Join FP2020 by Making a Commitment

• Le gouvernement du Mali s’est engagé à renforcer le partenariat avec tous les acteurs autour de la mise en œuvredu plan d'action National PF : Secteur privé, société civile, organisations professionnelles.
  • Existence du groupe multisectoriel PF, cadre de concertation pour toutes les questions relatives à la PF et qui est composé des acteurs Secteur privé, société civile, organisations  professionnelles, PTFset confessionnelles
• Le gouvernement du Mali s’est engagé à veiller au suivi régulier de la mise en œuvre du Plan d'Action National PF à un très haut niveau décisionnel (Ministre).
  • Le point de mise en œuvre du plan a été fait au Ministre de la Santé et de l’Hygiène Publique a l’occasion de la visite des bailleurs du partenariat de Ouagadougou. Le MSHP a recommandé que plus d’efforts soient fournis afin d’améliorer les indicateurs au prochain bilan
• Le MSHP a coordonné et piloté toutes les phases de la mise en œuvre de la campagne PF 2016 à travers une implication forte de son cabinet
• Le gouvernement du Mali s’est engagé à disséminer la loi de la Santé de la Reproduction élaborée depuis 2002.
  • Cette activité avait été réalisée depuis la conception de la loi en 2002
    • Niveau national : Assemblée Nationale, des Ministères de l’éducation, des finances, de la promotion de la femme et développement social et des
  • Niveau régional : au niveau des gouvernorats
  • Niveau local :

            Mais  cette dissémination n’a pas continué au niveau local suite à la crise institutionnelle et sécuritaire.

• Le Gouvernement s’engage avec ses partenaires à remettre cette activité dans l’agenda 2016 dès lors que de nouveaux acteurs opèrent dans le domaine de la SR /PF.
• Des efforts sont en cours pour l’adoption des textes d’application de la loi  avec l’appui des OSC.

• Le gouvernement du Mali s’est engagé à faire un plaidoyer au plus haut niveau de l'Etat (Chef de l'Etat, Première Dame, Premier Ministre, Présidents des institutions, ministres, leaders communautaires, religieux et traditionnels) en faveur de la Santé de la Reproduction et de la Planification Familiale comme priorité de développement.
  • Engagement du Ministère des affaires Religieuses et du Culte en partenariat avec le MSHP à travers l’élaboration d’un plan d’action de plaidoyer en faveur de la SR /PF
  • Elaboration d’outils de plaidoyer pour les organisations confessionnelles
  • Partage d’information avec les organisations confessionnelles
  • Engagement de la Première Dame à soutenir les actions de SR y compris la PF dont le lancement de la campagne PF 2016
  • Participation des organisations de la société civile à travers la coalition dans la promotion de la PF
• Le gouvernement du Mali s’est engagé à poursuivre et renforcer les campagnes nationales de promotion de la planification familiale institutionnalisées depuis 2005 sous l'égide du Premier Ministre.

Les campagnes nationales de promotion de la PF continuent avec le soutien de l’ensemble des PTF sous l’égide du Ministère de la Santé et de l’hygiène publique accompagné de ses pairs (Ministre de la Population, promotion de la femme, Education, Solidarité et Action Humanitaire) et de la présidence de la première dame en 2016

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

• The Government of Cameroon introduced Implanon NXT and Sayana Press in 2015. The Family Health Department is currently developing a pilot project for community-based distribution with Sayana Press in two health districts.
• The [Family Health Directorate] is organizing a family planning caravan that will offer free family planning services and raise awareness amongst the population. The caravan will visit two regions for the first phase. This caravan is expected to start in the coming weeks. 
• 690 providers were trained in family planning in 2015.
• The Logistics Management and Information System (LMIS) was developed and launched to improve the management and availability of contraceptives and other medicines. Data was collected monthly on contraceptives at the central and regional levels.
• The “SMS for Life” campaign for the telephone collection of data on the stock levels of contraceptives and family planning services among 22 districts in 6 regions of the country was launch.

• A joint effort by the Government of Cameroon’s Department of Family Health/Ministry of Public Health, UNFPA, and the Clinton Health Access Initiative, Inc., has resulted in implant distribution in public health facilities increasing 3.7 times between 2013 and 2015.
• Specifically, Cameroon’s central warehouse distributed 33,708 implants to public health facilities in 2015 compared to 9,063 implants two years before.
• Various factors contributed to this increase: stronger forecasting; the procurement of sufficient buffer stock to gauge true consumption; an investment in targeted healthcare worker training; and strategic planning by the government, which enabled thousands more women to access contraceptive implants, helped reduce high levels of unmet need, and advanced progress toward Cameroon’s FP2020 commitments.
• Historically, Cameroon’s chronic stock-outs of contraceptives, particularly implants, have contributed to a low CPR (16.1%) and high maternal mortality (720 deaths/100,000 live births).

Implant Distribution in Cameroon, 2013-2015

• La campagne PF est institutionnalisée depuis 2015 en Guinée.
• Depuis 2015, le Ministère de la santé en collaboration avec ses PTF (USAID, UNFPA) à travers leurs agences d’exécution ont intégré les méthodes de longue durée d’action dans plus de 15 districts de santé Formation/Recyclage du personnel de toutes les formations sanitaires publiques (1117prestataires) en TCMLDA/PF, PFPP/DIUPP et MLDA
• Offre effective de services de MLDA dans 126 structures sanitaires
• Introduction récente des MLDA dans 330 structures sanitaires
• Mise en place base de données/Rapidpro: Formation de 700 gestionnaires et prestataires des centres de santé ; Achat et distribution de 700 téléphones et accessoires
  • Mise en place de l’apprentissage individualisé (AI) sur site en PFPP/DIUPP:
  • 16 sites: 8 a Conakry, 3 a Kissidougou, 1 a N’zérékoré et 4 a Kindia
  • 27 facilitateurs
  • 124 apprenants
  • 578 Causeries éducatives réalisées
  • 247 DIUPP insérés (Octobre 2015 – Mars 2016)

Un projet pilote de distribution du dépoprovéra  a été initié dans la préfecture de Mandiana

• Institutionnalisation des campagnes PF :(Résultats 2015) 8008 FAP ont bénéficié de toutes les méthodes confondues dont 4912 implants, 682 DIU, 1369 dépo provéra;
• Nouvelles utilisatrices PF 2014-2015:
• 268 512 toutes méthodes confondues :13950 implants ; 6600 DIU ; 155 LT

Le gouvernement de la Guinée s’est engagé à recruter 2 000 travailleurs de la santé en 2014, à un coût de 3,5 millions de dollars américains :

• Contractualisation de 68 sages femmes pour les préfectures frontalières affectées par la MVE en 2015
• Contractualisation de 168 sages femmes pour les 33 préfectures de la Guinée en 2016. Ces sages femmes sont déjà déployées à l’intérieur du pays
• Un test de recrutement a été organisé de 2000 travailleurs de santé toutes catégories confondues en décembre 2015 le processus est en cours de finalisation à la fonction publique
• Toutes les 8 régions ont intégrées les services de PF adaptés aux jeunes en matière de santé sexuelle et reproductive
• Contractualisation avec les ONG évoluant dans la santé sexuelle et reproductive (AGBEF, JHPIEGO) pour la mise en œuvre des formations ne SR/PF, la distribution des 13 produits vitaux y compris les contraceptifs avec la PCG (centrale d’achat des médicaments)
• Pour améliorer la gestion des données, le Gouvernement vient d’octroyer des ordinateurs portables à tous les chefs de centre de santé, les sous préfets et aux préfets. Un logiciel est en cours d’installation suivi de la formation des gestionnaires et prestataires de santé

Reproductive Health Supplies Coalition provided the following updates on progress in achieving its FP2020 commitments:

Under the auspices of the Reproductive Health Supplies Coalition, Secretariat staff and members of the Advocacy and Accountability Working Group (formerly known as RMA WG) launched an interactive online platform—www.supplypromises.org—that provides easy access to close to 140 supply-related commitments made by governments and development agencies over the last decade, shares lessons on their implementation, and offers guidance on the formulation of new commitments.1

• The Coalition also completed an analysis of the country-level commitments contained within “supplypromises.org,” which gleans lessons from a decade of supplies commitments, and clarifies the processes and rationale behind them.2
• The Coalition is applying the lessons derived from this analysis in Uganda, where in 2014 it launched an initiative to galvanize multisectoral support and national ownership needed to accelerate progress on Uganda’s reproductive health supplies promises to FP2020, the UN Commission on Life Saving Commodities for Women and Children and Every Women, Every Child. The Coalition has convened members and local partners in Uganda to unpack Uganda’s commitments and build consensus around a set of achievable joint targets, identified by partners, to yield the greatest returns. The resulting joint strategy is providing the backbone for enhanced coordination and focused action by local stakeholders to accelerate progress on Uganda’s commitments.
• The Coalition is launching two field-based initiatives in Ghana and Burkina Faso to advance supply-related commitments made at the London Family Planning Summit. These initiatives will see the Coalition work with members and partners in Burkina Faso and Ghana to reinvigorate efforts by local champions to turn national reproductive health supplies commitments into actions.
• In building www.supplypromises.org and completing the analysis of the process and rationale behind governments making commitments, the Coalition learned how difficult it is to extract commodity security from other broader reproductive health commitments. The Coalition also came to appreciate the wide range of motivations that drive countries to make commitments in the first place. Commitments are a highly effective development tool but also one very prone to attrition and turnover at the country, and especially the government, level.

^[1] The  supplypromises.org online platform is also featured on the K4Health toolkit (https://www.k4health.org/toolkits/fp-logistics/supply-promises) and the Procurement Management Toolbox (http://www.psmtoolbox.org/en/tool-details|Distribution|SupplyPromises-online-database-of-reproductive-health-supplies-commitments|515)

2 “Analysis of the Dynamics Surrounding Reproductive Health Supplies Commitments” is available on the RHSC web site at http://www.rhsupplies.org/uploads/tx_rhscpublications

In August 2015, the Children’s Investment Fund Foundation shared an update on progress in achieving its commitments to FP2020.

• In 2015, we launched two new monitoring and evaluation initiatives–the first an impact evaluation of our Kenya investment, which is being managed by the International Centre for Research on Women; secondly, performance monitoring and generation of user-insights as Sayana Press is rolled-out in Nigeria, which is being managed by the University of California San Francisco.
• We recognize the importance of strengthening adolescent-specific data collection and analysis, and to link this with advocacy and accountability. Our health team is working on a new investment to leverage existing surveys to better track adolescent indicators related to reproductive health outcomes and risk factors, which we hope to launch in 2016.

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.