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Dakar Conversations I: Progress at the national level since the 2009 International Conference on Family Planning in Kampala conference    


Dates: 10-15 July 2011
http://www.knowledge-gateway.org/intlfp/dakarconversations_eng

This forum is the first in a series of global conversations aimed at laying the groundwork for discussions around some of the key topics of the 2011 International Conference on Family Planning: Research and Best Practices, taking place from November 29-December 2, 2011 in Dakar, Senegal. 

Discussion Statistics


Number of participants: 191
Number of participants' countries: 44
Number of contributions: 11
Number of countries contributing: 3 countries

Contributing countries: Kenya, Uganda, United States


Purpose and Objectives

Purpose:

This forum is the first in a series of global conversations aimed at laying the groundwork for discussions around some of the key topics of the 2011 International Conference on Family Planning: Research and Best Practices, taking place from November 29-December 2, 2011 in Dakar, Senegal.


                                                                                                                                
Day 1 

Question:

What progress has been made at the national level since the 2009 Kampala conference? What led to this progress?

Emerging themes and issues: Much progress has been made in terms of policy development – at national and district levels:

  • Uganda: In February 2011, the Ministry of Health signed into policy an addendum to Uganda’s National Policy Guidelines and Service Standards for Sexual and Reproductive Health in support of Community-based Access to Injectables (CBA2I). Nine districts are currently implementing CBA2I. With the impending policy amendment and the development of new national public health sector Village Health Teams, the potential for national scale-up of CBA2I in Uganda is great.
  • Nigeria:  A recent policy change has made contraceptive commodities free for clients; there used to be a fee.
  • Kenya: It is in the final stages of developing a Community Health Worker Strategy that includes a minimum package of reproductive health and HIV/AIDS integrated services.
  • Tanzania: Ministry-led FP/HIV Technical Working Group planning for a National Strategic Framework for Integration; National target set for 2013 of at least 80% of PMTCT clients to receive FP services; Government-led development of Round 10 HIV/AIDS Proposal for the Global Fund included request for FP; and Updated clinical guidance standard operating procedures (SOPs), procedure manuals, training curricula, and HMIS tools all include integrated FP/HIV components
  • South Africa: Recently revised national policies on ART and PMTCT recommend FP as part of standard care; Current revision of national FP policy to address contraceptive needs of PLWHA
  • Rwanda: MOH currently developing a “protocol” for integration of health services


              
Day 2 

Question:

How has the global environment impacted national level changes related to family planning in your country?

Emerging themes and issues: Importance of country ownership:

  • USAID review indicated that seven Cs accounted for the successes of the program including: country commitment, community ownership, contraceptive availability, capacity to scale up the program, communications, conducive social and program environment and cost effectiveness and funding.
  • Kenya officials organized a meeting of national leaders and openly discussed population growth as a threat to the achievement of their vision 2030. This was the first such meeting in the African continent as Africans shied from talking about population growth rate reduction. About a thousand leaders from all sectors of the economy and all levels of administration attended and strongly endorsed the population programs. A senior official from the Ministry of Health who participated at the Kigali meeting was so inspired that he decided to come to US for additional training. This meeting created the most conducive and receptive environment for the family planning program. A meeting of the parliamentarians is being organized to translate the ideas into action at the grassroots level.
  • Nigeria also organized a similar meeting on family planning and sent its Muslim women religious leaders to Mali to learn from its religious leaders views’ on family planning. These leaders endorsed family planning and considered it essential for women’s health. Nigeria allocated funding for family planning for the first time.
  • Rwanda revised its family planning strategy to increase the focus on youth and undertook a study of myths and misconceptions about family planning. The purpose was to reduce contraceptive discontinuation rate. Malawi also revised and strengthened it Family Planning and Reproductive Health Policy.
  • The participants at the Kigali meeting identified three areas for further discussion in order to learn from each other’s experiences. These were: effective approaches to community level programs, youth and financing. A meeting on effective community approaches is being planned for July 25-29, 2011 in Nairobi, Kenya. In the spirit of Kigali, the meeting is being organized by the National Coordinating Agency for Population and Development, Government of Kenya. The Kigali group of countries plus a few others are participating in the preparation of the meeting.
Day 3

Question:

What challenges have you faced at the national level? How have you tried to overcome these challenges?  Have any specific tools or approaches helped you to overcome these challenges?

Emerging themes and issues: Increasing recognition and appreciation that family planning has a fundamental role for national development (economic benefits of FP)

  • FP is a national investment and not an expense, or the sole burden of international donors, is a message we can all share.  
  • Family Planning confers both development benefits for the economy, by relieving pressure on government budgets to respond to growing population needs, and health benefits at the mother, child and family levels.
  • Uganda: The advocacy efforts to increase funding for family planning have been designed around the economic benefits for investing in family planning. Every dollar spent on family planning saves more than $3 that would otherwise be spent on health costs associated with unplanned pregnancies, therefore, investing in family planning programmes is one of the most cost-effective and developmentally sound investments for the country.
  • The dissemination of the RAPID Uganda model has also increased awareness about the potential benefits of family planning for national development and preservation of natural resources. The model has been disseminated to MP, district leaders across the country, religious and cultural leaders.
  • Prioritizing family planning in planning and budgeting processes. Two districts were approached and have indeed prioritized family planning in the district plans and budgets right from the Sub county levels (where actual service delivery takes place).
  • Ugandan Parliamentarians intervened and lobbied for a revision of the World Bank Infrastructure loan of USD $120 million to include maternal health support of USD $31 million. 75% of the $31 million has been earmarked for and dedicated to family planning commodities.
Day 4

Question:

What arguments and statistics have worked best for you in convincing government officials the importance of family planning (FP)?

Emerging themes and issues: Importance of high-level leadership and political commitment

  • Family planning has received weak or fluctuating levels of commitment from national policy elites hence undermining implementation. Governments have made progress in committing to family planning, population and reproductive policies, yet prioritization of the issue by policy elites and resource allocations have fluctuated.
  • Much of the success known today in many countries is due in great part because many nations had the necessary leadership to face the opposition, such was the case of Chile in the late 50s, Costa Rica, Mexico and Colombia in 1960s, and not to mention Thailand, Taiwan and Hong Kong, also in the 50s, and most recently Morocco.
  • Stewardship by all leaders at all levels (national, district and lower levels) - African Union Heads of State approved the Maputo Plan of Action extension to 2015 and African First Ladies agreed to include RH/FP in their core agenda of OAFLA which had hitherto concentrated only on HIV/AIDS.
  • RH/FP Champions are making strong supportive statements (e.g. in parliament, at World Population Day ceremonies in various countries, at the launches of CARMMA in a number of countries, and regularly in op-ed articles on RH/FP in local newspapers, etc.).
  • Quotations by Hon. Janet K. Museveni, Uganda’s First Lady, Member of Parliament and Minister of State for Karamoja Affairs
  • “Family planning is to maternal health what immunization is to child health.”
  • “I believe that investing in maternal and child health including emphasizing reproductive health and family planning is very crucial for the future of our nation.”
  • Cultivating new and younger leadership is an important strategic step.
  • There has been a long time since technical assistance has focused on family planning leadership building, and many of the old school leaders have retired and some of them have left us. It is time to implement leadership building in family planning, much scarce and needed to revert the road towards collapsed health systems due in great part to rapidly increasing populations, as a result of lack of contraceptive options to allow voluntary decision making to select the number and time to have children.
Day 5

Emerging themes and issues: Social acceptance of family planning remains a challenge.

  • Kenya: We find even leaders are not yet informed to talk/accept the fact that FP is the best buy. Also, contraceptives devices are not taken as FP device rather as HIV prevention device.
  • Kenya: Talking about FP in a country that is a multi-tribe as is Kenya face large resistance; to most leaders the [population] number counts hence to encourage own tribe to have as many as one can is the policy in Kenya. However, we try to put reality by giving the real situation like poor living conditions and it’s relation to poor FP uptake.
  • Major challenge Uganda is grappling with is changing the mindset of the people (both men and women) to accept and appreciate the benefits of family planning to them as individuals, their families and the nation at large. Probably we have not communicated correctly or worse still not enough to the people who need to hear the message so as to influence them to make informed choices and decisions in response to their own reproductive health needs.
  • Some women and men still strongly hold on to their religious and cultural beliefs and practices, so probably our communication is bypassing the custodians of people’s reproductive rights. Myths and misconceptions of family planning are also still rampant in the communities.
  • Below is a list of specific approaches that have helped Uganda to overcome these challenges:

  1. Targeted advocacy efforts by different stakeholders through the Reproductive Health Supplies Advocacy Network have been phenomenal.
  2. Call-in radio programmes in the local languages are conducted in some districts and these have wide catchment areas.
  3. The Family Planning Champions with in the communities are preaching the benefits of family planning either as satisfied users or those who have been converted after they have had large families. (These are very few because they are working in only few districts and the operation areas within the districts are also limited).
  4. Working with the Village Health Teams will also go along way in increasing acceptance for family planning.
  5. Working with religious leaders, some of whom have incorporated family planning in the respective church or mosques programmes and developed work plans to communicate to the believers and/or offer family planning services
Programmes Examples

  • Uganda: In February 2011, the Ministry of Health signed into policy an addendum to Uganda’s National Policy Guidelines and Service Standards for Sexual and Reproductive Health in support of Community-based Access to Injectables (CBA2I). Nine districts are currently implementing CBA2I. With the impending policy amendment and the development of new national public health sector Village Health Teams, the potential for national scale-up of CBA2I in Uganda is great.
  • Nigeria:  A recent policy change has made contraceptive commodities free for clients; there used to be a fee.
  • Kenya: It is in the final stages of developing a Community Health Worker Strategy that includes a minimum package of reproductive health and HIV/AIDS integrated services.
  • Tanzania: Ministry-led FP/HIV Technical Working Group planning for a National Strategic Framework for Integration; National target set for 2013 of at least 80% of PMTCT clients to receive FP services; Government-led development of Round 10 HIV/AIDS Proposal for the Global Fund included request for FP; and Updated clinical guidance standard operating procedures (SOPs), procedure manuals, training curricula, and HMIS tools all include integrated FP/HIV components
  • South Africa: Recently revised national policies on ART and PMTCT recommend FP as part of standard care; Current revision of national FP policy to address contraceptive needs of PLWHA
  • Rwanda: MOH currently developing a “protocol” for integration of health services
  • Uganda: The advocacy efforts to increase funding for family planning have been designed around the economic benefits for investing in family planning. Every dollar spent on family planning saves more than $3 that would otherwise be spent on health costs associated with unplanned pregnancies; therefore, investing in family planning programmes is one of the most cost-effective and developmentally sound investments for the country.
  • Ugandan Parliamentarians intervened and lobbied for a revision of the World Bank Infrastructure loan of USD $120 million to include maternal health support of USD $31 million. 75% of the $31 million has been earmarked for and dedicated to family planning commodities.
 














Post-forum survey results

Number of surveys completed ?

% who have passed content to others 33%

% who have or will use in their work  91%

% very satisfied with forum content 67%


References and resources

Community-based Access to Injectables (CBA2I) toolkit: http://www.k4health.org/toolkits/cba2i

Nigeria 2010 National FP Conference: http://nigeriafpconference.org/

Kenya 2010 National Population and Development Conference: http://www.kenyapopconference.org/

Participants’ recommended resources:
Plan of Action on Sexual and Reproductive Health and Rights in Africa from 2010 to 2015: http://www.africa-union.org/root/UA/Conferences/2010/juillet/Summit_2010_b/doc/DECISIONS/EX%20CL%20Dec%20556-599%20%28XVII%29%20_E.pdf
UNFPA’s press release: http://www.unfpa.org/public/home/news/pid/6396
African First Ladies agreed to include RH/FP in their core agenda of OAFLA which had hitherto concentrated only on HIV/AIDS: http://ppdafrica.org/index.php/en/programs/policydialog/meetings-with-first-ladies





Next Steps
  • A French virtual discussion forum on the same topic took place from 25-29 July.
  • Also, as part of this series, a September discussion forum on youth in French and English and an October discussion forum on contraceptive security in English and French are scheduled.
  • These discussions will culminate in face-to-face discussions at the 2011 FP Conference in Dakar from 29 Nov-2 Dec.

Organizing groups

Johns Hopkins Center for Communications Programs/K4Health Project, WHO/RHR, IBP Knowledge Gateway and USAID, in collaboration with The Bill and Melinda Gates Institute of Population and Reproductive Health and other partners

Contributing experts/facilitators 

Ward Cates, President of Research, FHI 360

Ishrat Z Husain, Senior Health Adviser, US Agency for International Development, Africa Bureau

Nicole Judice, Technical Advisor, Futures Group

Amy Tsui, Director, The Bill and Melinda Gates Institute of Population & Reproductive Health; Professor in the Bloomberg School’s Department of Population, Family and Reproductive Health

Other acknowledgements

• Tricia Petruney,FHI 360

• Diana Nambatya Nsubuga, Programme Officer, Partners in Population and Development Africa Regional Office

• Samuel Mwaniki Mwangi, Core Solutions seekers center

• Luigi Jaramillo, Senior Technical Advisor, International Development Group (IDG), University Research Co. LLC (URC)

Moderators 

Lisa Basalla Mwaikambo, Knowledge for Health, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs

Cassandra Mickish, Knowledge for Health, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs