1. Data whats, whos and hows towards public-private partnerships in reproductive health policy reform Imelda Zosa-Feranil (CEDPA) APHA Annual Meeting, Philadelphia, USA December 2005

2. Outline Framework Study countries Conclusions and Questions for the future

3. Framework: Components of policy reform Issue Context Actors Process ―What is the problem? What policy action can address it? Supporting data? ―What is the socio-economic and policy environment? ―Who identifies an issue? Who develops the policy? Who decides? Who implements? ―How are problems or policy solutions identified? How is policy developed? Implemented? Evaluated? Sources: Walt and Gilson, 1994; Hardee et al. 2003

4. Study countries Countries assisted by USAID : Turkey, Philippines and Romania –POLICY Project (Global) 1995-2006 Focus: Reproductive health, family planning, HIV/AIDS, maternal health Futures Group, CEDPA, and RTI –The Social Acceptance Project (TSAP)– Philippines Focus: Family planning AED, CEDPA, and Futures Group

5. Turkey, 1997 IssuePolicy development Program planning and financing “USAID phase- out” MOH contraceptive self- reliance policy MOH strategy and budget Implementation MOH Source: POLICY, 2000 Context: “Parent” government

6. Turkey, 2000-2002 Issue definition Policy development Program planning and financing “Without government support, poor women have no access” … KIDOG network Multisectoral advocacy and policy dialogue on contraceptive self- reliance Increased MOH funding Implementation KIDOG and MOH Source: POLICY, 2002

7. Philippines, 2000 IssuePolicy development Program planning and financing “Contraceptive independence” with USAID phase-out … Economic Planning Secretary Multisectoral initiative of the National Population Program Multisectoral strategy Government budgetary allocation Implementation Health and economic development leaders Source: POLICY, 2001 Context: Catholic Church opposition to FP; political leaders’ reluctance

8. Pangasinan Province, Philippines, 2002-2004 IssuePolicy development Program planning and financing “Address unmet need through contraceptive self reliance” …Pangasinan Governor Target services to those with unmet need, especially the poor Budget appropriations from provincial and local governments Implementation Governor and advocacy network Source: POLICY/Philippines, 2004 Context: Decentralization

9. Autonomous Region of Muslim Mindanao, Philippines, 2003-2004 IssuePolicy development Program planning and financing “Are RH and FP as implemented in the country in accord with the teachings of Islam?” Official Ruling (Fatwah) of the Assembly of the Darul-Iftah Public education through Muslim religious leaders Implementation Religious leaders, local government and NGOs Source: TSAP, 2004 Context: Decentralization

10. Romania, 1999-2000 IssuePolicy development Program planning and financing High maternal mortality due to continued reliance on abortion to control fertility Coverage of FP/RH services in the new social health insurance law MOH budget allocation for contraceptives for the most vulnerable Implementation RH Coalition and national policy champions Source: POLICY, 2000 Context: Entitlement mentality, low status of women

11. Romania, 2001 IssuePolicy development Program planning and financing “Women’s health, especially among the most vulnerable” Increased health insurance coverage of FP/RH services Increased MOH budget for contraceptives Implementation Local advocacy networks and MOH Source: POLICY, 2001

12. Romania, 2002 IssuePolicy development Program planning and financing “Poor women have very limited access to subsidized contraceptives” 1.Poverty self - certification 2.Health insurance coverage of FP/RH services and contraceptives 1.Increased resources (MOH and donations) for free contraceptives 2.Improved provision in rural areas Implementation Source: POLICY, 2003 Local advocacy networks and MOH

13. Conclusions Issue framing is important –Who frames the issue? –How is issue framed using data? Context shapes who and what in policy reform Data-based advocacy works –Direct effect: policy change –Indirect effects: Broaden the policy process Build public-private partnerships Change context

14. Questions for the Future Public-private commitment for recent policy reforms? Commitment to broadened policymaking and partnerships? –Changing leaders, actors –Changing context –Numerous development challenges