EngenderHealth has engaged in the following activities in support of its commitment to FP2020.

West Africa: EngenderHealth has been working intensively in West Africa, where the need for family planning outweighs access to and use of contraceptives. In collaboration with the U.S. Agency for International Development (USAID)/West Africa, and our local partners , EngenderHealth is managing a five-year project known as Agir pour la Planification Familiale (AgirPF) to improve access to high-quality, voluntary family planning services in Togo, Niger, Burkina Faso, Côte d’Ivoire, and Mauritania, where unmet need is the greatest. EngenderHealth has developed partnerships with local and international partners to leverage technical, human, and financial resources for family planning in the region and to ensure sustainability. A cornerstone of this is the partnership developed with the West Africa Health Organization.

• In addition to training health care providers in gender-sensitive and youth-friendly services, EngenderHealth is leveraging mobile technology to reach underserved communities and is reducing financial barriers through partnerships with ministries of health and local organizations to improve access to health services.
• To date, EngenderHealth has initiated intensive training at family planning Centers of Excellence in Togo, Niger, and Burkina Faso, to ensure quality in family planning services in the region through provision of training and supervision.
• In Nigeria, together with the Ministry of Health, EngenderHealth is training health care providers and has developed tools to respond to the health needs of women and girls in a conflict environment, after 200 abducted girls were returned from Chibok to Borno State.
• In Guinea, the Ebola crisis hit the country very badly; just like other international development partners working on family planning and health-related matters, EngenderHealth’s operations there were negatively affected. Despite this hurdle, EngenderHealth’s operations resumed normally in February 2015. We learned from the Ebola crisis that health systems in Africa remain extremely fragile and highly vulnerable to health emergencies. The Ebola crisis affected the entire health systems, thus taking national human, technical, and financial resources away from family planning and other health matters. In this regard, we urge continuing financial investment and priority attention to family planning and to strengthening health facilities and human resource capacity, which will supply entire health systems with sustainable human resources to face future crises.
• Accordingly, EngenderHealth continues to advocate for and to support the implementation of the 2001 Heads of State and Government Abuja Declaration on HIV/AIDS and other infectious diseases for the financial commitment by Africa countries to 10% of their national budget for health, as a means to ensure sustainable commitment to and implementation of the FP2020 agenda and sustainable family planning services beyond 2020.

Rights-based family planning: EngenderHealth is a trusted global leader in advocating for family planning programs that are designed, implemented, and monitored in a way that protects and fulfills human rights and puts women’s needs, desires, and preferences at the center. Last year, EngenderHealth developed two publications designed to assist diverse audiences, including donors, policymakers, program planners and managers, service providers, rights advocates, and community members, in their efforts to achieve rights-based family planning programs.

The first publication is the Voluntary Rights-based Family Planning Conceptual Framework User’s Guide, a practical resource to help stakeholders design, implement, and monitor family planning programs that respect, protect, and fulfill human rights. Coauthored with the Futures Group, with support from the Bill & Melinda Gates Foundation, the guide is a companion to the recent publication of Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework, which took long-standing family planning concepts, such as quality of care, voluntarism, and service access, and linked them with human rights principles, such as empowerment, equity, nondiscrimination, and accountability. The Framework provides a holistic vision of what a rights-based family planning program looks like; the User’s Guide provides a pathway to applying the framework in actual practice. The guide will:

• Help facilitators orient stakeholders on the voluntary, rights-based family planning conceptual framework;
• Support assessments and action planning related to strengthening human rights in family planning programs; and
• Guide stakeholders to monitor, evaluate, and hold programs accountable.

EngenderHealth also developed Checkpoints for Choice: An Orientation and Resource Package, which takes a closer look at the concept of voluntarism—one component of a rights-based approach—and helps stakeholders understand the clients’ experience and their ability to make full, free, and informed choices about family planning. It consists of a detailed plan with support materials for a one-day workshop to enable family planning program planners and managers to strengthen the focus of family planning programs on clients’ ability to make full, free, and informed contraceptive choices in the context of a rights-based program. In addition to the workshop guidance and materials, the package includes links to recommended references, tools, and additional reading.

EngenderHealth also manages a blog focused on the topic of rights and choice, called Champions for Choice (www.champs4choice.org), which features regular posts by technical experts, policymakers, and program leaders.

Advocacy: EngenderHealth launched a new campaign, Where’s The Family Planning?! (WTFP?!) in late 2014 to raise awareness of the important need for family planning around the globe.

• The campaign seeks to inspire American women in their 30s to take action in support of the 225 million women who want, but do not have, access to contraception and safe childbirth. We partnered with Academy Award–winning actress and humanitarian Mira Sorvino to generate greater visibility, and the response to our campaign to date has been extremely positive.
• Our first video, “History’s Worst Contraceptives,” was viewed nearly 400,000 times on YouTube, and we received mentions in TIME, Glamour, Cosmopolitan, Upworthy, BuzzFeed, RH Reality Check, Jezebel, and The Huffington Post, among other top outlets. To date, we have made strong progress, including campaign impressions reaching nearly 800 million, campaign views (website and video) approaching nearly 500,000, 66,000 new social media followers and fans, and continuing online engagement and action.

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 the Philippines shared an update on progress in achieving its policy, financial and program and service delivery commitments to FP2020.

The Government of the Philippines has engaged in the following activities to establish a national policy on reproductive health and population development and to allocating funds to implement the policy:

• The National Implementation Team (NIT) and Regional Implementation Teams (RITs) created in 2015 served as the oversight and steering committee for RPRH implementation across the country. As provided in Department of Health (DOH) AO No. 2015-0002, they served as venue to discuss and resolve issues confronting implementation of the RPRH Law at all levels.  Moreover, they also served as the coordinating bodies at the national and regional levels in harmonizing work and financial plans for various RPRH programs and monitor progress of implementation. Among the key NIT accomplishments of 2015 are: the development of the Monitoring and Evaluation Framework for the 5 Key Areas on Reproductive Health (Maternal and Newborn Health, Family Planning, Adolescent Reproductive Health, STI and HIV-AIDS, and Gender-Based Violence), the development of the Philippine Health Insurance (PHIC or PhilHealth) benefit packages to improve access to services (such as the progestin subdermal implant and post-partum IUD), the active involvement of other national government agencies (such as the DSWD, DepEd, DILG, NAPC and PCW) in RPRH Law implementation; and the development of modalities for greater participation of civil society organizations and professional groups in government’s RH program.
• The Women, Men’s Health Development Division and Children’s Health Development Divisions (WMCHDDs) under the Disease Prevention and Control Bureau (DPCB) also provided technical oversight to the implementation of the RPRH Law. Through its various programs and resources, the WMCHDD were able to provide national, regional, and local technical guidance on the conduct of capacity building and demand generation activities, and provision of care, including distribution of essential RPRH commodities. The DOH awaits the creation of the Family Health Bureau (FHB) through an Executive Order as specified in the IRR of the RPRH Law to “expand organizational structure that will ensure provision of the needed technical guidance and coordination support for the systematic and integrated provision of reproductive health care to all citizens, prioritizing women, the poor, and the marginalized population groups”. The creation of the FHB is now awaiting the endorsement of Office of Organization, Position, Classification and Compensation Bureau (OPCCB) of Department of Budget and Management (DBM) to the Office of the President for final approval.
• POPCOM led in drafting the Planning, Monitoring and Evaluation (PME) Guide, which provided guidance not only for the development of RPRH work and financial plan for 2015, but also for monitoring progress of its implementation. More specifically, the PME identified the process of collection, consolidation and processing of data coming from the reports of the different agencies and units, CSOs and other implementation partners.
• In support of the various provisions under the RPRH Act and its Implementing Rules and Regulations, the DOH in coordination with other agencies and with technical assistance from CSOs and other development partners issued the following Administrative Orders (AO) related to Family Planning in 2015.
  • Administrative Order No. 2015-0006 Re: Inclusion of Progestin Subdermal Implant as One of the Modern Methods Recognized by the National Family Planning Program. This AO provides for guidelines in introducing Progestin Subdermal Implant as a new family planning program method to both the public and private sector providers as well as program managers and key stakeholders. It specifically described the key elements on how it will be integrated in existing FP services in the field.
  • Department Circular No. 2015-0300. Re: Clarification of Annex A Section 4 of Administrative Order 2015-0006 entitled "Inclusion of Progestin Subdermal Implant as one of the Modern Methods recognized by the National Family Planning Program." Note however that implementation is temporarily on hold due to the TRO issued by the Supreme Court.
  • Administrative Order 2015-0037 Re: Guidelines on the Registration and Mapping of Conscientious Objectors and Exempt Health Facilities Pursuant to the Responsible Parenthood and Reproductive Health Act. The DOH issued these guidelines for the registration and mapping of conscientious objectors and exempt health facilities to ensure delivery of the full range of reproductive health services and minimize encumbrance to clients seeking such services.
  • Department Memorandum No. 2015-0186 Re: Access to the Family Planning (FP) Commodities by DOH Regional Hospitals and Medical Centers and Provincial Hospitals. In support of the setting up family planning services in hospitals, this Department Memorandum was issued to provide guidance in the allocation and distribution of FP commodities to DOH retained hospitals and medical centers and provincial hospitals. It also includes the allocation of FP commodities to Civil Society Organizations.
  • Department Memorandum No. 2015-0174 Re: Reiteration of Compliance to the Policy on Informed Choice and Voluntarism in Delivery of Family Planning Services. The Department Memorandum directs all DOH Bureaus, Offices, Medical Centers and attached agencies and Regional Offices to organize the key staff and monitoring mechanism to observe compliance with the policy on Informed Choice and Voluntarism in the delivery of Family Planning services nationwide.
  • Administrative Order 2015-0021 Re: Guidelines on the Deployment of Physicians Graduating from the Residency Training Programs in the Department of Health DOH) –Retained Teaching and Training Hospitals. This AO responds to the growing inequitable distribution of medical professionals in the urban and rural areas thru expanding its residency training programs as human resource for health complements in government hospitals in priority poor and underserved areas.
  • Department Memorandum No. 2015-0341 Re: Reiteration of Access to Family Planning (FP) Commodities by DOH Regional Hospitals and Medical Centers, Provincial Hospitals and Civil Society Organizations (CSOs).This Department Memo further defines instrumentalities that will be used by Regional Offices in engaging the civil society organizations as partners in the delivery of FP services to include the use of appropriate forms such as the revised FP Form1, and the reporting forms for service utilization
  • Department Memorandum No. 2015-0366. Re: Hiring of Consultants for the Fast Tracking of Service Delivery of Family Planning (FP) Services. The DM supports Section 6 of the RPRH IRR specifying the hiring and engagement of skilled health professionals for Maternal Health Care and Skilled Birth Attendance at the local levels with assistance from the DOH.
  • Department Memorandum No. 2015-0357. Re: Use of the Revised FP Form 1. This DM provides instructions to all health providers on using the revised FP Form 1 as standard client record of family planning acceptors at the service delivery points.
  • Department Memorandum No. 2015-0384. Re: Establishment of the Family Planning Logistics Hotline. This DM supports Section 8.10 on Tracking and Monitoring of health products purchased or received and distributed to local health systems. The FP Logistics Hotline monitors distribution and status of commodity stocks at the distribution points (local health service delivery points).

• Other national agencies such as the DSWD and DILG also contributed to policy development covering FP concerns as specified in the RPRH IRR. DSWD has a finalized Memorandum Circular which deals with Institutionalization of Women Friendly Space in Camp Coordination and Camp Management. DILG has issued Memorandum Circular No. 2015-145: Reiteration of Local Government Unit’s Role and Function in the Implementation of RA No. 10354 or The RPRH Act Of 2012 and its IRR. The circular addressed to all DILG field units and LGUs reiterate the observance of the RH Law’s provisions to the LGUs. It also specifies that each LGU to designate a Reproductive Health Officer (RHO) and to submit all data related to RPRH implementation to the DOH.

Since 2013, the DOH has been centrally procuring FP commodities that are then distributed to various service delivery points.

• In 2015, the DOH distributed FP commodities to public facilities like RHUs, hospitals, and CSO FP providers. The following are the quantity of commodities distributed by the DOH: 11,125,623 cycles of Combined Oral Contraceptive (COC) pills; 1,338,162 cycles of Progestin Only Pills (POP); 3,228,950 vials of DMPA or injectables; 82,918 IUDs; and 449,464 Progestin Subdermal Implants (PSI).
• Some of the DOH Regional Offices procured various modern FP commodities to augment the supply coming from the DOH Central Office. The procurement, distribution and use of these commodities were in accordance with existing government rules and regulations. These also include recertification of FP commodities by the Food and Drugs Administration as non-abortifacient, as required by the RPRH Law.
• In addition, UNFPA donated 74,546 subdermal implant (PSI) units to POPCOM, other DOH-retained hospitals, LGU health facilities and CSOs providing FP services. These were then translated to PSI users. Note, however, that in June 17, 2015, a Temporary Restraining Order (TRO) was issued by the Supreme Court preventing the DOH and its attached agency, the Food and Drug Authority, “granting any and all pending application for reproductive products and supplies, including contraceptive drugs and devices; and DOH and its agents and representatives from “procuring, selling, distributing, dispensing or administering, advertising and promoting the hormonal contraceptive Implanon and Implanon NXT”.
• Distribution of Progestin Subdermal Implants were temporarily put on hold after the issuance of the TRO. The issuance of the TRO has affected not only the provision of PSI services at the service delivery level but eventually will impact on the availability of all FP commodities in the local market. This has to be addressed with urgency at the national level.
• Commodities that were proposed for procurement in 2015 by the DOH are expected to be delivered in the 1st quarter of 2016 to the service delivery points. CSOs can also access and utilize DOH FP commodities delivered to the DOH Regional Offices as provided in the DOH Department Memoranda (DM) No. 2015-0186 and DOH DM No. 2015-0341.
• The DOH, with technical assistance from development partners established a Technical Working Group for Supply Chain Management.  In addition to recommending evidence-based policy and operational reforms, USAID further assisted in establishing a tracking system for family planning commodities.  Through the FP Hotline, reports from the field via emails, phone calls, short messaging system and Facebook posts, the Department of Health is alerted when there are stock outs and low stock levels in specific geographic areas and facilities, enabling a rapid response to replenish stocks. While the FP Hotline provides a quick assessment on commodity stock status on the service delivery level, however, there is a need to establish a more long term system that will be able to track field level consumption data to capture the commodities that are actually being required in the service delivery points. This way a more realistic way of computing allocation of FP commodities based on actual MFP needs will be more effective.

In August 2015, the David and Lucile Packard Foundation shared an update on progress in achieving its commitments to FP2020.

As the Packard Foundation continues its collective push toward FP2020 and other long-term goals, more women and girls around the world are gaining access to sexual and reproductive health care. So far, the program has learned that focusing on access alone is not enough–quality matters. Greater progress will be made by securing everyone’s right to quality care that’s centered around women’s lives and goals. This will help more women and girls secure knowledge, exercise their choices, shape their own destinies–and contribute to measurable progress on a whole range of public health issues.

The foundation supports courageous, visionary providers, advocates and researchers working to advance everyone’s right to quality sexual and reproductive health care. Grantees provide access to comprehensive information, services, and skills that help women and girls – and the men and boys in their lives–secure their right to the quality sexual and reproductive health care they want, need and deserve.

Quality sexual and reproductive health care is woman-centered. It means:

• She understands her body and feels empowered to keep herself healthy with accurate, unbiased information about sexuality and reproductive health.
• She gets care that is centered around her life and goals–and decides whether and when to have children, chooses from a full range of contraceptive options, and can obtain safe and legal abortion follow-up care without stigma or interference.
• She shapes her own destiny–making decisions about her health and wellbeing that empower her at home, at the clinic, and in the community.

Working with young women and men, families, communities, and government leaders, the foundation’s grantee partners are making meaningful, measurable progress for people facing the greatest obstacles to reproductive health and rights through the following activities: 

• Quality and rights: The foundation’s Global Family Planning portfolio funds initiatives to improve measurement, develop and scale up innovations, and improve policies and programs that prioritize quality and rights. The foundation also support initiatives to end early marriage, and support programs and research to build evidence on sexual and reproductive health services for youth.

• Quality Innovation Challenge: During the 2013 International Conference on Family Planning in Addis Ababa, Ethiopia, the Foundation’s Population and Reproductive Health program launched a global challenge to support innovations that improve quality in reproductive health care. Following a competitive selection process, nine organizations were awarded grants of up to $100,000 to implement their innovations. A second Quality Innovation Challenge will be held at the 2015 International Conference on Family Planning in Nusa Dua, Indonesia.

• Measuring Quality: In 2014, the foundation partnered with the Population Council to bring field-level attention to issues of measurement in quality. The work commenced with a convening of stakeholders from across the measurement community, including donors, implementing partners, and key global measurement organizations. In addition, support of the Global Early Adolescent Study has highlighted the need for better information on young adolescents within the donor and research communities.

• Advocating for Quality: In 2014, the foundation supported the launch of QUEST (Quality Upheld: Every Service Every Time), a five-year initiative in partnership with Population Action International to improve quality and fulfill rights within family planning service delivery settings by advocating for improvements in health, regulatory, and legal systems in Ethiopia, the Democratic Republic of Congo, India, Myanmar, and Pakistan.

• Quality in South Asia: The Foundation’s South Asia subprogram makes deep investments in Bihar, India with targeted investments in Uttar Pradesh, Karachi in Pakistan, and select states of Myanmar. In India, the program continues to improve access to quality services in the public and private sectors, increase demand and awareness of family planning, and further develop innovative approaches to deliver comprehensive sexuality education (CSE). In Myanmar, the program aims to accelerate access to family planning through research, strategic advocacy, and technical assistance. At the regional level, the program supports the development of youth leadership for advancing commitment to the sexual and reproductive health and rights of young people.

• Innovations in Sexuality and Education in South Asia: In India, grantee partner CorStone has demonstrated the importance of adopting a mental health approach to comprehensive sexual education (CSE) by integrating a resilience training component to existing sexuality education programs in Bihar. After a two-year process, the Center for Catalyzing Change launched a first of its kind CSE program for middle school students in Jharkhand. In Pakistan, grantees Aahung, Rutgers World Population Fund, and Indus Resource Centre continue to forge stronger relationships with institutions and communities to deliver quality CSE.

• Family Planning Quality and Access in Sub-Saharan Africa: The Sub-Saharan Africa subprogram seeks to expand access to quality family planning and reproductive health services, including youth friendly sexual and reproductive health services; and build local and regional movements to advance political and financial support for family planning and reproductive health. The foundation makes strategic investments to support the scaling up of services; shifting socio-cultural norms to enable communities and families to support young people to make their own sexual and reproductive health decisions, including a delay of early marriage and first pregnancy; and building leadership and advocacy capacity by cultivating new leaders in the region. This includes support of programs in Ethiopia and the Democratic Republic of Congo; and targeted investments in Kenya, Rwanda, and regional advocacy.

• Family planning access and quality in the DRC: Tulane University's Community-Based Distribution program has contributed to an impressive increase in modern contraceptive use in Kinshasa, DRC over the past year.

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 Bangladesh shared an update on progress in achieving its policy, financial and program and service delivery commitments to FP2020.

• The 66^th meeting of the National (family planning) Technical Committee (NTC) held on 3 February 2016 approved the Implant and Progesterone-only pills (POP) as an immediate post-partum family planning (PPFP) method and as such Implants and POPs can be provided to clients immediately after delivery irrespective of parity. This is a major policy shift based on sustained advocacy from FP2020 partners, which would expand the method mix for post-partum women nationwide.

• Other key policy level changes that have happened in the reporting period.
  • Relaxation in the required age of the last child to one year for two child couples who want sterilization;
  • Allowing trained and skilled staff nurses to insert IUDs;
  • Allowing trained and skilled Female Sub-Assistant Community Medical Officers (SACMOs) to insert IUDs
  • A joint circular was issued by both DGFP and Directorate General of Health Services (DGHS) informing program managers and service providers on: 1) counseling pregnant women about family planning in all ANC; 2) providing FP counseling and services including pills, condoms, injectables, and implants in all PNC and immunization visits; and 3) providing PPFP methods for women undergoing home delivery which included: LAM (Lactational Amenorrhea Methods), Condoms, ECPs and Progestin-only Pill (POPs).
  • Relevant section of the National Family Planning Manual is being revised as per latest WHO MEC for contraceptive use.

• A key strategy that the Government developed to address discontinuation was to decentralize service provision by further capacitating domiciliary workers (the family welfare assistants or FWAs) to both initiate and provide follow up family planning services to clients

• 34 district and Upazila level trainers (ToT) of Brahmanbaria were trained in August 2015 to conduct cascade training to lower cadres. Local level trainers further trained 147 FWAs for providing 1^st and subsequent doses of injectable, previously allowed to only provide the 2^nd and subsequent doses. 258 FWAs who had received an earlier round of training and 84 Family Welfare Visitors (FWVs) of the same district received refresher training. By June 2016, two other districts, Cox’s Bazar and Dhaka have completed training of FWAs including required refreshers.
• Immediately after the training FWAs of all three districts have started providing the 1^st dose of injectables in the community. These efforts have helped the clients to save travel time and costs which may lead to increased acceptance and reduced discontinuation rates with regard to injectables.
• To complement the above initiative, DGFP has also completed training to community health care providers (CHCPs) for provision of the second and subsequent doses of injectable contraceptives at the Community Clinics in the same districts; a cadre which was previously not allowed to provide injectables. Based on positive feedback from the field, DGFP has started implementing the activity in another three districts (Laxmipur, Noakhali and Chandpur) and subsequently plan to scale up to all 64 districts.
• The USAID-funded Mayer Hashi Project has worked with the DGFP and the Bangladesh Garments Manufacturer and Export Association (BGMEA) to train health providers in family planning and to ensure a supply of contraceptives in BGMEA clinics and has already ensured availability of temporary contraceptives in 10 BGMEA clinics. Clinical providers of the BGMEA clinics have been trained on Implant and Injectable. Approximately an additional 40 garment factory clinics are providing condoms, orals and referrals for long acting and permanent methods.  Workplace FP services efforts will help to decrease discontinuation rates of temporary contraceptives by the garments workers.

The Government of Bangladesh/MOHFW committed to increasing the availability and accessibility of Long Acting and Reversible Contraceptives (LARCs – IUD and Implant) and Permanent Methods (PMs – Tubectomy and Vasectomy) in order to help shift their share of the method mix from 8% to 20% by 2021, the revised target. Following activities are ongoing to achieve this goal:

• Increasing availability of FWVs: The MOHFW has recruited 1,320 FWVs, of which 805 have already been trained to provide IUDs and assigned to vacant positions and the remaining 415 are in training. The MOHFW is recruiting an additional 638 FWVs.
• Increase availability of family planning medical officers: The DGFP received MOHFW approval to recruit of 535 Medical Officers (MCH-FP) which is in process.  Once recruited and trained, these physicians will be assigned to vacant positions, enabling increased NSV, Tubectomy and Implant service provision.
• Private-sector partnership: The DGFP has allowed the local Social Marketing Company (SMC) to market over-branded IUDs and Implants. Approximately 400 trained physicians have been trained with USAID support to provide the over-branded IUDs and Implants in private chambers, clinics and hospitals.  The DGFP initiated a Technical Committee to support the Private Sector Initiative on LARCs and PMs under the leadership of the Line Director, Clinical Contraceptive Services Delivery Program (CCSDP), DGFP.
• Creation of mobile service delivery care teams: Two NGOs funded by USAID as well as Marie Stopes Bangladesh are supporting DGFP through roving teams to provide LARC/PMs during Special Service Delivery Days, especially in government Union Health & Family Welfare Centers (UHFWCs) and NGO facilities.
• Creating an enabling environment: Certain policies have been changed as indicated above, including:
  • Relaxation in the required age of the last child to one year for two child couples who want sterilization;
  • Allowing nulliparous married women to accept Implant;
  • Allowing trained and skilled Staff Nurses to insert IUDs;
  • Allowing trained and skilled Female Sub Assistant Community Medical Officers (SACMOs) to insert IUDs;
• Demand creation and community mobilization: The IEM Unit of DGFP has initiated several BCC activities with support from UNFPA and USAID’s funded Bangladesh Knowledge Management Initiative (BKMI) Project including direct distribution of BCC/counseling materials and orientation of the providers on use of those materials in 38 out of 64 districts.
• Motivation of prospective clients: As a part of this intervention, orientation sessions of satisfied NSV acceptors with support from USAID-funded Mayer Hashi Project been carried out in more than 350 upazilas and in 40 upazilas with satisfied IUD acceptors.
• Mobilizing religious leaders as prompters of LARC/PM in Bangladesh: A book published by DGFP in Bangla titled, ‘Family Planning in the Eyes of Islam’, is used widely to orient Islamic religious leaders in training funded by USAID through the Mayer Hashi Project.  This booklet is accompanied by a smaller FAQ booklet.

The Government of Bangladesh committed to increasing training and workforce development by engaging in the following activities:

Recruitment:

• In 2015: 382 Medical Officers, 530 FWVs and 72 SACMO recruitment is completed.
• In 2016; 153 Medical Officers, 108 FWVs and 68 SACMO recruitment process is ongoing.

These technical cadres provide family planning and MCH services under the DGFP/MOHFW.

Training:

• In 2015-2016: 70 Medical Officers and 632 Paramedics were trained on Postpartum Family Planning (PPFP), much of it funded by USAID through the Mayer Hashi Project.
• In 2015-2016; 120 Paramedics received basic training on LAPMs.
• 761 participants (Deputy Director, Assistant Director, Medical Officer – Clinic, Upazilla Family Planning Officer and Medical Officer-MCH-FP) were trained on Progesterone-only Pill (POP).
• 1770 Field Staff (FWA, FWV, FPI and SACMO) received refresher training on Progesterone-only Pill.
• Government & NGO coordination workshops were held in all districts to increase demand for FP services.
• 929 service providers received training on injectable. Service providers targeted include FWV, FWA, CHCP in Noakhali, Laxmipur and Chandpur districts.
• 30,000 service providers such as FWA, FPI, SACMO and FWV attended trainings on newly revised FWA register (8^th edition) and reporting forms.
• 800 managers received training on LAPM users track and bottom-up projection related software.

The Government of Bangladesh committed to increasing adolescent-friendly sexual and reproductive health and family planning services and to providing adolescent sexual and reproductive health services at one-third of maternal, newborn, and child health centers.

• The MCH Services Unit of the Directorate General of Family Planning has started implementing Adolescent Friendly Health Services(AFHS) in 128 service centers (13 MCWCs & 115 UH&FWCs) in 13 districts. To increase demand of seeking care from these centers, DGFP recently conducted 5 advocacy meetings at the union level with the participation of adolescents, Community Health Care Provider, local leaders (Chairman of Union Parisad with 2 women members) and members of UH&FWC management committees.
• Three batches of three days-long training of the supervisors, service providers have been conducted and establishment of the AFH Corners are now going on. Soon these centers are expected to function fully. The MCH Services Unit of the DGFP is developing IEC materials (for display and for take away) for these AFH Corners. Messages for IEC materials have already been developed through 4 days-long workshop, technically supported by BCCP and attended by the expertise from different UN organizations, Government and NGOs.
• The Adolescent Sexual and Reproductive Networking Forum developed in 2015 and convened its’ regular meetings to discuss approaches to scaling up ASRH programmes in the country. A review of 32 Adolescent Health Programs of different NGOs has been completed by Population Council with USAID funding in partnership with DGFP and was shared with different stakeholders at the divisional level through consultative meetings to share knowledge. An Adolescent Health Newsletter providing programmatic and policy updates has been developed by DGFP with partners and will be regularly published on a quarterly basis.

• One of the milestones of Adolescent Health Activities of MCH Services Unit of the Directorate General of Family Planning is the creation of a website for adolescents with the support of UNFPA. The website will build awareness among adolescents by providing accurate and relevant information on their health related issues. This website has a mobile friendly version also as most of the adolescents use internet on their mobile phone.

The Government of Bangladesh committed to monitoring to ensure that quality of care is strengthened, including informed consent and choice.

• DGFP has extended the FP quality improvement teams from 8 to 10 and is planning to increase more teams to cover all districts in the next sector program period which will start in 2017. FP QI teams are working closely with national QI secretariat to ensure clients rights (availability, affordability, privacy, confidentiality etc.) at different level of facilities. FPQI teams are accountable to ensure rights based volunteer family planning services through their physical monitoring and exit interview of clients. DGFP is following up feedback from FPQI teams and addresses them accordingly. USAID-funded Mayer Hashi Project provides technical assistance to the DGFP on FP quality and compliance with informed choice requirements and provides a FP QI and Compliance Team for each of the seven, soon to be eight, Divisions.

DGFP conducted two days training on total quality improvement for Family Planning Clinical Supervisor Team/Quality Assurance Team (FPCST/QAT) in November 2015. As part of the training teams had to visit a model clinic (Narshindi) for “5S” intervention for hands on training. 5S concept was introduced in another two DGFP clinics to improve quality of FP-MCH services to learn implementation challenges and for scale up.  Biannual meeting were also organized at national level to review the FP performance in terms of quality of services.

The Government of Bangladesh committed to working with leaders and communities to delay early marriage and childbirth.  Please kindly provide an update on this commitment here.

• The IEM Unit of the DGFP has already implemented different innovative approaches to engage community leaders, gate keepers, local elites, religious leaders, school teachers, adolescent groups under the last sector program HPNSDP. These are as follows.
• Conducted 670 workshops on adolescent reproductive health, discourage child marriage, improve adolescent nutrition, and hygiene in all the upazilas of Sylhet and Chittagong Divisions with the students of Class VII to Class X, teachers and parents/guardians.
• Conducted workshops on the importance of population dynamics, importance of small family norms, ANC, PNC, institutional delivery, and neonatal care with the print and electronic media journalists in all 64 districts of the country.
• Organized workshops to advocate family planning methods in the light of Islam, discourage early marriage, importance of ANC, PNC and institutional delivery with local public representatives, religious leaders including Imams, Madrasa teachers and marriage registrars at 326 upazilas.
• Conducted 350 workshops with low parity couples, newly wed couples, young married couples to delay space and limit family size.
• Conducted training on interpersonal communication for the newly recruited field workers i.e. FWA, FWV, SACMO to motivate clients.

The following innovative service delivery activities were carried out by the DGFP:

• A digital archive for all FP SBCC materials was developed with the technical support of USAID-funded BKMI Project. Regular updating and uploading of the produced materials is ongoing.
• An e-Toolkit for frontline health workers and program managers was developed and is available in an Android version both in online and offline for fieldworkers, with the support of BKMI.  It is in the digital archive and updated annually. This e-Toolkit is now in use on pilot basis in Comilla and Tangail district’s front line workers through electronic tablets.
• An e-learning course on SBCC for frontline workers, program managers and planners were developed with support from BKMI. Program Managers and Planners are now using this e-learning course to improving their knowledge on SBCC regularly.

A dissemination and distribution guideline of IEC/BCC materials was developed.  Through the USAID-funded SIAPS, Mayer Hashi and BKMI Projects, the DGFP system to order and distribute SBCC materials is being strengthened, including integrating IEC/BCC materials into the DGFP’s eLMIS dashboard.

• Aman Foundation, through the Sukh initiative is committed to share best practices and research to aid evidence based decision making. The intention is to share the best of time practices for family planning project scale ups and sustainability with potential users of the information. The Department of Community Health Sciences, Aga Khan University as a measurement partner for Sukh Initiative, is to provide an external and independent measurement of program impact through a cross sectional survey of a sample population within the 1 million intervention population in the form of a baseline and an endline. Program impact will be measured as per the objectives and program goals outlined and agreed upon in the Sukh program framework. The measurement partner will conduct a mid-term assessment of program progress towards identified goals and also an independent analysis of progress monitoring and PMIS data on an annual basis and participate in an annual review of program progress. A dedicated position of Manager Research and Metrics has been introduced to the Sukh initiative with sole responsibility of identifying and developing research questions and hypotheses and with program data to identify best practices and evidence based impact studies. The activity is to commence from 2015 when field level service data becomes available for a meaningful and effective sample study.   

• To increase the ambit of Sukh strategy and build on the success of different models implemented in the country, Sukh Initiative has evolved an exclusive technical body which is widely represented by the Sindh Government, development partners, technical experts both from public and private sector. This body aims to create synergy between different stakeholders including the government departments in Sindh. Sukh is also working at the community level through more than 200 community base organizations. To create an enabling environment for family planning services, Sukh is working in close collaboration with the provincial Departments of Health, Population Welfare, Education and Youth Affairs, to strengthen the existing systems in the intervention areas and play a leadership role in advocating for the sustainability of its objectives.

• [Aman Foundation's family planning] program will promote longer term, more effective contraceptive methods. Sukh through increasing MCPR will motivate new users to adopt family planning for the first time, and encourage users of traditional methods to switch to more reliable modern methods. The connection between increased MCPR and reduced maternal mortality rates is well established, as is its direct contribution to lowering the total fertility rate. To improve quality of services to increase access to family planning, Sukh strengthens the quality of services locally available and will develop capacity of maternity homes to offer quality post-partum and post abortion family planning services. Jhpiego as implementing partner will work with public sector facilities to improve access to FP services (by method) and with improved quality of service.

• One of the multiple service provision levers for the Sukh project is Family Life Education through Aahung, a local organization with previous experience in working with young girls and boys in communities on the sensitive issues related to maternal health, marriage rights and communication. Sukh will include door to door counselling and service delivery through Aman Community Health Program, to educate and inform the family planning clients on importance of family planning, choices available for family planning supplies, health hazards and other healthcare topics. In addition, Aman TeleHealth a 24-hour round the clock, 26-desks Health Helpline services over 3 shifts with medical advisors, counselors and doctors, will provide health advice and referral information over the phone. This will empower and encourage women and youth in particular, to avail the widely used mobile phone services to seek timely medical counseling that otherwise would not be accessible to them.

• The UK is a proud supporter of FP2020, supporting family planning programmes in 20 countries as well as a large global programme to enhance reproductive health commodity security. We also support non-governmental organisations such as Marie Stopes International, International Planned Parenthood Foundation and Save the Children. 

• The UK’s Department for International Development (DFID) began funding a Scaling Up Family Planning Programme (SUFP) in Zambia in 2012. Up until this time, family planning was integrated within broader primary healthcare but had, in reality, not been progressing much as Zambia has one of the highest fertility rates in the region. After the London Summit in 2012, with the help of partners, including SUFP, Zambia produced its first ever 8 year family planning scale up plan and the issue was firmly placed on the national agenda. SUFP now operates in 26 districts and has reached over 100,000 new users with family planning.   

• The UK has recently approved and begun the tendering process for a new programme to support civil society to build accountability to citizens for delivering on the financial and policy commitments of FP2020 made by governments. This will ensure that programmes respect and promote women’s and girls’ rights to determine reproductive choices and is likely to begin in early 2015.

Since 2012, the UK government has supported family planning (FP) programmes in the majority of our focus countries (currently in 18 out of 28).  Most of these involve strengthening the health system to deliver a quality service as well as working closely with communities and families to explain the benefits of family planning and to change social norms in this area.  Some of our country programmes work in fragile settings and also in the hardest to reach areas.  Examples include some of the work in Pakistan as well as a project to reach pastoral women in Ethiopia.  Other programmes, for example in India, work with the private sector. 

Apart from country level work, DFID (with other donors) supports family planning through a number of global programmes that explore innovative contracting approaches and focus on understanding markets, demand and data.  DFID is the largest donor (£356m from 2013 to 2020) to the Global Programme for Reproductive Health Commodity Security, implemented through UNFPA and providing contraceptive commodities and supply system strengthening capacity building to 46 countries around the world, according to their needs.  This programme provides 27% of the global commodities required to reach the FP2020 goal of 120 million.   

DFID also supports the Reproductive Health Supplies Coalition, a group of over 300 members from private and public sectors.  The RHSC fosters innovation, sharing and discussion around reproductive health commodities.  We provide support to the Clinton Health Access Initiative to give technical assistance to some of the new family planning market shaping initiatives that have emerged. 

With the Bill and Melinda Gates Foundation, DFID supports the FP2020 Secretariat based at the UN Foundation and tasked with sustaining the global movement towards increased access to family planning in 69 countries.

Most of DFID’s country programmes have a component focused on social and cultural barriers to access and some of the work of the FP2020 secretariat also lies in this area.  The UK has long pushed the international community to break the silence on adolescent sexual and reproductive health and rights, including family planning.  Whilst a lot more remains to be done, Nigeria, Ethiopia, Ghana and Zambia all have programmes specifically targeted at young people and there is an increasing focus on addressing the social barriers to contraceptive uptake, including discrimination against young or unmarried women and social norms around women and girls being able to make their own decisions to use modern contraception. 

Most of DFID’s work in supporting partners to ensure safeguards against coercion and discrimination has been through the Rights and Empowerment working group of FP2020.  DFID was instrumental in the setting up of this group and its ongoing aims and objectives.  The group has been working to ensure rights-based programming and to embed rights within all aspects of family planning work, including monitoring. 

In addition, DFID funds a strategic accountability programme to ensure that governments and family planning service providers in up to 10 countries are held to account by their citizens to deliver the full family planning commitments made under FP2020 and ensure full, free and informed family planning choice for all.  The programme, currently in its design phase, will run for an initial period of three years with the possibility of a two year extension if it is achieving the desired impact on the ground.