Global Financing Facility in supportof Every Woman Every Child

Family Planning in the context of the RMNCAH investment case

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Session Overview

• Overview of Family Planning 2020 (FP2020)

• FP Costed Implementation Plans: Senegal Experience (CIPs)

• Steps in embedding FP in RMNCAH investment framework 1.Diagnostic assessment2.Identification of barriers and challenges3.Mapping design options to overcome priority barriers 4.Consult CIPs

• Example: An application to Niger

• Group Work: Questions and Action Steps For Follow Up

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• Family Planning 2020 (FP2020) is an outcome of the 2012 London Summit on Family Planning where governments, NGOs, private sector and foundations made commitments to address policy, financing, and delivery barriers in 69 countries.

• The goal was established to provide an additional 120 million women and girls with access to lifesaving contraceptives without coercion and discrimination.

• The strategy is designed to drive momentum for the broader Reproductive Maternal Newborn Child and Adolescent Health (RMNCAH) continuum of care.

Overview | 2012 London Summit

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Why Family Planning? Accelerating achievement of the SDGs

Eleven reasons to invest in family planning:Accelerating achievement of the SDGs

SEE HANDOUT

Eleven reasons to invest in family planning: Accelerating achievement of the SDGs

NUMBER OF ADDITIONAL USERS OF MODERN CONTRACEPTION IN 2015

2012 2013 2014 2015 2016 2017 2018 2019 20200

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

Historic Trend Trend in Upcoming Progress Report FP2020 Goal

Number of additional users in 2015 34.5 m Benchmark for July 2015 London Summit 24.4 m Estimate for Nov 2015 Progress Report 17.9 m Historic trend

21.2 million of these are coming from commitment making countries

10.1 million gap

FP2020 WHEEL OFACTION

GOVERNMENT PLEDGE

Commitment: Country goals to accelerate

progress and support quality, access and

equity

Leadership: FP champions identified at

federal, state and

local levels

STAKEHOLDER ALIGNMENT

Engagement: Active engagement of public,

private and civil society

Coordination: Committee coordinates

stakeholder actions

TRANSPARENCY &

ACCOUNTABILITY

Accountability: Global and local partners

working together to track commitments,

document results and ensure pledges are on

track

NATIONAL PLAN & POLICY

Planning: Development of evidence-based costed

implementation plans (CIPs) by government and

local stakeholders

Rights: Promotion of quality, voluntarism, equity,

youth and hard-to-reach populations

Policy: Removal of barriers and equitable access

accelerated through policies

RESOURCE MOBILIZATION

Resource Mobilization: Donors and countries

align resources to fund priority interventions;

funding gaps identified

SCALE-UP

Execution: Public, social and/or private-sector

platforms expand quality and access to

information, services and supplies

Innovation: New solutions tested to make

products and services more affordable,

accessible and client-centered

PERFORMANCE MONITORING &

MANAGEMENT

Data and Analysis: Data routinely collected and

analyzed to monitor performance and adjust

programs as needed

WWW.FAMILYPLANNING2020.ORG

INFO@FAMILYPLANNING2020.ORG

@FP2020GLOBAL

CORE PARTNERS

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Costed Implementation Plan: Learning from FP2020 and Partners

• Aligns all stakeholders on goals and objectives: access, quality, equity, and choice

• Stakeholder consultation process contributes to overall success: Need public and private sector partnerships in supply and demand to drive transformational change

• To optimize investments and impact, CIP must be evidence based and address barriers/use diagnostics and analysis to identify solution levers

• Performance monitoring and management is a critical element to track progress and adjust program interventions

• CIPS can be successfully used to identify funding gaps for resource mobilization-priorities and gaps need to link into GFF process

• CIPS need to be living documents and used by government, donors and stakeholders to drive change

• We have new FP data from Track20, PMA2020, DHS, MICS, etc. need to emphasize data use now to sharpen our investment plans and make program adjustments.

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Step 1. Diagnostic Assessment Senegal

What are the relevant indicators and data sources?

• National level

• Disaggregated levels – e.g.:• Urban / Rural• Regional• Level of education• Household wealth quintile/income• Age

• Data sources:• DHS• MICS• World Population Projections (age

structure, future projections)

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CIP Presentation By Dr. Bocar Daff, Ministry of Health, Senegal

PPlaceholder for presententation by Dr. Bocar DaffDaff, Ministry of Health,

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Step 2. Identification of Barriers and Challenges

What are the biggest barriers to prioritize overcoming?

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Step 3. Identification and adaptation of evidence-based approaches to overcome specific barriers

• Map barriers to relevant best practices and adapt as needed to country context

– Niger Case Study– How to apply the analytical approach

• References for evidence based-approaches – some examples– World Bank: Population and Development in the Sahel:

Policy Choices to Catalyze a Demographic Dividend -– USAID: HIPs for family planning– WHO/PMNCH- Success Factors- Country Case Studies

Synopsis

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Group Work:

Some questions for the country group work:

• How has prioritization been addressed in the CIPs?

• Role of the Private Sector- what would be the mix in the Public and Private Sector roles in the implementation of the CIP; How would you determine that?

• Based on the systematic diagnosis, are there any additional challenges that need to be considered while doing the above?

• What is the quality assurance process followed for the CIPs? What lessons can be learn from this?

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Group Work

Action Steps to take this Forward • How can the CIP be integrated into a broader RMNCAH

approach (Tanzania Experience)?

• When and how would the countries activate the process for the above?

• Would technical support be required for developing the integrated RMNCAH investment plan? If possible specify the type of TA support required.

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Questions and Discussion

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Annex1: Application in Niger

• Young population, high dependency ratio• High actual & adolescent fertility + high wanted fertility (and

increasing)• High (but decreasing) U5MR and IMR• Early marriage, childbearing• Low CPR and unmet need

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Step 1: Diagnostic Assessment: Niger

• Disaggregated levels:Urban / Rural

Differences between rural and urban areas (83% live in rural areas):

• AgeAdolescents disadvantaged in terms of information, access, appropriate service provision, affordability, decision-making power

• Level of educationSubstantially better indicators with secondary+

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Step 2: Identification of Barriers and Challenges: Niger

Demand-Side Barriers? Supply-Side Barriers?• Availability• Accessibility• Acceptability• Quality

High demand for children Poor geographic distribution of health centers implications for mode of delivery:• Community outreach clinic• Doorstep delivery

High child mortality (but decreasing) Supply chain issues unavailability of affordable contraceptive supplies

21 percent of women stated needing husband’s permission created problems in seeking care

Health financing unpredictable and late reimbursements at health facilities

Lack of / limited knowledge on:• 90% 15-49 know of a modern method• 77% 15-19 know of a modern method • 40% of current users know of possible side

effects 35% of current users know of mitigation efforts

Human resources for health• 86% of non-users did not receive FP

information from CHW or at health facility• Inconsistency of clinical practices• Staff absenteeism• Lack of privacy• Lack of adolescent-friendly approaches

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Step 3: Identification and adaptation of evidence-based approaches to overcome specific barriers: Niger

Given small gap between actual and wanted TFR (both increasing) and other indicators, immediate priority should be on overcoming social norms, knowledge, and information barriers, especially in rural areas

• Use a combination of supply + demand-side strategies to overcome priority barriersGeographic inequity Distribution of supplies, info and services at community level, engage private sector (e.g. NGOs, CBOs)

 

FP education in ANC visits, postpartum visits, immunization days

HRH training on FP counseling and service provision

Youth-friendly SRH service provision & life skills training for adolescents

SBCC strategies: interpersonal communication, community discussions, mass media campaign targeted to various members of the household and community

Comprehensive SRH education in schools

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Annex 2: Evidence-Based Approaches

Policy and program design lessons, investment recommendations, and expected timing of results

Reference: Population and Development in the Sahel: Policy Choices to Catalyze a Demographic Dividend

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DESIGN LESSONS INVESTMENT RECOMMENDATIONS INDICATORS FOR EXPECTED RETURNS

FAMILY PLANNING PROGRAMS

Supply + demand has more

impact than supply alone.

Distribution of supplies & info by community members better than by health workers.

FP education in ANC visits,

immunization days & nurse/midwife training helps.

Initiatives to reduce cost to

client (subsidies, vouchers) have increased uptake of FP.

SBCC strategies: radio and TV

programs/dramas, community discussions, and reaching men increase knowledge and uptake.

Short-term: Strengthen community-based distribution of

contraceptives via existing health system

Integrate FP education into existing health services (standard ANC package, immunization days)

Develop social marketing/BCC strategy, in

partnership with NGOs and private sector (where relevant)

Improve method mix Medium-term: Train community members on FP, and provide

them with contraceptive supplies

Facilitate community-level communications campaigns, including religious and traditional leaders. Ensure involvement of men

Introduce vouchers or other cost-reducing

mechanisms, particularly for vulnerable groups (adolescents, low-SES households)

Launch media campaigns (radio, TV broadcasts)

about FP issues Long-term: Develop subsidies for FP products

Short-term: Changed knowledge and

attitudes about FP, contraceptive methods

Changed stated ideal family size

Use of contraception, and traditional/modern methods mix

Unmet need Equity Medium-term: Age at first childbirth Birth spacing Age-specific fertility rates Long-term: Total fertility rate (TFR) Infant mortality rate (IMR) Maternal mortality rate

(MMR) Female labor force

participation

DESIGN LESSONS INVESTMENT RECOMMENDATIONS INDICATORS FOR EXPECTED RETURNS

AGE AT MARRIAGE INTERVEN- TIONS

Provide health (including FP)

education to adolescents.

Strengthen social support (mentoring, peer groups).

Conduct community

discussions, and involve traditional and religious leaders.

Engage families, formally

(contracts, rewards) or informally (via visits and dialogue).

Pair individual interventions

with community-based interventions.

Short-term: Expand youth programs to include FP, health,

and education topics

Develop programs for peer-education among traditional and religious leaders about early marriage

Medium-term: Create mentoring and peer group programs

for girls at risk for early marriage

Introduce community discussions about early marriage

Long-term: Develop interventions that target families,

informally and/or with formal incentives (contracts, promised rewards).

Short-term: Changed knowledge and

attitudes about FP, contraceptive methods (among adolescents)

Use of contraception, and

traditional/modern methods mix (among adolescents)

Changed knowledge and

attitudes about early age at marriage (legality, religious aspects, health risks e.g. fistula, etc)

Changed ideal age at

marriage/first childbirth Medium-term: Age at marriage/first childbirth

Age-specific fertility rates Long-term: Total fertility rate (TFR)

Infant mortality rate (IMR)

Maternal mortality rate (MMR)

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DESIGN LESSONS INVESTMENT RECOMMENDATIONS INDICATORS FOR EXPECTED RETURNS

INFANT & CHILD HEALTH

Community provision of health

supplies for infants and children

Postpartum education and peer groups around infant health care

CCTs for routine and preventative

health care, as well as nutrition subsidies/supplementation

Short-term: Integrate infant care into postpartum

services

Support community distribution of health technologies for children via existing health system (vaccines, ORS, nutritional support, antibiotics and antimalarials)

Medium-term: Develop new mechanisms for community-

based distribution of health technologies for children

Develop social programs—peer groups,

social support—for behavior change and demand-generation for child health care

Long-term: Introduce vouchers or other cost-reducing

mechanisms for preventative/routine child health care

Develop nutrition

subsidies/supplementation for poorest households

Short-term: Immunization rates

Treatment rates for

childhood illnesses (diarrhea, respiratory infections)

Medium-term: Prevalence of childhood

illnesses

Anthropometric indicators (stunting, wasting)

Nutrition indicators (nutrient

deficiencies, anemia) Long-term: Infant mortality rate (IMR)

Under-five mortality rate

(U5MR)

Total fertility rate (TFR)

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Footer Information

DESIGN LESSONS INVESTMENT RECOMMENDATIONS INDICATORS FOR EXPECTED RETURNS

EDUCA-TION

Potential for policy changes around

mandatory years of schooling

Financial incentives (CCTs, fee subsidies, in-kind transfers) can be impactful, particularly around primary schooling

School construction may increase

enrollment and attendance There is more evidence on primary

schooling & out-of-school girls than on secondary schooling

Short-term: Provide in-kind financial incentives for

schooling: uniform subsidies, school canteens, take-home food rations

Design programs with rigorous evaluation

designs (e.g., randomized experiments) for girls’ schooling programs in the local context, with particular attention to primary versus secondary schooling, and measured outcomes that include fertility effects

Medium-term: Strengthen infrastructure (school

construction)

Offer fee subsidies and/or CCTs for vulnerable groups (areas with low enrollment, lowest-income households)

Long-term: Change policies about required number of

years for primary schooling

Short-term: Enrollment ratios, general

and by sex

Attendance rates, general and by sex

Medium-term: Grade attainment rates,

general and by sex

Enrolment ratio of boys to girls

Age-specific fertility rates Long-term: Total fertility rate (TFR)

Female labor force

participation