| Organization | Lafiya |
| Location | Sokoto, Kebbi, Jigawa, and Kano states, Nigeria |
| Amount | $1 million |
| Approval date | March 2026 |
| Funded by | Unrestricted funds designated for grantmaking |
Summary
This grant will fund Lafiya to train nurses, midwives, and community health workers to provide family planning counselling, short-term contraceptives, and referrals for other methods in northern Nigeria, where modern contraceptive use is among the lowest in the world.1 We expect the grant to increase the number of women who can act on their decision to delay or avoid a pregnancy and allow us to learn more about the impact of community-based family planning.
Published: September 2026
The challenge this grant addresses
In the rural communities of northern Nigeria where Lafiya works,2 few women use modern contraception, even though many want to avoid or delay pregnancy. The 2023–2024 Nigeria Demographic and Health Survey found that in the states where Lafiya works,3 11%-26% of married women want to avoid pregnancy but are not using contraception,4 and 3%-11% of married women are using modern contraceptive methods.5
We think this gap may be driven in part by a lack of sufficient and reliable family planning supplies, and lack of information about family planning.6 For example, in Lafiya's operating states, stockouts appear to be widespread: depending on the commodity, an average of 23% to 45% of facilities in each state were recorded as experiencing a stockout during the two-month periods for which we had data.7
How this grant could help
Lafiya is a nonprofit founded in 2021 and incubated by AIM (Ambitious Impact) that focuses on last-mile delivery of family planning services in northern Nigeria.8 It recruits and trains midwives, nurses, and health workers, working in the communities where they live, to counsel women on family planning, distribute a limited set of contraceptives, and make referrals for other methods.9 The community-based workers, known as Lafiya Sisters, receive a small stipend and a bonus for each counselling session.10 As of early 2026, Lafiya reported working with approximately 470 Lafiya Sisters across more than 200 government health facilities in four Nigerian states.11
This grant provides unrestricted funding to support Lafiya’s work in 2027 and 2028,12 including:13
- Continued and expanded delivery across Sokoto, Kebbi, Jigawa, and Kano states
- Procurement of contraceptive commodities, primarily Sayana Press,14 a self-injectable long-lasting method15
- Working with state governments on cost-sharing arrangements for commodities16
- Monitoring and evaluation, including spot checks and reconciliation against government facility records
We think that increasing access to modern contraception in low- and middle-income countries has a range of potential benefits including averting maternal mortality from unintended pregnancies and improved health for women and children. For more on how GiveWell currently values increasing access to modern contraception see here.
Our reasoning
We think this grant could be highly cost-effective, because modern contraceptive usage is extremely limited in the areas where Lafiya works, its community-based distribution model plausibly addresses obstacles to access, and the contraceptive methods it provides are inexpensive.17 Our rough back-of-the-envelope calculation estimates that the grant is 14 times more cost-effective than our benchmark, which clears our funding threshold.18 We expect that this grant will result in approximately 260,000 additional couple-years of modern contraception.19
We think that Lafiya’s program is likely to reach women who would not otherwise have access to modern contraception and may have other benefits.20 A quasi-experimental evaluation that Lafiya commissioned found that contraceptive prevalence rose 39 percentage points more in areas where Lafiya worked and that 55% of the women reached by Lafiya reported not having used contraception previously.21 There are significant limitations in the study design (as described below), but the results are encouraging.
We also think that the grant will provide us with important information about community-based family planning delivery. Family planning is a relatively new area for our grantmaking. We expect to learn more about a number of questions, such as:
- Whether Lafiya's community-based delivery model can sustain impact and cost-effectiveness at scale, or whether it seems that growth comes more and more from women who would have likely accessed family planning commodities anyway, or who had a low risk of pregnancy
- How Lafiya’s community-embedded approach compares to MSI’s mobile outreach model, which uses a strategy of small teams visiting targeted communities periodically
- Whether the cost-sharing agreements Lafiya is negotiating with state governments lead to commodity procurement
Monitoring and evaluation
We will assess the impact of this grant primarily by reviewing Lafiya’s own monitoring data. Lafiya operates a digital monitoring system that uses metadata to check counseling session length and location, reconciles stock against reported sessions each week, has data verification officers conduct spot checks, and triangulates its records against government facility registers each month.22
We plan to track Lafiya’s progress at signing new government cost-sharing agreements, request an update on Lafiya’s efforts to strengthen its monitoring and evaluation practices, and review the progress we make on our learning agenda. Lafiya told us it plans to commission a process evaluation, and we will request findings when they are available.23
How we could be wrong
Our key uncertainties about this grant include:
- Lafiya is a new organization running a new program, and the evidence base is limited. The main evidence for its impact is a study Lafiya commissioned, which is encouraging but has only limited, noisy evidence that treatment and comparison areas followed similar trends before the program,24 was designed with Lafiya's input,25 and tested a more intensive version of the program than Lafiya may run at scale.26 We're also unsure how much of the contraception Lafiya distributes is genuinely additional, since Lafiya Sisters are paid per counselling session and may focus on the women easiest to reach, such as those already visiting health facilities, who might have accessed contraception anyway.27 Lafiya has monitoring checks in place (see above), but we don't know how reliably they detect this.
- We are unsure how much of the increased contraceptive use reflects women’s genuine preferences. While Lafiya Sisters provide information about a range of methods, they mainly carry Sayana Press,28 so women who would prefer another method, particularly longer-acting methods, may have to travel elsewhere to get it. This may lead some women to accept Sayana Press even if it is not their preferred choice.29 Separately, Lafiya tracks doses distributed as a core success measure, which could create informal pressure to encourage adoption. However, Lafiya pays for each visit rather than for each dose distributed,30 which guards against the most direct incentive to encourage women to accept contraception. We plan to review Lafiya's monitoring practices during the grant period.31
This page summarizes our research at the time of approval and was reviewed by the grant recipient.
Sources
- 1See Our World in Data, Share of women using modern contraceptive methods, 2024.
- 2"Lafiya currently operates in four states in northern Nigeria, bringing high-quality family planning counselling and products to women in rural communities." Lafiya, Lafiya's current funding gap, 2025.
- 3"Now we have officially crossed over 50,000 doses distributed to tens of thousands of women across Jigawa, Kebbi, and Sokoto…The entire Lafiya team is tremendously excited to bring our model to Kano, the largest state by population in the country and the pride of Hausa Northern Nigeria." Lafiya, Lafiya's Summer of Impact, 2025.
- 4The full definition used by the Nigeria Demographic and Health Survey for this category is: "Unmet need for family planning. Percentage of women who (1) are not pregnant and not postpartum amenorrhoeic and are considered fecund and want to postpone their next birth for 2 or more years or stop childbearing altogether but are not using a contraceptive method, or (2) have a mistimed or unwanted current pregnancy, or (3) are postpartum amenorrhoeic and their most recent birth in the past 2 years was mistimed or unwanted." Nigeria Demographic and Health Survey 2023–24, p. 21
- 5Nigeria Demographic and Health Survey 2023–24, Table 9: Need and demand for family planning among currently married women and sexually active unmarried women, p. 22.
- 6"Many of our users report fear of side effects, fear of infertility, and lack of any education of family planning as the reasons of their previous lack of FP usage." Chmielowska, "Introducing Lafiya Nigeria," EA Forum, 2023.
- 7Lafiya has shared screenshots from Nigeria Health Logistics Management Information System (NHLMIS) with us that show the percentage of facilities in Sokoto, Kebbi, Jigawa, and Kano which experienced stockouts for specific family planning products in three two-month periods. We have summarized the data shared with us in our Family Planning Stockouts Summary. As a rough indication of the scale of stockouts, we calculated a simple average across all states of stockout rates for each commodity. This ranged from 23% to 45% across the commodities for which we had data.
We did not independently investigate how NHLMIS defines a stockout or how long recorded stockouts persisted. For example, a facility recorded as having experienced a condom stockout during Sep 1–Oct 31 may have been stocked out only briefly, or for most of the two-month period. Additionally, we do not have per-state facility counts, and weighted all states equally in this average. These figures therefore should not be interpreted as the probability that a given method is unavailable at a facility on a given day. We use them only as a rough indication of how commonly facilities were recorded as experiencing commodity-specific stockouts over these periods.
- 8
- "We launched in 2021 and were incubated by Charity Entrepreneurship [now Ambitious Impact] in 2023." Kamsteeg and Chmielowska, "Lafiya's current funding gap," EA Forum, 2025.
- "This gap [in family planning commodity usage] persists not due to low demand, but because existing supply systems face significant inefficiencies that limit consistent availability of family planning commodities at the last mile, particularly in hard-to-reach or underserved areas…To address these access barriers in a scalable and cost-effective way, we designed an approach centred on community-based last-mile delivery." Lafiya, Lafiya’s 2024 Review, Updated CEA and Plans for 2025–2026, 2025.
- "Now we have officially crossed over 50,000 doses distributed to tens of thousands of women across Jigawa, Kebbi, and Sokoto…The entire Lafiya team is tremendously excited to bring our model to Kano, the largest state by population in the country and the pride of Hausa Northern Nigeria." Lafiya, Lafiya's Summer of Impact, 2025. Jigawa, Kebbi, Sokoto, and Kano are all in the North West zone of Nigeria.
- 9
- "We recruit "Lafiya Sisters" from existing local networks of nurses and midwives who were chosen by their communities to receive a 2-year healthcare education. Then we upskill them in FP counselling and administration, and equip them with Sayana-Press contraceptives, which they routinely distribute to rural women while working in health clinics and informal community settings." Chmielowska, "Introducing Lafiya Nigeria," EA Forum, January 2023.
- "We have recruited, trained, and now supervise 300 existing government midwives, nurses and community health workers as paid ‘Lafiya Sisters’." Lafiya, Case for Support, 2025.
- Lafiya have told us that they train Lafiya Sisters not to indicate that the contraceptive they have is Sayana Press until after the client chooses a method; if that choice was for Sayana Press, the Lafiya Sister will provide it, and otherwise will refer the client to another provider or pharmacy. Lafiya, conversation with GiveWell, March 2025 (unpublished).
- 10
- "We recruit existing community health workers, on government payroll, and give them specialised training in family planning and a small additional stipend." Kamsteeg and Chmielowska, "Lafiya's current funding gap," EA Forum, 2025.
- Lafiya have additionally told us that they provide Lafiya Sisters with a bonus based on the number of counselling visits. Lafiya, conversation with GiveWell, February 2026 (unpublished).
- 11
- "We have recruited, trained, and now supervise 300 existing government midwives, nurses and community health workers as paid ‘Lafiya Sisters’. They work across 200+ government health facilities." Lafiya, Case for Support, 2025, p. 5
- Lafiya told us in February 2026 that the number of Lafiya Sisters had increased to 472. Lafiya, conversation with GiveWell, February 2026 (unpublished).
- See Lafiya Reach Data; in January-February 2026, counselling sessions were being held in Jigawa, Kebbi, Kano, and Sokoto.
- 12The grant covers about 15% of the organization’s remaining funding need for 2027 and 2028, based on Lafiya 2027 and 2028 budgets (unpublished).
- 13These are the expected uses of funds stated at the time of approval based on our conversations with Lafiya and the 2027-2028 budgets they shared with us. Because the grant is unrestricted, actual allocation may differ.
- 14
- As of October 2025, Lafiya told us that they had recently trained all Laifya Sisters on usage of an expanded method mix. At that time Lafiya was still providing Sayana Press only, and Lafiya Sisters would only be able to administer other methods if supply was available at a public source or if clients brought commodities for help in administering. Lafiya, conversation with GiveWell, October 2025 (unpublished).
- As of March 2026, Lafiya told us that "Lafiya Sisters have started the distribution of other commodities, but the volumes are low…stockouts have increased, and many products are unavailable in the health clinics where Lafiya Sisters are linked." Lafiya, Lafiya responses to final batch of questions, 2026 (unpublished).
- 15"Sayana Press, also known as DMPA-SC, is an easy-to-use injectable contraceptive for women. Sayana Press works by preventing ovulation, and provides contraceptive cover for at least 13 weeks." Lafiya, What is Sayana Press?
- 16"We scale by working with governments to execute, pay and take ownership of the model. We get states to commit budget to family planning by matching with philanthropy, increasing the available budget for family planning commodities." Lafiya, Our Work.
- 17We estimate that it costs about $7.10 to provide one couple-year of protection, based on Lafiya’s projected 2026 budget and the number of doses of Sayana Press they intend to distribute.
- 18Our funding threshold was 8x at the time of the grant decision in March 2026. For more information on how we value contraception-related interventions, see our page here.
- 19Couple years of protection is a metric used in family planning to estimate the total contraceptive protection provided to a population during a one-year period. See the calculations in GiveWell, BOTEC of Lafiya, 2026.
- 20Our cost-effectiveness estimate captures only Sayana Press distribution. Lafiya's expansion into additional contraceptive methods could generate benefits we don't model (though it is possible women would mainly switch methods rather than gain coverage). In addition, we think its advocacy for domestic commodity financing and its supply chain work could also improve government systems beyond Lafiya's direct delivery.
- "We share data with the government to inform more accurate national projections of contraception demand." Lafiya, Our Work.
- "The reason we are putting so much effort into this process and getting to know the state processes so intimately is that we want to ascertain that this cost-sharing will lead to longer and larger monetary commitments; we want to truly embed this commitment into state structures." Lafiya, Lafiya responses to final batch of questions, March 2026 (unpublished).
- 21
- "Lafiya increased uptake of modern contraception from 2% to 56% in only 8 months, and to 72% at 18-month follow up. This was based on an evaluation with a difference-in-differences design conducted in Sokoto state from 2024-2025. This represents a statistically significant 39 percentage point increase over the counterfactual (what we can assume would happen without Lafiya if other health system activities continued)."
- "55% of users are first time ever contraceptive users."
- Lafiya, Our Work, Field Study section. See the endline results of this study here.
- 22
- "Data Verification Officers conduct structured interviews with randomly selected clients to ensure counselling is done to a high standard. Questions in this interview include whether clients are informed about side effects, took contraception voluntarily and free of charge, and whether information about various methods has been accurately given. If any of the questions in the spot check is answered with ‘no’, this triggers a deeper check into this Lafiya Sister’s data and she will receive an additional mentoring session….We cross-check reported sessions with the stock provided to each Lafiya Sister on a weekly basis, to ensure these reported counselling sessions are consistent with the number of doses that are distributed. When discrepancies arise, this triggers a spot check to inquire about and verify them…Additionally, before deciding Lafiya Sisters' bonus stipend amount, our MEL team checks the data submitted in SurveyCTO. They look for very short timestamps of questionnaires, repeated user names entered, locations that do not correspond to the geo tag, or any other outliers." Lafiya, Answers to first set of GiveWell questions (unpublished).
- "Step 4: Government reporting check (See Health facility survey in SurveyCTO). External Cross-Verification: Use the pre-extracted data (or facility copies of reports) to verify alignment with national systems." Lafiya, SOP Spotchecks, 2026 (unpublished).
- 23Lafiya, conversation with GiveWell, October 2025 (unpublished).
- 24Lafiya reports that administrative facility data from 2023–24 show broadly similar trends in contraceptive uptake in treatment and comparison areas, though we’re worried that the data might be noisy due to inconsistent reporting practices: "Administration data from health facilities in 2023 and 2024 can help us review the parallel trends assumption. While this data is a bit noisy given variable reporting practices, these two areas generally had similar trends in contraceptive uptake before the program start date." Gulliver and White 2025.
- 25"This evaluation was designed and overseen by an independent consultant with input from the Lafiya Nigeria senior management team and senior leadership from a local research firm." Gulliver and White 2025.
- 26In particular, they recruited more Lafiya Sisters for a given population size than the current program uses. Sophie Gulliver, study author, conversation with GiveWell, April 2025 (unpublished).
- 27Lafiya have told us that they provide Lafiya Sisters with a bonus based on the number of counselling visits. Lafiya, conversation with GiveWell, February 2026 (unpublished).
- 28
- "Lafiya Sisters provide proactive outreach and comprehensive counselling on the full range of contraceptive methods, and deliver methods that are suitable for community-based distribution (injectables, condoms, pills, counselling on lactational amenorrhea method). Lafiya Sisters receive self-injectables from Lafiya, to ensure there is at least one method always available. They source alternative methods (other injectables, pills, condoms) from the health facilities as and where available." Lafiya, Our Work, "Our Model."
- "If a woman wants a longer-acting method, like an IUD or implant, Lafiya Sisters counsel her and connect her to a nearby clinic that can provide it." Lafiya, A Mid-year update from Lafiya.
- 29Lafiya have told us that they train Lafiya Sisters not to indicate that the contraceptive they have is Sayana Press until after the client chooses a method; if that choice was for Sayana Press, the Lafiya Sister will provide it, and otherwise will refer the client to another provider or pharmacy. Lafiya, conversation with GiveWell, March 2025 (unpublished). However, we believe that this does not fully address our concern that this may increase the usage of dispreferred methods, because some women might switch to choosing Sayana Press after learning that their preferred method would require potentially difficult travel or additional appointments.
- 30Lafiya have told us that they provide Lafiya Sisters with a bonus based on the number of counselling visits. Lafiya, conversation with GiveWell, February 2026 (unpublished).
- 31Our follow-up plan includes a requested update on Lafiya's monitoring and evaluation practices in early 2027.