Country Ownership and Reproductive Health : The Role of CSOs beyond Service Delivery

1. Country Ownership and Reproductive Health: The Role of CSOs beyond Service Delivery MacBain Mkandawire Executive Director Youth Net and Counselling (YONECO) Malawi

2. Youth Net and Counselling (YONECO) - Malawi • Youth Serving NGO that seeks to empower youth, women and children, prevent the spread of HIV infection, mitigate the impact of AIDS, promote human rights and democracy for socio economic development • YONECO work in HIV and AIDS prevention activities, sexual and reproductive health and rights promotion and advocacy • Sexuality education for youth and women • Prevention of violence against women and children • Life skills development for youth and women for the own growth and development • Advocacy for improved services for youth and women in areas of education, SRH&R and GBV

3. YONECO Partners • UNICEF, UNFPA, National AIDS Commission, HIVOS, Interact Worldwide, COMIC, Nowergian Church AID, USAID through the Bridge Project, Government of Malawi • Manages the National Youth/ child Helpline in Malawi (secretariat) with huge component of SRH&R for young people • Coordinates a number of youth related initiatives on SRH&R, youth leadership development and provision of SRH services to marginalised groups

4. Presentation Outline • Reflecting on Paris and Accra Declaration • Defining Civil Society Organisations • Civil society’ and ‘country ownership’ • Challenges in CSOs meaningful participation • Recommendations for Action

5. Reflecting on Accra Declaration • The Paris Declaration on Aid Effectiveness (2005) is “a roadmap to improve the quality of aid and its impact on development” • Most recent agreement between donors and recipients • Strongest commitment between donors and recipients • Paris Declaration has five (5) Principles • Ownership, • Alignment, • Harmonization, • Managing for Development Results • Mutual Accountability

6. The Accra Agenda for Action on Aid Effectiveness • High Level Forum (HLF3) in Accra, Ghana was meant to assess progress towards Paris Declaration • Accra Agenda for Action was adopted in 2008 • Country ownership was identified as a key component in the implementation of the Paris Declaration. • The question is: How far have we gone with the country owner in particular in FP? Whose programmes are we running? Donors programmes? Government’s programmes? CSO’s programmes? Or People’s programme?

7. Country Ownership Defined • Country ownership requires • broadening country-level policy dialogue on development • Developing country governments working more closely with all actors including CSOs. • Donors supporting all development actors including CSOs to take an active role in dialogue on development policy. • Governments and donors’ policies and programmes are consistent with their agreed international commitments on gender equality, human rights, disability and environmental sustainability. • These need to apply to reproductive health as with other development priorities

8. Civil Society Organisations • “non-governmental and not-for-profit organizations that have a presence in public life, expressing the interests and values of their members or others, based on ethical, cultural, political, scientific, religious or philanthropic considerations. Civil Society Organizations (CSOs) therefore refer to a wide of array of organizations: community groups, non-governmental organizations (NGOs), labor unions, indigenous groups, charitable organizations, faith-based organizations, professional associations, and foundations”. World Bank Definition • For purposes of this discussion, CSO shall mean all of the above including media and other social movement organisations

9. Advocacy role of CSOs in Country Ownership (1) • Conducting advocacy for the increased support for family planning services and commodities in the health facilities because sometimes FP services and commodities are not government priorities • (In Malawi supply of condoms is affected by this situation – where preventive health services are a priority and condom supplies are not leading to poor service delivery, in Uganda there was a Condom Crisis because it was not seen as a priority (these are commodities) • Continued advocacy with the government has resulted in the government reviewing the position and seeking more support for the provision of such supplies • Family planning services should not be seen as luxury but rather main issue in the health sector • Advocacy is required to ensure this is achieved

10. Advocacy role of CSOs in country Ownership (2) • Advocacy to increase service delivery closer to the people for family planning including quality services and user friendly • Government have the existing policies on YFHS and yet small number of young people access the services. Government claim that services are there but are they close enough to young people • YONECO and Scottish Government under a Project Called Yankhulani! Speak Up! Piloted a model of taking the SRH&R services to young people in 6 health centres and 6 community based facilities (where youth, CSWs and married adolescents meet and the response has been enormous • CSWs and married adolescents are getting engaged in the comprehensive FP as the services are at the door steps with their peers • The need to advocate for the services to be closer to people that need the services. Distance prevents people from accessing the services (YONECO Drop in Centres are hub of condom distribution as opposed to YFHS points in the hospitals

11. Advocacy role of CSOs in Country Ownership (3) • Budget tracking, monitoring and accountability for the effective use of the resources for the family planning resources • As a result of HIV and AIDS, less resources have been allocated to FP leading to poor service delivery • In Malawi, CSOs like BLM have been the centre of FP provision as opposed to government because resource are available • In some instances, FP resources are diverted to other preventive health services as FP is not a priority • CSOs should monitor how resources are allocated, ensure FP is a priority and how resources are utilised

12. CSOs can effectively Engage the public on Family Planning Issues • Is the public part of community ownership? Whose services are the FP? What would be the role of CSOs in public engagement? • Conducting education or awareness on the various methods of family planning • Providing space for networking, coordination and collaboration among the key stakeholders • Public engagement on FP and quality of the services • Engaging the media to conduct public education and awareness on Community ownership of FP • Strengthening the Media to conduct advocacy and awareness people on FP for increased demand of the commodities

13. Policy recommendations for better programmes (bringing FP closer to the people) • Thinks tanks for policy development and review for the effective delivery of family planning services delivery at community and national levels • Engaging with policy holders for the development and review of family planning policies and strategies • Budget tracking, monitoring and accountability for the effective use of the resources for the family planning resources • Conducting research into the effective use of family planning services among different social groups and why there are challenges in accessing these aspects [Again, it would be good to give examples here]

14. Identify and champion groups who are missing out • One size fits all (Standard FP Services) miss out on number of key social groups • YONECO uses out reach services and youth corners or drop in centres to reach to groups that are missing out • CSOs can easily identify and champion the groups that missing out • Special group associations like commercial sex workers groups, widows association etc can be useful in identifying the special needs for these groups

15. Capacity constraints for CSOs participation • CSOs are voluntary in nature and operate with limited budgets but with passion, drive and commitment to the cause • CSOs are on the ground where sometimes government is unable to reach, but sometimes have capacity gap to collect data effectively to inform policy decisions • CSOs do a lot of work and contribute to the changes at various levels, but have challenges in documenting the work to inform policy work

16. Inadequate recognition of CSOs role in FP • Poor policy frameworks that do not recognise the role of CSOs in family planning beyond service delivery • Cosmetic policy documents (CSOs are mentioned as donor conditionality's and yet the practice is different (Sector Wide Approaches in Health as an example) • CSOs are not usually in government budgets as actors in development (Fundamental questions of whether the state should finance CSOs or if state finances CSOs, will they play a watch dog role?)

17. Inadequate resources • Inadequate resources for CSOs to conduct the various activities beyond service delivery and the advocacy work seem not to produce “results” as perceived in the development work • Changes in international agenda recently with the global financial crisis has made this more serious • Lack of information flow from the services providers and research institutes relating to family planning – for example it takes long before CSOs are aware of international agreements that our governments have signed making advocacy a huge challenge • Most developing country CSOs government budgets does not include the CSOs support and even government budgets that are earmarked for CSOs often do not get spent on CSOs, (e.g. SWAP in Malawi is supposed to support CSOs but not implemented)

18. Recommendations to Govt and the international community on CSOs engagement • Transparency • Engage with CSOs on policy dialogue • Support capacity building

19. Improve Transparency • Improve policy frameworks to include the role of CSOs in Family planning beyond service delivery including the government policies on sexual and reproductive health • Policies should not be cosmetic for CSOs but should have meaningful participation of the CSOs • Enhance the coordination, collaboration and networking activities among CSOs while also providing a forum for networking and coordination • Donors and government at country levels should provide the space and resource for coordination and networking

20. Support Capacity Building • Capacity building for CSOs in conducting evidence based advocacy, research and policy analysis in family planning sector • Provide more resources for CSOs to do work outside service delivery of family planning • Enhance CSOs capacity to mobilise resources beyond the traditional donors and resource providers to include private sector, own income generation through training, linkages and networking (the forum in Addis now is an example of how to enhance capacity)

21. Engage with CSOs in Meaningful policy dialogue • Enhance the coordination, collaboration and networking activities among CSOs while also providing a forum for networking and coordination • Support linkages and networks for CSOs and governments to share and compare notes

22. Thank you for your attention • Contacts • Email 1: macbainmkandawire@yoneco.org.mw • Email 2: macbainmkandawire@yoneco.org • Email 3: macbain.mkandawire@gmail.com