1. National Strategies to Achieve Universal Access to Reproductive Health: Scaling Up IPCI/ICPD Meeting Bangkok, Thailand 22 November 2006 Stan Bernstein Senior Policy Adviser, Office of the Director Technical Support Division November 2006 bernstein@unfpa.org

2. Entering the MDGs As committed to by the world’s leaders at the World Summit in September 2005 As recommended by the Secretary General in his Report on the Work of the Organization in August 2006 As noted by the General Assembly in October 2006 As affirmed by the Interagency and Expert Group on MDG Indicators A new target has been added to MDG Goal 5 “Improve maternal health”: “Universal access to reproductive health by 2015”. Key indicators are being attached. It must now be in national and international monitoring reports on MDG progress and integrated in development plans, action strategies and budgets.

3. Where are we now? Significant numbers of women and couples lack access to key RH information and services Poorer countries and poorer people within countries suffer the greatest deficits Rural and poor peri-urban population lack access Young people lack access Successful models exists but they must be scaled up to reach everybody

4. Unmet need for family planning (Latin America examples)

5. Skilled attendance among the Poorest and Richest Women Source: World Bank, 2004, Round II Country Reports on Health, Nutrition, and Population Conditions Among the Poor and the Better-Off in 56 Countries Percent of women ages 15-49

6. Large differences exist in access in different population groups

7. Proportion of desires for family planning met (by wealth quintile)

8. Scaling up: principles Definition: The process of expanding the scale of activities with the ultimate objective of increasing the number of people and increasing the impact of the intervention with a specific objective of regularizing it into routine public sector health services for interventions that have been well evaluated with demonstrated evidence Universal access to RH means ensuring that each person who wants a service can get it – it is available, accessible, acceptable, affordable and of quality.

9. Scaling up: routes to coverage Expanding coverage: alternate modalities – pooling risk, mobilizing demand and action Social insurance schemes Social protection funds Vouchers and private incentives Civil society involvement Expanding the range of actors – beyond the health system Full integration in the health system

10. National development strategies National strategies include expanding service delivery points, integrating services in basic service packages and integrating components with each other (e.g., HIV/AIDS and SRH). The national development plans have increasingly become and will become the action plan to achieve the MDGs. Plan ahead: Developing human resources and institutional capacity takes time and investment. Incentives (not only financial) need to be sufficient to retain staff.

11. Engaging in all stages of national planning Poverty analysis—provides the rationale for intervention, or the ‘why’, ‘what’ and ‘where’; Strategy—outlines the ‘how’ to reduce poverty; Costing—evaluates ‘how much’ it costs for the policies as outlined; Budgeting—articulates the distribution of funds among competing priorities; Policy matrix—clarifies ‘who’ does ‘what’ in the implementation; Monitoring indicators—track progress towards poverty reduction based on the outlined targets/objectives

12. Needs assessments and situational evaluation Identifying a range of necessary interventions; For each intervention define targets; Compare lists of interventions to avoid overlaps; Cost the needs by adding coverage targets and unit costs in costing models; Develop a financing strategy.

13. Aligning initiatives: the challenge for donors, policy makers and implementers Other initiatives need an RH vision (e.g., Global Fund on HIV/AIDS – RH integration; Road Maps for Maternal Health and Child Survival; Scaling Up for Health in Africa) Logistics and commodity security – including RH security Strengthening health systems as a whole (not just disease-specific programmes) Influencing regional initiatives: E.g. the African Union and the Maputo Plan of Action

14. Sector wide approaches SWAps: a method of coordinating donor support in a particular sector, so that all significant government and donor funds support a single policy and expenditure program led by the government. Goals of SWAps: –reducing earmarked money –eliminating geographic and programmatic fragmentation associated with individual donor priorities –coordinated missions and reviews –a comprehensive budget that consolidates sources of financing (government, donor and other) to the sector The national development plan should reflect the commitments to policies and programs developed through SWAps and SWAps should become more aligned with the poverty-reduction orientation of the national development plan

15. Monitoring and evaluation: principles Improving data and performance monitoring is a must. Coverage, contents and quality. Using marginalized groups as signals of generalized access (rural, poor and the young). Mobilizing resources from multiple sources for impact. Creating constituencies – organizing community reporting and action, participatory approaches Monitoring budgets and resource flows (reproductive health accounts)

16. Monitoring and evaluation: methods Aligning reports with actors – making efforts accountable major administrative units (states, provinces, districts) political units (parliamentary constituencies) Selecting units that can influence policy, legislation and budgets and increase accountability. Mapping service coverage and outcomes can identify gaps and strategies.

17. Your Questions HOW CAN YOU ADVANCE SCALE UP EFFORTS? WHAT ARE YOUR ENTRY POINTS? WHICH ACTORS TO YOU HAVE ACCESS TO? WHAT INSTRUMENTS CAN YOU USE TO ENSURE ACCOUNTABILITY? WHAT HELP DO YOU NEED? HOW CAN YOU HELP EACH OTHER BETTER?