Moving from Policy to Implementation MSI experience in Uganda, Malawi and Zambia

1. Moving from Policy to Implementation MSI experience in Uganda, Malawi and Zambia

2. This Presentation • MSI brief overview • Policy to Implementation • Malawi: Partnership with Government • Uganda: Taking action on Supplies • Zambia: Facilitating access to Safe Abortion

3. MSI’s Strategic Focus MSI’s Mission – Children By Choice Not Chance We aim to contribute to: • eliminating unplanned pregnancy and unsafe abortion, especially among the underserved • revolutionising sexual and reproductive health service delivery • reducing the barriers to SHR services and supplies • strengthening health systems

4. Geographic Focus • MSI’s 6500 staff, in 43 offices and country platforms • Over 6 million clients and 17.8 million Couple Years of Protection in 2009

5. MALAWI

6. Malawi: Health SWAp • Malawi Government Health SWAp objectives includes Marie Stopes International (BLM in Malawi) • Banja La Mtsogolo (BLM) is a major player: • 31 static clinics (5% of overall health system infrastructure) • Outreach sites for un-served or underserved populations • 35% of all modern family planning methods delivered by BLM

7. Why include BLM in national health priorities? • GoM lack resources to fully implement RH care, BLM logical partner • BLM has expertise and competencies to deliver on Malawi health SWAp, RH Policy, HIV/AIDS action Framework • Joint Financing Agreement (or “mini-SWAp”) for RH services between DFID, Norway, MoH, and BLM 2006-2010.Will continue to 2015

8. Successes and Challenges • Funding and supplies from GOM inadequate/slow. No supplies first 5 months-BLM kicked in own resources, MSI had to supply and Norway had to add funds. • Aligned strategy and policy with Government, BLM part of strategy and policy setting • GoM recognises the comparative advantage of private sector service delivery – reaches where GoM cannot reach

9. UGANDA

10. Supplies in Uganda a major Challenge • The Problem: Service Providers (public and private) do not have enough supplies to meet need of FP • Government of Uganda might decide that National Medical Store can no longer supply to private providers (ie. NGOs) • Supplying to NGOs is not the main cause of the current shortages in all health facilities

11. Potential Consequences if this policy is implemented: • Split between MoH and Private Providers • Immediate vs long-term needs – solution a parallel system? • For example MSI: • providing 16% of modern contraceptive methods • working in post conflict area and other hard to reach places where government services do not reach

12. Partnership for Impact • Coalition of NGOs and Donors are getting together to respond: • Ensure access to key supplies by beneficiaries: now! • Fill current gaps in financing and procurement of MoH system • Advocate to MoH + other donors about urgent need for supplies

13. ZAMBIA

14. Abortion in Zambia • The problem of unsafe abortion is large: • Causes 1/3 of Maternal Mortality • 80% of deaths of unsafe abortion < 19yrs • However, abortion Law is reasonably liberal, since 1972 • But…. providers nor women know the law

15. MSI relatively new in Zambia, provides 1.2% of all safe abortions • MSI on government task force to create guidelines for CAC and PAC • Working with others to catalyse change in safe abortion services

16. Increasing Access • Distribution of guidelines to health facilities • Training of service providers • Educating the public about their right • In motion for only 6 months • MSI figures for save abortion services are increasing – will have to wait for wider results

17. Lessons • Work together • Educate • Advocate • Capitalize

18. Women like Rachel have been waiting for change, and the right to control the size and spacing of their family