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• With support from USAID, the Bill & Melinda Gates Foundation, and other donors, FHI 360 is implementing a wide variety of projects to expand the evidence base for safe and effective family planning and translating high-quality evidence into policy and practice. For instance, a new award from the Saving Lives at Birth program will seek to synchronize immunization visits with family planning re-supply to improve immunization coverage, promote a more logical infant growth-monitoring schedule and raise contraceptive prevalence. Under the Advancing Partners & Communities (APC) Project, FHI 360 is studying self-injection of the contraceptive DMPA in a subcutaneous formulation and delivery system known as “Sayana Press” in Malawi. Also under the APC project, FHI 360 advocates for the scale-up of community-based family planning programs and supports the implementation and monitoring of national costed implementation plans (CIPs).

• Support to the family planning strategies of local governments and for scale-up of evidence-based practices is provided by FHI 360 in multiple countries, including India (Uttar Pradesh state), where FHI 360 leads the Urban Health Initiative. FHI 360 also conducts systematic reviews on family planning for the Cochrane Collaboration, an important source of evidence for the WHO Medical Eligibility for Criteria (MEC) Guidance.

In August 2015, the Government of Togo shared an update on progress in achieving its policy, financial and program and service delivery commitments to FP2020.

• The Government of Togo held regional meetings in the country’s six health regions from July 3 to 10, 2015, to disseminate the 2013-2017 Family Planning Repositioning Plan.
• The preparations for implementing regulations for the reproductive health act is not yet effective. Negotiations with partners to finance this activity are ongoing. The Government of Togo hopes the workshop to develop this legislation will be organized before the end of August 2015 as it is scheduled from August 25 to 28.
• The Reproductive Health Act has not yet been disseminated since the implementing regulations have not been developed. Once they become effective, the government will schedule the dissemination workshop that will also be regional.
• The Government of Togo partnering with the private sector through social franchising to provide FP services.

• Les textes d’application de la loi de la santé de la reproduction en ce qui concerne la session « Planification familiale » sont élaborés en novembre 2015.

• 959 prestataires formés en Technologie contraceptive  depuis 2015 jusqu’en juin 2016. La formation en TC est une  nouvelle approche basée sur les compétences pour dispenser toutes les méthodes contraceptives en générale et particulièrement la pratique humaniste de pose et de retrait de l’implant et DIU en utilisant les modèles anatomiques adaptés , la prévention des infections ,la gestion des effets secondaires et le counseling.
• Depuis 2015 Jusqu’en mai 2016, 49 003 DMPA ont été administrés au niveau communautaire par les Techniciens de promotion de la santé,
  • 487 646 personnes sensibilisées dont 207 646 femmes par les Agents de santé communautaires.
  • 6066 cycles de pilules et 137 739 préservatifs ont été distribués par les agents de santé communautaire en 2015.
  • 33 Postes secondaires ont été mis en place dans les zones inaccessibles géographiquement et à proximité des Centres de santé confessionnels   qui ne proposent pas de méthodes de contraception modernes pour  augmenter l’accès aux  services de planification familiale.
• Le gouvernement du Burundi s’est engagé à intégrer ces services à d’autres programmes, comme l’immunisation et le VIH :
  • Le renforcement des capacités des prestataires travaillant dans les services de maternité en technologie contraceptive.
  • 60% des femmes opérées des fistules obstétricales adoptent une méthode contraceptive avant la sortie du centre de traitement
• Le gouvernement du Burundi s’est engagé à augmenter les services communautaires en mobilisant la communauté et en fournissant des méthodes de planification familiale, y compris le transfert de tâches en formant des techniciens de promotion de la santé et des agents sanitaires de collectivité (ASC) pour proposer des injections :
  • 338 TPS ont été formé sur l’administration du  DMPA au niveau communautaire et 3940 Agents de santé communautaire ont été formés  sur la distribution à base communautaire des contraceptifs (Pilules et Condoms).
  • Depuis 2015 Jusqu’en mai 2016, 49 003 DMPA ont été administrés au niveau communautaire par les Techniciens de promotion de la santé,
  • 487 646 personnes sensibilisées dont 207 646 femmes par les Agents de santé communautaires.
  • 6066 cycles de pilules et 137 739 préservatifs ont été distribués par les agents de santé communautaire en 2015
• Des émissions radiophoniques sur la SR mettant un accent particulier sur la PF et la SSRAJ ont été récoltées au cours des réunions régionales de coordination, des campagnes sur la PF  et diffusées.
• Les campagnes de sensibilisation des leaders en planification familiale et l’introduction du DMPA dans la distribution à base communautaire des contraceptifs. Au total, plus 2750 leaders proches de la communauté ont été sensibilisés et vont disséminer les messages sur la PF jusqu'au niveau communautaire pour susciter l'adhésion et utilisation des services de PF. Selon les statistiques de service, le taux de prévalence contraceptive est passé de 34,3% en 2014 à 37,4% en 2015
• Elaboration de la stratégie Condom, campagnes zéro grossesse, intégration de la SSRAJ dans les curricula de l’école Fondamentale (8ème) 9ème pour 2015 et révision pour la 7ème en 2016.
• En collaboration avec les opérateurs des Téléphonies mobiles et avec l’appui des partenaires techniques et financiers ,le gouvernement a assuré l’information et la référence aux services de santé sexuelle et  reproductive en faveur des adolescents  et jeunes grâce aux nouvelles technologies de l’informations et de la communication .C’est notamment par l’envoi périodique des SMS média sur la santé .La promotion des groupes virtuels à travers les réseaux sociaux permettant à plus de  10000 Jeunes d’échanger et partager leurs idées et informations sur la  SSRAJ .Exemple : Adv4Youth sur facebook  et Watch up.
• Le Gouvernement vient d’initier, en 2016 et pour une période de 5 ans, un programme conjoint (regroupant 3 ministères clés : santé, éducation, jeunesse et mis en œuvre par 4 partenaires : UNFPA, CARE, CORDAID, RUTGERS en santé sexuelle et reproductive des adolescents et jeunes.
• Le MSPLS vient d’élaborer une stratégie nationale de financement de la santé et est entrain de cheminer vers la mise en place d’une couverture sanitaire universelle à l’horizon 2018, intégrant les différents mécanismes de financement de la santé dont le Financement basé sur la performance. Dans cette perspective, la mise en œuvre du FBP est en train d’être repensée pour s’orienter vers un FBP seconde génération centré sur le renforcement de la qualité des soins et la levée des principaux goulots d’étranglement du système de santé.

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 July 2016, the Government of Ethiopia 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:

• To help meet the needs of married and unmarried adolescents and youth, the government has undertaken the following activities in 2015-2016:
  • Training on comprehensive family planning was given for university clinic personnel and health professionals to make family planning services available for youths and adolescents in collaboration with partners and Ministry of Education.
  • The government are working to strengthen youth reproductive health services in youth centers by providing training and IEC/BCC materials and franchising private clinics to address both in- and out-of-school adolescents and youths.
  • The Ministry of health has developed a 2015-2020 adolescent youth health strategy and made adolescent and youth reproductive health as one of the components.
  • The government is conducting research on the “factors affecting utilization of family planning among adolescents” and developing a policy brief focused on examining the risk-taking behaviors of adolescents and youth in the country.
  • Taskforce Update Nationally as a country Ministry of Youth and sport established and working specifically on adolescent and youth.
  • The Ministry of Health is a member of a taskforce on adolescents and youth, which has been formed by the Ministry of Youth and Sport.

• The Government of Ethiopia has engaged in the following activities to improve access to family planning for isolated pastoralist communities:
  • In 2015-2016, the ministry continued conducting advocacy activities to promote family planning by engaging religious and community and clan leaders.
  • The government has also started conducting fully-funded research on the barriers for utilization of family planning among pastoralist communities to design evidence-based interventions.
  • In addition, Ethiopia has developed the Health Sector Transformation Plan to 2015-2020, which states equity as one of the transformation agenda focus areas; based on this agenda, the ministry is expanding access for quality family planning services for these communities.

• The government of Ethiopia has engaged in the following activities in 2015-2016 to strengthen commodities security and to monitoring the availability of contraceptives:
  • The Pharmaceuticals Fund Supply Agency (PFSA) has established a family planning logistics technical working group to coordinate all stakeholders for the efficient management of the logistics system; the technical working group meets monthly.
  • A three-year forecasting and quantification analysis has been developed under the leadership of the Ministry of Health’s Pharmaceuticals Logistics Management Unit (PLMU) and Pharmaceuticals Fund Supply Agency (PFSA), and with technical support from the USAID | DELIVER PROJECT for advocacy and resource mobilization.
  • Regarding the availability of contraceptives, supportive supervision and evaluation has been undertaken to monitor stock-outs at service delivery points. UNFPA has also conducted a stock status survey.
  • The government has continued to fulfil commodities needs based on gaps and requests made by health facilities.

• The government of Ethiopia has engaged in the following activities to increase the uptake of long-acting reversible methods:
  • Both the Implanon Scale-Up and IUCD Scale-Up initiatives continue to be implemented, with more than 3000 health extension workers being trained on Implanon and 2401 health care providers being oriented to the new Implanon NXT.
  • In addition to this, the ministry is piloting IUCD provision by level 4 health extension workers in selected woredas and zones with high population pressure and low family planning use. The government has trained level 4 health extension workers from selected zones and equipped them.
  • To address high unmet need, the government is expanding post-partum family planning services in hospitals and health centers with high delivery caseloads.

• 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.

CARE International provided the following updates on progress in achieving its FP2020 commitments:

Building political will and mobilizing action at all levels ensure accountability to commitments: At the global level, CARE has actively contributed to key processes to shape standards and commitments to delivering universal access to high-quality, rights-based family planning, and to strengthen systems for ensuring meaningful accountability of all actors to deliver on these commitments.  Highlights of this work include:

• CARE served as one of four civil representatives on the Accountability Work stream for the UN Global Strategy for Women’s Children’s and Adolescents Health, which shaped guiding principles and structures for monitoring and accountability of the Global Strategy at global, national and sub-national levels.
• CARE provided significant staff time to support FP2020; specifically, supporting membership on the FP2020 Rights and Empowerment Working Group.  This group contributed to the development of FP2020 Rights and Empowerment Principles, and the development of rights indicators to measure progress in achieving FP2020 goals.  CARE continues to advocate for the inclusion of citizen-generated feedback on FP services in FP2020 monitoring and accountability systems.
• CARE contributed to a multi-stakeholder consultation convened by the Guttmacher Institute to develop a set of relevant and measurable SRHR indicators for the post-2015 SDG framework.

Ensure implementation of policies and programs that are rights-based, effective, and culturally appropriate and address the needs of communities: Since 2011, CARE has been working in southern Chad to increase access to high-quality family planning services for host and internally displaced (IDP) populations served by the government’s primary health care system.

• This initiative emphasizes long-acting reversible contraceptive (LARC) methods and comprehensive counseling in order to ensure that women obtain the method that best meets their needs and preferences. When CARE began this work, national guidelines for SRH service delivery restricted LARC services to hospitals. Furthermore, these guidelines required nurses and midwives to be supervised by a doctor whenever providing LARC services. These conditions effectively prevented many women in Chad from accessing LARC services. CARE helped change these guidelines by working hand-in-hand with local government and communities to demonstrate that nurses and midwives can safely and effectively deliver these services in health centers if they receive competency-based training and regular supportive supervision. Based in large part on this joint effort, the Ministry of Health convened a series of workshops with key partners (e.g. CARE, UNFPA and an IPPF affiliate) to produce the 2013 National Family Planning Policy, which, among other things, permits LARC service delivery in any primary health center by any trained nurse or midwife regardless of a doctor’s presence.
• At the other end of the spectrum, CARE has been working with local government officials, law enforcers, and community leaders to raise their awareness of existing national policies and laws protecting women’s right to SRH services. The national 2002 SRH law (2002) protects women’s right to receive family planning, without consent from a father or husband and without regard to her marital status. However, when CARE began its work, many people, including police officers, were unaware of this law and believed that it was illegal to provide family planning to young or unmarried women and to women without their partners’ knowledge or permission. After several men registered official complaints with the police concerning their wives’ use of family planning services without their consent, CARE met with local police officers to discuss the national SRH law and the right of women to SRH services. Not only did the officers end up supporting the law, but also they requested more information about various family planning methods and their benefits. In response, CARE held two workshops for police on the national SRH law, SRH rights, family planning and birth spacing. Since then, police have facilitated similar workshops for men’s groups and both health care providers and women have reported referring husbands to the police to verify and explain the legality of contraceptive use. Consequently, CARE has made it a best practice to ensure that all stakeholders know about and understand the provisions of the national SRH law.

Developing approaches for addressing gender and social barriers to increased family planning use: Since the London Summit, CARE has continued to strengthen our knowledge and evidence base for catalyzing meaningful change in the social and gender norms that restrict health and rights.  A core approach used by CARE is Social Analysis and Action (SAA), a participatory dialogue process that enables men, women and youth to explore and challenge the social norms, beliefs and practices that shape their lives and health.

• The SAA approach was used in the Results Initiative, (RI) a four year project carried out in Kenya, Ethiopia and Rwanda with the goal of increasing and sustaining the use of family planning by addressing the underlying social and cultural barriers to family planning, including gender norms. The project catalyzed ongoing dialogue with men, women and youth about how gender roles restrict family planning and provided role models for equitable communication and use of family planning. In Kenya, results from the project revealed significant increases in the current use of modern family planning between baseline and endline: use of modern family planning increased among women by 17.2% (from 34% to 51.2% of women) and among men increased by 24.3% (from 27.9% to 52.2%). Women who participated in SAA dialogues were significantly more likely to use modern family planning methods. Women’s reported use of modern FP was significantly associated with higher spousal communication, control over their own cash earnings and self-efficacy to use FP. Men were significantly more likely to use modern FP if they reported high approval of FP and more equitable gender beliefs. In qualitative interviews, men and women described how community dialogues addressed myths and misconceptions, normalized discussion about FP, and increased its acceptability. Public examples of couples making joint FP decisions and using FP provided models appeared to legitimize communication and joint decision-making with spouses about FP especially for men. Women described partner support as a key enabler of FP use, offering practical and emotional benefits; however, women emphasized the importance of their ability to access FP without their partners’ knowledge and support when facing partner opposition. Couples reported that increased communication contributed to increased couple-level ha 
• Similarly in Ethiopia, the project evaluation reported significant change in the use of family planning, where women’s FP current use changed from 32%-61% and men’s from 38%-82%. Inter spousal communication is found to be positively and significantly correlated with levels of exposure to the RI project and is positively associated with FP use for both men and women in the household survey. CARE continues to address gender and social norms in our SRMH programming.
• The SAA approach has also been used to improve family planning use among married adolescent girls in Ethiopia by the TESFA Working with key ‘gatekeepers’ of married adolescent girls to critically reflect on the barriers to FP use and the negative consequences of the restrictions to access services, it was possible to create support for the most marginalized and invisible groups of adolescent girls to access FP information and services. By the end of the project, use of modern family planning methods showed a 27 percentage point increase among the targeted adolescent girls.
• CARE has conducted a recent mapping that revealed that the SAA approach has been adapted and used for sexual and reproductive health projects including family planning in more than 10 CARE country offices. The lessons and experiences of using the approach and some of the results have been shared with partners at key international conferences including the International Conference on Family Planning (2013) and Women Deliver (2013).
• The success of SAA hinges on creating an effective cadre of change agents: CARE staff/SAA facilitators build awareness about how their own assumptions, beliefs, and attitudes about gender, power and sexuality shapes their work, and build concrete skills for facilitating productive dialogues about gender, sexuality and power. CARE is developing training materials for SAA facilitators to build key facilitation skills and provide tools and guidance for catalyzing community dialogues for social change.