A presentation from the Global Financing Facility (GFF) in Support of Every Woman Every Child Workshop, held in Nanyuki, Kenya.

1. Global Financing Facility in support
of Every Woman Every Child
Family Planning in the context of the RMNCAH investment case

2. Session Overview
2
• Overview of Family Planning 2020 (FP2020)
• FP Costed Implementation Plans: Senegal Experience (CIPs)
• Steps in embedding FP in RMNCAH investment framework
1.Diagnostic assessment
2.Identification of barriers and challenges
3.Mapping design options to overcome priority barriers
4.Consult CIPs
• Example: An application to Niger
• Group Work: Questions and Action Steps For Follow Up

3. 3
• 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

4. 4

5. Why Family Planning?
Accelerating achievement of the SDGs
Eleven reasons to invest in family planning:
Accelerating achievement of the SDGs
5
SEE HANDOUT
Eleven reasons to invest in family planning: Accelerating achievement of the SDGs

6. NUMBER OF ADDITIONAL USERS OF MODERN
CONTRACEPTION IN 2015
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
2012 2013 2014 2015 2016 2017 2018 2019 2020
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

7. FP2020
WHEEL OF
ACTION
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

8. Costed Implementation Plan: Learning from FP2020 and Partners
8
• 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.

9. Step 1. Diagnostic Assessment Senegal
What are the relevant indicators and data sources?
9
• 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)

10. CIP Presentation By Dr. Bocar Daff, Ministry of Health,
Senegal
PPlaceholder for presententation by Dr. Bocar DaffDaff,
Ministry of Health,
10

11. Step 2. Identification of Barriers and Challenges
What are the biggest barriers to prioritize overcoming?
11

12. Step 3. Identification and adaptation of evidence-based
approaches to overcome specific barriers
12
• 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

13. 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?
13

14. 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.
14

15. Questions and Discussion
15

16. Annex1: Application in Niger
16
• 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

17. Step 1: Diagnostic Assessment: Niger
17
• Disaggregated levels:
Urban / Rural
Differences between rural and urban areas (83% live in rural
areas):
• Age
Adolescents disadvantaged in terms of information, access, appropriate
service provision, affordability, decision-making power
• Level of education
Substantially better indicators with secondary+

18. Step 2: Identification of Barriers and Challenges: Niger
18
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

19. Step 3: Identification and adaptation of evidence-based
approaches to overcome specific barriers: Niger
19
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 barriers
Geographic 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

20. Annex 2: Evidence-Based Approaches
20
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

21. 21
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

22. 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)
2

23. 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)

24. Footer Information2
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