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

• Family planning services are not systematically offered in universities, and the [Family Health Directorate] is working with the Minister of Higher Education to establish family planning in medico-social centers (MSCs) and to ensure family planning is integrated in universities. The first step was to review and validate the white paper that indicates which services the MSCs can offer. We are also currently working with partners to ensure the MSCs have a free supply of contraceptives. The launch is scheduled for the start of the next academic year, during medical visits, and will be accompanied by awareness activities with the health club.
• Family planning mobilization week: This mobilization week for repositioning family planning, which was held during the week of February 23, 2015, affected 800 women and young people and saw commitments from the Minister for Women’s Empowerment and the Family, Territorial Planning and Development, and political leaders from the Government of Cameroon. During this week, the Family Health Directorate disseminated the 2015-2020 Family Planning Operational Plan to policy makers, NGOs and partners as well as appointed singer Mani Bella as a family planning champion within the country.
• A subcommittee of the Family Planning Sub-Group was formed to develop the family planning norms and standards, and to work toward a system for the certification of providers and the accreditation of health training. In addition, the Family Planning Sub-Group established a contraceptive safety subcommittee.
• The United Nations system, as well as the partners, are committed to supporting Cameroon in meeting its commitments.

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 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 policy and political commitment:

• The government of Zimbabwe reports significant improvement toward its commitment in removing the user fees for family planning services. In most of the health facilities only a consultation fee is being charged and the services being provided free of charge. This has contributed to the reduction in cost of accessing FP services in the country. In few health facilities a minimal charge on FP commodities is being charged to cover operational costs. Advocacy meetings and campaigns with decision makers were conducted during the year, specifically targeting parliamentarians, and family planning champions were used to reinforce the message to the intended audience. These activities have contributed toward the reduction of costs associated with accessing FP services.
• The government remains committed to providing services that meet the needs of teenagers in the country. One of the key activities carried out this year was the Teenage Pregnancy Study to determine factors contributing to teenage pregnancies and service availability .The study is now in its final stage and the results are expected soon. The government also renovated Youth Centers and has started offering clinical services to the adolescents’ youths of the country.
• To ensure that the needs of adolescents are addressed at policy and strategy formulation levels, an adolescent youth has been appointed as board member on the Zimbabwe National Family Planning Council. During 2015-2016, the government targeted youths in tertiary institutions and provided them with information and ASRH services, tended to help young people make informed decisions about their health. Furthermore, ASRH committees were formed at district levels to coordinate activities and ensuring that the adolescents have been targeted in all programs.
• As a way of increasing knowledge on FP service among disadvantaged women, the government rolled out a massive sensitization campaigns targeting key informants and community leadership. Advocacy meetings were held with traditional leadership to spearhead and promote the use of FP service in the countries. Such meetings were conducted with traditional chiefs in selected provinces to encourage disadvantaged women access available services .The parliamentarians were also targeted as they have access and influence on the marginalized communities. An advocacy meeting with parliamentarians was held on Dec. 16, 2015. The purpose of the advocacy meeting was to generate awareness and educate policy makers and opinion leaders on FP/RH issues.
• The government of Zimbabwe also carried out different activities to promote awareness and use of FP services in the country. The activities included printing information, education, and communication materials on FP and reproductive health (posters, pamphlets and fliers) under the Marvelon 28 pill mass media campaign, FC2 Female Condom Education and Promotion program, ASRH/IPPF, Global Female Condom Day, and World Contraceptive day celebrations were also used for promoting awareness. Short videos on family planning were screened on national television with the aim of promoting the use of FP services for all women in the country.
• During the development of the country’s costed implementation plan and FP strategy it was emphasized that developmental partners play a critical role in complementing government efforts in providing quality FP services for the country. Stakeholders, such as NGOs, are part of the National Family Planning Forum and have participated in different technical working groups, including the M&E, Marketing and Communications, and Demand Creation groups. Strengthening public-private partnerships, including civil society organizations in the provision of community-based and outreach services, were also seen in the CIP development process as civic organizations actively participated during the entire process in shaping the strategic direction of the country. The government has also renewed Memorandum of Understandings (MOUs) with national and community-based NGOs and has given civic organizations an increased mandate to offer FP services in the country with the aim of targeting community levels.

The Government of Zimbabwe has engaged in the following activities to developing a research agenda on family planning and to strengthening overall monitoring and evaluation efforts, including operations research in family planning:

• During 2015-2016, the country has developed the CIP on Family planning. One of the activities in the CIP is the strengthening of the M&E unit of the ZNFPC and having a harmonized FP M&E system. Activities towards the development of a national research agenda on FP were put in place and subsequently costed. This was a major step in promoting operations research and the use of evidence in decision making in the country. A research agenda will be finalized by the end of 2016 after all the inputs from stakeholders. Plans were made to strengthen the M&E technical working group and improvements on the data collection tools with the development of the national FP register being piloted in some provinces. Key activities conducted to strengthen the M&E of FP in the country were:
  • Finalization of the ASRH M&E framework with a set of core indictors to track;
  • Development of the national family planning register; and
  • Strengthening of the M&E technical working group to effectively monitor FP activities.
• The recruitment of Track20 M&E officer seconded to the Ministry of Health and Child Care to track country progress of 17 FP2020 Core Indicators and identify possible areas of improvements and indicator projections for 2020.
• The first family planning Consensus Building workshop for the country was conducted with the support from Track20 to discuss country progress towards FP2020 commitments.
• Other studies conducted throughout the year included the one titled “The Role of Family Planning: Addressing the Determinants of Unmet Need in HIV-Positive Women in Matabeleland South and Mashonaland Central Provinces” with support from UNICEF. This was aimed at determining the factors contributing to the high unmet need of FP services among the HIV positive women within the reproductive health age group. During the year, the Government conducted an IUCD qualitative study. This was aimed at assessing the determinants of the low uptake of IUCD in Zimbabwe paying particular attention to both the supply and demand sides of service delivery. The finalization and dissemination of the study results are expected by end of 2016. There was also representation in the planning and implementation of the National Adolescent Fertility Study. During the 2015-2016 time period, Zimbabwe was privileged to host the International Conference on STIs and AIDS in Africa (ICASA) and an abstract on the Role of FP in PMTCT was accepted for poster presentation. On another note, out of the 3 abstracts which were submitted to International Conference on Family Planning (ICFP) 2 were accepted for presentation in Indonesia.

In July 2016, the Government of Malawi 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 Malawi’s activities in support of developing a comprehensive sexual and reproductive health program for young people include the following:

• Malawi conducted an assessment and evaluation of Youth Friendly Health Services in 2013, and the results of which were disseminated in July 2014. These results were used to develop a Sexual and Reproductive Health and Rights Strategy for Young People.
• The newly developed standalone National Youth Friendly Services Strategy of 2015-2020 was endorsed by Senior Management Committee in the Ministry of Health in August 2015 and officially launched in September 2015. It is now a guiding document that is used for implementation.
• In addition, the National Standards on Youth Friendly Health Services 2015-2020 was finalized in October 2015. The revised Youth Friendly training manual is currently in the final stages of its development.

• In addition, the Ministry of Education has included age appropriate sexual and reproductive health information in primary school curricula as part of life skills education which pupils and implementation commenced in September 2014.

The Government of Malawi through its partners namely Population Services International (PSI), Banja La Mtsogolo (BLM), Strengthening Outcomes through Private Sector (SHOPS), and the Family Planning Association of Malawi (FPAM) has partnered with these organisations, which are engaging private clinics to provide family planning services by training the staff and providing FP commodities at a highly subsidized rate to those who are able to pay at all levels of health care delivery system. In approximately 308 private clinics, personnel have been trained in the provision of long-acting and reversible contraceptives throughout the country out of the targeted 300.

One of the core features in the management of the country’s health care delivery system is to ensure that there is an effective and integrated supply chain system. The Government of Malawi, through the Ministry of Health, with financial and technical support from donor partners is strengthening the forecasting and data management through several efforts:

• Training of all health personnel managing health products (medicines and other medical supplies) at all levels of health supply systems in Logistics Management Information System. The purpose of these trainings is to ensure that correct and timely data is available to make informed decision regarding supply chain
• Decentralization of the forecasting exercise commenced in 2013 where districts are now provided with technical knowledge and skills to conduct district forecasting and quantification. This forecasting is consolidated into a national forecast. All activities to ensure that there is a coordinated forecasting and data management in supply chain are ongoing and regularly monitored and evaluated to increase the efficiency.
• The supply chain for all commodities has greatly improved; family planning commodities are supplied to health facilities using consumption data based on Logistics Management Information System reports from each district and the distribution list compiled at a central level. By February 2014, stock out rates for family planning commodities were below 10%.
• Training of health personnel in managing health commodities in logistics management information system are still on-going with a bias towards family planning commodities at all levels.
• The Ministry of Health through Health Technical Support Services-Pharmaceuticals continues to take the lead in coordinating forecasting and health commodities data management at all levels of service delivery points.
• The supply chain for all commodities continues to improve greatly with family planning commodities stock out rates averaging below 5%.
• Districts are now encouraged to pull health commodities especially family planning commodities as to when their stocks are low though distribution lists are still compiled at central level. This is one way of ensuring districts are empowered in forecasting their requirements and ably manage their drug budgets.
• There is a Reproductive Commodity Security (RHCS) steering committee that meets on quarterly basis. Its composition includes different directorates in the Ministry of Health, Regulatory bodies, Private sector and professional association. The RHCS steering committee review issues of stock status, stock outs and advices on strategies that can be taken.

The Ministry of Health has engaged community and traditional leaders through the following activities:

• The Government of Malawi through the Ministry of Health has developed and endorsed a Health Promotion Policy where advocacy on increased community participation including FP services is mainstreamed through different local structures including the Traditional Chiefs Committee, Police Victim Support Unit and Community Action Groups (CAG). With the elections of Councilors and Chairperson of District Health Councils in all 28 Districts, the Ministry of Health appeals for more resources to orient them in monitoring and supervising all structures in mainstreaming FP championing.
• The Ministry of Health, through UNFPA with RMNCH Trust Funds, conducted advocacy with Ward Councilors, Chiefs, Church Leaders, Members of Parliament, CSOs, and village Maternal and Neonatal Counselors on issues of family planning in 10 out 28 administrative districts in Malawi. The advocacy meetings took place from September –November, 2015 and are scheduled to continue in 2016.

The Presidential Safe motherhood initiative also engages Chiefs and other traditional leaders in advocating and raising awareness on broad SRH issues including community participation in family planning.

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

• The newly developed stand-alone Youth Friendly Health Service Strategy was endorsed for dissemination and implementation by the Senior Management Committee in the Ministry of Health on Aug. 3, 2015 (scheduled to launch August 2015).
• About 159 of 300 targeted private clinics have personnel trained in the provision of long acting and reversible contraception throughout the country.
• The Government of Malawi has conducted the annual national quantification exercise for all health commodities including family planning commodities since 2013 and a budget proposition was formalized for 2014/15 financial year.
• The Government of Malawi reports significant progress in its national LMIS. The average monthly reporting rates by health facilities has increased from about 55% in 2013 to about 90% in 2015. Moreover, the quality of data reported by health facility has improved. This improvement has increased the reliability of the national forecast, supply planning and related supply chain decisions for the family planning program.

The Government of Malawi has also engaged in several activities to increase community participation in family planning services.

• The Ministry of Health developed and endorsed a Health Promotion Policy where advocacy on increased community participation, including family planning, is mainstreamed through different local structures including the Traditional Chiefs Committee, Police Victim Support Units and Community Action Groups (CAG). The Ministry of Health appeals for more resources to orient councilors and chairpersons of District Health Councils in all 28 districts in monitoring and supervising all structures in mainstreaming family planning.
• The Ministry of Health through UNFPA has identified funds from the RMNCH Trust Funds to advocate with Ward Councilors, Chiefs, Church Leaders, Members of Parliament and village Maternal and Neonatal Counselors on issues of family planning in 13 of 28 administrative districts in Malawi. The advocacy is planned to take place from September to November2015.
• In 2013, Ministry of Health through Support for USAID’s Support for Service Delivery Communication, launched the nation-wide, multi-channel and multi-level 'Moyo ndi Mpamba' (Life is Precious) health promotion campaign with key family planning messages.

• The National Partnership to Promote Maternal-Child Healthcare is being revitalized, whereby its launch is scheduled for November 2014. The government, via the Ministry of Health, is working with its partners to make this event a moment of mobilization for everyone to speed up the actions that contribute to reaching MDG 4 and 5. An internal working group led by the public healthcare sector was established and involves senior sector levels, whose goal is to monitor all the acceleration processes involved in the reduction of maternal and infant mortality.

• With the approval in 2010 of the integrated package of services offered to adolescents and youth by the National Healthcare Service (SRH/STD/HIV/AIDS, Mental Health, Nutrition and Hygiene/Sanitation of the area), a space opened to discuss adolescent and youth issues in a holistic manner, which has contributed to the improvement in access to information, especially family planning, among the various services.

• In 2013, a National Adolescent and Youth Meeting was held, where participants from different sectors in the government and partners discussed the situation of adolescent healthcare and the means of improving access to information by that specific group. This meeting defined the guidelines for the adolescent and youth healthcare strategy which is being drafted. On the other hand, the revitalization of areas in public schools where a student has access to healthcare information and education is underway.

• In collaboration with UNFPA, a partnership was established with DKT International, focused on training healthcare providers in the public and private sector. Since 2012, 511 public sector and 28 private sector providers were trained in this partnership.

• Considering the primary network, the current coverage of healthcare centers offering at least 3 methods of contraception in the country is 89 percent. The country is focused on increasing that coverage, however, the lack of human resources has been the main limitation.

• The number of technicians trained in postpartum counseling, family planning, and contraception for 2012/2013 was 3,633, listed in the table below:

• In order to increase community access to FP, the following interventions are underway, namely:
  1. District-level training of community healthcare agents in promoting and offering contraceptives (birth-control pills and condoms), in partnership with non-governmental organizations (NGOs). By 2013, 3,323 community healthcare agents were active promoting FP and distributing birth control pills in communities.
  2. Offering complete family planning services (with exception of IUD insertion) in communities via Mobile Brigades and National Healthcare Weeks.

The process of revising the curriculum for training Elementary Multi-Task Agents is underway to ensure that the latter are the permanent agents offering information, education, and anti-conception methods at the community level.

• The intensification of community involvement ... in education activities related to family planning will be invigorated by the healthcare and co-management committees, respectively. Between 2012 and 2013, 1,283 new healthcare committees and 302 new co-management committees were created.

• The healthcare committee members are the community reference agents, that is, religious leaders, community leaders, traditional midwives, traditional medicine practitioners, healthcare providers, among others. They are the beneficiaries of a holistic training package in community healthcare, so they can support healthcare-promoting activities, specifically in relation to the disclosure of services, community education via lectures, the identification of healthcare problems in the community and their reference. These groups have played a fundamental role in family planning education and the need for an institutionalized delivery.