• Laboratory test and specialised investigation ~- · jj Providers: Some as Comprehensive Health Centre level
• Definitive t reatment including artificial insemination plus specialists
~-: jl
• Assisted conception and adoption Specialist I Tertiary Hospital
I
•
• Referrals ~- ! ~ Services: As in the General Hospital plus other definitive

~- ! ~
Serv ices and service providers f or prevention and treatments such as assisted conception
management o f infertili t y sha ll include: Providers: Some as General Hospital
I
• Community
Services: BCC, counselling, promotion of condoms, and
~ ifl Appropriate logistic support shall be provided as indicoled in
referral ~ · !I the standards .
Providers: CBD, TBAs, CH EWs, Pharmacists.
• Health l,ost ~ ·~ PREVENTION AND MANAGE MENT OF
I CANCERS OF THE FEMALE AND MALE
Services: BCC, counselling, condoms promotion and ~ ; JI REPRO DUCTIVE SYSTEMS
referral. I
Providers: CHEWs, Pharmacy Technicians 1!: •!1 Cancers of the reproductive systems shall include cancers of
• Basic Health Centre breast, cervix and prostate .
Services: As in the health post plus clinical exam ination ~ · !I
and syndromic treatment of RTis ~ · !I The aims of this service com ponent ore:
Providers : Midwives, Nurses, CHEWs, C HO (Nurse I
• Prevention of reproductive tract cancers .
Midwives) E · !l • Early detection of reproductive tract cancers
• Comprehensive Health Centre
E ·!l
• Treatment of patients with reproductive system cancers
Services: As in the Basic Health Centre plus syndromic • Management of terminally ill patients including home
and definitive treatment of RTis, clinica l examination and ~ · !I based core
laboratory tests and some defin itive treatment of infert ility
such as eduction of ovulation ~ · !I The target groups shall include:
Providers: Some as Basic Health Centre plus Physicia ns, • Men
~ · !I
Laboratory technicians • Women
~ ·~ • Adolescents
Nigerio National FP/RH Service Policy and Standards Nigeria Nalional FP!RH Service Policy and Slondords
t'. ~
10 11
~ ·~
The activities to be undertaken shall include: ~ ' JI Providers: As at the Basic Health center plus Physicians
• BCC ~ · :I • Gen eral Hospital
• Counselli ng ~ · :1
Services: As at Comprehensive Health Centre plus
• Provision of condoms (to help prevent RTis which ore risk laboratory diagnosis of early stage of diseases e.g.
factors for cervical cancer)
~ · ~ Prostate Specific Antigen (PSA) test, mammography
• Early detection and definitive tr'eotment of RTis and where avai lable
defin itive treatment of pre-malignant cond itions of the ~ : ~ Providers: As at the Comprehensive Health Center plus
cervix, breast and p rostate specialist
~ , ~ Specialist I Terti ary
• Definitive treatment of the specific cancers •
• Follow-up i! i )l
Services : As at General Hospital plus definitive treatment
• Referrals of pre-ma lignant conditions and specific cancers
• Management of terminally ill patients l! i)l Providers: Same as General Hospital

The services and providers shall be: ~ · I

Appropriate logistics support shall be provided at all levels for
• Community
Services: BCC, counselling, promotion and provision ~ ' !I the management of reproductive system ca ncers as indicated in
the standards.
of condoms, referra ls and follow-up IE: · II
~' ~
Providers : TBAs, CHEWs, CBDs 1.6 RESPONDING TO CONCERNS ABOUT
• H ealth Post MENOPAUSE AND ANDROPAUSE
Services: As at the community level E. · !I The aims of this service a re to
Providers : As a t the community level
• Creole awareness and educate people about menopause
• Basic H ealth Centr e Leve l ~ ~
a nd a ndropouse (awareness and education)
Services : As a t the health post plus syndromic
~ : ~ • Provide appropriate management for patients wit h
management of RTis and early detection of pre-malignant
sym ptoms and signs o f menopause and and ropause
conditions especially of the cervix through direct visua l
observation and gynoscopy The target grou ps are:
Providers : CHEWs, Nurses, Midwives, CHOs (Nurse • Men and women of reproductive age and above
M idwives) • Cl ients with menopause and ondropouse symptoms
• Comprehensive Health Centre • Spouses/partners of clients with menopause and
Services: As at the Basic Health Centre plus biopsy of ondropouse symptoms
lesion

Nigeria National FP/RH Service Policy and Standards Nigeria Notiona l FP/RH Service Policy and Standards

12 13
The activities t o be undertaken for menopause and
Providers: As for Basic Health Centre plus Physicians
andropause management shall include:
and laboratory technicians
• BCC
• General Hospital
• Counselling Services: As at the Comprehenstve Health Centre
• Clinical examination t! • JI Providers: As at the Comprehensive Health Centre
• Laboratory investigation plus specialists
• Treatment i! · jl • Specialist I Tertiary:
• Referral when applicable
~ ! il Services: Some as for General Hospital plus Specialist
The strategies far respondin g to concerns about care
menopause and andropause shall i nclude: I! ! Providers: Same as for General Hospital
• Interpersonal communication I
I! · ~
• Mass-media com munication Appropriate logistic support shall be provided at al l levels as
I
• Enter-educate (Entertai n.ment Education) needed.
I! · ~
• Focus group discussions I 2. 0 BEHAVIOURAL CHAN G E COMMUNICATION (BCC)
• C li nic based services
~~ AND COUN SELLIN G
The services and providers sha ll be: ~ ,
• Community Behavioural change communication is the process of educating,
Services: BCC, counselling, referral ~ ~ !I persuading and disseminating information to people, to positively
Providers: CBDs, TBAs, CHEWS influence their behavioura l poHerns and enable them take actions
l! i ~ that will enhance their reproductive health status.
• Health Post
~ · !tl
Services: Same as at community level
Provider: CHEWs as community level The a ims of this service component are to
~,­ • Increase awareness and use of family planning/child
• Basic Health Centre It s spacing methods and o ther relevant reproductive health
Services: BCC, counselling, clinical examination and services
referrals ~ · t. • Promote client/provider intetoction
Providers: C HEWs, Nurses, M idwives, CHOs I
Comprehensive Health Centre It · ~
• For effective BCC, a multimedia approach shall be used. BCC
Services: As at the Basic Health Centre plus laboratory I!; • A messages shaU be correct, timely, audience specifi c, culturally
investigation and treatment sensitive and acceptable.
It ! ~
Nigeria Notional FP/RH Service Policy and Standards I Nigeria Not•anol FP!RH Service Po/.cy and Standards

14 ~ · ~ 15
~ · I.
 ~· ~ • Training
The target groups shal l include
• Policy makers £ il BCC promotion sholl be undertaken at various levels by
• Opinion leaders ~ ~
the following category of prov iders/offi cers:
• Religious bod ies Community
• Adolescents and youth I! j]
• All men and women • CBD
I! ~ • TBAs
• Clients with reproductive health concerns or problems
I! jj • Potent Medicine Dealers
The main BCC activities for the promotion of reproductive health • VHWs
shall include the following: ~- jJ • Community Volunteers
• Data collection, analyses and presentation • Peer Counsellors
• Commu nity involvement 1!. ~ • Teachers
• Tra ining
It, 11
• CHEWs

• Materia l production Health Post

• Field tes ting ~ !I • As for community level
• Presentation
• Materia l distribution ~ ~
Basic Health Centre
Resource mobilisation
Community mobil isation e.g . during new yam festival,
~ ~ • Same as commu nity level
• Public Health Nurses
durbors ~ !I • M idwives
• Counse lling
Interpersonal communication ~ ~ Comprehensive Health Centre

The following strategies shall be used for the pro motion of ~ ~

• Same as Basic Health Centre
• School Counsellors
Reproductive Health
!It · ~ • Physicians
• Advocacy • Public Health Nurses
Community mobilisation I involvement ~ !I • Health Educators
Involvement of the adult literacy programmes (in and • Peer Counse llors
~ !I
out of school) at promoting Family Life Education (FLE) • Social Health Workers
• Strengthening the use of reproductive health database ~ !I • NGOs
• Intensifying outreach programmes
I! !I
Nigeria Notional FP/RH Service Policy and Standards Nigeria National FP/RH Service Policy and Standards

16 17
 ~ ~~
General Hospital
~ Jl 3.0 TRAINING OF FP/ REPRODUCTIVE HEALTH
• Same as Comprehensive Health Centre
• Health Education Officers of different agencies ~ jl SERVI CE PROVIDERS
BCC specialists
~ ~ All persons involved in the provision of family planning/
• NGOs
reproductive health services shall be given the appro priate
Specialist/Tertiary Hospital ~:
trai ning.
• Same as above
~:I

Local Govt. Level

TRAINING CONTENT
~ : ji Training shall focus on :
• LGA Chairmen
• BCC
PHC I Director I Coordinator I

t! l !l
• Counselling Skills
State Level t: : - • Interpersona l Communication Skills
• M inistry of Information Family Planning/Contraceptive Techno logy
•
• Ministry of Health (; I ­
Adolescent Reproductive Health
•
• Ministry of Education RTI including STI/HIV/AIDS and PMTCT
E ~ JI
I
•
Prevention and Management of Infertility
National Level
•
~ ~ ~ • Infection Prevention
• The Health Education Branch of the Federal Ministry of
Health ~ · JI
• Post-abortion Care
Reproductive System Cancer Prevention and Screening
• DCDPA, Federal Ministry of Health •
(breast, cervix, p rostate)
• Population Information and Communication Bureau ~ · ~
• M enopause/And ropause
(Federal Ministry of
Information) ~ : JI
• N igerian Education Research and Development Council • Clinical Skills
I
• Training and faci litation Skills
(N ERDC) ~ · ~ Contraceptives Logistics Ma nagement
•
M anagement Information System
II! •
Supervision, Monitoring and Evaluation
I! • JI •
• Operations Research
I! tl
~ !I
Nigeria Notional FP/RH Service Policyond Stondords Nigeria Notional FP/ RH Service Policy ond Standards
18 ~ ~
19
PRE-SERVICE TRAINING ~ · II TRAINI NG OF OTHER REPRODUCTIVE HEALTH
• FP/RH shall continue to be integrated in the pre-service SERVICE PROV IDE RS
~ ~
tra ining curricula of all health workers in order to provide
for full integration of reproductive health services in the ~ :. • Trained staff shall be expected to transfer the knowledge
and skills to colleagues in the ir work place. On-the-job
N ationa l Hea lth Care Delivery System training shall accompany all monitoring and supervisory
~ )I
activities prescribed by the Standards
IN-SERVICE TRAI N ING f!i jl
• In-service training in FP/RH shall be in line with the
• Duration of training shall be commensurate with the
content and level of skills needed, as determined by
Reproductive Health standards usi ng the approved ~ · jl
accred ited resource persons and as required by training
curricula to ensure sustained quality of service modules
• In-service train ing programmes shall ensure coverage t! · JI
of all service providers in both publ ic and private sectors
• All service providers shall be required to have undergone
I! · ~ the appropriate in -service training before carrying out
with regular updating of knowledge and skills any additional or new tasks
• The RH Division of the Federal M inistry of Health, in ~ ~ t The Federal M inistry of Health, in collaboration with
concert with other stake holders collaborating in other relevant stakeholders and resource persons, shall
reproductive health, shall regu larly review the Policy, I! ~
regularly update resou rce materials, w hich should be
Standards, Protocols and curricula as necessary
~ !I made available to all training centres
• Relevant aspects of reproductive health shall become
on integral part of structured in-service tra ining by health I! !I
care providers
• In-service tra ining services sha ll be decentralised to the ~ jl
States, LGAs and NGOs using identified a nd experienced I! · !I
RH trainers
~ .tl
POST BASIC AND POST GRADUATE TRAINING
~ ~
The training of Nurses, Midwives, Physician & Specialists shall
include: ~ !I
• Reproductive health components
I! !I
t Revision of curricula
t Specialised training in reproductive health planned ~ !I
according to the needs
I! Jl
Nigerian National FP/ RH Service Polley and Standards Nigerian Notional FP/ RH Service Polley and Standards

20 If !I
21
I: ~
 ~ ·~ • Polyvalent-skilled cadres shall provide Reproductive
4.0 HUMAN RESOURCE DEVELOPMENT Health services that are integrated into other health
~ · JI services
Human Resource Development shall address issues related to
the cadres of healthcare providers, their numbers, functions, ~ : :~~ These workers will increase the availability o f
distribution, competences and the training and support they Reproductive Health skills at all levels for service
need to ensure equitable and quality RH services. It shall also ~ ji
provision. . .
take care of the present and future needs as an integral part of
~ • Specialised training sha ll take into cons1deratton
the National Human Resources Development Policy for Heal th. National, Stale and LGA requirements and needs
~ • Access to Reproductive Health services, especially in
PLANNING O F HUMAN RESOURCE DEVELOPMEN T ru ra l areas, shall remain an important factor in the
AND MANAGEMEN T development and assignment of service providers
• The Health Sector, at all tiers of governance, shall develop
projections of future needs and supply of Reproductive I
I
Health Service providers I
I
• Management of the Reproductive Health workforce shall ~ · ~~
invo lve decentralised processing of personnel I
administration through the appropriate department or E: jti
agency I

• Appropriate cadres of service providers shall be ~ · ~

distributed, according to wo rkload as well as ~ · ~
geographical spread, to cater for eq uitable access to
services t! !II
• Commun ity pa rticipation shall include provision of
~ · tl
incentives for officers with heavy workloads and those
working in 'hardship' areas ~ !ti

TRAINING AN D HUMAN RESOURCE DEVE LOPM ENT It !II

• All pre-service trai ning cu rricula shall include 1:
Reproductive Health components
I!;

It •
•
Nigerian National FP/ RH Service Polley and Standards Nigerian National FP/ RH S ervice Polley and Standards

22
It • s 23
It
•
5 .0 MANAG EMENT INFORMATION SYSTEM (MIS)
• % o f adm ission for abortion related complications
The aim o f management information system is to • Number of deaths as a result o f aboriion

Gather information that will facil itate decision-making STI Management

for planning, implementation and evaluation of FP/RH • % of clients counselled and given treatment on STI HIV
services. alSOP
• Types and number of condoms distributed
To achieve this, data collection tools shall be standardised. • STI/HIV prevalence
Data shall be collected, collated and analysed to inform and
influence decisions at all levels. Reproductive Tract Cancer Management
I
~ · ti • Number of clients screened
Al l Ministries and Non-Governmental Organisations (NGOs) I • Types of cancer
shal l ensure timely feedback to the appropriate levels through t! I· • Number of cases referred
the esta blished channels .
~! Prevention and Managemer1t of lnfertilty
Information sha ll be collected o n the fo llowing: I • Numbers of clients screened
~ · • Numbers of pregnancies achieved
General I
• Client records ~ · Management of M enopause/Andropause
• Service statistics
~
• Numbers of clients reporting
• Logistics records • Numbers of clients treated
• Contraceptive methods I! · • Numbers of clients referred
• Personnel
• Equipment ~ ~

Family Planning I! ~
• Contraceptive method
• Method mix-modern, traditional I!
• Couple Year of Protection (CYP)
t!
• Contraceptive prevalence by methods
I!
Post-abortion Care
• Number of post-abortion care services rend ered I! ~

• % o f post-abortion core clients using a FP method I! !I

Nigerian Narlonal FP/ RH Service Polley and Srandards
Nigeria r lotionol FP/RH Se..rcl" Polocy Olld Stondords
I! !A
24 25
~ ~
6 .0 QUALITY ASSURANCE

The aim of quality assurance is to improve provider's 7.0 FINANCIAL RESO URCES
performance and increase client's satisfaction.
The aim o f these guidelines about financial resources shall be
Special oHention shall be paid to:
to ensure that adequate funds ore available to support the
• Client-Provider Interaction
provision and sustenance of quality and FP/RH services at all
• Privacy and confidentiality
levels.
• Counselling for informed choice/decision
• Access to widest possible mnge of effective FP/RH services The sources of funding shall be both internal and external.
• Access to Integrated Services • Government and people of Nigeria shall strive to increase
• Infection Prevention and Control internal fund ing for FP and related RH programmes
~ · !II
• M echanisms to ensure follow-up • Federal, Stole and Local Governments shall provide
• Effective logistics management system
~· annual budgetary allocations and re lease funds for
• Technical competence of service providers implementatio n of FP/RH policy and programmes
• Service providers morale ~ · !JI • Federal Government sha ll mobilise external funds from
• Effective referra l system developml;(nt partners for FP/RH policy programme
E
implementation including the RH Strategic Framework
Strategies shall include:
• Training and acquisition of skills
I! . !tl '. and Pion
• Federal, State and Local Governments sha ll provide
• Provision of: I! · ~ necessary counterpart funding and contributi ons for the
Practical Guidelines
implementation of donor-assisted programmes and
Administrative Procedures 1! · !1
projects
Performance Standards and Protocols
Specifications ~ · • Government shall encourage orgonisea private sector
to support FP/RH programmes and activities
• Development of indicators to monitor quality of service ~ • Other financial management issues shall be as decided/
delivery
directed by relevant governments, communities and
• Provision of materials to support services ~ · partners
• Supportive supervision, monitoring ond evaluation
It !II
Mechanisms/strategies to perform continuous monitoring of
quality of core shall be based on clients' satisfaction and ~ ! !I
perception of the qua lity of core.
Nigeria Notional FP/RH Service Policy and Standards
~'~ Nige ria n Notional FP/ RH Serv/co Polley and Sta n dards

26 27
 ~1!: •· )1· 8.0 SUPERVISION, MO'N ITORING, EVALUATION AND
RESEARCH
~ :tl
SUPERVISION
The a i ms o f supervision ore to :
~ · JI
+ G uide, assist and support staff in order to im prove their
performance in their assigned tasks
~ ·~ + Provide support to providers to resolve emerging concerns
SECTION TWO ~ ! il and problems
I MONITORING AND EVALUATION (M&E)
~~· The aims o f M&E ore to:

~ ~~ Assess, on a continuous and periodic basis how resources

are being deployed to achieve set gaols
l! i ~ • Provide information to moke judgements and
decisio ns on programmes
l! i ~ Monitori ng assesses the progress of implementation whi le
~ ~~ evaluation determ ines the effectiveness of activities and strategies.

I! · ~ Managers and Service Providers shall carry out monitoring and

evaluation at all levels of the health core delivery system.
1!!:
I RESEARCH
t! i ~ Th'e a ims o f research ore to:
• Find out the magni tude of RH issues and collect
~~ •
information to help formulate appropriate stra teg ies
Generate information to infl uence policy
f!: • S
Governments at a ll levels shall encourage the development of
I! a research culture within government, agencies, training and
research institutions and NGOs in support o f Reproductive Health
~ · programmes.

I! · ~ This shall inc lude basic and operations research, the findings
o f which sha ll be dissemina ted and applied to improve the
I! !I reproductive health status o f the people.
Nigeria Notional FP/RI I Service Policy and Standards N igerian National FP/ RH Service Policy and Standords
~ !I
28
1: ~
9.0 BCC METHODS, CHANNELS AND MATERIALS IIi !A Projectors
•
Models (penile, breast, pelvic)
Behavioural Cha nge Communication (BCC) is a crosscutting I! · •
Samples o f contraceptives
activity for all FP/RH services. It shall be provided at all levels •
o f health co re (Com mu n i ty, H ealth Post s, Basic and
t! • Newspapers

Comprehensive Health Centres, General H ospi tals and ~!~ • Billboards

• Bonners

~'
Specialist I Tertiary Centres} through t he following methods and
using the underlisted materials: • Souvenirs

~I!! !'
RAPID• Presentation
•
METHODS/ CHANNELS •RAPID is Resources for the A wareness of Population In
• Health Talks D evelopment. It is on advocacy tool used in promoting
• Demons! rations
~ · s
I issues o f population as they impact on development.
Video shows
Drama, songs I! ! These methods and materials shall be used at all levels

~'
• Cultura l festivals depending o n the target group and resources available.
• Comm unity meeti ngs

~ I'
• Home visits
Discussions with o rganised groups
• Film shows
Radio and TV ~ ·
• I
• Quizzes ~ ·
• Debates I
Panel discussions l!. i!tl
I! • Ji
MATERIALS
• Flip Charts ~I
• Posters
Leaflets I!
•
• Pamphlets
Video a nd audio equipment
I!
•
• Video came ra I!
• Films/Slides
~
Nigeria Notional FP/RH Service Policy and Standards Nigeria Notional FP/RH Service Policy and Standards
~
29 30
~ ~
 ~ ~ • Side effects and their management
Eligibility and non-el igibility criteria
10.0 INFORM ATI ON FOR CLIEN TS
~ jjl
•
SEEKING RH SERVICES • Return to fertility
Clarification of misconceptions/rumours
It is important that providers o bserve all ethical issues in clients ~ ~ •
• Where to get them and cost
seeking FP/ RH services. At the end of the session, the client
I! · ~ Warning ~ig ns for early return to the health facility
shall be provided information appropriate to his/ her need from
•
Follow up and re-supply (where applicable)
the topics listed below, to enable him/her to make on informed E
•
Prope r storage and maintenance .
decision regarding the FP/ RH service. • Proper disposal of used and expired suppltes
~ •
General Topics STis & HIV/AIDS
Relevant elements of: I!! jj
Information:
• Anatomy and physiology o f the human reproductive ~ ~ • On the ca uses o f STis including HIV/AIDS
system • On Voluntary Counsell ing and Testing (VCT)
• H uman growth and development I!!! !II • On risk factors and how to prevent them
• Menarche/Mole Puberty Infertility
I!! !II
• Ferti lisation • Causes o f infertility
• Pregnancy I! I
• Relationship between infe rtility and RTis
• Adolescence I
I!!! · ~
• Principles of ma nagement of i nfertility
·• Adulthood Cancers Of Reproductive System .
• Parenthood I • Informatio n rega rding common cancers - cervtx,
~ · ~
•
• Menopause/Andropouse
STI and HIV/AIDS risk behaviours
I
l! • !tl
breast, prostate
• Risk factors
• Breastfeeding • Early detection (screen ing) ­
• Gender issues ~ !11 • Principles of management
• Social/Cultural issues
~
I
I M enopa use & Andropause
• Rumo urs/Misco nceptions
Family Planning ~
I
I
• Information on the physio logy of menopause and
andropause
• Types o f avai lable methods
i!
I• Jjl • Common symptoms and signs
• How the method fo r which client shows interest works

~'~
• Coping mechanisms
• Advantages a nd disadvantages for methods that in­ Principles of management
terest the client •
• Effectiveness of the method ~
Nigeria Natipnal FP/RH Servke Policy and Standards Nigeria National FP/RH Service Policy and Standards

31 32
11 .0 FAMILY PLANNING METHODS AND SERVICES
i 2 .0 H ISTO!\"f T~ )o.. J NG ..\NO F"H1~ 1 ~l E\.4.\1 , .\Th.'\1
Types of family planning methods and services provided at each
level of the health delivery system and the various cad res of ser­
HISTORY TAKING
vice providers : History taking is the process of collecting information from the
TYPES Of' rAt.IILY SERVICE PROVIDlR client to enable the service provider assist the client in making
trvns OF
SERVICES
PlAllt :·r JG /.lET HODS AIH an informed decision/choice. Ensuring privacy and confidentiality
SER'. :..I:S
ore important requirements during history taking .
• Counselong
• CBD Agent, TBA
t Community • Condoms
• Potent medicine dealers
• Spermicides
• Phonmocists
The in forma ti on obta ined shall include
• LAM
• CHEWs
• Re supply o f oral
contraceptives
BI ODATA
+ {Name, age, address, sex, marital status,
• H~olth Post
Some os communoty • CHEWs religion)
+ Social History
• Bos•c Health Centre • MidWives
+
•
Some os lor above plus
F~nilily oworeness methods •• Nurses
CHO
Medical History (Past and Present)
• lnjectobles + Menstrual H istory
• IU D ~ · + Sexual H istory
• Oro! contraceptives
+ Gynoecologic /Obstetric History
• Diaphragms
~ ·
• Emergency
Contraception
+ Contraceptive History

t Comprehensive Some as lor bosic health PHYSI CAL EXAMINATI ON

Heolth Centre Some os lor bosic health centre centre plus
Physical exam ination assesses the client's health status and
above plus
• • Physicions I

•
Implants ond
Sterilization lor both men • Specialists (Ob/Gyn)
~ ·~
sui tability for a chosen service. This consists of the general and
ond women
if ovoiloble systemic examinations.
t Specialist I Tertiary li! !
Some os above plus
Hospital
Genera l Examination
Some os obove Specialists
(Ob/Gyn) I! ! + Gait
I + Facial expression
~ ·
I + Pronounced disability or obvious ill-health
e: · ~ + Pallor

~'
+ Jaundice
+ Temperature
I!! Nigeria Nolionol FP/ RH"-Service Policyond Standards
Nigeria Notional FP/RH Service Policyond Standards

33 ~ 34
1: •
 • Pulse ~ iJt
•+ Respiration rote
Blood pressure ~ Jj
13.0 FAMI LY PLANNING / REPRODUCTIV E HEALTH
• Weight
~ !I BASIC LABORATORY TESTS
• Height
~ !II These tests shall be carried out at various levels of core, where
Systemic Examination (if relevant and accepted ind icated , as facilities permit. However where facilities are not
b y client) ~ !IJ available for necessary tests, the client shall be re ferred
+ Breast
~ a ppropriately.
!II
+ Abdomen
+ Pelvic - speculum and bimanual ~ · !IJ TYPES
+ Rectal (Prostate examination) men for over 50 years I • Urinalysis (hot and cold) - albumin, glucose and acetone
~ · ~ • Blood for Hb, PCV, malaria parasites and sickling test
I!! · ~ • Pregnancy test
• Po p smear
~ l !li M icroscopy, culture and sensitivity (high vaginal I
endocervical swabs)
~ · ~
I
~ · !Ji
I
~ · ~
I
~ · !II

~ · !II
I
~ · !II
-I
~ · !ll
I
I! • !&
I­
~! • :&

I! !1.
Nigeria Notional FP/RH Service Policy_ ond Standards N igeria Notional FP/RH Service Policy and Standards

35 Ji !I
36
/ ~ !I
I
14.0 ELIGIBILITY CRITERIA FOR E · iJJ • History of allergy o r sensitivity to
FAMILY PLANNING METHODS
Diap hragm •• Intercourse is infrequent
No other contraceptive method latex rubber or spermicides

The following tables will guide the provider in assessing the

is available or acceptable Ia • Post toxic shack syndrome
client
eligibility of clients to use the various methods o f family planning. • Other contraceptives ore
unsuitable
METHODS WHO CAN USE WHO CANNOT USE • The woman's choice is
t Client's choice is influenced by • ADsence ol knowledgeable diaphragm
Fertility Awareness instructor to leach the client
Method religious or other personal
• Client is not motivated
reasons
• Client cannot understand
• Other methods ore unsuitable
now to use the methods
• Medical core is inaccessible
• Menses ore irregular (lor
• An inexpensive method is
calendar method)
required
• There is alteration of
cervical mucus e.g.
infections, erosions
• Immedia te postpartum,
post-abortion, during
breostleeding Mole Condom t Nan-prescription-type
Wno con use with caution t Allergy to latex (rubber)
• LAM cannot be used in contraceptive is desired • Inability Ia sustain
• IJ\M is not advisable lor HIV
clients treated lor some chronic t The mole wants to snore tne ereclion
positive mothers because of risk
illnesses such as hypertension contraceptive responsibili ty
of transmission from mother to
and diabetes (because of • No other contraceptive
child. However, il HIV + mother
presence of drug in methods ore ovo•loble or
chooses to breostfeed, LAM is
breoslmilk). acceptable to the couple
recommended.
• LAM con not be used in • Multiple sexual partners ore
clients treated for some involved
chronic illnesses • Bock up contraceptive for some
t Client does not wont to use • Allergy to ingredients of other methods, if required, or
Spermicides
systemic or other forms of the spermicides · dual protection
controception t Cervical or vaginal • Sexual intercourse is infrequent
• O ther methods ore not suitable
• Intercourse is infrequent
lesions
t High risk of STis
• Wonts STI/H IV protection

• There is need to enha nce the • HIV/AIDS: risk of HIV

effectiveness of the diaphragm
ond/ar col)dom
• There is lear !not other methods
may interfere with successful
lactation
• Emergency Contraception is
more effective than Spermicides
lor foiled withdrawal
• Medical personnel ore
unavailable or inaccessible to
initiate ather clinical methods
• There is a need to delay first
pregnancy.
transmission is increased
+ Its typical high failure
role makes it unsuitable
lor those whose health
will be endangered by
pregnancy e.g. in sicklers.
Female Condom • Non-prescription-type • Genital prolapse
canlroceptive is desired Vaginal obnormolilies
~ · s. • No other contraceptive
methods ore available or
e.g. septa, atresia/stenosis
acceptable Ia the couple
~ I i,
• Clients not eligible far IU D &
hormonal contraceptives
• Multiple sexual partners are
involved
t Bock up contraceptive lor same
other methods is required

Nigeria Notional FP/ RH Service Policy and Stondards Nigeria Notional FP/R_H Service Policy and Standards

37 38
Combined Oral t Adolescf!nls
• Pregnancy ,: ~ Clients·
Conlroc~ptiv~s t
t
Nulliparous worMn
Post portum (3 weeks if not breast
• Hi"ory of raised blood
pressure (Sys•olic above
Emergency + Of oil reproductive ages and + There ore no
contraindications lor
feeding) 140 mmHg and/or I! ~ Contraceptive' panty including adolescents
t Who hove just e~penenced rope, srngle use except current
•• Women wilh varicose ve·ns
Immediate Post-abortion diastolic above
or incesl severe mogroine hostory o 1
90mmHg). ~ !). t With contraceptive forlure e g deep venous thrombosis
t Any weight (lot or thin)
• Astlvno••c client
• HIStory of
cerebrovascular disease
brea~oge of condom, or m•ssed or thromboemboJ.sm
(stroke) ti !). pill
Women with these conditions can
use COCs with caution (I.e. being
• Hove coronary artery
disease (heart attock)
• Who hod unplanned sexual
intercourse
~- !)r
seen by physician)
t Oiabett'S mellitus (stabilised,
• History of pre-existing
tumours olthf! breo•l or
without kidney. eye o r vo•culor geoi!ol orgorn I! !),
disoose)
• Current or post Clients· • Breost ond genital
cancers
•
•
Severe headache• (migraine)
Epilepsy
thrombophlebitis (e.g
constant o nd severe poi(ls 1!: · !I • Of oil reproduchve ages
includ•ng adolescents and the • Abnormal vogrnol
bleedrng
•
•
Varicose veins {deep)
Benrgn breast disease {non
•
at the bock of the legs)
Ag!! above 35 years and
nulliparous
Who ore breostfeedrng, ofter 6
•• Pregnancy
OPpression
oestrogen dependent) smokes ~ ~ lnjectobles t
• I Irstory of stroke,
weeks heart attock or blood
t
•
Uterine lrbroids
Endometrio•is
• Breost leeding ~css thon e Progesti n t Desiring hormonal controcept•on clot problem
6 months post portum)
~ • !It t Who wonl to use o contracephve • H(perlension (systolic
• Existing liver disease.
(ioundice o r yellow eyes) method conl1den tiolly
o 160 mmHg ond
above and/or
• Gallbladder disease ~ ~
t In whom combined pills ore diostolrc o f I 00
mmHg and above)
• Use of rifompin or contraindicated
• History o f liver
anliconvulsonts
~
•
t
With sickle cell disease
With oestrogen rela ted
disease o r acute liver
disease
Progeshn Only Clients:
• or all reproductive ages and • Mononucleosis (relapsing
lever)
complica tions
• Diabetes with
vascular diseases
Oral Contraceptive ~ I I
parity (Adolescent and • Tuberculosis poflcnl on
•
Nullrporovs)
Breastlecdin~ (after 6 weeks)
rifampicin treatment,
• Combined Cl enls: • Pregnancy

• Wrth raised b ood pressure,

ontjconvulsonls
~ • Of oil reproduchve ages and • Breostfeeding of le.s
varicose veins or sickle cell • <6 weeks postpartum &
b<eostfeeding
{oestrogen
parity includrng null•porous
than 6 weeks post
onocmoo and progest:n) portum
• Severe libro•is of the "'er ~ I I women
t With oestrogen related side
effects • l iver tumo~ (benign & • Who wont hrghly effective • Gollblodder d•seose
• Desiring mrnrpills mortgnont) method ogornst pregnancy • Usong
•t or any weitl (lot or thin) • Thromboembolic ~ I 1
• Who ore breastfeedrng (6 anticonvulsonls or
Who fUSI od on abqrtron disorders rophompin
months and above)
Smokin~ c:igoretle
t
•• Beni9n roost disease
Hea aches
• Unexplained vaginal
bleeding ~ I I • Who ore post porlum ond • Unexptorned vaginal
bleedrng
not breastfeeding
• Iron deficiency anaemia • Breast cancer
• Acli•e liver disease
• Varicose veins ~ • Who ore post obortron
(viral hepatitis)
t Valvular heart disea se • With onaemro
• Over 35 years ond
• Sickle cell disease • With severe menstrual
who smoke
• PID ~ ' 11 cramping
• History of heart
• STis disease, stroke or
•
t
Heavy painful menstrual period
Uterine frbroid
~ I
li hrgh blood pressure
(> 180/1 10 mmHg)
• Epilepsy
~ I I

Nigerio No tional FP/RH Service Policy and Standards Nigeria Notional FP/RH Serv1ce Polocy and Standards
39 ai • 1

40
~ '.8
 • Gall bladder disease
• Woth orregulor menstrual
• Clients usong Anti­
cycles convulso!nls or Rilompico
• Who cannot remember to
• History of blood clotting
tole their p I every day problems or uncontrolled
d obetes
• Migraines and focal
neurologic symptoms
• Breast cancer
Controcephve
Implant • Wont long-term controcep­
• liver disease ijoundice,
toon po·nful or enlarged liver
• Wont hoghly ellect.ve v ral hepot:tis, tumour)
reversible contracept'on tnct
does not require dooly action
• Unexplooned vogonol
bleeding
• Are delaying the start of
tneor fam ily, hove completed
• History of blood dol in
the legs, lungs or eyes
their family or do not wont
• Cancer of the breast
~ •"li
Intra Uterine Devices
• Desinng chold spocong • Sus peeted pregnancy,
IP i_l • Prefers it and has no (Intrauterine or ectopic)
controindocohon • Mohgnoncy of the genolol
• For whom hormonal organs
~ ~ •
..
cor>trocep!•ves ore Abnormal vaginal
controindoco•ed bleedong of undetermoned
~ • Has completed ongon
ell dbeoring but does
not wish to hove
• Acute pelllic
inflammatory d•sea.e
~ il surgery (PID)
• Has menorrhagia of • TB pel..s
~
functional nature (use • STI/HIV 'AIDS
progestin bearing
IUD where ovooloble)
•• Chorioomnionotos
Prolonged premature
~ !)
Women who con usc
rupture of membranes
(for PPIUD only)
I!' !I
IUD with follow - up • History of acute PID

•
children
• Stroke • Chronic Pelvic (wothin the lost three
Require user-independent
• little tolerance for Inflammatory Disease months)
method m enstrual bleedong I! •!I • Recurrent heovy • Aller sephc obor1ion (i.e
• Hove completed their family irregu la rities periods (use IUD woth ommediotely alter
sizes but ore not yet decided
• Brea stfeeding< 6wecks
I!! !I
levonorgestrel aborti on involving
on, or ore not suitable lor
sterilisation
• On rifampicin or
griseo fulvin
• Cervicitis or cervical
erosion •
genital tmct infection)
Allergy to copper (for
• Cannot use estrogens
• On onticonvulsonts ~ !.1 • Severe anaemia (PCV copper IUDs)
less than 25%)
Women who can use with
follow-up visit I! ~ • Utenne lobrotds
(m01n ly sub-mucous
ones)
• Benign breast d isease
~ · ~ • Age less than 16 years
• Doobetes meilotus without
kidney disease
except tn special
corcumstonces
• Blood clothng problems I! !A • Nulligravida
• Roosed blood pressure
• Muft,ple sf!xuol
-
(systolic above 160 Mm Hg II! !l partners
or diostoloc above 1OOmm
• S ckle cell d·seose
Hg)
I! !I • Vascular heor1 doseose
• Epilepsy
.. • Clotting d•sorders
• Gallbladder disease (e•cessive bleedong)
• Mental depression ~ !I
• Headaches
• Sickle cell doseose
~ J..l
• Thyroid disease
• Obesoty
• Iron deficiency onoemio ~ !I
• Vorocose veins
• Benign ovonon tumours
nn..l lohrni..l, I! ~
Nigeria Notio nal FP!RH Service Policy and Standa rds Nigeria Notional FP!Ri l Service Policy and Standards
~ ~
4l 42
II: !)
 ••
Volunlary Surgical C:lient preference
Couples who do not Wom en Who Canno t Us e
Conlroc:eplton
wont more children • Pregnancy

• Clients with bod • Infection I

obstetric history. e.g • Genilol tract cancers I
severe pregnancy­ • Anaemia < < CDCOUO
nduced hyhertension,
those who ove hod 3 M en W ho C a nnot Use
or more repealed • Scrotal Infection "8
caesarean sections, and • Filadosos I Elephant osis ..
:;

•
trondmuhips) of the scrotum 0 ..
E
ouples with serious
• lntroscrolol moss >
..
-~
mherited diseases such
os haemophiloo • Client uncertain abo..t
the decision •!I u

• Systemic conditions Cl
£c
:! O < UOOU < .. COOCDO 0
such os severe kidney, u
lover or heart disease.
...g ~
• Clients lhot hove severe
mental ond physical
0 CD U OOO IIl 0
hondocops thoI make ,_
cor~in~ a pregna ncy or z
mol er ood o major
problem
...a:j <O< U << 0 u u uouo
0
• Conlroindicotions lo
temporary methods ..,
z

• HIV/AIDS
z 0 u 0 0000

Can use w ith f o llow-up zw

W omen : ....
IX
+ AJe less l hon 18 years u
(on yin special conditions) ...z
Ill uu uu uu 0 0 0 0000

• Has nol become

pre~nont s1nce PID
w
::;
(w1t out using u
controcephves)
•
ischoem•c/volvulor heart
d•seose
•Strokes

•••
Uterine l obroids
Obesity
Hypot'J.ro1dosm
•
Blood oseoses, e.g.
sickle cell disease
oo u ouu u u 0 0000

•
Anoemios ( inhented,
iron defoc1ency, onaemio
woth lib of 7· 1Ogm/dc)
• Epilepsy
Can u se with follow-
M!:en
• w1th diabetes 0
If")

Nigeria Notional FP/RH Service Policy and Standards

43
 ~ ~
17.0 CLI ENT SCREENING : SPECIAL O N SI DERATI ONS

.,.. i! !)
:r.,;c:x~} r-rrn:
"'•; ,. :;.., ~__~~
1'1 • Screening shal l include the following services Pap
~~ ~ ~ ~ ;;
)(

<

.. ..,.• ...z
~ ;)
,.z
i .....
,.,. c 0
n
n • )> ;II:
.. "'

•
3 0 ....
., rn
o cn
3: ll: "'
,.z.... :;:~~
........
smear, colposcopy, gynoscopy
..•
!"
c
• 0

• •
'<
•..... a ""'
5(1)
6
z
0
~
• For diabetic clients, it is advisable to perform
• I I I
"'' random and fasting blood sugar before providing
.
I I I
.J
~
••
..!!. !- I:; .. •..; ..•
,. Ci
~ · !)
hormonal, surgical, or IUD to assess the degree
3 z :; 0 3
• ! .,.a
.. .,a •~
~
:;
a a
.,. •
a ;!
of the control o f the d iabetics
~ ii.,. 3 ~

<~~~~
c n
• 3 ~~
..... : • Fo r clients with raised BP, blood pressure
7
•• ~ ii ~
0
~ !!.
.,.,a •...:>
ii" oonn ~ 0 ~ on
:; ~ a
...•ii: ;... ~

.,.... •;"...
c
...
:> measurement is mandatory prior to initiation and
;; '"0 .,• !!.
ft
0 z
1
,.!!: nln O"
., ~ ~ ~ ~
•
~
;
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noon ~
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re-supply of hormonal methods and prior to
• •! G!
ft
; ; ...
:>
provision of sterilisation
~I!
c
......
0
= o·
3 D
I! !I
..
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j
ii
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~ 0 • The combi ned ora l con traceptive (COC) a nd
~ 0 ;· on no mn nom Q
(")
,g·
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ft
0
.. combined injectable contraceptives (CIC) ore not
(I)

... ...
0
.,.. ..3
~
a . 0
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.,a
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;;<) "T1 the first cho ice for clients with sickle cell disease
" c :>
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"
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;. Nigeria Notional FP/RH Service Policy and Standards
...
0
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18.0 POST-ABORTION SERVICES

Trained service providers at the appropriate level of service delivery shall provide post-abortion care

LEVELS

B.aslc Health Comp,....hensive General HospiUI Specialist / Tenlary

Community Health
post Health

ACTIVITY/
TBA CHEW N
/MW
I CHEW CHO.
PHN
N/MW PHY CH().I N / MVV
PHN
PHY OBS NIMW PHY OBS

PROVIDER
0 0 0 0 0 0 I 0 0 0
Regoslration + + + + + I

.. .
+ + + + + +
HistO<y + + + + + + I + +
+ + + + + + + +
Physocal Exam
Ot:>st El<am
0
0
0
0
+
+
+
+
+
± I + I . + + + + +

+ + + + + + 0 + +
Vagonal Exam 0 0 + + ±
0 + + + + + i + + + + 0 0 0
Lab 0
+ + + + + +
Resusc~atoon 0 0 + + + + + I +
Referral
Mgt o/ complications
+
0
+
0
+
+
+
•
+
+
+
+
+
+
l . .
+ + +
+
+
+
+
+
+
+
0
•
useofMVA
FP Counselling and
0
+ l
0
+
+
+
0
+
0
+
+
+
+
• I
I
::
+ .
!: +
+
+
.. ±
+
+
+
+
+

seMCes

Key
0 • No PHY • Phys1C1311 CH().PHN • Convrunoty
Yes NJMW = Nurses/Midwife Health Otrcer
= : 'Mlere Traoned 1 Competent to perfonn OBS z Ot:>stet11C1311 / Gynaecoklgost wtUt Pul:>lic
CHEW • Communoty Heahh Extensoon Wor1Cer Health Nurse
N/Qenan National FP/RH Service Policy and Standards

48
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23.0 FUNCTIO NS OF REPRODUCTIVE HEALTH CARE ~ ·~
All of the above plus
I! ! ~
Physicians/Specialists
PROVIDERS • Voluntary Surgical Contraception (if trained)

• Management of method failure

<;fRVIO PROVI[)[R fUNCTIONS li !!a • Management of sode effects ond comphcolions of
contraceptives
CBD!TBNPotent • Counselling clients on family planning metnods,
• Definthve management of Reproducl.ve Health condition
Med cme Sellers STis/HIV ond onlerti ;ty prevention t! · !t such os infertolity and cancers of reproductive organs
• ln.t.ote ond supply borrier me~hods (except d ophrogm)
• Re-supply pats
• Refer cloents requesting other methods os necessary
• Perform oclivoties of sole motherhood core especially
those that will help to overcome the three levels of de oy ~ · !)

~ I' !I
• Counsel ond refer clients witn other reproductove health
problems e.g complications of obor'oon, onlertility, STD,
victims o f unprotected sexual intercourse
• Record keeping ond reporting
• And ony other Reproductive Health lunchons approved
by the Minostry of Health
~ ~ !I
Pharmacists
All o f the above plus ~ ~~
• Emergency Oral Contraception (os slated in the
CHEWs
•
Notional FP/RH service protocols
And ony other Reproductive Health functions t! i ~
approved by the Ministry of Health
1! •!.1
All of the above plus I
~ · !I
Nurses • lnohote and re-supply pills
• Admonister onjectobles
• And any other Reproduchve Health funchons
oppro·1ed by the M:nistry of Health
~ ·~
'vlidwoves/Fomoly
Plonnong Nurses
All of the above plus I! · !I
• lnsert'on/Removol of IUD fo! trained)
CHOs (PHN)
• Insertion I Removal ol Implants (if trained)
~ ~
• First lone management of side effects and
compltcohons
• Post-oborhon core includmg Manual Vacuum
Asporotoon (MVA) (if trained)
• Prevention and Monogemen! of RTI including
STis/HIV/AIDS
• Operaloons research
• Any other Reproductive Health functions approved by
the Minos lry of Health
~!; · ~

It · ~
I .
~ ·~
Nogeria Nato.:-nal FP/RH Service Policy and Standards
I[ ! ~ Nigeria Na tional fP/RH Service Policy and Standards

61 62
e.· .I !..
:•

I
 ~ I~
24.0
''
TRAIN ING REQU IREMENTS BY TYPE OF Phormocisls, CHEWs All o f the above, plus
HEALTH CARE PROVIDER ~ ·~ • Adolescent reproductive health
S[RVICE PROVIDER TRAINING RlQUIREI,\ENTS • Emergency oro! contraception

CBD/TBNPotent
~ !1
medicine sellers • Bos•c Human Reproduct"e Anatomy on
Nurses , CHOs
Physiology
~ !l All o f the above, plus
• Antenatal core [Rosk assessment), support lor
household productio
• Physical examination skills for FP/Reprod~o~ctive Health
(especially recognition of RTis ond reproduchve system
• Rot•onote lor Family Pla.,n•ng ~ !l cancers)
• Types of Family Planning methods
• Doognosis and Management of Reproduchve Tract
• EC and Counselrng s~1lls Infections, including STis ond HIV/AIDS
• Breast Exorninoloon t Supervision, Momtoring & Evoluotion of services

..
• General counselling
Method specific counselling
And any other subjects os per pre·service curriculum

.
..
Counselling on 5Tis/HIV/AIDS
Dual pro'ecron
Ado escenl health
MidWIVes/Family All of the above plus

0
Menopause
Cancers of the reproductive system
Plannong Nurses, CHOs
(PHN) • .
Antenatal core
Risk assessment

..
and breast
Infertility and RTis
Breast Exommo tion
..
• Tetanus toxoid immunisation
Breast examination
Identifica tion ond referral of
• D•spetling rumours ond m•sconcephons on family pregnancy compl'cohons

•
p onning and reproducl ve heo''h
Promof1on of exclusive breastleed'ng in the 1sf 6
months
• ..
labour ond delivery
Use of portogroph
Active management of labour
• Screening lor oppropriote contraceptive methods
using o checklist ond referral procedures
including breech
• Vacuum extroction
• Prevcnt1on and control of infect•on, mcluding STts/ • Episiotomy repoir
•
HIV/AIDS
M~>nopouse .
• Manual removal of placenta
Resuscitotion of mother ond/or neonate
• Prevention of inlerhl1ty • Postnatal care
• ldcnhl1cahon ond referral of clients w1th obortoon
and pregnancy related complicohor1s
• Initiation of breostleedlng
• Core of the neonate
• Family Planning Commodities and suppl•es/logistics
management
• Prevention and management of unsafe abortion:
use of MVA, emergency treatment of abortion
• R~>cord ~eeping ond reportmg comp!.cotions, counsell~ng and provis•on of
• Oral Rehydration TheroP)' posl·obortion, contraceptive method of choice
• Prevention o nd Trtoatment of malono • IUD insertion and 1emovol
• Immunisation. promotion • Implants insertion ond removal
• D•scourogement of harmful prochces that affect • Referral lor other Reproductive Health services
rpproductive system e.g Female gcnito• mutiloron
• And ony ot'oer subjects os per e..s•ong curricula
CBD supervisor
• All of the above, plus supervision

Nigeria Notional FP/RH Service Polqond Sta ndards N;gerio Notional FP/RI I Service Pol;cyond Standards

63 64
 II l!}
IE I

• ..
Screening lor cancers of reproductive system :
Unaided visual inspection
I !)
~ I]
Obstetrician/Gynaecolo­
gist
All of the above plus
t Specialised management of infertility
Gynoscopy Tubal microsurgery/Endoscopic surgery
• Management Information System (MIS)
E 'itI 1 Myomectomy
• Clinic organisation and management loporoscopy and hysteroscopy
• Quality assurance of reproductive health services
~ I~
Assisted conception techniques
• First line management of side effects and complications
of contraceptive methods
• Artifici al insemination
t Specialised management ol cancers of the
• Operolions research: dolo collection, basic dolo analysis, E I:!) reproductive trod
interpretation and application of results Cone biopsy

Physicians
And any other subjects os per pre-service curricula
~ ! !) Cryotherapy
Abdominol/voginol hysterectomy

•
All of the above plus
low cavity forceps delivery ~ I_! :~ t Repair of obstetric lisluloe
Repair of uterovaginal prolapse
• Caesarean section t

• Evacuation of the uterus using MVA or

~ ~ :1
t Amniocentesis

..,.
dilatation and curettage (D&C) t Chorionic villus sampling
All of the above
• Endotracheal intubation of the neonate
~
t

• Cut down procedures done when it is difficult to

access the veins
- ,~

•
•
•
Emergency laparotomy (e.g. for obstetric hysterectomy)
Miniloporotomy Sterilisation
Vasectomy
~ i:l
• Screening and management of breast and ~ ,~
reproductive tract cancers (pop smear, PSA etc)
• Management of infertil ity: evaluation of infertility
(including HSG, loporoscopy/dye lest, endometrial ~ ~ :a
biopsy, semen analysis), induction of ovulation
• Management of side effects a nd complications of
contraceptive methods including method failure
l: i!l

...
• Management of high-risk pregnancy
Pregnancy- induced hypertension f: i!l
Diabetes in pregnancy

. Hearl disease in pregnancy t, ~ ~~

Rhesus isoimmuniso!ion
• Anaemia in pregnancy
e ~~
• .
Complicated deliveries
Craniotomy
And any other topics as per undergraduate and/or
postgraduate curricu la ~ ~ ~~
t: · ~
~ Iii
t I· ~­
Nigeria No tiona/ FP!RH Service Policy and Standards Nigeria Notional FP/RH Service Policy and Standards
65 E ~~ 66
~ ·!I
I
 t;l~ 3. Training Materials package
2 5 .0 LIST OF REQUIREMENTS FOR EFFECTIVE
TRAINING CENTRE
~La + Standardised, integrated, comprehens ive and
competency-based curricula for the oppropri ote

1. Training Centre Facilities ~ L. types of training e.g. modules, manuals, refe r­

ence materia ls
+
+
Conference room with appropriate furniture
Meeting rooms for group work (up to 4 groups)
~t~ •
•
Service policy and standards
Notional FP/RH Service Protocols
•
+
Washrooms
Kitchenette
~ l!l •
+
Training sched ule
Handouts
+ A ir conditioning ~l!l + Stationery

~lJ
+ Good lighting 4. Practicum Sites
+ Screen
+ Accessible

~~
+ Overhead proieclors (2)
+ Adequate space
+ Slide p rojectors (2)
• Adequate client load
• TV and Video-CosseHe Recorder (VCR)
+ Adequate equipment/supplies
+
+
Fli pcharts/eosel board (3)
Camcorder
~ra + Adequate number of clinical instructors
~ r!J. + Anatom ical models
+ Radio-cassette p layer
+
+ Anatomical Models (pelvic, pe nis, breast, mole and - 1,..
R:: r!.a
IEC materials for client education

+
female reproductive system)
Posters
I_ 5. Fun ds
I! ..-~. + Adequate funds to meet all expenses

~lia
+ Public address system
+ Photocopying machine
+ Desktop computer with p ri nter
+ Telephone I fax
- j:a
~ j~·
+ Reference library
+ Transport facility ~ i~
• First Aid kit
f: i ~
2. Personnel
+
+
Adequate number of effective tra iners
Logistic Officer
i
li! ~.
+ Secretaria l Stoff t: •!J4
~ ,...,
- 1:..

t: ! ~
~ ' !II
Nigeria National FP/RH Service Policy and Standards
Nigeria National FP/RH Service Policy and Standards
68
~ I' ~
67
 26.0 LOG ISTI C STANDARDS I
JIP ~:t
STANDARD EQUIPMENl' AND SUPPLY
BY SERVICE DELIVERY POINT i:L, + Stationary

Community level ~ L. +
+
Registers
Files

~ ~~
+ IEC materials
Contraceptive supplies
+ Out-patient cords
+
+ ID cords
+
~ L1
Container for storage o f s••• plies
+ Radio cassette p layer with audio cosselles
+ Carrier Bog

~ !~
+ Wheel chair
+ Megaphone
• Trolley
+ ID cords

~!!.J
+ Height measure
+ TBA kit contents
+ Gynoscope
+ Mackintosh sheet
+ Mackintosh apron ..:'­
~ i ii
+
+
Cheatle forceps and instrument jar
Oxygen cylinder, regulator, mask and tubes
• Soap dish with soap
+ Wall clock
•+ Hand towel
2 medium plastic bowls
~j!l + Exam ination table with stirrups
+ Pedal bin
•+ Blade (pkt)
Cord ligature
~ ·!I
-I • Angle-poised lamp/torch light with batteries
+ BP apparatus/stethoscope/
+ Cotton wool in a bog ~i~ foetoscope (sonicoid and Pinnord's)
+ Dettol or sovlon (in bottle) + Weig hing scales
•+ Methylated spiri t (i n bottle) ~ j~· + Screen
Bleach (Hypochlorite 0 .5%) +
I! '!J. Wooden steps/stool
• ORS sachets
-1,. + Instrumen t troy
•+ Gloves
Er·gometrine tabs t!i ~' + Hand wash basin/sink
t Storage tonk with top
+
+
Penis model
Record forms
£ i ~• + Soap/detergents
• Bed li nen/pillow
•+ Referral cords
TBA record book
~ j ~· + Sterilisers
• Disinfectant
+ Checklist
~ i ~' + Arm length gloves
Basic H ealth Centre level t: ' ~­ + Gloves
+
+
Furniture e.g. filing cabinet/cupboard
IEC material
..~ I.j ~· +
+
Face mask
Dressing
+ Bowls for chlorine solution
Nigeria Nalional FP/ RH Service Policyond Slandards t: i ~~
69 ~;- i!I. Nigeria National FP/RH Service Policy and Standards

70
~.~ · !:&
 ~ •i.a,
• Mucus extractor
• Ambu bag ~ !!), • Suction machine
• Resuscitation kit
~ !!t, • Infusion pump
• Instrument drum
• Autoclave
• Urine testing kit
~ !i). • Theatre table
• IUD kit
• Theatre light

~'it
• Contraceptive supplies
• Surgical gowns
• IV Infusion set and drip stand
• X-ray
• i! ~!). •
Syringes & needles Blood bonk
• Essential drugs
• Sponge holding forceps
•
•
Delivery kit
Sanita ry pods
~ !~ •
•
Artery forceps

~ l~~
Antibody Test Kit
• Cotton wool
• Genera l Hospital Level

~.
Microscope, slides and cover slips and
reagents All of the above plus
t •
• Vacuum extractor Laparoscope and specialised equipment

• Bacteriology swabs
t: l!t. • Ultra-Sound Scanner

• Generator/hurricane lamp • Colposcope

• Cervical screening kit t; r~• • Amnioscope

.~ I!~.
• Refrigerator
• Hysteroscope
• Stove
• Co rdiotocograph (fe tal monitor)
• Lamp stand
~ r~
• Hypochlorite solution Specialist I Teaching Hospital Level
•
•+
Oxytocin
ARVs
~ L,~ •
All of the above, plus
Computerised Axial Tomography Scan
Misoprostol
r:. l!t. • Bone scanner
Compre hensive H ea lth Centre Level • Radio lmmuno Assay
All of the above p lus
i
t: !J. • Assisted conception equipment
• TV and Video Cossette Recorder (VCR) • Sperm bank

• Video Cosselles t •!J. • Amniocentesis and Chorionic Villus

• Implant Kit
t !!J. •
Sampling ·equipment

• MVA Kit (2)

•
Magnetic Resonance Imaging

• ~ ' !J
Minilap Kits (4) Endoscopic (Tuba l) Surgery Equipment/
Tubal M icrosurgery Equipment
• Emergency laparotomy kits (2)
• Anaesthetic machine (2)
~ J_
Nigeria Notional FP/ RH Service Policy and Standards Nigeria Notional FP/ RH Service Policy and Standards

27.0 MANAGEMENT INFORMATI ON SYSTEM
Officers responsible for data collection and types of forms
required at each level of family planning/reproductive health
service delivery.
Co mmunity level
+ The TBA/CBD, VHW, CHEWs, Agent shall collect
reproductive health information in his/her record book
and forward some to the health facility under which he/
she operates monthly.
State Level
• The Stale FP/RH Coordinator shall hove responsibility for the
collection of the monthly return forms from the LGAs which are
used to complete the quarlerly repor1 forms for onward
transmission to the Zonal Office of NPHCDA. In addition, the
coordinator shall complete the following:
• Requisition and issue forms
Zonal Level
• At the zonal level, the NPHCDA Coordinator receives and
collates data from the stole within the zone and forwards semi­
annual returns to the DCDPA for lunher processing.

LGA Leve l
Non-Gov ern mental Organisations
+ The officer-in-charge of each health facility shall collect
data using the following standard forms: + All non-governm ental organisations, including private sector
practitioners, shall submit their completed service dolo collection
• Client Forms/Cords forms to the LGA/Stotes in which they ore located
• Tolly Cords
• Doily Registers DATA ANALYSIS AND REPORTING
• Family Planning Monthly Returns Forms
• FP Doily Consumption Record Forms + All service providers shall collect data, analyse and repor1
• NHMIS Forms periodically as indicated below:

+ The officer in-charge of MIS at the clinic will use the

!I Community- monthly
information obtained from the above forms to complete • LGA monthly I quarterly
the monthly FP returns and forwa rd the completed form(s) • State monthly I semi-annua lly
to the LGA FP/RH supervisor. • Zona l I Notional semi-annually

The LGA FP/RH Supervisor collates all returns from the health
facilities into the LGA monthly returns forms which are forwarded
to the State RH Coordinator.
Nigeria Notional FP/RH Service Policy and Standards
73
• Officer receiving reporls shall send feedback to service providers
as indicated above through the established channels.
+ Data collection receive regular feedback concerning the data
they provide
Nigeria Notional FP/RH Service Policy and Standards
74
 ~
I

·•
.•
28.0 SUPERVISION, MONITORING, EVALUATION ·'
AND RESEARCH 5I ,.
• Determining the adequacy o r otherwise of reproductive health ~
resources (human, material and financial)
t Ensuring provision of services according to set standards io \.
t Conducting training needs assessment by use of performance
assessment instrument (e.g. competency based checklist) and ~ ':·•
~ ~~·
provid ing on-site training where applicable
• Examination of stored contraceptives, other supplies and stock
cards for the purposes o f reconciliation with the reco rds [. !4
• Ensuring compliance wi th work plan

~ >·
• Technical supportive supervision
I

Supervision responsibilities and activities at different ~ >4

levels of service de live ry (
l.Pv'El 'M-0 Vvt-\AT I-ON Vvt-EN ~ ,(>·
CcnYf'U'Ii'y 1-Wdbasic I Pofonnnco I . GJid:n:e a-od
..
.. ..
te.d hedih cerlte objcdivcs: lrcirirg M:w'll-ly ~ ,.
.lcb cboiplion (
TaJc a-od Tag>~ 2 As.sisbla! ,.,~,
r~a-od ~
2 fh,<sicd kx:ifi'"' lcgstia (
~
3. Kro.JccW ood
skills
OCCood
Co..nsdling
ScMce ilir..ey
3 l'd.'OCDC:)'
suppa1ood
..~ ~
•II
..
(
(

4. l.c9~ ood supplies

~ ~· (
~

5. Cqx.jtybuildrg ~ ~·
6 Rcc:crd h,.,P rg crd ~£ :•
rt'PO'~eoclxrl
Bosicood LG\fP/RH

~~ '~··
Corprdlensive ~SO" h dx>.oe hdx>.oe k. dx:>.. . ,.
G:rie
G:n>.ru ooc~ s:DeRH
SpJciciist
1-bPtci
Cocrclrdor hdx>.oe k.dx>.oe Q.oo1e<ly
..
~ ;oo·
Nigerian National FP/ RH Service Polley and Standards

75
\

E ·•·