From choice, a world of possibilities
EFFECTIVE SERVICE DELIVERY MECHANISMS FOR REDUCING UNMET NEED
Performance, partnership and innovation: increasing access to SRHR in South Asia Regional realities: Large population living below US$2/day
High level of gender inequality
Our response:
High unmet need for family planning
High maternal mortality and morbidity
s p i h s r e n Pa r t En
en
Community based campaigns Static clinics
Radio talks
Community based distributors
Hotline
Demand generation Street shows Mobile units Inter personal communication
Group / education interactive sessions and games
Birthing centres Evening clinics for boys and men
b
as ed
Youth centres
fu nd ing
m u t r a p t s Po
io n
ce an rm fo Per
Satelllite clinics
Task shifting
S yt e m s str e ng t he
Frontline workers
m
nin g
Hospitals
ga ng gi
Service delivery
c
c a r t on
t p e
Results: 7.9 million
7.9 million contraceptive services provided
47% of total SRH services provided to young people
1.8 million couple years of protection contributing to 477,872 pregnancies averted
14.7 million SRH services provided
8 out of 10 clients served were poor or vulnerable
1.5 million HIV and AIDS services provided
Partnerships for national capacity building - India:
• FPAI has been identified as the singular national institution to provide in-service skill-based training to Government and private doctors on laparoscopic tubal ligation services • FPAI, in addition to being an advocate on safe abortion, is the leading institution to provide skill-based training to NGO and private doctors on comprehensive abortion care services
Expanding access and choice to contraceptives through social marketing programmes - Sri Lanka: • FPASL’s social marketing programme has deeper market access backed by a strong network of over 5,000 outlets nationally with 14 products in its fold: condoms, OCP, ECP, in jectables, IUCDs, implants and lubricants • FPASL is the market leader with an impressive 65% market share of condoms, 85% of OCPs and 95% of ECP backed by robust quality and brand image • Marketed 8.2 million condoms, 1.7 million OCP and 1.5 million ECP in 2011
Future direction: Innovative strategies for reaching out to the poor and vulnerable Roll out of IPPF’s Integrated Package of Essential Services Generate evidence to strengthen advocacy for SRHR
Registered UK Charity Number: 229476 www.ippf.org
Ever-increasing contribution to meeting the unmet need Nepal: • FPAN contributed 22% of modern contraceptive methods to the national FP programme in 2011 • Accredited training institution to build capacity of mid level service providers to provide long-acting contraceptive methods • Widest contraceptive choices (condoms, OCP, ECP, injectables, implants, IUCDs, male and female sterilization) offered
EFFECTIVE SERVICE DELIVERY MECHANISMS FOR REDUCING UNMET NEED
Family planning in Pakistan: at a glance Stagnation in FP services evident The Situation: Situation: from halting of TFR and CPR Total fertility rate:
Contraceptive prevalance rate: 40
8
30
6
20
4
10
2
0
0
1996
2000
2003
1990
2009
Source - PDHS 2006-07 (Pakistan Demographic and Health Survey)
1994
1996
2000
2003
2009
Source - 2009 world population data sheet
Reproductive health/family planning The Situation: Challenges: is not a government priority agenda
Lack of funding:
Access:
Quality:
Equity:
Since the introduction of the 18th Amendment on the 30th June 2011, Pakistan does not have health, population or youth ministries.
• Only 25% of the population served by government • Only 8% of these have female medical staff
Deteriorating quality indicated by increasing gap in ever user and current user
The rural population is severely underserved
TFR
Ideal family size
CPR
Urban
3.0
3.7
41
Rural
4.5
4.3
24
National
4.0
4.1
30
40
Current CPR 30
Resulting in: • Zero public funding for family planning • With held funds from major international partners
20
75% of population not served by Government
Ever user
10
0
Source - Pakistan Economic Survey 2010-11
Source - PDHS 2006-07
Source - PDHS 2006-07
Lady doctor based clinics with strong The Situation: Solution: social mobilization in rural/urban areas
Current model:
Missing link:
Current model:
LHV* based Family Health Clinics (FHC):
Doctor based Family Health Clinics:
Family Health Hospitals (FHH):
• Single room, semi-urban/rural • Basic FP and SRH services • Annual 1,300 CYPs, 800 basic safe motherhood and 1,700 reproductive health services • Unable to serve the MR, PAC needs of the community
• Three room, semi-urban/rural • Comprehensive FP and SRH services • Annual 2,600 CYPs, 2000 cwomprehensive safe motherhood and 8,500 RH services • Ability to serve the MR, PAC needs
• Comprehensive FP and SRH services • Specialized staff including gynecologist and OT technicians • Annual 5,232 CYPs, 13,000 safe motherhood and 18,000 reproductive health services
Rural
Semi-urban/rural
Urban
*LHV - lady health visitor ** LHW - lady health worker
Impact of lady doctor based clinic with community mobilization:
The Situation:
Poverty alleviation
LHWs
Other FHCs
Other CBOs/ NGOs
Community leaders
FHC
Shopkeepers
Clerics
Adolescent groups
Schools
Male groups
Mobile services
• 80% increase in long term methods • 40 % increase in short term methods • Two-fold increase in CYPs • 158% increase in safe motherhood services • 421% increase in reproductive health services • Addition of MR and PAC service
Additional running cost: Only US$1,100/month
TBAs
Registered UK Charity Number: 229476 www.ippf.org
From choice, a world of possibilities
EFFECTIVE SERVICE DELIVERY MECHANISMS FOR REDUCING UNMET NEED
Addressing needs of the most vulnerable in a context of widening disparities in South-East Asia and Pacific Economic development in Asia and the Pacific has lifted millions out of poverty, however 900 million people still subsist on less than US$2 a day. This is a region with widening socioeconomic inequities that impact on the poorest.
IPPF Member Associations work in many countries where the government health expenditure is low, out of pocket spending is the highest in the world and where paying for health care pushes many into poverty.
MONGOLIA
The context of ESEAOR: widening inequality
NORTH KOREA SOUTH KOREA
CHINA
MYANMAR
We support MAs to focus on the poorest and most marginalized, providing services and care, while critically analyzing the best methods to do this.
JAPAN
HONG KONG TAIWAN
MACAU
LAOS
THAILAND CAMBODIA
VIETNAM
MALAYSIA
PHILLIPINES FEDERATED STATES OF MICRONESIA
BRUNEI
33%
Income share held by highest 10% of population
72%
Average out-of pocket expenses for health
KIRIBATI
MALAYSIA
SINGAPORE PAPUA NEW GUINEA
INDONESIA
SOLOMON ISLANDS
TUVALU
EAST TIMOR
SAMOA
COOK ISLANDS
FIJI VANUATU
TONGA
NEW CALEDONIA
AUSTRALIA
Decentralized health services NEW ZEALAND
Results: (2010 Global Indicators Statistics) Others 9,753
Total number of clients: 9,718,728
Number of poor or vulnerable clients: 7,428,458
Right: services provided by service delivery points:
Community based 2,435,680 Static clinics 5,392,582
Mobile clinic/unit 3,050,301
Total SRH services provided: 12,415,678
Total contraceptive services: 4,712,654
Services provided to young people: 4,096,130
Associated clinics 1,357,176
Our strategies to tackle unmet need: Bridging the service delivery gap We reach out to people most in need including women in rural areas and young people via mobile and youth friendly services. For example, in Myanmar, Thailand, Vanuatu, Vietnam and Cambodia.
Working with displaced populations We provide access to SRH services in communities affected by natural disaster, conflicts and fragile states. For example, in China, Indonesia, Malaysia, Philippines and Thailand.
Tackling stigma and discrimination We break down barriers that prevent vulnerable people from accessing SRH services. For example, in Cambodia, China, Indonesia and Malaysia.
Maternity homes in Myanmar that provide pre and post natal care to rural women.
Health camps in southern Philippines for communities caught in the middle of armed conflict.
Provision of vouchers to Men who have sex with men (MSM) in Cambodia so they can avail STI and HIV services from trained staff.
Using boats to bring SRH services to island communities in Vanuatu.
Provision of mobile and facility-based SRH services including contraception to Burmese refugees in Malaysia.
Reaching out to MSM in Muslim provinces of China to provide them with HIV and related information as well as service referrals as needed.
The huge disparity between classes of people in East and Southeast Asia and Oceania means that not everyone in this region has access to life changing social goods.
Health services, including sexual and reproductive health, are beyond the reach of millions of people in this region due to socioeconomic and political factors.
Roughly one-third, or more than two billion of the world’s population live in this region, yet it gets the least share in development assistance.
It is a social injustice to ignore the plight of ESEAOR’s poor and vulnerable populations. Let’s work together to close this development gap. Registered UK Charity Number: 229476 www.ippf.org
EFFECTIVE SERVICE DELIVERY MECHANISMS FOR REDUCING UNMET NEED
Reducing unmet needs in Cambodia through service delivery innovations Our innovations:
Dedicated services to entertainment workers (EWs) In collaboration with entertainment establishments, police officials and MOH, EWs can access quality integrated SRH and HIV services in RHAC’s clinics.
Health care financing Equitable access to health care among the poor is provided through trained CBDs at the village, district and provincial level, with specific voucher scheme for maternal and new born health care.
Community and public health support Provide support to 30% of government health centres in family planning, by enabling the government health facilities and village volunteers to provide family planning methods to the community.
RHAC coverage areas: 14 provinces, 39 ODs and 439 HCs
ToGoH Coverage Areas:
- Clinic - Youth Health Program
- 9 Provinces
- Work Place Health Program
- 26 ODs
- Community and Public Health Support Programme
- 270 HCs
- Community Home Based Care Project
- Clinic 15
- HIV/AIDS for Vulnerable People
- CPHSP 18 ODs
- Pediatric AIDS Care, Support and OVC / ILI
- YHP = 38 Schools, 856 Villages
- Health Care Financing
- Factory = 10, FM = 5, CW = 18
October 2011
How are we doing? Approximately 3.4 million services were provided in 2010 through the following service delivery points (SDPs): • 16 static clinics • 296 government health centres • 3,454 rural community-based distributors (CBDs)
Trends of SRH services provided by RHAC - 2006-2010 4,000,000 3,500,000 3,000,000 2,500,000 2,000,000 1,500,000
All the associated clinics (government health centres) and CBDs are located in the rural areas.
1,000,000
- SRH (non-contraceptive) - Contraceptive - Total
500,000 0
2006
2007
2008
2009
2010
Services to poor, marginalized, sociallyexcluded and/or underserved (PMSEU) Approximately 80% of the clients are poor, marginalized, sociallyexcluded and/or underserved (total number of clients in 2010 was 938,146). RHAC’s clinics provided services to 11,696 Entertainment Workers and 1,503 MSMs in 2010. Among, the PMSEU that RHAC currently works with – 10,000 entertainment workers (27% of the total estimate in the country), and 9,500 fishermen & their families.
National results to which RHAC contributed: Indicators*
2005 2010
Total fertility rate
3.4
3.0
Maternal mortality rate (per 100,000 live births)
472
206
Infant mortality rate (per 1,000 live births)
66
45
% of married women using a modern method of contraception
27%
35%
Ante-natal care from health professionals
69%
89%
* Source: Measure DHS – Cambodia – 2010
Registered UK Charity Number: 229476 www.ippf.org
From choice, a world of possibilities
JOINING FORCES FOR VOICE AND ACCOUNTABILITY
Linking international commitments to national accountability
European Network Regional Office
K A Z A K H S T A N M O L D O V A
B O S N I A A N D H E R Z E G O V I N A
Western Hemisphere Regional Office
K Y R G Y Z S T A N
A L B A N I A T A J I K I S T A N
D O M I N I C A N
M E X I C O
R E P U B L I C
P A N A M A
P E R U B O L I V I A
- European Network (EN) participating countries - Western Hemisphere (WHR) participating countries - Participating Regional Offices - Links between Regional Offices - Links between Regional Offices and participating countries
The Situation: Short and long term objectives Civil society organizations networks demand government accountability
Governments commit to international commitments
Improved sexual and reproductive health for all the people
Governments are more accountable
Member Associations increase capacity for advocacy
The Situation: Results Political changes: Creation of sub-national youth bodies to hold governments accountable on youth policies
Financial support to implement youth friendly services
Sexual and Reproductive Health for Adolescents Plan
CSO strengthening: Amnesty International HIV groups (Aid for Aids)
National strategy on SRHR
22
Implementation of SRHR Plans, including M&E mechanisms
political changes Sub-national legislation to provide universal access to specialized services for youth
Comprehensive sexuality education (CSE) guidelines and budget allocation Earmarked budget to provide SRH for adolescents
National standards for safe abortion and of postabortion care
Budget experts (Fundar, Agreement plus, IBP)
36
Parliamentarian dialogue
GCPA (Global Call to Action against Poverty)
new or strengthened networks/ alliances
National universities
Youth groups Indigenous movements
LGBT groups
Disabled, rural women and other vulnerable groups
According to the independent mid-term review conducted by the TCC Group, 80% of MA outcomes and 45% of the project’s long-term outcomes have already been achieved. Registered UK Charity Number: 229476 www.ippf.org
JOINING FORCES FOR VOICE AND ACCOUNTABILITY
Overcoming barriers for implementing effective public policies “Working with Mexfam has been strategic for this Center in terms of creating synergies in support of projects aimed at generating public policies in sexual and reproductive for adolescents” Dr Marco Olaya - Director of Family Planning, National Center for Gender Equity and Reproductive Health, Ministry of Health, Mexico
The Situation:
State fulfils its obligations related to SRHR and civil society
SRHR policies and expenditures are implemented as intended
CSO Strengthening, Capacity Building, Strategic Organization
Public policies including budget allocation are better connected to citizen’s SRHR needs
The Situation:
Community is included and incentivized to participate in public policy
Citizens demand government accountability related to SRHR
w
The process in Mexico: ‘CRAFTING LEAPS FORWARD’ How?
With whom?
Creativeness Resilience Accuracy Flexibility Timing Innovation Nearness Grants
Legislative branch Executive branch Advocates Partnerships Civil Society
What?
Financial allocation Ownership Resources for sustainability AWareness Accountability Recognition Development of Public Policies
The Situation: Political changes Publication of National Sexual and Reproductive Health Program for Adolescents
Implementation of SRHA program in 5 states
Decisionmakers involved in followingup on a the implementation of existing program for ASRH
4
MOH invited Mexfam to coordinate project aiming at providing quality services for adolescents
political changes
MOH esponding to transparency demands
Creation of Inter-institutional Groups in SRH in 5 states
Legislators placing ASRH as a key issue in their agendas in project areas
$16 million USD in 2011 and $32 million USD in 2012 were earmarked to implement the SRHA program
Registered UK Charity Number: 229476 www.ippf.org
From choice, a world of possibilities
JOINING FORCES FOR VOICE AND ACCOUNTABILITY
IPPF Member Associations’ enhanced role in strenghtening democracy and good governance The Situation:
State fulfils its obligations related to SRHR and civil society
SRHR policies and expenditures are implemented as intended
DEMOCRACY Governence and Accountability
Public policies including budget allocation are better connected to citizen’s SRHR needs
Parliaments
IPPF MAs CSOs
Media
Other Social Movements
Internationalcommitments Commitments International andnational Nationalpolicies Policies and
The Situation:
Community is included and incentivized to participate in public policy
Citizens demand government accountability related to SRHR
Why civil society is crucial for democracy - lessons: 1. Introducing human rights principles
4. Connecting national and local levels
7. Creating enabling environments
2.
3.
Providing continuity and stability
5.
Innovating
6.
Supporting local authorities
8. Providing specific expertise
Partners to parliamentarians
9. Networking across issues
According to the independent mid-term review conducted by the TCC Group, 67% of MA showed evidence of moderately or significantly strengthening the coalition and many show evidence of being in better positions to implement activities. This includes expanding the number of participating organizations, involving ‘vulnerable groups’ and increasing skills such as advocacy.
Registered UK Charity Number: 229476 www.ippf.org
CSO Strengthening, Capacity Building, Strategic Organization
JOINING FORCES FOR VOICE AND ACCOUNTABILITY
Investing in civil society as a winning factor for democracy under political instability “Before the project, I was thinking that the main thing young people need is the opportunity to earn money, a good job for a good life… but now I understand how SRH is important; I realized that special attention to youth is needed from all governmental levels” Murat Uraimov, Vice Mayor of Kyzyl Kia (south Kyrgyzstan)
The Situation:
State fulfils its obligations related to SRHR and civil society
SRHR policies and expenditures are implemented as intended
Public policies including budget allocation are better connected to citizen’s SRHR needs
Community is included and incentivized to participate in public policy
Citizens demand government accountability related to SRHR
The process in Kyrgyzstan
Changes at city, town, and regional
Society
level
Legislative
reaction
changes
Pa
Policy
rlia
ia
nt
and procedures
me
fy
ou
ng
pe
op
ers
mb
on accountability
le
mechanisms
me
Ne
tw
youth in
or
political agenda
Pa
rti
Youth friendly
Politica
cip
Finance
eo
SRHR of
Vo ic
Bridging local and national levels of collaboration between civil society and decision-makers
Youth
Sustainable
Med
The Situation:
CSO Strengthening, Capacity Building, Strategic Organization
k
in
te
ra
dget
bu Local
ct
io
n
Package
at
ion
l comm
of
itment
civ
il s
allocation
oc
al litic
nge
cha
r po
o se f i t r e
iet
clinics/ cabinets
on youth friendly services
Exp
y
of documents
MA Team
Partnerships
National advocates
Decision makers
Exchange of experience
Human rights
Knowledge and skills
Financial support
International commitments
The Situation: Results
SRHR Coalition and SRHR Experts
Budget Transparency Alliance
National Alliance to Defend Children and Family Rights
6
Networks or new partners
Association of Civil Society Support Centres
Expansion of the areas of influence in Kyrgyzstan - CSO strengthening
Coalition for Democracy and Civil Society
Vulnerable Group Experts
Registered UK Charity Number: 229476 www.ippf.org
From choice, a world of possibilities
A HIGH PERFORMANCE FEDERATION, REMAINING RELEVANT AND ACCOUNTABLE TO A CHANGING WORLD
IPPF Africa Region Learning Centre Initiative: a new approach to technical assistance Rationale: Level of country SRHR needs
Categorization of MAs based on their level of institutional capacity and programme Areas
Low unmet needs in SRHR
Strong
Moderate
Weak
Governence and leadership EXPECTED
Finance
IDEAL
Management
OUTCOME
Programme Accountability and responsiveness Moderate unmet needs in SRHR
Governence and leadership Finance Management Programme (5 in 1 and 1 in 5) Accountability and responsiveness
Strong unmet needs in SRHR
Governence and leadership Finance Management Programme (5 in 1 and 1 in 5) Accountability and responsiveness
Learning Center MAs and area of speciality:
Selection criteria: Sound programmes – range/quality of services
MALI CAPE VERDE
GUINEA BISSAU
CHAD
GHANA
BENIN
NIGERIA
CÔTE D'IVOIRE TOGO
SAO TOME & PRINCIPE
CAMEROON
DEMOCRATIC REPUBLIC OF CONGO
EQUATORIAL GUINEA
GABON
Ghana
1. Adolescent and Youth Sexual and Reproductive Health 2. Governance
SEYCHELLES
TANZANIA
COMOROS
ANGOLA
MALAWI MOZAMBIQUE
ZAMBIA MADAGASCAR
ZIMBABWE NAMIBIA
1. Governance 2. Sexual and Reproductive Health for Marginalized Groups
Robust financial systems
MAURITIUS
Mozambique
BOTSWANA
LESOTHO
SWAZILAND
1. Governance 2. technical hub for Lusophone countries
SOUTH AFRICA
IPPF Africa Regional Office • Strengthen the capacity of MAs • Coordinate between LCs, MAs and partners • Facilitate MA-to-MA technical assistance and support • Monitor, evaluate, document and disseminate the LC achievements
Beneficiary MAs Capacity strengthened in the areas of: • Programs management and accountability • Service delivery and quality of care including youth friendly services • Governance and leadership • Transformation to Mentoring Sites and LCs
KENYA BURUNDI
ANGOLA
Cameroon
Structures and functions:
UGANDA
RWANDA
CONGO
Effective management
S
ETHIOPIA
CENTRAL AFRICAN REPUBLIC
LIBERIA
Strong governance
ERITREA
BURKINA FASO
GUINEA SIERRA LEONE
1. Quality of Care 2. Family Planning 3. Governance
NIGER
SENEGAL THE GAMBIA
Community responsive – client base
Uganda
Other partners Learning Centers (LCs) with Learning Center Coordinating Units (LCCU)
(NGOs, Universities, Colleges, MOH, Development Agencies) Support has been provided to partners in the following areas: • Exchange visits • IEC/BCC materials design and production • Program management
Additional mentoring sites • The existing LCs play key role in transforming some MAs to mentoring sites and LCs • LCs provide technical support to the existing mentoring sites
Achievements to date:
The way forward:
• Facilities upgraded (renovations, information technology, furniture etc.)
• Continuously upgrading skills
• A core team of trainers in place operations manual developed and in use
• Documenting process for future expansion of LC sites (from 4 to 15 by 2015)
• Training modules on YFS, access, governance, leadership and management are in place
• Expanding LC to include M&E, eIMS, Including e- and virtual learning opportunities
• Improving logistical capacity
• Developing branding and marketing
Registered UK Charity Number: 229476 www.ippf.org
From choice, a world of possibilities
A HIGH PERFORMANCE FEDERATION, REMAINING RELEVANT AND ACCOUNTABLE TO A CHANGING WORLD
Delivering better services in Palestine: improving performance to optimize service delivery in challenging circumstances Situation: Increasing restrictions on personal mobility means that health services must be offered close to the clients’ home
S
High and increasing levels of poverty among clients which means they can’t afford health services from expensive static facilities
?.
High levels of political uncertainty makes long term planning difficult
Reduction in priority of health in Palestine among international donors
800
0.25
2,500
0.2
2,000
0.15
1,500
%
600 400
0
0
Service delivery points
He
Be
Be
th
G
le
az
m he
ou lh Ha
br on He
G
az
m Be
th
le
he
ou lh Ha
He
Service delivery points
br on
0
a
500 l
0.05 a
200
l
1,000
br on
0.1
he
3,000
US$
0.3
Number of clients
1000
m
Laboratory revenues:
% Revenue coverage of expenses/workday:
le
Clients served/work days:
th
- 2010 - 2011
Service delivery points
Lessons learned: When implementing changes, need to be decisive
Efficient services balance time management and quality of care
Key criteria for change is to prioritize meeting the needs of poor and vulnerable populations
Continuously monitoring quality systematically increases quality
Using the Core Analysis Tool staff were able to consider a range of factors beyond only income and expense – for example time and cost spent, service provided and position Providing a package of diverse services which comprehensively meets health needs attracts more clients to service delivery points
Making services providers responsible for achieving results increased motivation, accountability and pride leading to improved productivity and results Create strong referral networks from the beginning to ensure client expectations are met
What would we do differently in the future? S
Pay specialist service providers (doctors/ gynaecologists) a percentage of the income earned rather than a fixed salary. Note that this increases productivity and reduces cost per client.
Stronger enforcement of quality standards from the beginning.
Registered UK Charity Number: 229476 www.ippf.org
Evolve PFPPA’s service delivery model to strengthen community service provision by strengthening mobile clinic geographic and service range.
From choice, a world of possibilities
A HIGH PERFORMANCE FEDERATION, REMAINING RELEVANT AND ACCOUNTABLE TO A CHANGING WORLD
Responding to evidence – tailoring services and reaching more clients Integra is a 5 year initiative to support integration of sexual and reproductive health (SRH) and HIV services. Integra initiative is managed by the International Planned Parenthood Federation (IPPF) in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM) and the Population Council, and is supported by the Bill and Melinda Gates Foundation (see www.integrainitiative.org). Integra goal: To strengthen the evidence base for integrating HIV and sexual and reproductive health services – documenting and operationalizing ‘programme science’
Research objectives:
Organizational objectives (FPAM):
1. Efficiency of operational models to deliver integrated
1. Strengthen FPAM’s capacity to provide
services. Criteria used: cost; existing infrastructure; human resources
integrated services at facility and community level
2. Increase the number and range of services
2. Benefits of different integrated SRH/HIV models to
provided by FPAM
increase service: range; uptake; quality
3. Strengthen FPAM’s institutional capacity
3. Impact of different integrated services on changes
including sustainability
in: HIV risk behaviour; HIV stigma; and unintended pregnancies
4. Use of research findings by policy and programme decision makers
- FAMILY PLANNING - VCT
FPAM is active in Dedza, Dowa, Lilongwe, Kasungu and Ntcheu Districts of Malawi covering a population of 1.8 million people.
12,000 10,000
Fivefold increase in family planning and doubling VCT by extending SRH services to include:
8,000 6,000 4,000 2,000 0
1st Half 2008
2nd Half 2008
Total 2008
Total 2009
Key activities
Total 2010
• • • • •
Anti-retroviral therapies Cervical cancer screening Ante-natal care Cryotherapy Laboratory services
Key achievements and results
• Upgrade static service delivery facilities • Improve and expand outreach service delivery sites • Improve quality of care/rights based, stigma free services • Develop staff capacity and improve staff motivation • Upgrade equipment • Improve mechanisms for commodity security (reduce stock outs) • Strengthen data management system • Improve sustainability through introduction of laboratory and pharmacy services • Mobilize and engage communities, expanding partnerships • Publicity
Responds to the evolving SRH/HIV needs of Malawian population: Increased clients: Under 25, Sex workers and YPLWH. Increased national relevance/formulating policy: Member of the Health SWAp Member of the SRH Technical Working Group Strengthened partnerships: Government/private clinics Ministry of Health UN Agencies Donors – European Commission Change in IPPF Membership: Was Observer Status, now Associate Member, working towards attaining full membership before end of this year (2012)
Lessons learnt
Priorities for the future
• Every step is a learning step in integrating services, whether one has experience or not • Infrastructure improvement brings quality to service provision • Learning from the clients – continuous quality assessment ensures client satisfaction • Integration brings convenience in client management
• Increase sustainability - strengthen FPAM districts to be strategic business units (plan, manage, execute, evaluate and report) • Increase accuracy of information to improve decision making - creating a strong research, monitoring and evaluation function • Extend training – enhance number of people with multiple skill sets
Registered UK Charity Number: 229476 www.ippf.org
From choice, a world of possibilities
A HIGH PERFORMANCE FEDERATION, REMAINING RELEVANT AND ACCOUNTABLE TO A CHANGING WORLD
Performing under pressure - advancing reproductive rights in turbulent times The Situation: Rewarding superior performance:
Performance-based funding now governs EFPA support to branches
Assessment criteria include clinical programme performance, including quality of care, adherence to governance and management standards, staff performance
Non-adherence to standards triggers claw-back of funds from the branch
The Situation: Increasing access for underserved women: A recent youth needs assessment exercise revealed that young women in rural areas face particular problems accessing reproductive health services Mobile clinics are expensive to purchase and administer; EFPA has now established Mobile Service Teams, which hire micro buses to travel to rural areas
The Situation: Results:
SRH service provision
CYP
Sustained year-on-year increases in the delivery of comprehensive SRH services:
Arrested decline in the number of CYPs delivered per clinic:
2,500
530 520
2,000
510 500
1,500
490 480
1,000
470 460
500
450 440
0
2007
2008
2009
2010
430
2007
SRH during the Egyptian revolution: In 2011, mobile service teams carried out 3,000 home visits in rural areas to meet the needs of young women currently denied access to services; this resulted in nearly 1,200 referrals to EFPA clinics.
Registered UK Charity Number: 229476 www.ippf.org
2008
2009
2010