Linking Mission Bilaterals to PVO

1. Linking Mission Bilaterals to PVO/NGO Programs: The Case of Ethiopia

3. Ethiopia Ethiopia Demographics Population: 77,431,000 (85% rural; 2/3 illiterate) Population Ages 10-24 :33 % TFR: 5.9 CPR (Married Women): 8 % MMR: 850 /100,000 live births IMR: 100 /1000 live births HIV/AIDS Prevalence Rate:4.4 % Source: Population Reference Bureau, 2006 

4. Challenges Facing Ethiopia Pervasive levels of poverty Extreme food insecurity/high malnutrition Previous poor government policies Alarming HIV/AIDS growth High disease burden/lack of health care Severe environmental degradation Conflict and high population growth

5. USAID Mission in Ethiopia: Social Resilience - Health, HIV/AIDS and Education Added this slideAdded this slide

6. USAID Funded RH/FP Activities in Ethiopia Modern CPR increased among married women in USAID focus regions 23.8% compared to national CPR of 8% Increase new users of all methods, incl natural FP Increase LTP Methods and PAC Increase referrals of women and children for health care Strengthen IEC/BCC activities Strengthen gender activities and RH rights Early marriage and fistula repair Female genital cutting Violence against women Strengthen government and NGO capacity Governance Community Sentinel System

7. Flex Fund in Ethiopia Funded in 2003 ADRA, PLAN & Save the Children-US Initially 2 years to be considered for further funding Envisioned as a supplement to on-going programs (Child Survival, Development Assistance Program)

8. Project Background

9. Map

10. Main Interventions Community mobilization for increased use of FP/RH practices and behaviors BCC strategies based on Formative Research ? development & production of IEC materials based upon formative research in SC project CBD of contraceptive methods (pills, condoms, LAM (TTBAs)) & referrals Health facility strengthening to provide quality FP services including: IEC, improved counseling, Access to longer acting methods (IUD, Norplant) & outreach DMPA improved reporting& LMIS Quality improvement (COPE) Information/experience sharing: local, regional and national Involvement of local partners: MOH, NGOs, communities including women�s support groups and youth clubs

11. Preliminary Results Increased the number of FP users: 6,344 & 4,787 for ADRA and SC Registered new acceptors: 5,930 & 10,959 for ADRA and SC Expanded method mix to include outreach DMPA, Norplant and IUDs Trained TTBAs to promote LAM Created women�s support groups for FP users

12. Challenges for Flex Fund Small funding amounts � short implementation period Not fully integrated into local mission�s portfolio Implementation in hard-to-reach areas so more difficult to achieve results High reliance on spacing methods despite high unmet need for limiting (23-48% - PI survey 2001) Hard to collaborate and coordinate activities with other organizations working in FP given geographic location and distance Informal partnership � less productive (costs more, takes longer, need for more community outreach, logistical challenges to maintaining adequate contraceptive supplies in addition to national stock-outs, take more time to organize trainings) (costs more, takes longer, need for more community outreach, logistical challenges to maintaining adequate contraceptive supplies in addition to national stock-outs, take more time to organize trainings)

13. Advantages & Opportunities Community mobilization is our strength Operating in hard to reach areas ? equity Opportunities to share activities (such as trainings, exchange visits to learn about COPE) with Pathfinder and other Flex Fund grantees � difficult to arrange due to geographic challenges, communication difficulties?

14. Pathfinder International�s Involvement in Ethiopia Pathfinder collaboration with public, private and FBOs since 1993. Support local NGOs and FBOs to increase access to FP/RH services Provide community-based services Targeted to peasants and urban poor

15. Pathfinder International: Community-Based FP/RH Program Delivery of information and services through Community-based RH agents Volunteers selected by communities Trained for two weeks Transport allowance, regular supervision and meetings Provide information, pills, condoms & referrals to clinics

16. Flex Fund linkages with USAID mission USAID partners meeting scheduled quarterly Useful activities Mapping of organizations working on FP/RH provided resources for referrals (vasectomy) Conducted an equipment needs assessment for grantees Sites visits

17. Flex Fund Linkages with Pathfinder International Provision of contraceptive supplies. Helped address stock-outs Longer acting methods: IUDs and Norplant still in short supply Developed the manual used for training CBD agents Funding mechanism from Sept 2007

18. Missed Opportunities for Partnership Collaboration for activities such as access to longer acting and permanent methods (LAPM) could be strengthened by having a more formalized partnership with Pathfinder International: To train providers To conduct regular mobile clinics (referrals done by FF grantees)

19. Recommendations Need for formalized partnership: MOU, joint work plans, sub-agreements Formalized linkages should be established right from the beginning Clear communication strategy would help overcome geographic and communication challenges