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 program and service delivery commitment:

• In an effort to implementing a monitoring system to strengthen quality of care, the government of Myanmar agreed to—during the discussion for nationwide Implant training—the Lead FP Working Committee agreed to use a post training assessment form and quality control checklist with technical support from JHPIEGO and PSI as part of monitoring effectiveness. An assessment study on implant removal will also be conducted by MOHS and JHPIEGO to highlight the quality of care in service provision.
• Myanmar is working continuously on strengthening its logistics management information system to ensure reproductive health commodity security. Since 2014, RH Commodity Logistic System was being implemented in 12 townships. In 2016, with technical support from JSI and financial support from UNFPA, 55 townships under Shan (South) and Mandalay regions are having the LMIS expanded. To cover all other State/ Region, The funding gap to cover all other states and regions still exists and is under the negotiation of the MOHS with 3MDG fund.
• Nationwide Implant Training will be provided to health care providers in public in 2016 through a public-private partnership approach. The Total Market Approach for FP is being conducted by PATH in collaboration with MOHS and UNFPA. Introduction of Sayana Press in Myanmar is still going on in collaboration with UNFPA and other private partners. UNFPA will be supplying 0.8 million doses of Sayana Press in 2016 and, with the MOH’s lead to get pre-registration waiver, Sayana Press initiation program begin in the second quarter of 2016. This will increase additional users of modern method of contraception.
• To improve the monitoring system of family planning, the capacity building of M&E officers was carried out with the support of the Track 20 team and Consensus Building Workshops were conducted since last year to get consensus among stakeholders and discuss data utilization, data monitoring, private sector involvement, and other monitoring issues.

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 Zimbabwe has engaged in the following activities to increase access to a comprehensive range of family planning methods:

• Training health service providers in both private and public sectors.
• Awareness campaigns in both electronic and print media are under implementation.
• Integration of sexual and reproductive health services at all levels are being encouraged.
• Operational studies on determining factors associated with uptake of LARCs are underway; however, the efforts are being drawn back by negative media publicity which are playing down the use of LARCs.

The Government of Zimbabwe has engaged in the following activities to develop innovative service delivery models to meet the needs and rights of adolescent girls:

• Community, facility, and school-based approaches to reach the adolescents in line with the National ASRH Strategy are being implemented.
• Efforts to mainstream ASRH issues in other ministries have been made. For example, the Ministry of Primary and Secondary Education launched the Life skills, Sexuality and HIV and AIDS Strategy in 2013.
• Operational studies around issues affecting the youths and national ASRH program evaluations are being conducted to inform future programming; these include the Determinants of Teenage Pregnancy, ASRH County Programme Evaluation, and ASRH Interventions Review.
• Policy inconsistences in the country which hinder the full implementation of some of the recommendations from study findings and program evaluations are being addressed.
• Limited resources to expand the coverage of ASRH service provision to youths is a major challenge.

The Government of Zimbabwe has engaged in the following activities to increasing knowledge on all family planning methods:

• Targeted IEC material for SRH and family planning are being printed and distributed nationally.
• Awareness campaigns through road shows about importance of family planning are currently underway.
• Social media is also being used as a channel to disseminate and educate the public on the importance of family planning.
• However, due to financial constraints essential activities, such as awareness campaigns and advocacy and social mobilization campaigns are not being conducted as per national expectations.

The Government of Zimbabwe engaged in the following activities to improved gender-sensitive family planning services:

• Providing men with relevant family planning information.
• Training service providers in ASRH so that they are able to provide quality services.
• Involving young people in ASRH issues e.g ASRH forum at national level.
• Training service providers in family planning services, including at youth centers.
• Development of brail material to enhance access to family planning information for the blind.

The government has engaged in strengthening the integration of family planning with reproductive health, HIV and maternal health services:

• Training service providers in the provision of quality integrated services, so providers can offer a comprehensive package of SRHR; trainings include voluntary medical male circumcision, cervical cancer screening, HIV testing and counseling, PMTCT, Syndromic STI management.
• Piloting the Electronic Patient Monitoring System, which now awaits rolling out nationally in both private and public sectors.
• The Government of Zimbabwe also improved on family planning method mix by introducing Implanon and Revoke 72 (emergency contraception).

The Government of Zimbabwe has engaged in the following activities to promoting dual protection for the prevention of unwanted pregnancy and STI/HIV&AIDS by increasing the availability of male and female condoms for sexually active persons:

• The family planning commodity delivery system being used in the country ensures that commodities including male and female condoms are always available and accessible at all Service Delivery Points (SDPs). The national commodity stock out for all commodities has been below 5% for the past 5 years.
• There has been efforts to promote the use of the female condom through engaging external funders such as the Female Health Company (FHC) so as to promote dual protection.
• Awareness campaigns and production of IEC materials specifically for the use of condoms for dual protection have been carried out although the funds are not adequate.
• All public sector brand condoms are issued for free.

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.

• Rwanda has scaled up its Community Based Provision Programme across the country. Through this programme, all community health workers are trained on the provision of pills, injectables (DMPA), male and female condoms, and cycle beads, provide them and refer women to the health center if a client wants to change her method, or if a client is a new family planning user. Community health worker data is reported to the health center; they have never experienced stock out.

• All 45,000 community health workers provide comprehensive information on family planning and refer clients to health facilities for long acting and permanent methods, according to the informed and free choice Integrated Maternal and Child Health Week Campaigns are organized twice a year and constitute a good opportunity to provide information and services on family planning. Additional opportunities include Community Work (Umuganda) organized on a monthly basis (last Saturday of each month), World Population Day Commemoration (11 July), Vasectomy day (18 October), International Women Day (8 March), State of World Population day, World AIDS Day, etc.

• Behavior change communication materials on family planning have been developed and are currently being distributed to the general population with the aim of increasing awareness on family planning benefits, addressing social norms, rumors and misconceptions around family planning and impacting behavior change.

• However, unmet needs for family planning is still high and requires strengthening awareness of the general population including young people, parents and teachers in order to increase the demand side and reach the Contraceptive Prevalence Rate targets in Economic Development Poverty Reduction Strategy II.

• Long acting methods (Intra Uterine Device and Implants/Jadelle) were scaled up in all health facilities and each health facility has at least two health providers skilled in insertion and removal of the above methods. To increase methods mix and broad range of contraceptives, Implanon has been introduced and as end of August 2014, 17 out of 30 districts are covered. Vasectomy and Tubal ligation were also scaled up in all hospitals. 

• Rwanda has already made significant progress in the implementation of family planning and other health services integration. Policies were reviewed regarding the integration of family planning and other health indicators. Many tools were also reviewed towards monitoring the integration of family planning and other health services and programs. Family Planning indicators are also included in the Health Management Information System (HMIS), and reported by health facilities. 

• On the job trainings are being offered to family planning providers for all facilities. Family planning related topics are shared at staff meetings with other health topics. Joint supervisions are conducted on a quarterly basis by central, district hospital and health center levels. Ministry of Health monthly coordination meetings are held with the inclusion of family planning on the agenda.

• All of these interventions are intended to ensure high quality integrated family services in Rwanda.

• Quality assurance, supervision, and monitoring and evaluation activities are conducted on regular basis to ensure the implementation of family planning activities

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.

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

Expanding choice and method mix through contraceptive research and development and assessment of the safety and efficacy of new and existing methods: The WHO supported a clinical study that assesses the effectiveness of the three-year one rod etonogestrel (ENG) and the five-year two rod levonorgestrel (LNG) releasing contraceptive implants.  At three years of follow-up, the trial found that annual cumulative pregnancy rate was very low and similar between both implant groups with a three-year cumulative rate of 0.4 per 100 (95% confidence interval [CI] 0.2-1.0) for both ENG- and LNG-implants users.   No additional pregnancy was recorded beyond three years up to five years of follow up in 1-rod ENG and the 2-rod LNG, indicating the effectiveness of implants up to five years; including Implanon (1-rod ENG) which is currently recommended for three years of use.  The results indicating that both the one rod etonogestrel (ENG) and the two rod levonorgestrel (LNG) can be effectively used for 5 years have been submitted for publication.  

One of the key studies supported by WHO on safety of contraception is the Evidence for Contraceptive options and HIV Outcomes (ECHO) Trial a multi-center study designed to compare the risks of HIV acquisition between women randomized to DMPA, levonorgestrel (LNG) implant, and copper Intra-Uterine Devices (IUDs). The study is set to be initiated in 11 sites in four South and East African countries in collaboration with Family Health International 360, Wits Reproductive Health and HIV Institute and University of Washington.

Scaling up the availability of high-quality contraceptive commodities through product prequalification and Expert Review Panel (ERP) fast track mechanisms: In 2015, WHO approved the addition of three new methods in the latest edition of the WHO Essential medicines list (EML), 2015: the Levonorgestrel intra-uterine system, Progesterone vaginal ring (for use in women actively breastfeeding at least 4 times a day) and the etonorgestrel releasing hormonal contraceptive implant. As a member of the Technical Reference Team on Reproductive Health/Contraceptives within the UN Commission on Life Saving Commodities, WHO promoted access to under-utilized commodities.  For contraception, this includes Levonorgestrel as emergency contraception, hormonal contraceptive implants, and the female condom.  Milestones achieved include, the generation of best-practice tools for advocacy, quantification, demand generation, supply chain and provider training; and several product innovations. Slower progress was evident around regulatory harmonization and quality assurance.

Synthesizing and disseminating evidence on effective family planning delivery models and actions to inform policies, address barriers and strengthen programs: WHO in collaboration with the United States Agency for International Development (USAID) convened a technical consultation in January 2015 to discuss the implications of contraceptive classification, existing approaches of contraceptive classification, measurement of contraceptive use and proposed revisions to existing contraceptive classification system. The consultation identified the need to consistently classify Modern methods such as Lactational Amennorrhea Method (LAM) and the Standard Days Method (SDM), and to accurately report on users of emergency contraception.

WHO has published the following documents/articles to guide policy development and for research prioritization:

• Workforce interventions to improve access to emergency contraception pills: a systematic review of current evidence in low- and middle-income countries and recommendations for improving performance. 
• Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle-income countries 
• A global research agenda for family planning: results of an exercise for setting research priorities 

WHO serves as the secretariat of the Implementing Best Practices Consortium, which is made of 44 international reproductive health organizations.  The main purpose of the consortium is to scale-up effective reproductive health practices.  Key activities that support our commitments to FP2020, include the IBP knowledge Gateway  https://knowledge-gateway.org/, a virtual platform that hosts a global community of over 60,000 reproductive health professionals where new research, tools and approaches in RH/FP as well as communities of practice addressing key issues in RH/FP are shared.

At the global level, IBP organized 28 sessions at the ICFP/Addis Conference in 2013 focused on overcoming obstacles to scaling up effective practices in FP and disseminating tools, guidelines, and approaches to knowledge sharing.  At the regional level, WHO/IBP has supported West Africa Health Organization (WAHO) since 2013 to develop an approach to documenting effective practices in RH/FP and organizing a Forum of Good Practices that took place in Ouagadougou in July, 2015 and hosted over 300 participants from their 15 member states.  IBP’s June, 2015 semi-annual meeting held in Addis Ababa, hosted over 200 participants from East and Southern Africa to share effective practices, tools and approaches for documenting and scaling up RH/FP practices in the region.  At country level numerous countries, such as Zambia, Burkina Faso, Zimbabwe, Togo, Chad and Democratic Republic of Congo (DRC) are using tools and approaches introduced by WHO and IBP on the documentation and scale-up of effective practices in RH/FP. 

Working with countries with the highest levels of unmet needs to examine inequalities, vulnerabilities and reasons for unmet need, in the context of the Commission on Information and Accountability for Women's and Children's Health: WHO is undertaking several activities to address unmet needs in family planning/contraception using strategies such as community participation, leveraging missed-opportunities and focusing on vulnerable groups.

•  The UPTAKE Project is a context-specific health sector and community-based participatory approach, to increase met needs for contraception, in a human rights framework.  The project aims to increase met need for Family Planning/Contraception through the development, implementation and testing of an intervention involving community and health care provider participation within a human rights framework. This multi-country study is a complex designed intervention to increase the participation of the community and health care providers in the provision of family planning and contraceptives. The Project uses a Theory of Change framework to define the pathway to the desired overall outcome.
• The strengthening Post-Partum Family Planning Operations Research Project focuses on strengthening existing Post-Partum Family Planning (PPFP) service delivery in countries in order to better meet the needs of women during the post-partum period.   The study is taking place in DRC and Burkina Faso with results being applicable to numerous countries in the West Africa region and beyond. The study is a complex intervention, using a mixed method approach including qualitative and quantitative methods.
• Women living with HIV face many challenges in accessing contraception and WHO has identified the need to strengthen HIV, sexual and reproductive health and contraceptive linkages. WHO has published guidelines on care, treatment and support for women living with HIV/AIDS and their children in resource-constrained settings. 
• WHO is also conducting research in Multipurpose Prevention Technologies (MPTs) to provide women and young girls with more choices for their sexual and reproductive health needs. Information on these activities can be accessed at http://www.who.int/reproductivehealth/topics/linkages/mpts/en/.  
• The Discordant Couples Project is an ongoing research project to understand the family planning needs of HIV - discordant couples in urban Kenya.

• 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.