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

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

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

• Le gouvernement du Madagascar s’est engagé à institutionnaliser la campagne nationale annuelle en planification familiale :
  • La campagne PF est déjà célébrée chaque année depuis 2012, le problème est surtout le manque de financement pour sa réalisation.
  • L’institutionnalisation n’a pas encore été effectuée.
• Le gouvernement du Madagascar s’est engagé à renforcer la mobilisation et la distribution à base communautaire en priorisant les zones non accessibles :
  • On est entrain de redynamiser la fourniture des injectables au niveau communautaire avec développement d’un guide de redynamisation pour baliser les services à base au niveau communautaire.
  • On va faire une évaluation de l’offre des injectables (dépoprovéra et sayana press) au niveau communautaire.
  • On va aussi réactualiser le curriculum de formation sur les injectables au niveau communautaire pour allouer plus de temps au stage pratique jusqu’à la maitrise de la compétence.
• Le gouvernement s’est engagé à assurer la sécurisation et la disponibilité des produits contraceptifs incluant les produits pour la contraception d'urgence jusqu’au niveau des bénéficiaires :
  • Pour Madagascar tous les besoins en produits contraceptifs sont honorés, mais c’est l’acheminement du district vers les formations sanitaires qui pose problème.
  • Pour ce 3ème trimestre un PTF (UNFPA) a alloué un certain montant pour l’acheminement des produits en Santé de la Reproduction y compris les contraceptifs du niveau district vers les formations sanitaires.
• Le gouvernement du Madagascar s’est engagé à renforcer les plateaux techniques des formations sanitaires en PF notamment pour les méthodes de longue durée et permanentes, en mettant en exergue la PF post-abortum/post-partum :
  • Cette activité a commencé en 2015 et se poursuit actuellement. La situation est qu’on a déjà fait 5 régions depuis et en 2017 on va faire 7 régions.

L’activité consiste au renforcement de compétence des prestataires ensuite dotation en matériels /équipements.

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.

• Australia’s funding for maternal and child health has increased from $360 million in 2011/2012 to $374 million in 2012/2013. 

• Australia’s funding for maternal and child health, over the last three financial years, are as follows:

• Australia’s financial years run from 1 July to 30 June. For this reason we are unable to report on this current financial year (2013-14) until the publication of Australia’s international development assistance statistical summary 2013-14. Funding allocations for future years will be determined through future budget processes.

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

The government reports performing the following activities in support of its financial commitment:

• In the FYI 2016-2017, the government of Uganda maintained its allocation of USD $3.3 million from domestic resources towards family planning supplies. This varies from last year’s allocation because the procurement under the World Bank loan ended in fiscal year 2015-2016. A lump-sum amount has been allocated to reproductive health and a detail breakdown as relates to family planning supplies will be communicated to the FP2020 Secretariat at a later point.
• The government of Uganda has hired Marie Stopes International-Uganda has been hired to manage the voucher program to increase use of family planning and safe motherhood services among the poor. MSI Uganda is in advanced stages of implementing the voucher system for maternal health and family planning under the Uganda Reproductive Health Improvement project. A contract has been signed and will cover the next four years.
• The national health insurance bill was sent to the cabinet and because of the new cabinet, the bill is still pending approval by Parliament. The National Population Council is engaging new legislators on the importance of family planning being included as one of the packages in the bill.

Advocacy by Reproductive Health Uganda, an IPPF Member Association, helped to achieve the pledged budget allocation of USD$5 million from the government for contraceptive supplies. This work was in partnership with Advanced Family Planning.  

In September 2016, the Government of Tanzania 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 Tanzania in collaboration with family planning partners continued to provide family planning services through outreach. Forty-four mobile outreach teams provided FP services in all regions across the country and 14 bajaj teams operated in peri urban areas. For the period of July 2015 to June 2016, the total number of clients served through outreach services were 357, 244.
• A total number of 4,539 young people accessed sexual and reproductive health services in 16 selected referral public facilities after being referred by youth peer educators in their communities.
• The number of facilities that are reporting on stock status increased from 4,654 in last year to 4,840 this year. Central and zonal quarterly RMNCH commodity security meetings continued to be conducted. A youth campaign focusing on adolescent girls was conducted to Accredited Drug Dispenser Outlet sellers to be able to provider family planning education and services to young girls. The campaign was conducted in four regions of Dar es Salaam, Mwanza, Mbeya, and Shinyanga.
• In June 2016, the Ministry of Health Community Development Gender Elderly and Children launched One Plan II and disseminated to 16 regional authorities.
• In strengthening the quality of community based family planning service provision, the government in collaboration with family planning partners developed a five-day Community Based Family Planning (CBFP) refresher training package that will be used to update existing community health workers (CHWs). Forty-six CHWs and 17 CHW supervisor were refreshed using the developed training package. The post-partum family planning and post abortion family planning training packages were also developed; they are now in the pre-testing stage.
• The regional relaunching of the Green Star Campaign was conducted in the Central Zone (Singida), Southern Highlands (Katavi), and Eastern Zone (Dar es Salaam) in September 2015. These campaigns were accompanied with TV and radio spots using national and local media to increase family planning awareness.
• The government committed to improving method mix through public-private partnerships. To this end, some family planning partners have partnered with private health insurance companies, and one of them—AAR Insurance—integrated family planning services in their health benefit package, over and above their outreach initiative (called AAR Wellness Services Program).
• In the 2015 to 2016 time period, the government procured Microval, male condoms, and Injectable Depo-provera. In supporting the government to improve Tanzania’s methods mix, other family planning partners, including USAID and UNFPA, supported public facilities in procuring other commodities like Microval, male condom, circle beads, microgynon, implants, Depo-provera, emergency contraceptive pills, female condoms, and Copper T 380A.
• In fostering partnership through social marketing, private FP partners improved methods mix through social marketed FP products, such as Dume Condoms and Flex P COC Pills (TMARC), Familia brand of products such as pills, injectables, and condoms by PSI, and Trust brand of FP methods by DKT.  

The Government of Myanmar provided new information on its progress in April 2017.  Read the revised update here.

In July 2016, the Government of Myanmar 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.

The Government of Myanmar provided new information on its progress in April 2017.  Read the revised update here.

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

The government reports performing the following activities in support of its policy and political commitment:

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

• Mozambique continues to offer integrated sexual and reproductive health services in all health facilities in the country, as an approach to increase access to these services. This commitment is evident in the Health Sector Strategic Plan 2014-2019, recently approved at the highest government level.

• Under the scope of the implementation of the family planning (FP) strategy, the offer of providing counseling in FP in all sexual and reproductive health services (SRH) was introduced, including the bureaus of HIV counseling, testing and Care and Treatment Services. Providers of other services (not just maternal and child health) were also included in ongoing training as a means of ensuring service provision to women in a "one stop" approach, where a package of SRH/FP services are offered, including at the pre-natal, postpartum, child at risk, and child vaccination visit.

• The implementation of offering long-term methods (IUD) immediately [following] postpartum are underway. The integration of offering modern contraceptive methods in the HIV program is also in the discussion phase.

• In the context of integrating SRH services, the capacity of screening Breast and Cervical Cancer (BCC) expanded from 31 US [Unidades de Saúde (Healthcare Centers)] in 2012 to 83 US at the moment, via training more than 670 healthcare professionals (530 - SMI [Saúde Materno-Infantil (Maternal and Child Healthcare)] nurses, 113 - general physicians, and 27 - gynecologists-obstetricians) and the allocation of the respective screening kits. During this period (2012 to July 2014), 203,110 women took the screening exam for cervical cancer. To accommodate these structural changes , all the registration instruments for Maternal and Child Health were reviewed, involving several sectors and institutions linked to the program, for the purpose of harmonizing said registration. The implementation of these instruments is set forth for January 2015, and they are being reproduced at this time.

• The government has focused on establishing a legal framework that permits the upholding of individual sexual and reproductive rights, with a particular emphasis on risk groups. The Assembly of the Republic approved the Law of Decriminalizing Abortion, the implementation of which is awaiting promulgation. In addition to laws, the Government approved strategies such as the Prevention and Treatment of Obstetric Fistula in 2012, as a means of increasing access to the treatment of fistula that affect women in low income families. With this action, a basic right is given back to these women that enables their social and familial re-insertion.

• To improve coordination, a family planning technical sub-group [has been] established; [its] mission is to review the policies, strategies, norms, and plans set forth in SRH/FP, as well as monitor family planning on a national level and mobilize human resources and materials for the implementation of activities. This working sub-group is lead by the Ministry of Health [Ministério da Saúde] and currently co-lead by UNFPA and meets regularly once a month and extraordinarily whenever necessary. As a result of this group's work, the following instruments were established:
  • The family planning consultation norms
  • The family planning acceleration plan
  • Emergency contraception norms
  • The quality standards of RH/FP consultations
  • The criteria for family planning in the mobile brigades and National Healthcare Week.

• The family planning sub-group, in coordination with other areas, will be performing various research/evaluations, namely:
  • The evaluation of availability of modern contraceptive methods at Healthcare Centers;
  • The evaluation of Elementary Multi-Task Agents' follow-up in the community of women using DEPO as a method of contraception; and
  • The evaluation of the integration of SRH and HIV services.

• To further improve coordination and ensure better logistical management, a technical sub-group for materials and products for RH/FP lead by MISAU (FP Program and Central de Medicamentos e Artigos Médicos - CMAM) exists, with the support and contribution of Cooperation and Implementation Partners. This sub-group, among other activities, is responsible for analyzing and revising requirements on a provincial level to avoid errors, given that one of the weaknesses is the rigor in accounting for needs at all levels.

In July 2016, the Government of Ghana 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: 

Community based nurses are presently used to deliver family planning services in rural areas including Implant services

• A total of approximately 2,100 auxiliary nurses have been trained in FP services, including contraceptive implants in line with the government’s task shifting policy (introduced in 2013) since the beginning of 2015. This has been achieved largely with support from partners (DFID, UNFPA, DANIDA, WAHO). This has led to a significant uptake of implant services.
• Training materials and job aids have been developed for auxiliary nurses across the country.
• Research is presently being conducted on the feasibility of task shifting in IUD insertion and removal.

The government of Ghana is working involve men in family planning in the various communities.

• The use of chiefs and male community leaders in community outreaches on family planning is ongoing. Reproductive health briefings have been carried out for the national houses of chiefs.
• Males who accompany their spouses for service are attended to promptly to encourage their continuous support.
• Workplace services, particularly condom distribution, continue to be supported.

The Government of Ghana is working to improve workforce training and options for task shifting:

• The training of auxiliary nurses is ongoing in all regions. Regional Resource Teams for FP have been established in all regions since 2015 to provide training and supervision. These teams have contributed to more than 2,100 auxiliary nurses being trained between 2015-2016.
• All the Regional Resource Teams have been trained in counselling, and they are rolling out the training of family planning service providers in the regions. All trainings include customer care.
• RHCS Facility survey was conducted in collaboration with UNFPA to assess FP service delivery in health facilities including customer care and client satisfaction. Findings will be used to improve customer care.

Postpartum and post-abortion care services are provided in all facilities that have trained personnel.

• In collaboration with IPAS and MSI comprehensive abortion services have been scaled up from 2 regions to 8 out of the 10 regions since 2015.

The Government of Ghana committed to offering expanded contraceptive choices including a wider range of long acting and permanent methods. Presently the method mix includes condoms, pills, implants, IUD’s/IUS, vasectomy and bilateral tubal ligation.

• Implanon has been introduced with a smooth transition to Implanon NXT in 2015.
• Sino implant has been introduced in the private sector by MSI Ghana.
• Limited quantities of IUS have been re-introduced in a few centers in the country.

The Government of Ghana committed to provide adolescent-friendly services for sexually active young people.

• All facilities are encouraged to offer adolescent friendly services.

Ghana has 218 fully functional adolescent friendly corners and 54 were built in 2015-2016.

In July 2016, the Government of Ghana 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 National Health Insurance Authority (NHIA) law has been amended to include family planning (FP) in the benefit package. Full cost estimates including projections were submitted to NHIA in 2014/2015 and the NHIA has made a commitment in writing that includes all FP clinical methods. Currently the NHIS is undergoing restructuring after which implementation will begin.

IPPF Member Association the Planned Parenthood Association of Ghana (PPAG) played a very active role in making contraception free in the public sector. The Association participated in the Contraceptive Security Committee, which plays a leading role in finding solutions to challenges to contraceptive availability. In 2013, the government added contraception to the list of free services provided to women as part of maternal health care.

• The German government has increased its bilateral commitments for RMNCH. Disbursements will increase accordingly, but there is a time lag due the project cycle.

• Data is not yet available for 2013; the German government will be able to report on 2013 funding flows only when OECD DAC data is released in December 2014.

• The tables below show how Germany’s commitments and disbursements towards RMNCH have developed in 2011 and 2012:

Note: The funding that Germany committed at the London Family Planning Summit is not additional to funding committed as part of Germany’s Muskoka commitment. It is a specification of part of the Muskoka commitment by earmarking 25% for interventions targeting family planning.

G8 Muskoka- Initiative (disbursements), in Mio. €

G8 Muskoka- Initiative (commitments), in Mio. €

• No major changes in how the Government of Germany allocates resources to health/RMNCH are foreseen for the near future.

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

IPPF has committed to significantly increasing the number of family planning services—a trebling of services from 2012 to 2020. IPPF is on track to reach the FP2020 targets to enable 120 million more women and girls to use contraception by 2010. By 2020, IPPF will increase family planning services to save the lives of 54,000 women, averting 46.4 million unintended pregnancies and preventing unsafe abortion. Results from 2014 show significant progress towards achieving this ambitious target:

• Delivery of 60.2 million contraceptive services through 54,000 service delivery points. The number of contraceptive services provided in 2014 includes 8.9 million new users. Over 5.7 million contraceptive services were deliver to young people under 25 years of age.
• Averted 5.9 million unintended pregnancies and 677,000 unsafe abortions through a CYP of 14.6 million. The number of couple years of protection (CYP) provided in 2014 increased by 21 percent to 14.6 million, which averted an estimated 5.9 million unintended pregnancies and 677,000 unsafe abortions. In the Africa and Arab World regions, the percentage increases from 2013 were 83 and 37 percent, respectively. In Africa, the growth was predominantly due to injectables, intrauterine devices, and oral contraceptive pills. In the Arab World, it was due mainly to intrauterine devices and implants.
• Delivering an Integrated Package of Essential Services. IPPF remains committed to providing a range of contraceptive choices to service users. The services in the package are proven by WHO to deliver high impact in resource-poor settings and when combined these services have the ability to transform the lives of women, girls and other poor and vulnerable populations. Our Integrated Package of Essential Services requires IPPF Member Associations to provide short- and long-acting reversible methods, as well as emergency contraception. Within IPPF’s CYP for 2014 of 14.6 million, 44 percent was provided by short-acting methods; 42 percent by reversible long‑acting methods; 14 per cent by permanent methods.

By 2015, we expect to double the number of comprehensive and integrated SRH services annually by:

• Investing in countries with the greatest need. The majority of IPPF’s unrestricted investments are made in countries with the greatest need for SRH information, education and services. These countries, identified by the Human Development Index as having low or medium levels of human development, have disproportionately high levels of maternal and child mortality, unmet need for contraception, HIV prevalence, and early marriage and childbearing. In the 73 countries identified as having low or medium levels of human development3 and where there is an IPPF Member Association or collaborating partner, the total number of sexual and reproductive health services provided in 2014 reached 122.4 million, an increase of 13 per cent from 2013. The most common categories of services provided were contraception, maternal and child health, and HIV-related services;
• Reaching poor and vulnerable groups. In 2014, IPPF reached 52.6 million poor and vulnerable service users with sexual and reproductive health services, 3.7 million more than in 2013. The estimated proportion of all service users who are poor and vulnerable is 85 percent, the highest ever achieved by IPPF. These results illustrate IPPF’s commitment to serving those most in need of sexual and reproductive health services. IPPF has more than 54,000 service delivery points, and 59 per cent of them are located in peri-urban or rural areas. This enables Member Associations to provide information, education and services to people living in hard-to-reach areas where there are few, if any, other service providers. Member Associations provide services to under-served groups who are not reached by other public or private providers, due to a reluctance to work with such marginalized populations, the additional costs involved or an absence of the specialized skills needed. Such groups are often those with greatest need, and include young people, sex workers, men who have sex with men, people who inject drugs, sexually diverse populations and prisoners.
• Adolescents and young people. In 2014, IPPF provided 66.6 million sexual and reproductive health services to young people. This represents 45 percent of all services provided, and illustrates our commitment to the largest generation of young people ever. Over the last five years, IPPF has focused on the needs of young people, with the proportion of sexual and reproductive health services provided to youth rising from 35 per cent in 2010 to 45 per cent in 2014. The most common services accessed by young people in 2014 were contraception (37 percent), HIV-related services (22 percent) and gynecology (10 percent).

Throughout 2014, IPPF continued to invest in and strengthen organizational systems and business processes to support a strong culture of performance, effectiveness, learning and accountability. Being part of a large Federation means that many Member Associations have the opportunity to learn from and share their expertise with others. While IPPF Regional Offices provide technical support to Member Associations in their regions, there is a growing trend to promote capacity building directly between Associations. In addition, as experts in the field of implementing sexual and reproductive health and rights programmes, Member Associations are also asked by external private and public health organizations to share their knowledge and experience.

• Learning Centers in the Africa Region. The Africa Regional Office has supported nine Member Associations to become designated Learning Centers. These Centers offer training and other forms of technical assistance to organizations, both within and outside the Federation. Based at the Member Associations of Cameroon, Côte d’Ivoire, Ethiopia, Ghana, Kenya, Mozambique, Swaziland, Togo and Uganda, the Learning Centers promote peer-to-peer learning by transferring expertise in how to design innovative programmes. These Member Associations consistently demonstrate their capacity to provide quality SRH information and services, and have the expertise, skills and systems to provide technical support to other Member Associations. Each Centre reflects the acknowledged strengths of that particular Member Association.
• Engaging volunteers and staff. In 2014, volunteers and staff of the Member Associations with Learning Centers took part in refresher training in their core areas of expertise to strengthen their ability to provide support on topics in demand. These included family planning, with a focus on long-acting and permanent methods; public–private partnerships; and how to deliver integrated SRH including contraception. Member Associations were supported to convert areas within their facilities into meeting spaces, and to develop or adapt training modules based on national sexual and reproductive health policies and curricula. Exchange visits involving the Member Associations in Cameroon, Ghana and Uganda offered valuable opportunities to share experiences in the day-to-day management of running a Learning Centre.
• Member Association exchange. Reproductive Health Uganda (RHU) demonstrates one example of a Learning Centre building the capacity of multiple Member Associations across the region. RHU provided training to Member Associations from Ethiopia, Kenya, Malawi and Mozambique on how to design and manage surgical camps, as well as training for Member Associations in Ethiopia, Kenya, Malawi, Namibia, Swaziland and Tanzania on a parent-focused intervention exploring the sexual and reproductive health and rights of young people. In 2014, three Member Associations with Learning Centers were successful in generating income from training public or private health providers. The Family Guidance Association of Ethiopia trained 2,628 health professionals from public and private clinics, generating 16.7 million Birr (US$816,000); Family Health Options Kenya trained 300 service providers, generating 3 million Ksh (US$32,000); while Côte d’Ivoire’s Association Ivoirienne pour le Bien‑Être Familial trained nearly 200 service providers and generated 62.6 million FCFA (US$100,000).

IPPF is currently building on the work previously undertaken across the Federation to support client-centered, integrated, rights based quality family planning services within a comprehensive approach to SRH. IPPF is building a strong civil society response to strengthen national health systems. Member Associations are part of the grassroots movement in their respective countries. They play a critical role not only as service providers within the health system, but also as a significant contributor to strengthening the health system by disseminating new guidelines and technologies, building the capacity of other peers working within the health system, and advocating for supportive policies. Below are highlights from our work in 2014:

• IPPF is reinvigorating our International Medical Advisory Panel to respond with best practice and clinic based guidelines and to share our experience amongst communities of best practice, and provides timely guidance to IPPF on critical issues related to SRH and family planning. IPPF Medical Bulletins are produced to address gaps in bio-medical evidence or critical issues relating SRHR programming.

IPPF’s commitment to quality of care is demonstrated through our Quality Assurance Package which also guides Member Associations on establishing the Integrated Package of Essential Services (IPES). In 2014, quality of care was included as a key principle for Member Associations accreditation, underpinning our continual quest for quality. Evidence from our safe abortion and family planning programmes shows that satisfied clients are one of the top three sources of referral for new clients. IPPF’s Quality of Care Technical Working Group provides global technical leadership in quality of care, along with information and policy updates, sharing guidelines and best practice, training and resources.

IPPF remains committed to building the advocacy capacity of Member Associations in 40 countries to advance rights-based family planning, within a comprehensive approach to SRH. IPPF defines capacity building as development of IPPF’s core skills in order to enable the organization and individuals to address weaknesses, to bring about change and increase effectiveness. IPPF Regional Offices are the hub of capacity building activity in the Federation and provide technical assistance to Member Associations in every aspect of organizational life, depending on their needs–including advocacy capacity building.  Our Regional Offices provide on the spot assistance, regional training workshops, publishing toolkits and arranging south to south technical assistance. Specific examples in 2014 include:  

• IPPF worked to increase Member Association capacity to advocate on sexual rights—including access to contraception—through the Universal Periodic Review Mechanism. IPPF supported Member Associations to press their governments for change, including training for Member Associations from Austria, Albania, Bosnia-Herzegovina, Bulgaria, Estonia, Kazakhstan, Spain and Tajikistan to use the UPR process. Most recently, two Member Associations who participated in the workshop have submitted shadow reports that will be reviewed by the Human Rights Council over the next year. The Macedonian and Bulgarian Member Associations also attended the adoption of their respective country UPR reports in Geneva and made oral statements on the recommendations that were adopted or rejected.
• Advocacy with the UN. Every year, IPPF successfully advocates for progressive language to be included in UN documents, including the conclusions of the Commission on the Status of Women (CSW) and the outcome document for the Commission on Population and Development (CPD). IPPF supports Member Associations to participate in these UN processes, and hold their governments in capital to account on key issues related to SRH and rights-based family planning.
• Joining Voices. IPPF’s Joining Voices project plays an important role in supporting civil society advocacy on family planning to make sure commitments are delivered. As part of Joining Voices, Countdown 2015 Europe is a consortium of 15 leading European non-governmental organizations, of which over half are IPPF Member Associations, working to ensure funding for sexual and reproductive health and rights in developing countries. Coordinated by IPPF’s European Network and working with European Union institutions, Countdown 2015 Europe holds donors to account for their policy and funding commitments to achieve universal access to reproductive health and to address the unmet need for family planning.
• Tracking advocacy progress. In 2012, new questions on advocacy were included in the Global Indicators Survey to provide additional information on advocacy progress made by Member Associations. However, certain Member Associations suggested a new approach to gathering information on advocacy progress. Currently, we are providing support for Member Associations to assess their advocacy capacity better, through a tool based on a self-assessment checklist to identify strengths and areas that need improvement.

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.

CARE International provided the following updates on progress in achieving its FP2020 commitments:

Building political will and mobilizing action at all levels ensure accountability to commitments: At the global level, CARE has actively contributed to key processes to shape standards and commitments to delivering universal access to high-quality, rights-based family planning, and to strengthen systems for ensuring meaningful accountability of all actors to deliver on these commitments.  Highlights of this work include:

• CARE served as one of four civil representatives on the Accountability Work stream for the UN Global Strategy for Women’s Children’s and Adolescents Health, which shaped guiding principles and structures for monitoring and accountability of the Global Strategy at global, national and sub-national levels.
• CARE provided significant staff time to support FP2020; specifically, supporting membership on the FP2020 Rights and Empowerment Working Group.  This group contributed to the development of FP2020 Rights and Empowerment Principles, and the development of rights indicators to measure progress in achieving FP2020 goals.  CARE continues to advocate for the inclusion of citizen-generated feedback on FP services in FP2020 monitoring and accountability systems.
• CARE contributed to a multi-stakeholder consultation convened by the Guttmacher Institute to develop a set of relevant and measurable SRHR indicators for the post-2015 SDG framework.

Ensure implementation of policies and programs that are rights-based, effective, and culturally appropriate and address the needs of communities: Since 2011, CARE has been working in southern Chad to increase access to high-quality family planning services for host and internally displaced (IDP) populations served by the government’s primary health care system.

• This initiative emphasizes long-acting reversible contraceptive (LARC) methods and comprehensive counseling in order to ensure that women obtain the method that best meets their needs and preferences. When CARE began this work, national guidelines for SRH service delivery restricted LARC services to hospitals. Furthermore, these guidelines required nurses and midwives to be supervised by a doctor whenever providing LARC services. These conditions effectively prevented many women in Chad from accessing LARC services. CARE helped change these guidelines by working hand-in-hand with local government and communities to demonstrate that nurses and midwives can safely and effectively deliver these services in health centers if they receive competency-based training and regular supportive supervision. Based in large part on this joint effort, the Ministry of Health convened a series of workshops with key partners (e.g. CARE, UNFPA and an IPPF affiliate) to produce the 2013 National Family Planning Policy, which, among other things, permits LARC service delivery in any primary health center by any trained nurse or midwife regardless of a doctor’s presence.
• At the other end of the spectrum, CARE has been working with local government officials, law enforcers, and community leaders to raise their awareness of existing national policies and laws protecting women’s right to SRH services. The national 2002 SRH law (2002) protects women’s right to receive family planning, without consent from a father or husband and without regard to her marital status. However, when CARE began its work, many people, including police officers, were unaware of this law and believed that it was illegal to provide family planning to young or unmarried women and to women without their partners’ knowledge or permission. After several men registered official complaints with the police concerning their wives’ use of family planning services without their consent, CARE met with local police officers to discuss the national SRH law and the right of women to SRH services. Not only did the officers end up supporting the law, but also they requested more information about various family planning methods and their benefits. In response, CARE held two workshops for police on the national SRH law, SRH rights, family planning and birth spacing. Since then, police have facilitated similar workshops for men’s groups and both health care providers and women have reported referring husbands to the police to verify and explain the legality of contraceptive use. Consequently, CARE has made it a best practice to ensure that all stakeholders know about and understand the provisions of the national SRH law.

Developing approaches for addressing gender and social barriers to increased family planning use: Since the London Summit, CARE has continued to strengthen our knowledge and evidence base for catalyzing meaningful change in the social and gender norms that restrict health and rights.  A core approach used by CARE is Social Analysis and Action (SAA), a participatory dialogue process that enables men, women and youth to explore and challenge the social norms, beliefs and practices that shape their lives and health.

• The SAA approach was used in the Results Initiative, (RI) a four year project carried out in Kenya, Ethiopia and Rwanda with the goal of increasing and sustaining the use of family planning by addressing the underlying social and cultural barriers to family planning, including gender norms. The project catalyzed ongoing dialogue with men, women and youth about how gender roles restrict family planning and provided role models for equitable communication and use of family planning. In Kenya, results from the project revealed significant increases in the current use of modern family planning between baseline and endline: use of modern family planning increased among women by 17.2% (from 34% to 51.2% of women) and among men increased by 24.3% (from 27.9% to 52.2%). Women who participated in SAA dialogues were significantly more likely to use modern family planning methods. Women’s reported use of modern FP was significantly associated with higher spousal communication, control over their own cash earnings and self-efficacy to use FP. Men were significantly more likely to use modern FP if they reported high approval of FP and more equitable gender beliefs. In qualitative interviews, men and women described how community dialogues addressed myths and misconceptions, normalized discussion about FP, and increased its acceptability. Public examples of couples making joint FP decisions and using FP provided models appeared to legitimize communication and joint decision-making with spouses about FP especially for men. Women described partner support as a key enabler of FP use, offering practical and emotional benefits; however, women emphasized the importance of their ability to access FP without their partners’ knowledge and support when facing partner opposition. Couples reported that increased communication contributed to increased couple-level ha 
• Similarly in Ethiopia, the project evaluation reported significant change in the use of family planning, where women’s FP current use changed from 32%-61% and men’s from 38%-82%. Inter spousal communication is found to be positively and significantly correlated with levels of exposure to the RI project and is positively associated with FP use for both men and women in the household survey. CARE continues to address gender and social norms in our SRMH programming.
• The SAA approach has also been used to improve family planning use among married adolescent girls in Ethiopia by the TESFA Working with key ‘gatekeepers’ of married adolescent girls to critically reflect on the barriers to FP use and the negative consequences of the restrictions to access services, it was possible to create support for the most marginalized and invisible groups of adolescent girls to access FP information and services. By the end of the project, use of modern family planning methods showed a 27 percentage point increase among the targeted adolescent girls.
• CARE has conducted a recent mapping that revealed that the SAA approach has been adapted and used for sexual and reproductive health projects including family planning in more than 10 CARE country offices. The lessons and experiences of using the approach and some of the results have been shared with partners at key international conferences including the International Conference on Family Planning (2013) and Women Deliver (2013).
• The success of SAA hinges on creating an effective cadre of change agents: CARE staff/SAA facilitators build awareness about how their own assumptions, beliefs, and attitudes about gender, power and sexuality shapes their work, and build concrete skills for facilitating productive dialogues about gender, sexuality and power. CARE is developing training materials for SAA facilitators to build key facilitation skills and provide tools and guidance for catalyzing community dialogues for social change.

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

• The Government of Burkina Faso has developed a 2013 to 2015 family planning recovery plan. The plan has been broken down into regions and health districts and periodic monitoring outputs have been carried out at all levels in order to guide actions towards achieving goals. This plan expires this year and the evaluation of its implementation is expected to take place in the last quarter of 2015.

Le Burkina Faso a mis en œuvre son plan national de relance de la planification familiale qui est arrivé à échéance en 2015. Le processus de l’évaluation du plan de relance a commencé avec l’appui technique et financier de l’UNFPA. En effet les termes de référence ont été finalisés ainsi que le timing de l’évaluation. Le recrutement des consultants est en cours et l’évaluation devrait démarrer en août 2016.  A l’issu de cette évaluation un nouveau plan dit de seconde génération couvrant la période 2016-2020 sera élaboré. Signalons en outre que le Burkina Faso vient d’adopter son Plan National de Développement Economique et Social (PNDES) où la Planification Familiale a été considérée, non pas comme un indicateur d’offre de services, mais plutôt comme un indicateur de développement.

In August 2015, Bloomberg Philanthropies shared an update on progress in achieving its commitments to FP2020.

• Bloomberg Philanthropies has engaged CDC Tanzania to conduct an impact evaluation of the Philanthropies’ work in Tanzania and found that on average, at least 100 maternal deaths and 2,000 injuries are being prevented annually because of interventions. Their evaluation also found that interventions increased access to emergency obstetric care within 2 hours from 68% to 72%
• CDC also conducted a household survey of 4,000 women of reproductive age in Kigoma, and findings from that survey were used to shape Philanthropies’ reinvestment strategy for the region.

In August 2015, Bloomberg Philanthropies shared an update on progress in achieving its commitments to FP2020. Below are updates on Bloomberg Philanthropies three-pronged investment strategy:

• Integration of Comprehensive Reproductive Health Services in Kigoma, Tanzania: Bloomberg Philanthropies are supporting the integration of family planning and comprehensive post-abortion care into the 17 health centers the Philanthropies has upgraded for comprehensive emergency obstetric care in Tanzania. The next phase of Bloomberg Philanthropies investment in Tanzania has a goal of increasing CPR in Kigoma Region by 3 percent annually over 4 years (total 12 percent increase). Our implementing partners, World Lung Foundation and EngenderHealth, are using multiple strategies to reach that goal, including: behavior change communications, partnership with local women’s groups, outreach to youth, training and deployment of community health workers, and partnership with local government to ensure sustainability. Bloomberg Philanthropies’ partner, EngenderHealth, has already begun providing family planning counseling and services in 17 supported health facilities. In 2014, nearly 50,000 clients, including about 10,000 clients aged 10-24, were able to access the contraception of their choice.
• Advocacy Grants in Nicaragua, Burkina Faso, Senegal and Uganda: Bloomberg Philanthropies’ partner Planned Parenthood Global has identified promising local organizations in the four target countries and convened them to select policy priorities. Planned Parenthood will provide technical expertise and build capacity to support them in conducting effective advocacy that leads to improved access to reproductive health services.
• Rapid Response Mechanism established and launched in partnership with FP 2020/UNF: To date, the Rapid Response Mechanism has supported 12 grantees in South America, Asia, and Africa.

• 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.

• As of April 2014, the Bank has provided a total of US $2 billion ($1.2 billion committed and $755 million in pipeline) to support 21 countries for the 35 priority countries for MDGs 1c, 4 and 5. This includes $1.6 billion IDA financing and $298 million HRITF financing. A specific breakdown for sub-themes within RMNCH, such as family planning, is not available.

The following tables provide the portfolio data for new IDA commitments for reproductive, maternal, newborn and child health and disbursements on active projects with RMNCH components.

New IDA Commitments for RMNCH FY10-FY13 (with HS contribution added) in US$ Million

IDA Disbursements for RMNCH FY10-FY13 (with HS contribution added) in US$ Million

• The World Bank has been addressing some challenges through results based financing (RBF). RBF has shifted the focus from inputs to This has been essential in achieving strong results in our Health Results Innovation Trust Fund (HRITF) funded projects. Moreover, by building strong M&E components into these projects, we have been not only better able to gauge progress, but also build country level capacity for M&E. Data from several countries, including Nigeria, and Zimbabwe, show that RBF programs are increasing coverage and quality of services. They are also making health systems stronger, more efficient and more accountable.
  • In Zimbabwe, coverage in institutional increased from 50% to 75% between March to December 2012 because of the focus on results, and in Nigeria, the quality of service increased from 28% to 55%. Countries have also seen significant increases in the number of beneficiaries who now have access to RMNCH

• As a result of the Reproductive Health Action plan, the number of World Bank country strategies and projects that address reproductive health is increasing. The Country Assistance Strategy (CAS) or Country Partnership Strategy (CPS) guides the World Bank’s multi-sectoral engagement with a country. Between FY11 and FY13, of the 44 CAS/CPS approved in high-burden countries, 100 percent included reproductive health. The CAS/CPS reflect the country-specific issues, such as family planning, skilled birth attendance, emergency obstetrics care (for instance), which are all part of RH. In terms of lending, of the RMNCH funds, more than 67% of new health, nutrition and population projects occurred in countries with high maternal mortality and high fertility to address RMNCH.

• 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.

In August 2015, Merck for Mothers shared an update on progress in achieving its commitments to FP2020.

• Since last reported, the Informed Push Model in Senegal has been scaled nationally to over 1,300 health facilities in all 14 regions of the country, ensuring reliable access to modern contraceptives for over 32 million women.
• To date, Merck for Mothers has expanded reliable access to modern contraceptives to nearly 280,000 women across three states: Jharkhand, Rajasthan, and Uttar Pradesh.
• Merck for Mothers is also partnering with the Population Council in Kenya to develop a mobile phone-based platform for women to select a family planning method of their choice, refer her to a nearby facility that offers her selection and follows up with her to rate the quality of care she received.
• The Merck for Mothers Global Giving Program was designed to amplify the reach of the Merck for Mothers initiative and engage MSD offices around the world by supporting local projects to improve maternal health and access to family planning. In Indonesia. Merck for Mothers has partnered with Project Hope across four factories to reach nearly 8,000 women about family planning and maternal health, connect them to workplace-based health services, and link them to external health services.

In July 2016, the Government of Indonesia 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:

• Strengthening the Inclusion of Family Planning in the Universal Health Coverage (UHC) Program/ Program Jaminan Kesehatan National (JKN): Based on the current Presidential Decree No.19 Year 2016 Article 21, FP package under the UHC scheme now covers all types of contraceptive methods includes interval tubect Individuals who are enrolled in the Universal Health Coverage (UHC) Program/JKN will be able to access all types of contraceptive methods provided through family planning services for free; from primary health care facilities to secondary and tertiary health care facilities that have the MOUs with the Social Insurance Board (BPJS). As follow up action, the government is working to:
  • Expanding access to accredited Family Planning Service Delivery Points by increasing the total number of Family Planning Service Delivery Points to be registered under the Social Insurance Board (BPJS)’s network; and
  • Facilitating the existence of private midwives in the UHC Scheme as sub health facility contracted by the Social Insurance Board (BPJS).
• The government has provided policy briefs for recommendations to improve the family planning component in UHC Scheme particularly related to the provision of postpartum family planning services. This is based on the case found at district level that family planning services providers tend to delay the provision of postpartum family planning services due to UHC Scheme regulations, which put no difference rates between cesarean procedure with or without tubectomy – Ministry of Health Regulation No.59 Year 2014.
• BKKBN has released policies to increase Long Acting Permanent Method (LAPM) use:
• Service/Supply side activities include ensuring the provision of LAPM contraceptive commodity to support of LAPM services and improving the competency of LAPM service providers.
• Demand creation activities include providing promotional and IEC materials, promotion at service delivery points, and grassroots empowerment.
• In order to support these policies, BKKBN has released decrees consisting of 1) BKKBN Chairperson Decree No. 78/PER/E3/2011 on provision of free contraceptive medicine and devices in FP services to all childbearing age couples which has brought positive results in increasing FP participation including LAPM; 2) BKKBN Chairperson Decree No. 151/PER/E1/2011 -- aimed at increasing access, quality, and assuring post-partum FP service in all service delivery points; and BKKBN Chairperson Decree No. 165 year 2011 on FP LAPM services -- aim at assuring sustainability and increasing achievement of LAPM service for all childbearing age couples.
• The Government of Indonesia committed to improving 23,500 family planning clinics between 2006 and 2014, and increasing mobile family planning services in remote areas. Activities in support of this commitment include:
• Improving supply chains, systems, and service delivery models: In 2015, three models in supply chain management representing different geographic backgrounds were developedto address some challenges and in ensuring family planning commodity security at the district level, including remote areas.

In line with these efforts, the central government also continues to provide funding assistance to the local governments through the Special Allocation Funds (DAK). The assistance is provided to the low-to-medium fiscal capacity local governments to cover expenses for infrastructures; procurement of vehicles and; materials for IECs; and medical supplies that will support better access to family planning services and family planning information. Total allocation of DAK Fund is Rp. 603,3 billion for 508 districts/ municipalities in year 2016.

In addition, starting in 2016 the central government also provides additional allocation for Family Planning Operational Funds (Bantuan Operasional Keluarga Berencana/BOKB) to support distribution cost of contraceptives and drugs from warehouses at district level to health facilities/FP clinics. Total allocation of BOKB Fund for year 2016 is Rp. 215,6 billion.

In order to integrate these efforts, in year 2016, BKKBN in collaboration with UNFPA Indonesia will develop policy advice to readjust/strengthen Supply Chain Management (SCM) to be in line with UHC (JKN) Scheme implementation and be integrated with Family Planning Operational Funds (Bantuan Operasional Keluarga Berencana/BOKB) and Special Allocation Funds (DAK) at district level particularly at Kampung KB locations.

• Improve distribution of capable health providers in providing a wide range of contraceptive methods: CTU training conducted by BKKBN with support from related stakeholders has not yet fulfilled the need of adequate distribution of capable health providers in providing a wide range of contraceptive methods particularly LARCs. As a result, BKKBN in collaboration with the Ministry of Health and related strategic stakeholders will improve skill retention of trained providers by reformulating effective CTU Training through the ‘on the job training’ method.

• Strengthening public-private partnerships to address issues related to more accessible FP service by:
  • Providing refresher training, particularly on LARCs, for private midwives;
  • Distributing LARC IEC Materials at private midwife clinics; and
  • Advocating for promoting the use of LARCs through Public Service Advertising (PSA) on various mass media outlets, including radio, TV, print, and online media.

Please see the full the full commitment update from the government of India here.