• Trainings are being conducted towards the expansion of method mix and task shifting to community health assistants and community based distributors towards increasing access among underserved populations, particularly women in rural areas and adolescent girls. This has been done in 27 of 72 districts.

• Community health assistants are now trained in providing long-acting reversible contraceptives; this is being piloting with community based distributors who are volunteers. The biggest challenge is the need for good supervision of the workforce.

• While there were reports of increased FP access among married women, there were increases in reported pregnancies and abortions amongst adolescent girls. To address this issue, there has been dialogue with different ministries (education and traditional affairs), as well as with community leaders with regard to adolescent RH and sensitization to increase FP service demand and access. Work with traditional leaders also meant that community distributors and health workers are trained in providing FP services; this was conducted in 16-20 districts.

• Preliminary data collected for the country scorecard indicates that there is increased demand, especially in areas where there are community-based distributors and active dialogue with traditional leaders has been conducted. In some areas, there has been increases of up to 15 percentage points, from 20-30% baseline.

• A model is currently being searched towards initiating dialogue with religious leaders to generate demand and dispel myths on FP, though male involvement remains the biggest challenge.

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

• The Government of Zambia offers short-term methods (pills, injectables, male and female condoms), long acting reversible (Implants and IUDs) and permanent methods of contraceptives (BTL and Vasectomies). Additionally, the government is exploring introducing Implanon in the country and the product is already registered awaiting roll out. The government is also exploring the introduction of Sayana Press to facilitate access to contraceptives especially for hard-to-reach areas by community based volunteers.
• The Community Health Assistants are allowed to offer pills, condoms and injectable contraceptives, with additional training where necessary. Trained community based volunteers are allowed to offer pills and condoms.
• The government is exploring policy changes to allow trained community based volunteers to offer injectable contraceptives. Guidelines for rolling out injectable contraceptives by community based distribution have been developed and we are currently having conversations with professional bodies (health professions council and the general nursing council) and other relevant government wings on the operationalization of the initiative and the role of health care providers in supervision of the volunteers.
• Messages on sexual and reproductive health and family planning have been incorporated in most national events, including traditional ceremonies. Some traditional leaders are champions for sexual and reproductive health.
• The country is developing a strategy for ending child marriage and prevention of teenage pregnancy. This is an important opportunity to engage on conversations around family planning for adolescents.
• The Ministry of Community Development Mother and Child Health, through stakeholders, identified some influential individuals, including traditional and religious leaders as family planning champions. The champions are being engaged to reach out to other opinion leaders.
• All demand degeneration activities are done at district level for targeted service delivery points. Family planning is also part of the periodic national events, such as Child Health Week, Safe Mother Week, International AIDS Day and stakeholders take advantage of the community mobilization and demand generation that takes place at the subnational level to raise awareness on family planning.
• The family panning scale-up plan has been disseminated to all the 10 provinces of Zambia and districts are incorporating FP2020 initiatives into their annual plans. This will ensure that most interventions, including demand generation is done at sub-district structures.
• The Ministry of Community Development Mother and Child Health has a Family Technical working group (FP TWG) that provides technical support to the Ministry on Family Planning issues including issues on demand generation. The TWG conducts annual review meetings for the FP2020 scale-up plan with all provinces. During this meeting the stakeholders outline the work they plan to do at subnational level, including in demand generation.

In July 2016, the Government of Zambia 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, with support from UNFPA, introduced Implanon NXT in five provinces. This included procurement of commodities and capacity building for 40 trainers and 200 providers.
• The Zambia Medicines Regulatory Authority recently registered Sayana Press and the first shipment is expected in-country by end 2016. This consignment will be initially used by community based distributors (CBDs) to provide injectable contraceptives.
• The Ministry of Health has issued policy guidance allowing trained CBDs to provide injectable contraceptives. National training manuals have been developed and the draft CBD strategy has incorporated injectable contraceptives. The MOH has commenced the process of developing the Community Health strategy and CBDs, under the SARAI project, are providing injectable contraceptives in their communities.
• Through the Church Health Association of Zambia (CHAZ), the government is engaged in a dialog on family planning, with the first meeting held in September 2015. CHAZ has lined up other engagements with religious leaders in 2016. In addition, the Ministry of Chiefs and Traditional affairs government has engaged chiefs in addressing child marriage and teenage pregnancies, including in the promotion of family planning.
• Demand generation for family planning is being done through sub-district structures using community volunteers such as safe motherhood action groups—groups of women and men that promote safe motherhood practices including antenatal clinic attendance, institutional deliveries, and family planning. In collaboration with partners, the MOH has used innovations such as the camping approach, social marketing strategies, and integrated outreach activities to generate demand in various communities.

• The budget amount allocated for FP commodities has not yet doubled, however funding has increased by 70% in 2013 compared to 2012.

• Zambia has successfully secured increased funding for FP through existing donors and new partnerships over the past two years with more partners still coming in. The largest donors for FP commodities in Zambia are DFID, the US government and UNFPA.

• More partners are coming in to support, mainly with RMNCH. Country has developed a scorecard to help with fundraising. There has been an increase of interest from bi- and multilaterals to put in funds.

• More funding is needed for human resources.

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

• The Government of Zambia reports increasing the budget for family planning by more than 100 percent.
• There are other budgetary allocations for the family planning program that may not be easily disaggregated; for example, staff costs related to time spent in family planning because health care providers and managers are trained to provide integrated services.
• Additionally, we have received significant support for family planning commodities from multilateral and bilateral donors, particularly UNFPA and USAID who are the major funders for contraceptive commodities. We have also seen significant support from corporate partners for other program related areas such as capacity building of health care providers in long acting reversible contraceptives, implementing a community based distribution initiative related to family planning, and implementing service delivery models such as mobile outreach models to reach the underserved populations.

In July 2016, the Government of Zambia 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 financial commitment:

• The government has received increased funding for two dedicated members of staff, under the Mother and Child Health Directorate, whose role is to focus on family planning.
• The government has procured 45,000 units of the Implanon implant and the entire national needs for Microgynon pills. The government continues to receive support for contraceptive commodities from UNFPA and USAID.
• The government has also incorporated family planning in programs supported by other bilateral and multilateral donors in Zambia, such as UK DFID, the European Union, the World Bank, the Swedish International Development Cooperation Agency, and programs supported by other UN agencies, such as the WHO.

• Steps towards supply chain strengthening for FP commodities are taking place in tandem with JSI and MoH collaboration in regards to quantification.

• The Essential Medicines Logistics Improvement Program was not used as it is still in pilot phase in certain facilities and has not yet been rolled-out.

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

• The Government of Zambia has expanded the Essential Medicines Logistics Improvement Programme (EMLIP) to 7 out of the 10 provinces currently implementing EMLIP.
• Additionally, Zambia is in the process of rolling out the electronic Logistics Management Information Systems (eLMIS) to all districts with some facilities connected directly to the central medical stores whilst others are connected through the district health office to the central medical stores. This electronic system is helping the central medical stores to get real time data on the availability of commodities at health facilities and manage any potential stock outs promptly.
• The government thorough the central medical stores is implementing lastmile distribution of commodities including contraceptives directly to the districts as opposed to the previous system where they would distribute to provincial level.
• The government is building capacity in forecasting and quantification for contraceptives at the national and subnational level. This is done by a national team that includes provincial pharmacists, Ministry of Community Development Mother and Child Health (MCDMCH) and Ministry of Health (MoH) officials and other stakeholders such as bilateral and multilateral partners and NGOs.
• Additionally, the government through the MCDMCH has recruited a reproductive health commodity logistics coordinator to oversee forecasting and quantification, procurement, and distribution of reproductive health commodities including contraceptives.

In August 2016, the Government of Zambia 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:

• The government of Zambia has expanded the Essential Medicines Logistics Improvement Programme to 85 of 106 districts, covering 8 out of 10 provinces.
• The government is still rolling out use of the electronic Logistics Management Information Systems and is working towards harmonizing all existing electronic logistics management systems.