Family planning strategies, policies, programs, and advocacy can be more effective if they are grounded in a comprehensive understanding of the accountability ecosystem for family planning. To help stakeholders better understand the accountability ecosystem, HP+ has published a Legal and Policy Framework to Accountability Approach, which was applied in Zambia in 2020. The framework document provides an overview of a 10-step process that can be used to guide organizations aiming to understand the higher-level legal and policy frameworks within their country and how these influence accountability relationships, structures, and mechanisms for family planning. With a solid understanding of the accountability ecosystem for family planning, stakeholders can design more strategic advocacy campaigns, establish connections with new partners, and address underlying systemic challenges to achieving family planning objectives in strategies and policies.
HP+ has published key takeaways from an expert consultation to advance dialogue and find common ground for including a gender lens in family planning financing, recognizing that gender is one of multiple factors that inhibit many individuals’ access to family planning. The May 2021 consultation convened family planning financing and gender experts from USAID, nongovernmental organizations, and the private sector to discuss how to better integrate gender into family planning and health financing systems to make access to family planning information and services more gender-equitable for all clients. In addition to the key takeaways, the brief provides the group’s perspectives, recommendations, and practical next steps.
In August 2021, the National Alliance of Indigenous Women's Organizations for Reproductive Health (ALIANMISAR) and the Human Rights Ombudsman's Office (PDH) completed their most recent indicator data collection and health clinic monitoring using the V1000D monitoring tool. Previously, HEP+ supported the development of the tool—which houses indicators related to health services, products, and human resources—and has strengthened the capacity of ALIANMISAR to conduct data analysis and advocacy. The monitoring exercise revealed an undersupply of family planning methods, ferrous sulfate, and rotavirus and pneumococcal vaccines as most doctors were busy attending to COVID-19 patients, limiting their availability to provide other essential health services. ALIANMISAR presented department-level findings to relevant health area directorates to make the case for solutions to health service issues. PDH will compile and share findings and recommendations at the national level.
On September 30, 2021, HP+ oriented stakeholders from international and local reproductive health nongovernmental organizations, multilateral and bilateral partners, and the Democratic Republic of the Congo’s ministries of health and planning on the application of the Family Planning-Sustainable Development Goals (FP-SDGs) model, which is currently underway. The model allows users to simulate the effects of family planning on a variety of health and non-health SDG indicators. It is anticipated that data resulting from use of the model will inform advocacy messages in support of a new five-year family planning strategy and ongoing family planning programs. As part of this application of the model, HP+ is developing an additional module to be completed by the end of the year connecting population to deforestation. The module is expected to simulate the impact of various policy scenarios on population as well as other factors that contribute to deforestation, such as gender, economic development, forest management, and governance.
A review published in the October edition of the Bulletin of the World Health Organization by the partnership on High Impact Practices in Family Planning, with HP+ Senior Technical Advisor for Family Planning Sara Stratton as the lead author, looked at how equity is measured in family planning programs. The review of eight studies revealed variations in how equity is defined, with most addressing economic barriers to contraceptive use. Drawing on the findings, the authors propose a more comprehensive approach for examining and addressing inequities in family planning. The article recommends expanding how inequities are characterized and how they are measured and evaluated to go beyond wealth as the sole driver of inequity and contraceptive use as the primary outcome.
In Malawi, HP+ launched an intergenerational mentoring activity to support emerging young leaders to engage village, district, and national stakeholders to deliver on the sexual and reproductive health and rights promises laid out in national policies. Connecting emerging young leaders with more experienced mentors in a structured advocacy mentoring program provides a unique opportunity to support young people to affect the institutions with which they work. In line with positive youth development methodologies, the purpose of such a mentoring program is to (1) provide one-on-one support to build the agency of young people to participate in decision-making processes and (2) cultivate their knowledge, leadership skills, and abilities to meaningfully participate and advocate for their priorities. This guide provides best practices in mentoring learned from the experience in Malawi.
Madagascar’s Ministry of Public Health has published a final review of its 2016-2020 Costed Implementation Plan (CIP) in a new report available through HP+. The CIP is a five-year roadmap that identifies evidence-based strategies and approaches for improving family planning programs and estimates the costs of implementing those strategies. The final review report examines and details the CIP achievements using Organisation for Economic Co-operation and Development (OECD) criteria of effectiveness, efficiency, coherence, relevance, impact, and sustainability. The effort was part of the project’s commitment to help strengthen Malagasy capacity to develop, implement, and monitor health sector policies and strategies to improve equity and sustainability of health services. Information from the review report, which also includes perspectives of family planning stakeholders in-country and a literature review, will be used by Madagascar stakeholders as they develop the country’s next CIP and to improve the nation’s family planning program. HP+ had previously supported the government of Madagascar’s efforts to develop and implement the national costed implementation plan (CIP) for family planning (2016-2020).
Turkana county health leaders pledged to reinstate budget lines for HIV (Ksh 500,000), as well as restore subprogram budget lines for reproductive, maternal, neonatal, child and adolescent health care (RMNCAH) (Ksh 6.4 million) interventions. As HP+ supported the Turkana County Department of Health to hold consultative discussions with the County Treasury, it presented data to illustrate how the county historically underfunded these programs and over-relied on donor support. It advocated for the county to not only finance these critical interventions, but also realign the county budget to a program-based budget approach and ensure they receive the money budgeted to them. These funds, once implemented, will support community-based interventions such as psychosocial support and adherence counseling, as well as nutrition, immunization, and reproductive health services. By improving service delivery and institutionalizing the funds for these interventions, the county aims to improve health outcomes across HIV and RMNCAH. Moving forward, HP+ will continue training county teams to monitor fund absorption and generate evidence to advocate for subsequent increased budget allocations. In doing so, it will strengthen the county’s capacity to efficiently allocate and execute its budgets as well as generate and use evidence to advocate for and promote sustainable financing of the key disease programs.
Madagascar’s Ministry of Public Health has finalized its final review of the 2016-2020 Costed Implementation Plan for Family Planning. HP+ provided updated gap analysis results and costed implementation plan (CIP) dashboard data, as well as a CIP execution checklist (part of the CIP Resource Kit). The final review report was validated in April by Madagascar’s Family Planning Committee, technical and financial partners, representatives from regional and district health directorates, civil society organizations, and youth networks. Key successes identified in the review include an increase in the modern contraceptive prevalence rate from 33 percent in 2012 to 41 percent in 2020, representing an estimated 959,000 more contraceptive users. Further, the political environment was improved through passage of the law regulating reproductive health and family planning, ensuring access to reproductive health and family planning services to vulnerable populations, youth, and individuals with disabilities without discrimination. HP+ contributed significant technical and financial support to the development of this law. The Madagascar Ministry of Public Health Family Health Directorate demonstrated strong country ownership and staff capacity throughout the final review process, including through its assessment and validation of all tools and materials used during the review.
A radio station based in Kenya’s southeastern coast recently hosted a live family planning discussion between a Muslim leader and a local Kilifi County government official. HP+ helped arrange for the interviews and discussed key talking points with the presenters. The discussion on Lulu FM between Muslim leader Ustadh Rashid and Kilifi County reproductive health coordinator Ken Miriti highlighted collaborative efforts between the county government and religious leaders to promote uniform messaging for family planning among interfaith communities in Kilifi. Kilifi County has among the lowest modern contraceptive uptake rates in Kenya and religion and cultural issues were identified in the county’s costed implementation plan as key contributing factors. Faith leaders in the area use different avenues to address existing myths and misconceptions about family planning through the lens of religious norms and beliefs. HP+ has fostered joint accountability between the county government and faith leaders from Christian and Muslim communities to implement family planning interventions. Throughout the COVID-19 pandemic, HP+ has supported this strong network of interfaith leaders from Christian and Muslim communities in Kilifi County to be more involved with family planning. HP+ will continue to support the Department of Health to engage with more leaders from established faith networks, to sensitize them on family planning, and enlist them as family planning champions in their communities.
The Burkina Faso national government, local officials, and community leaders recently agreed to a plan to coordinate family planning activities in two eastern communes. The signed partnership agreement, facilitated by HP+, enabled an annual allocation of FCFA 2 million (approximately US$3,600) for community leaders in Fada/Dori and Kaya communes to continue conducting awareness-raising activities on local radio, in health facilities, and during cross-generation dialogue. Parties to the agreement are the Ministry of Health, the East Region municipality of Fada, health districts, and the local community leaders’ union (Union des Religieux et Coutumiers du Burkina pour la Santé et le Développement or URCB/SD). The agreement is just one effort in Burkina Faso to promote family planning as a way to lower birth rates and infant mortality. Through the Sahel project, HP+ collaborated with URCB/SD to map community influencers and potential family planning spokespersons in three regions. A total of 720 local leaders were identified and trained in family planning promotion. Afterward, they held sessions on community radio and organized awareness sessions in health and social promotion centers. The messages were developed by the leaders and linked family planning advocacy to holy texts and cultural values. In each region, the leaders held an intergenerational dialogue on sexual and reproductive health with more than 30 participants including other traditional leaders, religious leaders, women, youth, teachers, and parents. Finally, leaders held advocacy meetings with local elected officials and health officials, where they shared community feedback from their family planning awareness-raising experiences and discussed ways to sustain the interventions, which were appreciated by their constituencies.
Family planning is a key part of Liberia’s first private sector engagement strategy, advanced during a recent workshop in Monrovia supported by USAID and HP+. “The Ministry of Health has recognized the need to engage effectively with the private sector if we are to succeed in our mission,” Assistant Minister George Jacobs told the assembled Ministry of Health staff and representatives from professional associations, federation and regulatory bodies, nonprofit organizations, and the private health sector. The strategy for 2021–23 calls for private facilities offering family planning services to have regularly trained providers, consistent with the ministry’s family planning costed implementation plan. Government approval of the strategy is expected by fall 2021. Following that, the Ministry of Health will begin implementation with a multisectoral technical working group led by the ministry’s newly designated focal point for private for private sector engagement. The group will bring together public and private sector actors, begin rollout of the strategy at county level, and undertake a master training for key ministry focal persons.
In a historic accomplishment, Malawi youth clubs supported by HP+ have banded together to form the first youth-led and youth-centered cooperative in Mangochi District. The cooperative will continue the individual businesses established by the clubs—beekeeping and the sale of honey—and the businesses’ support of local family planning initiatives. Such initiatives include revamping youth corners, buying bicycles and motorbikes to ferry youth to and from facilities, and supporting youth-friendly health services/family planning coordinators to conduct limited outreach. Members also hope to establish a facility separate from the hospital space where they now hold their regular meetings. The Thema Honey Youth Producers and Marketing Cooperative Society is one of only 12 in the district. To establish the cooperative, the individual clubs completed a required training facilitated by a multisectoral government team from central, district, and community levels and with financial and technical assistance provided by HP+. After the training, members applied to the Ministry of Trade and Industry for certification. Once certified, the cooperative will be eligible to access better markets for their honey as well as other government initiatives and opportunities.
After receiving an entrepreneurial training delivered jointly by HP+ and Feed the Future’s Agriculture Diversification Activity, participants from Nankumba Traditional Authority in the Mangochi district of Malawi used the curriculum and their own resources to orient other youth clubs on the topic. This raises the total number of youth clubs conducting social enterprises (such as bee keeping, maize farming, and goat farming) from the initial 15 clubs, two years ago when the training was first provided, to 29. Since a proportion of the profits from these businesses are invested in youth-friendly health services (YFHS), an increase in the number of clubs translates to an increase in YFHS investments. The vision of these clubs is to construct a youth resource center in their community through collective contributions, beyond the other investments currently being made. The youth resource center will serve as a separate space where FP information and some services can be provided, as the YFHS facility where youth currently access services is located within the local hospital and is quite small.
Prominent civil society organizations in Guatemala have come together to raise the profile of family planning and its role in men’s lives. Guatemala’s Network of Indigenous Women for Reproductive Health, the Young Artists for Social Justice of San Marcos, and the Network of Men for Health, Education, and Nutrition held an online conversation May 15 on “Family Planning and New Masculinities” to commemorate the International Day of Families. HEP+ supports gatherings such as this by facilitating partnerships between participating organizations. This discussion among network representatives promoted the importance and benefits of family planning, as well as the important role men have in family planning. This conversation is part of a broader HEP+ effort to build community understanding of and support for sexual and reproductive rights and to emphasize men’s responsibility in supporting their families.
Tanzania has taken some steps to broaden financing for family planning. During a two-day workshop convened last month by HP+, Tanzanian stakeholders discussed options for sustainable financing for family planning services, focusing on segmentation of the family planning consumer market and integration of family planning into the county’s national health insurance scheme. HP+ will model several policy scenarios for financing the scale-up of family planning services to reach the modern contraceptive prevalence rate outlined in the Tanzania National Costed Implementation Plan. The modeling will quantify costs to the government and to women under scenarios in which family planning is offered for free to all users, is incorporated into the health insurance benefits package, and is expanded through commercial products. The findings will be used to advocate for a sustainable option to finance family planning scale-up, with the intent of increasing domestic resource mobilization for family planning, increasing private sector engagement in the delivery of family planning services, and improving access to family planning for the underserved and vulnerable in Tanzania.
With HP+ technical support, Madagascar’s Ministry of Public Health recently validated the Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition Investment Case for the Global Financing Facility. The investment case outlines priorities for interventions and regions in addressing the country’s RMNCAH-N objectives and health system improvements. HP+ was the lead technical partner, in collaboration with UNICEF, the United Nations Population Fund, the World Bank, and the World Health Organization, supporting the ministry in the development of the investment case. The process offered the opportunity to improve the alignment of donor financing with government priorities and objectives. It also focused on targeting limited government resources on high-impact practices and healthcare access for the country’s most vulnerable populations. HP+ will continue to provide technical assistance to build the ministry’s capacity to monitor the implementation of the investment case at national, regional, and district levels. The investment case aims to reduce the total fertility rate—the average number of births a woman has over a typical lifetime—from 4.6 to 4.2 and aims to reduce the adolescent fertility rate from 151 to less than 130 births per 1,000 women. The five-year plan would reach 17 out of 22 prioritized regions, covering 19.1 million people (78 percent of the population) and avert more than 9,000 neonatal deaths, approximately 3,000 maternal deaths, and nearly 40,000 deaths of children under five years of age.
HP+ is supporting FP2030, the next iteration of the FP2020 global effort to enable 120 million more women and girls to use contraceptives. Participating in the new family planning commitment-making process, HP+ health financing experts will provide feedback on country commitments and act as a one-on-one resource for country focal points. A number of reports and briefs developed under HP+ are included in FP2030’s Incorporating Domestic Financing in Commitments brief as part of the FP2030 Commitments Resource Kit developed for countries to use as they develop their family planning financing commitments. The kit includes HP+ documents on legal, regulatory, and financing considerations of universal health coverage, health insurance, catalytic investments for family planning, and the Family Planning Financing Roadmap.
In its efforts to improve its family planning programs, Guatemala is moving ahead with addressing guidelines outlined in the country’s National Family Planning Strategy. With technical and financial support from HEP+, the Department of Guatemala last month formally established a Subcommittee on Contraceptive Security. Subcommittee members will develop their 2021-2022 work plan by August of this year and plan to address the guidelines outlined in the National Family Planning Strategy. Goals include strengthening family planning services, implementing comprehensive sex education in schools, and guaranteeing the supply of contraceptive methods in all health services. The Department of Guatemala is the largest of the county’s 22 geographic divisions and membership in the subcommittee includes representatives from the region's four health area directorates, which cover 20 percent of the country's total population. The subcommittee also will have representation from key nongovernmental organizations: the Asociación Pro Bienestar de la Familia de Guatemala, the Guatemalan Social Security Institute, the Organization for Women's Health & Development, the Reproductive Health Watchdog, and the Presidential Secretariat for Women. The establishment of the subcommittee is part of HEP+’s larger efforts to support the National Contraceptive Security Commission and the Ministry of Health and Social Assistance’s National Reproductive Health Program.
HP+ has completed a financial gap analysis to accompany the Mali Costed Implementation Plan for Family Planning (2019–2023). The analysis was prepared to help Mali’s Sub-directorate of Reproductive Health better implement its costed implementation plan, understand the extent to which activities and strategic areas have been allotted funding, and advocate for future funding to drive achievement of Mali's family planning objectives and larger development goals. The costed implementation plan, completed in July 2019, is a five-year roadmap designed to help the Malian government achieve its family planning goals.
HP+ has developed a guide on how to incorporate the priorities of Malawi’s national costed implementation plan for family planning into local district-level plans. The guide calls for a three-step approach to helping councils increase their awareness of national objectives and develop district-level plans based on the Costed Implementation Plan (CIP) for Family Planning (2016–2020). HP+ collaborated with the Ministry of Health’s Reproductive Health Directorate to facilitate implementation in several districts by establishing multisectoral task forces to facilitate the integration of priority plan activities into district implementation plans. One district, Machinga, allocated its own resources to implement family planning activities for two years in a row, while other district task forces directed available donor resources to family planning activities. The guide is intended to enable others to replicate and refine this approach beyond the life of the project. While the guide was developed for Malawi's health context, it could be adapted and used in other decentralized settings.
HP+ has produced a tool that expands the definition of conventional inequities in family planning to include such concepts as quality of care and access to information and services. In a blog post published by Knowledge Success earlier this month, HP+ shared the Family Planning Equity Tool, which goes beyond the traditional metrics of family planning inequality such as contraceptive uptake. Application of the tool in Uganda suggests that unmarried and less-educated women may be underrepresented in traditional measurements of family planning inequality.
HP+ has helped the Kenya Ministry of Health retain its current allocations for national HIV, malaria, and reproductive health programs into the next fiscal year even in the face of economic constraints due to COVID-19. HP+ provided technical assistance to the Ministry of Health program teams to develop budget justification memos that supported the need to continue to fund these programs. The memos were used during the sector performance review and resource sharing process, helping to ensure that each program is able to continue supporting its respective critical disease area. In preserving budget allocations despite a tightened fiscal space, the health programs established their continued importance among the nation’s priorities, allowing Kenya to maintain stewardship and accountability for funding these programs. The FY 2021/22 funding for HIV, malaria, and reproductive, maternal, newborn, adolescent, and child health programs is US$12 million, $8 million, and $8.63 million, respectively.
Field, Kenya, Health
Domestic Resource Mobilization
Community and faith leaders have come together in Kilifi County, Kenya, to craft uniform, consistent messaging in support of family planning. At a workshop in February convened by HP+, the leaders developed messages they will use to advance family planning in their communities through their respective forums. One message, for example, posed the question: Did you know that family planning is not against our faith? The goal of the campaign is to foster a better understanding of family planning and address misconceptions that impede its uptake. The hybrid physical/virtual workshop was an outgrowth of an action plan developed with HP+ support during a workshop in November 2019. The activity is intended to encourage demand for family planning services and to address Kilifi County’s all-method contraceptive prevalence rate of 38 percent, lower than Kenya’s national rate of 58 percent.
HP+ worked with the FP2020 Secretariat to develop new guidance on establishing strong “mutual accountability” approaches. The new guidance provides a “how-to” for governments to meaningfully engage civil society throughout the commitment process and how government and civil society can hold each other accountable for meeting 2030 commitments to family planning. The FP2020 Secretariat is rolling out the new guidance, and it will be officially launched in the coming weeks. The accountability guidance builds on HP+’s extensive experience supporting accountability for FP2020 commitments. It promotes including civil society throughout the commitment process—commitment-making, implementation, and tracking—and includes examples derived from an HP+ global review of existing social accountability mechanisms. FP2020 will disseminate this guidance through its country focal persons and other venues. Both the guidance and examples are available online.
HP+ Kenya has helped the Kenya Ministry of Health develop budget proposals that align with its health sector priorities and craft advocacy materials in support of these proposals. The MOH requested an additional US$12 million for HIV commodities, an additional US$8 million to procure first line anti-malarial drugs and to settle tax obligations arising from donor-procured malaria commodities, and an additional US$8.6 million for family planning. HP+ Kenya supported national performance reviews of HIV, malaria, and reproductive, maternal, newborn, child, and adolescent health programs to develop sector working group reports that inform the MOH and Treasury budget allocations.
Senegal’s Ministry of Health and Social Action used HP+ supported resources to raise the visibility of and consensus around the need for domestic resources for family planning, helping lead to an increase in the government’s budget allocation to contraceptives. In 2019, HP+ worked with the MSAS and other family planning stakeholders to identify and evaluate opportunities to catalyze domestic resources for family planning, based on an HP+ framework. HP+ also led a budget advocacy training, supporting stakeholders to develop an action plan to influence the next budget cycle. In a recent news article, MSAS Cabinet Director Alphonse Ousmane Thiaw discusses a consultation on mobilizing domestic resources for family planning. He quotes a report supported by HP+ that suggested a focus on national and subnational government advocacy and strengthening support for family planning under Senegal’s Agency for Universal Health Coverage. Thiaw reaffirms the government’s commitment to financing family planning and announces an increased allocation for contraceptives in 2021. This allocation of CFA 500 million (US$926,000) aligns with the country’s FP2020 commitment, reverses the trend of decline in this allocation between 2016 (CFA 300 million) and 2019 and 2020 (CFA 117 million) and will support the annual contraceptive needs of approximately 160,000 family planning users.
Family planning stakeholders can find recommendations for how best to participate and influence the development and implementation of Global Financing Facility-financed projects in the recently published Opportunities for Financing Family Planning Through the Global Financing Facility. The report by Health Policy Plus provides 19 recommendations tailored to the stages of GFF funding: before or following the decision of country selection by the GFF Trust Fund Committee, during the development of the project appraisal document, at the start of the World Bank project implementation phase, and throughout implementation. The report also offers 15 family planning intervention ideas for stakeholders to consider. The GFF, housed at the World Bank, presents an opportunity for low- and middle-income countries to leverage additional funding for family planning. However, its grant mechanisms can be complex and the role of family planning programs within them not always clear. The report also describes how family planning has been included in GFF-funded programs and what family planning interventions are most often financed.
HP+ is supporting the Government of Indonesia to advance subnational performance geared toward achieving the Minimum Service Standards in Health (SPM) for 12 primary healthcare services, including services for pregnant women, delivering mothers, and newborns, as well as family planning education and services. In partnership with PPJK, HP+ improved the planning and budgeting platform for SPM by decreasing complexity of the user interface, designing an error detection system to identify cost outliers and improve data collection from primary healthcare facilities, and enabling the platform to be interoperable with other information systems. HP+ also supported the development of e-learning modules, which are critical to the successful national rollout of the revised platform. The improved platform will equip district health officials across the archipelago with the budgeting and planning tools needed to estimate resources required to achieve SPM targets and improve allocation of resources for health to achieve better health outcomes. The revised platform was officially launched this week in Jakarta by the Secretary General of the Ministry of Health for all 514 districts across Indonesia.
Quality family planning information and services have not yet reached those with the greatest need. To support progress toward equitable healthcare, HP+ developed an approach for diagnosing inequity in family planning programs. This approach identifies inequities: 1) for a diverse range of disadvantaged subgroups; 2) for various programmatic components of family planning; and 3) at national and subnational levels. Replicable across countries, this approach enables users to easily transform demographic and health survey data to better understand the profile of inequity. This information can be used to develop evidence for policy, financing, and programmatic decisions at national and subnational levels. The new methodology and replication guide describes the approach and provides step-by-step instructions for running the open source code independently. Results from the application of the approach to Uganda can be found in the brief and in this webinar.
In Togo, HP+ West Africa recently convened a gathering of national and regional stakeholders to collect, review, and validate data to update the costed implementation plan (CIP) for family planning performance dashboard. Updating the dashboard—a critical first step in the CIP execution process—supports the country to monitor progress toward achieving its family planning goals, which include reaching a contraceptive prevalence rate of 22 percent by 2022 (from 17 percent in 2017). Training stakeholders on use of the CIP tool and dashboard supports family planning decision making and helps to focus family planning activities and implementation on meeting CIP goals.
In Kenya, HP+ supported Mombasa County to finalize Sector Working Group reports under the three-year budget plan, called the Medium-Term Expenditure Framework. These budget reports, used at national and county levels, are required to secure stakeholder input on family planning and other health spending priorities. HP+ provided technical and logistical assistance to develop the reports, highlighting priority needs and programs to guide resource allocation. Through HP+ support, these budgets and budget processes are better positioned to respond to citizen needs and resources specific to the county’s context.
Since July, over 129,000 new households have been enrolled in Cambodia’s largest social health protection scheme, the Health Equity Fund, which entitles families to receive free healthcare—including family planning services. This accelerated rollout follows publication of a secondary analysis, conducted by HP+, which found that 36 percent of Cambodians living under the national poverty line do not hold an equity card, making them ineligible to benefit from the fund. The study was cited by a Deputy Secretary of State of the Ministry of Economy and Finance in the rationale to accelerate national rollout of the system, which will benefit an additional 47,785 households.
Health Policy Plus (HP+) marked World Contraception Day this year with a focus on the positive, a welcome distraction from the COVID-19 pandemic, by asking our colleagues and partners, “what about contraception puts a smile on your face?” With a reflection by family planning and reproductive health lead, Jay Gribble, and a photo collage featuring messages from around the world, HP+ demonstrates many reasons to smile as voluntary contraception and method choice continue to improves the lives of women and men, their families, and communities.
HP+ recently launched revamped message boards in the Family Planning Financing Roadmap website’s Community of Practice to support the sharing of information and resources about family planning financing among decision-makers, policy-makers, and advocates. The Family Planning Financing Roadmap is an online resource, which enables stakeholders to explore specific family planning financing options based on country context. The message boards and other learning materials are expected to help stakeholders identify sustainable ways for countries to fund their family planning initiatives and underpin their long-term health and development goals.
HP+ and FP2020 co-hosted a webinar exploring ways to catalyze a shift in domestic financing for family planning. The webinar introduced a new framework that provides a structure for development partners and advocacy groups to work with country governments to identify and implement catalytic interventions for family planning in advocacy, capacity development, policy, and expansion of the family planning market. USAID’s Susanna Baker provided relevant HIV case studies from PEPFAR’s Sustainable Financing Initiative; Martyn Smith of FP2020 discussed the need for such investments; and Kojo Lokko of the “Challenge Initiative” shared experiences on matching funds and other means to raise domestic resources for family planning.
In Madagascar, HP+ has been supporting journalist trainees to provide information and news about family planning/reproductive health (FP/RH). Twenty news articles have since been produced that reach local, regional, and national audiences. Last November, 11 journalists were trained by HP+ on the fundamentals of FP/RH, the FP/RH law, and issues related to population and development. The following January, with HP+ support, nine of the trainees conducted field investigations to raise public awareness of early pregnancy, break taboos on contraception, and disseminate the FP/RH law. In July 2020, HP+ supported the development of a yearlong editorial calendar and dissemination strategy to support these efforts.
This month, HP+ and Tanzania’s Reproductive and Child Health Section of the Ministry of Health, Community Development, Gender, Elderly, and Children worked together to convene the first semi-annual family planning implementers meeting. The meeting, which was held virtually, focused on review and discussion of current progress in implementing the country’s family planning costed implementation plan (CIP) related to subnational roll-out, program and funding coverage, and achievement of results. According to performance data collected for the first year of CIP, Tanzania is on track or gaining traction to meet performance targets for six of ten results; progress has been delayed for the remaining four results.
A local leader in Niger has invested FCFA 57 million (US$97,500) in the purchase of family planning products and the financing of income-generating activities for women in his municipality—about 2.7 million individuals—as a result of HP+ advocacy. Following an HP+-supported regional workshop aimed at engaging communities in advocacy to support costed implementation plans for family planning, Dosso Mayor Issoufou Idrissa mobilized the funds for the rehabilitation of health centers, purchase of family planning commodities, and financing of income-generating activities. Since January 2020, 966 new users have accessed health services in the municipality are a result of this investment.
In Malawi, district youth-friendly health services (YFHS) coordinators are using performance data to analyze YFHS uptake nationwide, sharing best practices and challenges encountered to improve program decision-making across all levels of the health system. Since 2018, HP+ has supported the Ministry of Health’s Central Monitoring and Evaluation Directorate to analyze district performance in reporting YFHS uptake and share these results with district-level coordinators via WhatsApp. As a result, the overall national reporting performance of the YFHS program has improved from 13 percent in 2018 to 72 percent as of March 2020, demonstrating strengthened capacity to submit complete, timely data critical to supporting informed decision-making.
The New Security Beat, a Wilson Center blog, published a piece by Sara Stratton, HP+ technical director for family planning and maternal and child health. Pandemic Preparedness: Strengthening Family Planning Policies Today to Secure Essential Services for Tomorrow discusses the COVID-19 response and threats to contraceptive access for women in low- and middle-income countries. It sets out policy recommendations to ensure essential services for women and girls are maintained during this and future pandemic responses, including policies on task sharing with private sector suppliers such as pharmacies; policies on self-injection of contraceptives; and gender-informed policies for a female-dominated healthcare workforce.
In May, HP+ supported Madagascar’s Ministry of Public Health’s Family Health Directorate to convene two virtual meetings with the multisectoral family planning committee to address decreases in family planning and maternal and child health service use nationwide. The meetings resulted in development and finalization of a budgeted action plan to ensure continuity of family planning service availability for the 27 districts under stay-at-home orders imposed as a result of COVID-19. Plan activities include ensuring continued availability of family planning products, extending the DMPA subcutaneous auto-injection approach in three regions to prolong the amount of time between visits to health facilities, and emphasizing community health service provision.
An HP+ webinar on May 28—Diagnosing Inequities in Family Planning Programs: A Case Study from Uganda—introduced a new, replicable approach for diagnosing inequities across family planning programming outputs and outcomes at both national and subnational levels. Presenters showcased results from its application to Uganda, focusing on the sub-regions, disadvantaged sub-groups, and family planning components for which inequities are most pervasive, and demonstrated its applicability to other countries. Use of the model is intended to increase the quality of family planning information and services for women.
A new HP+ blog post shares key lessons to advance universal access to family planning from 16 francophone countries. The lessons emerged from discussions among representatives from 15 francophone countries and Haiti—comprising government, civil society, development partners, and youth—convened by Family Planning 2020. Recommendations from the meeting included the establishment of a legal framework to include family planning in reforms aimed at achieving universal health coverage; using evidence and advocacy to make the case for including family planning in health insurance benefits packages; and strengthening stakeholder capacity to understand and manage health financing schemes.
In December 2019, Burkina Faso’s Ministry of Health launched a monitoring and evaluation (M&E) plan to measure its progress on increasing contraceptive access. The finalization and implementation of the Costed Implementation Plan M&E plan is an important milestone showcasing the country’s commitment to increasing modern contraceptive prevalence, which at 30.7 percent, is the highest in the West Africa region. The M&E plan was developed following the formation of a multisectoral steering committee and thematic groups comprised of public, private sector and civil society representatives who advocated for a tool to track progress, a model for the region. Read our news story for more details.
Malian mayors, community health associations, and communities mobilized over 7,850,000 FCFA (approximately US$13,305) in local resources to support payments of community health worker (CHW) stipends in Mali. The funds, mobilized by local stakeholders in the regions of Kayes and Sikasso between October 2019 and January 2020, enable CHWs to continue to continue providing essential care following the end of funding from USAID via the SSGI Project this past September. CHWs, who reach Malians who live more than five kilometers from community health centers, have contributed to increased modern contraceptive prevalence. According to the 2018 Mali DHS, modern family planning use among married women age 15-29 increased from 10% in 2012-13 to 16% in 2018.
In January 2020, Cambodia’s Ministry of Economy and Finance’s inter-departmental health working group accepted 32 recommendations crafted by the National Social Protection Council. The recommendations, which include expanding coverage to dependents and raising the income threshold for premium contributions, came from HP+-generated evidence aimed at advancing the government’s social health protection agenda by promoting ownership and empowering key influencers to effectively advocate for policy change. The recommendations, which the government will begin to implement over the coming year, could significantly benefit Cambodia’s most vulnerable citizens by expanding social health insurance to 3.8 million family dependents and 3.1 million vulnerable people, who will gain improved access to long-acting and reversible and permanent family planning methods to be reimbursed under the HEF benefits package
In Madagascar, the Ministry of Public Health’s Family Health Directorate (DFSa) is using a web-based dashboard tool to facilitate data analysis and visualization as part of its semi-annual costed implementation plan (CIP) execution review meetings. HP+ developed the dashboard and trained the DSFa and CIP committee on its use. The dashboard, which is owned by CIP committee members, allows for strategy adaptation and orientation for improved family planning programming and CIP implementation in the country. The dashboard encourages country ownership of the CIP process and progress toward achieving its goals, including increasing the contraceptive prevalence rate to 50 percent.
In Burkina Faso, one mayor has successfully mobilized more than US$124,100 to support the implementation of family planning activities under his jurisdiction. Following an HP+-supported sub-regional family planning workshop in 2018, Bobo-Dioulasso mayor Bourahima Fabéré Sanou committed to allocating 20 million CFAF (US$33,000) to family planning. Under his stewardship, the municipality mobilized an additional US$91,000 from the International Association of Francophone Mayors to support training and awareness-raising activities, contraceptive procurement, and the promotion of service delivery campaigns in secondary health and professional establishments. As a result of these activities demand for sexual and reproductive health services have increased 52 % in Bobo-Dioulasso, adding 1,335 users to the existing 2,578.
In December 2019, Madagascar integrated a tax exemption for contraceptives into the country’s finance law. The exemption, which will remove the 20% value-added tax applied at customs, followed HP+ support to the Ministry of Public Health’s Family Health Directorate to write advocacy messages encouraging key decisionmakers to make contraceptives tax-exempt. This exemption will reduce purchase costs, contributing to operationalization of the new Reproductive Health and Family Planning Law (2018) that promises access to contraceptives for all, and encourage private sector engagement in family planning service delivery.
Recent data indicates that Ghana is on track to meet the milestones in its costed implementation plan for family planning, including achieving the goal of increasing modern contraceptive prevalence among currently married women from 22.2% (2014) to 29.7% (2020). HP+ has supported the development of performance indicators to monitor execution of key results and established and rolled out a web-based performance monitoring dashboard to government stakeholders and implementing partners. Ghana is estimated to have added 590,000 contraceptive users since 2012, bringing coverage to a total of 1,676,000 users and averting 213,000 unsafe abortions and 1,100 maternal deaths.
HP+ applied the Family Planning-Sustainable Development Goals (FP-SDGs) Model with stakeholders in Tanzania to project how family planning investments can accelerate progress toward the SDGs. HP+ worked alongside local stakeholders to strengthen their capacity to generate projections from the model and interpret results. Advocates have used results to make the case to Parliamentarians and others to prioritize and expand family planning in support of broader development goals. Model results estimate that increasing family planning investments in Tanzania could, by 2030, reduce maternal mortality by 47% and increase the proportion of the population using safe drinking water by 20%, among others.
The Economic Association of Malawi (ECAMA), an independent association of economists, committed in early November 2019, to the management of population growth and investments in youth and articulated the importance of policies that support job creation as key in harnessing Malawi’s demographic dividend. At their annual meeting, ECAMA members published a resolution detailing 10 steps that will improve human development. Health Policy Plus provided evidence from RAPID to support the Ministry of Health and Population’s planning team make a case for the integration of population in planning. HP+ technical advisor of family planning, Julius Chingwalu participated as a discussant on the population and development panel.
A key component of successful advocacy is engaging media to promote issues relevant to a wide audience in order to build awareness of critical issues and garner support for change. To this end, HP+ conducted a training workshop for national journalists on the fundamentals of family planning and reproductive health (FP/RH) and their importance in underpinning the country’s development and future growth. The workshop, held November 12-14 in Antananarivo, brought together 11 national and local journalists from radio, television, and print media to learn about the importance of FP/RH and provided the opportunity to role play interviews with health workers and clients from primary healthcare centers. Moving forward, HP+ will serve as a bridge between journalists and experts on FP/RH in Madagascar, supporting journalists to network with and source their information from knowledgeable health personnel. As a follow up with a stipend from HP+, each journalist will undertake investigative reporting on topics such as early pregnancy, early marriage, barriers to family planning use, access to family planning services, and family planning for homeless people to be published in January and February. These stories on reproductive health will bolster advocacy efforts.
Since 2011, Malawi’s HIV clinical guidelines have recommended that providers proactively offer family planning to all clients at each ART visit to ensure no missed opportunity to support PLHIV’s reproductive intentions. This approach, called Provider-Initiated Family Planning (PFIP), calls for condoms and injectables to be available at the ART clinic, and referrals for other methods as needed. In 2015, the USAID-funded Health Policy Project assessed the extent of PFIP implementation in Malawi by collecting data at 41 health facilities (both public and NGO) through facility audits, provider interviews, client exit interviews, and mystery client visits. This study – discussed in a new article in Global Health Science and Practice Provider-Initiated Family Planning within HIV Services in Malawi: Did Policy Make It into Practice? – found that contrary to clinical protocols, only 14% of clients at the ART clinic reported being offered family planning during their visit that day. Furthermore, only 24% of providers had received training in FP-HIV integration, 21% had no family planning training at all, and only half of providers had information on where to refer clients for family planning. Only 24% of sites had both condoms and injectables on hand, and only 15% of ART clinics had a full range of FP available. Overwhelmingly most ART clients relied on condoms for FP, yet there was significant demand for family planning among the female ART clients, with about half wanting no more children. These findings suggest that although Malawi has been an early adopter of PFIP, this innovative policy is not being implemented in practice. The authors, Erin K. McGinn (Palladium) and Laili Irani (Population Council), conclude that the demand for integrated services and high unmet need for FP among PLHIV underscores the need for more focused efforts to fully implement PIFP in Malawi’s HIV services.
A new blog -- Integrating Services Means Thinking Outside Silos -- published on Science Speaks, the global health blog of the Infectious Disease Society of America, addresses the need for greater integration of family planning and HIV service delivery. The commentary, by Health Policy Plus deputy director for family planning and reproductive health, Jay Gribble, and the project’s technical lead on stewardship, RTI’s Alyson Lipsky, discusses the complexity of integration and explores three policy approaches to support it. They conclude that, “To move forward, health system actors must identify the problem that integration is trying to fix and which approach to integration best addresses that underlying problem. Often, the biggest challenge is breaking down the health system silos and being open to finding new ways to respond to people’s health needs.”
Guatemala’s government leadership extolled the country’s progress and ongoing commitment to decentralization at the first-ever congressional session on decentralization and at a related meeting held days apart in early October. With acknowledgement of the USAID-funded Health and Education Policy Plus (HEP+) for its support of the government’s efforts, outgoing President Jimmy Morales and incoming political leaders both reiterated their commitment to decentralization of primary health care and education to the municipal level and the expected positive impact on health, education, and economic development of Guatemalans at all levels of society. Guatemala’s commitment to decentralizing primary health service delivery and education is enshrined in legal and regulatory statutes but implementation had lagged for several years. The congressional gathering comes at a time of political transition and was remarkable for the commitment to continue the effort by both outgoing and incoming leaders. The progress in implementing the country’s decentralization policy is at a pivotal time and comes after many years of effort by USAID and HEP+ to develop guidelines for implementation; support for civil society networks that demand accountability and monitor implementation; and for the development of an information system that supports decentralization. The SIPRODES information system, developed with support from HEP+, is an important data visualization tool that tracks the capacity and readiness of each municipality to take on newly devolved responsibilities; identifies and highlights areas for capacity development within the municipality; and establishes a communication path from the municipalities to the central government to signal readiness and evaluate how the municipalities are doing.
In Madagascar, HP+ has been working to support efforts to harness the demographic dividend as the country’s age structure shifts toward a larger workforce, boosting economic growth. On September 12, the Ministry of Economy and Finance, with support from HP+ and UNFPA, organized the official launch of the country’s Demographic Dividend Roadmap at an event in Antananarivo. The event, which brought together stakeholders involved in coordination of activities aimed at achieving the demographic dividend, was attended by the Minister of Economy and Finance Richard Randriamandrato and actors from the public and private sectors, civil society, and technical and financial partners. At the launch, Randriamandrato formally validated the roadmap and discussed the importance of considering the country’s family planning/reproductive health law in efforts geared toward achieving the demographic dividend. At the end of September, HP+ is supporting the Ministry of Economy and Finance to finalize a follow-up plan, including details on monitoring and evaluation, budgeting, and resource mobilization for key activities.
Malawi's population is one of the fastest-growing in Africa, placing great strain on its health system, environment, and economy—hindering the country's ability to meet its development goals. To address unmet need for family planning services and the needs of adolescent girls and young women at all levels, HP+ is coordinating across multiple sectors including engaging traditional and religious leaders and communities. Christian Connections for International Health (CCIH) published a story this week about a family in Malawi helped by the Evangelical Association of Malawi, under an HP+ supported activity. The account of a family receiving marriage and birth-spacing counseling after a family tragedy, demonstrates how engagement with community leaders on family planning messaging helped on family mend and achieve financial security.
Government and civil society health leaders from nine Francophone countries of West Africa called for the integration of community health workers into their nations’ health systems at a ground-breaking meeting in Lomé, Togo. The three-day workshop, held from September 16 – 19, gathered health officials and implementing partners, and local community health workers, who shared their perspectives. Senior officials from Togo’s Ministry of Health, WAHO and WHO’s West Africa office, along with U.S. Ambassador, Eric Stromayer joined a high-level opening ceremony. Eleonore Rabelahasa, the Senior Health Systems Strengthening and Policy Advisor in USAID’s regional health office, also participated in the three-day workshop. Five Togolese CHWs, who deliver a range of family planning, malaria and health consultations interventions, discussed the challenges and opportunities they face as front-line health workers and their perspectives to improve their capacity to improve equitable access to health services. The delegates developed action plans for each country with a goal to convene key stakeholders and put in place a plan of action by June 30, 2020.
On April 29 and 30, a caravan of Ouagadougou Partnership donors visited Mali to view progress that has been made in achieving family planning objectives and to understand existing challenges to these efforts. Since February, HP+ Mali has led the process of finalizing the country’s second generation costed implementation plan for family planning (CIP) that includes plans to accelerate modern contraceptive prevalence in the country from 16 percent in 2019 to 30 percent by 2023. The donor caravan deemed the CIP process to be “inclusive” of all necessary actors, highlighting the success of HP+ Mali in convening and executing the planning process. The project is in the process of finalizing the CIP in line with final recommendations from the pilot committee and aims to launch the plan in June 2019.
This year’s annual national campaign for the promotion of family planning in Mali, "Multisectoral commitment to achieving the objectives of sustainable development through family planning," was launched on December 17 under sponsorship of the First Lady of Mali, Keita Aminata Maiga. For the second year in a row, HP+ was recognized by the Minister of Health and Social Affairs as the recipient of a Certificate of Acknowledgement of Family Planning Champions for its technical assistance efforts to provide the country with a consensus-driven costed implementation plan. This campaign is one of the key priorities of the Ministry of Health and Social Affairs aimed at reducing maternal and infant mortality nationwide.
The Ministry of Public Health has announced it will more than triple its budget to procure contraceptives in 2019. The budget item jump, from 62 million FCFA in 2018 to 200 million FCFA in 2019 comes as result of USAID-supported advocacy by family planning groups and support from Health Policy Plus (HP+), and promises to vastly increase the country’s capacity to provide voluntary family planning to meet demand. HP+ assisted Nigeren family planning advocates in forming The Network of Champions in Advocacy for Adequate Health Financing (RCPFAS) and, with the Directorate of Maternal and Child Health, provided guidance to its members to make the case for the increase, which meets a pledge made by the government at the Family Planning Summit in London in 2017. HP+ also helped organized a series of meetings with civil society and key Ministry of Health and Ministry of Finance decision makers to secure the commitment and the sign off by the Secretary General Ranaou Abache on November 22, 2018. Read more in our news story.
In December, USAID, through the Health Policy Plus (HP+) project convened a special plenary at the 5th Nigeria Family Planning Conference in Abuja. The session, “Financing Family Planning in Nigeria within the Context of the Basic Health Care Provision Fund and State Health Insurance,” featured panelists from USAID and Palladium—the prime implementer of the HP+ project—and discussants from the private sector and government. Dr. Kolade Oluwatosin, director of the private-sector firm Health Systems Consult Ltd., said during the meeting, “Best practices from countries like Kenya [another HP+-supported country] have shown that insurance can be used to address issues in family planning, but stakeholders—from donors, insurance bodies, civil society organizations, and government—must come together to agree on robust benefit packages.” From the meeting, a list of recommendations was generated for how Nigeria’s government could improve access to family planning while strengthening standards of care.
Under the leadership of Senegal’s Ministry of Health and Social Action, HP+ West Africa organized an unprecedented family planning advocacy workshop in Dakar in August to secure support and financial commitments from the private sector. The workshop resulted in more than US$630,000 pledged for family planning funding. The International Management Group (IMG), a private company from Cote d'Ivoire that took part in the Dakar meeting disbursed funds for family planning advocacy and clinic services in December 2018. Their contribution provided access to contraceptive pills, injectables, implants and IUDs to 121 additional women on voluntary contraception. This is just a start. IMG expressed a commitment to sustain its engagement moving forward.
Under the leadership of the Senegal’s Ministry of Health and Social Action, USAID-funded HP + West Africa organized an unprecedented reproductive health and family planning advocacy workshop August 30 and 31, 2018, in Dakar to secure support and financial commitments from the private sector resulting in more than approximately USD 630,000 pledged for family planning funding. Participants, including representatives of Banque of Africa, Nantou Mining SA, Mata Holding and other private sector groups, signed a collective declaration in support of reproductive health and family planning policies and programs in their respective countries. USAID Senegal representative, Omar Sanga, the senior government-to-government financing advisor, said of the workshop: "It is exceptional what I saw, such a success with the Private Sector of the sub-region. It is thanks to the expertise of HP+." Follow-up will be done by HP+ at the country level to ensure that the commitments made by the private sector will be implemented.
In late July, close to 100 traditional and religious leaders hailing from 10 West African nations gathered in Burkina Faso to share experiences and renew commitments in implementing innovative strategies to take advantage of the region’s demographic dividend—the accelerated economic growth that can result from changes in the age structure of a population. Among the nine-point pledge announced by the religious leaders is a commitment to advocate with their peers for the acceptance of family planning through use of methods that conform with their values and a commitment to fostering dialogue between couples on reproductive health issues. The forum, organized with support from the USAID-funded Health Policy Plus (HP+) project, “Reaping the Demographic Dividend: Religious and Traditional Leaders Get Committed,” held July 24-26 in Ouagadougou, was attended by the President of Burkina Faso, Roch Marc Christian Kaboré; the Mossi Emperor, Moogho Naaba Baongho; and the U.S. Ambassador to Burkina Faso, Andrew Young. HP+ plans to support the implementation and monitoring of action plans developed during the regional meeting.
An event on July 10 co-hosted by the PACE Project and held the Wilson Center, A More Prosperous World: The Role of Population Dynamics and Family Planning for Economic Growth, Education, and Health featured Health Policy Plus Deputy Director for Family Planning and Reproductive Health, Jay Gribble. Jay joined a panel of experts who discussed how population dynamics drive development and how access to family planning services enables countries to meet their education, employment, and public health goals. The event also featured Peter McPherson, former USAID Administrator and Deputy Secretary of the Treasury, who is now President of the Association of Public and Land-Grant Universities.
A national youth conference on HIV/AIDS and sexual reproductive health and rights, organized by the National Youth Council of Malawi (NYCOM) and supported by the Global Fund, was held June 28, 2018, in Lilongwe. The conference provided a venue for youth, government, and civil society leaders to exchange best practices and recommendations in sexual and reproductive health, HIV, and other issues that impact youth under the theme is “Reflect and Act for Improved Youth Participation and Leadership.” USAID through the Health Policy Plus (HP+), supported the participation of five youth champions and five district Youth Friendly Health Services coordinators and held capacity building and leadership strengthening sessions for the youth leaders. As a result of advocacy led by youth at the conference, the U.S. Embassy revised its criteria for youth organization eligibility for PEPFAR’s Small Grants Program and NYCOM announced on July 1, 2018, its new board of directors, which until then had several vacancies in critical leadership positions.
Ministries of Health across West Africa are taking action to meet ambitious family planning commitments made in the past several years in support of FP2020 goals. In Burkina Faso, where the use of reproductive health services is only 22.5 percent, the government has issued its 2017-2020 Family Planning Acceleration National Plan (PNAF 2017-2020). The action plan is part of the nation’s strategic vision for improving modern contraceptive prevalence to 32 percent by 2020. In Niger, with a goal of 50 percent contraceptive prevalence by 2020, the Ministry of Health has issued a new operational plan that focuses on identifying and mobilizing resources for contraceptive products. Mauritania is repositioning family planning to focus on birth spacing as an appropriate strategy to improve the supply of family planning and other health services. There, the Ministry of Health has issued a National Action Plan on Birth Spacing with the goal of increasing the modern contraceptive prevalence rate for women in union from 11 percent in 2013 to 18.5 percent in 2018. The USAID-funded Health Policy Plus project provided technical assistance to each of the ministries and key partners, conducted reviews and analyses, and provided recommendations in support of implementing these crucial plans.
On May 15, during the official launch of Mali’s 2018 National Family Planning Campaign, the USAID-funded Health Policy Plus (HP+) project was awarded a certificate of recognition as a family planning champion by First Lady of Mali, Mrs. Keita Aminata Maiga. The certificate serves as a recognition of HP+’s valuable contribution to the Division of Reproductive Health over the past two years, particularly in capacity strengthening, improving coordination of family planning stakeholders, and in support of the country’s costed implementation plan. At the event, Dr. Boré Saran Diakité, Head of the Division of Reproductive Health said, “HP+ stands out for the relevance of their support, the quality of the products produced with their support, and their partnership with all the [family planning] stakeholders in Mali.” Rokia Sissoko, who accepted the certificate on behalf of HP+, thanked the First Lady for her collaboration in improving the lives of women and children in Mali. The launch—which took place as part of Mali’s annual event to provide family planning outreach and services—attracted approximately 2,500 people, including representatives from USAID, WHO, UNFPA, and various implementing partners.
The government of Mauritania, on International Women’s Day (March 8, 2018), signed a regulatory decree to implement a new reproductive health law in focus counties. The law was originally passed in January 2017. With the signing of this new regulatory guidance, there is now approval for community health workers to provide birth control pills and injectables. Nurses are now allowed to provide IUDs and implants. This policy advance, which promises to bring efficiency and scale to contraceptive use, comes as a result of advocacy efforts led by USAID and supported by the HP+, FP2020, AgirPF, Stop Sida, UNFPA, and local partners.
An article describing a University of North Carolina (UNC) study and co-authored by Health Policy Plus Malawi country director, Olive Mtema, was published this month in the International Journal of Gynecology & Obstetrics. The article, “Effect of family planning interventions on couple years of protection in Malawi,” features USAID-funded work by the Health Policy Project (HPP) to sensitize religious leaders and their congregations on the benefits of family planning, and address barriers to family planning related to religious beliefs. This work was part of the community mobilization and demand generation aspect of a package of services delivered to two intervention sites as part of a quasi-experimental study conducted by the University of North Carolina (UNC) Project-Malawi. The full package of interventions delivered to study sites included community mobilization and demand generation for family planning, and training and mentoring of health providers in LARC insertion. The study found that uptake of family planning methods, particularly long-acting reversible contraceptives (LARC), increased following implementation of the package of family planning interventions.
The Reproductive Health Supplies Coalition Advocacy and Accountability working group hosted a webinar, Expanding Access: Estimating the Impact of DMPA-SC Introduction, in December 2017. The webinar, now featured on their website, was led by Erin McGinn, Jim Rosen, and Michelle Weinberger of the USAID-funded Health Policy Plus (HP+) project, provided an overview of the HP+ Microsoft Excel-based model to project the potential contribution of DMPA-SC (also referred to as Sayana Press) to a national family planning program. This model covers both hypothetical public health impact and potential cost savings and returns on investment. Results of recent country applications in Nigeria and Cameroon were shared during the webinar. Read our brief for more information.
Burkina Faso's reproductive health law has been strengthened with the Minister of Health's approval of new regulatory language that emphasizes the rights of users, including new text that states, "People of reproductive age or adolescents can freely use family planning without any barrier or constraints related to sex, religion, [or] marital status." The reproductive health law, originally passed in 2005 with support from USAID-funded health policy projects in collaboration with the National Assembly, had previously lacked enforceability. The new language, developed in collaboration with HP+, the West Africa Health Organization Network of Champions, and AgirPF, extends rights to reproductive health and family planning to all persons of childbearing age, including adolescents.
On December 12, 2017, the Senate of Madagascar passed a landmark reproductive health and family planning law that marked the final step in the law's adoption, following approval by the Council of Government, the Council of Ministers, and the National Assembly earlier in the year. The president's promulgation of the new law will be a tremendous step forward toward rights-based reproductive health services in Madagascar, which had been operating under a 1920s French colonial framework that prohibited distribution of contraception to youth or married women without spousal consent. HP+ was integral to this win, providing technical and financial support to revise the law and advocate to decisionmakers at each step of the approval process. HP+ Madagascar continues to support the new family planning law by supporting CIP execution; mobilizing family planning resources; supporting the development of application decrees for the law; working with a team to develop communication materials to disseminate the law; and monitoring the progress of actions that contribute to an enabling legal environment. In FY19, HP+ Madagascar plans to finalize an animated film to help disseminate the law and work with civil society organizations to both promote the law and hold the government accountable for dissemination and adherence to the law.
Three recent launches of results from HP+ led state-level applications of the RAPID (Resources for the Awareness of Population Impacts on Development) model in Nigeria are raising awareness of the potential impact that family planning and child spacing can have on the country’s development, and leading to pledges of new resources and support in Bauchi, Ebonyi, and Sokoto states. Factsheets for each state, as well as national-level, results are available.
The Governor of Nigeria’s Ebonyi State, David Umahi, pledged new resources and called for traditional leaders to promote family planning in their communities on November 1, 2017, at the launch of the Ebonyi State RAPID (Resources for the Awareness of Population Impacts on Development), which was developed with support by the USAID-funded Health Policy Plus (HP+). The Ebonyi State RAPID provides easy-to-use facts and figures that support the case for investment in family planning in Ebonyi based on a model application projecting the impact of rapid population growth on various sectors. The RAPID estimates that a total fertility rate reduced to three births per woman by 2037 and then reduced to about two births per woman by 2050 could save approximately $107 million (Naira 38 billion) in primary education costs between now and 2050. Governor Umahi pledge a bus to be used for community mobilization and outreach services in rural parts of the state. The event was broadcast live on state TV and included the HP+ country director, Onoriode Ezire, members of the state executive council and traditional leaders.
Burkina Faso’s Ministry of Finance's 2018 general budget includes a line item for purchase of contraceptives, which represents 68% of the total estimated cost of contraceptives the country requires for 2018. The Ministry is recommending an increase from CFA 500 million to CFA 1.300 billion to purchase contraceptives. With this recommendation, Burkina Faso is demonstrating political will and prioritizing family planning for investment. No other Francophone West African country has committed this level of domestic resources for contraceptives to date.
The decision to increase domestic resources for family planning commodities is based on the activities outlined in Burkina Faso’s new Costed Implementation Plan (CIP 2017-2020) for family planning. The costed implementation plan’s stated objective is to attain a modern contraceptive prevalence rate (mCPR) of 32% by 2020. Burkina Faso’s current mCPR is estimated at 22.5%, so given that objective Burkina Faso’s contraceptive need for 2018 will cost about CFA 1.900 billion. USAID/West Africa’s Health Policy Plus activity supported Burkina Faso’s multi-sectorial reproductive health steering committee to develop the costed implementation plan.
This story originally published by USAID WA in its newsletter, written by Eleonore Rabelahasa, USAID/West Africa
Participants in the HP+ Women Leadership activity in Pakistan successfully developed and advocated to the Plan Implementation Unit (PIU) of the Population Welfare Department (PWD) for the inclusion of youth-specific standards in the National Manual on Family Planning Standards & Guidelines. As a result, the manual now has a section on youth-friendly family planning services, which includes a youth-friendly facility description and checklist for all district level outlets where family planning services are being provided. For the first time, district health facilities will have guidance to ensure youth find services tailored to their needs. Using results from the RAPID model , the HP+ Pakistan team developed a video showing the effects of population growth on agriculture, water, education and health, and illustrated the number of unintended pregnancies and maternal and child deaths that will be averted if the contraceptive prevalence rate goal in the Costed Implementation Plan is met. The Plan Implementation unit showed the video during a high-level policy forum on August 11th.
The USAID-funded Health Policy Plus project was represented at the Global Health Mini University on September 14, 2017. In Roadmaps and Mapping: Two Tools to Promote Governance and Accountability for Stronger Health Systems, Alyson Lipsky and Sue Richidei presented data on strengthening the capacity of women leaders in Africa and Asia to hold local health officials accountable. Breakout sessions provided attendees an opportunity to use presented data to brainstorm ways to create stronger health systems. In a separate session, In or Out? Adding Sayana Press to Your FP Methods Mix, Erin McGinn and Jim Rosen provided an in-depth look into the future prospects of accessible and effective family planning through self-injecting Sayana Press. Sayana Press has been referred to as a “game-changing” family planning method and attendees engaged in interactive exercises that evaluated its potential community-level impacts.
A new journal article published in Global Health: Science and Practice examines the intersection of universal health coverage (UHC) and family planning efforts to understand to what extent selected countries in Latin America and the Caribbean have been successful in integrating family planning services and UHC-oriented schemes. Adopting a family planning lens, the Health Policy Plus authors examine access along the three dimensions of UHC: coverage, range of services (i.e., contraceptive methods), and financial protection. In addition to identifying barriers to access, this analysis takes a first step toward understanding the causal relationship between insurance coverage and family planning access.
Côte d'Ivoire’s Ministry of Health and Public Hygiene in April 2017 issue new guidance scaling up post-partum family planning to increase women's access to family planning services. The new guidance directs health facilities and qualified service providers to inform new mothers of the full range of family planning methods to ensure free and informed choice of options immediately following delivery. This comes as a result of advocacy efforts by a range of stakeholders. The USAID-funded Health Policy Plus (HP+) provided guidance and capacity development for advocates using the AFP SMART advocacy tool.
To fulfil national family planning commitments, countries must be strategic in how they invest limited resources. A costed-implementation plan (CIP) is a multi-year roadmap designed to help governments achieve their family planning goals by the most effective, efficient means possible. In May 2017, Sierra Leone’s Ministry of Health Services and its partner the UNFPA incorporated contraceptive commodity forecast data into their procurement planning. The data, based on the anticipated method mix and growth in contraceptive use generated by increased support for family planning, was drawn from Sierra Leone’s CIP, which is currently being developed with support of the USAID-funded Health Policy Plus (HP+). Evidence-based decisions using the CIP are already helping the ministry to calculate its budget requirements and will help ensure a sustainable supply of family planning commodities throughout Sierra Leone.
In June, the USAID-funded Health Policy Plus (HP+) project collaborated with the Bill and Melinda Gates Foundation’s TSU Nigeria project to test a new model that projects the potential public health impact, costs and benefits of introducing and scaling up DMPA-SC (or “Sayana Press”). Nigeria is in the process of developing its strategy for Sayana Press scale up, with the BMGF TSU project providing technical assistance. This served as an ideal opportunity to apply the model with these stakeholders and the results will inform and be included their strategy, expected final in late July. The model was developed by Palladium and Avenir staff. PATH, one of the lead organizations spearheading Sayana Press research and scale up in several countries, was at the model application workshop in Nigeria. PATH had contributed data to the model development over the past year, but this was their first time seeing the model in action. Soon after the meeting, PATH staff requested a call with HP+ to go over the model in more detail and discuss how it could potentially be applied in other countries where PATH is working on scale up. This initial meeting is tentatively scheduled for July 12th or 13th. HP+ is also in discussions with UNFPA Cameroon to apply this model there in August or September.
Participants in the USAID-funded Health Policy Plus (HP+) project’s Women's Leadership initiative in Pakistan have had tremendous success, directly contributing to policy and other efforts aimed at expanding outreach and access to family planning services for youth. Collectively, the women successfully advocated for the inclusion of youth-specific indicators to monitor the country's costed implementation plan and developed youth-specific guidelines for Pakistan's Manual of Standards for Family Planning Services. They provided recommendations to Sindh province's FP2020 working group and to the government—the latter of which ensured the funding and operationalizing of critical youth-friendly activities.
These wins come on the heels of three HP+ Women's Leadership for Family Planning workshops focused on increasing the women's confidence, capacity, and connections to achieve health policy and governance outcomes. HP+ initiated the Women's Leadership program in Pakistan late last year. The last of the three workshops was held in April.
Now, HP+ is continuing to support the women in their advocacy efforts and tracking their successes in our unfolding story on their progress.
Full implementation of the Task Sharing Policy and Funding for Family Planning Costed Implementation Plan (CIP) in all States were among the key issues Family Planning Advocates identified as priorities that need urgent attention to scale up access to voluntary safe and quality Family Planning services in Nigeria. These issues were addressed earlier this month when the Federal Ministry of Health (FMoH) and the USAID-funded Health Policy Plus (HP+) project hosted a high-level Family Planning (FP) Advocates’ workshop in Abuja that highlighted the urgency and importance of Nigeria’s investment in expanding coverage and uptake of FP services. The event brought together prominent Nigerians from a wide variety of backgrounds to explore the challenges facing Family Planning and to commit to specific actions advocating for increased resources for FP intervention. Participants included religious leaders, elected officials, journalists, and leaders of business associations. Budget allocation; donor dependence; state-level service delivery; and data generation and management were identified as key advocacy issues to prioritize moving forward.
Pakistani ministers of education, planning and development, and food security drew content from the recently published paper by the USAID-funded Health Policy Plus project called 17 Reasons to Invest in Family Planning in Pakistan: Accelerating Achievement of the Sustainable Development Goals to inform their remarks at a recent population research conference. The conference – Investing in Family Planning for SDGs 1 to 6 – included a special ministerial session on family planning and the Sustainable Development Goals (SDGs). The event was hosted by the Population Association of Pakistan on November 25-26, 2016.
Mauritania’s Council of Ministers, on October 6, 2016, approved the text of a new Reproductive Health Law, which explicitly states that the right to reproductive health care is a universal right guaranteed to all throughout the course of their lives and prohibits forms of violence against women, including female genital mutilation. The law, submitted by the Minister of Health, brings Mauritania’s national policies into alignment with those of other countries of the Ouagadougou Partnership pursuing commitments on family planning outlined in FP2020 goals. This comes as a result of nearly a decade of unceasing effort by USAID and its policy advocacy partners, including UNFPA, Health Policy Plus and its predecessor projects, which helped draft an early version of the law for FP2020 advocacy efforts across West Africa. The bill will be presented to Parliament for passage in the coming months.
In recent decades many Latin America and Caribbean (LAC) countries have lowered fertility rates and increased contraceptive prevalence. This progress is due in part to broad social reforms, including the adoption of universal health coverage (UHC) policies. To extract lessons for countries—both within LAC and beyond—who are in the early stages of implementing UHC programs, USAID through the Health Policy Plus project examined the interplay between UHC and family planning (FP) in nine countries. They found that, while LAC’s progress in moving toward UHC and expanding FP access has been positive, systematic inequalities persist. Most social health insurance schemes cover FP, but method choice is not always guaranteed and there are disparities in access and coverage between ethnic, geographical, and wealth groups. The briefs are available for download from the HP+ website.
Madagascar’s current family planning (FP) law was adopted around 1920, and restricts contraceptive access to young people. HP+ co-facilitated a workshop on Advanced Family Planning SMART to train stakeholders on FP advocacy techniques and develop a plan of action to assure that the country’s newly revised family planning and reproductive health law—created with drafting and technical review support from HP+—is reviewed and passed by parliament this year. The project is also active in the development and advancement of universal health coverage (UHC) and is represented on the UHC technical working group. The project has collaborated with the World Bank to introduce the RMNCAH (reproductive, maternal, newborn, child, and adolescent health) investment case to the MOH, and will support the ministry in its development.
Appearing at Madagascar’s First National Family Planning Conference (September 13–16), the head of the Ministry of Health (MOH) family planning division presented on findings from an application of ImpactNow, a USAID-supported model available through HP+. The division head highlighted that Madagascar could prevent over 4 million unintended pregnancies and 12,000 maternal deaths by 2020 if modern contraceptive prevalence increases to 50 percent among married women. The presentation material is also available as a brief.
At the conference conclusion, the MOH director of family health presented and highlighted the importance of key elements of the Costed Implementation Plan (CIP) for family planning. The CIP development process has been guided by HP+ and is close to completion in Madagascar. The country will join other FP2020 countries with a comprehensive roadmap to achieve its FP2020 goals by late 2016.
Supported by USAID's Health Policy Plus project, Kenya's parliamentary health committee adopted an amendment bill to the National Hospital Insurance Fund (NHIF) act. The proposed reforms impact delivery and financing of the mandated benefits package (inclusive of FP and HIV), supporting Kenya's efforts to achieve universal health coverage (UHC). The amendment will facilitate an increase in the number of individuals with health insurance, reducing out-of-pocket expenditure and ultimately reducing catastrophic health expenditure. If adopted, the bill will streamline administration at the NHIF, freeing up resources to be used for service delivery, contributing to domestic resource mobilization for health, and increasing access to essential health services. The bill now moves to the National Assembly for discussion and full adoption by September 2016.