Status and trends of family Planning in Sub-Saharan Africa “Forward to the Fundamentals”

1. Status and trends of family Planning in Sub-Saharan Africa “Forward to the Fundamentals” ---------------------------------- Challenges and opportunities The Rwanda Case Washington DC, October 30, 2002

2. CHALLENGES FACING FAMILY PLANNING IN AFRICA • Dramatic drop in funding: 46% out of $17 billion promised annually • Shift on Priority towards STI/HIV/AID and other acute infectious diseases • Instability and poverty exacerbated by wars and/or natural disasters • Main focus on population control benefit of Family Planning • Programs totally funded by external donors • Use of Costly vertical programs

3. THE CASE OF RWANDA THE COUNTRY GENERAL CHARACTERISTICS • 7.6 million in 2001 • 90% rural, living within 26,300 sq.km • CPR decreased from 12%(1992) to 4% (2000) • TFR very High 6+ in 2000 • Maternal mortality rate increased from 500 (1992) to 810/100,000 Life Births (2000) • HIV/AIDS prevalence rates range from 16.2% to 24.2% in the age group 20-44 years.

4. THE CASE OF RWANDA IMPACT OF THE GENOCIDE • Almost 1 million people were killed, millions displaced, and over 200,000 Rwandan women and girls experienced sexual violence • A high proportion of households are now headed by women • 120,000 people are in prison awaiting trial • Health and social welfare infrastructures were destroyed • Organization and functioning social services including health dramatically weakened • People’s priority needs and interests focus on survival

5. THE CASE OF RWANDA HIV/AIDS AND FP • Wide spread of HIV infection: 11.6% in urban and 10.8% in rural areas/ male (10.8%) and female (11.3%). • Lack of Integration of FP into general HIV/AIDS activities • Cannot meet demand for VCT & MTCT services • FP services not part of the VCT/MTCT activities • Opportunities for integration missed • Similar issues for MTCT

6. MAJOR OBSTACLES TO FAMILY PLANNING IN RWANDA • Lack of Government commitment and adequate funding for FP • Insufficient trained and motivated Human resources • Limited FP methods choice available daily in sites • BCC/IEC – counseling not available in sites • Limited to no collaboration between different levels of providers • No standards of FP services for quality • Limited involvement of the private sectors • lack of integration of FP into existing health services

7. HIDDEN RESOURCES AND OPPORTUNITIES IN RWANDA COMMUNITY-BASED STRUCTURES • Women Organizations and Associations • Youth Associations and Clubs • Religious institutions and Groups • Labor unions: exple CESTRAT in Rwanda • School children Parents’ Associations • Existing network of local NGOs

8. KEY STRATEGIES TO REPOSITIONING FP • Refocus messages for Advocacy and Marketing for FP on its health and other benefits: • - Reduction of Maternal Mortality, • - Reduction of Infant Mortality, • - Increasing women productivity and power, • - Social and Economical development • - Tool for family survival • Strong advocacy: - (1) for increasing donors funds, • - (2) for local funding • - (3) for policy makers commitment • Better management and use of mobilized resources • Appropriate involvement of community-based structures, NGOs and the private sector • Integration of FP activities into other health and health related activities (FP/MCH/HIV+++)

9. EXPECTED CHANGES • New policy supporting FP developed in target countries • More sustainable funding for FP including local contribution, • National FP programs adapted to local situation • Better integration of FP activities into health and non health activities in public and private sectors, mainly into HIV/AIDS activities such as VCT, MTCT….. • Organization and functioning of FP services improved: • - better trained and motivated providers, • Effective and efficient supply systems: contraceptive security • geographical and financial accessibility of FP services increased, • Coverage rate (CPR) of target population increased (adolescents +++), • Indicators of all expected benefits from FP improved.