Join FP2020 by Making a Commitment

In July 2016, the Government of Zimbabwe shared an update on progress in achieving its policy, financial and program and service delivery commitments to FP2020.

The government reports performing the following activities in support of its program and service delivery commitment:

• The government of Zimbabwe has engaged in various efforts to promote the use of long-acting and reversible contraceptives (LARCs). These activities include training of health service providers to administer LARCs and awareness campaigns. Trainings have been conducted in implant insertion and removals and Implanon insertion for doctors, midwives, and registered general nurses from selected districts across the country. The uptake of these services has increased as shown by the preliminary results of the ZDHS 2015, which shows an increase in the use of implants from 2.7% in 2010 to 9.6% in 2015. The government also began the postpartum IUCD program. A training of trainers workshop was conducted for facilitators and the program is being piloted in one province. In addition, the government conducted an IUCD study to determine the reasons for low uptake of IUCD and the results will inform future activities.
• In an effort to revitalize and scale family planning services for adolescents, more service providers have been trained and provided resource materials on ARSH. The government has also conducted an evaluation of the Health Facility Approach and facilitated the development of the community level training package and its rolling out in Hurungwe District. Additionally the government of Zimbabwe also coordinated the review of ASRH interventions by the John Hopkins Bloomberg School of Public Health and rolled out the adolescent fertility study. Regional documentation exercises on ASRH best practices in Zimbabwe have begun.
• The Ministry of Health has also strengthened collaboration with the gender department in the Ministry of Women Affairs, Gender, and Community Development. The head of the RH program is a member of the Anti-Domestic Violence Council (ADVC). The ADVC is a statutory body established in terms of Section 16 of the Domestic Violence Act (Chapter 5:16). The overall function of the Council is to ensure effective implementation of the Domestic Violence Act. This is achieved through the establishment of partnerships coupled with the provision of all necessary support to various stakeholders to ensure comprehensive multi-sectoral response to domestic violence in Zimbabwe. The council successfully coordinated commemoration of the 16 days against gender based violence campaign.
• The government made efforts to ensure that male and female condoms are always available for free especially in public places. This was augmented by massive advocacy and campaigns for dual protection through the development of IEC material in the form of pamphlets, fliers, banners and T-shirts that were distributed during annual commemorations. All these activities contributed to a 15% increase in the uptake of male condoms and 19% for female condoms during the year.

In August 2015, the David and Lucile Packard Foundation shared an update on progress in achieving its commitments to FP2020.

As the Packard Foundation continues its collective push toward FP2020 and other long-term goals, more women and girls around the world are gaining access to sexual and reproductive health care. So far, the program has learned that focusing on access alone is not enough–quality matters. Greater progress will be made by securing everyone’s right to quality care that’s centered around women’s lives and goals. This will help more women and girls secure knowledge, exercise their choices, shape their own destinies–and contribute to measurable progress on a whole range of public health issues.

The foundation supports courageous, visionary providers, advocates and researchers working to advance everyone’s right to quality sexual and reproductive health care. Grantees provide access to comprehensive information, services, and skills that help women and girls – and the men and boys in their lives–secure their right to the quality sexual and reproductive health care they want, need and deserve.

Quality sexual and reproductive health care is woman-centered. It means:

• She understands her body and feels empowered to keep herself healthy with accurate, unbiased information about sexuality and reproductive health.
• She gets care that is centered around her life and goals–and decides whether and when to have children, chooses from a full range of contraceptive options, and can obtain safe and legal abortion follow-up care without stigma or interference.
• She shapes her own destiny–making decisions about her health and wellbeing that empower her at home, at the clinic, and in the community.

Working with young women and men, families, communities, and government leaders, the foundation’s grantee partners are making meaningful, measurable progress for people facing the greatest obstacles to reproductive health and rights through the following activities: 

• Quality and rights: The foundation’s Global Family Planning portfolio funds initiatives to improve measurement, develop and scale up innovations, and improve policies and programs that prioritize quality and rights. The foundation also support initiatives to end early marriage, and support programs and research to build evidence on sexual and reproductive health services for youth.

• Quality Innovation Challenge: During the 2013 International Conference on Family Planning in Addis Ababa, Ethiopia, the Foundation’s Population and Reproductive Health program launched a global challenge to support innovations that improve quality in reproductive health care. Following a competitive selection process, nine organizations were awarded grants of up to $100,000 to implement their innovations. A second Quality Innovation Challenge will be held at the 2015 International Conference on Family Planning in Nusa Dua, Indonesia.

• Measuring Quality: In 2014, the foundation partnered with the Population Council to bring field-level attention to issues of measurement in quality. The work commenced with a convening of stakeholders from across the measurement community, including donors, implementing partners, and key global measurement organizations. In addition, support of the Global Early Adolescent Study has highlighted the need for better information on young adolescents within the donor and research communities.

• Advocating for Quality: In 2014, the foundation supported the launch of QUEST (Quality Upheld: Every Service Every Time), a five-year initiative in partnership with Population Action International to improve quality and fulfill rights within family planning service delivery settings by advocating for improvements in health, regulatory, and legal systems in Ethiopia, the Democratic Republic of Congo, India, Myanmar, and Pakistan.

• Quality in South Asia: The Foundation’s South Asia subprogram makes deep investments in Bihar, India with targeted investments in Uttar Pradesh, Karachi in Pakistan, and select states of Myanmar. In India, the program continues to improve access to quality services in the public and private sectors, increase demand and awareness of family planning, and further develop innovative approaches to deliver comprehensive sexuality education (CSE). In Myanmar, the program aims to accelerate access to family planning through research, strategic advocacy, and technical assistance. At the regional level, the program supports the development of youth leadership for advancing commitment to the sexual and reproductive health and rights of young people.

• Innovations in Sexuality and Education in South Asia: In India, grantee partner CorStone has demonstrated the importance of adopting a mental health approach to comprehensive sexual education (CSE) by integrating a resilience training component to existing sexuality education programs in Bihar. After a two-year process, the Center for Catalyzing Change launched a first of its kind CSE program for middle school students in Jharkhand. In Pakistan, grantees Aahung, Rutgers World Population Fund, and Indus Resource Centre continue to forge stronger relationships with institutions and communities to deliver quality CSE.

• Family Planning Quality and Access in Sub-Saharan Africa: The Sub-Saharan Africa subprogram seeks to expand access to quality family planning and reproductive health services, including youth friendly sexual and reproductive health services; and build local and regional movements to advance political and financial support for family planning and reproductive health. The foundation makes strategic investments to support the scaling up of services; shifting socio-cultural norms to enable communities and families to support young people to make their own sexual and reproductive health decisions, including a delay of early marriage and first pregnancy; and building leadership and advocacy capacity by cultivating new leaders in the region. This includes support of programs in Ethiopia and the Democratic Republic of Congo; and targeted investments in Kenya, Rwanda, and regional advocacy.

• Family planning access and quality in the DRC: Tulane University's Community-Based Distribution program has contributed to an impressive increase in modern contraceptive use in Kinshasa, DRC over the past year.

In August 2015, the David and Lucile Packard Foundation shared an update on progress in achieving its commitments to FP2020.

• Strengthening donor and recipient country government partnerships, political will, and funding commitments for family planning: In focus areas, the foundation continues to fund grantee partner work to foster an enabling political environment and secure funding commitments for family planning.

Collaborative donor efforts in South Asia totaled approximately $32 million in 2014.

• The Sukh Initiative: The largest of these collaborations is the Sukh Initiative in Karachi, Pakistan–a $15 million initiative to improve family planning access and quality of care. The Sukh Initiative is supported by the David and Lucile Packard Foundation, the Bill & Melinda Gates Foundation and the Aman Foundation. The program aims to provide more women with access to family planning and seeks to increase contraceptive use by 15 percent by 2018 in underserved Karachi communities.

• Contraceptive Access in India: A second key partnership in South Asia is with the Gates Foundation to support Abt Associates in launching a multi-year initiative to expand access to injectable contraceptives through the private sector in Bihar and Uttar Pradesh. 

• Global donor collaboration through Amplify Change: This fund aims to empower young people, men and women to realize their sexual and reproductive health and rights, and increase funding for the most neglected issues within the sexual and reproductive health and rights agenda.

• Strengthening partnerships to advance quality in Sub-Saharan Africa: In Ethiopia, partners initiated discussions on the themes of quality and youth, and made progress in addressing quality of care at the health-post level. Targeted investments in Rwanda have helped foster a climate favorable to improved access to adolescent sexual and reproductive health. At the regional level, several African governments have moved towards integrating family planning into their development agendas.

• Strengthening partnerships to support youth in Sub-Saharan Africa: The Ethiopian Ministry of Women, Children and Youth Affairs, with the support of grantee partner Pathfinder, held the first national Youth Development Forum. Young people, government officials, program managers, private sector representatives and donors gathered to develop a coordinated, multi-sectorial approach to youth development. The foundation engaged with the African Union’s Youth Division to promote the youth agenda across the continent.  

• Strengthening partnerships to advance quality in South Asia: In India, grantees have completed a review of state policies for quality, and the foundation’s partner Population Foundation of India successfully advocated for a government ban on sterilization camps. In Pakistan, implementation plans are being developed in Punjab and Sindh provinces with a focus on quality.

During the London Summit on Family Planning, the government of Rwanda committed to ensuring the availability of family planning services in each of the 14,841 Rwandan administrative villages (Imidugudu) through delivery by the 45,000 community health workers already in service. In 2014, the government reported that family planning services had been scaled across the country through community health workers.

In 2015-2016, the government of Rwanda reported that family planning services were provided countrywide at community level by Community Health Workers (CHWs) and the following activities were undertaken in support of this commitment:

• Updating and procuring FP tools used at community level, related to the register, supply chain management, reporting, and referral forms for CHWs
• Training new CHWs to overcome the dropout among CHWs and additional CHWs (ASM)
• Refresher training of already trained CHWs
• Training and monitoring of the Supply Chain Management and Waste Management system.

The government of Rwanda engaged in the following activities to expand existing family planning communications programs to raise awareness of family planning choices:

• A communications campaign was organized countrywide to raise awareness of FP choices and provide clear messages on contraceptives, benefits of FP use, and management of side effects. All four provinces and Kigali City were reached and 10 districts out of 30 conducted a special mobilization through community events, dramas, and meetings with community leaders.
• Mass mobilization activities were planned and organized by the Rwanda Health Communication Center (RHCC) with regular talk shows on national and local radios and TVs
• Training of journalists and the creation of a network of journalists on reproductive health and maternal and child health (including family planning)

The Government of Rwanda engaged in the following activities to introduce LAPMS and high-quality integrated family planning services in hospital and health centers:

• Health care providers from hospitals and health centers were trained on the clinical FP focusing on long-acting Methods (Implants and IUDs) for two weeks per session, with one week for theory and exercises on anatomic models and one week for practice on clients
• Physicians and counselors were trained on FP permanent methods: In total 22 district hospitals were trained on Tubal Ligation on local anesthesia (MINILAP) and 10 district hospitals trained on No Scalpel Vasectomy (NSV). The validation of trained staff and the post training follow will continue across the 2016-2017 year.

• Le Sénégal dispose désormais d’un plan de communication SR/PF et Survie de l’Enfant et son plan fait budgétisé mais l’accent sur la création de la demande. De même un plan de communication spécifiquement adressé aux jeunes est en cours d’élaboration. Les deux premiers seront validés au cours du mois d’aout 2016. Les religieux sont aussi parties prenantes du plan PF 2016 -2020. Présentement ils organisent des émissions à la radio pour soutenir le programme PF.
• L’IPM est généralisé dans le pays et les ruptures de stocks sont très rares et la durée est très réduite. Le Ministère à travers la PNA est entrain de s’en appropriée. Le passage du témoin entre le projet et la PNA débute cette année selon un scénario proposé par le Ministère
• La quantification des besoins se fait régulièrement au niveau national (2 fois par an). Avec l’appui des partenaires les régions seront formées sur le Reality Check afin de faire leur propre quantification.
• Dans le nouveau plan PF, les propositions faites multiplient le nombre de cliniques mobiles et les services franchisés. Ceci permet d’atteindre les populations les plus éloignées qui sont en général les plus vulnérables. Le programme cherche aussi à acquérir des kits d’insertions retraits pour les méthodes de longues durée afin d’éviter les prescription faites aux femmes.
• Le Sayana Press est offert sur l’ensemble du territoire national. Le programme insiste beaucoup sur les services de PF offerts aux jeunes notamment la communication sur les méthodes disponibles, la contraception d’urgence et surtout la nécessité de leur donner les connaissances nécessaires afin de les préparer à leur futur statut.
• L’offre de service à base communautaire est généralisée pour les pilules, les injectables en IM et en sous cutanée. L’intégration de la PF aux services de vaccination n’est pas encore généralisée mais est commune et est considérée comme une pratique prometteuse. Il est encore tôt d’évaluer son intégration avec le VIH.

In August 2015, Bloomberg Philanthropies shared an update on progress in achieving its commitments to FP2020.

• Bloomberg Philanthropies has engaged CDC Tanzania to conduct an impact evaluation of the Philanthropies’ work in Tanzania and found that on average, at least 100 maternal deaths and 2,000 injuries are being prevented annually because of interventions. Their evaluation also found that interventions increased access to emergency obstetric care within 2 hours from 68% to 72%
• CDC also conducted a household survey of 4,000 women of reproductive age in Kigoma, and findings from that survey were used to shape Philanthropies’ reinvestment strategy for the region.

• Aman Foundation, through the Sukh initiative is committed to share best practices and research to aid evidence based decision making. The intention is to share the best of time practices for family planning project scale ups and sustainability with potential users of the information. The Department of Community Health Sciences, Aga Khan University as a measurement partner for Sukh Initiative, is to provide an external and independent measurement of program impact through a cross sectional survey of a sample population within the 1 million intervention population in the form of a baseline and an endline. Program impact will be measured as per the objectives and program goals outlined and agreed upon in the Sukh program framework. The measurement partner will conduct a mid-term assessment of program progress towards identified goals and also an independent analysis of progress monitoring and PMIS data on an annual basis and participate in an annual review of program progress. A dedicated position of Manager Research and Metrics has been introduced to the Sukh initiative with sole responsibility of identifying and developing research questions and hypotheses and with program data to identify best practices and evidence based impact studies. The activity is to commence from 2015 when field level service data becomes available for a meaningful and effective sample study.   

• To increase the ambit of Sukh strategy and build on the success of different models implemented in the country, Sukh Initiative has evolved an exclusive technical body which is widely represented by the Sindh Government, development partners, technical experts both from public and private sector. This body aims to create synergy between different stakeholders including the government departments in Sindh. Sukh is also working at the community level through more than 200 community base organizations. To create an enabling environment for family planning services, Sukh is working in close collaboration with the provincial Departments of Health, Population Welfare, Education and Youth Affairs, to strengthen the existing systems in the intervention areas and play a leadership role in advocating for the sustainability of its objectives.

• [Aman Foundation's family planning] program will promote longer term, more effective contraceptive methods. Sukh through increasing MCPR will motivate new users to adopt family planning for the first time, and encourage users of traditional methods to switch to more reliable modern methods. The connection between increased MCPR and reduced maternal mortality rates is well established, as is its direct contribution to lowering the total fertility rate. To improve quality of services to increase access to family planning, Sukh strengthens the quality of services locally available and will develop capacity of maternity homes to offer quality post-partum and post abortion family planning services. Jhpiego as implementing partner will work with public sector facilities to improve access to FP services (by method) and with improved quality of service.

• One of the multiple service provision levers for the Sukh project is Family Life Education through Aahung, a local organization with previous experience in working with young girls and boys in communities on the sensitive issues related to maternal health, marriage rights and communication. Sukh will include door to door counselling and service delivery through Aman Community Health Program, to educate and inform the family planning clients on importance of family planning, choices available for family planning supplies, health hazards and other healthcare topics. In addition, Aman TeleHealth a 24-hour round the clock, 26-desks Health Helpline services over 3 shifts with medical advisors, counselors and doctors, will provide health advice and referral information over the phone. This will empower and encourage women and youth in particular, to avail the widely used mobile phone services to seek timely medical counseling that otherwise would not be accessible to them.

In July 2015, World Health Organization shared an update on progress in achieving its commitments to FP2020.

• In 2013, WHO published a resource on programming strategies in post-partum family planning (PPFP) to guide the designing interventions to integrate postpartum family planning into national and subnational strategies for program planners and managers: http://www.who.int/reproductivehealth/publications/family_planning/ppfp_strategies/en/. This guide was extensively used by select countries and key international stakeholders in, a global, action-oriented meeting, titled Accelerating Access to PPFP in Sub-Saharan Africa and Asia. Following this meeting, WHO is supporting 10 African countries develop and implement plans to accelerate PPFP.  A key upcoming milestone with the support of the Bill and Melinda Gates Foundation is the launch of the postpartum family planning compendium that will support providers and clients in expanding choice and access to contraception.
• In 2014, WHO published a landmark guideline called, “Ensuring human rights in the provision of contraceptive information and services.” The guideline is the first authoritative, evidence-based tool that provides recommendations for policies and programs as to how they can ensure that human rights are respected, protected and fulfilled, while services are scaled up to reduce unmet need for contraception. Both health data and international human rights laws and treaties were incorporated into the guidance. This guidance is complementary to existing WHO recommendations for sexual and reproductive health programs, including guidance on family planning, maternal and newborn health, safe abortion, and core competencies for primary health care.
• A key upcoming milestone with the support of the Bill and Melinda Gates Foundation is the launch of two tools, based on the principles and standards laid out in the WHO Guidelines on human rights and contraceptive services, 1) a set of quantitative indicators for monitoring the promotion or violation of rights in health programs; 2) an implementation tool for facilitating the incorporation of the guideline recommendations were developed and published in 2015. In June 2015, the World Health Organization (WHO) released its Medical eligibility criteria for contraceptive use, Fifth edition (or MEC) which contains the latest recommendations on contraceptive eligibility for women and men with various medical conditions and personal characteristics. To compliment this release, the 2015 edition of the MEC Wheel-a tool that allows providers to more easily locate the information and recommendations for contraceptive methods was released.   The MEC Guideline and Wheel have been introduced in several international professional conferences and family planning/contraception consultations. Each of these events enabled stakeholders and professional groups to learn about the new recommendations and to become familiar with the 2015 MEC Wheel.  As a result of these opportunities, multiple requests (for example, Lao PDR and the Solomon Islands seek to integrate the newly relaxed recommendations into the midwifery services provided during the immediate postpartum period).  WHO has provided the revised MEC to Ministries of Health in several countries (e.g., Mexico and Iran); in turn these countries have initiated revisions of their national contraceptive policies.

WHO also contributes to and promotes the online Family Planning Training Resource Package which provides training modules on Medical Eligibility Criteria Family Planning wheel and related tools and guidelines. The package includes training objectives, session plans, facilitators’ guides, handouts, presentations, role play sessions, and training evaluation tools intended to provide easy access to updated, evidence based instructional materials on contraceptive methods, to improve the quality of training of providers. The TRP has been presented in large conferences and fora Orientation and training workshops on the TRP were conducted for more than 30 countries in Africa and Asia over the last few years.

In July 2016, the Government of Indonesia shared an update on progress in achieving its policy, financial and program and service delivery commitments to FP2020.

The government reports performing the following activities in support of its policy and political commitment:

• Based on the Presidential Instruction on changes in planning approaches of the Government Work Plan (Rencana Kerja Pemerintah/RKP) year 2017, BKKBN has developed strategic planning that is based on holistic, thematic, integrated, and spatial approaches. In the context of a holistic approach; BKKBN will have to mobilize all potential resources of BKKBN, related government agencies and all strategic stakeholders/partners at all levels to achieve the target of the National Medium Term Development Plan (Rencana Pembangunan Jangka Menengah Nasional /RPJMN) related to Population and Family Planning, and BKKBN Strategic Plan Year 2015-2019.

In order to implement the thematic approach, BKKBN strategic program and activities will have to focus on the main theme to decrease total fertility rate by increasing contraceptive prevalence rate (CPR), lowering drop out (DO), increasing the use of long term family planning contraception method, and lowering unmet need of family planning, the government states.

 In the context of the integrated approach, BKKBN will have to develop integrated programs and activities that involve across government sectors and strategic stakeholders/partners at all levels, particularly targeted at Kampung KB areas.

 Related to the spatial approach, BKKBN will have to focus the intervention to the main target areas of FP program at the district level to better reach targeted poor communities at isolated/remote area; densely populated urban areas; fishing villages; slums and other disadvantaged areas across the sub national level.

 Based on this design of the Government Work Plan (Rencana Kerja Pemerintah/RKP) year 2017, development of the population and family planning program will focus on five (5) national priorities, among them are 1) family planning services; 2) advocacy and IEC; 3) youth; 4) family development; and 5) regulation, institutional development, data and information. All five national priorities should be developed into activities that directly touch target communities’ needs. In order to achieve these objectives, BKKBN strategic and policy direction as documented in National Medium Term Development Plan for year 2015 – 2019, highlight the importance of:

• Strengthening and integrating FP & RH services policy;
• Increasing access to FP services: Ensuring availability of commodity security in all SDPs – SCM and LMIS
• Promoting LAPM services to potential LAPM acceptors by providing adequate information and improving quality assurance of FP services to reduce drop-out risk;
• Increasing number & improving capacity of FP field workers and enhancing local institutional capacity to support FP Program;
• Developing and promoting national advocacy and communication strategies for decision makers focusing on the major unmet needs and unreached groups;
• Maintaining family resilience through beyond family development group activities in order to preserve FP participation and initiate community participation to become FP acceptors; and
• Strengthening management of Population and FP development.

Further to support these policies, BKKBN in the future will focus supporting priority activities at field level by reviving activities in village level. Various priority activities to be developed at field level are:

• Mobilizing family planning and reproductive health services at all levels, especially for mobilizing long-acting and reversible contraceptive services;
• Improving the provision of family planning and reproductive health services particularly to poor communities at isolated/remote area; densely populated urban areas; fishing villages; slums and other disadvantaged areas across sub national level;
• Increasing advocacy and IEC activities and counseling on health and the rights of reproduction to communities;
• Improving operational mechanism at field level especially for the mobilization FP Field Workers/Cadres
• Strengthening the function of Counseling Center as the Control Center for operational mechanism at field level;
• Implementing integrated priority activities across government sectors and strategic stakeholders/partners at "Kampung KB";
• Strengthening advocacy and IEC of FP Program to engage across government sectors and strategic stakeholders/partners to reach major unmet needs and unreached groups;
• Strengthening Data and Information Systems with focus on the IDHS in 2017 as a measure of program success over the last five years; and
• Improving pre-marriage counselling by involving religious leaders and community leaders.

• BKKBN will also strengthen revitalization of family planning through the implementation of “Kampung KB” initiatives at sub national level as mandated by President Joko Widodo during the 2016 International Conference on Family Planning. Under the  Kampung  KB  initiative, BKKBN will collaborate across government agencies and strategic stakeholders to develop  a range  of  multi-sectoral advocacy and collaboration activities  to ensure  better  access  to  family  planning  services  particularly to LARCs for poor communities in isolated areas; densely populated urban areas; fishing villages; slums and other disadvantaged areas across sub national level. The target in year 2016 is 1 Kampung KB per district/municipality

The government of Indonesia supported South-to-South cooperation and learning by establishing the Center of Excellence of Comprehensive Rights-based FP at Gadjah Mada University, Yogyakarta.