Join FP2020 by Making a Commitment

Pathfinder International shared the following update on progress in achieving its FP2020 commitments:

• Pathfinder International has also raised about $1.4 million in private funds since the London Summit to increase our support to the Tuungane project, a joint project with the Nature Conservancy and Frankfurt Zoological Society in Tanzania. This project couples family planning activities with environmental protection activities in the Lake Tanganyika basin to ensure communities’ sustainability in ecologically fragile zones. 

In July 2016, the Government of Nepal 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:

• In 2016, Myanmar has made some progress in the policy environment for providing clinical contraceptive methods by trained and skilled nurses and volunteered, such as the commitment for task shifting to Auxiliary Midwives (AMW) in FP services; some methods of family planning like OC pills and condom can be provided by AMW. Long-term methods of family planning (particularly, implant) training is scheduled to start in July 2016 for the public sector, with a nationwide roll out planned for 2016-2017 with the support of UNFPA, PSI, Jhpiego and ObGy Society/ MMA. There will be trainings of health care providers to give services targeted to peri-urban poor in the Yangon region (reaching 34 townships), in the Mandalay region (23 townships), and in the Magway region (25 townships), where maternal mortality is high and unmet need is high.
• Myanmar has developed a five-year strategic plan for reproductive health and developed a Costed Implementation Plan (CIP) in 2014 to meet the commitment on Family Planning 2020. All implementing partners are providing FP services according to the strategies and guidance of that plan, but the government plans on revisiting the CIP this year 2016 to explore the gaps in family planning.
• Lead Working Group on Family Planning and Lead Working Group on RH are being conducted quarterly in alignment with the Reproductive Health Technical Working Committee meetings and any recommendations are discussed at the Maternal Newborn and Child Health Technical Strategic Group. In addition, the FP commodity meeting and coordination meetings of the nationwide training effort are also occasionally conducted occasionally.

• Le gouvernement du Mali s’est engagé à diversifier les sources de financement des activités de la Santé de la Reproduction/Planification Familiale, en mobilisant notamment auprès du secteur prive à travers des stratégies novatrices.
  • Partenariat avec les Agences de téléphonie mobile et de communication (Ligne vertes pour le partage d’informations et la communication sur les services de PF et leurs accès)
  • Développement des réseaux sociaux pour soutenir les actions de promotion de la PF
  • Le partenariat avec les structures privées
• Le gouvernement du Mali s’est engagé à renforcer les mécanismes de gestion transparente et de redevabilité.

Veuillez indiquer ici une mise à jour sur cet engagement.

• Le mécanisme de gestion transparente et de redevabilité se font à travers les organes de gestion du PRODESS : comité de suivi, Comité technique, les missions conjointes de suivi.

• Ces dispositions sont renforcées avec les revues annuelles des programmes et la carte score
• Le gouvernement du Mali s’est engagé à assurer la disponibilité et l'accessibilité des produits contraceptifs sur toute l’étendue du territoire.
• La mise en œuvre d’un plan de sécurisation des produits SR y compris les contraceptifs
• Le respect du schéma d’approvisionnement et de distribution des médicaments mis à jour
• Mise en place de Logiciel de gestion des produits au niveau décentralisé (CHANNEL , OSP santé ) dans tous les districts sanitaires
• NB environ 68% des points de prestation n’ont pas connu de rupture de stock de produits contraceptifs selon le rapport mensuel juin 2016 de OSP santé
• Le gouvernement du Mali s’est engagé à renforcer les activités de changement.de comportement autour de la planification familiale ciblant davantage les jeunes, les adolescents, les femmes et les hommes des milieux urbain, périurbain et rural.
  • Mise à échelle des approches réussies de communication et de mobilisation communautaire (Approche « Ardents défenseurs » PF, Jeunes Ambassadeurs, coalition société civile, Implication des maris, leaders religieux, belle- mères, etc.)
  • Développement des approches novatrices de mobilisation et de sensibilisation par rapport à la PF en suivant l’exemple des activitésintégrées de nutrition et vaccination; Utilisation des TIC pour sensibiliser les jeunes

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

• The government of Uganda has undertaken the following to improve midwifery profession:
  • Skills training: In 2015, Uganda finalized the review of the midwifery curriculum to make it competency based. The curriculum emphasizes more practical time than theory and includes a module on family planning. 160 midwifery tutors and clinical Instructors were given skills in mentoring and coaching of students to improve the quality of training for midwives. The aim is to produce competent midwives to offer quality maternal and child health services including family planning. Four clinical instructors in charge of midwifery skills labs were trained on how to use the equipment that had been supplied by UNFPA. Forty newly recruited midwives have been oriented on maternal health and family planning services. Ninety midwives have been recruited to serve in the hard-to-reach areas.
  • Involvement in Policy Dialogue: More than 200 midwives met the First Lady of Uganda and discussed the challenges they face in delivering midwifery services. More advocacy meetings for improving the midwifery program to be spearheaded by the First Lady have been planned for 2016.Through national and regional symposia, midwives have been supported to establish a Midwives Association that will spearhead the policy dialogues. A constitution for the association is being drafted and will be disseminated to stakeholders in September 2016. Forty Young Midwives Leaders have been equipped with skills in leadership and advocacy for improved maternal health and family planning services. A scheme of services for midwives and nurses, and nursing and midwifery policy were developed and presented to the senior management of the Ministry of Health for approval.
  • Midwifery career promotion: Midwifery career promotions in secondary schools in four hard-to-reach districts were conducted. Midwifery career promotional materials have been developed to be used across the country.
• Uganda is implementing a self-injection pilot using Sayana Press in some communities with good result. Now with support from UNFPA, the government is scaling up the distribution of Sayana Press through community health workers in selected districts. Ninety midwives have been recruited to support the service delivery.
• UNFPA through the RMNCH Trust Fund has supported the government to renovate some health facilities and to purchase hospital equipment; the Association of Obstetricians and Gynecologists of Uganda (AOGU) is now helping to build capacity for use.
• With support from UNFPA, the Ministry of Health, through JHPIEGO, has helped build the capacity of 941 service providers in the provision of family planning, especially postpartum family planning and long acting reversible contraception. In addition, equipment (PPIUDs kits, Mama Natalie, and Mama U models) were given to 160 health facilities and 18 midwifery schools so that health workers have the required tools and skills for service provision and continuous practice following the training.
• Medical Eligibility Criteria Wheel: Trainer-of-trainers training was carried out with selected participants from districts, referral hospitals, and partners supporting family planning to input the development of a localized Medical Eligibility Criteria (MEC) wheel for Uganda, based on the 5th edition of World Health Organization MEC wheel. A final draft was developed and its undergoing validation from various stakeholders. A cascade training of the wheel has also been done in selected districts, and we hope to scale up the training to the rest of the country.
• Uganda has also embarked on improving the quality of services provided by community health workers (CHEWs) by developing a CHEW strategy to be able to increase family planning services at community level. The strategy has been endorsed by the top management of Ministry of Health and is now due for presentation to the cabinet.
• In 2015, UNFPA supported 7 (out of 112) core districts to provide youth-friendly (YFS) services according to national standards in 100 percent and 86 percent of the hospitals and Health Centre IVs, respectively. Furthermore, 15 health centres were supported to establish YFS in targeted districts through faith-based organizations. UNFPA supported the government of Uganda to increase YFS in humanitarian setting with 90 percent of the Health Centres in four refugee settlements by establishing 20 youth spaces reaching out to 59,100 young people with SRH information and services.
• The Ministry of Health, with support from UNFPA, conducted a national assessment on the knowledge, briefs, practices, needs of young people (10-24 years), and on access, appropriateness, and effectiveness of sexual and reproductive services.
• A scorecard has been developed to link results with resources at different levels of service delivery and aligned in the district league table. It is currently being piloted in some districts with capacity building of service providers. This will be disseminated and rolled out in 2016-2017.
• The Uganda RMNCAH assembly was held in December 2015 and stakeholders made commitments in various areas. Most importantly they committed to strengthen accountability and coordination for RMNCAH at the national, district, and community levels in order to streamline RMNCAH implementation. The government plans to hold annual RMNCAH assemblies.
• Uganda has conducted the Annual Household Panel Survey and has completed wave four (series 4) and now is in the process of data collection for wave 5. Through the Joint Assessment Framework (JAF)— a local DP platform—Uganda is able to track the annual CPR using information from panel survey and assess household behavior on family planning uptake.

RHU also helped achieve a task shifting policy that enables clinical staff to undertake sterilization (previously not allowed) and the establishment of the national Population Council, through the passing of the Population Council Bill in 2013 and its signing by the President in 2014.

• Le gouvernement du Togo s’est engagé à accroître la couverture des services en tenant compte des structures privées et associatives dans la fourniture de services de planification familiale:
  • Continuité de la franchise sociale et de la participation des structures privées à la formation pour l’offre de service de PF, aux journées portes ouvertes
• Le gouvernement du Togo s’est engagé à organiser des services de planification familiale au bénéfice de groupes isolés et marginalisés et à améliorer l’accès des populations locales aux méthodes de planification familiale au moyen de stratégies innovantes:
  • Continuité des stratégies innovantes : Stratégie mobile, stratégie avancée, Distribution à base communautaire, Journée Portes Ouvertes
• Le gouvernement du Togo s’est engagé à intégrer les services de santé sexuelle et reproductive des adolescents et des jeunes au PMA (ensemble minimal de services) des structures de santé et à recruter et former du personnel qualifié afin de proposer des services de qualité:
  • Renforcement des infirmeries scolaires pour l’offre de service de PF (formation, équipement, dotation de produits contraceptifs),
  • Formation des prestataires des formations sanitaires sur la santé sexuelle et de reproduction des jeunes et adolescents pour une intégration de la prise en charge dans le PMA.
• Le gouvernement du Togo s’est engagé à promouvoir la planification familiale avec des outils de plaidoyer (RAPID, RAPID religieux) et à institutionnaliser la campagne nationale sur la planification familiale:
  • Continuité du plaidoyer avec le modèle RAPID (RAPID, RAPID religieux)
  • Institutionnalisation de la semaine nationale pour la promotion de la santé maternelle et infantile
• Le gouvernement du Togo s’est engagé à renforcer les prévisions et la gestion des données afin d’optimiser la chaîne d’approvisionnement et de promouvoir l’excellence de la chaîne d’approvisionnement des produits contraceptifs:
  • Continuation des ateliers pour élaborer le Tableau d’Acquisition des Contraceptifs (TAC)
  • Continuité de remplissage annuel du formulaire du Système d’Alerte Précoce (SAP)

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:

Validating tools to measure the impact of key approaches on health outcomes: CARE has developed three tools to support measurement of women’s empowerment, governance and health outcomes.

• WEMEASR (Women’s Empowerment- Multidimensional Evaluation of Agency, Social Capital and Relations). WEMEASR is a quantitative survey tool designed to use with women and consists of 20 short scales that measure women’s empowerment in domains critical to sexual, reproductive and maternal health. CARE is using various adaptations of WE‐MEASR in program evaluations in several countries to assess how well the scales work in other contexts and to explore associations between programming, empowerment and health behavior outcomes.
• Health Worker VOICES (Voices in Open, Inclusive Communities and Effective Spaces): A Tool to Measure Governance in Sexual, Reproductive and Maternal Health Programs (under review)
• Women’s VOICES : A Tool to Measure Governance in Sexual, Reproductive and Maternal Health Programs (under review)

The growing popularity and promise of social accountability approaches within the health sector makes it particularly important to foster good evaluation research to ensure that these approaches are effective. To this end, we developed and tested a set of measures evaluate a social accountability approach—CARE’s Community Score Card (CSC)—on reproductive and maternal health. We developed two survey tools—one for women (Women’s VOICES) and one for health workers (Health Workers’ VOICES). These tools include scales to measure constructs within CARE’s key governance outcomes domains: empowerment of women and community members; empowerment of health workers; and expanded, inclusive, and effective negotiated spaces in which the two groups can effectively interact to improve health service delivery and outcomes.

Reaching the most vulnerable and marginalized populations to reduce inequality: CARE focuses on reducing global poverty and inequality, and increasing social justice through the empowerment of women, girls and other vulnerable and marginalized populations. CARE has worked in several countries to implement programs and activities that work to reduce inequality:

• In Bangladesh, CARE is working with GlaxoSmithKline and the Government of Bangladesh to ensure mothers and children in remote areas of the country receive appropriate and necessary maternal and child health services, including family planning information and methods. CARE has worked with these partners on the Community Health Worker Initiative, to develop a skilled cadre of private MNCH providers that can complement government services in remote areas where the public health system is not adequately functioning. These private, skilled providers are women who come from the communities themselves, receive government training on skilled birth attendance and receive payment for their services, either through government entitlement schemes or fee for service from clients (these providers meet with communities and local government to establish fees that everyone can pay). The next phase of the project will include training specifically on family planning information, methods and services. This cadre of private, skilled providers is reducing a reliance on unskilled providers and ultimately, reducing geographic and wealth inequities in access to critical healthcare services.
• Through the Supporting Access to Family Planning and Post Abortion Care (SAFPAC) Initiative, CARE supports the delivery of family planning and other essential SRH services within CARE’s emergency response in Nepal and Syria, to those most affected and left vulnerable by emergency and conflict. In Nepal, CARE has been providing clean delivery kits and dignity kits to women living in the hardest-hit rural areas and is working with partners, such as UNFPA and local NGOs, to ensure access to life-saving SRH services (family planning, safe delivery, rape treatment, and STI treatment). In Syria, CARE is providing financial, technical and material support to a local NGO to deliver comprehensive family planning services to Syrian women served by 6 health centers in Idleb and Aleppo governorates.
• In Ethiopia, the TESFA project had targeted married adolescent girls who are hard to reach, most vulnerable, socially isolated groups in their community. The primary goal of the project was to improve their sexual reproductive health, with a particularly focus on increasing access to family planning and improving their economic empowerment. The initiative helped to draw lessons on how to reach an isolated subgroup of girls, recruit them into program and facilitate their empowerment process including their access to FP information and services. At the end of the project, access to FP services had significantly increased, with current use of modern contraception increased from 51% to 78%.

Ensuring women and girls’ family planning and reproductive health needs are addressed in both development, emergency and post-conflict response activities: CARE’s sexual, reproductive and maternal health programming works throughout the emergency to development continuum to reach the needs of the most vulnerable, especially women and girls. CARE works with partners such as UNFPA and UNHCR to reach the most vulnerable in emergency and crisis-affected settings.

• Since 2011, CARE’s Supporting Access to Family Planning and Post-Abortion Care in Emergencies (SAFPAC) Initiative has been reducing unintended pregnancies and deaths from unsafe abortion by delivering FP and PAC services to crisis-affected populations in 5 countries with large SRH needs: Chad, Djibouti, DR Congo, Mali, and Pakistan. Core interventions include: 1) providing competency-based training with follow-up clinical assessment and coaching to health providers; 2) ensuring a continuous supply of reproductive health commodities to all health facilities and strengthening inventory management practices; 3) making supportive supervision visits to health facilities on a regular basis; and 4) mobilizing communities to raise awareness about family planning and to shift norms that block women’s access to family planning services. At the same time, the initiative has been strengthening CARE’s institutional capacity to support SRH programming across its emergency response. Currently, the initiative supports the delivery of family planning and other essential SRH services within CARE’s emergency response in Nepal and Syria (see above). Between July 2011 and May 2015, the SAFPAC project reached 98,658 new users of modern contraceptive methods across the 5 countries (with a catchment population exceeding a half million women of reproductive age), 57% of whom chose long-acting methods of implants or intrauterine devices
• CARE is also committed to reaching the FP and RH needs in emergency and post-conflict responses though our leadership in and engagement with the Interagency Working Group on Reproductive Health in Crises (IAWG). CARE serves on the IAWG steering committee where it has successfully advocated for the inclusion of family planning as part of the Minimum Initial Service Package for Reproductive Health in Crisis Situations (MISP).

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.