1. Factors Influencing the Success of Family Planning Programmes: Case studies from Kenya, Tanzania, Rwanda, Ethiopia and Malawi 1 Population Association of Kenya, 4 th Conference Nairobi Safari Club, Lilian Towers, Nairobi 24 th October, 2012 Nyokabi R. Musila (Ph.D.), Violet I. Murunga (MSc.) and Eliya M. Zulu (Ph.D.)

2. Use of modern contraceptives by married women in Sub- Saharan Africa has markedly increased in Eastern and Southern Africa between 2000 and 2010

3. Trends in modern FP use amongst married women in select Eastern and Southern African countries Modern CPR (%) Rwanda Malawi Kenya Tanzania Ethiopia

4. Rwanda, Ethiopia and Malawi have shown the most progress in modern contraceptive use over the last decade (2000 to 2010) Kenya and Tanzania recovered from their stalled programmes between 2005 to 2010

5. What led to the stall in use of modern FP methods in Kenya between 1998 and 2003? Shift in national priorities to other emergent issues Shift in external funding priorities Weak institutionalisation of the FP Programme

6. What led to the deceleration in uptake of modern FP methods in Tanzania between 1999 and 2004/5? Shift in donor priorities to HIV Weakened human resource capacity Premature health systems reform

7. Aim and Objectives of the Study Aim: To identify and document lessons and disseminate to less well performing countries Objectives: To conduct rapid assessments of drivers of progress in increasing contraceptive use in Ethiopia, Malawi, and Rwanda at the policy, system, and service delivery levels; and to make comparisons to Kenya and Tanzania

8. Methods Review of the literature Review of population, reproductive health and FP policies, strategies, service guidelines (including government and external funding for FP) to summarize key drivers of change Stakeholder interviews to understand their perspectives on policy and programme changes and future directions

9. These were found to be identical across the countries However, the contextual circumstances within the countries (political, systems, infrastructure, cultural) inform how the drivers have uniquely played out in individual countries to achieve increases in contraceptive use in the recent past Drivers of Progress in Increasing Contraceptive Use

10. Systems strengthening Health work force training Taskshifting at facility level Integration of services Supply chain management Taking services to the community Mobilisation of funds and good coordination of activities Political will and commitment Sustained advocacy Drivers of Progress in Increasing Contraceptive Use

11. Political will and commitment for FP Manifestation of political will: o Conducive policy environment o Development and prioritization of FP programmes by state and non-state actors o Demand creation for FP by leaders through changing negative attitudes that ordinary people may have about FP and family limitation

12. The Architecture of Political Will Definition: The way in which leaders champion FP Kenya, Malawi, Ethiopia and Tanzania: no visible political stewardship of FP Rwanda: Explicit top-level stewardship o Public support and promotion of FP by President Kagame and leaders at all levels – multisectoral institutionalisation o FP was declared a national priority o FP uptake is a performance indicator for leaders o Informal family contracts at community level

13. “We can not develop into a middle income country without addressing high population growth” Dr. Ntawukuliryayo, Senate President, Rwanda

14. The Origin of Political Will Sustained advocacy is central to achieving and maintaining political will Local and international champions Evidence that demonstrated: o Prevailing demand for FP o Health benefits of FP use o Broader development benefits of FP use

15. Systems strengthening Human resource capacity strengthening o Pre- and in-service training o Performance incentives Task shifting Integration of FP services with HIV Supply chain management

16. Taking services to the community Decentralisation “Demedicalization” of FP products in Rwanda, Malawi and Ethiopia – Community Health Worker Programme

17. Mobilisation of funds and good coordination of activities State and non-state funding; Budget line to monitor government allocation and expenditure Fora for government and development partners FP and Commodity Security Technical Working Groups

18. Key lessons for Kenya Sustainability of community health workers Increased access to a wide range of FP products through community-based distribution

19. Conclusion Political will and strong leadership engineered the overall successes of FP programs Understanding the architecture of political will can help o Governments achieve FP uptake goals o Align technical and financial support of non-state actors Examination of drivers of success within specific in- country contexts of less-well performing countries may help support FP uptake

20. Acknowledgements FP stakeholders in Malawi, Rwanda, Ethiopia, Kenya and Tanzania Funders: UNFPA-ARO, Packard Foundation, The Joffe Charitable Trust and AFIDEP

21. THANK YOU Email: info@afidep.org nyokabi.musila@afidep.org Web: www.afidep.org