THE SPARHCS PROCESS GUIDE A Planning Resource to Improve Reproductive Health Commodity Security

Acknowledgements United States Agency for International Development (USAID) United Nations Population Fund (UNFPA) USAID | DELIVER Project USAID | Health Policy Initiative (ACQUIRE) Project Engender Health

Purpose Provide guidance on the uses of the SPARHCS Diagnostic Tool Demonstrate and encourage the implementation of the SPARHCS Approach A set of activities from awareness raising and diagnosis, to monitoring the effectiveness of a funded and implemented strategic plan A set of activities from awareness raising and diagnosis, to monitoring the effectiveness of a funded and implemented strategic plan

Background Over 40 SPARHCS assessments in Africa, Asia/Pacific, LAC, & Eurasia regions Limited documentation examining diagnostic methods, or guidance to adapt approach for objectives, resources, and constraints of country Focus on joint diagnosis and strategic planning Audience: TA providers, donors, MOH officials

Supporting the Program Cycle

I.Getting Started: Pre-Process Checklist ConsiderationDescription Rationale (or impetus) for SPARHCS Example rationales are: high unmet need, low CPR; design for new donor assistance, donor scale-back; perceived problems in service delivery or logistics Product focusDetermine category of products for which stakeholders are seeking to strengthen RHCS Short and long term expectations and results Achieve consensus on what is expected in the next two and then ten years Available resourcesEstimate potential funding levels and human resources for the process

Examples of Key Decisions THE COMMODITIES The implications of securing the full range of essential RH medicines are substantially different than a focus on contraceptive commodities, and should be carefully considered by stakeholders with regard to available resources and political commitment. TAKING ACTION Provide support for advocacy workshops to sensitize decision-makers of the importance of RHCS at national and local levels. Encourage agreement by all that the assessment findings will be used as the basis for concrete RHCS action plans.

II.Awareness Raising – Point of Entry for the Process Helps obtain the needed political support for the process Helps obtain the needed political support for the process Involves regular communication with target audience Involves regular communication with target audience Local data will make presentations more relevant and useful Local data will make presentations more relevant and useful Emphasize SPARHCS approach should be part of, not displace existing systems Emphasize SPARHCS approach should be part of, not displace existing systems Tools: Workshops, the SPARHCS Framework, examples, country data analysis Tools: Workshops, the SPARHCS Framework, examples, country data analysis

III.The Joint Diagnosis Understand and document the RHCS status nationally, locally, or within a region Identify specific gaps/challenges Identify specific gaps/challenges Provide basis for strategic planning Provide basis for strategic planning The Diagnostic Tool is flexible, intended to be customized. Example: If RHCS gaps are known to be more prevalent in the supply chain, then adapt the diagnostic to focus specifically on logistics Example: If RHCS gaps are known to be more prevalent in the supply chain, then adapt the diagnostic to focus specifically on logistics

The major steps of a Joint Diagnosis The Pre-Process Checklist? 1.Form an RHCS Committee 2.Desk-based research/data collection 3.Stakeholder consensus on methodology 4.In-country interviews, workshops 5.Presentation and consensus on findings 6.Agreement on 6.Agreement on strategic planning!

RHCS Committee What A multi-sectoral group of technical and policy-level stakeholders supporting the assessment and strategic planning. If an RHCS Committee does not exist, one should be formed before the diagnosis Why Identifies a group that is an essential resource, facilitator, and advocate for assessment and strategic planning. Builds ownership among stakeholders of the assessment, its results, and of the subsequent strategic planning.

Desk-based Research/Data Collection What The assessment team should collect and analyze existing RHCS data. Existing data may include DHS and RHS surveys, economic and health- related statistics available from the World Bank, WHO, and other international organizations, and in-country sources. A request should be made to in-country stakeholders for technical reports, policy papers and related assessments. Why Data collected from desk- based research allows the diagnostic process to begin early, Take advantage of existing data to help lower assessment costs, and Identify early issues and areas where further investigation will be necessary.

Stakeholder Consensus on Methodology What Present the objectives, expected outputs and proposed methods to key stakeholders, and obtain their feedback. Discussion on key RHCS issues should take place and assessement methods should be adapted accordingly Why Allows stakeholders the opportunity to ask questions and provide guidance. Raises awareness and strengthens buy in and local ownership of the process

Adapting the Framework Customizing the approach promotes country ownership by better aligning the process with local priorities and needs Stakeholders often elected to identify RHCS components using different criteria or to merge two or more components. Examples: Madagascar - demography, policy, demand, service delivery, and finance Madagascar - demography, policy, demand, service delivery, and finance Egypt - advocacy, finance, logistics, service delivery, collaboration & coordination Egypt - advocacy, finance, logistics, service delivery, collaboration & coordination UNFPA – RHCS Situational Analysis Tool (RHCSAT), which looks at all the SPARHCS components with a special focus on the supply chain UNFPA – RHCS Situational Analysis Tool (RHCSAT), which looks at all the SPARHCS components with a special focus on the supply chain

In-Country Interviews & Workshops What Interviews provide in-depth feedback from individuals with policy and program experience. The workshop can be used in place of or in combination with interviews depending on time and availability of informants. This setting allows informants to compare and share experiences that may be missed in individual interviews. Why The interviews promote more open discussion about existing issues. Data may also be easier to obtain in an interview setting. Different interpretations of the RHCS situation can be identified and clarified in a workshop setting. Participants can also work in groups to identify preliminary approaches to the issues they identify.

Presentation and Consensus on Findings What A half or full day workshop can be used to present and validate the draft findings with the RHCS Committee Why Builds consensus and acceptability of the findings; presents a rationale for and builds commitment to develop a strategic plan to strengthen RHCS

IV. Strategic Planning The joint diagnosis identifies RHCS strengths and weaknesses, the strategic plan is the opportunity to address them Planning is based on the findings from the diagnosis; CS experts CS committee meetings & workshops required Why it is important:  Unify stakeholders around a common set of objectives;  Prioritizes challenges;  Catalyzes stakeholder commitment to action

The Essential Elements of a Strategic Plan

Defining the Elements Goal - broad, general statement of long-range purpose. Priority Issues – Major barriers to RHCS; Major barriers to RHCS; Feasibility of addressing those issues within the plan Feasibility of addressing those issues within the plan Objectives – One clear and measurable objective that address the priority issues (e.g., “Capital: increase and diversify sustainable funding for RH commodities.”) Actions/sub-Actions – specific tasks carried out to achieve the objectives

Defining the Elements (cont’d) Coordinating/Implementing Agencies – Groups that manage and carry out the activities Budget component – “Bottom Up” budgeting by estimating costs for each activity. Accuracy important for obtaining financial commitment M&E Plan – Develop output indicators and define expected outcomes to inform M&E Plan Output - The intermediate result of the action and sub-actions Output - The intermediate result of the action and sub-actions Outcome - The (beneficial) effect on the targeted population Outcome - The (beneficial) effect on the targeted population

Notes on Strategic Planning Process Generally requires the RHCS Committee to meet several times to develop the elements A Technical Working Group (TWG) proven useful to carry out detailed planning Diverse group from all sectors, national and local experts needed to increase ownership Plan’s value is in implementation!

V. Implementation Achilles heal of RHCS is transition from planning to implementation Critical Factors: Critical Factors: Political Will – the leadership factor. Public sector leaders demonstrating commitment to the implementation process Political Will – the leadership factor. Public sector leaders demonstrating commitment to the implementation process Detailed Work Planning - help ensure that the strategic plan is easily embedded within the implementing institutions Detailed Work Planning - help ensure that the strategic plan is easily embedded within the implementing institutions Program Integration – included in national policy and operational documents, (e.g., PRSPs, SWAPs, MTEFs, and MOH work plans). Program Integration – included in national policy and operational documents, (e.g., PRSPs, SWAPs, MTEFs, and MOH work plans).

VI. Model Approaches Several options to implement SPARHCS Process Funding Funding Available technical resources Available technical resources Scope of the problem Scope of the problem Level of political support Level of political support Three proposed models have been used in different environments that represent variations in cost, time, and results

Model 1 MODEL 1 COST: $ OF $$$ Key Elements  Adaptable for programs with limited financing.  Effective when there is widely available RH/FP program data.  Focuses on strengthening RHCS within existing programs.  Useful when there are widely accepted priorities.  Example of a joint diagnosis: Malawi: Contraceptive Security Desk Assessment

Model 2 MODEL 2 COST: $$ OF $$$ Key Elements More resource intensive; involves efforts that are directed toward increasing awareness of RHCS prior to beginning the joint diagnosis. Detailed joint diagnosis based on desk analysis and in- country data collection A Strategic plan is developed, but needs to be balanced with need to limit expenditures on activities. Example of a joint diagnosis: Madagascar: Joint RHCS Evaluation

Model 3 MODEL 3 COST: $$$ OF $$$ Key Elements Activities are included to increase awareness of RHCS and to form or engage an RHCS committee prior to the joint diagnosis. The committee will facilitate a more in-depth assessment Detailed joint diagnosis based on desk analysis and multiple forms of data collection Increased resources for joint diagnosis and strategic planning to ensure a comprehensive, detailed process leads to funded implementation Focus on the RHCS committee or technical working group and local organizations actively participating and leading the process High visibility launch of RHCS strategic plan Example of an awareness raising exercise: The Use of the SPARHCS in Ukraine (POLICY, 2006)

Conclusions Measure of success will not be in this process, but improvements in RH supplies to clients The Process Guide is a tool to help manage the complex process and define how the process should be adapted Evidence exists that the process works when backed by leadership and commitment