Annual Report 2010 by IPPF

Annual report 2010

Who we are

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.

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Contents

Letter from the Director-General

Abbreviations

01 Impact through family planning

02 More than just family planning

03 Vulnerable people, difficult places

04 Value for money

05 Going forward

Annex 1 References

Annex 2 Photo credits

Annex 3 Membership list

iv Annual report 2010

Letter from the Director-General Across the Federation, 2010 was a critical year in our institutional development. Through our service delivery, advocacy, comprehensive sexuality education, and our campaigns like ‘Criminalize Hate not HIV’, we have continued to make a tangible difference to people’s lives – particularly the poor and most vulnerable.

I will complete my five-year term in a few months, and hand over to our incoming DirectorGeneral Designate, Tewodros Melesse. My predecessor led the process to develop our Strategic Framework 2005–2015, and my successor will have the privilege of delivering it. The Strategic Framework introduced our focus on the 5’A’s – adolescents, HIV and AIDS, abortion, access, and advocacy – and situated us as an organization able and willing to take on some of the most pressing, and too often neglected, health issues in development. Some of our key achievements in the past five years, since I became Director-General, were described in our ‘Five Year Mid-Term Review’ published in 2010. Based on that review, we have developed a Results Framework which looks forward to what IPPF must achieve in the remaining years of the Strategic Framework. When I joined IPPF my vision was that by the end of 2011 the Federation would be a bolder, braver and stronger movement, a Federation of well-managed national Member Associations making a significant difference, individually and collectively, and supported by an effective Secretariat. There is much more to be done, but I believe we have made considerable progress towards this aim.

Bolder Through our essential package of sexual and reproductive health (SRH) services centred on family planning and increased provision of long acting reversible contraception, IPPF averted over 2.1 million unwanted pregnancies in 2010, by delivering over 8.3 million couple years of protection. We also provide much more than just family planning – for each contraceptive service we delivered, we also delivered another noncontraceptive sexual and reproductive health service. Our focus is on results; but today we are more committed than ever to providing essential SRH services to those who are poor and vulnerable, building institutions and local leadership, and working in the toughest and hardest-to-reach areas. That may mean some services can cost a little more, but are still good value. So we will continue to prioritize increasing access to clients in resource-poor settings, and supporting country ownership. Over the last five years, IPPF has transformed itself from an organization that works with youth to one that is focused on youth. Youth participation is a principle we pursue with passion – since 2005, the global number of SRH services we provide to young people increased four fold. We are optimistic that youth programming will grow in strength, particularly with the recent development of the ‘All One Curriculum’ in partnership with the Population Council. IPPF is an innovator in the field of HIV policies and programmes, in particular in the integration of HIV services into SRH. Our holistic integrated model of services decreases total healthcare costs, reduces stigma, and minimizes loss of patients through referrals. The Integra project sees us partnering with the London School of Hygiene and Tropical Medicine and the Population Council to help gather evidence to determine the costs and benefits of using different models for delivering integrated HIV and SRH services in high and medium HIV prevalence settings. We have also greatly strengthened our response to emergency situations resulting from conflict or natural disasters through the unique SPRINT Initiative, which has built the capacity of more than 4,300 humanitarian workers in the last two years to respond to SRH needs during crises.

Annual report 2010 v

Braver Our introduction of the Sexual Rights Declaration has provided a rights-based framework for increased service delivery and advocacy linked to issues such as men having sex with men, female genital mutilation, child marriage, sexual violence, sexual orientation, abortion and gender. The Declaration has been translated into 24 languages, which enables IPPF’s 153 Member Associations to integrate human rights in relation to day-to-day service provision and advocacy. We will continue to advocate for action on neglected and sensitive issues, even when others do not. The Global Comprehensive Abortion Care Initiative has strengthened the abortion-related services of many Member Associations and our global advocacy on this issue – an issue that remains highly politicized. Since 2005, our safe abortion services have increased ten-fold, and our advocacy efforts have resulted in 58 legislative and/or policy changes worldwide in support of safe abortion. Globally we have continued to build our leadership as an influential voice of civil society, with major advocacy initiatives linked to internationally agreed goals such as MDG5b, the MDG Summit and the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health (GSWACH), and raised awareness of regional strategies such as the Maputo Plan of Action.

Stronger Our Governing Council is committed to ensuring increased efficiency, effectiveness and accountability. In 2010, IPPF piloted a system to allocate resources to Member Associations on the basis of results rather than on inputs alone – we are committed to improving performance, demonstrating results, and achieving value for money. 2010 has also been an important year for IPPF as we redefined our Governing Council in size, following the transfer in 2008 of regional governance functions from Regional Councils to small Regional Executive Committees. This enables our governing structures to be more responsive and efficient. All this has been achieved in a particularly challenging environment of economic crisis, political uncertainty, vocal but also covert opposition, and competing development priorities such as climate change. I am confident that with strong new leadership, with the continued dedication of our volunteers and staff, and with reinvigorated donor support to deliver our GSWACH commitments, we will build on our achievements of the last five years and attain IPPF’s full and unique potential. It has been a pleasure and privilege to be part of that journey with the Governing Council, volunteers, staff, donors and critical friends. I thank you for your support, both as advocates for the issues which are so important to us all, and as funders who provided the resources to make this progress possible.

Dr Gill Greer Director-General, IPPF

vi Annual report 2010

Abbreviations ART

Antiretroviral Therapy

ARV

Antiretroviral Drug

CYP

Couple Years of Protection

DFID

Department for International Development for United Kingdom

ESEAOR

East & South East Asia and Oceania Region, IPPF

FGAE

Family Guidance Association of Ethiopia

FPAP

Family Planning Association of Pakistan

GBV

Gender Based Violence

GSWACH

United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health

HIV

Human Immunodeficiency Virus

ICPD

International Conference on Population and Development

IDP

Internally Displaced Person

IPPF

International Planned Parenthood Federation

Member Association

MDGs

Millennium Development Goals

MISP

Minimum Initial Service Package

PPFN

Planned Parenthood Federation of Nigeria

RDF

Results Driven Financing

RHU

Reproductive Health Uganda

RTI

Reproductive Tract Infection

SRH

Sexual and Reproductive Health

SRHR

Sexual Reproductive Health and Rights

STI

Sexually Transmitted Infections

UNFPA

United Nations Population Fund

USAID

United States Agency for International Development

VCT

Voluntary Counselling and Testing

WHR

Western Hemisphere Region, IPPF

Impact through family planning Annual report 2010 7

01 Impact through family planning IPPF averted over 2.1 million unwanted pregnancies in 2010, by delivering 8.3 million couple years of protection

In 2010, IPPF Member Associations provided 30 per cent more contraceptive services and non-contraceptive services compared to 2009

IPPF service delivery points attracted over 6 million new family planning users in 2010

IPPF provided an increased number of contraceptive and non-contraceptive services in 2010 Globally, we increased the number of contraceptive and non-contraceptive services in the last year by 30 per cent – from 33.9 million in 2009 to 43.8 million in 2010, and from 34.6 million in 2009 to 44.4 million respectively. While contraceptive services increased, the number of couple years of protection1 (CYP) marginally decreased to 8,308,427 (a slight reduction of 3,000 CYP). This apparent discrepancy is explained by IPPF’s growing strength in youth services – most young people choose shorter-acting over permanent methods.2 In response to our clients’ requests, IPPF is currently working on a strategy to roll out a wider range of longer-acting contraceptive methods across its service delivery network. These are often more appropriate for young people. These numbers illustrate the importance IPPF places on a comprehensive and holistic approach to service provision – for each contraceptive service we delivered, we delivered another noncontraceptive sexual and reproductive health (SRH) service. In the particularly important regions of sub-Saharan Africa and South Asia, Nigeria and Pakistan stand out as strong examples of the improvement of service provision. The IPPF Member Association in Nigeria was a key performer: (a) because clients from HIV and malaria programmes were also counselled for, and provided with, family planning services. This integrated model drove increased counselling numbers and also contraceptive uptake; (b) because services increased in rural areas where eight static clinics were converted into small hospitals complemented by an integrated training programme for service providers, peer educators and other community-based agents; and (c) because the Member Association improved reporting from outreach service-delivery points. Pakistan also saw a substantial increase in both contraceptive and noncontraceptive services provided, mainly because our Member Association actively responded to the unmet need in rural areas, and started providing services in 36 more static clinics (from 82 in 2009 to 118 in 2010).

IPPF continues to promote sustainability and choice through provision of quality family planning IPPF ensures that services are implemented on the basis of our Quality Assurance Package. This details how we deliver the integrated package of essential SRH services using a client-centred approach, in a way that is sensitive, observes privacy and confidentiality, and is respectful of sexual rights and of the needs of different populations (e.g. age, gender, sexual orientation). In order to ensure high quality of care, IPPF Member Associations provide professional training and development in sexual and reproductive health and rights (SRHR) to service providers. In 2010, nine out of ten Member Associations who provide clinical services had comprehensive quality of care assurance systems, using a rights-based approach.

1 One couple year of protection (CYP) is equivalent to one year of contraceptive protection for one couple. Calculating CYP reveals useful information about service delivery and impact. However, there is no globally agreed conversion method to calculate CYP. Hence, impact estimates vary significantly as a result of differing approaches. IPPF is fully supportive of the valuable work carried out by the Futures Group and USAID to develop a standard and improved CYP conversion model. Compared to other conversion models currently being used by the spectrum of organizations, IPPF’s conversion model actually under-estimates CYP. 2 Long-acting or permanent methods are equivalent to more years of couple protection than short-term methods.

8 Annual report 2010 Impact through family planning

Case study 1

Providing SRH services using a rights-based approach in Pakistan

addresses a disadvantaged woman’s sense of empowerment; in the eloquent words of Fatimaa, one of IPPF’s peer educators in Quetta, who is describing her encounter with Zeba a sex worker she had counselled:

“I later found Zeba at (IPPF’s) Drop-In IPPF provides contraceptive services in Centre. Her time with us had given her difficult environments often to people confidence to stand up for herself” marginalized by traditional health structures. Throughout our work, we maintain a focus on a rights-based In Northern Pakistan, FPAP works with approach. The work of the Pakistan women and girls who are coerced into Member Association, Rahnuma – Family forced marriages to compensate for crimes Planning Association of Pakistan (FPAP) committed by male members of their illustrates how we sensitively reach young family. This tradition of ‘swara’ is present women and girls with essential services, particularly in Pashtun communities in even in difficult security contexts. On the province of Khyber Pakhtunkhwa in the precarious Pakistani border with north-west Pakistan. In 2010, through the Afghanistan in the city of Quetta, FPAP Innovation Fund,3 the Member Association has distributed more than 200,000 provided these young women and girls condoms to female sex workers since April with much-needed SRH services through 2009. FPAP has worked through a Drop-In 120 mobile medical camps – over 14,000 Centre and via community outreach to contraceptive services and almost 20,000 brothels. Consequently, reported condom non-contraceptive services (including use at last sexual act has virtually doubled counselling and referrals). Over half the from 33 to 63 per cent among sex workers contraceptive clients were girls under 25, and their clients. Through this work, the thus helping to avert pregnancies among Member Association simultaneously young women – those who are most at reduces unintended pregnancy, STI risk of maternal mortality and morbidity and HIV transmission. This work also because of their age. Delivery of essential

services has been successfully combined with effective advocacy strategies with religious leaders and key stakeholders, culminating in a ground-breaking national conference in Islamabad (December 2010) where policy-makers, parliamentarians, the media, and service providers were brought together with survivors of coerced marriages, hearing their stories first-hand. This helped enlist stakeholders’ support to replicate the programme in other regions of Pakistan.

IPPF works closely with government partners to support their delivery of SRH services. We actively advocate for governments to increase their commitment to sexual and reproductive health and rights. Whenever and wherever governments successfully provide services, we strategically reallocate our resources to target other parts of the population who are in need and under-served. In 2010, the IPPF Member Associations in Brazil and India worked with their respective governments to strengthen health systems, and support increased responsiveness to SRHR within the public sector. In India, the government rolled out its National Rural Health Initiative in 18 states. This initiative includes the delivery of contraception to poor and vulnerable rural populations. Similarly in Brazil, the Ministry of Health increased its provision of contraceptives to municipalities. This has allowed the IPPF Member Association to withdraw its support. Now, the IPPF Member Association is beginning to redirect much-needed resources to poorer and less well-served parts of the country. In both cases the Member Associations are keen advocates for the government to take full responsibility for universal access to sexual and reproductive health services.

3 This project is funded by the Innovation Fund, part of IPPF’s core funding that fosters innovative initiatives in the Member Associations, supporting them to reach vulnerable populations.

Impact through family planning Annual report 2010 9

80 0 0 0 0

78 9, 4 32

10 0 0 0 0 0

1,059,149

120 0 0 0 0

600000

400000

5 47,9 8 9

There was a significant increase in the number of CYPs delivered overall in the Africa Region and the East & South East Asia and Oceania Region (ESEAOR). Major contributors to this increase were the Member Associations in Nigeria and Vietnam.

Figure 1: Increase in CYP in Africa and East & South East Asia and Oceania regions, 2009 to 2010

9 47,633

If we examine why IPPF’s CYP rate levelled off in 2010, it demonstrates the responsiveness of IPPF Member Associations to opportunity. For example, 2010 saw a 25 per cent increase in the number of condoms provided, from 152,397,194 to 190,094,648. This increase was partially due to the Vietnamese Member Association working in collaboration with the General Office for Population and Family Planning on a collaborative social marketing project – another example of good government interaction. It also demonstrates responsiveness to the needs of our clients. Another factor was that 2010 witnessed a substantial (26 per cent) increase in the number of services provided to youth compared to 2009. As noted earlier, young people are less likely to use long-acting and permanent methods (which contribute highly to CYP) as their family planning method of choice.

200000

0 09 10 Africa region

Case study 2

Improving access to family planning in Uganda The SRHR situation in Uganda remains poor. At 3.2 per cent, Uganda has one of the highest average annual population growth rates in the world, the maternal mortality rate remains high at 435 per 100,000 live births, and 6.4 per cent of people between 15–49 live with HIV. In addition, about a third of the population lives below the poverty line. It is within this context that the IPPF Member Association, Reproductive Health Uganda (RHU), provides services through 50 clinical centres, 74 mobile clinics and 900 community volunteers/workers. RHU also trains other non-governmental organizations and government health officials. RHU actively works to reach the most vulnerable sectors of the population by running a door-to-door client mobilization strategy. This is spearheaded by peer educators and community-based

reproductive health assistances (who include sex workers and people living with HIV/AIDS). Despite its size and scale as a large national service provider, advocate and educator, RHU tailors its programmes to meet the day-to-day challenges its clients face. On 8 January 2010, when Hillary Clinton, US Secretary of State, commemorated the 15th Anniversary of the ICPD, she chose to highlight RHU’s work with the Moonlight Stars. “[RHU works with a group of] teenage girls called the Moonlight Stars, their parents are dead, leaving them the sole providers for their younger brothers and sisters. [Through RHU] they gain access to condoms and comprehensive sexuality education to protect themselves from disease and pregnancy. They also take classes in sewing and knitting and other kinds of skills that could be used to support their siblings.” This engaged, sensitive and ultimately client-centred approach explains how RHU managed to distribute nearly 1.5 million contraceptives in 2010 and why almost two-thirds of RHU’s 680,000 SRH services were received by young people.

09 10 East & South East Asia and Oceania region

10 Annual report 2010 More than just family planning

02 More than just family planning 1 in 3 of the total services IPPF’s ‘one-stop shop’ approach provided in 2010 were to young is holistic and integrated. In people 2010, our HIV-related services increased by 27 per cent since 2009

IPPF addresses the needs of youth Over a third of IPPF’s total services provided in 2010 reached young people (35 per cent). Most Member Associations view the provision of services to young people (people under 25 years old) as one of their primary activities. IPPF has long been the vanguard of defining and providing youth-friendly services – that are non-judgmental, confidential, and innovative in engaging young people. IPPF is often seen as responsible for bridging the gap where the public sector does not and/or cannot provide adolescent reproductive health services appropriately or sensitively. The number of SRH services provided to young people (including contraceptive and non-contraceptive services) reached just over 31 million services in 2010 – an increase of 26 per cent from 2009. This was driven primarily by a significant increase in services to clients under 25 in Cuba, Ethiopia, India, Nigeria, Pakistan and Vietnam.

In 2010, the advocacy efforts of Member Associations contributed to more than 47 significant national policy and/ or positive legislative changes in support of SRHR

Integrated package of essential SRHR services IPPF is increasingly providing a client-centred integrated package of essential SRH services. This package is strongly centred on family planning, one of the most cost-effective interventions to lift communities out of poverty. It also includes the provision of emergency contraception, abortion-related services, pre and postHIV test counselling, treatment and testing for sexually transmitted infections (STIs) and reproductive tract infection, gynaecological examinations, pregnancy testing and prenatal counselling, and screening for gender-based violence. In 2010, we agreed to roll out the provision of the integrated package of essential, high-impact SRH services based on the growing body of evidenceb that the integration of services translates into better health outcomes for women and girls, and saves both time and money.

Figure 2: SRH services provided to young people in key performing countries, in 2009 and 2010

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More than just family planning Annual report 2010 11

Case study 3

A ‘one-stop shop’ approach to meet the needs of young women living with HIV in Sudanc Despite having the highest level of HIV prevalence in the Arab world, there is limited access to antiretroviral therapy (ARTs) in Sudan. Young women in particular have difficulty accessing HIV care anywhere, even though young women are the most at risk because the main mode of transmission is heterosexual intercourse (97 per cent). The Sudan Family Planning Association aimed to scale up and increase access to ART treatment through integrating HIV with SRHR, particularly for women under 25, living with HIV in three sites in North Sudan: El Obied, Sennar and El Fasher.

IPPF’s Member Association conducted training for its own staff, as well as employing a series of people living with HIV as volunteers. This helped to reduce stigma. A survey conducted among 150 women attending the clinic in Sennar showed that 100 per cent of women revealed that they were treated respectfully. This sensitivity training, combined with community outreach sessions that address women’s nutritional status in addition to other health issues, has been a cornerstone of the project. Several clients living with HIV in Sennar and El Obeid came out and spoke in radio programmes. The project is successfully challenging the current social norms and stigma around people living with HIV. For example, in El Obeid, when the child of an HIVpositive mother was expelled from school, Member Association staff worked closely with the State AIDS programme to lobby successfully to get the child readmitted. Even in El Fasher, where stigma is relatively

high, a 42 year old male living with HIV commented on the benefits of the project: “I take my pills and go to work every day, I don’t have any complaints. Everybody in my neighbourhood knows my HIV status now; because of the availability of treatment I look like a normal person. I took my children to test them and thank God they are all negative”.

12 Annual report 2010â&#x20AC;&#x201A; More than just family planning

Box 1: Selected examples of successful national policy and legislative changes in support of SRHR to which Member Associationsâ&#x20AC;&#x2122; advocacy efforts have contributed in 2010

Access

In Guatemala, the Member Association worked with the government on the annual Budget Law, and successfully advocated to include budget lines for anti-retrovirals, contraceptives, and vaccines. This has the potential to substantially reduce costs, and therefore increase access to the poorest populations.

Access

In Burkina Faso, the Member Association supported the revision of the national policy on population, which saw commitment to increase contraceptive prevalence rate from 17 per cent by 1.5 per cent per year. This is a substantial increase from 0.5 per cent per year, which it was previously.

More than just family planningâ&#x20AC;&#x201A; Annual report 2010 13

Stigma

The Member Association in Kazakhstan was instrumental in bringing about changes to the Ministry of Healthâ&#x20AC;&#x2122;s Action plan. The 2010 Action Plan introduced funding of specialized equipment for females with disabilities in health centres, so they could more easily access SRHR services.

Abortion

The Member Association in Kyrgyzstan worked closely with the government to develop the national protocol on medical abortion, piloting the method in-country.

Gender-based violence

The Member Association in Uganda successfully advocated with other members of civil society and with the government for the passing of the first law to convict those that promote and conduct female genital mutilation.

Abortion

In Tajikistan, the Member Association played a leading role in the working group of experts who developed safe abortion protocols. This contributed to the revision of the Law on Reproductive Health and Rights by the government in 2010.

Adolescents

In three of the more conservative districts in Malawi, the Member Association successfully advocated for the development of bylaws preventing early marriage.

Adolescents

The government of Nepal endorsed a reference manual developed by the Member Association that addressed comprehensive sexuality education for school teachers. Since its acceptance, the Member Association has trained school teachers in how to use the manual in 75 districts.

14 Annual report 2010 More than just family planning

IPPF increases its HIV-related service provision in 2010 IPPF has significantly increased the number of HIV-related services (including STIs and RTIs) from 9.3 million (2009) to 11.8 million (2010). We have long recognized that an integrated package of services reduces stigma of accessing care for people living with HIV, those seeking an abortion, or those who are a victim of gender or sexual violence. A ‘one-stop shop’ holistic approach also makes

sense from a public health standpoint. For example, a person living with HIV is counselled on their reproductive choices so as to prevent unwanted pregnancies, or a young person accessing contraceptive services can also be counselled on HIV prevention. As seen in Figure 3, IPPF Member Associations in key countries significantly increased the HIV-related services they provide in 2010.

Figure 3: Increase in HIV-related services in key countries, 2009 to 2010

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More than just family planning Annual report 2010 15 IPPF continues to advocate for SRHR In 2010, Member Associations’ advocacy efforts have contributed to more than 47 significant national policy and/or positive legislative changes in support of SRHR. IPPF has a strong track record of shaping and creating a supportive environment where we tackle some of the root causes of poor health such as gender inequality, poverty, rights, education, stigma and discrimination.

Case study 4

Nigeria –“Reach Out”: Improving sexual and reproductive health and rights for prison inmates Globally male prisoners are recognized as a population at higher risk of HIV exposure, due to men having sex with men and injecting drug use in prisons. The impact of HIV infection on inmates and their families lasts long after the sentence is over. In Nigeria, limited and rapid surveys have shown higher HIV prevalence in male prisons than in the general population. The Planned Parenthood Federation of

In 2010, IPPF rolled out an advocacy planning training module which is specifically adapted to Member Associations and the constraints that they face. This advocacy training module was developed in the Western Hemisphere Region (WHR) and has now been implemented in three other regions of IPPF. At the global level, IPPF continued to advance its mission at the UN through direct advocacy with Member States and provided training for Member Associations and like minded NGOs on language to advance SRHR within UN outcome documents.

Nigeria (PPFN), began to pioneer Nigeria’s first sexual and reproductive health (SRH) service delivery with male inmates in mid-2010, working in Kaduna and Kuje prisons.d Currently, inmates are legally required to be screened at the point of incarceration (a debatable rights issue in itself). However, recent surveys have shown that there are limited test kits and other clinical commodities following testing. The project provides access to testing, counselling, and referral to military hospitals for the 1,500 male inmates. Due to the excellent relationship with the National Prison System and prison staff on the ground, PPFN is able to sensitively provide services within the prisons, including condom distribution and even getting ARVs into

the prison clinic. This significantly improves access to SRH services for inmates as they do not then have to rely on the availability of security staff to take them to hospitals.

16 Annual report 2010 Vulnerable people, difficult places

03 Vulnerable people, difficult places In 2010, 72 per cent of IPPF’s clients were classified as poor, marginalized, socially-excluded and/or under-served

In 2010, 87 per cent of IPPF’s non-clinic-based servicedelivery points were working at community level and were managed by the communities they served

IPPF proactively supports those who are poor, marginalized and least served – those who need the most support yet don’t often receive it from traditional providers. Using a rights-based approach, we treat those at the fringes of society with dignity and respect, affording them much-needed inputs to support their health and well-being, and advocating on their behalf within the larger political and cultural structures of their community.

In 2010, IPPF increased the capacity of more than 4,300 humanitarian workers in 81 countries in providing SRH services in humanitarian settings

Reaching vulnerable populations While reaching the poor and vulnerable is generally more difficult and expensive, it is also the most effective way to increase equity and is a critical factor towards achieving the MDGs. In 2010, 72 per cent of our clients were classified as poor and vulnerable. As figure 4 illustrates, almost all IPPF’s regions saw an increase in the proportion of poor and vulnerable clients.

Case study 5

Member Association of Ethiopia Ethiopia has one of the highest maternal mortality rates of 850 per 100,000 live births; a modern contraceptive prevalence of 6 per cent; total fertility rate of 5.5; and only 6 per cent of women delivering with the assistance of a skilled birth attendant. The IPPF Member Association, the Family Guidance Association of Ethiopia (FGAE), is one of Ethiopia’s most effective providers of SRH services, and has emerged as an ally of the poor and marginalized, many of whom have reproductive health needs that are not met by national health services or the private sector. Every morning, long and winding queues of women, men, and young people form at FGAE clinics. The Member Association provides a comprehensive package of SRH services ranging from family planning to abortion care, to maternal and child health, and a continuum of care in the HIV spectrum such as voluntary counselling and testing, and treatment of opportunistic infections. Askala lives in the town of Ticho in a rural part of Ethiopia with her husband and two

small children. She explains how FGAE services are supporting her: “I heard about family planning from a volunteer from the centre... family planning has given me freedom. Before FGAE there weren’t any family planning services in the town at all. My husband would never have been able to fulfil his dream of becoming a teacher unless I had been able to support the family while he trained. I am healthy and active; this wouldn’t have been possible without contraception. Now I have the benefit of a smaller family.”

In efforts to reach marginalized groups, FGAE implements projects to provide health services to street children, children orphaned by AIDS, sex workers, including young migrants in eight out of 11 principal towns of Ethiopia. FGAE runs 8 branches, 18 clinics in urban areas, and 740 community based distributors in peri-urban and rural areas, including 28 youth centres. In 2010, 8 out 10 clients served by FGAE were classified as poor or marginalized.

Vulnerable people, difficult places Annual report 2010 17 Figure 4: Proportion of IPPF’s clients classified as poor and vulnerable, 2009–2010

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where the health care infrastructure is weak and SRH services practically do not exist. As figure 5 illustrates, we offer clinical and non-clinical services with service delivery points ranging from static clinics, mobile/outreach clinics, community-based distribution, health posts, private agencies and hospitals. The number of IPPF’s service delivery points increased from 58,470 in 2005 to 63,689 in 2010.

Figure 5: IPPF’s service delivery points in 2010

Other agencies

Member Association social marketing

Private physicians

Government

IPPF clinics (static & mobile)

13%

Small commercial distributors

31%

IPPF’s geographical reach into peri-urban and rural areas is unparalleled by any other sexual and reproductive health NGO. Figure 6 shows that in 2010, half of our service delivery points were outside urban areas. Figure 6: Geographical distribution of IPPF’s clinics in 2010

Community-based distributors

44%

Rural

12% Urban

Peri-urban

38%

Broad reach through wide range of service delivery points IPPF’s strong community-based presence means that we access some of the world’s hardest-to-reach and often underserved communities, and ensure a range of high impact interventions through multiple service delivery points. In 2010, 87 per cent of IPPF’s service delivery points were located at the community level

50%

18 Annual report 2010 Vulnerable people, difficult places

Case study 6

Helping Colombia’s internally displaced people

In 2010, 7 out of 10 clients of Profamilia were classified as poor or vulnerable. In remote settings, Profamilia carries all supplies for their clinics, including water, and provide services to hundreds of people in one day. Teenage mothers receive contraception and counselling

to prevent future pregnancies; women receive treatment for sexually transmitted infections or screening for cervical cancer. These mobile clinics are often located in regions where Profamilia is the only healthcare option for these people.

Colombia has a population of 44 million, 47 percent of whom live below the poverty line; it also has the second highest number of internally displaced people (IDPs) in the world due to the endemic violence of drug traffickers and armed guerrillas. Nationwide the incidence of teen pregnancy is one in five. Profamilia, the IPPF Member Association in Colombia, provides services in this challenging environment, reaching out to IDPs through mobile clinics as well as converting neighbourhood community centres into health clinics to provide much needed SRH services for many young people, men, and women. In 2010, 66,898 contraceptive services and 37,829 non-contraceptive services were provided through Profamilia’s 32 mobile health clinics reaching over 22,000 people. Consequently, the CYP achievement through these clinics increased by 146 per cent in 2010.

IPPF’s work in humanitarian settings Women, children and young people make up 75–85 per cent of the estimated 65 million people who have been forcibly displaced from their homes by conflict or natural disasters. They are at increased risk of rape, sexually transmitted infections, unintended pregnancies, unsafe abortion, and maternal ill health and deathe. The need for SRHR and empowerment of women and girls in humanitarian settings remain significant, and the international community has agreed that there is sufficient evidence showing that SRH has to be treated as a priority intervention in emergencies.f

The SPRINT initiative is currently the only multicountry programme that works to strengthen national capacity and preparedness to coordinate MISP implementation in humanitarian settings. IPPF is uniquely positioned to mobilize funding and services in sudden humanitarian emergencies through the flexibility offered by unrestricted core funding. IPPF’s presence on the ground through the Member Associations means that we can quickly offer services and experts to the affected areas and reach those most in need, immediately after a crisis erupts.

SPRINT Initiative To protect and promote the health of women and girls living in forcibly displaced situations, and mainstream SRH into country emergency plans, IPPF launched the SPRINT initiative in 2007. SPRINT promotes interventions defined by the Minimum Initial Service Package (MISP)g for SRH – a set of priority lifesaving SRH activities to be implemented in humanitarian response to conflict or natural disaster. MISP saves lives and prevents illness, trauma and disability. Initiated in the East & South East Asia and Oceania Region, SPRINT is currently being rolled out globally. Between 2007–2010, the SPRINT initiative has provided training, technical assistance and emergency response funding to more than 4,300 humanitarian workers in 81 countries, involving 38 Member Associations in implementing the MISP. The SPRINT initiative is currently the only multi-country programme that works to strengthen national capacity and preparedness to coordinate MISP implementation in humanitarian settings, especially ensuring collaboration between grassroots and international agencies. Local players are able to respond effectively to a crisis without having to wait for international intervention. This is particularly important in smaller scale crises that typically do not trigger an international humanitarian response. SPRINT also fosters a supportive policy environment to integrate MISP into national health emergency management and disaster risk reduction mechanisms, and to increase funding in humanitarian appeals for MISP.

Vulnerable people, difficult places Annual report 2010 19

Case study 7

Emergency response to Haiti earthquake A 7.0 magnitude earthquake struck Haiti and devastated Port-au-Prince in January 2010. An estimated 220,000 people were killed, 306,000 injured, and over 1.2 million people displaced. In the immediate aftermath of the earthquake, the IPPF Member Association in Haiti, PROFAMIL, was severely damaged. Two of their three main clinics were destroyed and many staff were injured and displaced. Thanks to IPPF’s core funding and support from other donors, PROFAMIL managed to quickly set up tent clinics in three major tent cities housing displaced people. Initially, PROFAMIL focused on the provision of basic health services. As other organizations began to fill the need for basic services, PROFAMIL has refocused on its primary mission – responding to

the significant unmet needs in SRH. In addition to the tent clinics, outreach teams equipped with essential supplies were deployed in multiple tent communities. Mobile clinics were set up for communities on the outskirts of main cities. Additional clinics began operating in rented buildings and small sites called ‘SRH posts’ were established within the facilities of select partner agencies. In the immediate aftermath of the earthquake, PROFAMIL was one of the very few national NGOs that provided much needed SRH services including: • Family Planning to 16,687 women • Antenatal care to 1,258 pregnant women • Gynaecological and basic health care to 26,505 women • HIV testing and counselling to 3,624 people • Counselling and treatment for STI to 4,261 people • Psychological support for GBV and Sexual Violence to 173 people

A year after the earthquake, PROFAMIL has emerged as a stronger institution. Service provision began in a number of newly built sites and old clinics have been renovated. New management and many new staff members have been hired. With a solid management team and physical locations for its services, PROFAMIL is now rebuilding its youth programme in an effort to bring integrated SRH services to young people. While there are still many organizational challenges to overcome a year after the earthquake, PROFAMIL has establishing itself as a key SRH service provider in the country.

20 Annual report 2010â&#x20AC;&#x201A; Vulnerable people, difficult places

Box 2: SPRINT coordinated implementation of the MISP since 2008; successes in 2010 highlighted

2010

Southern Sudan Haiti Earthquake 2010

Ivory Coast Civil conflict 2010

Our Member Associationâ&#x20AC;&#x2122;s capacitybuilding efforts resulted in the inclusion of MISP in the Health Cluster Contingency Planning in preparation for the groundbreaking January 2011 elections.

Togo Floods 2010

Uganda Landslides 2010

Vulnerable people, difficult placesâ&#x20AC;&#x201A; Annual report 2010 21

China Sichuan earthquake 2011 Myanmar Cyclone Nargis 2008

Vietnam Typhoon Ketsana 2009

Sri Lanka Civil conflict 2009

2010

The Philippines

In the Philippines, a country that is both disaster-prone and generally conservative on SRH issues, the MISP was integrated into the Magna Carta of Womenh, a significant step to ensuring SRH services are available for women and girls in emergencies. The country faced typhoons Ketsana and Ondoy in 2011.

India Cyclone Alia 2009

2010

Pakistan

In the aftermath of the 2010 flooding, the Pakistan IPPF Member Association played a major role in providing relief services to cope with the unprecedented number of people needing assistance. The Member Association provided training in all four affected provinces in partnership with UNFPA which led to successful implementation of the MISP. The Member Association provided primary healthcare and SRH services to more than 180,000 beneficiaries.

Bangladesh Cyclone Alia 2009

Southern Thailand Civil conflict 2010

2010

Indonesia

In Indonesia, following the West Sumatra earthquake in 2009, SPRINT trainees participated in revising the Ministry of Health National Guidelines for Health Disaster Management to include the MISP; worked to integrate SRH kits into the Indonesian national procurement system; and contributed to changes in the health law in Indonesia to legalize abortion for rape survivors and in the case of medical emergencies.

22 Annual report 2010 Value for money

04 Value for money In 2010, IPPF embarked on developing a standardized service activity costing methodology, to track accurate costing information at the Federation level

By 2014, 66 per cent of Member Associations will receive grants through resultsdriven financing

Value for money is essential for IPPF to deliver its mandate. Even before the recent economic downturn, IPPF was developing a value for money strategy to ensure our investments in key SRH services and programmes deliver results and high levels of accountability and transparency to our clients and donors. Therefore, an important addition to our monitoring and evaluation programme has been measuring the ‘value for money’ associated with our services. In 2010, IPPF collaborated with various technical partners and experts to develop standardized tools to measure the value for money of our programmes. These measurements will allow IPPF to better understand the relationship between our initial investment and the impact on improving the health conditions of the people we serve. We define value for money as: • economy – the cost of putting the necessary resources (inputs) in place to provide services; • efficiency – the provision of services (outputs) which are timely, good quality and well-priced; • effectiveness – the contribution of our services to fulfilling IPPF’s overall objectives as well as to achieving internationally agreed targets for improving SRHR (impact). This chapter presents our new systems and tools to improve our performance, and provides a summary of IPPF’s accomplishments throughout 2010 in implementing our value for money strategy.

Value for Money – Economy Each Member Association of IPPF is audited by a reputable firm annually and is required to complete an audited full review of their internal financial control systems. The combination of these two processes ensures that Member Associations have a robust financial control environment and are able to produce reliable economic data. We also require Member Associations to report annually on their activity and expenditure and key performance indicators. As part of the budget review process, planned activity is reviewed to ensure that it is cost effective and aligned to IPPF’s Strategic Framework. This process often allows us to reduce service delivery costs on an on-going basis.

In 2010, IPPF partnered with the Guttmacher Institute to develop an impact calculator to measure impact values for key indicators

Box 3: Improved cost savings in 2010

Working with Member Associations, the IPPF Secretariat identifies and acts on specific opportunities to improve costeffectiveness in service delivery. • In Bangladesh, the IPPF Member Association converted its vehicles from petrol to CNG-based systems, and reduced total vehicle numbers from 16 to 11. • In Bolivia, the IPPF Member Association reduced head office staff by 17 per cent while implementing an institution-wide financial and information system. This allowed its regional clinics better control over resources by strengthening performance at local level, resulting in a 30 per cent saving in total operational costs. • In Palestine, the IPPF Member Association coordinated with the Ministry of Health and UNFPA to provide free family planning supplies, resulting in savings in commodity costs.

Standardized service costing IPPF recognizes that by having a good understanding of service costs, Member Associations will be better informed to make decisions to improve efficiency and therefore achieve better value for money. In 2010, IPPF embarked on a new initiative to develop a standardized service costing methodology for the Federation to allow the calculation of comprehensive costing information at Member Association level. By developing accurate costing information, Member Associations will be able to identify and act upon cost improvements more systematically. The standardized approach to service activity costing will also allow IPPF to track progress at the country level, as well as monitor trends across countries and regions. To assist Member Associations in the implementation of the methodology, IPPF will provide detailed costing tools with guidance notes on measurement and standardized costing categories to ensure that the reported unit costs are comparable among countries and across services. The development of the methodology will be completed in 2011 with the aim of rolling it out to six Member Associations in 2012, and to 18 by 2014.

Value for money Annual report 2010 23 Administrative costs In 2010, IPPF continued to promote a culture of value in all types of transaction and at all levels of the Federation. Compared to US benchmarks, IPPF is recognized as having a low level of indirect and administrative costs. IPPF’s operational support cost for running the London-based Secretariat was 6.5 per cent of total expenditure in 2010. IPPF’s commitment to minimizing management costs is also a feature of our staffing model. Secretariat support staff numbers have risen by 10 per cent since 2003 despite the fact that annual income has increased by 47 per cent over the same period. This ensures that as much donor funding as possible reaches people in need. Furthermore, in 2010, grants provided to Member Associations accounted for USD $78.3 million, only 4 per cent lower than 2009, despite an 11 per cent drop in donor funding. Procurement of commodities IPPF delivers significant value through centralized purchase of contraceptive supplies and assets (e.g. ambulances) via its subsidiary company ICON. By leveraging the volumes of Member Associations, and the ‘brand value’ of the Federation, IPPF achieves the lowest possible prices for quality-assured products. In 2010, our contraceptives procurement continued to be cost-effective against global benchmarks. ICON is currently working closely with UNFPA to develop a mechanism that can potentially secure access to cheaper contraceptives for our Member Associations through consolidated demands and volume discounts.

Value for Money – Efficiency IPPF’s Secretariat assures quality through its accreditation process, quality of care programmes, financial and human resource management, and its internal audit function. We measure results using the global indicators and service statistics that are collected across all the Member Associations on an annual basis.

Results-Driven Financing Value for money is also a measure of efficiency of our country programmes in delivering services. Until 2009, IPPF operated a system of grant allocation to Member Associations based on a combination of need, capacity and performance. Over 70 per cent of grants are received by Member Associations operating in countries where unmet need for SRH is highest. The remainder went to Member Associations in other developing countries that provide services specifically targeted to poor and vulnerable populations. Based on the growing body of evidence, 2010 marked a change from ‘business as usual’. Whilst we will continue to ensure that funding goes to those Member Associations where unmet need is highest, we have developed a result-driven financing (RDF) system to strengthen the connection between funding and the delivery of outputs and to increase accountability of funded programmes and services and efficient use of limited funds. It is important to note that strengthening the connection between funding and performance has also been a key priority agreed by IPPF’s volunteer-based Governing Council. By incentivizing Member Associations to focus on timely completion of targets and results, we expect over time to improve programme implementation, and promote use of evidence for decision making more systematically. In 2010, the new RDF system was piloted with four Member Associations: Bolivia, Ghana, India and Uganda. All four Member Associations agreed that the new system allowed better use of performance data, increased transparency and strengthened accountability of their work. As seen in Table 1, the new financing model is based on a performance metric with ten clearly verifiable, quantitative indicators that are linked to IPPF’s strategic priorities. The metric represents a diverse range of services covering all of the 5 ‘A’s, and is based on serving poor and vulnerable people. By 2012, we will expand the RDF to an additional 25–30 countries; and by 2014, 66 per cent of grant receiving Member Associations will be rolled into this system.

Table 1: IPPF performance metric

‘A’ Adolescent

Indicator 1 Number of services to youth, by type 2 Provision of essential components in sexuality education programme 3 Number of young people who have completed a comprehensive sexuality education programme

HIV and AIDS

4 Number of HIV-related services, by type

Abortion

5 Number of abortion-related services, by type

Access

6 Number of total SRH services, by type 7 Clients who are poor, marginalized, socially-excluded and/or under-served 8 Number of CYP, by method 9 Provision of comprehensive service package

Advocacy

10 Demonstrated contribution to advancing the SRHR agenda

24 Annual report 2010 Value for money

Box 4: How will results-driven financing work?

Each Member Association will report on these 10 performance indicators on an annual basis. These results will be verified by staff in regional offices, and performance scores will be calculated for each indicator. The overall scores will then be used to set the level of financing the MA receives the following year. Many of the indicators that Member Associations will produce for this system will also be used to estimate outcome-level impact. The new financing system is intended to transparently, consistently, and fairly reward good performance on the basis of accurate and verifiable results. To support the introduction of results-driven financing, we will also introduce IPPF’s clinic management information system (CMIS) into more Member Associations. This will facilitate client management, integrating financial and inventory systems thus reducing administrative burden and ensuring that we receive accurate data for unique clients and services. IPPF will provide Member Associations with technical assistance grants to help with building the CMIS. In 2010 we rolled out CMIS to 43 clinics in seven countries, and we expect to reach 250 clinics in 17 countries by 2012. The CMIS will also enable Member Associations to monitor clinic performance on a real-time basis, enabling them to deliver improved value for money.

Value for Money – Effectiveness Value for money is ultimately a measurement of our effectiveness and impact. Designing and scaling up programmes to achieve internationally agreed targets for SRHR not only requires accurate budgeting and controls of available resources, but also careful evaluation of results in order to improve their health impact. The past year has seen several of our donors and partners strengthen their commitment to demonstrating impact. We at IPPF are just as committed to demonstrating the results of our work effectively and ensuring impact. In 2010, we began working with the Guttmacher Institute to calculate the impact of IPPF’s contraceptive, abortion and obstetric services, and to review the applicability of models for a number of other SRH services that IPPF provides. These results will give us information on a range of impact values, including unintended pregnancies averted, unsafe abortions averted and DALYS (disability adjusted life years). Through this impact model, IPPF for the first time will be able to measure its impact against the internationally-set targets such as the GSWACH commitments and the health MDG targets. As our new tools and systems for measuring value for money become fully operational, we will become better at demonstrating where and how our investments are making a difference, managing risk, doing the same with fewer resources, thereby improving our efficiency and effectiveness. Ultimately, our value for money strategy will strengthen the Federation’s accountability towards its clients and donors.

Going forward Annual report 2010 25

05 Going forward The statistics are a stark reminder of why IPPF’s contribution in service delivery, comprehensive sexuality education and advocacy at every level is so important: the unmet need of 215 million women for family planning, the morbidity and mortality of the 19 million women and girls who face the consequences of unsafe abortion, the millions of young people infected with STIs, the 250,000 women who die annually from cervical cancer and the millions infected every year with HIV. As a community we are far from delivering the promises made at the International Conference on Population and Development (ICPD) in 1994. This is part of the reason why the ICPD Programme of Action was extended indefinitely by the General Assembly in late 2010. Our work now is to ensure that the central goals of the ICPD Programme of Action – including ‘universal access to reproductive health’ – are incorporated into the development framework that succeeds the MDGs in 2015. This is particularly relevant as the United Nations’ own report on the MDGs (2010) cited a shortage of donor funds as the principal reason this target had not yet been met. The sharp decline in donor funds, in the face of growing demand, is why there remains an unmet need for 215 million poor and vulnerable women.

will allow us to measure the impact of our services against national and international targets.

For IPPF, evidence collected in the Five-Year Mid-Term Review gave us a clear indication that our Strategic Framework is working and that significant progress has been made since 2005. As we transition to a new Director-General in the final months of 2011, we are focusing our energy on implementing our Results Framework, which will accelerate performance across the Federation. We have already agreed a number of implementation strategies to enable us to deliver our Results Framework. These include:

As we move towards the end of 2011, cross-Federation implementation strategies of our Results Framework will be finalized and shared with key stakeholders. We will hold ourselves accountable for their delivery and achievement. Through this work we will establish IPPF as a thought-leader in the provision of high quality, cost effective community health services. Similarly, we will continue to work with existing stakeholders to build new alliances to elevate SRHR as a keystone development issue in advance of and during negotiations around the successors of the MDGs.

Increasing service coverage By the end of 2014, all IPPF Member Associations will provide a package of essential, high-impact sexual and reproductive health and rights services (see chapter 2). With increased service provision, IPPF will therefore make a significant contribution to the overall United Nations Global Strategy for Women’s and Children’s Health commitments. SRHR for vulnerable populations We are working with a renewed focus to increase universal access to SRHR information and services particularly to the poor and vulnerable populations. This will continue to be a key priority for IPPF. In 2014, poor and/ or vulnerable people will form 80 per cent of IPPF’s clients. Helping the world’s poorest and hardest to reach people is not only the right thing to do but is imperative to achieving the health MDGs. Performance Culture IPPF’s commitment to achieving value for money in providing services and developing a performance culture will only continue to intensify. Results-driven financing will ensure that funding decisions are based on measurable country-owned results against time-bound targets. The new standardized costing methodology will help our Member Associations offer the best possible prices for their services. And, for the first time, through our partnership with Guttmacher Institute, our impact calculator

Advocacy Our advocacy work in 2011 will focus on holding governments and agencies accountable for existing political and financial commitments to reproductive health at the global and regional levels including, ICPD, Beijing, MDG5b and the GSWACH. We will also be focusing on identifying advocacy outputs for our five-year ‘Girls Decide’ campaign towards provision of SRHR services to young women and girls. In addition, we will focus on highlighting the importance of sexual rights in existing legal and political mechanisms.

Box 5: Excerpt from IPPF’s Results Framework

• By 2014, 4 out of 5 of IPPF clients will be poor and/or vulnerable people. • By 2015, IPPF will double the number of unitended pregnancies averted. • By 2015, IPPF will more than double the number of HIVrelated services. • By 2015, IPPF will increase services to young people by more than 50 per cent. • By 2014, all service-delivering IPPF Member Associations that are receiving funding will provide a package of essential, high-impact sexual and reproductive health services. • By 2015, the number of new users at IPPF service delivery points for contraceptive services will go up by at least 50 per cent.

26 Annual report 2010 Annexes

Annex 1 References

a All names in case-studies have been changed to protect confidentiality. b Jamison DT et al (2006) Priorities in Health. Disease Control Priorities Project. World Bank, and Integra, IPPF, LSHTM and Population Council (2008). An ongoing study funded by the Gates Foundation. c This project is funded by the Innovation Fund, part of IPPF’s core funding that fosters innovative initiatives in the Member Associations, supporting them to reach vulnerable populations. d Ibid. e Coghlan B, et al. Mortality in the Democratic Republic of Congo: a nationwide survey. The Lancet, 2006, Vol. 367 No. 9504 pp 44–51 f The Inter-Agency Standing Committee – Global Health Cluster has agreed that SRH has to be treated as a priority intervention. g In 1995, the Inter-Agency Working Group on Reproductive Health in Crisis Situations developed guidelines on how to address SRH for refugees; and this resulted in the development of the Minimum Initial Service Package (MISP) for SRH. h A comprehensive women’s human rights law that seeks to eliminate discrimination against women by recognizing, protecting,and promoting the rights of Filipino women, especially those in marginalized groups.

Annex 2 Photo credits FC Family Planning Association of the Islamic Republic of Iran – Iran

v IPPF / Chloe Hall

7 IPPF / Chloe Hall – Cuba

8 IPPF / Peter Caton – Uganda

9 IPPF / Peter Caton – Uganda

11 IPPFWHR – Colombia 14 IPPF / Paul Bell – Palestine 15 IPPF / Peter Caton – Bangladesh 16 IPPF / Chloe Hall – Ethiopia 18 IPPFWHR – Colombia 19 IPPF / Chloe Hall – Indonesia 24 IPPFWHR – Colombia BIC Family Planning Association of the Islamic Republic of Iran – Iran

Annexesâ&#x20AC;&#x201A; Annual report 2010 27

Annex 3 Membership list

IPPF currently has 153 Member Associations, working in 164 countries (this latter figure takes into account the 12 countries that are part of the Caribbean Family Planning Affiliation). In addition, IPPF is active in a further 10 countries where there is not currently a Member Association. This brings the total number of countries in which IPPF is working to 174. Association names in bold are founder members of IPPF.

FULL MEMBERS

ASSOCIATE MEMBERS

TOTAL

Africa

Arab world

East & South East Asia and Oceania

European Network

South Asia

Western Hemisphere

Members outside regions

Total

131

153

28 Annual report 2010 Annexes

Africa Region

Country

FULL MEMBERS

ASSOCIATE MEMBER

Name of Member

TOTAL

Year of Associate Membership

Year of Full Membership

Association Béninoise pour la Promotion de la Famille Botswana Family Welfare Association Association Burkinabé pour le Bien-Etre Familial Association Burundaise pour le Bien-Etre Familial Cameroon National Association for Family Welfare Association Centrafricaine pour le Bien-Etre Familial Association Tchadienne pour le Bien-Etre Familial Association Comorienne pour le Bien-Etre de la Famille Association Congolaise pour le Bien-Etre Familial Family Guidance Association of Ethiopia Planned Parenthood Association of Ghana Association Guinéenne pour le Bien-Etre Familial Association Ivoirienne pour le Bien-Etre Familial Family Health Options Kenya Lesotho Planned Parenthood Association Family Planning Association of Liberia Fianakaviana Sambatra Association Malienne pour la Protection et la Promotion de la Famille Mauritius Family Planning & Welfare Association Associação Moçambicana para Desenvolvimento da Familia Namibia Planned Parenthood Association Association Nigérienne pour le Bien-Etre Familial Planned Parenthood Federation of Nigeria Association Rwandaise pour le Bien-Etre Familial Association Sénégalaise pour le Bien- être Familial Planned Parenthood Association of Sierra Leone Family Life Association of Swaziland Uzazi na Malezi Bora Tanzania Association Togolaise pour le Bien-Etre Familial Reproductive Health Uganda Planned Parenthood Association of Zambia

(1975) (1990) (1982) (1998) (1993) (1991) (1994) (2002) (1994) (1971) (1968) (1986) (1988) (1963) (1968) (1967) (1971) (1975) (1959) (2002) (1997) (1998) (1967) (1988) (1981) (1968) (1985) (1969) (1977) (1964) (1978)

1980 1995 1989 2002 1995 1995 2000 2010 1998 1977 1969 1992 1995 1965 1975 1975 1983 1983 1965 2010 2002 2009 1970 1998 1992 1973 1992 1973 1980 1976 1983

Associação Angolana para o Bem Estar da Familia Associação Caboverdiana para a Proteção da Familia Association pour le Bien-Etre Familial/Naissances Désirables Mouvement Gabonais pour le Bien-Etre Familial Associacao da Guine-Bissau Para a Educacao e Promocao de Saude Familiar Family Planning Association of Malawi

(2002) (2002) (1978) (2002) (1994)

Full Members Benin Botswana Burkina Faso Burundi Cameroon Central African Republic Chad Comoros Congo Ethiopia Ghana Guinea-Conakry Ivory Coast Kenya Lesotho Liberia Madagascar Mali Mauritius Mozambique Namibia Niger Nigeria Rwanda Senegal Sierra Leone Swaziland Tanzania Togo Uganda Zambia

Associate Members Angola Cape Verde Congo, Dem. Republic Gabon Guinea-Bissau Malawi

(2007)

Annexes Annual report 2010 29

Arab World Region

Country

FULL MEMBERS

ASSOCIATE MEMBERS

Name of Member

TOTAL

Year of Associate Membership

Year of Full Membership

Association Algérienne pour la Planification Familiale Bahrain Reproductive Health and Family Planning Association Association Djiboutienne pour l’Equilibre et la Promotion de la Famille Egyptian Family Planning Association Iraqi Reproductive Health & Family Planning Association Association Mauritanienne pour la Promotion de la Famille Association Marocaine de Planification Familiale Palestinian Family Planning and Protection Association Sudan Family Planning Association Syrian Family Planning Association Association Tunisienne de la Santé de la Reproduction

(1989) (1977) (1994) (1963) (1971) (1989) (1971) (1964) (1971) (1975) (1969)

1992 1989 2007 1969 1975 1998 1975 1965 1975 1980 1971

Aman Jordanian Association Association Libanaise pour une Famille Moderne Somaliland Family Planning Association Yemeni Association for Reproductive Health

(2009) (2009) (2010) (2009)

Full Members Algeria Bahrain Djibouti Egypt Iraq Mauritania Morocco Palestine Sudan Syria Tunisia

Associate Members Jordan Lebanon Somaliland Yemen

30 Annual report 2010â&#x20AC;&#x201A; Annexes

East & South East Asia and Oceania

Country

FULL MEMBERS

ASSOCIATE MEMBERS

Name of Member

TOTAL

Year of Associate Membership

Year of Full Membership

Sexual Health & Family Planning Australia China Family Planning Assocation Family Planning Association of Hong Kong The Indonesian Planned Parenthood Association Japan Family Planning Association, Inc. Korean Family Planning & Maternal Child Health Association of DPRK Planned Population Federation of Korea Federation of Reproductive Health Associations of Malaysia Mongolian Family Welfare Association New Zealand Family Planning Family Planning Organization of the Philippines Samoa Family Health Association Singapore Planned Parenthood Association Planned Parenthood Association of Thailand Tonga Family Health Association Vanuatu Family Health Association Vietnam Family Planning Association

(1953) (1981) (1952) (1968) (1953) (1991) (1961) (1961) (1995) (1955) (1965) (1998) (1952) (1971) (1998) (1998) (1982)

1969 1983 1952 1969 1954 1995 1961 1961 2005 1959 1969 2002 1952 1975 2009 2002 1989

Reproductive Health Association of Cambodia Cook Islands Family Welfare Association Reproductive & Family Health Association of Fiji Solomon Islands Planned Parenthood Association Tuvalu Family Health Association

(1996) (2006) (2000) (2004) (2008)

Full Members Australia China Hong Kong Indonesia Japan Korea, Dem. Peopleâ&#x20AC;&#x2122;s Rep Korea, Republic of Malaysia Mongolia New Zealand Philippines Samoa Singapore Thailand Tonga Vanuatu Vietnam

Associate Members Cambodia Cook Islands Fiji Solomon Islands Tuvalu

Annexes Annual report 2010 31

European Network

Country

FULL MEMBERS

Name of Member

ASSOCIATE MEMBERS

TOTAL

Year of Associate Membership

Year of Full Membership

Shoqata Shqiptare per Popullsine dhe Zhvillimin FOR FAMILY AND HEALTH Pan-Armenian Association Österreichische Gesellschaft für Familienplanung Fédération Laïque de Centres de Planning Familial Association for Sexual and Reproductive Health XY Bulgarian Family Planning and Sexual Health Association Family Planning Association of Cyprus Spolecnost pro plánování rodiny a sexuální výchovu Sex & Samfund – The Danish Family Planning Association Eesti Seksuaaltervise Liit / Estonian Sexual Health Association Väestöliitto Mouvement Français pour le Planning Familial Association HERA XXI PRO FAMILIA Bundesverband Family Planning Association of Greece Magyar Család- és Nõvédelmi Tudományos Társaság Fræðslusamtök um kynlíf og barneignir Irish Family Planning Association Israel Family Planning Association Kazakhstan Association on Sexual and Reproductive Health Reproductive Health Alliance of Kyrgyzstan Latvijas Gimenes planosanas un seksualas veselibas asociacija Seimos Planavimo ir Seksualines Sveikatos Asociacija Societatea de Planificare a Familiei din Moldova Rutgers Nisso Group Sex og Politikk Towarzystwo Rozwoju Rodziny Associação Para o Planeamento da Família Health Education and Research Association Societatea de Educatie Contraceptiva si Sexuala Russian Association for Population and Development Slovak Family Planning Association Federación de Planificación Familiar de España Riksförbundet für Sexuell Upplysning Fondation Suisse pour la Santé Sexuelle et Reproductive Tajik Family Planning Alliance Türkiye Aile Planlamasi Dernegi FPA Uzbek Association on Reproductive Health

(1997) (2000) (1971) (1955) (2003) (1975) (1973) (1994) (1956) (1995) (1959) (1959) (2000) (1952) (1985) (1975) (1995) (1973) (1975) (2000) (2003) (1995) (1995) (1996) (1952) (1970) (1997) (1971) (2006) (1992) (1993) (1994) (1989) (1952) (1993) (2005) (1965) (1952) (2002)

2002 2005 1973 1965 2006 1983 1975 1998 1956 2000 1965 1965 2005 1952 1992 1983 1998 1975 2000 2006 2010 2000 2000 2010 1952 1975 2005 1975 2009 1998 2000 1998 1995 1952 1998 2008 1973 1952 2005

Serbian Association for Sexual and Reproductive Rights NGO Women Health and Family Planning

(2010) (2010)

Full Members Albania Armenia Austria Belgium Bosnia & Herzegovina Bulgaria Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Kazakhstan Kyrgyzstan Latvia Lithuania Moldova Netherlands Norway Poland Portugal Republic of Macedonia Romania Russia Slovak Republic Spain Sweden Switzerland Tajikistan Turkey United Kingdom Uzbekistan

Associate Members Republic of Serbia Ukraine

32 Annual report 2010â&#x20AC;&#x201A; Annexes

South Asia Region

Country

FULL MEMBERS

Name of Member

ASSOCIATE MEMBERS

TOTAL

Year of Associate Membership

Year of Full Membership

(2005) (1975) (1952) (1995) (1994) (1960) (1954) (1954)

2008 1977 1952 1998 1998 1969 1955 1954

Full Members Afghanistan Bangladesh India Iran Maldives Nepal Pakistan Sri Lanka

Afghan Family Guidance Association Family Planning Association of Bangladesh Family Planning Association of India Family Planning Association of the Islamic Republic of Iran Society for Health Education Family Planning Association of Nepal Rahnuma-Family Planning Association of Pakistan Family Planning Association of Sri Lanka

Associate Members Bhutan

Respect Educate Nurture Empower Women

Annexes Annual report 2010 33

Western Hemisphere Region

Country

FULL MEMBERS

ASSOCIATE MEMBERS

Name of Member

TOTAL

Year of Associate Membership

Year of Full Membership

(1957) (1992) (2001) (1967) (1963) (1973) (1965) (1968) (1967) (1969) (1969) (1969) (1990) (1965) (1957) (1967) (1975) (1969) (1969) (1982) (1954) (1990) (1960) (1952) (1995)

1957 2008 2008 1971 1965 1992 1965 1971 1971 1971 1971 1971 2008 1975 1957 1971 1992 1975 1971 1998

Full Members Barbados Belize Bolivia Brazil Canada Caribbean Affiliation Chile Colombia Costa Rica Dominican Republic El Salvador Guatemala Guyana Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Puerto Rico Suriname Trinidad and Tobago United States Venezuela

The Barbados Family Planning Association Belize Family Life Association Centro de Investigación, Educación y Servicios Bem-Estar Familiar Canadian Federation for Sexual Health Caribbean Family Planning Affiliation Ltd Asociación Chilena de Protección de la Familia Asociación Pro-Bienestar de la Familia Colombiana Asociación Demográfica Costarricense Asociación Dominicana Pro-Bienestar de la Familia Asociación Demográfica Salvadoreña Asociación Pro-Bienestar de la Familia de Guatemala Guyana Responsible Parenthood Association Asociación Hondureña de Planificación de Familia Jamaica Family Planning Association Fundación Mexicana para la Planeación Familiar Asociación Pro-Bienestar de la Familia Nicaragüense Asociación Panameña para el. Planeamiento de la Familia Centro Paraguayo de Estudios de Poblacion Instituto Peruano de Paternidad Responsable Asociación Puertorriqueña Pro-Bienestar de la Familia Stichting Lobi Family Planning Association of Trinidad and Tobago Planned Parenthood Federation of America Asociacion Civil de Planificacion Familiar

2000 1971 1952 2004

Caribbean Family Planning Affiliation (CFPA) Anguilla Antigua Aruba Bahamas Bermuda Curacao Dominica Grenada Guadeloupe Martinique St. Lucia St. Vincent

Anguilla Family Planning Association-The Primary Health Care Antigua Planned Parenthood Association Foundation for the Promotion of Responsible Parenthood Bahamas Family Planning Association Teen Services Foundation for the Promotion of Responsible Parenthood (FPRP) Dominica Planned Parenthood Association Grenada Planned Parenthood Association Association Guadeloupéenne pour le Planning Familial Association Martiniquaise pour I’Information et l’Orientation Familiales Saint Lucia Planned Parenthood Association St. Vincent Planned Parenthood Association

(1992)

(1969)

Associate Members Argentina Ecuador Haiti

Fundación para la Salud del Adolescente Asociación Pro-Bienestar de la Familia Ecuatoriana Association pour la Promotion de la Famille Haïtienne

(2010) (2007) (2001)

1992 1992 1992 1992 1992 1992 1992 1992 1992 1992 1992 1992

34 Annual report 2010 Annexes

Members outside regions

Country

Name of Member

Year of Associate Membership

Year of Full Membership

Associate Members Cuba

Sociedad Cientifica Cubana Para el Desarrollo de la Familia (SOCUDEF )

(1980)

Non-Members in which IPPF is active Africa Region Equatorial Guinea

Association Bienestar Familiar de Guinea Equatorial

Sao Tome & Principe

Associação Santomense para o Planeamento Familiar

Seychelles

Alliance of Solidarity for the Family

Zimbabwe

Zimbabwe National Family Planning Council

Africa Region total

Arab World Region Oman

OMAN

Somalia

Somali Family Health Care Association

Arab World Region total

East & South East Asia and Oceania Kiribati

Kiribati Family Health Association

Laos

Lao Field Office

Myanmar

Myanmar Maternal and Child Welfare Association

Papua New Guinea

Papua New Guinea Family Health Association

East & South East Asia and Oceania total

Staff from the Resource Mobilization, Advocacy and Communication and Organizational Learning and Effectiveness teams worked together to produce the IPPF Report 2010. We are especially grateful to the volunteers, and tens of thousands of staff of Member Associations; this Annual report would not have been possible without their commitment, dedication and tenacity. 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 www.ippf.org or contact IPPF Central Office in London, UK

Published in June 2011 by the International Planned Parenthood Federation 4 Newhams Row, London SE1 3UZ, UK tel fax

+44 (0)20 7939 8200 +44 (0)20 7939 8300

web email

www.ippf.org info@ippf.org

UK Registered Charity No. 229476