IMPACT MAGAZINE

SECTION 1

#PeoplePowered

By Jennifer Pope, VP, Sexual and Reproductive Health, HIV, and TB, PSI

As we come together for this International Conference on Family Planning (ICFP), we have an opportunity to collectively reflect on key questions critical to achieving universal access to sexual and reproductive health and rights:

  • How do we break down barriers standing between people and their sexual and reproductive health and rights (SRHR)?
  • How do we support health providers to deliver quality, empathetic care?
  • How do we expand our definition of health systems to include self-care… and then build those systems including digital solutions to be responsive, equitable and accountable to the people and communities we serve?

And, perhaps most importantly, how do we achieve Universal Health Coverage (UHC) that is inclusive of SRHR needs?

Individual people – their unique needs and lived experiences – are at the center of these questions, and our collective work to find sustainable SRHR solutions. Through PSI’s FP2030 commitment, we have pledged to innovate and scale person-centered solutions that enable 100M people to make full, free, and informed sexual and reproductive health choices throughout their life course. Core to our approach is #PeoplePowered healthcare, and why this ICFP issue of Impact centers on how #PeoplePowered solutions can help get us to UHC, and beyond.

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Women attend a group counseling session on methods of contraception led by PSI staff member Doung Mao at Sovannay Health Care Room, a Sun Quality provider in Kampong Cham, Cambodia. November, 2010 – PSI Cambodia. Photo by Jake Lyell
 

By Dorine Irankunda,  SRH Senior Technical Advisor, Quality of Care, PSI

#PeoplePowered healthcare necessitates stronger, resilient and inclusive health systems that uplift the voices, needs and experiences of the people and communities we serve. It supports us to go beyond traditional problem-based, vertical strategies and take a holistic approach to meeting people’s needs.

As this Impact underscores, to get #PeoplePowered, we must disrupt the status quo. SRHR movers and shakers—including youth activist Brown Niyonsaba, ICFP’s Dr. Jose “Oying” Rimon II, Ouagadougou Partnership’s Marie Ba, Fos Feminista’s Fadekemi Akinfaderin, CIFF’s Faustina Fynn-Nyame, PSI Ethiopia’s Metsehate Ayenekulu, UNFPA’s Dr. Natalia Kanem, and PSI Uganda’s Dr. Lillian Sekabembe, among so many others, probe us to consider how.

Specifically, what will it take to…

As these authors share, we can and will achieve UHC if we invest in #PeoplePowered health solutions and systems. This #ICFP2022, let’s chat how.

Advancing consumer-powered healthcare (CPH) – namely, care that is dignified, respectful, responsive and adaptive to consumers’ preferences and needs – is inextricably linked to achieving Universal Health Coverage (UHC).

That’s why, as part of Family Planning 2030 (FP2030), PSI commits to accelerating consumer-powered health systems that enable 100 million people in low-and middle-income countries to make full, free and informed sexual and reproductive health choices throughout their lives – all by 2030.

To achieve this commitment, PSI will focus on advancing autonomy, agency and self-empowerment in sexual and reproductive health and rights (SRHR) systems, including developing standard indicators to track the person-centeredness of PSI’s programs.

“Everything we do is informed by consumers of healthcare. For more than five decades, we have used consumer insights and research to guide every aspect of our work; we know that health outcomes are better when designed with people rather than for them,” says Karl Hofmann, PSI President & CEO. “Meeting consumers where they are by incorporating consumers’ voices into the system and equipping consumers to be agents of their own health through digital, self-care and private sector integration will make health systems more resilient, responsive and powered by the people we work with and for.”

“FP2030 pledges from partners like PSI advance the ultimate goal: ensuring that every person, no matter where they live, can make the sexual and reproductive health decisions that enable them to participate as equals in society. When we commit to sexual and reproductive health equity, we commit to catalyzing the change needed to achieve UHC,” says FP2030 Executive Director Dr. Samukeliso Dube.

PSI’s FP2030 commitment follows the organization surpassing its FP2020 commitment to support 10 million consumers under the age of 25 to choose modern contraception.

And still, millions of people in low and middle-income countries remain without access to modern contraception methods and basic SRHR care. Taking a person-centered, consumer-powered approach to healthcare delivery is critical for expanding access to contraception, safe abortion and other SRHR services as the global health community works together to achieve UHC.

“The time is now to reimagine how we design, deliver, measure and scale consumer-powered care. We join the global health community in committing to investing in and strengthening how we measure SRH programs that advance people’s autonomy, agency and self-empowerment,” says Jennifer Pope, PSI’s VP of SRH, HIV and TB.

To expand access to person-centered care, PSI will:

  • Partner to accelerate implementation of person-centered SRH delivery models, reaching 100 million people.
  • Support healthcare systems to integrate routine monitoring and accountability mechanisms for person-centered care.
  • Support development and adoption of policies to expand person-centered SRH care.

To advance measurement of client experience of care, PSI will:

  • Develop, test, validate and integrate new indicators of client experience with a focus on measurement in the context of routine programming.
  • Develop measures specific to private sector healthcare consumers, adolescents and youth, and or self-care including digitally enhanced health solutions.

For media requests, please contact [email protected].  

By Dr. Tlaleng Mofokeng, MD and the UN Special Rapporteur on the Right to Health; and Kerigo Odada, Lawyer and PhD researcher at the University of Pretoria, Centre for Human Rights

Under Sustainable Development Goal (SDG) 3, target 3.7, universal access to sexual and reproductive healthcare services includes family planning (FP), information and education, and the integration of reproductive health into national strategies by 2030.

According to UNFPA, in 2021, 49 percent of women aged 15–49 years worldwide, and 32 percent in least developed countries, were using some type of method of contraception. This drives the International Conference on Family Planning which, since 2009, has brought together the global development community to take stock of developments around access to family planning, and chart the way forward for achieving the shared vision of universal FP access.

FP, which refers to supplies and services that enable individuals and couples to attain and plan for their desired number of children, including the spacing and timing of births, is fundamental to the health and survival of women and girls.

Access to FP, including emergency contraception, safe abortion services, and post-abortion care, is a component of the right to health and, in particular, the right to sexual and reproductive health (SRH). The United Nations Department of Economic and Social Affairs, Population Division, reports that the past two decades have witnessed a rise in the demand for FP; use of modern contraceptives increased from 663 million to 851 million between 2000 and 2020. This growth is expected to continue by 2030.

All plans for universal coverage must include FP access.

Regrettably, a large gap persists between women’s reproductive needs and options. Significant disparities remain across countries and regions due to limited choice of methods; limited access to services; stigma; cultural or religious opposition; poor quality of available services; and users’ and providers’ bias against some methods. Gender-based barriers exacerbated by underlying structural, social and political systems of discrimination, continue to disproportionately affect young women, indigenous women, women with disabilities, rural women, migrant women, and LGBTQIA+ persons. Many people still do not have complete bodily autonomy and reproductive choices as envisioned in the International Conference on Population and Development program of action and Beijing declaration and platform for action.

Against this backdrop, therefore, ICFP 2022 must reinforce all existing policy, structural and social measures meant to safeguard access to FP globally and further advocate for new and renewed support for access to family planning and protection of bodily autonomy as a whole. Bodily autonomy is a political, social and legal principle that underscores the importance of respecting the capacity of persons to think for themselves, and make judgments about what they deem to be good for them.

FP is a fundamental pillar in universal health coverage, and in ensuring the well-being of individuals, families, and communities worldwide. The ICFP is a community of changemakers, and must continue to be resourced to continue the various work on policy, services, research, and funding of programs to ensure the realization of SRH and rights.

By Dr. Natalia Kanem, Executive Director, United Nations Population Fund (UNFPA)

On November 15th, the world’s population will hit 8 billion.

As the Executive Director of the United Nations Population Fund (UNFPA), I believe the international community should view this day as a success story. After all, we have gotten to this point because people are living longer, fewer women are dying giving birth, childhood mortality has declined, and healthcare systems are getting better. While many have used this milestone in population growth—and every other before it—to focus on the climate crisis and other challenges the world faces, let us instead focus on the opportunities.

No demographic trend is solely bad or good, and with the right investments, sound policies, and advance planning, governments can empower every person in their population to achieve a good quality of life. At UNFPA, we help countries unlock this potential by helping them understand their changing demographics, project their future population, and devise policies that build healthy and inclusive societies, with a focus on ensuring rights and choices for all.

Let us address the topic most fundamental to our growing population—reproductive health and rights. Nearly half of all pregnancies are unintended and more than 250 million women do not want to become pregnant, but are not using modern contraception. Yet, in our research and programmes we see firsthand that providing every person with access to safe, voluntary family planning is one of the best investments a country can make. Access to contraceptives not only prevents unintended pregnancies and lowers maternal death rates, it also reduces poverty and helps people complete their education. These benefits pay dividends to the development of countries’ economies and social structures. In fact, some estimate that the long-term socioeconomic benefits of achieving universal access to quality sexual and reproductive health services, including contraception, would yield returns of $120 for every dollar invested.

When we invest in family planning, we’re investing in girls’ futures. Teaching adolescents about their reproductive health and options improves their long-term health outcomes and lowers their chance of pregnancy and childbirth complications—the leading cause of death among adolescent girls. Together, knowledge and access to reproductive health services benefit all areas of girls’ lives, from their education to their level of autonomy in the household.

Let’s plan for a future in which all 8 billion of us can fulfill our potential. By prioritizing the issues that impact the most vulnerable, we can support those bearing the brunt of the world’s most pressing challenges. In our increasingly unequal world, we need to invest in people and the promise they hold – irrespective of their gender, race, nationality or creed. When we do, a future in which all 8 billion of us can thrive will be within our grasp.

This blog post was originally published on UN DESA Voice.

By Marie Ba, Director, Ouagadougou Partnership Coordination Unit (OPCU)

In 2011 – the year the Ouagadougou Partnership (OP) launched—the nine Francophone West Africa (FWA) countries (Benin, Burkina Faso, Côte d’Ivoire, Guinee, Mali, Mauritania, Niger, Senegal, and Togo) had some of the lowest contraceptive rates in the world.

Here we are, a decade late later.

OP has changed the narrative, supporting 4 million new modern users to choose contraception, and powering countries to double their contraceptive rates. The factors enabling this success are well documented. They include firm commitments to family planning (FP) by member countries driven by emulation and healthy competition, national costed implementation plans (CIP), active participation by civil society, notably youth and religious leaders, and donor coordination to avoid duplication and optimize alignment with country plans.

However, much more needs to be done to maintain the momentum in the region.

Many countries have reached the easier segments of users, and new strategies and innovations are required to continue strong growth. We collectively must address these four key priorities to achieve our new ambitious goal of doubling the current number of modern contraceptive users of 6.5 million to reach 13 million by 2030.

  • Social behavior change (SBC). OP countries must move beyond availability and toward the acceptability of contraception services. We must focus on shifting social norms and behaviors to generate organic demand for family planning services. The OP will continue to fund SBC projects and research in the region, gather, develop and publicize SBC resources in French, and track measures of provider behavior and quality of services.
  • With up to 70 percent of its population under 30, the OP sees youth as agents of change. Our youth strategy catalyzes leadership and skills development for the emergence of a capable generation of young leaders. It also tackles obstacles preventing access to quality contraceptive services and options for young people.
  • There is a significant gap in FP knowledge and research on SBC and youth attitudes in Francophone West Africa. The OP launched a research fund for local institutions to build evidence in order to advance and improve current national family planning strategies and programs and better inform future policies. The fund will prioritize applied research on youth and SBC, help develop research agendas and funding criteria collaboratively with regional experts, and make local and regional FP research more useful, visible, and accessible from FWA to the continent and globally.
  • Family planning in a crisis context. Many OP countries are facing security, health, and humanitarian crisis. The OP must involve humanitarian experts in CIP development to plan for FP in emergency situations, build partnerships with humanitarian organizations and participate in resiliency projects, activities, and conferences.

Looking toward 2030, we envision a Francophone West Africa where easy access to quality family planning services saves and improves women’s and young people’s lives and serves as a catalyst for sustainable development for all. We are confident that our new strategies will help pave the way for a stronger and more successful partnership.

By Duff Gillespie,  Project Director, Advance Family Planning

Effective, evidence-based advocacy can increase access to quality and voluntary family planning. From its beginning in 2009, the Advance Family Planning (AFP) initiative has aimed  to demonstrate just that. Using the  SMART Advocacy[1] approach, AFP advocates have achieved nearly 3,000 advocacy wins contributed to improved family planning policies, and generated $168 million in funds from national and local governments and the private sector.

What have we learned in the last decade that can help advocates in future? We offer five lessons advocates may find useful over the next decade.

1. Devolution is a Game Changer

Context: Historically, governments centralized family planning policy and funding decisions. Today, many national governments have transferred power over family planning programs to local or regional officials. Sub-national decision-makers –  governors, legislators, district medical officers, mayors, and many others—now hold the success or failure of global and national family planning commitments in their hands. The result is a kaleidoscope of local programs and policy priorities that can spur innovation and influence neighboring decision-makers as well as those in the national government.

Learning: To be effective, advocates should continually assess the diversity of local political and socioeconomic factors and be on the lookout for local leaders ready to act.

 

2. Advocate for Policy Implementation

Context: Compared to 30 years ago, most countries in Africa, Asia, and Latin America have policies promoting and supporting family planning.[2] Despite these favorable policies, policy implementation faltered in many countries.

Learning: Advocates can ask decision-makers for discrete actions such as funding or regulatory change that will facilitate the government reaching their own policy goals. Indeed, government officials very often became active players in the advocacy efforts. Civil society can play a critical partnership role in helping the government achieve policy aims that it is already on record as wanting.

 

3. Evidence Is Not Enough

Context: Advocates often point to “evidence-based advocacy” to highlight what contributed to their advocacy successes. The reality is that most decisions are not based solely on evidence.

Learning: Advocates need to know how emotions, ethics, and relationships factor alongside evidence in developing messages. Advocates should be strong storytellers who are able to make any evidence connect to a decision-makers personal beliefs and objectives. While evidence is not everything, developing messages based on truth and data is essential to avoid running counter to existing knowledge.

 

4. Local Ownership is Here to Stay

Context: Development assistance is donor driven with major donors dictating who, how, and on what their funds will be spent. External donor funds make up 45 percent of family planning funds in the Global South.[3] While donors philosophically have long embraced local ownership, they are now actually, albeit slowly changing funding strategies to support locally led, indigenous non-governmental organizations (NGOs). Many of these NGOs have limited administrative capacity and fiduciary control to compete for and be able to fully implement awarded programs, i.e., effectively spend donor funds.

Learning: The transition to local ownership would significantly shorten if donors designated more resources to organizational capacity so that local organizations would be better situated to receive and administer direct donor funding.

 

5. Monitor Advocacy Impact

Context: Tracking outputs and outcomes of advocacy wins is often more difficult and more expensive than achieving the initial win. And therefore, there is little interest to include and fund monitoring and evaluation activities in the overall advocacy effort.

Learning: Determining if advocacy wins resulted in the desired policy and programmatic changes is essential to progress and an important way for others to replicate success.

In conclusion, AFP’s experience suggests that change in the next decade will be incremental, at the subnational or local level, and with less headline-grabbing policy implementation. There are governments that remain hostile toward many SRHR issues, which makes advocacy feel impossible. However, advocates are equipped with the ingenuity and grit to achieve change through diverse coalitions, evidence-based strategies, and stronger local advocacy organizations.

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[1] David-Rivera,V.,Whitmarsh, S., Gillespie, D., and Fredrick, B. (2021). SMART Advocacy User’s Guide. April 2021.

[2] United Nations Department of Economic and Social Affairs, Population Division (2021). World Population Policies 2021: Policies related to fertility. UN DESA/POP/2021/TR/NO. 1.

[3] FP2030. (2021) FP2030 Measurement Report 2021. January 2022.

Section 1/4

Cover

01 #PeoplePowered

02 Breaking Taboos

03 Section Title

04 Section Title

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