ANNEX 1: SCOPE OF WORK - WHO

Global Business Plan for Millennium Development Goals 4 & 5 Advocacy Plan Phase I: Research and Mapping

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ANNEX 1: SCOPE OF WORK

Scope of Work

Global Business Plan for Millennium Development Goals 4 & 5 Phase I: Assessment, Mapping, & Analysis

“Solutions can only have traction if the advocacy community itself generates and embraces these in a collective analytical and consensus-building effort.”

--Jeremy Shiffman Background and Current Situation In the summer of 2006, the Norwegian Prime Minister’s office convened several partners, including Norad (the Norwegian Development Aid Agency), the United Kingdom (UK) Department of Treasury, the UK Department for International Development (DFID), and the Bill and Melinda Gates Foundation. This group launched a new initiative called the Global Business Plan (GBP) to reach Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health). Norwegian Prime Minister Stoltenberg and UK Chancellor Gordon Brown have made public commitments to improving child and maternal health, which has been a catalytic and hopeful first step in building global political will to make change. Other critical players to achieving success for this initiative include The Partnership for Maternal, Newborn, and Child Health (PMNCH), UNICEF, WHO, USAID, and the World Bank. These organisations participated in a meeting in London in February 2007, to discuss the technical, financial and advocacy aspects of the Plan. Norway hosted a further meeting of the Advocacy Working Group (AWG) of the GPB in March 2007. A consensus emerged from this meeting that Options Consultancy Services (Options) would develop a detailed scope of work for implementation of the first phase of the Advocacy Plan development process. The impetus behind the initiative is that progress towards Millennium Development Goals 4 and 5 has stalled. More than 500,000 women die from pregnancy related causes every year. Many women survive childbirth but suffer from short- or long-term illness related to complications of pregnancy and childbirth -- over 300 million women. Eleven million children die before their fifth birthday – nearly 40% in the first month of life. Health statistics related to maternal, newborn and child health show the greatest disparity between developed and developing countries. More than 99% of maternal deaths and 98% of child deaths occur in the developing world. Answers to these problems exist, but they will only be solved by building political will to address maternal, newborn and child health.


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Advocacy Goal Build political will in the South, North and globally to get MDGs 4 and 5 back on track Objectives Increase awareness and action in developed countries, and generate support and demand for better policies and funding in developing countries Detailed Scope of Work Three phases are envisaged for the development of the Advocacy Plan: Phase I – research and assessment; Phase II – campaign design; and Phase III – campaign roll out. Each phase will build capacity for the next. These phases were conceived by the AWG and presented to the plenary as shown below. The advocacy process must involve several players working together at the global, regional, national and sub-national levels. The work will be driven by answers to the core communication question: among the concerned stakeholders, who has to do what differently to get MDGs 4 & 5 back on track?

The Three-Phase Advocacy Process

ASSESSMENT DESIGN (creative, plan)

ROLL OUT

Advocacy processAdvocacy processRegional

Global

NationalSub-national

Leadership

Management

Monitoring

This scope of work will focus on Phase I – assessment and mapping. Approach Phase I consists of the following tasks: a) Survey of capacity and resources for advocacy, including established networks

(who is, and should be involved in delivering advocacy?) b) Mapping of audiences (stakeholders) for advocacy (who are the decision makers,

the influencers, the activists, the social mobilisers, etc.?)


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c) Identification of lessons learned on advocacy processes d) Analysis of messages that have worked/not worked. These approaches will help us to identify:

• What are the advocacy opportunities over the next 1-3 years? • Where are the entry points at multiple levels? • What are the potential challenges and responses to mitigate them? • What are the messages that would resonate at different levels? • What is the most effective process for developing communication strategies

at the country level, to be taken forward in Phase II? In short, research about the advocacy capacity and messages will help identify the key players in the GBP campaign, gaps in terms of commitment, advocacy capacity and resources, and what inputs are needed to get national level campaigns off the ground (such as advocacy training).52 Deliverables At the end of Phase I, Options will produce a report which presents the findings of the mapping and analysis, to inform the development of the Advocacy Plan in Phase II. Throughout, compelling anecdotes and messages will be passed on to the GBP writer, as she develops the GBP report. Scope - Core country selection Phase I will focus on four developing countries, and three developed countries. For the developing countries, Options and the AWG used following criteria for selecting countries for the mapping process:

• Potential to reach MDGs • Data on indicators available • Political receptiveness • Capacity to act • Windows of opportunity • Existing contacts/networks • Leader countries

On this basis, the following countries were selected as case studies to inform the bigger picture:

• India (Orissa) • Pakistan • Tanzania

Criteria for selecting donor country case studies are:

• Emphasis on MNCH within funding portfolio 52 GBP working groups 1 – 5 will provide information on evidence of the problem and rationale for taking action.


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• Membership of the PMNCH • Potential to influence other donor countries

The current study will include three donor countries, including Norway, the UK and Japan. Options will reach agreement with the GBP Advocacy Working Group during the PMNCH Forum on which countries to include. Scope – Stakeholder selection In each country, Options will identify the types of organisations and individuals that can be contacted, surveyed and analysed according to their relative power, influence and potential to support or oppose the advocacy campaign. Stakeholder groups are likely to include the following groups:

• Political entry points (e.g., development cooperation agencies, opinion formers and decision takers North and South)

• Civil society, faith based organisations and networks at global, regional and country

• Private sector – corporate social responsibility • Communication channels (e.g., media, formal, informal, interpersonal, peer

networks) • Technologies – shifting power from state to citizens

Analytical Framework Analysis of advocacy initiatives will use the analytical framework for social initiative effectiveness proposed by Jeremy Shiffman (Table 2). The analytical framework identifies conditions that facilitate the effectiveness of social initiatives and the extent to which advocacy communities have influence over these.


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Table 1: Factors that enhance social initiative effectiveness 53

Factor Description 1. Enduring policy

venue Powerful organizations with a recognized mandate to address the problem and lead the initiative

2. Strong leader Persons whom advocacy community members coalesce around and recognize as particularly effective champions for the cause

3. Resonating frame A positioning of the issue that unifies the advocacy community and inspires external audiences to act

4. External political opportunities

Political conditions external to the initiative that are favourable for promotion of the cause

5. High severity A large burden relative to other social problems

6. Clear indicators Credible measures that demonstrate the severity of the problem and that can be used to monitor progress in addressing it

7. Cost-effective interventions

Interventions that are easy to carry out, relatively inexpensive and backed by rigorous scientific evidence

8. Agreement on interventions

Agreement among advocacy community members on what needs to be done to address the problem

9. Politically empowered victims

Strong organization among the aggrieved individuals that enable them to press governments to act

10. Blameless victims Aggrieved individuals who are perceived not to bear responsibility for causing the problem

Indicative Methodology The PNMCH Forum in Tanzania in April provides a timely opportunity to discuss the proposed methodology in more detail. Information gathered at this meeting will help shape the detailed tools and to define the audiences and stakeholders to include in the mapping process. However, based on our experience and discussions to date, we would expect the methodology to include the following tools:

• Survey of available tools, including advocacy mapping currently being done by DFID and reports on advocacy mapping in Africa supported by the Gates Foundation

• Design and administration of survey tools, including defining audience, developing questionnaire, creating list of survey participants, etc.

• Literature search – both published and unpublished • Internet research • Stakeholder and network mapping54 • Semi-structured interviews (by phone, email, etc.) • Key informant discussions (by phone and in person)

We would expect to adapt the tools above depending on the level of analysis at which the team is working. For instance, different key information interview

53 “A protracted launch: the first two decades of the safe motherhood initiative” Shiffman & Smith, 2007 54 We will draw on DFID’s experience of the Drivers of Change analysis in Nigeria which aims to identify what are the entry points for change at the structural, institutional and change agent levels.


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schedules will be developed for high level political actors to those used for community-based advocates. Where possible, the aim is to use and build on existing resources such as the Advocacy and Communication Action Plan for Sexual and Reproductive Health and Maternal, Newborn, and Child Health currently being conducted by DFID, the advocacy mapping reports commissioned by the Gates Foundation (by groups such as Washington State University, World Vision and Constella/Future Group International), and Jeremy Shiffman’s research on how maternal health issues got on policy agendas in countries like India and Nigeria. The case study country work would comprise desk-based research and four one-week country visits. In each country we will identify and contract a national consultant skilled in advocacy to work alongside the Options Team Leader. For the northern donor country research, the work will be desk-based and will utilise existing networks and identified focal points, including building on the findings of the DFID mapping of advocacy initiatives. The above case studies will be used to develop an advocacy model or template that can be used and adapted for the development of different advocacy campaigns that will be rolled out at the national level in future years. Human Resources We propose to use a structure of a core team, supported by a Technical Advisory Panel (TAP). In addition, a national consultant will be identified for each of the four developing countries to contribute to the in-country research. The core team composition and main responsibilities are as follows (profiles of which are included in Annex 1): Team Leader – Rachel Grellier – a leading Options researcher, based in the Options South Africa office in Johannesburg. This location will facilitate quick access to the three African countries in order to carry out the in-country research, as well as direct access to India, and regular communication with the other team members. The Team Leader will refine the methodology and prepare the research, including identifying and managing the in-country researchers. She will also undertake the desk-based mapping as well as the in-country research, analysing the findings and managing the writing of the reports and other deliverables. Team Coordinator – Elizabeth Ransom – Options’ Business Development Manager has a strong communications and MNH background. Her main responsibilities will be coordinating communications with the team members, and with both the Technical Advisory Panel and the Advocacy Working Group. She will work closely with the Advocacy Specialist in order to synthesise the research results from the advocacy mapping. Advocacy Specialist – Ann Pettifor – a world-reknown advocacy expert. Ann is an experienced advocacy specialist who has worked on many successful international campaigns. Her main responsibilities will be the analysis of messaging, and the formulation of the storyline that will provide a basis for Phase II. She will work with both the Team Leader and the Team coordinator to ensure developing country perspectives are considered in this process through the identification of appropriate


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advocacy specialists from Asia and Africa. She will also provide an institutional linkage with an advocacy/strategic communications company for Phase II. Technical Supervisor – Katie Chapman – Options’ Technical Team Coordinator. Her main responsibilities will be providing guidance to the whole team on the methodology and undertaking the mapping of the three developed country strategies. Project Manager – Katie Tong – a member of Options’ Programme Management team who will provide part-time support for the contract management and logistics of the project. Technical Advisory Panel (TAP) The following experts will provide advisory input into the project: Political Strategist – Jeremy Shiffman. Jeremy is an internationally recognised political scientist with a specialisation in the political dynamics of public health policy-making, particularly in developing countries. He will provide advice on developing the methodology for the stakeholder mapping, and will help analyse the political constraints and opportunities for advocacy in the selected countries. Maternal, Newborn, and Child Health Advisor – Louise Hulton. Louise is a demographer and statistician with a specialisation in maternal and newborn health in both the developed and developing world. Louise will provide guidance on the key health issues related to MDGs 4 & 5, which will be relevant for the advocacy mapping. Advocacy Specialists – One each from Asia and Africa. These advocates, who will bring a developing country perspective, will be identified during the PMNCH Forum in Dar Es Salaam.


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Structure and Reporting

Proposed structure of project

ClientAdvocacy Working

Group

AdvisorsTechnical Advisory

Panel

OptionsRachel Grellier

Elizabeth Ransom Katie Chapman

Ann Petiffor

Jeremy ShiffmanLouise Hulton

Developing Country Advocacy Experts

Cyndi LewisLori McDougalEamoinn Taylor

Arletty PinelLars Grønseth

Phase 2 – Advocacy initiative plan

Phase 1 – Mapping, analysis, storyline

Options will report directly to Lori McDougall, PMNCH Senior Advocacy Advisor, and via Lori to the GBP for MDGs 4 & 5 Advocacy Working group. Milestones The scope of work for Phase I will be carried out from 10 April 2007 – 31 July 2007. April 20, 2007: Country advocacy specialists and country researchers identified April 26, 2007: Draft questions and indicative list of stakeholders sent to TAP May 4, 2007: Draft questions returned to Team Leader (TL) May 9, 2007: Draft questions sent to Advocacy Working Group (AWG)

Country researchers identified and agreed in principle May 16, 2007: Draft questions returned to TL by AWG May 21, 2007: Data collection begins (analysis concurrent with data collection) May 28, 2007: Email update to AWG on progress June 22, 2007: Progress report sent to AWG July 3, 2007: Data collection complete July 16, 2007: Draft report sent to team members July 23, 2007: Draft comments returned to TL July 31, 2007: Report submitted to AWG

Global Business Plan for Millennium Development Goals 4 & 5 Phase I: Key issues for assessment and mapping of donor countries N.B. 1) At the beginning of the interview the term ‘advocacy’ will be discussed e.g.media attention, political meetings, elections and campaigns etc. Also, the newly defined category of MNCH. 2) The following is a guide not a formal interview schedule. Interviewees will have more knowledge about some subjects and less on others. We will concentrate on what they each know most about. If an interviewee raises a critical related issue not covered by the interview guide this will be followed up to obtain unanticipated inside information. Overall objective of mapping in donor countries: To analyse what it will take – in Japan, Norway and the UK - to raise the political profile of and mobilise additional resources for MNCH in developing countries. Four key questions we want the mapping to answer:

Who can help get/raise international MNCH issues on the political agenda in Japan, Norway and UK? Output = identification of audiences/constituencies to be mobilised.

What signals will Development Cooperation Agencies and politicians and their constituencies respond to within the domestic political arena? Output = identification of unifying, energising resonating frame (internal and external)

and messages.

How can these these buttons be pushed? Output = identification of advocacy processes and opportunities over next 1-3 years.

Who can push these buttons? Output = identification of advocacy resources for design and implementation of advocacy campaign in Japan, Norway and UK (Phase II and III).

Stakeholders to be interviewed within donor countries: bilateral donor representatives, civil society advocates (MNCH and beyond eg. women’s movement), parliamentarians, media, research experts (see Stakeholder list for details) Information required

Questions Who to ask (to be tightened up following initial interviews)

Attitudes to MNCH

MNCH is a newly created category. With which of these causes (M, N, C), if any, do you most closely identify in your work?

Politicians, media, health specialists, CSOs, Development

MNCH is largely based on the concept of ‘continuum of care’ (explain this). What are your thoughts on this? Definition of ‘continuum of care’: Mothers, newborns, and children are inseparably linked in life and in health care needs. In the past, maternal and child health policy and programmes tended to address the mother and child separately, resulting in gaps in care which especially affect newborn babies. Instead of competing calls for mother or child, the focus is on universal coverage of effective interventions, integrating care throughout the lifecycle and building a comprehensive and responsive health system. (Source: The Health Newborn Partnership)

Health specialists, CSOs, Development Cooperation Agencies, policy makers

What are the policy groups or networks that exist in Japan, Norway, UK around international MNCH? Do they tend to focus on just M, N, or C health? Are they integrated?

Politicians, health specialists, Development Cooperation Agencies, policy makers, CSOs

What are your thoughts on their work and effectiveness in policy influencing/advocacy?

Politicians, health specialists, Development Cooperation Agencies, policy makers, CSOs

Evidence for MNCH

What evidence/data on international MNCH issues has been used in advocacy efforts? What kind of data makes the case compelling?

Politicians, media, health specialists, CSOs, Development Cooperation Agencies, policy makers

How was this evidence/data on international MNCH been used in advocacy efforts?


What lessons can be learnt from this? (Important question: probe responses for detail, including whether advocacy is needed to promote and clarify the very concept of MNCH)


cost of available skilled care and medication? c) the extensive use of untrained traditional midwives (traditional birth attendants), that lack hygienic equipment and medication? d) cultural attitudes that under value the role of women and mothers in society? e) cultural attitudes that marginalize pregnant women and deny them support during pregnancy and childbirth?

Development Cooperation Agencies, policy makers

Level of priority for MDGs 4 & 5

What is the level of political priority in Japan, Norway and UK – within and outside Government - to meeting MDGs 4 & 5? (Prompt/follow up: What form does this take? If not MNCH, then M&N, & C.

Politicians, health specialists, CSOs, Development Cooperation Agencies, policy makers

In what ways are MDG 4 & 5 targets institutionalised as an international development policy priority? (Prompt: eg. donor Health Strategy, or more specific MNCH strategy, donor membership of PMNCH)

Politicians, health specialists, Development Cooperation Agencies, policy makers

What donor budgetary resources are prioritised for international MNCH programmes/research/advocacy? (Prompt: disaggregate for M&N, and CH? What aid instruments are used to disburse funds – sector budget support, programme, etc.?)

Politicians, policy makers, Development Cooperation Agencies

Many argue that for Japan, Norway and UK governments to increase resources to support health provision for pregnant mothers and their babies in developing countries will require a change of the domestic public’s attitude to women and infants in developing countries. Do you agree that attitudes inside your country have to change?


Mapping stakeholders and audiences for advocacy

How organised and vocal has the policy community been around international M&N, &CH? (Prompt: Who has been the main force in leading activity in this field – civil society, parliamentarians, Govt dept etc.? Are stakeholders coordinated? What are the mechanisms for this? How often do they meet, is there an organized forum, what power does the forum have etc. Important question.

Politicians, policy makers, Development Cooperation Agencies, health specialists, CSOs

What have been the barriers to stakeholders pooling their efforts? What needs to happen to get them working together better?


Who are the champions for international M, N & C health (if any) Politicians,

health specialists, CSOs, media

Do they have any overarching strategy? (What is this?)


To what extent is/is not the existing network of champions a potent political force? (Why?)

Politicians, policy makers, Development Cooperation Agencies, health specialists, CSOs, media

Whose attitudes stand in the way of improved care for pregnant mothers and their babies? (Prompt: The attitudes of Politicians? Officials? The World Bank? The medical profession? The IMF? Fathers, husbands and brothers? Community leaders? Religious leaders? Others).


What would need to happen to change such attitudes? Politicians, policy makers, Development Cooperation Agencies, health specialists, CSOs, media

Who in your country are the influential ‘opinion-formers’ that could help to bring about such a change in attitudes? (Prompt: e.g. new or ‘unlikely’ champions such as Women’s Institute, women’s rights movement)


Who are the key decision-makers in your country that could help bring about a change in attitudes to pregnant mothers and their infants.? (Prompt: Please list the following (and any others you may add) in order of importance: NGO leaders? US government representatives? European government representatives? Politicians? Officials? The medical profession? World Bank and IMF staff? UN representatives? NGO leaders?)


Who are the key audiences for advocacy? (Prompt: whose ‘ear’ do we need to get to make a difference?)

Politicians, policy makers,

specialists, CSOs, media

What are potential entry points for advocacy which could really make a difference (at multiple levels)?


Capacity and resources for advocacy (nat. & internat.)

Who are effective advocates in Japan, Norway, UK for international MNCH issues? (Prompt: Need to be specific e.g. anyone in parliament, upper and lower houses, NGOs, civil servants, outside MNCH, eg. is women’s movement something to piggyback on? Which other advocates need to be brought into the GBP advocacy effort? Need to be specific – who has power and voice).


What advocacy networks are already established that work on international MNCH issues, OR have the potential to work on these issues? What are their strengths and weaknesses? (Get names and contact details)


What is the most effective process in Japan, Norway and UK for developing effective advocacy strategies on international MNCH issues? (Prompt: who needs to be targetted as a ‘champion’, where are decisions made?)


Analysis of previous advocacy campaigns

What are the key lessons that can be learnt form previous advocacy campaigns/communication strategies on international MNCH issues – including non-MNCH advocacy strategies? (Prompt: E.g. what has/has not worked in the past and why?; Discuss both messages and process of advocacy; use of ‘focusing events’; influence of transnational actors etc.)


The way forward

N. B. The overarching question for the future is: Who needs to do what differently? To analyse what it will take – in Japan, Norway and the UK - to raise the political profile of and mobilise additional resources for MNCH in developing countries.

1. Audiences/ constituencies to be

Who in Japan, Norway, UK can help get/raise international MNCH issues on the political agenda and mobilise resources for international MNCH? (parliamentarians, media (broadcast,

Politicians, policy makers, Development

CSOs, media Whose ear to we need to get to make a difference for Japan,

Norway and UK to increase profile and resources for international MNCH?


Who are the champions (existing and potential) that should be brought into the advocacy campaign?


2. Unifying, energising resonating frame and messages

How do you think the case for raising profile and resources for international MNCH can best be made – key unifying messages(s)? Internal and external. [Probe: What signals will Development Cooperation Agencies and politicians and their constituencies respond to within the domestic political arena?


Should the government alert the domestic public to the full, terrible facts of maternal and child mortality, and the suffering endured by women and vulnerable infants in developing countries? Would this change public attitudes?


Alternatively, should the government encourage everyone to respect, defend and protect pregnant women, young and old, and their newborn children? Would such a campaign work in your country? For example, is it likely that the male population would change their attitudes to pregnant women and mothers if encouraged to do so by respected politicians/celebrities/religious leaders? Please comment.


Can you suggest messages that you think would hit home, influence and change opinion in your country in order to mobilise resources for developing countries? (Prompt: e.g. financial, rights based, etc., etc.) (N.B. The messages will need to be cross-cutting i.e. incorporating the three ‘components’: maternal/newborn/child


3. Advocacy processes and opportunities over next 1-3

What do you see as being the key advocacy opportunities over the next 1-3 years? (Prompt: e.g. foucsing events, influence of transnational actors, media attention, political meetings, elections and campaigns etc.)

Politicians, policy makers, Development Cooperation

How can the message best be ‘got out’ to key audiences? How to push their buttons? (Prompt: What should we say to the parliamentarians? Which media are important? What is the best way to convince the health journalists on the importance of maternal, newborn and child health?)


What are the potential challenges, and responses to counter these challenges?


What are the best ways of building and sustaining advocacy partnerships? (Prompt:: This is less about advocacy MESSAGES, and more about the process/means of advocacy, what can we learn from the past to avoid similar difficulties occurring again?)


What are the best ways of leveraging funding? Politicians, policy makers, Development Cooperation Agencies

4. Advocacy resources

Who is best- placed and has the capacity to implement advocacy campaign? Usual suspects and unusual suspects (eg. women’s movement)?


What PR or any other strategic communications and management companies exist and might be suitable for taking this work forward (Phases II and III)?


What support will these advocates need to move forward?


Agencies, health specialists, CSOs, media

Global Business Plan for Millennium Development Goals 4 & 5 Key questions for assessment and mapping (Phase I): N.B. 1) At the beginning of the interview the term ‘advocacy’ will be discussed e.g.media attention, political meetings, elections and campaigns etc. Also, the newly defined category of MNCH. 2) The following is a guide not a formal interview schedule. Interviewees will have more knowledge about some subjects and less on others. We will concentrate on what they each know most about. If an interviewee raises a critical related issue not covered by the interview guide this will be followed up to obtain unanticipated inside information. Overall objective of mapping in developing countries: To analyse what it will take – in Pakistan, Orissa and Tanzania - to raise the political profile of and mobilise additional resources for MNCH. Four key questions we want the mapping to answer:

Who can help get/raise international MNCH issues on the political agenda in Pakistan, Orissa and Tanzania? Output = identification of audiences/constituencies to be mobilised.

What signals will national leaders, and stakeholder representatives and their constituencies respond to within the domestic political arena? Output = identification of unifying, energising resonating frame (internal and external)

and messages.

How can these these buttons be pushed? Output = identification of advocacy processes and opportunities over next 1-3 years.

Who can push these buttons? Output = identification of advocacy resources for design and implementation of advocacy campaign in Pakistan, Orissa and Tanzania (Phase II and III).

Stakeholders to be interviewed within developing countries: parliamentarians, bilateral donor representatives, civil society advocates (MNCH and beyond eg. women’s movement), media (see Stakeholder list for details)

required (to be tightened up following initial interviews)

Attitudes to MNCH

MNCH is a newly created category. With which of these causes (M, N, C), if any, do you most closely identify in your work?


MNCH is largely based on the concept of ‘continuum of care’ (explain this). What are your thoughts on this? Definition of ‘continuum of care’: Mothers, newborns, and children are inseparably linked in life and in health care needs. In the past, maternal and child health policy and programmes tended to address the mother and child separately, resulting in gaps in care which especially affect newborn babies. Instead of competing calls for mother or child, the focus is on universal coverage of effective interventions, integrating care throughout the lifecycle and building a comprehensive and responsive health system. (Source: The Health Newborn Partnership)

Health specialists, CSOs, Development Cooperation Agencies, policy makers

What are the policy groups or networks that exist in your country around MNCH? Do they tend to focus on just M, N, or C health? Are they integrated?


What are your thoughts on their work and effectiveness? Politicians, health specialists, Development Cooperation Agencies, policy makers

Evidence for MNCH

Does credible national evidence exist in your country regarding levels of MNCH? If ‘yes’ what are they (Prompt: DHS, multiple indicator cluster surveys)


How do you find out information about the state of health of these groups?


country? Do you think that ????? out of 100,000 women and children die during pregnancy, childbirth and infancy in your country? ????? out of 100,000, or ?????out of 100,000?

media, health specialists, CSOs, Development Cooperation Agencies, policy makers

Are you aware that these are higher (much higher ) than a country similar to yours with a similar population/GDP (e.g. Honduras/Bangladesh/ other examples and data?).


Are you aware that in western countries like Britain and Sweden it is unheard of for women to die in childbirth?


Are you aware that mortality associated with childbirth and infancy is far higher in your country than deaths from HIV/AIDS?


Can you offer any likely explanation/s of why maternal and child mortality is so high in your country? Is this because of a) the absence of skilled health care for the pregnant mother and her baby? b) the cost of available skilled care and medication? c) the extensive use of untrained traditional midwives (traditional birth attendants), that lack hygienic equipment and medication? d) cultural attitudes that under value the role of women and mothers in society? e) cultural attitudes that marginalize pregnant women and deny them support during pregnancy and childbirth?


How has evidence on MNCH been used in advocacy efforts?


What lessons can be learnt from this? (Important question: probe responses for detail, including whether advocacy is needed to promote and clarify the very concept of MNCH)


Level of priority for MDGs 4 & 5

What is the level of political priority in your country - within and outside Government - to meeting MDGs 4 & 5? (Prompt/follow up: What form does this take? If not MNCH, then M&N, & C.


In what ways are MDG 4 & 5 targets institutionalised as a national concern? (Prompt: Does this occur through, for example, inclusion in PRSPs; national frameworks/strategies, First Lady champions etc)


Have Development Cooperation Agencies providing funds to the health sector geared financing and programmes towards MDGs 4 & 5? (Prompt: who are the key Development Cooperation Agencies for M&N, and CH? Is there coordination between Development Cooperation Agencies and between funds for M&N, & CH?)


Is there a difference in the priority that national and state/district/local government give to MNCH? (Prompt: which States/Districts specifically have prioritised M&N, & CH; what evidence exists to indicate priority at this level? How did it emerge on the policy agenda there?)


What significant budgetary resources are prioritised for MNCH? Prompt: e.g. separate budget lines.


Many argue that for government to improve health provision for pregnant mothers and their babies will require a change of the public’s attitude to women and infants in your country. Do you agree that attitudes inside your country have to change?


What attitudes do you believe stand in the way of improvements to healthcare for pregnant mothers and their babies? (Prompt: structural, health systems, and beliefs)


Mapping stakeholders and audiences for advocacy

How organised and vocal has the policy community been around M&N, &CH? (Prompt: Who has been the main force in leading activity in this field - The First Lady, Development Cooperation Agencies etc.? Are stakeholders coordinated? What are the mechanisms for this? How often do they meet, is there an

Politicians, policy makers, Development Cooperation Agencies,

efforts? What needs to happen to get them working together better?

policy makers, Development Cooperation Agencies, health specialists, CSOs

Who are the champions for M, N & C health (if any) in government and civil society, at national/state level? (Prompt: are there any champions for all three? Are there any champions not in any of these groups but who is particularly capable, and might become interested in these causes?)


Do they have any overarching strategy? (What is this?)


To what extent is/is not the existing network of champions a potent political force? (Why?)


Whose attitudes stand in the way of improved care for pregnant mothers and their babies? (Prompt: The attitudes of Politicians? Officials? The World Bank? The medical profession? The IMF? Fathers, husbands and brothers? Community leaders? Religious leaders? Others).


What would need to happen to change such attitudes? Politicians, policy makers, Development Cooperation Agencies, health specialists, CSOs, media

Who in your country are the influential ‘opinion-formers’ that could help to bring about such a change in attitudes? (Prompt: e.g. new or ‘unlikely’ champions such as football celebrities/religious leaders/royalty/musicians/film stars)

Politicians, policy makers, Development Cooperation Agencies, health

infants.? (Prompt: Please list the following (and any others you may add) in order of importance: NGO leaders? US government representatives? European government representatives? Politicians? Officials? The medical profession? World Bank and IMF staff? UN representatives? NGO leaders?)

Development Cooperation Agencies, health specialists, CSOs, media

What general advocacy networks are already established? What are their strengths and weaknesses? (Get names and contact details)


Who are the key audiences for advocacy? (Prompt: whose ‘ear’ do we need to get to make a difference?)


What are potential entry points for advocacy which could really make a difference (at multiple levels)?


Capacity and resources for advocacy (nat. & internat.)

Who are effective advocates at national/state level? (Prompt: Need to be specific e.g. anyone in parliament, upper and lower houses, NGOs, civil servants, outside MNCH, eg. is women’s movement something to piggyback on? Which other advocates need to be brought into the GBP advocacy effort? Need to be specific – who has power and voice).


What advocacy networks are already established, OR have the potential to work on these issues? What are their strengths and weaknesses? (Get names and contact details)


What is the most effective process for developing effective advocacy strategies on MNCH issues in your country? (Prompt: who needs to be targetted as a ‘champion’, where are decisions made?)

Politicians, policy makers, Development Cooperation Agencies, health

previous advocacy campaigns

advocacy campaigns/communication strategies – including non-MNCH advocacy strategies? (Prompt: E.g. what has/has not worked in the past and why?; Discuss both messages and process of advocacy; use of ‘focusing events’; influence of transnational actors etc.)

policy makers, Development Cooperation Agencies, health specialists, CSOs, media

The way forward

N. B. The overarching question for the future is: Who needs to do what differently? To analyse what it will take – in Pakistan, Orissa and Tanzania – to raise the political profile of and mobilise additional resources for MNCH in developing countries.

1. Audiences/ constituencies to be mobilised

Who in your country can help get/raise MNCH issues on the political agenda and mobilise resources for MNCH? (parliamentarians, media (broadcast, print), advocates, researchers/ publications)


Whose ear to we need to get to make a difference, and to increase the profile and resources for MNCH in your country?


Who are the champions (existing and potential) that should be brought into the advocacy campaign?


2. Unifying, energising resonating frame and messages

How do you think the case for raising the profile and resources for MNCH can best be made – key unifying message(s)? (Prompt: What signals will politicians, stakeholder representatives and their constituencies respond to within the domestic political arena?)


Should the government alert the public to the full, terrible facts of maternal and child mortality, and the suffering endured by women and vulnerable infants? Would this change public attitudes?


would change their attitudes to pregnant women and mothers if encouraged to do so by respected politicians/celebrities/religious leaders? Please comment.

Agencies, health specialists, CSOs, media

Can you suggest messages that you think would hit home, influence and change opinion in your country in order to mobilse resources? (Prompt: e.g. financial, rights based, etc., etc.) (N.B. The messages will need to be cross-cutting i.e. incorporating the three ‘components’: maternal/newborn/child


What are your thoughts on presenting the key unifying message(s) as …… (to be inserted after prelimary research and discussions with Ann Pettifor).


3. Advocacy processes and oportunities over the next 1-3 years

What do you see as being the key advocacy opportunities over the next 1-3 years? (Prompt: e.g. media attention, political meetings, elections and campaigns etc.)


How can the message best be ‘got out’ to key audiences? How to push their buttons? (Prompt: What should we say to the parliamentarians? Which media are important? What is the best way to convince the health journalists on the importance of maternal, newborn and child health?)


What are the potential challenges, and responses to counter these challenges?


What are the best ways of building and sustaining advocacy partnerships? (Prompt:: This is less about advocacy MESSAGES, and more about the process/means of advocacy, what can we learn from the past to avoid similar difficulties occurring again?)


What are the best ways of leveraging funding? Politicians,

4. Advocacy resources

Who is best- placed and has the capacity to implement advocacy campaign? Usual suspects and unusual suspects (eg. women’s movement)?


What PR or any other strategic communications and management companies exist in your country which might be suitable for taking this work forward (Phases II and III)?


What support will these advocates need to move forward?


What challenges will these advocates faces and how can these be mitigated?



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ANNEX 4: INTERVIEWEES

Name Organisation/Position Sector

(Gov/NGO etc) UK - Interviewed

Fran McConville Health Adviser, DFID Policy & Research Division Govt Ros Ebdon Social Development Adviser, AIDS &

Reproductive Heath Team, DFID Policy & Research Division

Govt

Eamoinn Taylor

Senior Adviser, Communication for Effective Development, Communication Division, DFID

Govt

Debbie Porter Communications Director, DFID Govt Megan Lloyd-Laney Communications Adviser, DFID Govt Nicola Woods Information & Communications for Development

consultant Consultant

Sally Keeble MP (Labour) Veronica Oakeshott

MP (Labour) Parliamentary Researcher, SK’s office

Parliamentarian

Christine McCafferty MP (Labour) Kari Mawhood

Chair of All Party Parliamentary Group on Population, Development and Reproductive Health

Parliamentarian

Ros Davies

Chair, UK NGO Sexual & Reproductive Health and Rights Network and to be Chief Executive of Women and Children First from July 2007

NGO network

Brigid McConville White Ribbon Alliance UK Board of Directors Network Catharine Taylor White Ribbon Alliance UK Board of Directors and

HLSP Network

Simon Wright (ActionAid)

Action for Global Health (European advocacy network – covers UK, France, Italy, Spain, Germany, Brussels/EC)

NGO network

Kate Hawkins Policy and Advocacy Officer (Action for Global Health), Interact Worldwide

NGO network

Felicity Daly Advocacy Officer, Interact Worldwide NGO Mark Wilson Executive Director, the Panos Insitute NGO Dorothy Flatman Women and Children First NGO Leo Bryant Michael Holscher

Marie Stopes International Director of External Relations, Marie Stopes International

NGO

Matthew Lindley Alison Pollard

Head of Resource Mobilisation, IPPF Senior Resource Mobilisation Officer

NGO

Jeff Mecaskey

Head of Health, Save the Children Fund UK

NGO

Alice Schmidt Health Advocacy Adviser NGO Frances Day-Stirk

Director of Learning, Research and Practice Development, Royal College of Midwives

Professional association

Professor Anthony Costello

UCL Institute of Child Health, London University

Oona Campbell Veronique Filippi

London School of Hygiene & Tropical Health University


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Judith Bueno de Mesquita

Senior Research Officer to Paul Hunt, UN Special Rapporteur on the right to the highest attainable standard of health

University

UK – Not available for interview

Richard Horton Editor, The Lancet Journal Professor Jim Dornan

Senior Vice President, Royal College of Obstetricians & Gynaecologists


Professor Allan Templeton

President, Royal College of Obstetricians & Gynaecologists


Jo Leadbetter

Head of Advocacy OXFAM NGO

Baroness Angela Billingham

House of Lords Parliamentarian

Baroness Shriti Vadera

Gordon Brown’s advisor. Since July 07, DFID Under-Secretary of State

Parliamentarian

NORWAY - Interviewed

Tore Godal Special Advisor to the Prime Minister, Prime Minister’s Office, Norway

Govt

Lars Grønseth Senior Advocacy and Communication Adviser, NORAD

Govt

Berit Austveg Responsible for Sexual and Reproductive Health and Rights team, NORAD

Govt

Mina Gerhardsen Political Adviser to the PM Govt Bjorn Lydersen

Senior advisor – National Association of Heart and Lung Patients Previously director of National Association of Cot Death

NGO

Trond Enger

Secretary General, National Council for Child and Youth Organisations

NGO

Monica Sydgård International Advisor, National Council for Child and Youth Organisations

NGO

Ms Eldrid Midttun Education Adviser, Norwegian Refugee Council NGO Olav Kasland

Director Notodden Office, Norwegian Labour and Welfare Organisation -NAV

NGO

Solvieg Hokstad

Executive Director of NSSR, IPPF’s Norwegian Member Association

NGO

Lisbet Nortvedt Former Executive Director of NSSR NGO Ms Eva Bratholm Information Director of NORAD Government Mr Trond Mathiesen Secretary General, Landsforeningen uventet

barnedød (LUB) Norwegian SIDS Society (Sudden Infant Death Syndrome)

NGO

Kjersti Flogstad UNICEF Norway, Secretary General Multilateral NORWAY – Not available for interview

Anniken Huitfeldt

MP for Labour Party -Stortinget , Head of Labour Partys Women network and member of the board of Save the Children Norway

Govt

Mrs Sonja Irene Sjøli Member of Parliament and the Standing Committee on Health and Care Services

Parliamentarian

Solveig Torsvik Political Adviser, to Minister, Ministry of Health and Care Services

Govt

Anne Kari Holm Secretary General, Norwegian Foundation for Health and Rehabilitation - Hese og rehabilitering

Umbrella NGO Organisation


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Mr Petter Eide National Director, CARE Norway NGO

Nils P. Mørk Advisor, Policy and Communication, CARE Norway

NGO

Mr Atle Sommerfeldt Secretary General, Norwegian Church Aid NGO Mrs Gro Braekken Secretary General, Save the Children Norway NGO

Bjorn Hoftvedt Norwegian Medical Association Professional association

Helga Fogstad Coordinator, MNCH, Global Health and AIDS Dept, NORAD

Govt

Marianne Borgen Director of Norwegian Programmes, Save the Children

NGO Potential politician

Britt Hildeng Member of Stortinget for Oslo (Labour party) Parliamentarian Sigrun Møgedal Ambassador, Ministry of Foreign Affairs, Global

Health, Norway Parliamentarian

Terje Svendsen

Acceptus Partner

NGO?

Elisabeth Kjær Head of our Advocacy and Communication department, Save the Children Norway - Reddbarna

NGO

Kaja Storvik Journalist, Dagsavisen. Media Petter Gjersvik Media/Medical

journal Sissel Henriksen Journalist, Klassekampen Media Professor Johanne Sundby

Section for International Health, University of Oslo University

JAPAN - Interviewed

Mr Naoyuki Kobayashi

Team Director Reproductive Health Team, Human Development Department JICA

Govt

Hideyuki Takahashi

Director, Resource Development and Campaign, Japanese Organization for International Cooperation in Family Planning (JOICFP). JOICFP is a member of White Ribbon Alliance

NGO

Mrs Sumie Ishii Executive Director, JOICFP NGO Mr Masaki Inaba Program Coordinator on HIV/AIDS and Infectious

Diseases, Africa Japan Forum NGO

Yuri Nakamura Resource Mobilization/Japan Trust Fund Officer / External Relations officer for Japan, IPPF

NGO

Hitoshi Murakami, MD, MPH, PhD

Bureau of International Cooperation International Medical Center of Japan

NGO

Ms Naoko Shimizu

WRA member & Midwife, St Luke's College of Nursing, Graduate School

Technical expert

Mr. Dan Rohrmann Representative, UNICEF Tokyo Office Multilateral Dr. Kunihiko Chris Hirabayashi MD PhD.

Senior Programme and Planning Specialist UNICEF Tokyo (Office for Japan & the Republic of Korea)

Multilateral


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JAPAN – Not available for interview

Mrs Sadako Ogata President of JICA (Japan International Cooperation Agency)

Govt

Mr Furukawa Mitsuaki JICA Resident Representative, London Govt Ms Kitabayashi Harumi Deputy resident representative of JICA JICA

Office Philippines Govt

Ms Kiyoko Ikegami

UNFPA Tokyo Rep

Multilateral

Mr. Ken Hayami

Executive Director, The Japan Committee for UNICEF

Multilateral

Mr. Yojiro Ishii Group Director, Group 3, JICA Govt Pakistan - interviewed Dr Zeba Sattar Country, Director, Population Council Expert Peter Miller Country Director, Population Council Expert Dr Ebrahim Representative, UNICEF Pakistan Donor Melissa Corkum Programme Comms Officer, UNICEF Donor Sheeba Afghani Programme Comms Officer, UNICEF Donor Dr Donya Aziz MP Parliamentary Secretary, Ministry of Population

& Welfare, Government of Pakistan Government

Tor Haug First Secretary, Norwegian Embassy Donor Janis Bjorn Kanavin Norwegian Embassy Donor Jane Edmondson DFID Health Adviser Donor Muhammad Najeeb Director, Intermedia NGO Sajjad Malik Senior Staff Reporter, Daily Times Media Mohsin Babbar Development Sector Freelance Journalist Media Dr Shaffiquidn Chief of Health Section, Ministry of Planning

and Development Government

Rehani Hashmi Women’s Political School (WPS) Project, Ministry of Women’s Development and UNDP

Government

Dr Ann Ghazala Obstetrician, Islamabad Medical Centre Obstetrician Dr Tauseef National Institute of Population Studies Statistician Dr France Donnay Representative, UNFPA Donor Dr Nabeela Ali Chief of Party, Pakistan Initiative for Mothers

and Newborns (PAIMAN), John Snow Inc. Health consulting firm

Orissa - interviewed Badal Kumar Tah Ankuran NGO Lalatendu Acharya UNICEF Donor Chelapila Shantakar The Hindu Newspaper Media Doordarshan Public Broadcaster Media Multiple members ASHA NGO Sudhansu Mohan Dash State Institute of Health and Family Welfare NGO Brahmananda Panda Member of the Biju Janata Dal (BJD) political

party Government

Namita Panda Chairperson, State Women's Commission Government Dr Saraswati Swain NIHARD NGO Shaktidhar Sahoo and Nabin Ku Pati

White Ribbon Alliance NGO

Dr A.K. Sen UNICEF Donor A.J.J. Raju CCD NGO Sushil Kumar Lohani Director, National Rural Health Mission Government Shri Jagandananda Centre for Youth and Social Development

(CYSD) CSO

Sarita Barpanda Interact Worldwide INGO Narendra Kumar UNFPA Donor Tahagat Satpathy Dhariti Newspaper & MP Media &

politician


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S. K. Lohani National Rural Health Mission Government Pramila Malik Minister for Women and Child Development Government K. C. Malik BISWA NGO Duryodhan Majhi Minister for Health Government Dr Seba Mohapatra Consultant Abhiram Panigrahi Sambalpur Integrated Development Institute

(SIDI) NGO

Biswajit Padhi Society for Rural Upliftment & Socio Technological Initiative (SRUSTI)

CSO

Goura Hari Das Sambad Newspaper Media Priya Mahapatra DFID Donor Navin Nayak Nehru Yuva Kendra Sangathan (NYKS) CBO Sarada Lagangir Asian News International Media Tanzania - interviewed Nelson Keyonzo Country Representative, Pathfinder

International NGO

Mrs. Tibaijuka Committee member, White Ribbon Alliance NGO Dr Theopistha John Child Health Specialist, WHO Technical

expert Ms. M. J. Mwaffisi (Permanent Secretary) Ms. Namini Mangi (Senior Community Development Officer)

Director for Gender, Ministry of Community Development, Gender and Children (MCDGC)

Government

Dr Lunna Hemedi-Kyungu

Centre for Counseling, Nutrition and Health Care (COUNSENUTH)

NGO

Matilda Kambanga Care International NGO Nemat Hajeebhoy Director, Agha Khan Foundation Foundation Razia Mawanga Tanzania Media Women's Association

(TAMWA) Media

Gaudiosa Tibaijuka (Senior Midwifery Advisor) Dr. Muthoni Magu-Kariuki (Programme Manager) Ms. Scholastica Chibehe (Midwifery Advisor) Lucy Ikamba (Midwifery and Pre-Service Education Advisor)

JHPIEGO NGO

Grace Lusiola Director, Engender Health NGO Dr Agbo Child Survival Specialist UNICEF NGO/technical

expert Nicola Jones Country Representative, UNFPA UN agency Maggie Bangser Director, Women’s Dignity Project Regional

initiative Usu Malya (Executive Director) Marjori Mbilinyi (Acting Head Analysis, Research and Publications)

Tanzania Gender Networking Programme (TGNP)

Civil society organization

Dr. Calista Simbakalia

Consultant (Reproductive Health and HIV and AIDS), Healthscope

Consultancy Company

Rakesh Rajani Executive Director, Hakielimu NGO


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ANNEX 5 JAPANESE PARLIAMENTARIANS WITH AN INTEREST IN REPRODUCTIVE HEALTH AND POPULATION ISSUES

List provided by JOICFP.

Name of Parliamentarian Comment

Parliamentarians with whom JOICFP works:

These two have worked together with MPs from other political parties to create law against domestic violence. Now the law is under revision for the second time and will be passed in July 2007 (JOICFP is not involved in this process). JOICFP has worked with them to organise study sessions on RH/R since 2002.

Ms. Chieko Nohno

Liberal Democratic Party (LDP: ruling party), House of Councilors (Lower House) Midwife by profession, trained at IPPF

Ms. Yoko Komiyama Democratic Party of Japan (DPJ: largest opposition party), House of Representatives (Upper House) Attended Cairo conference as journalist, before becoming an MP

Other MPs, who are members of Japan Parliamentarians Federation for Population (JPFP) and are more interested in population issues than reproductive health:

Mr. Yasuo Fukuda

LDP, House of Representatives Chair of JPFP/AFPPD (Asian Forum for Parliamentarians on Population and Development: - Asian group of national MPs on population issues, such as JPFP)/APDA (NGO working as the secretariat of JPFP). His father was a prime minister of Japan and JOICFP's second president

Mr. Yoshio Yatsu LDP, House of Representatives Former chair of AFPPD

Ms. Kayoko Shimizu LDP, House of Councilors, Nurse by profession. She will be finishing her term as MP this month

Mr. Shin Sakurai LDP, House of Councilors Former chair of AFPPD. He will be finishing his term as MP this month

There is also a committee within LDP on international NGO and they are committed to promote collaboration between NGOs and ODA. But they do not necessarily work on population/RH. Core members of this committee are:

Mr. Itsunori Onodera LDP, House of Representatives Chair of this committee

Mr. Koichi Yamauchi LDP, House of Representatives Executive Director of this committee. Used to be staff of JICA as well as NGO, Peace Wids Japan.

Mr. Yasuhisa Shiozaki LDP, House of Representatives Former chair of this committee and current chief cabinet secretary of Abe


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administration. He has visited JOICFP's project site in the Philippines


129

ANNEX 6 UK MEDIA CONTACTS FOR HEALTH

List provided by Save the Children Fund UK

Media Contact

Freelance Kate Thomas

The Independent Andy Grice, Political Editor Larry Elliot.

The Independent on Sunday Frances Elliot

The Independent Ann Penketh

The Times Philip Webster

The Sunday Times

The Times (Other)

Jonathan Clayton Stringer Tristan McConnell

The Guardian (TB & Sierra Leone)

Patrick Wintour Joanna Moorhead

The Guardian (Other)

Xan Rice Or Chris McGreal

The Observer Ned Tempko

The Telegraph Abigail Wills

The Sunday Telegraph Brendan Carlin

The Mirror Rosa Prince (Political Correspondent) Oonagh Blackman (Political Editor)

The Sun George Pascoe-Watson

The Sun

The FT Brian Groom

The Economist Xan Smiley Adam Roberts

The Metro Bel Jacobs


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BBC Fofana -

BBC Online Steve Herman

BBC Woman’s Hour Colin Dallinar

Reuters James Knight: Katrina Mason

AP Clarence Macaulay

Newsnight Richard Collings

ITN FLORA.HUNTER

Al Jazeera gabi.menezes

BBC News Planning

Channel 5 News

Channel Four

Documents

ANNEX 1: SCOPE OF WORK - WHO