A common challenge for cities engaged with The Challenge Initiative (TCI) in Francophone West Africa (FWA) is forecasting and mobilizing financial resources from the local government each fiscal year for family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) programs.
While municipalities across TCI-supported cities have made significant gains by signing letters of commitment and disbursing funds for FP/AYSRH, the health system itself was not making a contribution. This is despite an official collaboration between TCI, the municipality and the health system in each city. While most health systems are not able to contribute cash to programs, they can make “in-kind” contributions by paying for contraceptive products or they can contribute through facility management committees known as COGES.
TCI is conducting resource mobilization advocacy activities in FWA, but its Young Transformational leaders (JLTs) and Advocacy and Monitoring Core Groups (AMCGs) were too focused on the municipality, and not enough on the health system. Therefore, the advocacy strategy had to be refined to designate specific advocacy activities for the health system.
Because of those advocacy efforts, new FWA cities joining TCI now will attempt to include in their expression of interest (EOI) not only the financial commitment of the municipality but also that of the health system for contraceptive products and the COGES financial contribution.
This new approach of engaging the health system was most recently done in Lomé, Togo. It started with a workshop to orient municipal and health system stakeholders on the TCI model and to support the preparation of Lomé’s EOI. The health system was coached on the importance of their contribution to the program, in the same way as the municipalities. This coaching allowed the health system through the Director of Mother and Child Health (DSME) to commit to making contraceptive products available for Family Planning Special Days (FPSDs) using their own resources.
Upon submission of the city’s EOI, the TCI Country Manager responsible for Lomé, Hugues Gnahoui, said:
There were only letters of commitment from the municipalities. Thus, advocacy and coaching exchanges were necessary towards the DSME in order to solidify the commitment made by the health system during the EOI process and program design development workshop. TCI then supported coaching of the Reproductive Health (RH) Focal Point of the Regional Health Directorate (DRS) of Greater Lomé to quantify and estimate the amount and cost of contraceptive products that the program would need – and that the health system would pay – to organize FP Special Days for a period of two years.”
As a result of these efforts, a letter of commitment was signed by the DSME, Dr. Agossou Abram Amétépé, including a commitment for the health system to provide contraceptive products up to 62,744,000 FCFA (USD $105,387) for two years.
This formal commitment from the health system in Lomé is a first and unprecedented in the implementation of the TCI model in FWA. It is important to note that in a program where more than 75% of the funding needs to come from the local government, the contribution of the health system is essential for success.
Furthermore, the health system contribution increases opportunities to scale FP Special Days in Lomé, thus expanding access to family planning services for more women. According to TCI’s National Focal Point of the Health System in Togo, Mr. Simtokina N’GANI:
TCI’s support comes at the right time because it is important for the implementation of the National Family Planning Budgeted Action Plan in Togo in general, and in the city of Lomé in particular.”