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High-Impact Practice
Galvanizing commitment to support family planning programs.
What Is It?
Galvanizing commitment involves the process of getting buy-in and support for family planning and adolescent and youth sexual and reproductive health (AYSRH) among leaders and decision makers in regions, provinces, states, districts and counties as well as identifying and empowering local, influential family planning champions who can advocate for family planning in the community while holding leaders and decision makers accountable for their commitments. Such advocacy is especially important in countries with decentralized governments where decision-making power is spread throughout the system, rather than being concentrated at the national level.
What Are the Benefits?
- Provides current information on the economic and health benefits of family planning/AYSRH to elected officials at the local level
- Helps local leaders make informed choices about population and family planning/AYSRH policies using data from their own community
- Builds broad-based support across communities, including among religious, political and other leaders
- Adds credibility to family planning advocacy activities, as champions are positive voices from within the community
- Helps local governments make commitments to prioritize resources for family planning/AYSRH at the regional, provincial, district and/or village levels
- Ensures that governments follow through on family planning/AYSRH commitments at all levels of a country, reducing dependence on donors and national governments
- Builds a supportive environment for family planning/AYSRH by dispelling myths and misperceptions about family planning services; as trendsetters and initiators of change, champions can speak positively to their communities about the importance of family planning
East Africa
East Africa’s Advocacy for Support and Resources approach provides guidance and region-specific tools on how to advocate for increased resources for family planning/AYSRH at the city and facility levels. In addition, TCI supports local governments to identify and train Family Planning Champions on advocacy tactics to promote family planning. This includes political leaders, such as the Mayor of Mukono, Uganda, who has become an outspoken advocate of family planning after engaging with TCI.
India
In India, the Planning and Budgeting approach provides guidance for district officials and NGO partners on the specific steps of planning and budgeting for family planning/AYSRH by preparing, submitting and monitoring an annual Program Implementation Plan (PIP) for the district. In addition, TCI coaches health care service providers and community health workers to serve as FP Champions and help women and men understand their reproductive health and rights. This increases demand for family planning and other reproductive health services and has prompted a number of satisfied contraceptive method users to become champions as well.
Nigeria
In Nigeria, advocacy at the sub-national level is separated into two approaches. The Enabling Environment approach includes advocacy efforts to assess the family planning landscape, coordinate family planning activities to reduce duplication, and ensure resource stewardship and accountability. The Resource Mobilization approach focuses on training relevant stakeholders on the strategic importance of securing a dedicated budget line for family planning, how to use grant management tools such as a performance-based tracker and dashboard, and forming a budget task team to monitor the release and expenditure of family planning budgets. TCI in Nigeria also enlists state leaders and religious and traditional leaders as family planning/child birth spacing champions to advocate for family planning in different fora, specifically training them to spread messages about FP/CBS in their religious communities and at religious events. This allows women and men to take up family planning when they learn that verses in the Qur’an support it.
Francophone West Africa
In Francophone West Africa, TCI strengthens the advocacy capacity of the Technical Program Management Unit (UTG) and the Joint Steering Committee (CCP), which are established to oversee TCI implementation. TCI engages them in the Orientation de la Municipalité sur la PF/SSRAJ approach and then through regular coaching supports them in uncovering solutions to common challenges, such as limited financial resources. A government official of Ziguinchor explained the significance of TCI:
With TCI, our three city councils have pooled their funds to deliver FP and AYSRH services in some geographies. We will respond collectively… and this practice is unusual. All of the activities in the action plan are implemented at the same time in Bignona, Oussouye, and Ziguinchor.”
TCI also supports the establishment of Groupe de Plaidoyer and identification of Champions pour la promotion de la Planification Familiale (Champion PF/SSRAJ) to not only support government in creating an enabling environment at the community level but also to pressure government to adhere to its commitments.
How to Implement
Identify key stakeholders and FP champions at the defined sub-national level
Key stakeholders for the Advocacy Working Group (AWG) include Ministry of Finance staff and others in charge of budget decisions and Ministry of Health staff and others who create policy related to family planning/AYSRH, health care providers and service delivery.
Other FP champions may include but is not limited to:
- Local politicians (such as mayors, governors, etc.)
- Religious leaders
- Opinion leaders
- Community health workers
- Health care service providers
- Satisfied contraceptive method users
- Youth leaders
Consider the following attributes in champions:
- Self-motivation
- Eagerness to actively participate in family planning activities
- Recognition and respect among peers and community members as an opinion leader
- Good public speaking abilities
- Ability and willingness to clearly articulate the values of family planning
You can use different methods to identify potential AWG and FP champions:
- The Net-Map method can help identify potential stakeholders, family planning champions and challenges, as was used in Nigeria and Francophone West Africa at the sub-national level to help guide their advocacy work.
- A “snowball” approach, in which you identify the first champions, for example by using information from key informant interview questionnaire and ask the interviewee to help identify other potential champions, and so forth.
Form an Advocacy Working Group (AWG)
- Referred to by different names – such as an Advocacy Working Group, Advocacy Core Group or District Working Group – this working group includes the individuals identified in Step 1 and will be the community voice for policy change. The working group will be a way to engage with key decision-makers, build consensus and secure funding and support for family planning and AYSRH.
- Within this group, form a budget task team to support and influence budget processes and decisions.
Convene regular meetings of the AWG
- Meetings should be held monthly, or more often if needed.
- During these meetings, share relevant data with the group including:
- Unmet need for family planning in the area
- Family planning commodity needs of the area
- Evidence related to infrastructure, facilities, equipment and human resources
- Evidence of impact of strengthening family planning services in nearby areas (if available)
- During these meetings, come to consensus about the important issues in the given area and for what the group will advocate such as additional funding.
Conduct formative research and analysis
- Conduct a Family Planning Effort Index assessment to understand the family planning environment. You can complete the tool with the Advocacy Working Group to understand how to communicate the family planning situation in your area and what to prioritize in the advocacy strategy.
- Conduct key informant interviews to better understand the policy environment for family planning. The Nigerian Urban Reproductive Health Initiative (NURHI) created a tool, which you can use or adapt, to conduct these interviews. In addition, TCI with support from the Reproductive Health Units of the States’ Ministries of Health has also employed the Policy Environment Score to serve as a baseline on how the policy environment supports effective policies and programs for reproductive health.
- Working with the budget task team, use the TCI budget tracking tool to identify and map out family planning allocations, release and expenditure for various components of a family planning program by financial year.
- Analyze the results from your formative research and determine main challenges to overcome during the design of the advocacy strategy.
Design and implement your advocacy strategy
- Convene the Advocacy Working Group and design a site-specific advocacy strategy.
- Based on the result of the budget questionnaire, develop specific goals related to family planning funding. For example, the first goal may be to establish a budget line item for family planning at the local level, followed by increased resource allocation. You may also want to include goals that address policy barriers, for example, allowing lower-level providers to deliver injectable contraceptives.
- Implement the specific activities of your advocacy strategy, which can vary widely depending on your strategy. For example:
- The budget task team members may meet with their Ministry of Finance colleagues to advocate a budget line item and increased funding for family planning.
- Other members of the Advocacy Working Group may organize sensitization meetings with other leaders (e.g., mayors, governors) to mobilize support and share information about the impact of family planning. One objective may be to include family planning within the integrated five-year plan at the province, village or district level.
- You and the other Advocacy Working Group members may hold community dialogues to exchange information about family planning services.
Include FP champions as part of the AWG's advocacy strategy
As part of the strategy with the Advocacy Working Group, include activities geared towards FP champions such as community events or orientation meetings. Assist the FP champions in developing their own action plans.
Hold advocacy trainings to increase skills and competencies of AGW members and FP champions
Training AWG members:
- Training Advocacy Working Group members will help sustain the advocacy activities and ensure members can advocate on the behalf of young people, women and couples who desire family planning. The AFP SMART advocacy tools can be used in advocacy training.
- Training members on budgeting and financing, for example, with resources included in the guide Enhancing Contraceptive Security Through Better Financial Tracking, can help them better track resources for family planning commodities. Avenir Health also hosts the helpful SPECTRUM tools, which provide policymakers helpful analytical tools to support their decision-making.
Training FP champions:
Different groups of champions may require specialized training. For example:
- Community health workers may need training on how to provide family planning to their clients, so they are better prepared to champion family planning in their work and with their communities. TCI East Africa’s five-day training on family planning for community health workers can be a guide.
- Religious, community and political leaders may benefit from an orientation event to better prepare them to talk about family planning at the national, community and individual levels. TCI East Africa developed a 1.5-day facilitators guide for orienting community leaders, religious leaders, champions and gatekeepers on the benefits of family planning. In Francophone West Africa and Nigeria, TCI engages with religious leaders and members of interfaith fora, coaching them in cohorts to support each other to share family planning messages in their religious communities. This can be a key way to recruit additional family planning champions. The orientation can include a range of materials depending on the champions’ needs. Examples include:
- East Africa’s Myth and Misconceptions Booklet and a presentation on Myths and Misconceptions can be adapted for your setting.
- The Population Reference Bureau’s ENGAGE presentations offer 1-3 minute introductions on a range of topics, which can be incorporated into the training.
- Family Planning Advocacy Through Religious Leaders can provide further guidance.
- Sermon notes can be particularly helpful for religious leaders in reaching out to their congregants with family planning messages.
Develop and use advocacy materials
- Prepare appropriate advocacy materials such as fact sheets, briefs and presentations that will meet the decision-makers’ needs, focusing on the latest evidence in your area. Meet the decision-makers where they are, and be creative. Think about using stories, photos, infographics or videos, along with data and facts, to communicate your message. Be specific, direct and succinct; many of these decision-makers may not have a strong technical background in family planning or have little time. Most importantly, concentrate on the “ask” – what do you want the decision-makers to do?
- Using data is a key element of advocacy materials. TCI has found much success in using data effectively for advocacy and decision-making.
- Advocacy materials can be city-specific and used to stimulate community dialogue.
- Think about when, where and how you will deliver the message. What kind of response do you expect from your audience and how will you address their concerns?
- For in-depth guidance on developing advocacy messages, see the box on p. 21 of the AFP guidance on developing a strategy.
Follow-up and monitor advocacy efforts
Monitoring advocacy efforts of the AWG:
- Convene quarterly review meetings to assess achievements – and any setbacks – of the Advocacy Working Groups and the budget task team. Shift activities as necessary.
- Hold annual site-specific implementation review meetings.
- Scale up successful interventions, as they are identified, to other areas.
- Work with Advocacy Working Group members and others (e.g., community organizations, religious organizations) to ensure sustainability of advocacy efforts.
- Track budgets to assess inclusion of family planning/AYSRH as a budget line item.
- Use a budget tracking tool, such as the TCI budget tracking tool, to ensure funding allocated for family planning/AYSRH is being used appropriately.
For additional resources and tools, see AFP Advocacy Portfolio: Capture Results.
Sample Indicators to Track Advocacy Efforts:
- Inclusion of family planning/AYSRH as a budget line item
- Increased allocation of funds for family planning/AYSRH
- Inclusion of family planning/AYSRH in the integrated plan of the given area
Monitoring advocacy efforts of FP champions:
- Maintain and manage a list of identified champions in your community (executive, political leaders, administrators and religious leaders).
- Track capacity-building efforts among champions on accurate family planning messages.
- After you develop an action plan, hold routine meetings with champions to monitor progress and track their relevant activities.
- Track the number of events (community events, religious meetings, etc.) in which family planning messages were included.
Develop a reward or recognition plan for FP champions
- Put in place cost-effective, sustainable rewards to motivate champions to continue volunteering their time. Depending on your budget, this could include tablets, cameras, flash drives, or other items to help with their work as champions. You could also provide nicely printed information packages with targeted messages and tips on how to deliver those messages to their communities.
- Recognize family planning champions during various forums at the community level such as World AIDS Day, World Contraception Day or International Women’s Day.
- Include active champions in various national and international meetings and trainings. You may invite them to deliver a keynote address or to participate in a discussion forum.
What Is the Evidence?
Francophone West Africa
By the end of December 2019, the 11 geographies supported by TCI in Francophone West Africa had disbursed $114,380 in locally contributed funding. Although this may sound modest, it is quite significant both because the health budgets for this region are often lower than in other LMICs and because local mayor-level contributions are exceedingly rare, as opposed to national-level allocations. TCI builds local governments’ financial management capacity by requesting that they contribute their funds in a separate commercial account* along with TCI’s contribution. TCI then works with the geographies’ accountants to monitor commitments and release funds as they plan and implement activities receiving Challenge Fund support. Another novel and promising example of growing local government contributions can be seen in the Union of Zou Municipalities (UCOZ), where between 2018 and 2019, it went from zero communes contributing funds for family planning activities to nine out of nine. Read more in TCI’s PASS Learning Series #3 City-Led Health Programming Begins With Financial Commitment.
*Senegal and Bouake, Côte d’Ivoire, are exceptions in that the local governments have set up sub-accounts within their local treasury account, as required by local law and an expectation of transparent governance for public funds.
East Africa
Kilifi County, Kenya has demonstrated its local ownership and political commitment to FP/AYSRH by increasing funding over the past three years. Since engaging with TCI beginning in 2017, Kilifi County’s budget commitment for FP has more than doubled from 2017-2019. Dedicated funds for AYSRH increased by 378% from 2018 to 2019, from $15,000 to nearly $72,000.
India
In India, TCI “unlocks” Government of India monies from three accounts – urban health, family planning and maternal and child health – as well as other underutilized funds to sustainably scale up proven urban reproductive health solutions. Before TCI, cities had limited understanding of the budgeting process for family planning interventions through the National Health Mission’s Program Implementation Plan (PIP). Since the National Urban Health Mission is still a new program, cities often had not secured funds for urban health services or experienced low expenditures prior to TCI’s engagement. TCI staff supported a PIP orientation for city and district health officers coupled with data-driven planning on evidence-based family planning and maternal and child health approaches. Through this orientation, TCI ensures officials understand the procedures for requesting funds for expanding family planning services. As a result of these efforts, 31 TCI-supported cities have unlocked more than $89 million to support TCI proven approaches at the community and facility levels. As of December 2019, 70% of these funds have been spent. Read more in TCI’s PASS Learning Series #3 City-Led Health Programming Begins With Financial Commitment.
Nigeria
In Nigeria, TCI’s efforts to establish or strengthen Advocacy Core Groups has resulted in dedicated budget lines for family planning at the Ministry of Health in all TCI-supported states.
A webinar highlighted TCI’s innovative co-financing strategy in Nigeria, which has galvanized increased domestic financing commitments by state governments to proven family planning interventions and resulted in increased release of those funds and spending. Co-financing ensures financial sustainability from the outset through a graduated co-financing mechanism. TCI works with partner states to design a robust advocacy strategy which includes setting the appropriate policy framework and engagement plans to foster consistent and sustained financing for health. Finally, the co-financing strategy institutionalizes health financing transparency, accountability and good governance. As of June 2020, a total of $2,080,864 has been released by state governments as co-investment into family planning programs and interventions.
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