The Leadership Gap Commitment and Performance on Reducing Unmet FP Need Repositioning Family Planning in West Africa Accra, Ghana February 2005 Developed by the POLICY Project and M. Moustapha Ka

THE LEADERSHIP GAP  What commitments have Governments made?  Who is in “Leadership”?  What can they do?  How well are they doing?

Commitments of Governments:  1994 Cairo Programme of Action (ICPD)  1997 Program of Action of Ouagadougou  1997 Reproductive Health Strategy for the Africa Region (WHO AFR/RC47/8)  2003 Women’s Health Strategy (WHO AFR/RC53/11)  2004 Repositioning Family Planning Framework (WHO AFR/RC54/11 Rev.1)  National laws, policies and strategies

Commitments – and yet… In the six years ( ) following ICPD, in this Region of West Africa:  12,000,000 unintended pregnancies  650,000 deaths of women and girls from largely preventable pregnancy-related causes  18,000,000 pregnancy-related infections, injuries, other disabilities

Who is in “Leadership”? Leaders are – At national, regional, district and local levels Those who set policies, control resources influence socio-cultural practices… In legislatures & ministries of health, plan, finance, education, gender, etc In civil society including NGOs, religious institutions, business and other

 Ensure access to information, services and contraceptives  Address unmet FP need in national development strategies  Strengthen public policy, planning and budgeting process  Implement public-private partnerships  Reduce vulnerability of women and girls What can Leaders do?

-Financing in national & decentralized budgets, alternative mechanisms, all sectors - Contraceptive security - Standards of care - Well equipped providers - Least restrictive services &method criteria - Programsthat guarantee informed consent, choice - Multisector physical, human resources What can Leaders do? Ensure Access

What can Leaders do? Address Unmet FP Need in Development Strategies  Unmet FP need = serious national problem · FP access a fundamental human right · Measure impact of unintended fertility · Comprehensive multisector strategy · FP needs addressed by all ministries · Role of unintended fertility related to HIV/AIDS, Poverty, other national problems

What can Leaders do? Strengthen Policy, Planning Budgeting Process  Systematic and transparent · Reflect laws & international commitments · Participation of civil society Directed by high level of authority · Responsive to needs & priorities Based on timely, accurate data · Translated into action

What can Leaders do? Implement Public-Private Partnerships Clear roles, reduced competition from free public services Functional partnership, e.g. shared training Favorable regulatory climate

What can Leaders do? Reduce Vulnerability of Women and Girls  Gender-sensitive public and private policies, programs, budgets  Legislative reform, enforcement to guarantee rights, protect against abuse

How well is leadership performing? Progress… New RH laws in 5 countries Increased parliamentarian role in many countries Religious institutions adopting supportive policies Significant presence of civil society in policy & advocacy Service policies & norms updated frequently

How well is leadership performing? Challenges… No cohesive effort targeting Unmet FP Need Little support from leadership outside health sector Absence of “FP need” in key development strategies Gaps in laws, policies, strategies (e.g.Contr.Security) Weak enforcement of existing laws Limited mandate & resources of agencies Little authority to enforce multmsector efforts Lack of routine participatory planning, budgeting Ineffective implementation of services policies & norms

The way forward for Leadership

Learn lessons from efforts in other areas …Tackles HIV/AIDS, Poverty, Malaria Mobilizing all sectors….

Learn lessons from efforts in other areas  Acknowledge unwanted fertility as a severe national problem  Demonstrate its impact on all sectors Mobilize energy and resources of all sectors to reposition FP

Strong leadership is the key to multisectoral repositioning of Family Planning to reduce unmet need

FINAL REMARKS From Family Planning repositioning to Leadership repositioning