IPPF in Africa

From choice, a world of possibilities

From choice, a world of possibilities

IPPF in Africa Pioneers in sexual and reproductive health IPPF IN AFRICA PIONEERS IN SEXUAL AND REPRODUCTIVE HEALTH

Pioneers in sexual and reproductive health Published in October 2008 by the International Planned Parenthood Federation IPPF 4 Newhams Row London SE1 3UZ United Kingdom tel +44 (0)20 7939 8200 fax +44 (0)20 7939 8300 email info@ippf.org web www.ippf.org UK Registered Charity No. 229476

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Individual profiles highlight each Member Association’s strengths, its target audiences and priority issues, and the networks and national initiatives in which it is involved.

With a brief history and details of services provided – both the numbers and the range of services delivered – the reader gains an understanding of the reach of the Member Association into the communities in which it is based and the scope of its work. We hope that this series will be a valuable reference to IPPF Member Associations and our work around the world.

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Printed on 75% recycled, chlorine-free paper, an NAPM approved recycled product.

The Pioneers in sexual and reproductive health series presents a broad overview of IPPF Member Associations in all of our six regions.

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The International Planned Parenthood Federation IPPF is a global service provider and a leading advocate of sexual and reproductive health and rights for all. We are a worldwide movement of national organizations working with and for communities and individuals.

IPPF works towards a world where women, men and young people everywhere have control over their own bodies, and therefore their destinies. A world where they are free to choose parenthood or not; free to decide how many children they will have and when; free to pursue healthy sexual lives without fear of unwanted pregnancies and sexually transmitted infections, including HIV. A world where gender or sexuality are no longer a source of inequality or stigma. We will not retreat from doing everything we can to safeguard these important choices and rights for current and future generations.

IPPF Central and Regional Offices International Planned Parenthood Federation (IPPF) 4 Newhams Row, London, SE1 3UZ, United Kingdom tel +44 20 7939 8200 fax +44 20 7939 8300 email info@ippf.org web www.ippf.org Africa Regional Office (IPPF/ARO) Madison Insurance House, 1st Floor, Upper Hill Road/Ngong Road P.O. Box 30234 00100 – GPO, Nairobi, Kenya tel +254 2 2712672/2712820 fax +254 2 2726596 email info@ippfaro.org web www.ippfaro.org Arab World Regional Office (IPPF/AWR) 2 Place Virgile, Notre Dame, 1082 Tunis, Tunisia tel +216 71 847 344/71/792 833 fax +216 71 789 934/71/788 661 email speac@ippf.org.tn web www.ippfawr.org East & South East Asia and Oceania Regional Office (IPPF/ESEAOR) 246 Jalan Ampang, 50450 Kuala Lumpur, Malaysia tel +603 4256 6122/6246/6308 fax +603 4256 6386 email ippfklro@ippfeseaor.org web www.ippfeseaor.org European Network (IPPF/EN) Rue Royale 146,1000 Brussels, Belgium tel +32 (2) 2500950; Fax: +32 (2) 2500969 email info@ippfen.org web www.ippfen.org South Asia Regional Office (IPPF/SAR) IPPF House, 66 Sunder Nagar, New Delhi – 110003, India tel +91 11 24359221/2/3/4/5 fax +91 11 24359220 email info@ippfsar.org web www.ippfsar.org Western Hemisphere Regional Office (IPPF/WHR) 120 Wall Street, 9th Floor, New York, NY 10005, USA tel +1 212 248 6400 fax +1 212 248 4221 email info@ippfwhr.org web www.ippfwhr.org If you would like to support the work of IPPF or any of our national affiliates by making a financial contribution please visit our website at www.ippf.org or contact IPPF Central Office in London, UK. Photo credits Front cover: • IPPF/Chloe Hall/The Gambia Back cover: • IPPF/Neil Thomas/Cameroon Inside pages: P2 P11 P15 P21 P31 P35 P36

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IPPF/Freddy Meert/Democratic Republic of Congo Javier Navos/Burkina Faso IPPF/Neil Thomas/Cameroon IPPF/Chloe Hall/The Gambia IPPF/Chloe Hall/Ethiopia IPPF/Chloe Hall/The Gambia IPPF/Dale Cooper/Ghana

P43 P51 P65 P73 P78 P83

IPPF/Paul Bell/Kenya IPPF/Yuri Nakamura/Malawi IPPF/Jane Mingay/Rwanda IPPFARO/Swaziland IPPF/Paul Bell/Uganda IPPF/Neil Thomas/Cameroon

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IPPF in Africa 01

Contents Trusted and true, pioneers from coast to coast Africa Regional Office Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Congo Brazzaville Côte d’Ivoire Democratic Republic of Congo Ethiopia Gabon The Gambia Ghana Guinea-Bissau Guinea Conakry

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02 03 04 06 08 11 12 15 16 18 20 22 24 26 28 30 32 34 36 38 40

Kenya Lesotho Liberia Madagascar Malawi Mali Mauritius Mozambique Namibia Niger Nigeria Rwanda Sénégal Sierra Leone South Africa Swaziland Tanzania Togo Uganda Zambia Glossary Bibliography

42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84

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02 IPPF in Africa

Trusted and true, pioneers from coast to coast IPPF in Africa provides a broad overview of our 39 African Member Associations and our work across the Region. These profiles highlight each one’s particular strengths, their priority groups and issues within sexual and reproductive health and rights, their capacity, the networks and initiatives in which they are involved, and their reach into communities across their respective countries.

The profiles include a brief history of the Member Association, information about services they provide notable successes, and the challenges they face. You will also find quantitative information on governing body members, staff, volunteers, and service delivery outlets, and the names of partner organizations.

We have included data from the annual IPPF global survey on our five strategic areas – adolescents and young people, HIV and AIDS, access, abortion and advocacy – and service statistics reports. The profiles include all the latest information available at the time of publication, however, as autonomous national organizations, data collection systems and recording procedures vary across our Member Associations and therefore may not always be comparable.

For example, when a client receives several services such as post-natal care, family planning counselling and a contraceptive supply in a single visit,

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one Member Association may record this as one service, while another will record all three services provided. Similarly, some report only clinical services, while others may include information, education, communication and advocacy campaigns.

Civil conflict, humanitarian emergencies and natural disasters have also had an impact on the quality of data reported by some Member Associations. We are working to ensure a universal standard of data reporting across the Federation, without imposing a single data collection system – and the unnecessary duplication and expense that would incur – on our Member Associations.

Pioneers in sexual and reproductive health: IPPF in Africa reflects a diverse group of organizations and the wide range of tools and systems they use in their day-to-day work. We hope you find it an enlightening and useful resource.

For more information visit www.ippfaro.org

Our work is driven by the needs and desires of the individuals and communities that we work with and for.

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IPPF in Africa 03

Africa Regional Office (IPPFARO) Madison Insurance House, 1st Floor, Upper Hill Road/Ngong Road P.O. Box 30234 00100 GPO, Nairobi, Kenya tel +254 2 2712672/ 2712820 fax +254 2 2726596 email info@ippfaro.org web www.ippfaro.org

The International Planned Parenthood Federation Africa Region (IPPFAR) is Africa’s leading non-governmental service delivery organization working to promote and provide services for sexual and reproductive health and rights. We provide a wide range of sexual and reproductive health services and information to women, men and young people from diverse social and economic backgrounds. Our network of Member Associations is working in communities across 39 countries, representing 2,800 clinics and service delivery points that serve over six million clients every year. Most of our clients are vulnerable, marginalized, poor and/or under-served.

Founded in 1971 by eight country representatives, IPPFAR and Member Associations in Africa are recognized as pioneers of the family planning movement throughout the continent.

Today, IPPFAR is building the capacity of African Member Associations, supporting them in their efforts to become strong, efficient and sustainable national organizations that deliver high quality sexual and reproductive health services, with integrated HIV and AIDS programmes. Recognizing the outstanding leadership that some Member Associations have demonstrated in particular areas of work, the Africa Region has established a number of learning centres in selected Member Associations to share good practices and lessons learned with other Member Associations and other nongovernmental organizations working in sexual and reproductive health and rights. The Region also ensures that services and programmes are centred around the needs of young people and women, focusing particularly on those who are marginalized, poor, socially excluded and/or under-served.

The Africa Regional Office, based in Nairobi, Kenya, also fulfils a vital role in advocating for greater financial and political support for sexual and reproductive health and rights among policy- and decision-makers. IPPFAR and other civil society groups work together to help build regional consensus, particularly in government-led arenas, and to ensure that agreed priorities are included in development agendas and plans, and – most importantly – in implementation. Most recently, working in collaboration with key stakeholders including the African Union Commission and UNFPA Africa Division, IPPFAR was vocal about the concerns of the people it serves by ensuring that their needs were reflected in the Continental Policy Framework on Sexual and Reproductive Health and its plan for implementation – the Maputo Plan of Action*.

IPPF Africa Region is focused on making progress toward the IPPF Strategic Framework 2005–2015 and our five strategic goals – the Five ‘A’s: Adolescents and young people, HIV and AIDS, Abortion, Access and Advocacy. These priorities are firmly entrenched within internationally agreed declarations and are reflected across the Millennium Development Goals.

Improved sexual and reproductive health is central to the task of enhancing the lives of the poorest and most marginalized people. We will make it happen.

* The Maputo Plan of Action is an advocacy instrument that will help African stakeholders to gain regional and national consensus and support for sexual and reproductive health among African heads of state. Adopted by the African Union in 2006, the Maputo Plan of Action built upon the previously agreed continental policy framework for sexual and reproductive health in Africa, known as the Gabarone Declaration. Please consult the African Union website for more information: www.africa-union.org.

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04 IPPF in Africa

Angola Associação Angolana Para o Bem Estar da Família P.O. Box, Municipio do rangel Block 12, House No 67, Bairro da Precol, Luanda tel +244 2 381139 email angobefa@snet.co.ao

Marking the road to good reproductive health

Challenges

The Family Planning Association of Angola/ Associação Angolana Para o Bem Estar da Família (ANGOBEFA) is committed to tackling the country’s daunting reproductive health situation and improving the lives of Angolans. Established in 1995 to champion the sexual and reproductive health and rights of women, ANGOBEFA has responded to high numbers of women dying in pregnancy and childbirth, limited access to family planning and other poor health outcomes by implementing sexual and reproductive health services and programmes.

Despite its triumphs, the Member Association still faces many challenges. High female illiteracy, traditional cultural practices around property ownership and inheritance, high unemployment, high maternal mortality (at 1,700 deaths per 100,000 live births) and high child mortality (at 141 per 1,000 live births), threaten to roll back the gains that have already been made in gender equality and women’s empowerment.

These play a powerful role in the sexual and reproductive health of women and the well-being of entire families and communities.

At its clinic in the town of Luanda, ANGOBEFA provides family planning; safe motherhood services, including prenatal and postnatal care; prevention and treatment of sexually transmitted infections; educational programmes for young people to raise their awareness of their sexual and reproductive health and rights; and general medical and laboratory services. This comprehensive mix of services is available to all. The Member Association aims to reach under-served groups including adolescents and young people, women, and people living with HIV and AIDS by accurately targeting its information, education and communication materials and promoting its services through appropriate channels, at the right times and in the right places.

Nevertheless increased awareness and heightened priority for sexual and reproductive health within the government and among the public will make it easier for ANGOBEFA to advance its strategic plan and serve its target groups effectively.

Success to be proud of The hard work of ANGOBEFA is highly valued and has proved its worth. In 2006, the majority of the clients the Association served were poor or socially excluded. ANGOBEFA’s considerable success in delivering services to hard-to-reach groups is due to its large volunteer base and Youth Action Movement members who work tirelessly to ensure that sexual and reproductive health services are accessible to those who need them most.

Recently, the Member Association of Angola initiated a unique information, education and communication project: 125 peer educators travel around the country’s provinces disseminating reproductive health information and commodities to young people both in and out of school. Due to the proven results and impact of the Association’s work, the government relied heavily on ANGOBEFA for technical advice when it developed its national HIV and AIDS policy.

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Angola 05

Strategic direction

Strategic Plan 2005–2009, based on the IPPF Strategic Framework

Year of membership

2002

Members of governing body 12 (including six women) Staff

25

Volunteers

96

Members of YAM

100

Peer educators

125

Service delivery points

3 branches, 2 clinics

Partnerships

Government: Ministry of Health, Ministry of Family and Promotion of Women, National Institute for Children

ANGOBEFA’s considerable success in delivering services to hard-to-reach groups is due to its large volunteer base and Youth Action Movement members who work tirelessly to ensure that sexual and reproductive health services are accessible to those who need them most.

NGOs: ANASO (HIV/AIDS Network), Luta Pela Vida (LPV), church-based organizations Donors: BMZ, Danida, UNFPA Networks: ANASO (HIV/AIDS Network), Women’s International Democratic Federation (FDIM), Women Network (Rede de Mulher)

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06 IPPF in Africa

Benin Association Beninoise pour la Promotion de la Famille Carré 791 Sikècodji, 01 BP 1486 Cotonou tel 229 21 32 00 49 / 21 32 32 34 email abpf@leland.bj, gilmameg@yahoo.fr

Innovation grows from solid foundations

The mark of success

Faced with deteriorating sexual and reproductive health in Benin, the Association Beninoise pour la Promotion de la Famille (ABPF) has adopted innovative approaches to tackle the critical reproductive health issues facing the country.

Taking full advantage of the depth of knowledge and experience it has accumulated throughout 38 years of operation, the Family Planning Association of Benin has designed and implemented programmes that empower its target audiences, particularly young people, with sexual and reproductive health information and services.

Investments in sexual and reproductive health services are paying off. In 2006, ABPF served 36,000 people, an estimated 70 per cent of whom were poor, marginalized, socially excluded and/or under served. The community-based programme to reduce the number of women dying from pregnancy- and childbirth-related causes has achieved positive results for the past two years, with the number of maternal deaths falling. In acknowledgment of ABPF’s expertise and accomplishments, the government invited the Member Association to be a member of the technical committee (within the Ministry of Planning) that drafts reproductive health policies. To date, these have included the Population Policy, the Family Health Policy, HIV and AIDS policies and the National Sexual and Reproductive Health Policy.

Through its eight clinics, ABPF offers family planning; prenatal and post-abortion care; infertility treatment; screening of cancers of the reproductive system; and management of sexually transmitted infections including HIV and AIDS. In addition to young people, women and men, the Member Association provides services to marginalized groups including prisoners, sex workers, refugees and internally displaced persons. To reduce the national maternal mortality ratio, ABPF operates an effective community-based obstetric and prenatal care service in 16 villages using traditional birth attendants and volunteer health workers who assist expectant women to access medical services. A proven delivery mechanism for health services across Benin, the Member Association’s community-based service also serves the needs of young people: community-based distributors and peer educators provide young people with sexual and reproductive health information, condoms and counselling.

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Challenges Even as the Member Association celebrates its results, challenges are ongoing. Just 6 per cent of married women of reproductive age use modern contraceptives, leaving more than a quarter (27 per cent) of women who want to control their fertility – to space or limit their births – without access to family planning1.

Over her lifetime, the average woman in Benin will give birth to 5.7 children, partly as a result of limited access to contraception.

Benin has a maternal mortality ratio of 850 deaths per 100,000 live births – one of the highest in the world – and the country is home to at least 34,000 AIDS orphans who need care and support. In addition, cultural and religious beliefs and practices that uphold male-dominant power structures prevent women and girls from making independent choices about their lives and have a negative impact on their health.

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Benin 07

Strategic direction

ABPF is repositioning itself as a leading national service provider for its target groups, including its priority of empowering young people by giving them unhindered access to sexual and reproductive health services.

Year of membership

1975

Members of governing body 9 (including six women and two young people)

Staff

55 (including three young people)

Volunteers

405

Members of YAM

160

Community-based distributors

154

Service delivery points

6 branches, 12 clinics

VCT sites

8

Youth centres

1 (includes clinical services)

Partnerships

Government: Parliament, Ministère de la Famille, Ministère de la Jeunesse, Ministère du Plan

To reduce the national maternal mortality ratio, ABPF operates an effective communitybased obstetric and prenatal care service in 16 villages.

NGOs: Centre de Réflexions et d’Actions pour le Développement Intégré et la Solidarité (CeRADIS), Africa Peace, Plan, Le Centre Multimedia (3S-ADO) Donors: USAID CCM: CCM for Health, CCM for sexual and reproductive health Networks: ROBS (National Network for Family Welfare)

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08 IPPF in Africa

Botswana Botswana Family Welfare Association Private Bag 00100, Gaborone tel +267 3900489 fax +267 3901222 email bofwa@info.bw

Stepping in to inspire hope

Successes registered

In a country where over a third of the population is infected with HIV or living with AIDS, and where there is a severe shortage of skilled health personnel, the people of Botswana look to the Botswana Family Welfare Association (BOFWA) to help them meet their sexual and reproductive health needs.

Formed in 1988 to respond to Botswana’s family planning challenges, BOFWA has worked hard to fill a gap left by the national health system to meet the sexual and reproductive health needs of the poorest and most marginalized people.

Volunteers performing roles such as community mobilizers and peer educators, and staff members who have been seconded by the government are trained by BOFWA on various sexual and reproductive health issues and to deliver high quality services. To meet demand for contraceptives among its target audiences and to ensure that staff are trained to the highest standard and aware of the most effective techniques, the Member Association has secured grants from the government to purchase commodities and to conduct trainings. The Botswana Family Welfare Association has found that collaboration with the police and hospitals has allowed its clients to access prompt, high quality and confidential abortion services.

The Member Association of Botswana runs programmes targeting adolescents and young people, sex workers, orphans, people with speech and hearing problems, and internally displaced persons. Services provided include family planning; infertility management; maternity services; voluntary counselling and testing (VCT), prenatal care; and diagnosis and treatment of sexually transmitted infections. Outreach programmes for young people in and out of school, community leaders and politicians, people with physical disabilities, people living with HIV and AIDS, sex workers and bar attendants are carried out by BOFWA staff and peer educators.

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Challenges While its achievements are a source of pride, BOFWA struggles to reduce unmet need for sexual and reproductive health information and services. There is a high teenage pregnancy rate in Botswana, partly as a result of young women being unable to access contraceptives when they need them.

BOFWA is one of the few reliable and accessible sources for family planning, but even its resources are under threat.

Demands on BOFWA are increasing, but without increased investment, in future the organization may have to be selective in the areas it can address effectively and the populations it can serve.

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Botswana 09

Strategic direction

BOFWA is committed to promoting and providing high quality and cost-effective sexual and reproductive health services, including HIV and AIDS prevention, treatment and care to enhance quality of life for young people and families.

Year of membership

1990

Members of governing body 7 Staff

17

Volunteers

32

Members of YAM

72

Service delivery points

4 branches, 6 clinics

VCT sites

4

Youth centres

4

Partnerships

Government: National Council on Population and Development (NCPD), National AIDS Council (NAC)

The Botswana Family Welfare Association has found that collaboration with the police and hospitals has allowed its clients to access prompt, high quality and conďŹ dential abortion services.

NGOs: Botswana Christian Aids Intervention (BOCAIT) Private sector: Botswana Confederation of Commerce Industry and Manpower, Barclays Bank of Botswana, Barlow World, the oil industry, Sexual and Reproductive Health Sub-committee, Steering Committee on the implementation of the UN Secretary General’s Report on Women, Girls and HIV and AIDS Donors: UNFPA, USAID, WHO, UNAIDS, IPPF, African Comprehensive HIV/AIDS Partnerships (ACHAP), Government of Botswana Networks: Botswana Council of NGOs, Botswana National AIDS Service Organizations, Botswana Network of People Living with HIV/AIDS, Botswana National Youth Council, Botswana Network of Ethics and Law for HIV/AIDS

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10 IPPF in Africa

Burkina Faso Association Burkinabe pour le Bien-Être Familial BP 535, Ouagadougou tel +226 50 30 75 10 / 50 31 05 98 fax +226 50 31 75 11 email abbef@fasonet.bf

Affordable, accessible and approachable services

Building priority for unmet need

In 1985, family planning and reproductive health services were becoming increasingly difficult for women and men to access due to rising prices, limited supplies and increasing demand.

In response, a group of concerned community members and health professionals came together and established a health care service organization to address the needs of the poorest people. Since then, the Family Planning Association of Burkina Faso / Association Burkinabe pour le Bien-Être Familial (ABBEF) has worked to provide family planning to poor and marginalized groups, particularly adolescents and young people.

Today the Family Planning Association of Burkina Faso upholds the principles that founded the organization, prioritizing those that fall through the gaps of the public health system. In 2006, ABBEF provided 46,343 services to a client base of people who are all poor and marginalized. One year later, ABBEF received the support of the country’s First Lady, who made a commitment to hold a meeting of Africa’s First Ladies to discuss the implementation of the Maputo Plan of Action, which seeks to implement a wide range of interventions to improve sexual and reproductive health across Africa. ABBEF is also a partner of the respected Pan African Film Festival, held annually to promote sexual and reproductive health issues, in particular safe motherhood.

ABBEF has expanded its services over the years to provide a comprehensive mix of sexual and reproductive health services, including: prenatal and postnatal care; treatment of sexually transmitted infections; infertility counselling; screening for cancers of the reproductive system; post-abortion care; prevention of mother-to-child transmission of HIV; provision of antiretroviral drugs; voluntary counselling and testing (VCT); and home-based care for people living with HIV and AIDS. The Member Association provides specialized services for targeted groups of young people on the streets, people living with HIV and AIDS, and students. To access these groups, the Member Association conducts outreach visits to cement factories and markets, to student association meetings, school and community events where ABBEF has the opportunity to distribute information on sexual and reproductive health and HIV and AIDS. Professional training is provided to young people living on the street and members of the Youth Action Movement to empower them to be selfsupporting through employment and other income-generating ventures. Together with the South African Broadcasting Corporation and TV5, the Association plans to raise awareness of maternal mortality issues in Burkina Faso.

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Challenges Burkina Faso has a contraceptive prevalence rate of just 9 per cent. If all women who wanted family planning methods to control their fertility were able to procure them, however, this figure would be much higher: 25.8 per cent of married women of reproductive age report an unmet need for supplies and services. In addition to the overwhelming challenges presented by unmet need and the country’s maternal mortality ratio – 1,000 women dying for every 100,000 live births every year – Burkina Faso faces an appalling record of female genital mutilation (FGM). According to the 2003 Demographic Health Survey2, 77 per cent of women report having undergone female genital mutilation. Female genital mutilation is a violation of the human rights of girls and women, and is directly linked to poor sexual and reproductive health. Though daunting, ABBEF has taken these challenges in its stride: the Member Association is committed to improving the sexual and reproductive health of the women and men of Burkina Faso in the years ahead.

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Burkina Faso 11

Strategic direction

The Strategic Plan 2005–2009 is aligned to IPPF’s Strategic Framework

Year of membership

1982

Members of governing body 17 (two members below the age of 25 years) Staff

64

Volunteers

945

Peer educators

10

Service delivery points

4 branches (4 regions and 19 communal sections), 2 clinics

VCT sites

2

Youth centres

4

Partnerships

Government: Ministry of Health NGOs: SPONG (coordinates NGO activities), REOPOD (Réseau des ONG en population et développement)

ABBEF provides comprehensive sexual and reproductive health services to all who want them, including agricultural workers such as these two women.

Private sector: Prestataires de services Donors: Danida, UNFPA, EU, UNICEF, Projet d’Appui au Plan National Multisectoriel de lutte contre le VIH/SIDA, Projet d’Appui au Plan National Multisectoriel (PAPNM) Networks: Conseil National de Population, Comité National de Lutte contre la Pratique de l’Excision, Comité consultatif de sélection des projets du service de coopération et d’action culturelle de l’Ambassade de France au Burkina Faso

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12 IPPF in Africa

Burundi Association Burundaise pour le Bien-Être Familial Quartier Jabe, Avenue de l’Imprimerie No. 6443, Bujumbura tel +257 22 23 2936 / 22 24 8472 email abubef@cbinf.com

Living up to expectations

Challenges

Inside one of the smallest countries in East Africa exists a vibrant organization whose name has come to mean good sexual and reproductive health. Since the formation of the Association Burundaise pour le Bien-Être Familial (ABUBEF) in 1991, Burundians in rural areas and at the margins of society, married Burundians and young people have placed their trust in ABUBEF. From its early years when it provided mainly family planning methods and services, the Member Association has widened the scope of its programming to cater for many other pressing sexual and reproductive health needs. Currently, ABUBEF provides prenatal and postnatal care; post-abortion care; prevention and management of HIV and AIDS; youthfriendly services; premarital counselling and treatment of male and female infertility. The Member Association offers specialized and/or outreach services for rural populations, young people living with HIV and AIDS, internally displaced persons, women of child bearing age, sex workers, drug users and street children.

ABUBEF is also determined that the Maputo Plan of Action will be implemented by the government, and advocates vigorously to realize this goal.

Many obstacles threaten Burundi’s sexual and reproductive health record, but ABUBEF is determined to overcome them.

Unsafe abortion is the cause of significant maternal illness and death. Of the women who presented themselves at ABUBEF clinics following unsafe abortions in 2004 – many of them in the backstreets of Burundi – 36.4 per cent had acquired infections and 31.8 per cent had experienced trauma and other major complications. A high national fertility rate – at 6.8 children per woman – is partly due to limited access to family planning.

Accounting for 66 per cent of new infections, women and children in Burundi are highly vulnerable to HIV and have a special need for prevention programmes and services that are focused on their circumstances and lives.

Meeting the needs of the poor ABUBEF’s largest beneficiary group is poor people. In 2006, the Member Association served 158,000 clients, of whom an estimated 150,000 were poor, marginalized, socially excluded and/or under-served. Of all services provided, 17,152 were voluntary counselling and testing services.

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Burundi 13

Strategic direction

To realize a society where men, women, and young people enjoy high quality sexual and reproductive health and rights through equal access to services; prevention and management of sexually transmitted infections, including HIV and AIDS; prevention and care for women who are vulnerable to or who have been subject to gender-based violence; and legal and policy frameworks that recognize sexual and reproductive rights.

Year of membership

1998

ABUBEF is determined that the Maputo Plan of Action will be implemented by the government, and advocates vigorously to realize this goal.

Members of governing body 16 (including nine women and three young people)

Staff

81

Volunteers

429

Peer educators

75

Members of YAM

56

CBDs

1176

Service delivery points

6 branches, 7 clinics, 1 mobile outreach unit

VCT sites

7

Youth centres

1

Partnerships

Donors: UNFPA, Family Health International, CARE, Conseil National de Lutte contre le SIDA (CNLS) Networks: RĂŠseau National des Jeunes EngagĂŠs pour la Lutte Contre le Sida (RENAJES), Association pour la Promotion de la Fille Burundaise (APFB)

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14 IPPF in Africa

Cameroon Cameroon National Association for Family Welfare BP 11994, Yaounde tel +237 223 6230 fax +237 223 6230 email camnafaw@ippf.org, camnafaw@yahoo.fr

Answering the demand for family planning

Challenges

In 1987, an organization was created to respond to the needs of women who wanted to plan their families and enjoy high standards of living. Since then, the Cameroon National Planning Association for Family Welfare (CAMNAFAW) has been the country’s leading provider of sexual and reproductive health services.

The Cameroon National Planning Association for Family Welfare faces a steep uphill climb with many obstacles to overcome.

A health sector that operates with just the bare minimum in financial, human and physical resources, women dying in pregnancy or childbirth numbering 870 per 100,000 live births and a modern contraceptive prevalence rate of just 13 per cent are some of the challenges the Member Association faces. In addition, it must address the vulnerability of girls and women to HIV infection. HIV prevalence is 6.8 per cent among women, compared to 4.1 per cent among men. The challenges are great, but the Member Association is deeply committed; it is focused on building on its successes and scaling up proven interventions so that the women, men and young people of Cameroon can plan their lives and enjoy their right to health.

As a full member of the International Planned Parenthood Federation, the Member Association of Cameroon offers a variety of services which include family planning; vaccinations; paediatric care; prenatal and postnatal care; post-abortion care; diagnosis and treatment of sexually transmitted infections and opportunistic infections; screening of cancers of the reproductive system; general laboratory work; voluntary counselling and testing; home-based care; and behaviour change communication, as well as public communications aimed at reducing stigma and discrimination associated with HIV and AIDS. Beneficiaries of these services include women of reproductive age, people living with HIV and AIDS, sex workers, and unmarried men and women.

Successes registered While implementing such a comprehensive range of services and programmes is demanding, the Member Association has registered inspiring successes. In 2006, CAMNAFAW served over 32,931 clients, including 2,872 people living with HIV or AIDS who were served at the clinic or through home-based care. In 2007, the Member Association reached a milestone when it extended its services to the gay, lesbian, bisexual and transgender community in the face of local opposition.

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Cameroon 15

Strategic direction

The Strategic Plan 2005–2009 is in line with IPPF’s five strategic areas of Adolescents and young people, HIV and AIDS, Abortion, Access and Advocacy.

Year of membership

1993

Members of governing body 22 (including six young people) Staff

37

Volunteers

1,200 volunteers (including 290 young people)

Members of YAM

200

Service delivery points

7 branches, 3 clinics

VCT sites

3

Youth centres

4 (three offer clinical services)

Partnerships

Government: Several government departments NGOs: Care Cameroon, FESADE, Youth Development Foundation, OFSAD, Scouts du Cameroun, CANADEL, Service Catholique de la Santé, Service Protestant de la Santé, SWAA CAMEROON Réseau Camerounais des associations des Personnes vivants avec le VIH (Récap+)

These three young women rely on their local CAMNAFAW youth centre for information, counselling and peer support.

Donors: Government of Cameroon, UNFPA, Government of Japan, IPPF Japan Trust Fund for HIV, Care Cameroon, Projet de Renforcement des Capacités des Réseaux des Femmes pour Lutter Contre la Pauvreté en République du Cameroun (CAREF).

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16 IPPF in Africa

Cape Verde Associação Cabo-Verdiana Para a Protecao da Familia P.O. Box 503, Conjunto Habitacional Nova Aurora, Bloco C, R/C, Palmarejo, Praia tel +238 612063 fax +238 612042 email verdefam@cvtelecom.cv, verdefam11@yahoo.com.br

Giving priority to sexual and reproductive health

Celebrating achievements

The 1990s represented a pivotal point in the history of Cape Verde. For many years, the people grappled with a myriad of sexual and reproductive health problems, from maternal mortality to sexually transmitted infections to unmet need for family planning. These concerns finally reached a point where they could no longer be ignored. In 1995, the Cape Verdian Association for the Protection of the Family/Associação Cabo-Verdiana Para a Protecao da Familia (VERDEFAM) was created to help meet the sexual and reproductive health needs of Cape Verdians.

Due to the quality of its services, demand for VERDEFAM’s services has grown over the years. In 2006, 37,000 clients were served, of whom 7,500 were extremely poor, marginalized or socially excluded. VERDEFAM is also part of the committee of sexual and reproductive health organizations that is consulted by the government on related policies and plans, such as the National Reproductive Health programme and the 2006–2011 National HIV/AIDS Strategic Plan.

Through its network of eight clinics, VERDEFAM offers: family planning; treatment of sexually transmitted infections, prenatal and postnatal care; HIV prevention and management; and HIV stigma reduction. VERDEFAM delivers behaviour change communication and educational messages through TV and radio, specifically to address neglected sexual and reproductive health issues including cancers of the reproductive system.

The Association operates a social marketing programme for condoms and in collaboration with Cape Verde national TV, the Member Association conducts sexual and reproductive health sensitization programmes targeting adolescents and women of reproductive age. VERDEFAM provides these services in six of the country’s 18 regions.

The sexual and reproductive health challenges facing Cape Verde remain an uphill struggle for VERDEFAM. While 46 per cent – a relatively high proportion, compared to the rest of the continent – of married women do use modern contraceptives, this does not take into account unmarried young people who require family planning services and methods. Restrictive abortion laws result in unsafe abortion, which in turn causes maternal deaths and illness. With increased support and investment, VERDEFAM plans to expand its services so it can be more effective in reaching poor, marginalized, socially-excluded and under-served groups.

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Challenges

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Cape Verde 17

Strategic direction

To protect the sexual and reproductive health and rights of women, men and young people, while at the same promoting the welfare of the family unit to the full enjoyment of reproductive health rights.

Year of membership

2002

Members of governing body 7 (including one young person) Staff

26 (including two young people)

Volunteers: peer educators

110

Service delivery points

8 clinics

Youth centres

1

Partnerships

Government: Ministry of Health, Cape Verdian Institute for Gender Equality and Equity, Committee for the Coordination and fight against HIV/AIDS, Committee for the Coordination of the fight against Drugs, Ministry of Education

VERDEFAM delivers behaviour change communication and educational messages through TV and radio, specifically to address neglected sexual and reproductive health issues including cancers of the reproductive system.

NGOs: Platform for NGOs of Cape Verde, OMCV, Red Cross, Acrides Private sector: Telecom, SOLGEI Donors: GTZ, UNFPA, National HIV/AIDS Council (BM/CCS-SIDA), Institute for Gender Equality and Equity, SNU, Cooperation Luxembourg, UNICEF, UNAIDS Network: Comité de Coordination du Combat au VIH/SIDA, Comité Municipal de Santé de la mairie de Praia, Plateforme des ONGS du Cap-Vert

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18 IPPF in Africa

Central African Republic Association Centrafricaine pour le Bien-Être Familial BP 1366 Bangui sise Derrière la Station Totale du 4ème Arrondissement 36 villas, République Centrafricaine tel +236 615435 fax +236 616700 email acabef@yahoo.fr, acabef@caramail.com

Transforming lives

Challenges

From the time it was founded in 1987, the Association Centrafricaine pour le Bien-Être Familial (ACABEF) has made major strides towards reaching its goal – of helping the people of Central African Republic gain unrestricted access to reproductive health services. From one milestone to another, the Member Association has moved from being a family planning service provider to a provider of a comprehensive range of sexual and reproductive health services, primarily targeted towards young people. The Member Association is implementing a variety of programmes and services that include providing sexuality education and sexual and reproductive health services to adolescents and young people; family planning; gynaecological counselling and care; post-abortion care; prenatal care; and voluntary counselling and testing (VCT) for HIV. Clients who need antiretroviral drugs are referred to facilities that offer free ARV treatment programmes. Other programme areas include involving men and reaching marginalized communities with quality reproductive health services. ACABEF is also focused on enhancing its institutional capacity to expand its range of services, to ensure good governance and management, and to increase the sustainability of its services and programmes.

Poor sexual and reproductive health across the Central African Republic continues to put pressure on the Member Association.

The Central African Republic has an HIV prevalence rate of 12.7 per cent among women and 8.7 per cent among men.

Men and women need specialized services to prevent HIV infection, and those already infected with HIV need access to care and treatment. In particular, pregnant women with HIV or AIDS need services that allow them to prevent mother-to-child transmission. With 1,100 women dying of pregnancy-related causes for every 100,000 live births, Central African Republic has one of the world’s worst maternal mortality ratios. Women need greater access to prenatal, postnatal and safe delivery services, attended by trained birth attendants. Limited access to modern contraceptives contributes to high rates of maternal death and illness; the rate of modern contraceptive prevalence is just 11.2 per cent. While reliable data about the number of women who want contraceptives and do not have access to them are not available, trends across Africa suggest that unmet need in Central African Republic may be substantial. These are all serious problems which ACABEF is working to improve.

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Central African Republic 19

Strategic direction

The Strategic Plan 2005–2009 aims to ensure that every person and every family enjoys quality reproductive health services.

It is dedicated to meeting the sexual and reproductive health needs of young people, women and men by upholding human rights and working in partnership to maximize impact.

Year of membership

1991

Members of governing body 7 (including one young person) Staff

37

Volunteers

672

CBDs

70

Members of YAM

922

Peer Educators

120

Service delivery points

5 clinics

VCT sites

2

Youth centres

1 (includes clinical services)

Partnerships

Government: Through its ministries in charge of planning, health, family and social affairs

While reliable data about the number of women who want contraceptives and do not have access to them are not available, trends across Africa suggest that unmet need in Central African Republic may be substantial.

NGOs: Centre d'Information, Education, Communication pour la Sante Sexuelle des Jeunes (CISJEU) Donors: PSI, UNFPA Networks: CIONGCA (coordinating the response of all NGOs working at national level), RECAPEV (caring for people living with HIV or AIDS), Congress of Women Living with HIV/AIDS, Reseau des Organisations Nationales de Lutte contre le SIDA (RONALSI): Idem. Amis d’Afrique

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20 IPPF in Africa

Chad Association Tchadienne pour le Bien-ĂŠtre Familial BP 4064, Ndjamena tel +235 51 45 48/51 43 37 fax +235 51 41 83/52 34 68 email astbef@mail.intnet.td

A community hub

Impressive results

When the Association Tchadienne pour le Bien-ĂŠtre Familial (ASTBEF) was created in 1991 to respond to the sexual and reproductive health needs of the Chadian population, very few people gave it a chance of succeeding. But more than 17 years down the line, the people of Chad look to ASTBEF with deep admiration. In addition to family planning, the Member Association provides a comprehensive array of sexual and reproductive health services that include: voluntary counselling and testing (VCT) for HIV; post-abortion care; youth-friendly services; prenatal and postnatal care; counselling and treatment of opportunistic infections; treatment of male and female infertility; premarital counselling; and advocacy against harmful cultural practices such as female genital mutilation and gender-based violence. The Member Association has also integrated family planning into maternal and infant health services, HIV and AIDS programmes, and its youthfriendly services.

ASTBEF has registered impressive results. In 2007, the Association provided 72,110 services, the majority of people who were estimated to be poor, marginalized, socially excluded and/or under-served.

Challenges ASTBEF faces a number of daunting challenges. A high national maternal mortality ratio of 1,100, a total fertility rate of 6.5, an infant mortality ratio of 102 and a modern contraceptive prevalence rate of just 1.6 per cent are some of the problems the Member Association is struggling against.

ASTBEF operates static and mobile clinics, allowing it to reach some of the most marginalized people in rural communities. In addition to three community-based service sites, ASTBEF operates services and programmes through 25 secondary schools, 12 youth and cultural centres, 12 sports clubs, 20 men and women’s associations, and a number of workplace service delivery points.

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Chad 21

Strategic direction

ASTBEF is dedicated to promoting reproductive health through family planning and safer motherhood, and reducing sexually transmitted infections including HIV and AIDS.

Year of membership

1994

Members of governing body 15 (including one young person) Staff

49

Volunteers

1022

Peer educators

66

Members of YAM

30

Service delivery points

7 branches, 4 clinics, 320 community-based sites

Youth centres

2

Partnerships

Government: Global Fund National Coordination Council, High Commission for Population and Human Resources; National Reproductive Health Programme Supporting Committee.

In a country where the modern contraceptive prevalence rate is just 1.6 per cent, ASTBEF promotes family planning actively and makes contraception available for all who want it.

NGOs: Comité d’information et de liaison des ONG (CILONG – NGO Information and Liaison Committee), Organisation des acteurs non étatiques (OANET – Organization of Non-State Actors) Private sector: PPFAI, NACA, HAPAC, SFH, The Central Bank of Nigeria, CAP Plc, Nigeria Breweries Donors: UNFPA, UNICEF, PNUD, Médecins du Monde, US Embassy, PSR, GTZ, Ministry of Social Action and Family Networks: Network of associations against AIDS, People living with HIV or AIDS network for open awareness raising on the pandemic

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22 IPPF in Africa

Comoros Association Comorienne pour le Bien-Être de la Famille BP 524 Moroni, Comoros tel +269 735301/735351 fax +269 735272 email ascobef@comorestelecom.km

Navigating uncharted waters

Increasing the number of clients served

In Comoros, the name Association Comorienne pour le Bien-Être Famille (ASCOBEF) evokes optimism and hope among women, men and young Comorians. Since its inception in 1995, ASCOBEF has navigated uncharted waters to offer reproductive health services to women, men and young people, and care for young children.

Tremendous success in the provision of sexual and reproductive health services is represented by the number of services provided and the number of clients attended to.

In 2007, ASCOBEF gained 833 new clients and distributed a total of nearly 12,000 contraceptives. ASCOBEF is continually working to expand awareness of and access to its services.

ASCOBEF’s menu of programmes and services includes family planning; gynaecological counselling and services; prenatal care; advocacy for prevention of gender-based violence and support for victims of gender-based violence; information, education and communication materials for sexuality education and behaviour change communications to promote healthseeking behaviour. In addition, voluntary counselling and testing services are offered along with referrals for clients who need antiretroviral treatment.

Challenges

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The demand for ASCOBEF services is likely to soar in Comoros: supply of contraceptives is increasingly under threat, the number and proportion of people of childbearing age is expanding rapidly, and funding for sexual and reproductive health at the international level is stagnating.

To combat the low modern contraceptive prevalence of 20.9 per cent and the total fertility rate of 4.9 – both due, in part, to current unmet need – the Member Association of Comoros is also advocating with the national government to demand that the sexual and reproductive health needs of the Comoros people be made a priority.

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Comoros 23

Strategic direction

The Strategic Plan 2006–2010 aims to: help reduce abortion, sexually transmitted infections, HIV, AIDS and malaria-related mortality and morbidity; build strategic partnerships with public authorities and development organizations; and strengthen its leadership in the area of sexual and reproductive health. The strategic plan is in line with IPPF’s five priority areas of: adolescents and young people, HIV and AIDS, abortion, access and advocacy.

Year of membership

2002

Since its inception in 1995, ASCOBEF has navigated uncharted waters to offer reproductive health services to women, men and young people, and care for young children.

Members of governing body 5 (including one young woman) Staff

22

Volunteers

56

CBDs

40

Members of YAM

39

Peer educators

32

Service delivery points

2 clinics

Youth centres

2

Partnerships

NGOs: Réseau Femmes et Développement Donors: UNFPA, Global Fund, UNICEF, World Health Organization Network: Member of the NGO network in Comoros

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24 IPPF in Africa

Congo Brazzaville Association Congolaise pour le Bien-Être Familial BP 850, Brazzaville tel +242 820670/5512168 fax +242 820670 email acbef@yahoo.fr, abubef@cbinf.com

Serving the needs of the Congo Brazzaville people

Challenges

From a small organization that started in 1987 to cater for the reproductive health needs of the Congolese living in urban centres, the Association Congolaise pour le Bien-Être Familial (ACBEF) has spread to every community of Congo Brazzaville.

Many Congolese look to the Member Association for a variety of sexual and reproductive health services. At the moment, the Association offers family planning; prenatal and postnatal care; voluntary counselling and testing (VCT); management of HIV and AIDS; post-abortion care; youth-friendly services; youth centres; and laboratory services. The Member Association has identified as its target audiences: young people below 25 years of age, rural and urban populations, internally displaced people, sex workers, and men and women of child-bearing age.

Though visibility of family planning and sexual and reproductive health is increasing, there is much work to be done. In many environments, people are still reluctant to speak openly and frankly about sex, and there is stigma and taboo attached to sexually transmitted infections, including HIV and AIDS. The use of modern contraceptives lies stagnant at 13 per cent prevalence, the total fertility rate stands at 5.3 per cent, and the maternal mortality ratio was 510 per 100,000 live births at the end of 2007. Limited resources to provide the services and information needed to change these figures is just one of the problems the Member Association is facing.

Working in partnership with the media and local civil society networks Every year ACBEF’s impressive service statistics are testimony to the reach and popularity of the Member Association. In 2006, ACBEF gained 1,122 new clients and distributed 25,555 contraceptives. The Member Association’s collaboration with the media has witnessed positive coverage and dissemination of sexual and reproductive health and rights information.

Similar arrangements with local non-governmental organization networks to advocate for better laws and influence politicians to put reproductive health on top of their health agenda are having a strong impact on raising the priority and visibility of sexual and reproductive health issues.

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Congo Brazzaville 25

Strategic direction

To strengthen its leadership position in the area of sexual and reproductive health by responding to the unmet need of populations through improved access to quality information and services, effective promotion and protection of clients’ rights.

Year of membership

1994

Members of governing body 7 (including two women) Staff

45

Volunteers

700

CBDs

100

Members of YAM

42

Peer educators

82

Service delivery points

12 branches, 6 clinics

VCT sites

3

Youth centres

1

Partnerships

Government: Ministry of Health, Ministry of Foreign Affairs; Ministry of Gender

ACBEF’s collaboration with the media has witnessed positive coverage and dissemination of sexual and reproductive health and rights information.

NGOs: Jeunesse Action Sida, Jeunes+ Donors: EC, UNFPA, Congolese Government

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26 IPPF in Africa

Côte d’Ivoire Association Ivoirienne pour le Bien-Être Familial 01 BP 5315 Abidjan 01 tel +225 21 21 80 80 à 84 fax +225 21 21 80 85 email aibef@afnet.net web www.aibef-ci.org

A leader in sexual and reproductive health

Outreach: the hallmark of AIBEF’s success

The Association Ivoirienne pour le Bien-Être Familial (AIBEF) was established in 1979. It works closely with the National Population Bureau in the planning and implementation of the National Population Policy and the National Youth Policy.

In 2007, the delivery of these services benefited 164,857 clients, with a significant proportion of these reaching people who are poor, marginalized, socially excluded and/or underserved. In order to reach those who are in greatest need, the Member Association has implemented sexual and reproductive health projects at 29 sites in the private sector and is currently providing family planning and treatment of STIs in 70 Ministry of Health centres.

The Association also provides comprehensive sexual and reproductive health services to its target group of young people, men and women. The services provided in the clinics and outreach visits include family planning; diagnosis and management of sexually transmitted infections (STIs); and voluntary counselling and testing (VCT) for HIV. Voluntary peer educators work in the youth centre – Centre Socio Educatif Aéré d’Abobo – and in the communities, where they provide information, counselling and condom distribution services and undertake campaigns around sexual and reproductive health issues. Community-based agents promote the use of contraceptive methods, provide education on the correct use of contraceptive methods, and distribute contraceptive supplies.

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Challenges However, the Association still faces many challenges with demand for services outstripping supply. The Côte d’Ivoire’s public health system is severely under-resourced and runs only a few public health facilities. For example, there is one dispensary for 10,000 people and one maternity clinic for 14,100 women.

As a result, 690 women die in pregnancy or childbirth for every 100,000 births. Modern contraceptive prevalence stands at only 9.2 per cent; and there is a high prevalence of female genital mutilation, which affects not only the health of girls and women, but also their education and potential throughout life.

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Côte d’Ivoire 27

Strategic direction

The Strategic Plan 2005–2009 is in line with the IPPF Strategic Framework.

Year of membership

1988

Members of governing body 5 Staff

58 (including 31 women)

Volunteers

1,000

Members of YAM

166

Service delivery points

8 branches, 15 clinics

VCT sites

4

Youth centres

1

Partnerships

Government: National Committee for Population

Community-based agents promote the use of contraceptive methods, provide education on the correct use of contraceptive methods, and distribute contraceptive supplies.

NGOs: Future Group, Pathfinder International, Population Council, Johns Hopkins University, John Snow Inc., Columbia University, FHI Private Sector: AIBEF has implemented a sexual and reproductive health project in the private sector at 29 sites Donors: EC, IPPF Japan Trust Fund for HIV, Global Fund, Alliance International, Safe Abortion Action Fund, World Bank CCM: Coordination for Sexual and Reproductive Health Actions, National Committee for Injections Security Networks: Collectif des ONG de Lutte contre le Sida en Côte d’Ivoire and RIOF which are both national networks aiming to increase capacity within the sector; Media Network

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28 IPPF in Africa

Democratic Republic of Congo Association de Bien-Être Familial – Naissances Désirables BP 15313 Kinshasa tel +243 81 374 7515 email abefbdrdc@yahoo.fr

Defying odds to meet demand

A cornerstone of the community

In 1977 in the vast land of the Democratic Republic of Congo (formerly Zaire), an organization was created to respond to the acute reproductive health needs of the population. That organization is the Association de Bien-Être Familial – Naissances Désirables (ABEF-ND). Since its foundation, the Member Association of the Democratic Republic of Congo has worked tirelessly to ensure that family planning gets the attention it deserves and to ensure the sexual and reproductive health and rights of its target groups.

The number of clients coming to ABEF-ND for these services has been growing tremendously. In 2006, the Member Association provided 62,685 services and distributed 1,810,867 contraceptives through its clinics and outreach visits. The Member Association played a crucial role during the National Conference on the Positioning of Family Planning in the country. This conference resulted in recommendations that saw the removal of Article 78 of the Penal Code, which posed a significant barrier to offering and using family planning services.

The Member Association has grown to include a comprehensive range of reproductive health services beyond family planning: this includes sexual and reproductive health information, education and communication for young people; prevention and management of HIV and AIDS; community-based distribution of contraceptives and advocacy around sexual and reproductive health issues. The main beneficiaries of these services are young men and women, couples, refugees and internally displaced persons.

Challenges

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Poor sexual and reproductive health indicators reveal that much work remains to be done. A high maternal mortality ratio of 990 per 100,000 live births, a modern contraceptive prevalence of 5.8 per cent, a total fertility rate of 6.7 and an infant mortality rate of 120 are some of the challenges that continue to make the work of ABEF-ND strenuous.

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Democratic Republic of Congo 29

Strategic direction

The Strategic Plan 2005–2009 is in line with the IPPF Strategic Framework and intends to reduce child and maternal mortality and empower women to take charge of their reproductive health.

Year of membership

1978

Members of governing body 5 Staff

31

Volunteers

461

CBDs

155

Members of YAM

192

Peer educators

68

Service delivery points

4 branches, 14 clinics

VCT sites

1

Youth centres

2

In 2006, ABEF-ND provided 62,685 services and distributed 1,810,867 contraceptives through its clinics and outreach visits.

Workplace outreach activities 4 Partnerships

Government: Ministry of Health CCM: Member (national level) Private sector: Faith-based health providers NGOs: SCEV, RAF, RCP+, Amo Congo Donors: PNLS, UNFPA, UNHCR, GTZ Networks: Member of the Federation of NGOs Against AIDS; Member of the National Council of NGOs Against AIDS.

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30 IPPF in Africa

Ethiopia Family Guidance Association of Ethiopia P.O. Box 5716, Addis Ababa tel +251 115 51 411 fax +251 115 51 2192 email fgaeed@ethionet.org web www.fgae.org

A leading provider of sexual and reproductive health services

A model of best practice: From services to advocacy to partnerships

Every morning, long and winding queues of women, men and young people form outside the clinics of one of Ethiopia’s most respected and leading providers of sexual and reproductive health care. Established in 1966, the Family Guidance Association of Ethiopia (FGAE) has emerged as an ally of the people who are poor and marginalized, many of whom have reproductive health needs that are not met by national health services or the private sector. From its early days when it simply provided family planning and counselling, the Member Association has increased its mix of services provided in response to clients’ needs. Currently, FGAE provides a comprehensive package of sexual and reproductive health services including family planning; abortion care; maternal and child health; treatment of sexually transmitted infections; and a continuum of care in the HIV and AIDS spectrum such as voluntary counselling and testing, and treatment of opportunistic infections.

FGAE’s efforts have been useful. The number of clients served in 2007 was about 888,000, of whom an estimated 799,000 were poor, marginalized, socially excluded and/or under served.

Advocacy efforts in recent years have resulted in the expansion of the country’s abortion laws to give women more freedom to choose whether or not to terminate a pregnancy. Family planning has been successfully integrated into maternal and child health services and family life education in school curricula.

The Member Association’s centre in Addis Ababa is recognized as a national facility for sexual and reproductive health training.

The Member Association has also increased access to high quality and youth-friendly sexual and reproductive health services with a specific emphasis on the prevention and management of sexually transmitted infections, HIV and AIDS, unwanted pregnancies and unsafe abortion. In efforts to reach groups that are increasingly marginalized FGAE is implementing projects to provide sexual and reproductive health services to street children, AIDS orphans, and sex workers, including young migrants in eight of the 11 principal towns of Ethiopia.

Community-based distributors and health extension workers assist people living in areas where public services are difficult to reach.

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Challenges The work of FGAE is never finished. There is a maternal mortality ratio of 850 per 100,000 live births, a modern contraceptive prevalence of 14 per cent, a total fertility rate of 5.4 and only 10 per cent of women deliver with the assistance of a skilled birth attendant. With further support and investment, the Member Association of Ethiopia will be able to expand its services to meet the needs of even more people.

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Ethiopia 31

Strategic direction

In line with the IPPF Strategic Framework

Year of membership

1971

Members of governing body 12 Staff

529

Volunteers

5000

Peer educators

740

CBDs

740

Service delivery points

8 branches, 48 clinics

Youth centres

28

Partnerships

Government: Ministry of Health has a representative with an advisory role on the Governing Body of FGAE NGOs: Family Health International, JPHEIGO, Mary-Joy Ethiopia, Ethiopia Christian Children’s Fund, DKT Ethiopia, Jamini Trust Ethiopia, Ethiopian Women Lawyer Association (EWLA), Dawn of Hope, Mekdem Ethiopia, Tilla HIV Positive Women’s Association, Hiwot HIV/ AIDS prevention service and care organization, Abebech Gobena project, Integrated Service for AIDS Prevention and Support Organization, Christian Relief Development Association.

Wosun volunteers at the Yergalem youth centre where she talks to young people about the realities of living with HIV. She says, “The support that I have received from FGAE has helped me to accept my situation and get on with my life. Now I want to help others.”

Private sector: Betezata Hospital, Janmeda medical/biological laboratories Donors: Royal Netherlands Embassy, Packard Foundation, IPPF Japan Trust Fund for HIV, Irish Aid Network: Consortium of Reproductive Health Association

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32 IPPF in Africa

Gabon Mouvement Gabonais pour le Bien-Être Familial BP 1158, Libreville tel +241 72 25 55 fax +241 72 25 56 email mouvementgabonais@yahoo.fr

One clinic and few staff, but notable success

Successes registered

Established in 1998, the Mouvement Gabonais pour le Bien-Être Familial (MGBEF) runs several sexual and reproductive health programmes, focusing mainly on creating awareness of prevention of sexually transmitted infections, HIV and AIDS, unplanned pregnancies among young women of reproductive age; and prevention of unsafe abortions. MGBEF runs activities at public forums, such as in educational institutions, market places and other public meeting places. At its only clinic in Libreville, MGBEF offers family planning and obstetric care to its clients. The Member Association also distributes condoms, shows films on sexual and reproductive health issues, and distributes information, education and communication materials as well as carrying out behaviour change communication activities among its target populations of adolescents, young women and men.

Despite having few staff and only one clinic, the Member Association has made significant progress. In 2007, they distributed over 16,000 male condoms, and the majority of clients served last year were poor or marginalized.

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Challenges Gabon has high rates of teenage pregnancy, with a third of 19-year-old women are mothers. This is not surprising, considering the frequency of commodity stock-outs. In Gabon, 420 women die of pregnancy-related complications for every 100,000 live births – a further and seemingly impossible challenge to tackle. With an HIV prevalence of 9.4 among women and 6.3 among men, there is significant demand for HIV management, treatment and care, which MGBEF – at its current level of funding and support – cannot manage alone.

There have been some positive advances in recent years, however: the legalization of contraceptive use and the adoption of a national health policy that guarantees child and maternal health are likely to enhance MGBEF’s work.

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Gabon 33

Strategic direction

MGBEF’s main objective is to expand sexual and reproductive health services and information to the people of Gabon, particularly young people who constitute the largest proportion of people affected by sexually transmitted infections and HIV and AIDS.

Year of membership

2002

Members of governing body 12 Staff

16

Volunteers

20

Service delivery points

4 branches, 1 clinic

Partnerships

Donors: UNFPA, UNICEF, PNLS

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MGBEF distributes condoms, shows ďŹ lms on sexual and reproductive health issues, and distributes information, education and communication materials.

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34 IPPF in Africa

The Gambia The Gambia Family Planning Association Kanifing Headquarters, P.O. Box 325, Banjul tel +220-4370325/ 4391473 fax +220 439 2463 email gfpa@qanet.gm

Transforming the lives of Gambians

Successes registered

Set up in 1968 as the country’s only organization catering for the family planning needs of Gambian women and couples, the Gambia Family Planning Association (GFPA) has grown over the years to become the leading provider of sexual and reproductive health services in the country.

In 2007, GFPA provided 82,285 services, an estimated three quarters of which were provided to poor, marginalized, socially excluded and/or under-served people. Between 2001 and 2006, the Member Association was part of the multisectoral team that helped develop and revise the National Reproductive Health Policy.

GFPA offers comprehensive, quality and gender-sensitive sexual and reproductive health services that include family planning; voluntary counselling and testing; treatment of sexually transmitted infections (STIs); and prenatal and postnatal care. The Member Association also screens for cancers of the reproductive system, provides infertility treatment and counselling, and post-abortion care.

Part of the Association’s mandate is to ensure that these services are accessed by poor and marginalized people through advocating for the sexual and reproductive rights of couples and individuals, and providing information and education. The Member Association also conducts social marketing campaigns for contraceptives and outreach visits.

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Challenges Despite the Member Association’s many successes, contraceptive prevalence is still only 9 per cent, the maternal mortality ratio is still high at 540, and the total fertility rate remains high at 4.2 children per woman, despite expressed fertility desires that are lower.

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The Gambia 35

Strategic direction

The 2005–2009 Strategic Plan focuses on two major programme interventions: scaling up prevention and care for HIV and AIDS, and social marketing of contraceptives. It also aims to increase the Member Association’s capacity to improve the quality of its services, underpinned by a rights-based approach and male involvement schemes.

Year of membership

1971

Members of governing body 18 (including six women) Staff

119 (including 10 young people)

Volunteers

837

CBDs

430

Members of YAM

210

Peer educators

80

Service delivery points

7 branches, 9 clinics

Partnerships

Government: National Aids Council, National Population Commission, RCH Committee.

These young deaf men are leading a group session to educate people living with disabilities about sexual and reproductive health issues.

NGOs: NGO Affairs Agency, The Association for Non-governmental Organizations (TANGO), National Association of Youth Conference and Organisation, Action Aid The Gambia Private sector: Private banks, Compagne Francaise Afric Ocidental Donors: UNFPA, IPPF Japan Trust Fund for HIV, EC, HIV/AIDS Rapid Response Programme, Global Fund Network: Network of Sahelian NGOs; Consortium of NGOs on gender, rights and sexuality; Partnership on advocacy for HIV/ AIDS prevention for bank employees

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36 IPPF in Africa

Ghana Planned Parenthood Association of Ghana P.O. Box 5756, Accra tel +233 21 310369 fax +233 21 304567 email ppag@africaonline.com.gh web www.ppag-gh.org

Making history in Ghana The Planned Parenthood Association of Ghana (PPAG) was the first organization to tackle population issues in Ghana.

Established in 1967, the Association is now the country’s main provider of family planning and comprehensive sexual and reproductive health services. In its clinics and outreach visits, the Association provides its target group of youth, men and women with the following services: post-abortion care; maternal and child health; infertility management; family planning, voluntary counselling and testing; treatment of minor ailments; and special services for men such as the management of erectile dysfunction. The outreach programme is run by staff, peer educators and non-traditional distributors, who conduct behaviour change communication, encourage male involvement, distribute contraceptives and offer some clinical services.

A trusted and recognized institution All this hard work has seen the number of clients rise significantly over the years. In 2007 alone, PPAG provided a total of 184,319 services and saw 173,831 clients. Of these, an estimated 112,990 people were poor, marginalized, socially excluded and/or under-served. In recent years, the Association has positioned itself as an efficient contractor of sexual and reproductive health services for government departments and other non-governmental organizations, whose staff PPAG trains on facility management and provision of services at the community level.

Challenges A maternal mortality ratio of 540, a modern contraceptive prevalence of 14 per cent, and the fact that more than half of all births are not attended to by skilled personnel are some of the on-going challenges.

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As community gatekeepers, village elders have a powerful role in making it socially acceptable for people to discuss sexual and reproductive health issues openly and to access services.

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Ghana 37

Strategic direction

PPAG’s strategy is in line with the IPPF Strategic Framework and is designed to achieve the goals of the Cairo Programme of Action, the Millennium Development Goals and the Ghana Poverty Reduction Strategy.

Year of membership

1968

Members of governing body 17 Staff

114 (including 33 women)

Volunteers

1,000

CBDs

551

Members of YAM

810

Peer educators

300

Service delivery points

17 branches, 11 clinics

VCT sites

9

Youth centres

7 (including clinical services)

Partnerships

Government: Ghana Health Service; Ghana Education Service; Technical Working Group for National Response on HIV/AIDS; Coordinating Committee of National Population Council (NPC) NGOs: National Youth Council, Church Hospitals Association of Ghana, Christian Council, CEDEP, municipal/district assemblies, Community and religious Leaders, Domestic Violence and Victims Support Unit (DVVSU), Community Development and Youth Advisory Centre (CODEYAC) Private sector: Ghana Registered Midwives Association, Society of Private Medical and Dental Practitioners, Christian Hospitals Association of Ghana, Pharmaceutical Society of Ghana, Ghana Red Cross, Ahmadiyya Muslim Mission Donors: JICA, JOICFP, UNFPA, PATH, African Youth Alliance (AYA), Big Lottery Fund, Danida, French Embassy, DFID, UNICEF, GTZ Networks: Ghana Civil Servants Association, Ghana Registered Nurses Association, Ghana AIDS Network (GHANANET), Ghana Coalition of Private Sector in Health, National Association of People Living with AIDS (NAP+), Coalition of NGOs in Health, Adolescents Reproductive Health Network

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38 IPPF in Africa

Guinea-Bissau Associação da Guine-Bissau para a Educacao e Promocao da Saude Familiar P.O. Box 455, Rua Edwardo Mondlane 1160, Bissau tel 245-222494/ 245 223769 fax 245222494 email jcesar1238@hotmail.com, rdgueseidi@hotmail.com

Daring to act

Reducing unmet need

Established in 1987, the Associação da Guine-Bissau para a Educacao e Promocao da Saude Familiar (AGUIBEF) is one of the most respected organizations in the provision of comprehensive sexual and reproductive health services in Guinea-Bissau. A full member of the International Planned Parenthood Federation, the Member Association is highly regarded by the government, which has appointed it to sit on the national Sexual and Reproductive Health and Commodity Security Committee, which ensures constant availability of contraceptives, and the HIV and AIDS Inter-Ministerial and prevention Committees.

Due to the preferential position it holds with governmental bodies, AGUIBEF is well-positioned to advocate for a favourable reproductive health policy environment.

Demand for these services has been growing steadily. In 2007, a total of 144,678 sexual and reproductive health services were provided and an estimated 87 per cent of clients served were poor, marginalized, socially excluded and/or under-served.

AGUIBEF also participated in the development of the national HIV/AIDS strategic plan.

Challenges The high total fertility rate of 7.1, low modern contraceptive prevalence of 4.4 per cent, a maternal mortality ratio of 1,100 deaths per 100,000 live births, and the high level of illiteracy that exists in Guinea-Bissau are on-going challenges.

AGUIBEF provides a comprehensive range of services to its target population of adolescents, women, parents, people living with and affected by HIV and AIDS, and men in four of the nine regions of the country. These services include: family planning; abortion-related services; voluntary counselling and testing; gynecological and obstetrical services; and sexually transmitted infection prevention and treatment.

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Guinea-Bissau 39

Strategic direction

The Strategic Plan 2005–2009 is in line with the IPPF Strategic Framework.

Year of membership

1994

Members of governing body 12 (including four young people and two women)

Staff

26

Volunteers

500

CBDs

150

Members of YAM

370

Peer educators

50

Service delivery points

3 branches, 2 clinics

Partnerships

Government: Ministry of Health, Ministry of Education, Institute of Children and Women, Ministry of Family and Fight against Poverty, Ministry of Youth, Sport and Culture

AGUIBEF is highly regarded by the government, which has appointed it to sit on the national Sexual and Reproductive Health and Commodity Security Committee, which ensures constant availability of contraceptives, and the HIV and AIDS Inter-Ministerial and Prevention Committees.

NGOs: Plan International; PPFAI, NACA (HAPAC), National Council for the Fight against HIV/AIDS, Society Family Health (PSI), Medicos do Mundo Private sector: Central Bank of Nigeria, CAP Plc, Nigeria Breweries Donors: Plan International, Secretariat Technique National de Lutta contre Sida, UNFPA, Global Fund CCM: AGUIBEF is the focal point of the country coordinating mechanism Network: A focal point for the Forum des ONGs

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40 IPPF in Africa

Guinea Conakry Association Guinéenne pour le Bien-Être Familial Immeuble Bleu Commune de Matam Quartier Coléah Cité, BP 1471, Conakry tel +224 462365 fax +224 468667 email agbefippfar@yahoo.fr

The pillar of hope

Challenges

Since its establishment in 1985, the Association Guinéenne pour le Bien-Être Familial (AGBEF) has been continuously improving its standard of care and piloting new approaches to better meet the reproductive health needs of its target groups: young people, displaced persons and refugees, and women and men of reproductive age. The Member Association offers a range of services, including: disseminating information, education and communication on sexual and reproductive health; youth-friendly reproductive health services; and prevention and management of HIV and AIDS through interventions such as voluntary counselling and testing. Improving access to contraceptives at community level and advocating and mobilizing the public to demand their reproductive health rights are other activities that the Member Association undertakes.

Guinea Conakry has a high maternal mortality ratio (at 740 deaths per 100,000 births) and a high infant mortality (at 113 deaths per 1,000 births). The Member Association of Guinea Conakry also faces the challenge of unmet need for services and contraceptives. The total fertility rate is 5.7 children per woman, partly due to unmet need for contraception, and with over three million young people aged 10–24 years – 30 per cent of the population – demand for contraceptives and sexual and reproductive health services will grow rapidly over the next few years.

Delivering the services AGBEF has been delivering supplies and services successfully, especially to poor and marginalized people. The Member Association provided a total of 127,180 services in 2007 and distributed 105,818 contraceptive supplies. Half of these supplies were provided to young people.

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Guinea Conakry 41

Strategic direction

To create a society in which individuals and families live free from poverty, harmful cultural practices, unsafe abortion and sexually transmitted infections, including HIV and AIDS; and where individuals can enjoy sexual and reproductive rights within a context where gender equality and equity is upheld.

Year of membership

1986

Members of governing body 9 (including one young person) Staff

50

Volunteers

200

CBDs

3,432

Members of YAM

100

Peer educators

235

Service delivery points

5 branches, 7 clinics

VCT sites

5

Youth centres

3

Partnerships

Government: Member of the ONCHO SR Initiative Steering Committee, National Reproductive Health Commodity Security Committee

The Association Guinéenne pour le Bien-Être Familial (AGBEF) is continuously improving its standard of care and piloting new approaches to better meet the reproductive health needs of its target groups.

Global Fund CCM: Member Donors: World Bank, PSI, Plan Guinée, UNFPA Networks: ROSIGUI (coordinator of nongovernmental organizations working on HIV and AIDS issues)

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42 IPPF in Africa

Kenya Family Health Options Kenya Family Health Plaza, P.O. Box 30581 00100, Nairobi tel +254 020 604 296 fax +254 020 603 928 email info@fhok.org web www.fhok.org

A national leader in sexual and reproductive health

Advocacy achievements

Family Health Options of Kenya (FHOK) opened the first model family planning clinic in the country in 1962. Today it remains the leading provider of sexual and reproductive health services.

The work of FHOK has benefited many Kenyans. In 2007, they served 192,444 clients, of whom an estimated 111,600 were poor, marginalized, socially excluded and/or under-served.

In collaboration with other organizations, FHOK advocated extensively with the government to increase funding for sexual and reproductive health. As a result, the government has increased the national budget allocation for reproductive health and it is in the process of developing a National Contraceptive Security Strategy.

A full member of the International Planned Parenthood Federation, the Member Association of Kenya provides integrated sexual and reproductive health and HIV and AIDS services to all who come to its clinics for services.

FHOK is especially focused on reaching sex workers, male workers in five sugar belt regions, and young people. Services provided include: family planning; emergency contraception; laboratory services; prenatal care and maternal services; postabortion care; voluntary counselling and testing; and HIV treatment including nutritional counselling and antiretroviral therapy. Clients are referred to other centres for CD4 count, viral load and drug resistance monitoring services. Outreach programmes target sugar factories, agricultural farms in six towns and six districts in Mombasa, with peer educators conducting lectures, group discussions, film shows, individual counselling, theatre performances, sexuality, relationships and family planning counselling with fellow young people, distributing contraceptives, drug abuse counselling and awareness raising around unsafe abortion. The Member Association implements specialized HIV and AIDS programmes with young people living with HIV and AIDS to enhance positive prevention; and it also works with HIV and AIDS networks and support groups to connect its clients to micro-financial institutions. The Member Association also provides postexposure prophylaxis to its staff members.

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Challenges With a high maternal mortality ratio (over 400 deaths per 100,000 live births) and a high infant mortality rate of 77, FHOK’s services needed more than ever. In addition, the country has fairly restrictive abortion laws, which contribute to incidences of unsafe abortion. Strong advocacy work will be needed to tackle these barriers to good sexual and reproductive health and realization of women’s rights.

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Kenya 43

Strategic direction

With a strong leadership, FHOK embraces gender equality and collaboration and has integrated these principles throughout its programmes. It offers sustainable, innovative, comprehensive services and information in response to the health and socio-economic needs of all. It aims to be a centre of excellence in capacity building to empower Kenyans, especially young people, to exercise and enjoy their sexual and reproductive rights.

Year of membership

1963

Members of governing body 15 (including two young people) Staff

142

Volunteers

6557

Members of YAM

143

Service delivery points

25 branches, 11 clinics

Youth centres

5

Partnerships

Government: Ministry of Health

Young prison inmates do street performances to raise awareness about sexual health, STIs and HIV prevention.

NGOs: Kenya AIDS NGOs Consortium, Population Services International, Engender Health, The University of Nairobi, FHI, National AIDS Control Programme Private sector: Chemelil Sugar Company, private medical practitioners Donors: UNFPA, EC, USAID, Rockefeller Foundation, Futures Group International, Plan International, the Netherlands Trust Fund, Kenya Family Health Programme, Sida, JOICFP Networks: Kenya Association for the Promotion of Adolescent Health (KAPAH), Kenya Broadcasting Corporation, Kenya Association of Professional Counsellors

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44 IPPF in Africa

Lesotho Lesotho Planned Parenthood Association Pope John Paul II Road, P.O. Box 340, Maseru 100 tel +266 2231 3645 fax +266 2232 1670 email lppa@lesoff.co.za web www.lppa.org.ls

Improving the sexual and reproductive health of the Lesotho people Since its creation in 1968, demand for the services of the Lesotho Planned Parenthood Association (LPPA) has steadily increased, and it has become a cornerstone of many communities. From its beginnings as a dedicated family planning provider, the Member Association of Lesotho now offers comprehensive sexual and reproductive health services and actively advocates for policies and laws that uphold the principle of gender equality.

The Member Association’s emphasis on women and young people is reflected throughout its activities. In 2007, 30 per cent of the organizational budget was dedicated to programmes for young people. LPPA also provides outreach services to other vulnerable groups, in particular cattle herders, prisoners, people in rural areas who have limited access to health facilities, factory workers, students, and people living with HIV and AIDS. Services offered include: family planning; testing and management of sexually transmitted infections; screening for cancers of the reproductive system; emergency contraception; pregnancy testing; post-abortion care; and voluntary counselling and testing. Clients are referred to other facilities for CD4 tests and antiretroviral treatment.

Better knowledge, better health LPPA’s wide-ranging services and programmes have resulted in good outcomes. While the Member Association provided clinical services to nearly 89,000 clients, it reached many thousands more through its information, education and communication programmes. The Member Association is also proud of its achievements in conducting research and advocacy on unsafe abortion and the rights of people living with HIV and AIDS.

Challenges A national HIV prevalence of 23.2 per cent, a maternal mortality ratio of 550 and a modern contraceptive prevalence of only 35 per cent are some of the difficulties the Member Association confronts on a daily basis.

Out-of-school youth volunteers deliver information, education and communication programmes in 21 schools in Maseru district, using drama, puppetry, sports activities and facilitated discussions. The Member Association delivers health information and education programmes to the wider public through health talks, workshops, drama performances, and radio and TV shows.

LPPA targets community leaders, teachers, religious leaders, and other stakeholders in its advocacy work to help ensure favourable policies and laws on sexual and reproductive health.

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Lesotho 45

Strategic direction

It is in line with IPPF’s five strategic areas: Adolescents and young people, HIV and AIDS, Abortion, Access and Advocacy.

Year of membership

1968

Members of governing body 15 (including seven women and four young people)

Staff

68

Volunteers

208

CBDs

14

Members of YAM

30

Peer educators

90

Service delivery points

3 branches, 9 clinics

Youth centres

1

Partnerships

Government: LPPA was offered two old government buildings in Quthing and Qacha’s Nek to renovate into clinics; LPPA is a member of the Reproductive Health Policy Technical Committee, the Population Executive Committee, the PMTCT Technical Committee and it also sits on the UN Gender Group

LPPA provides outreach services to vulnerable groups, in particular cattle herders, prisoners, people in rural areas who have limited access to health facilities, factory workers, students, and people living with HIV and AIDS.

NGOs: World Vision Lesotho, Academy for Educational Development, Alliance of Parents, Adolescents and Communities, Olympic Youth Ambassadors Project, SADAC/AED, ICRC, WiLSA, APADOC, International Committee of the Red Cross, CARE Lesotho, PSI Lesotho Donors: Irish Aid, UNDP CCM: LPPA is a member of the Global Fund Technical Committee and its country coordinating mechanism Networks: Positive Action, Lesotho Network of People Living with AIDS (LENEPWA), Lesotho Council of NGOs, Lesotho Network of AIDS Servicing Organizations

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46 IPPF in Africa

Liberia Family Planning Association of Liberia 18th Street and Payne Avenue, Sinkor 1000 Monrovia 10, P.O. Box 10-0938, Monrovia tel +231 077067913 email fpalliberia@yahoo.com

Experience pays off

Meeting the need for contraceptive supplies

Ranked as one of the oldest family planning associations in Africa, the Family Planning Association of Liberia (FPAL) has lived up to the expectations of Liberians by providing a wide range of reproductive health services. Established in 1956, the Association provides family planning; prenatal and postnatal services; infertility counselling and services; immunizations; information, education and communication around sexual and reproductive health, prevention and management of HIV and AIDS, including voluntary counselling and testing (VCT) for HIV. The Member Association has plans to extend its services to rural areas through outreach activities. It currently provides outreach services to disabled people, including a group of blind people called Group of 77 and provides specialized programming for young people and single mothers. The Member Association conducts community activities to raise awareness about sexual and reproductive health and rights, including a regular radio talk show and discussions with community and religious leaders.

FPAL’s services statistics are one clear indicator of the Member Association’s success. In 2007, FPAL distributed 634,962 contraceptive supplies, 452,081 of these to young people.

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Challenges FPAL struggles to make a real impact on the country’s poor sexual and reproductive health indicators. These include high maternal mortality, low modern contraceptive prevalence and a total fertility rate of 6.8 children per woman. Poor contraceptive security means that the supplies are not getting to those who need and want them, contributing, in turn, to unintended pregnancies and poor maternal health.

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Liberia 47

Strategic direction

To provide quality, accessible, affordable and sustainable sexual and reproductive health services that are informed by human rights and aim to achieve equal access for all men, women, and young people through service providers, volunteers and partners with whom FPAL shares a vision.

Year of membership

1967

Members of governing body 10 Staff

28 (including 14 women)

CBDs

42

Members of YAM

2

Peer educators

134

Service delivery points

12 branches, 2 clinics

Youth centres

2

Partnerships

Government: Ministry of Planning and Economic Affairs (MPEA), Ministry of Health and Social Welfare (MoH/SW), National AIDS Control Programme (NACP), Ministry of Youth and Sports (MYS), Ministry of Gender and Development (MGD), National Population Council and the Liberia AIDS Commission

FPAL conducts community activities to raise awareness about sexual and reproductive health and rights, including a regular radio talk show and discussions with community and religious leaders.

NGOs: AFRICARE, New Africa Research and Development Agency (NARDA) Donors: AfricaCare Network: New Africa Research and Development Association (NARDA), Christian Health Association of Liberia, Children Assistance Programme (CAP), John F. Kennedy Memorial Hospital

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48 IPPF in Africa

Madagascar Fianakaviana Sambatra Lot 11 H 1 Ampasampito, BP 703 Antananarivo 101 tel 261 20 224 0347 fax 261 20 224 1813 email fisa@blueline.mg

A comprehensive urban/rural service provider

Challenges

Established in 1967, the Family Planning Association of Madagascar/Fianakaviana Sambatra (FISA) provides a wide range of sexual and reproductive health services, including: family planning; prevention and management of HIV and AIDS; and sexual and reproductive health information, education and communication materials. These services are provided in six regions through nine clinics and affiliate organizations and mainly target young people, women, sex workers and rural populations.

The burden of poor sexual and reproductive ill health in Madagascar remains troubling for FISA. Abortion laws are very restrictive, which is partly responsible for the country’s significant number of maternal deaths. The number of women dying due to complications from unsafe abortion is contributing to a high prevalence of this tragedy across Eastern Africa, which is the region with the highest number of deaths due to unsafe abortion on the continent3. The problem of unsafe abortion is further exacerbated by a modern contraceptive prevalence of just 18 per cent, partly due to difficulties in commodity security.

Working in partnership to meet the needs of the poor FISA prides itself on reaching those people who are most often neglected by national health services and who cannot access private sector services. In 2007, an estimated 90 per cent of FISA’s clients were poor, marginalized, socially excluded and/ or under served. The role and accomplishments of FISA are respected by the government and donors. FISA plays an active role in advising on the development of national sexual and reproductive health policies.

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Madagascar 49

Strategic direction

To contribute to the improvement in wellbeing of the Malagasy population by promoting access to quality family planning as a fundamental human right, by targeting under-served groups, by providing appropriate information, education and communication, and through effective community participation and involvement.

Year of membership

1971

FISA prides itself on reaching those people who are most often neglected by national health services and who cannot access private sector services.

Members of governing body 16 (including nine young people) Staff

70

Volunteers

8 (including four women)

CBDs

2

Members of YAM

42

Peer educators

184

Service delivery points

6 branches, 14 clinics, 8 community-based sites

VCT sites

7

Workplace policy

FISA has a written HIV/AIDS workplace policy

Partnerships

Government: Ministry of Health, Family Planning and Social Protection, Ministry of Youth NGOs: Marie Stopes International, member of ASSONG – a coalition of non-governmental organizations working on sexual and reproductive health in Madagascar, member of DRV, coordinating body for women’s associations in Madagascar Donors: UNFPA, Big Lottery Fund, Amélioration de la Qualité de Services, EC, Interact Worldwide Networks: Member of the national coordinating mechanism on SSR programmes, member of the National Committee on Communication and Awareness Raising on Health

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50 IPPF in Africa

Malawi Family Planning Association of Malawi Private Bag B424, Lilongwe 3 tel +265 1 773 915/774 973/774 927 fax +265 1 771 032 email fpam@fpamalawi.org

Delivering sexual and reproductive health services with a focus on young people The Family Planning Association of Malawi (FPAM) has moved from focusing largely on family planning to providing a wide range of integrated sexual and reproductive health services, targeting young people and rural communities. FPAM provides youth-friendly information, education and behaviour change communication materials to young people at the Youth Life Centres and schools through peer educators, who use group discussions, theatre performances, publications and audio-visual materials to engage young people. Community reproductive health promoters and counsellors are also involved in delivering these programmes. Also provided at the Youth Life Centres are contraceptives, pregnancy tests, diagnosis and treatment of sexually transmitted infections; and voluntary counselling and testing.

FPAM conducts outreach programmes with sex workers: it provide skills training so that sex workers have the choice to generate income through other means; they advise sex workers how to negotiate safer sex with their clients; and they provide education on correct condom use. FPAM also distributes contraceptives by its community-based distributors and advocates for gender equality, especially in sexual and reproductive rights.

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Achieving targets for contraceptive distribution The work of FPAM has produced encouraging results. In 2007, FPAM distributed 575,461 contraceptive supplies, including 450,000 male condoms and nearly 120,000 female condoms, and provided nearly 15,000 HIV and AIDS services. An estimated 70 per cent of the Member Association’s clients are poor, marginalized, socially excluded and/or under-served. Research shows that modern contraceptive prevalence has increased from 7 per cent in 1992 to 28 per cent in 20044. FPAM is proud of the role it has played in this change. In collaboration with the National AIDS Commission, FPAM provided expertise and participated in the development of the national plan to fight HIV/AIDS.

Challenges Weak health systems present substantial barriers. With half of Malawi’s doctors working in the four central hospitals, there are few remaining health professionals to cover Malawi’s vast rural areas. With a total fertility rate of six children per woman, a maternal mortality ratio of 1,800, and HIV prevalence at 11.8 per cent, FPAM still has more work to do.

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Malawi 51

Strategic direction

The Strategic Plan 2005–2009 focuses on increased access to quality, comprehensive, integrated sexual and reproductive health information and services for young people and under-served people.

Year of membership

2007

Members of governing body 10 (including two young people) Staff

46

Volunteers

600

Members of YAM

10

Service delivery points

5 branches, 13 clinics

Youth centres

4

Partnerships

Government: Ministry of Health, Ministry of Women and Child Development, Ministry of Youth Development and Sports, National Youth Council of Malawi

These peer educators visit people on the outskirts of town to distribute condoms and information about sexual health and sexually transmitted infections.

NGOs: Malawi Girl Guides Association, Banja La Mtsogolo Private sector: Southern Bottlers Donors: UNFPA, JOICFP, UNICEF, National AIDS Commission, GTZ, Youth Incentives Network: Council for Non-Governmental Organizations in Malawi (CONGOMA), National Association of People Living with HIV/AIDS in Malawi, Youth Net and Counselling (YONECO)

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52 IPPF in Africa

Mali Association Malienne pour la Protection et la Promotion de la Famille P.O. Box 105 tel +222 4494 fax +222 2618 email amppf@datatech.toolnet.org

The people’s advocate

Expanding services and contraceptive distribution

Established in 1972 to tackle family planning challenges facing the Malian people, the Association Malienne pour la Protection et la Promotion de la Famille (AMPPF) remains one of the main sexual and reproductive health providers and advocates to increase access to sexual and reproductive health for all people, particularly the poor.

In 2007 AMPPF provided services to 76,404 clients, of whom nearly 53,500 were poor, marginalized, socially excluded and/ or under served. The Member Association of Mali has made a concerted effort to expand its contraceptive distribution and to improve its data collection system in recent years. Its efforts have paid off: in 2007 it distributed a total of 286,820 contraceptive supplies, an increase from 2006 of over 190,000 contraceptives.

AMPPF has expanded the scope of its services to meet the sexual and reproductive health needs of its target group, particularly young women and men. Services provided by the Member Association include: sexual and reproductive health counselling; information, education and behaviour change communications; neonatal care; gynaecological care; prevention and management of HIV and AIDS, in particular voluntary counselling and testing; post-abortion care; and family planning. In addition, the Member Association provides capacity building and clinical training to other non-governmental organizations.

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Challenges While AMPPF has achieved a number of successes, it has to deal with other challenges: poor access to sexual and reproductive health services, particularly among the poor, a maternal mortality ratio of 1,200, low modern contraceptive prevalence of 6 per cent, and a total fertility rate of 6.6 children per woman.

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Mali 53

Strategic direction

The Strategic Plan 2005–2010 aims to improve the living conditions of the Malian people by providing quality services within the framework of the IPPF Strategic Framework.

Year of membership

1975

Members of governing body 6 (including two young people) Staff

52

Volunteers

600

CBDs

627

Members of YAM

400

Peer educators

608

Service delivery points

6 branches, 9 clinics

VCT sites

3

Youth centres

1

AMPPF provides capacity building and clinical training to other non-governmental organizations.

Advanced workplace strategy 19 Partnerships

Government: Ministers of Planning, Health, Youth and Sports, Family NGOs: Population Service International (PSI), Conseil de Concertation et d'Appui aux ONGs, Federation Nationale des Associations de Santé Communautaire au Mali (FENASCOM), Association de Recherche, de Communication et d'Accompagnement à Domicile des Personnes vivant avec le VIH/SIDA (ARCAD), Sida Donors: WHO, USAID, UNFPA Networks: Member of the National Federation of Health Associations; Member of the NGO Coordination Committee in Mali CCM: Member Private sector: Groupe Pivot Santé Population

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54 IPPF in Africa

Mauritius Mauritius Family Planning and Welfare Association 30 SSR Street, Port-Louis tel +230 2114101 fax +230 2082397 email mfpa@intnet.mu

The daring advocates The Mauritius Family Planning and Welfare Association (MFPWA) has long been a pioneer in addressing the sexual and reproductive health needs of the people. As the government was struggling to come up with a viable public system to address population concerns in the 1950s, an active group of family planning advocates was already providing family planning services to women. In order to advocate and deliver their services more effectively, these advocates formed MFPWA in 1957.

The Member Association of Mauritius now provides a wide range of sexual and reproductive heath services in its clinics and drop-in centre in Port Louis. It serves the needs of sexually abused children, elderly and disabled people, and marginalized groups on Rodrigues Island. Any young person, woman or man can come to one of the Member Associations’ service outlets and benefit from services that include: family planning, prevention and management of sexually transmitted infections (STIs), including voluntary counselling and testing; support for people living with HIV and AIDS; infertility management; prenatal and postnatal care; post-abortion care; and screening of cancers of the reproductive systems. Using peer educators, MFPWA also runs an outreach programme that targets hotels, Export Processing Zones (EPZs), popular tourist hot spots and local communities. Due to the increased demand for its services, the Member Association has decided to set up two more clinics – a geriatric clinic to cater for the needs of the elderly and a diabetic and sexual health clinic to address issues such as sexual dysfunction.

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From delivering services, to advising the government on family planning policy MFPWA’s success is reflected in its client base. In 2006, the Member Association served 220,000 clients, providing a total of 348,742 services and distributing 112,697 contraceptive supplies. The Member Association has been increasing its collaboration with the national government and now receives regular political and financial support. The Member Association of Mauritius plays a critical role in integrating family life education into the national school curriculum and recently its advocacy efforts also paid off in the parliamentary sphere, with the successful passage of the HIV/AIDS Bill in parliament.

Challenges MFPWA has identified unmet need as one of its main challenges in years ahead. Nearly half of women of childbearing age do not use a modern contraceptive method, leaving many women without access to the supplies they need and want, and many women even unaware that they exist.

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Strategic direction

To be the leader in the provision of quality sexual and reproductive health care to all segments of Mauritian society through various strategies including education, research, training, advocacy, demonstration of best practices and provision of clinical services.

Year of membership

1959

Members of governing body 14 (including seven women) Staff

30

Volunteers

550 (including 240 women)

Members of YAM

10

Service delivery points

1 branch, 2 clinics

VCT sites

1

Youth centres

2 (one has clinical services)

Partnerships

Government: Ministry of Health and Quality of Life, Ministry of Women’s Rights, Child Development and Family Welfare, Ministry of Youth and Sports, Ministry of Social Security

Using peer educators, MFPWA runs an outreach programme that targets hotels, Export Processing Zones (EPZs), popular tourist hot spots and local communities.

NGOs: Mauritius Council of Social Service, Mauritius Alliance of Women, PILS (People living with AIDS), SOS Pauvrete, National Women Council, Senior Citizen Council, Link Donors: Indian Ocean Commission, UNFPA CCM: Member of the UN AIDS group Networks: MACOSS Collectif Arc-En-Ciel, Mauritius Council of Social Service, Mauritius Alliance of Women

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56 IPPF in Africa

Mozambique Associação Moçambicana para o Desenvolvimento da Família P.O. Box 1535, Tanzania Avenue, Maputo tel +258 1 405109 fax +258 1 405149 email amodefa@virconn.com

Increasing choices for the people of Mozambique

Serving clients and informing policy

In 1989, the formation of the Associação Moçambicana para o Desenvolvimento da Família (AMODEFA) heralded a new beginning for the people of Mozambique, who were in dire need of family planning services. AMODEFA has expanded its scope from family planning to comprehensive sexual and reproductive health services. Currently, the Member Association is offering family planning; emergency obstetric care; prenatal and postnatal care; and prevention and management of HIV and AIDS by providing care and support through community clinics and home-based care approaches in five of the country’s 11 provinces.

Targeting young people, pregnant rural women, people living with HIV and AIDS and affected family members, AMODEFA’s presence has been felt by many people across the country.

The success registered so far is demonstrated by the thousands of clients who gain from the Member Association’s services. In 2007, AMODEFA served 27,331 clients, many of whom are poor, marginalized or socially excluded. The Member Association has also played a pivotal role in advising the government on the development of the National Adolescent and Youth Reproductive Health Policy, which was integrated into the National Reproductive Health Policy.

In 25 private sector sites, the Member Association raises awareness around HIV and AIDS related stigma and discrimination, and provides information on where sexual and reproductive health services are available. AMODEFA also offers technical support to the private sector in developing HIV and AIDS workplace policies as well as the provision of family planning as part of its outreach services.

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Challenges The prevailing sexual and reproductive health situation in Mozambique remains daunting. The maternal mortality ratio is 1,000, unmet need for contraceptives is 22.5 per cent, and the HIV prevalence among adults is 16.1 per cent. Although the use of modern contraception in Mozambique increased fourfold in less than a decade – from 5 per cent in 1997 to 21 per cent in 20034 – there is still much work to be done.

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Strategic direction

The Strategic Plan 2005–2009 is in line with IPPF’s five strategic areas of: Adolescents and young people, HIV and AIDS, Abortion, Access and Advocacy.

Year of membership

2002

Members of governing body 5 Staff

27

Volunteers

450

CBDs

86

Members of YAM

250

Peer educators

300+

Service delivery points

5 branches, 2 clinics

Youth centres

1

Partnerships

Government: Ministry of Health, Ministry of Youth and Sport, Ministry of Education, Ministry of Women and Social Action

AMODEFA has played a pivotal role in advising the government on the development of the National Adolescent and Youth Reproductive Health Policy.

NGOs: National HIV/AIDS Council Private sector: ECOSIDA (Enterprises against HIV/AIDS) Donors: UNFPA, WHO, Africa Sweden Group, WFP CCM: Member of Sector Wide Approach Committee Networks: MONASO (Network for Organizations working on HIV/AIDS), Member of the National HIV/AIDS Council, International Baby Food Action Network (IPFAN)

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Namibia Namibia Planned Parenthood Association P.O. Box 10936, Khomasdal, Windhoek tel +264 61 230250 fax +264 61 230251 email nappa1@iway.na

Using advocacy to change lives

Making the message matter

Established in 1996, the Namibia Planned Parenthood Association (NAPPA) is improving access to sexual and reproductive health services, especially for the poorest and most marginalized people, by advocating such provision from a human rights perspective. The Member Association excels in delivering effective advocacy messages to the public and key stakeholders and implementing comprehensive educational programmes for young people.

In 2007 NAPPA reached an estimated 50,000 people with informational and educational materials on sexual and reproductive health and rights matters, greatly improving the sexual and reproductive health of many young people.

The Member Association of Namibia provides intensive peer education programmes at its multi-purpose youth resource centres, where young people receive information about a wide range of issues such as family planning, adolescent pregnancy and the prevention and management of sexually transmitted infections, HIV and AIDS. NAPPA provides information, education and communication (including sexuality education) to married and unmarried young people, young people in and out of school, young people living with HIV and AIDS, young people under 12 years of age, gay, lesbian and bisexual young people, socially excluded groups, and the parents and guardians of young people. Clinical services are limited, but the Member Association does distribute condoms and counsellors are available for one-to-one consultations about family planning, abortion, sexually transmitted infections and HIV, and alcohol and drug abuse. In collaboration with other organizations, the Member Association carries out public awareness-raising campaigns and advocates with high level policy- and decisionmakers for increased resources to combat gender-based violence and to liberalize restrictive abortion laws.

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Challenges There are significant challenges to achieving good sexual and reproductive health in Namibia. The HIV prevalence among adults of reproductive age is 19.6 per cent. Fifty-five per cent of those infected are women. At least 300 women are dying for every 100,000 live births, and the total fertility rate among the poorest fifth of the population – at six children per woman – is more than double the fertility rate of the richest fifth. Inequities suffered by poor and marginalized groups are an affront and a violation of human rights that the Member Association is determined to bring to an end.

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Namibia 59

Strategic direction

Promotion of sexual and reproductive health as a human right and active participation of young people at all levels as well as fulfilling the needs and rights of under-served young people, both in and out of school.

Year of membership

1997

Members of governing body 9 (including one young person) Staff

10

Service delivery points

7 branches

Youth centres

1

Partnerships

Government: Ministry of Health NGOs: Physically Active Youth, Lironga Eparu (for people living with AIDS), churches Donors: UNAIDS Networks: Adolescent-Friendly Health Services, National Working Group on Female Condom, National Network of Aids Services, Namibia Non Governmental Forum, Namibia National AIDS Network

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NAPPA provides information, education and communication (including sexuality education) to married and unmarried young people, young people in and out of school, young people living with HIV and AIDS, young people under 12 years of age, gay, lesbian and bisexual young people, socially excluded groups, and the parents and guardians of young people.

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Niger Association Nigerienne pour le Bien-ĂŠtre Familial Boulevard Mali Bero, Face Ambassade du Canada, BP 13174, Niamey tel +227 20 75 38 01 fax +227 20 75 38 01 email anbef@intnet.ne

A cornerstone of the Nigerien community

Successes registered

Established in 1996, the Association Nigerienne pour le BienĂŠtre Familial (ANBEF) started off by meeting the family planning needs of women and young people, before moving to the provision of comprehensive sexual and reproductive health services. Through its integrated clinics in Niamey and Tillaberi and the youth communication and listening centres, the Member Association provides sexual and reproductive health information and other services to street children, sex workers, young people under 25 years of age, men and women of child-bearing age and rural populations. The Member Association also provides services that include prevention and management of HIV and AIDS; post-abortion care in its clinics and health huts in rural areas; prenatal and postnatal care; treatment of male and female infertility; premarital counselling; and training of young people on income-generating activities.

In 2006, ANBEF served more than 32,832 clients, of whom 20,684 were classified as poor, marginalized, socially excluded and/or under-served. Another 2,614 clients received services at the Member Association’s voluntary counselling and testing centres.

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Challenges Niger has some of the worst sexual and reproductive health indicators, and these are likely to affect the work of ANBEF. These include a high maternal mortality ratio of 1,600, total fertility rate of 7.1, and 5 per cent modern contraceptive prevalence.

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Niger 61

Strategic direction

To sustain its contribution to the improvement of the living conditions of the family unit by playing a supportive and complementary role to government in improving sexual and reproductive health indicators around family planning, improving the sexual and reproductive health needs of young people, preventing sexually transmitted infections, HIV and AIDS, and contributing to poverty reduction among women, girls and boys through the promotion of income-generating activities.

Year of membership

1998

ANBEF provides sexual and reproductive health information and other services to street children, sex workers, young people under 25 years of age, men and women of child-bearing age and rural populations.

Members of governing body 12 Staff

40

Volunteers

886

CBDs

4

Members of YAM

150

Peer educators

150

Service delivery points

8 branches, 2 static clinics, 4 mobile units

Youth centres

4

Partnerships

Government: Technical Committee for the development of the national ICPD+10 report NGOs: CARE International, FCI Donors: UNFPA, IDA/World Bank (multi-sector programmes) Networks: Réseau d’Eraducation des Fistules; Réseau National des Organisations et des Associations de Population et Développement; Réseau des Acteurs Intervenants dans la Lutte Contre le Sida et les Infections Sexuellement Transmissibles; Réseau des Organisations Non Gouvernementales et des Associations qui Interviennent dans le domaine de la Santé Sexuelle et Reproductive des Jeunes et Adolescents, Central Pharmacy

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Nigeria Planned Parenthood Federation of Nigeria 4 Baltic Crescent, Maitama, Abuja tel +234 9 7809438/8033048146, email ppfn@ippf.org web www.ppfn.org

Standing tall among service providers

Trusted member of the community

The Planned Parenthood Federation of Nigeria (PPFN) is the leading service provider of sexual and reproductive health care in the country. Established in 1984, PPFN’s services now account for about 10 per cent of all family planning services delivered in Nigeria.

Through its network of static and mobile clinics, and through outreach visits, in 2007 the Member Association of Nigeria provided an outstanding 1,125,894 services. An estimated 90 per cent of its clients are poor, marginalized, socially excluded and under-served. A respected and known leader in sexual and reproductive health throughout the country, PPFN is trusted by the Nigerian people and benefits from political and financial support from the government.

PPFN provides a comprehensive range of sexual and reproductive health services, including: infertility diagnosis and counselling; voluntary counselling and testing; post-abortion care; prenatal and postnatal care; education and counselling on sexually transmitted infections including HIV and AIDS; and pregnancy testing. The Member Association’s target groups are sex workers, female students, people working at or visiting markets, and people living with HIV and AIDS. PPFN trains its volunteers and staff as well as the staff of other agencies on the delivery of these services to ensure a uniformly high quality of care that is consistent with good practice and current technology.

The Member Association has also established a clinic to cater specifically for people living with HIV and AIDS, and peer educators conduct community outreach visits to workplaces, markets and village centers to raise awareness about sexual and reproductive health issues and to distribute condoms.

PPFN is also a member of the PACNet, a network of organizations advocating for safe abortion, positive policies and laws.

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Challenges The high maternal mortality ratio of 800, modern contraceptive prevalence of 8 per cent, and HIV prevalence of 3 per cent among men and 4.7 per cent among females are some of the continuing challenges PPFN has to deal with.

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Strategic direction

The Strategic Plan is in line with IPPF’s five strategic areas of Adolescents and young people, HIV and AIDS, Abortion, Access and Advocacy.

Year of membership

1967

Members of governing body 14 (including two young people) Staff

110

Volunteers

774

Members of YAM

350

Service delivery points

6 regional offices, 34 state branches, 58 clinics

Youth centres

9

Partnerships

Government: PPFN is officially recognized by the Federal Government and is provided with grants and accommodation as well as exemption from some taxes and import duties. SACA Ondo Abia and Enugu States finance PPFN projects, mostly in AIDS and community outreach services

PPFN trains its volunteers and staff as well as the staff of other agencies on the delivery of services to ensure a uniformly high quality of care that is consistent with good practice and current technology.

NGOs: Strategic Pathway to Reproductive Health Commodity Security (SPARHCS), the Population Technical Working Group, National Technical Working Group for the intergration of HIV/AIDS with Reproductive Health Private sector: Central Bank of Nigeria, National Agency for the Control of AIDS, HIV/ AIDS Prevention and Care, Society for Family Health, Allied Products Plc, Nigeria Breweries Donors: UNDP, Global HIV/AIDS Initiative Nigeria, Pathfinder Nigeria, Global Fund, Country Coordinating Mechanism CCM: Nigeria Country Coordinating Mechanism Network: Network forum on sexual and reproductive health and rights in Nigeria, PACNet, Network of Nigeria NGOs for Population and Reproductive Health (NiNPREH)

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Rwanda Association Rwandaise pour le Bien-Être Familial BP 1580, Kigali tel +250 576127 fax +250 572828 email arbef@rwanda1.com

Serving the people with resilience Since it was founded in 1986, the Association Rwandaise pour le Bien-Être Familial (ARBEF) has been a stronghold of the community and is known for its unfailing commitment to the people it serves. Even in times of conflict, the Member Association has sustained its family planning and reproductive health services for the people of Rwanda.

Currently, the sexual and reproductive health services offered include: prenatal and postnatal care; family planning; diagnosis and treatment of sexually transmitted infections; prevention and management of HIV and AIDS which includes voluntary counselling and testing services. The Member Association’s target groups are young people who are in and out of school, young people living with HIV or AIDS, women and underserved communities. Through ARBEF’s extensive peer education programme, young people are sensitized, educated, and guided on sexual and reproductive health issues, and their access to condoms is increased. The Member Association also focuses on advocating for favourable sexual and reproductive health policies and their implementation. Besides this, ARBEF assists the government to deliver services on programmes such as safe motherhood, and has worked with the private sector to draft workplace policies on HIV and AIDS.

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Raising priority for family planning at the highest levels The results of ARBEF’s efforts have been inspiring. In 2007, ARBEF served nearly 80,000 clients, an estimated 85 per cent of whom were poor, marginalized, socially excluded or under-served. Through successful advocacy activities, the Member Association of Rwanda has raised the priority of family planning and persuaded the President of Rwanda and other senior government officials to seriously consider national funding and support for sexual and reproductive health and rights.

Challenges There is, nevertheless, still a lot of work to do in Rwanda.

The maternal mortality ratio stands at 1,400, not a great surprise considering that only 31 per cent of births are attended by skilled health personnel and only 4 per cent of women use modern contraceptive methods. The total fertility rate is 5.2 children per woman and there are a high number of teenage pregnancies. In addition, women’s health and rights are severely compromised by restrictive legislation on abortion.

All this adds up to a significant strain on ARBEF’s resources.

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Strategic direction

To reduce unwanted pregnancies, unsafe abortion, HIV prevalence, high maternal and infant mortality, eliminate gender-based violence and work towards providing a favourable environment for young people to access services and information about sexual and reproductive health.

Year of membership

1988

ARBEF visits women at home to provide antenatal and postnatal care services as part of its safe motherhood programme.

Members of governing body 10 Staff

57

Volunteers

807 (including 381 women)

CBDs

8

Members of YAM

60

Peer educators

4

Service delivery points

1 branch, 8 clinics

VCT sites

4

Youth centres

1

Partnerships

Government: Minisante Private sector: APELAS NGOs: HIV/AIDS forum, Profemme Twese Hamwe, Family Health International Donors: IPPF Japan Trust Fund for HIV, UNFPA, USAID, IMPACT Rwanda Networks: NGO HIV/AIDS forum; High Council of Press for the Regularization of Media in Rwanda

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Sénégal Association Sénégalaise pour le Bien-Être Familial No. 5 Route du Front de Terre, BP 6084, Dakar tel +221 824 2561/62 fax +221 824 5272 email asbefdk@sentoo.sn

Triumphing over the odds The Association Sénégalaise pour le Bien-Être Familial (ASBEF) is seen by many poor and marginalized Senegalese as an important resource for sexual and reproductive health. Since its formation in 1974 to counter the family planning challenges facing Senegal, the Member Association has expanded rapidly and now offers services in 10 of the country’s 11 regions.

Although it has a limited number of clinics, ASBEF has a solid reputation and is widely respected by government departments and other non-governmental organizations, including many health care service providers which refer their clients to ASBEF’s facilities. The Member Association is also deeply involved in advocacy to promote gender equality and improve the socioeconomic status of women and young people.

In its clinics and youth centres, a variety of services are offered to young people, poor people, women and men, including: family planning; prenatal and postnatal care; prevention and treatment of sexually transmitted infections (STIs); screening of cancers of the reproductive system; post-abortion care; and infertility diagnosis and counselling. ASBEF runs an outreach programme where peer educators visit workplaces to provide counselling and other sexual and reproductive health services.

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Ensuring that sexual and reproductive rights are enshrined in policy and action All this work has improved service delivery to ASBEF’s many clients. In 2007, the Member Association provided 112,773 services. The Member Association has also made significant contributions to the development of the Declaration of a National Population Policy (1988), the National Health Policy (1989), and the National Family Planning Programme (1991).

It also made presentations on behalf of the government and civil society at the International Conference on Population and Development in 1994 and the Beijing World Conference on Women in 1995.

Challenges Nevertheless, there are many stubborn challenges. A weak health system that has insufficient personnel as well as limited facilities is in part to blame for the country’s high maternal mortality ratio, its low modern contraceptive prevalence (8 per cent) and a fairly high total fertility rate of 4.5. Although the Member Association plans to extend its services further into rural areas, most of the services are currently concentrated in urban or peri-urban areas because of funding difficulties.

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Sénégal 67

Strategic direction

Holistic focus on sexual and reproductive health, with emphasis on young people and gender equality. Currently developing a new strategic plan that is in line with the IPPF Strategic Framework.

Year of membership

1981

Members of governing body 13 (including one young person) Staff

61 (including one young person)

Volunteers

312

Peer educators

1

Service delivery points

10 branches, 7 clinics

Youth centres

1 (offers clinical services)

Partnerships

Government: Ministry of Health

ASBEF runs an outreach programme where peer educators visit workplaces to provide counselling and other sexual and reproductive health services.

NGOs: Association Adama, Association Aamut Flash, Association Abcom, Ressip Donors: Alliance Nationale Contre le Sida, Sida Service, Global Fund, Interact, GRET Networks: Consortium des ONG d'Appui au Développement, SIGGIL JEGEEN (Against Gender Violence)

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Sierra Leone Planned Parenthood Association of Sierra Leone P.O. Box 1094 Freetown tel +232 22229139 email ppasl@sierratel.sl

Making women’s lives a priority

With services available, demand is growing

When it was established in 1959, the main task of the Planned Parenthood Association of Sierra Leone (PPASL) was to help counter unmet need for contraceptives by assisting women to access family planning methods and services. Civil conflict and complex socio-cultural factors affecting women’s rights and health have inspired the Member Association to expand the scope of its work.

PPASL has seen demand for its services grow steadily. In 2007, the Member Association distributed nearly 100,000 contraceptive supplies, including 73,000 condoms, which is 12,000 more than were distributed in 2006. Eighty per cent of its clients are estimated to be poor, marginalized, socially excluded and/or under-served.

The Member Association of Sierra Leone offers comprehensive sexual and reproductive health services that target young people in particular, as well as pregnant women, fishermen, community leaders, police and army personnel, and Muslim and Christian groups. Services provided include: family planning; counselling on various sexual and reproductive health issues; and information, education and behaviour change communication materials. Adolescent sexual and reproductive health services are offered in youth and outreach centres by peer educators.

The other core work of PPASL is to advocate for sexual and reproductive rights, particularly of young people, and to reduce maternal mortality and morbidity by implementing a safe motherhood model clinic. This maternal health initiative involves upgrading the knowledge, skills and equipment of traditional birth attendants and healers.

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Challenges The staggering maternal mortality ratio of 2,000; low modern contraceptive prevalence of 4 per cent, over 80 per cent of abortion procured unsafely, high total fertility rate of 6.5, and over 90 per cent prevalence of female genital mutilation among girls and women, are some of the major problems in the country that PPASL has to help solve.

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Strategic direction

PPASL strives to improve the sexual and reproductive health of men, women and young people by promoting and providing quality and affordable services and ensuring that human rights are upheld.

Year of membership

1968

PPASL distributes nearly 100,000 contraceptive supplies, including 73,000 condoms, annually.

Members of governing body 9 (including three women) Staff

40 (including 25 women)

Volunteers

274 (including 150 young people)

CBDs

9

Members of YAM

150

Service delivery points

4 branches, 4 clinics

VCT sites

1

Youth centres

3

Workplace outreach

MSSL, WFP, CARE–SL, HOSPICE, SWAASL, people living HIV or AIDS and their families, MYS, GOAL. Action for Development – SL and YWDO, chiefs and community members.

Partnerships

Government: Ministry of Health (Reproductive Health Unit), MEST, MYS, MODEP, Sierra Leone Armed Forces Hospital NGOs: Reproductive Health Service, CHASL, MSSL, National AIDS Secretariat/SHARP, Marie Stopes Society.

Donors: UNFPA, UNICEF, UNAIDS, Global Fund for HIV/AIDS, Plan International, Marie Stopes International, Sierra Leone Red Cross Society, ActionAid CCM: PPASL is a member Networks: MSWGAC, UNAIDS, Media Alliance, parliamentarians

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70 IPPF in Africa

South Africa Planned Parenthood Association of South Africa National Office, 81 Main Street, Nedbank Properties, Johannesburg tel +27 11 634 1500 fax +27 11 634 1501 email obvious.m@ppasa.org.za web www.ppasa.org.za

An evolving leader and advocate for sexual and reproductive health Since its establishment in 1932, the Planned Parenthood Association of South Africa (PPASA) has evolved each decade in response to the needs of its clients. In 1995, the Member Association was influential in the liberalization of abortion laws. At the moment, PPASA has placed priority on providing comprehensive sexual and reproductive health services to some key target groups: men who frequent shebeens (local and home-based beer halls) and football stadiums; school teachers, refugees, internally displaced persons, sex workers, former prisoners and newly married couples.

Services provided include: family planning, diagnosis and treatment of sexually transmitted infections; emergency contraception; pregnancy testing; voluntary counselling and testing; and community-based care. The Member Association also undertakes social mobilization and peer education through Department of Health clinics as part of its outreach programmes. Other activities involve disseminating information, education and communication in government provincial hospitals, while the youth arm collaborates with the Department of Health and the Ministry of Education in implementing the Men as Equal Partners programme in schools and communities. HIV positive clients serve on the PPASA advisory board.

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Serving poor and marginalized people In 2006, the Member Association of South Africa provided services across nine provinces and served tens of thousands of clients, many of whom are poor, marginalized, socially excluded and/or under-served. PPASA has also written a landmark advocacy policy on sexual and reproductive health, HIV and AIDS, and abortion that is also used by other organizations.

Challenges A host of challenges face PPASA. These include a countrywide HIV prevalence of 18.8 per cent, high teenage pregnancy rates, high incidents of rape, and the fact that nearly half of all women of childbearing age do not use modern contraceptives, mainly due to lack of access.

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Strategic direction

To influence, champion, and contribute to the development of sexual and reproductive health priorities and policies, and ensure that reproductive health rights are respected

Year of membership

1953

Members of governing body 7 (including two women and one young person)

Staff

285

Volunteers

55

Members of YAM

10

Service delivery points

9 branches, 3 clinics

VCT sites

4

Youth centres

4

Partnerships

Government: The Government of South Africa provides financial and political support for PPASA and its work, and PPASA works closely with the Mbabazane Department of Health

The youth arm of PPASA collaborates with the Department of Health and the Ministry of Education to implement the Men as Equal Partners programme in schools and communities.

NGOs: Community Chest Private sector: South Africa Breweries (SABS), Shoprite Donors: Henry J. Kaiser Family Foundation, Advocacy Initiatives, Health Systems Trust, Bill and Melinda Gates Foundation, USAID, UNICEF, EU-SAPS, Global Fund Networks: NGO Coalition on HIV and AIDS, Integrated Development Plan Committee, AIDS Council, youth friendly services

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Swaziland Family Life Association of Swaziland P.O. Box 1051, Manzini tel +268 5053082/ 88 fax +268 5053191 email flas@africaonline.co.sz web www.flas.org.sz

Meeting the needs of young people for information and services

Ensuring that the needs of the most vulnerable are given priority

The Family Life Association of Swaziland (FLAS) has developed from simply being a provider of family planning services to providing comprehensive sexual and reproductive health programmes to young people, men and women. Many of its clients live in rural areas or are young people in and out of school. Established in 1979, the Member Association gives young people priority and ensures that the right to sexual and reproductive health is respected.

In 2007 FLAS delivered 140,521 contraceptive supplies and 77,613 services. Most of these services were provided to poor, marginalized, socially excluded and/or under-served clients. FLAS also advocates strongly with the government for greater priority and funding for sexual and reproductive health.

One of the Member Association’s sources of pride is a recording studio, based in one of the youth centres. Young people prepare informational and educational programmes at the studio and then share them with national radio stations for transmission or they are broadcast during outreach road shows conducted by the Member Association.

Services provided are prevention and management of HIV and AIDS; post-abortion care; prevention of mother-to-child transmission; voluntary counselling and testing; family planning; and treatment of sexually transmitted infections (STIs). Peer educators are used to reach marginalized groups during outreach visits. FLAS also provides peer education training to members of the Business Coalition Against AIDS initiative.

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Challenges Although 70 per cent of births are attended by skilled health personnel in Swaziland, 370 women are still dying of pregnancy or childbirth related causes for every 100,000 live births. Evidence suggests that access to health care is highly inequitable. For example, 41 per cent of married women in the richest fifth of the population use modern contraception, compared to only 13 per cent of women in the poorest fifth.

In a country with 25.9 per cent HIV and AIDS prevalence among adults aged 15–49 years, and as poor women and girls remain the most vulnerable to new HIV infection, FLAS is focused on increasing the availability of adequate sexual and reproductive health care and family planning to all women and girls, especially those who are poor and marginalized.

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Strategic direction

The Strategic Plan 2005–2009 is in line with IPPF’s five strategic areas of Adolescents and young people, HIV and AIDS, Abortion, Access and Advocacy.

Year of membership

1985

Members of governing body 7 (including two young people) Staff

42

Volunteers

230 (including 140 women)

Members of YAM

180

Peer educators

29

Service delivery points

2 branches, 4 clinics

VCT sites

7

Youth centres

2

Partnerships

Government: Ministry of Health, Ministry of Education, Ministry of Regional Development and Youth Affairs (MRDYA), Ministry of Women Affairs

The Member Association of Swaziland serves over 1,000 new clients every year.

NGOs: Swaziland National Youth Council (SNYC), Swaziland Health and Population Education (SHAPE), Population Services International (PSI), Swaziland National AIDS Programme (SNAP), NERCHA (the public relations arm of the GFATM), PACT Private sector: Media, Business Coalition Against HIV/AIDS (BCAHA), SWANNEPHA, a National network of organizations of PLWHA. FLAS is a member of the Sexual and Reproductive Health Steering Committee, Gender Consortium, Male Circumcision Task Force, HIV/AIDS consortium Donors: USAID Networks: Alliance of Mayors Initiative for Community Action on AIDS

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Tanzania Chama cha Uzazi na Malezi Bora Tanzania (UMATI) P.O. Box 1372, Dar es Salaam tel +255 (0) 22 2117774 fax +255 (0) 22 2139050 email infor@umati.or.tz web www.umati.or.tz

UMATI

Expanding services and scope of work

Established in 1959, Chama cha Uzazi na Malezi Bora Tanzania (UMATI) advocates for the right of couples to choose the number and spacing of their children, simultaneously bolstering its advocacy efforts to champion reproductive health rights among policy- and decision-makers.

The demand for these services has been on the rise each year.

In 2007, UMATI served nearly 300,000 clients, including over a thousand new clients. Eighty per cent of its clients were estimated to be poor, marginalized, socially excluded and/ or under-served. UMATI also works in partnership with the government and is consulted on sexual and reproductive health issues.

Since then, UMATI has been at the forefront in advocating for sexual and reproductive health and rights such as safe abortion and providing information, education and communication and other reproductive health services to its target groups of young people, people living with disabilities, AIDS orphans, people living with HIV and AIDS (PLWHAs), men and women.

The Member Association of Tanzania provides a wide range of family planning methods; screening for cancers of the reproductive system, such as cancer of the cervix, breast and prostate; infertility diagnosis and counselling; and treatment of sexually transmitted infections. Other services include voluntary counselling and testing and management of opportunistic infections. UMATI also operates a home-based care service and support group for PLWHAs. To ensure that its services incorporate the latest in recognized good practice, the Association has introduced Quality of Care protocols in four of its clinics.

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Challenges The maternal mortality ratio stands at 1,500. The fact that 21.8 per cent of married women have an unmet need for contraception, as well as the fact that only 36 per cent of births are attended by skilled health personnel (dropping to only 29 per cent among the poorest fifth of women), are partly responsible for this high number of women’s deaths. UMATI works tirelessly to reduce inequities in health and health care, to improve knowledge of sexual and reproductive health, and to increase access to services for young people, but there is always more work to be done.

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Strategic direction

UMATI has reoriented its Strategic Plan to embrace the concept of a broad sexual and reproductive health and rights agenda and to reflect UMATI’s desire to be a youth-focused organization that provides comprehensive and integrated services in line with the IPPF Strategic Framework.

Year of membership

1969

Members of governing body 12 (including two young people) Staff

120 (including five young people)

CBDs

8

Members of YAM

250

Peer educators

120

Service delivery points

13 clinics

VCT sites

9

Youth centres

4 (with clinical services).

Partnerships

Government: Ministry of Health

This young woman participates in UMATI’s vocational programme for teenage mothers who are excluded from school.

NGOs: Interact Worldwide (UK), Youth Incentives, AMREF Donors: JOICFP, GTZ, Sida, Youth Incentives, AMREF, Interact Worldwide CCM: Member

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Togo Association Togolaise pour le Bien-Être Familial 623, Rue de la Binah, Quartier Tokoin-Gbonvié, BP 4056, Lomé tel 00228 221 41 93 email atebefsiege@yahoo.fr/atbef@laposte.tg

Going further than ever before to provide services

Challenges

Formed in 1975, the Association Togolaise pour le Bien-Être Familial (ATBEF) has expanded the scope of its services from family planning to a wide range of sexual and reproductive health services. Its target groups are young people under the age of 25, internally displaced persons, women of childbearing age, commercial sex workers, young people living with HIV and AIDS, street children, drug users and rural populations. These groups – many of them marginalized and under-served in some way - benefit from reproductive health services that include youth-friendly services; voluntary counselling and testing; post-abortion care; prenatal and postnatal care; ultrasound screening; treatment of male and female infertility; and premarital counselling.

There are vast differences in the fertility rates between the rich and the poor in Togo. The total fertility rate of the richest fifth of women is 2.9, whereas among the poorest fifth of women it is 7.3. Among the richest fifth of women, 91 per cent of births are attended by skilled health personnel, compared to only 25 per cent among the poorest fifth. The inequities that these differences represent are perpetuated by the weak health system, which remains more accessible to some than others, and are further sustained by social, economic and cultural factors, including poverty, that impact on actual and desired fertility.

Focusing on the HIV prevention to care continuum The Member Association of Togo distributed over 350,000 contraceptives and delivered 283,425 services in 2007. The Member Association also provided about 10,500 HIV and AIDS services, including counselling, testing and treatment. ATBEF’s intensive advocacy activities in 2007 and years leading up to 2007 contributed to the liberalization of abortion laws.

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Most women use traditional methods of family planning, but there is substantial demand for modern methods.

There is a modern contraceptive prevalence of 11.5 per cent, but in fact 32.3 per cent of women have expressed an unmet need for contraceptives. ATBEF will persevere in its efforts to reduce inequity and to ensure that all women, men and young people have access to the services and supplies that they need and want.

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Strategic direction

To promote a Togolese society where every child is wanted, where every person enjoys good sexual and reproductive health, where people live free from the devastating effects of HIV/AIDS, and where all the basic rights of men and women are guaranteed.

Year of membership

1977

Members of governing body 9 Staff

46

Volunteers

748

Members of YAM

203

Peer educators

203

Service delivery points

5 branches, 5 clinics

Youth centres

2

Partnerships

Government: National Committee for Contraceptive Commodity Supply Security, National Committee for the Monitoring of the Bamako Declaration on the Reduction of Maternal and Neonatal Mortality – HIV Counselling and Testing Cluster

ATBEF will persevere in its efforts to reduce inequity and to ensure that all women, men and young people have access to the services and supplies that they need and want.

NGOs: FORUMSIDA, FONGTO Donors: Plan Togo, PNLS, UNICEF, Global Fund.

Networks: Association Sauvons le Monde (ASSAM), Youth and Adolescent HIV/AIDS Association (RAJES), National Youth Forum.

Networks: ANASO (HIV/AIDS Network), Women’s International Democratic Federation (FDIM), Women Network (Rede de Mulher)

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Uganda Reproductive Health Uganda P.O. Box 10746, Kampala tel +256 414 540665/58 email fpau@fpau.org web www.fpau.or.ug

Taking lead in redefining sexual and reproductive rights Established in 1957, Reproductive Health Uganda (RHU) (formerly the Family Planning Association of Uganda) provides services in 29 districts, targeting young people and marginalized groups. It offers family planning services; HIV and AIDS services; diagnosis and treatment of sexually transmitted infections; advocacy against female genital mutilation (FGM); and postabortion care. Its target groups are internally displaced persons, people who are vulnerable to HIV and AIDS, young women in areas that are affected by conflict, sex workers, hawkers, girls and women working in bars, bicycle taxi drivers and maids.

Reproductive Health Uganda delivers information and services through three service delivery models – static clinics, outreach visits, and community activities and events – in order to reach the broadest audience, including many people who are neglected by public services. RHU also runs a door-to-door programme designed to educate and mobilize clients to access services. This programme was spearheaded by peer educators and community-based reproductive health assistants, who include sex workers and people living with HIV and AIDS.

The Association was selected to serve as the lead agency to manage the private sector component of the Global Fund to fight AIDS, Tuberculosis and Malaria in 12 districts of Central and Eastern Uganda. And, in collaboration with African Women Ministers and MPs (Uganda Chapter), RHU has developed a strategic plan for advocacy around safe motherhood.

Challenges Challenges for RHU include an unmet need for family planning of 41 per cent, a national fertility rate of 6.7, an annual average of 435 women dying in pregnancy and childbirth for every 100,000 live births; an estimated 300,000 unsafe abortions every year, and between 50,000 and 100,000 cases of fistula.

The disparities between the rich and poor, of those who access health care and those who do not, is significant, and there remains a lot of work to do to ensure that all women, men and young people have access to sexual and reproductive health services and can exercise their rights.

As well as provision of services, RHU offers training to other non-governmental organizations and government health professionals. Beyond Uganda, the Member Association continues to provide technical assistance to other Member Associations such as those in Namibia, Sierra Leone, Swaziland, Rwanda and Tanzania.

A cornerstone of the sexual and reproductive health landscape RHU provided 1,205,000 services in 2007, including 62,054 HIV and AIDS services. It also distributed over a million contraceptive supplies. Of 607,000 clients served, an estimated 99 per cent are poor, marginalized, socially excluded or under-served. RHU plays a key role as part of civil society in advocating for strong political and financial support for sexual and reproductive health in Uganda. The Member Association sits on the government’s sexual and reproductive health advisory board and has played a key role in the development of the Gender Policy, the Adolescent Reproductive Health Policy, the Domestic Relations Bill and the Private Partnerships for Health policy guidelines.

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RHU offers services and counselling at a resettlement camp for orphans who lost their families during the war.

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Strategic direction

To address the unmet needs and demands for quality sexual and reproductive health services and promote sexual and reproductive rights, with the primary focus on the young people aged 10–24 years.

RHU’s work places special emphasis on the challenges facing girls and women and employs an approach that recognizes the human rights of all clients, staff and volunteers.

Year of membership

1964

Members of governing body 9 Staff

117

Volunteers

3,895

CBDs

56

Members of YAM

848

Peer educators

118

Service delivery points

29 branches, 17 static clinics, 77 mobile clinics

VCT sites

4

Partnerships

Government: Ministry of Health; Ministry of Finance and Economic Planning, Parliamentary Forum on HIV/AIDS Committee, National Association of Women Members of Parliament, local district administrations Private sector: Micro Uganda Limited, Population Services International Media: New Vision, The Monitor, The Weekly Observer, Capital Radio, Radio Simba, Star FM, Supper FM, Top Radio, CBS, Impact FM, Uganda Broadcasting Corporation TV, Nation TV, Top TV Donors: UNFPA, NORAD, Plan International, CIDA, DFID, Netherlands Trust Fund, IPPF Japan Trust Fund for HIV, Earnest Kleinworth Charitable Foundation, John Snow Inc, Research and Training Africa Youth Alliance, USAID, Korean Embassy/ KOICA, IPPF Korea Africa Fund, Chinese Embassy, Pathfinder International, Save the Children Uganda, WHO Networks: Uganda Network for AIDS Services Organizations, Uganda Reproductive Health Adolescent Network, National Forum for People having HIV/AIDS Networks in Uganda, National NGO Forum

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Zambia Planned Parenthood Federation of Zambia P.O. Box 32221, Lusaka tel +260 211 256182/256283 fax 260 211 256123 email ppaz@zamtel.zm

Turning possibilities into realities From humble beginnings in 1972 as the main source of family planning services in the country, the Planned Parenthood Federation of Zambia (PPFZ) has evolved into an admirable organization that offers comprehensive sexual and reproductive health services. Currently, the Member Association is integrating gender and empowerment perspectives in its HIV prevention programme, which targets young people through the Young Men as Equal Partners project and the Participatory Behaviour Change Communication project that works in the community and among students in the districts of Kasama and Nakonde.

Although it provides a comprehensive range of sexual and reproductive health services and advocates broadly for sexual and reproductive rights, the Member Association of Zambia makes HIV and AIDS prevention, care and treatment one of its key priorities and areas of work.

Services provided include: family planning; voluntary counselling and testing; treatment of sexually transmitted infections (STIs); prenatal and postnatal care; emergency contraception; laboratory tests; ultrasound screening; and screening for cancer of the cervix. A community-based distribution programme in the Copper belt provides maternity services and trains employees of other non-governmental organizations in all aspects of high quality service delivery for pregnancy, delivery and postnatal care. PPFZ is also implementing peer education and parent-elder education projects.

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Delivering information, communication and education to young people PPAZ distributed 171,607 contraceptives in 2006. It served 240,000 clients, of whom an estimated 180,000 were poor, marginalized, socially excluded and/or under-served. Over 5,000 young people received information and/or education on gender, empowerment and HIV and AIDS.

Challenges In approximately a decade, the use of modern contraceptives more than doubled, from 9 per cent in 1992 to 25 per cent in 20014. The progress is encouraging, but there is still an unmet need for contraception among married women of 28 per cent; among young people and unmarried women the level of unmet need is not known. Without contraception, many women face unwanted pregnancies, and the health and education of mothers and children are compromised. In fact, maternal mortality has reached 750 per 100,000 live births. Though the challenges are significant, the Member Association of Zambia remains focused on serving its clients and expanding services to those who need them most.

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Strategic direction

The Strategic Plan is designed to contribute to the improvement of sexual and reproductive health and rights and a reduction in the prevalence of HIV and AIDS, in alignment the IPPF Strategic Framework.

Year of membership

1978

The Member Association of Zambia makes HIV and AIDS prevention, care and treatment one of its key priorities.

Members of governing body 9 Staff

35

Volunteers

1,300

CBDs

233

Peer educators

398

Service delivery points

38 branches, 2 clinics

VCT sites

3

Youth centres

1

Partnerships

Government: National Technical Population Committee, Reproductive Health Subcommittee NGOs: Youth Vision Zambia, Zambia Youth Development Council, Youth Media, Afya Muzuri, District AIDS Task Forces, Plan International Donors: Care International, UNICEF, JOICFP, Forum SYD, RFSU, IPPF Japan Trust Fund for HIV Private sector: Africare (Zambia Emory HIV project), Shelter Africa, Action Africa Networks: Africa Directions for Children in Need (open discussion, drama and debate), Non-Governmental Organizations’ Coordinating Council (NGOCC), Zambia White Ribbon Alliance for Safe Motherhood

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Glossary BMZ

Government of Germany

CBD(s)

Community-based distributor(s)

CCM

Country coordinating mechanism for the Global Fund (see below)

Danida

Danish International Development Agency

DFID

United Kingdom Department for International Development

EC

European Commission

FCI

Family Care International

FHI

Family Health International

Global Fund

Global Fund to Fight AIDS, Tuberculosis and Malaria

GTZ

German international cooperation enterprise

JICA

Japanese International Cooperation Agency

JOICFP

Japanese Organization for International Cooperation in Family Planning

NACA

National Agency for the Control of AIDS (Nigeria)

NGO

Non-governmental organization

PATH

Programme For Appropriate Technology in Health

PNLS

National Programme for the Fight against AIDS/ Programme National de Lutte contre le SIDA

PPFAI

Planned Parenthood Federation of America international

PSI

Population Services International

RFSU

Swedish Association for Sexuality Education

Sida

Swedish International Development Cooperation Agency

UNDP

United Nations Development Programme

UNFPA

United Nations Population Fund

UNAIDS

The Joint United Nations Programme on HIV/AIDS

UNHCR

United Nations High Commission for Refugees

UNICEF

United Nations Children’s Fund

USAID

United States Agency for International Development

VCT

Voluntary counselling and testing for HIV

Young people

Under 25 years of age

YAM

Youth Action Movement

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IPPF in Africa 83

Though she was told to stop having sex with her husband after she discovered she was HIV positive, Genevieve consulted the Cameroon National Association for Family Welfare for counselling, support and services. She learned that it was still possible to live a full and normal life. Now she is the proud mother of four children, none of whom have HIV.

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84 IPPF in Africa

Bibliography 1. USAID (n.d.) Perspectives on Unmet Need for Family Planning in West Africa: Benin. Policy Project Briefing Paper. [Cited: 15 May 2008] www.policyproject.com/pubs/policymatters/BEN_UnmetNeedFP.pdf 2. Measure DHS (2004) Burkina Faso Demographic and Health Survey 2003 – Final Report. Chapter 12. www.measuredhs.com/pubs/pdf/FR154/12Chapitre12.pdf 3. World Health Organization (2007) Unsafe abortion: Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2003. 5th edition. New York: WHO. 4. Khan, S., Mishra, V., Arnold, F. and Abderrahim, N. (2008) Contraceptive Trends in Developing Countries.

Comparative Reports, MEASURE DHS. No. 16.

Country indicators and statistics found in the ‘Challenges’ sections of the Member Association profiles are from the following resources: Population Reference Bureau (2007) 2007 World Population: Data Sheet. Washington, DC: PRB. Population Reference Bureau (2008) Datafinder: Data by geography, country. [Online]. www.prb.org/Datafinder.aspx.

Population Reference Bureau (2008) Family Planning Worldwide: 2008 Data Sheet. Washington, DC: PRB.

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The International Planned Parenthood Federation IPPF is a global service provider and a leading advocate of sexual and reproductive health and rights for all. We are a worldwide movement of national organizations working with and for communities and individuals.

IPPF works towards a world where women, men and young people everywhere have control over their own bodies, and therefore their destinies. A world where they are free to choose parenthood or not; free to decide how many children they will have and when; free to pursue healthy sexual lives without fear of unwanted pregnancies and sexually transmitted infections, including HIV. A world where gender or sexuality are no longer a source of inequality or stigma. We will not retreat from doing everything we can to safeguard these important choices and rights for current and future generations.

IPPF Central and Regional Offices International Planned Parenthood Federation (IPPF) 4 Newhams Row, London, SE1 3UZ, United Kingdom tel +44 20 7939 8200 fax +44 20 7939 8300 email info@ippf.org web www.ippf.org Africa Regional Office (IPPF/ARO) Madison Insurance House, 1st Floor, Upper Hill Road/Ngong Road P.O. Box 30234 00100 – GPO, Nairobi, Kenya tel +254 2 2712672/2712820 fax +254 2 2726596 email info@ippfaro.org web www.ippfaro.org Arab World Regional Office (IPPF/AWR) 2 Place Virgile, Notre Dame, 1082 Tunis, Tunisia tel +216 71 847 344/71/792 833 fax +216 71 789 934/71/788 661 email speac@ippf.org.tn web www.ippfawr.org East & South East Asia and Oceania Regional Office (IPPF/ESEAOR) 246 Jalan Ampang, 50450 Kuala Lumpur, Malaysia tel +603 4256 6122/6246/6308 fax +603 4256 6386 email ippfklro@ippfeseaor.org web www.ippfeseaor.org European Network (IPPF/EN) Rue Royale 146,1000 Brussels, Belgium tel +32 (2) 2500950; Fax: +32 (2) 2500969 email info@ippfen.org web www.ippfen.org South Asia Regional Office (IPPF/SAR) IPPF House, 66 Sunder Nagar, New Delhi – 110003, India tel +91 11 24359221/2/3/4/5 fax +91 11 24359220 email info@ippfsar.org web www.ippfsar.org Western Hemisphere Regional Office (IPPF/WHR) 120 Wall Street, 9th Floor, New York, NY 10005, USA tel +1 212 248 6400 fax +1 212 248 4221 email info@ippfwhr.org web www.ippfwhr.org If you would like to support the work of IPPF or any of our national affiliates by making a financial contribution please visit our website at www.ippf.org or contact IPPF Central Office in London, UK. Photo credits Front cover: • IPPF/Chloe Hall/The Gambia Back cover: • IPPF/Neil Thomas/Cameroon Inside pages: P2 P11 P15 P21 P31 P35 P36

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IPPF/Freddy Meert/Democratic Republic of Congo Javier Navos/Burkina Faso IPPF/Neil Thomas/Cameroon IPPF/Chloe Hall/The Gambia IPPF/Chloe Hall/Ethiopia IPPF/Chloe Hall/The Gambia IPPF/Dale Cooper/Ghana

P43 P51 P65 P73 P78 P83

IPPF/Paul Bell/Kenya IPPF/Yuri Nakamura/Malawi IPPF/Jane Mingay/Rwanda IPPFARO/Swaziland IPPF/Paul Bell/Uganda IPPF/Neil Thomas/Cameroon

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From choice, a world of possibilities

From choice, a world of possibilities

IPPF in Africa Pioneers in sexual and reproductive health IPPF IN AFRICA PIONEERS IN SEXUAL AND REPRODUCTIVE HEALTH

Pioneers in sexual and reproductive health Published in October 2008 by the International Planned Parenthood Federation IPPF 4 Newhams Row London SE1 3UZ United Kingdom tel +44 (0)20 7939 8200 fax +44 (0)20 7939 8300 email info@ippf.org web www.ippf.org UK Registered Charity No. 229476

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Individual profiles highlight each Member Association’s strengths, its target audiences and priority issues, and the networks and national initiatives in which it is involved.

With a brief history and details of services provided – both the numbers and the range of services delivered – the reader gains an understanding of the reach of the Member Association into the communities in which it is based and the scope of its work. We hope that this series will be a valuable reference to IPPF Member Associations and our work around the world.

Designed by Engage Group www.engagegroup.co.uk

Printed on 75% recycled, chlorine-free paper, an NAPM approved recycled product.

The Pioneers in sexual and reproductive health series presents a broad overview of IPPF Member Associations in all of our six regions.

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