Scaling-Up Excellence. Universal access, one woman at a time

Transcription

1 Scaling-Up Excellence Universal access, one woman at a time

2 Our story so far We are a global partnership, and our impact has been profound. In the last five years alone we doubled our health impact. These results are down to the drive and passion of our more than 12,000 team members in 37 countries delivering comprehensive contraceptive choice and safe abortion services to women in need. Our services have given millions more women around the world the ability to live healthier lives and pursue their ambitions by choosing to have children by choice, not chance. Our services have not just transformed the lives of individuals; they have made a measurable contribution to reducing unmet need for contraception and eradicating unsafe abortion at national and global levels. In our efforts to eradicate unsafe abortion, we have increased provision of safe, quality medical abortion and medical post abortion care four-fold since 2010, reaching over 3 million women in By focusing on increasing access to long-acting and permanent contraception across our global network, contraceptive prevalence has increased in all MSI countries including by more than 4+ percentage points in 60% of our countries since Last year alone, our services prevented more than 6.5 million unintended pregnancies, averted 4.4 million unsafe abortions, prevented more than 18,700 maternal deaths, and saved families and health systems 251m. At the end of 2015, more than 21 million women and men were using a modern method of contraception provided by Marie Stopes International. Last year we delivered more than 31 million couple years of protection (CYP), more than a 10 million annual increase on Of our 8.2 million family planning clients in 2015, more than 82% selected a long-acting contraception method and 39% were adopters of family planning. Of all our clients, 80% lived on less than $2.50 a day (29% on less than $1.25). Our programmes have had a marked impact on the communities and societies in which we work: reducing stigma, enabling women to make positive choices about their lives, removing policy restrictions, and revolutionising the way health care is provided. This success proves we are changing the lives of millions of women by giving them the power to have children by choice, not chance. 01/02

3 Going further We still have millions more women to reach worldwide. Our mission of children by choice, not chance has never been more critical. Every 11 minutes a woman dies from an unsafe abortion. The human cost of not accelerating universal access to contraception and safe abortion is staggering. Every year in the developing world, an estimated 74 million unintended pregnancies occur due to a lack of contraceptive access or method failure. Of these unintended pregnancies, 36 million end in abortion, more than half of which are unsafe. These unsafe abortions kill more than 47,000 women every year, and cause serious illness and long-term disability for 8 million more. While the combined efforts of our sector have dramatically changed the landscape of contraception and safe abortion across the countries where we work, the need for our services is growing every day. Today, an estimated 225 million women in developing countries want to use contraception but cannot do so. This demand will continue to increase, as unprecedented numbers of young people come of age and more women become aware that they have the ability to control their fertility. This means that we must reach more additional users every year to keep pace, while remaining committed to our existing clients. To realise our mission, we must accelerate efforts to ensure we are able to respond to this growing demand. New communication and medical technologies provide real opportunities for connecting directly with clients, improving quality assurance systems and operational efficiencies, and offering clients a wider selection of contraceptive options. National governments and donors are gradually increasing the funding available for contraception and safe abortion service delivery. But to realise these opportunities, we must adapt our strategy and evolve our operating model to be responsive to our clients evolving needs and the shifting health care landscape. We will be courageous, drawing on our pioneering spirit to deliver more services than ever before. I was a child giving birth to a child. Mi Aye Mi Aye married at the age of 13. Nine months later she was a mother. Nobody had ever talked to her about sex, not even after she gave birth. Barely into her teens, she was dealing with adult responsibilities. Worse than that, she didn t know how to stop it happening again. She was terrified. It wasn t until a Marie Stopes health worker came to her village that Mi Aye learned about the contraception that could help her regain control of her life. She described that first visit as like being thirsty and falling into a well. Marie Stopes Myanmar fitted an IUD that will prevent her falling pregnant for up to 10 years. With access to contraception, she now has the power to plan her future.

4 The next chapter: Scaling-Up Excellence We will remain driven by our values and our mission. These have been and will continue to be the bedrock of our success. Our commitment to putting our clients first and our dedication to quality of care remains unwavering. We have a firm foundation of proven results and the on-the-ground service delivery networks that enable us to achieve results at scale. We can rapidly replicate proven success models from one country to another, enabling us to bring new ways of working to scale, without compromising quality. Our new strategy, Scaling-Up Excellence: Universal access one woman at a time challenges us to go further to reach more women with services than ever before. The interconnected pillars of Scale and Impact, Quality, and Sustainability provide a clear framework for how we can leverage our client centred care approach, built on effective counselling and demedicalised, private sector service delivery models, to deliver a game changing level of impact. Scale & Impact Deliver increased scale and impact at lower cost per client served Quality Set the standard for clinical quality and client-centred care Sustainability Build long term sustainable service delivery models that go beyond donor support + = Scaling-Up Excellence Our 20x10 strategy focused on Quality Our Power of 10 strategy focused on Scale Our new strategy focuses on Quality and Scale Scaling-Up Excellence is a recognition of the success of recent years. It also challenges us to refine our models, taking them effectively to scale without ever compromising our commitment to quality or our clients. It demands that we keep a firm eye on operational efficiency, because every dollar saved is a dollar that could be spent on providing services to another woman in need. It also challenges us to fundamentally shift our thinking on sustainability. We have committed to our clients that we are here for the long term. To do this we need to leverage available donor and domestic financing to deliver high-quality services. We will also use our influence to shape markets, finding the right private sector solutions that will enable women and national governments to directly pay for core services. To be truly sustainable, we must ensure that access to contraception and safe abortion is affordable for women and national governments in 2016, 2020, 2030 and beyond. 03/04

5 We commit to: Doubling our health impact through contraception and safe abortion service delivery at scale. > We will continue to extend our services to high impact clients including adolescents aged years and the poor. > We will provide contraception to 12 million additional users by 2020, 10% of the global FP2020 commitment. > We will double our provision of safe medical abortion (MA) and medical post abortion care (MPAC), and increase post-abortion family planning (PAFP) to 90% for all safe abortion/pac clients. Delivering more with less by increasing provider productivity and scaling-up proven private sector cost-effective models for long acting and permanent methods (LAPM) and safe abortion/pac. We will make universal access to contraception an affordable choice for women, couples, national governments and donors. Setting the clinical, programmatic, and client care standards that other providers aspire to and embedding our services as the preferred choice for women. Using our expertise as a social business to build sustainable private sector models that go beyond donor support by ensuring that every service has a funding source. Our aim is that no woman who has been given access to contraception or safe abortion will ever be denied it again. What we will deliver We are delivering for women today, tomorrow and the next generation. In Scaling-Up Excellence, our success will come from delivering client-centred counselling and services that result in positive health outcomes for every client. When we combine this success at the individual level with the scale of our network, we can replicate that positive client outcome several million times over delivering transformative impact at scale, in a uniquely MSI way: one woman at a time. We will: > Only scale-up proven success models, replicating them across the Partnership. > Use client insight and evidence to clearly demonstrate how our service delivery models, client counselling and quality standards are the most effective in empowering women to choose when to have children. > Continue to evolve our service delivery channels to deliver greater scale and catalytic impact faster at lower cost. > Innovate to find new models that enable us to sustainably provide services to those most in need. > Realise cost efficiencies that enable us to invest savings directly into front line service delivery.

6 We will build on what we have learned Scaling-Up Excellence builds on the lessons we have learned from 40 years of providing contraception and safe abortion services in some of the world s most challenging and restrictive environments. It is deeply rooted in our values, our commitment to our clients, and our unwavering focus on clinical quality, client-centred care and effective governance. We have incorporated the lessons learned from our country programmes experiences in pioneering innovative service delivery models like outreach and social franchising, and radically transforming the provision of safe and affordable medical abortion. Our country programmes are constantly discovering new insights about what empowers or prevents a woman from voluntarily accessing contraception or safe abortion services. These insights have been and will continue to be instrumental in shaping our services, and how we evaluate our success in delivering client care. We will leverage our global profile and partnership to keep contraception and safe abortion at the top of the agenda as a foundation of social and economic development. We will continue to build relationships with host governments, donors and partners that shape policy at the global and national levels and secure new funds that enable our country programmes to deliver core services. We will also continue to develop tools and metrics that will define how our sector measures success, like Impact 2 and measuring additional users. Scaling-Up Excellence commits us to universally applying the global standards and policies developed over the last five years, enabling us to manage a growing global business and manage donor funding at scale. We will all be held fast to the standards articulated in the Partnership Manual, which provides guidance to all Country Directors and MSI global leadership so they can lead with confidence. We will do things differently While Scaling-Up Excellence is an affirmation of the achievements and lessons learned over the last decade, it also challenges us to do things differently and evolve as an organisation to be responsive to our rapidly evolving client circumstances and fast moving health markets. Delivering greater scale and impact at a lower cost per client served: > We will increase our global health impact by delivering more than 50 million CYPs per year by 2020, alongside targeted catalytic increases in contraceptive prevalence. Each country in the Partnership will provide a meaningful and measurable contribution to these goals. We will achieve this through a country portfolio strategy that focuses each country programme on specific high impact opportunities within their country. All countries will be focused on reducing unsafe abortion and increasing post-abortion family planning. In our portfolio approach, MSI countries will fall into five categories: Foundation, Acceleration, Catalytic, Emerging Commercial and Commercial. Each category has differing investment and resourcing profiles, and will be measured against tailored key performance indicators that capture their meaningful contribution to the Global Partnership's results. > Countries will be challenged to make deliberate choices about which channels they invest in to deliver sustainable change in access to contraception and safe abortion. Our channel strategy (see Annex 3) increases client access to quality and affordable core services at the community level. Client Care Centre Social Marketing Our client-centred channel strategy Data, analytics and insight underpins all channels to transform service, client experience and behaviour Outreach Social Franchise MS Ladies Clinic Centre 05/06

7 12% Did you know? We will leverage our channel strategy to: - Correct demographic gaps in our service provision, notably girls aged 15-19, who are underrepresented in most countries as users 7.4 million Globally, there are 7.4 million adolescent unintended pregnancies each year Teenage pregnancy is the number one cause of mortality for girls aged between of modern contraception and the most likely to have an unsafe abortion when faced with an unintended pregnancy. We will use insight directly from adolescents to innovate and tailor our services to provide better access for adolescents to affordable products and services in places and at times convenient for them, and with easy access to long-acting reversible contraception (LARC). Success will be demonstrated by how we increase adolescent services across our channels, and generate lasting demand for services among this critical age group. - We will continue to reduce unsafe abortion by broadening our efforts to expand access to quality medical abortion. We will double our current sales from 3 million to 6 million per year by We will increase our focus on client care and post-abortion family planning. This will be driven by the launch and implementation of a social marketing strategy that combines driving product availability with active links for clients to our call centres and our centres for continuing support and aftercare. We will aim to remove the legal and medical restrictions that currently limit this expansion. - In most countries where we work, the method mix is disproportionately skewed towards less effective short-term contraceptive methods. This imbalance is typically due to a lack of availability of long-acting methods, trained providers, or provider bias towards easier to administer short-term methods like pills and injectables. Our expertise in providing long-acting and permanent methods (LAPM) gives us a significant opportunity to correct this gap in service provision by giving women full contraceptive choice. Therefore we will build and expand our key differentiation expertise in providing LAPM, built solidly on our expertise in comprehensive counselling and client care. We will leverage partnerships and funding to ensure the sustainability of service provision across all channels. We will lead by example in delivery of proven value-for-money and cost-efficient solutions. > We advocate by doing, using our experience as a service delivery provider to influence countries to remove restrictions that limit access to contraception and safe abortion services. At country level, we will continue to ensure that progressive policies are turned into practice through our service delivery networks. We will leverage our growing global profile to influence policy and forge partnerships that result in: investments in longer term, sustainable demand creation and access provision; elimination of barriers to safe abortion services; and financing of contraception and safe abortion by national governments and donors. Our influence in practice: > Approval of task-sharing in Nigeria, allowing Community Health Extension Workers to provide implants and IUDs. > New regulations in Bangladesh permitting the use of misoprostol for menstrual regulation. > New guidelines in Ethiopia allowing nurses to provide medical abortion in more settings. > New guidelines in Afghanistan to legalise post-abortion care. > Guaranteeing universal access to contraception in the Philippines, through the Reproductive Health Act. Method mix of users in sub-saharan Africa Outer: regional average (2012) Inner: MSI users (2015) 84% 7% 0% 6% In sub-saharan Africa, short term methods are often the only types of contraception available. We focus on expanding the method mix and this chart shows the wider variety of methods chosen by our clients, compared to the regional average. Female Sterilisation Male Sterilisation Implant 15% 25.7% 24.7% 24% 3% 0% IUD 49% 49% 40.3% Short term methods

8 Setting the standard for clinical quality and client-centred care: > We profoundly believe in our client-centred approach. This must be built on client, channel and market insights. We will exploit our vast database of client insight and service statistics to create long term user demand, and services that cater to users not providers needs or preferences. We will invest in documenting our models, using verifiable data to build the case for why it worked and why national governments and donors should invest in contraception and safe abortion. > We will demonstrate integrity in every service and for every investment. We will continue investing in governance and audit oversight, clinical quality standards and provider training to provide services that surpass our clients expectations, and assure national governments and donors that they made the right choice by investing in us. > We will invest in our people. We believe that the key attraction for talent to MSI is our dedication to our mission and to our clients. Therefore, we have put investment in people and systems at the heart of our new strategy, ensuring we hire, train and retain the best talent, pay competitively, and focus on performance and results. Using our private sector expertise to build sustainable service delivery models that go beyond donor support: > To ensure that we are able to meet the needs of our clients today and beyond 2020, we will continue to build a diversified income base that leverages both substantial and significant donor investment with domestic financing and self-generated income. All service channels will have a sustainability model, meaning every service provided must be fully costed and completely supported by a funding source. As the anchor of our channel strategy and our centres of excellence, our centres must be self-sustaining. > In all our countries, we will provide national governments and donors with the evidence that positions contraception and safe abortion within Universal Health Care (UHC) provision. Where opportunities for domestic financing arise, we will actively pursue those funding opportunities and contracts. In countries where domestic financing will only emerge as a reality beyond 2020, we will engage to help countries shape their policies and planning to ensure women and contraception are included from day one. > We will innovate by developing new business models to achieve our mission objectives and to strive for greater sustainability of core service provision. This includes using technology to improve client counselling, like our interactive counselling app, and client follow-up, through our call centres. Technology will also improve management systems for quality. We will: - Work with partners from all sectors to introduce new contraceptive and safe abortion technologies and products to expand choice for women and men, like introducing generic hormonal IUDs (LNG-IUS) in countries across Africa and Asia. - Explore new models that can build our footprint in sustainable, private sector, sexual and reproductive health services, including maternity clinics and provision of basic emergency obstetric and newborn care (BEmONC) services alongside our core services. - Launch a new generation social franchising model that increases access to affordable contraception and safe abortion/pac services at MSI quality assured facilities. > We intend to become the reproductive health private provider of choice for our clients, national governments, donors, and philanthropists by virtue of our focus on quality service provision at low cost, and our broad service delivery network. We will use evidence to demonstrate that our approaches deliver the best value and impact proven by measurable results. Our ultimate vision is that in the future domestic financing will pay for contraception and comprehensive reproductive health services, as they do in the UK; however, until that becomes a reality in the countries where we work, we will continue to actively seek donor investment to provide subsidised services to the underserved. 07/08

9 How we will create lasting change We offer respect and quality of care for every woman, no matter what her circumstances. We measure our success by the number of women who choose to become users of modern contraception or access a safe abortion service. By delivering private sector solutions that increase equitable and affordable access to the full range of contraception methods and safe abortion/pac services, we empower individual women to make an informed choice for their reproductive health needs. As more women voluntarily choose to become users, their actions remove social stigma and encourage more women to come forward to seek safe services. Over time, first time users of contraception become users for life who support their friends and daughters to also become users. This establishes demand for safe and affordable services as a social norm. As a result, modern contraceptive prevalence rates rise, fewer women die due to unintended pregnancy and unsafe abortion, and women are empowered to achieve their aspirations and full potential. To achieve this vision of success we have successfully developed a diverse range of service delivery models through which we offer our clients a wide choice of high-quality reproductive health services. Our services are matched with client insights to better target our services to women. This holistic approach to client-centred demand generation and service delivery enables us to implement effective interventions that remove individual, provider and market level barriers that prevent women from choosing for themselves when to have children. As an individual, a woman's ability and motivation to access contraception and safe abortion services is influenced by many factors. These often include: myths and misconceptions about methods and side-effects; a lack of understanding of the risks of unintended pregnancy or unsafe abortion; inadequate knowledge about how and where to access services; and a lack of perceived or real social support from her partner or community or fear of stigma and discrimination. Our behaviour change framework (Annex 2) guides our country programmes on how to turn client insights into effective communication strategies to support women to overcome these barriers and seek care from a qualified provider. For many women, the service provider plays a critical role in a woman s decision to become a family planning user. Our experience confirms that when a client receives caring, respectful counselling from a trained provider, she is more likely to choose to become a family planning user and to be satisfied with her chosen method. This is especially true for uptake of long-acting contraception and post-abortion family planning. Therefore, we invest in our providers. Our supportive approaches help them to put the needs of the client ahead of their own and motivate them to take ownership for their clients outcomes. We know that convenience, affordability and choice of product and service are key market influences for women to become users of contraception or safe abortion. Therefore, we leverage our service delivery networks, as well as our local and global partnerships to ensure affordable and reliable services are available at the community level.

10 We are making difficult choices so that we stay focused on the client. 09/10

11 How we will prioritise To be successful we will need to make tough choices about how and where to invest our resources. Our strategy framework (below) will guide our business decisions and how we measure success over the next five years. MSI country programmes and support office teams will align their work in a way that contributes to achieving these strategic priorities. These priorities will guide our programmatic decisions, focus technical support, and the investment of donor and MSI resources. Our focus in delivering these strategic priorities, guided by our commitment to our mission of children by choice, not chance, will bring us ever closer to our vision of a world where every birth is wanted. Increased impact Our services will prevent 58m unintended pregnancies, avert 34m unsafe abortions, and avert 118,900 maternal deaths. Greater choice We will increase the number of contraception and safe abortion services that we provide, enabling more women to choose when they have children. Scale & Impact Deliver increased scale and impact at lower cost per client served Quality Set the standard for clinical quality and client-centred care Sustainability Build long term sustainable service delivery models that go beyond donor support Increase annual CYPs from 30m to 50m, and reduce our cost per CYP by 20%. Double the number of MSI contraceptive users from 20m to 40m. Deliver our pledge of 12m additional users by 2020 (from 2012). Double our annual MA/MPAC service provision from 3m to 6m. 90% in-centre safe abortion and PAC clients receive PAFP. Remove 30 policy and clinical restrictions that limit access to contraception and safe abortion services. 80% high impact clients including proportionate youth years, adopters and the poor. 90% of clients asked report that MSI s services exceeded their expectations. 100% reported client services trackable and auditable. 100% of service delivery channels meet MSI s productivity and performance standards. 100% of providers meet MSI s clinical quality standards. 100% of programmes meet MSI s standards for programmatic management. 80% of critical and bench vacancies are filled by MSI talent. 80% of employees asked report MSI is a great place to work. 40% of our international programmes income is self-generating and all countries are free of deficit funding. Increased annualised grant income to 250m in Increased fee generated service income from 81.5m to > 100m at 10% net surplus. Double global annual surplus and discretionary funding to 20m. Increase MSI global reserves to 30m. Reduce global support office costs <7% global income. Core services are funded by domestic financing in at least five countries.

12 Getting it done: achieving global milestones through the portfolio approach Scale & Impact > Double our health impact through service delivery and medical abortion provision at scale. We will continue to extend our services to high impact clients including adolescents under 19, new adopters and the poor. > Deliver more with less by increasing provider productivity and scalingup proven private sector cost-effective models. Global milestones Increase annual CYPs from 30m to 50m, and reduce our cost per CYP by 20%. Double the number of MSI contraceptive users from 20m to 40m. Deliver our pledge of 12m additional users by 2020 (from 2012). Double our annual MA/MPAC service provision from 3m to 6m. 90% in-centre safe abortion and PAC clients receive PAFP. Remove 30 policy and clinical restrictions that limit access to contraception and safe abortion services. Strategies Balanced country portfolio targeting high impact opportunities and correcting gaps in provision (including youth aged 15-19), where we can leverage scale for the most sustainable long term impact. Revitalised MA/MPAC and social marketing strategy. Expand and deepen our global expertise in longacting and permanent methods (LAPM). Remove policy and clinical restrictions that limit access to contraception, safe abortion, and post abortion care services. 80% high impact clients including proportionate youth years, adopters and the poor. We will make deliberate choices to keep the client at the centre of everything that we do. All strategic initiatives will be informed by a portfolio approach which will guide how and where we tailor technical support to each country programme. This will ensure that each country receives the technical support that they need to deliver against the performance indicators and to meet Marie Stopes International s standards for quality and governance. Our balanced country portfolio High 2020 Foundation Acceleration 2016 Catalytic Emerging Commercial CYPs Commercial Low 11/12 External Financing Domestic

13 Our diversified portfolio categories Foundation Countries already delivering impact at scale with a relatively low cost per CYP and client served. sustainability by increasing their annual service income and CYPs by at least 25% over the next 5 years, while increasing productivity, cost-recovery and surplus. They will Includes: Bangladesh, India, Pakistan, Philippines and Vietnam. Acceleration Countries with established service delivery platforms that will be the basis for rapid future growth, a strong existing donor base; donors will likely continue to fund services at scale through Includes: Ethiopia, Ghana, Kenya, Nigeria, Madagascar, Malawi, Myanmar, Sahel, Tanzania and Uganda. Catalytic Emerging Commercial Commercial Countries delivering impact in more fragile environments with lower prospects for sustainability. They will continue to be funded by donors, and will focus their service delivery choices on reaching high impact clients through fully cost recoverable channels. They are expected to grow in impact and income by 50% over 5 years. Includes: Afghanistan, Cambodia, Nepal, PNG, Sierra Leone, Timor-Leste, Yemen, Zambia and Zimbabwe. and generating surplus. They will leverage social marketing, safe abortion and MA/MPAC opportunities to become completely independent of new donor funding. Includes: Bolivia, China, Mexico, Mongolia, South Africa and Sri Lanka. Fully commercial and operating at scale to deliver surplus to fund service delivery in other MSI countries. These are social businesses that demonstrate the standard for safe abortion and client care, alongside high-productivity and return on investment. Includes: UK/Europe and Australia. Strategy 3 - Proven LAPM delivery models Strategy 1 - Balanced country portfolio We will demonstrate that our approach to service We will maximise the global impact of the delivery, which prioritises the needs of the partnership through a balanced country portfolio client, quality counselling, and comprehensive management approach that targets high impact opportunities and corrects gaps in service contraceptive choice, is the most cost effective provision (including married and unmarried in increasing contraceptive prevalence and adolescents aged 15-19). This approach enables delivers lasting change in behavioural norms us to leverage scale for the most sustainable and continued demand for contraception. long term impact, as well as create catalytic Strategy 4 - Remove restrictions change across our countries. We will make We will remove policy and clinical restrictions deliberate choices about where to invest MSI that limit access to contraception, safe abortion, and post abortion care services. We will choosing channels that deliver scale, impact advocate by doing, leveraging our experience and sustainability in each country. as a service delivery provider to shape markets Strategy 2 - Access to MA/MPAC to increase access to affordable contraceptives We will double MA/MPAC provision through and effectively implement policies that change a revitalised social marketing strategy supported the national and global landscape for universal by continuum of client care, integrated call contraceptive access. centres and active linkages to post abortion family planning (PAFP).

14 No compromise on quality Internal global milestones Strategies Quality Setting the clinical, programmatic, and client care standards that other providers aspire to and embedding our services as the preferred choice for women. 90% of clients asked report that MSI s services exceeded their expectations. 100% reported client services trackable and auditable. 100% of service delivery channels meet MSI s productivity and performance standards. 100% of providers meet MSI s clinical quality standards. 100% of programmes meet MSI s standards for programmatic management. 80% of critical and bench vacancies are filled by MSI talent. 80% of employees asked report MSI is a great place to work. Invest in governance and audit oversight, clinical quality standards and provider training. Invest in our people. Invest in client insight and success models. Our strategies reaffirm our commitment to quality in everything we do. Strategy 1 - Investing in governance We will continue to invest in governance and audit oversight, clinical quality standards and provider training to ensure that: a) every dollar invested is used effectively; b) fraud, misreporting and ineffective processes are eliminated; c) 100% of our services can be validated; and, d) we deliver services to a standard that always exceeds our clients and stakeholders best expectations and commitments. Strategy 2 - Investing in people We will nurture our unique MSI culture and grow our capacity by putting our investment in people at the heart of our new strategy. Our multi-cultural workforce will benefit from diverse backgrounds in the private, public and not-for-profit sectors. We will train and develop our leaders to promote quality, sustainability, and performance, enabling us to deliver client-centred care to even more women and couples. Strategy 3 - Investing in insight By focusing on the needs voiced by our clients and women and girls with unmet need, we will create enduring user demand for universal access to all methods of contraception. We will empower our providers to be responsive to the needs of their clients and overcome provider bias, ensuring that every client receives the method that suits her contraceptive needs and supports her to become a user for life. 13/14

15 Redefining sustainability Sustainability Using our expertise as a social business to build sustainable private sector models that go beyond donor support by ensuring that every service has a funding source. Our aim is that no woman who has been given access to contraception or safe abortion will ever be denied it again. Internal global milestones 40% of our international programmes income is selfgenerating and all countries are free of deficit funding. Increased annualised grant income to 250m in Increased fee generated service income from 81.5m to > 100m at 10% net surplus. Double our global annual surplus and discretionary funding to 20m. Increase MSI global reserves to 30m. Reduce global support office costs <7% global income. Core services are funded by domestic financing in at least five countries. Strategies Create sustainability models for all channels. Create a self-sustaining global network of clinics. Nurture relationships with donors, foundations, philanthropists and national Governments. Explore innovative and sustainable service delivery models. We have made a commitment to our clients that we will be here for the long term. To deliver on that commitment we must ensure the financial sustainability and resilience of our network. Strategy 1 - Sustainable models We will continue to develop sustainability models for all channels, with every service provided backed by a funding source. Strategy 2 - Self-sustaining centres We will evolve our global network of centres to be self-sustaining Centres of Excellence that embody MSI's core values and brand equity in every country where we work. They will set the standard for client care and clinical quality for contraception and safe abortion services across our network and the sector. By ensuring that they are self-financing, we can continue to provide essential core services without donor support. Strategy 3 - Shaping markets We will continue to be an active partner with national governments, donors, and other implementers from all sectors to increase access to and funding for contraception and safe abortion services. We will work with partners from all sectors to shape markets to ensure that comprehensive reproductive health services, including contraception and safe abortion/pac services are included in universal health care (UHC) frameworks and funded through domestic financing. Strategy 4 - Innovating We will innovate and test sustainable contraceptive technologies and service delivery models, including safe obstetrics and post-partum family planning (PPFP). To be successful, these private sector models will increase access to maternal health services to low and middle income clients, as well as generate surplus and increase the use of core services as part of achieving our global mission.

16 62% What will success look like By 2020 we will dramatically increase the number of services that we provide. By making choices about where we focus our time and resources, and consistently putting the client first, our services will: > Prevent 58 million unintended pregnancies > Avert 34 million unsafe abortions > Avert 118,900 maternal deaths > Save families and governments more than 2.21 billion in health care expenses. Annual performance Unintended pregnancies prevented 2.9 million 6.5 million 11.2 million Maternal deaths averted 7,400 18,700 27,400 Users of MSI contraception 10 million 21.6 million 37.7 million Unsafe abortions averted 1.6 million 4.4 million 7.1 million Figures on chart are annual Total CYPs, by region West Asia West Africa and Latin America 20x10 strategy Power of 10 strategy Scaling-Up Excellence strategy Southern Africa South Asia Pacific Asia East Africa 50m 40m The CYP continues to be an important output level indicator as it allows us to compare performance across countries and service delivery channels. 30m 20m This chart excludes performance of our Commercial Division and reflects changes in CYP policies for 2015 onwards. 10m Sources of international operations income 4% 2% 1% Total service income 23% 22% 37% Total grant income Consultancy and other income 92 million 73% 160 million 76% 244 million * based on country programme's projections * 15/16

17 Annexes Annex 1: Our core values and behaviours The culture that we want to live is defined by our mission, vision, values and behaviours. Values Mission driven: With unwavering commitment, we exist to empower women and men to have children by choice not chance. Client centred: We are dedicated to our clients and work tirelessly to deliver high-quality, highimpact services that meet their individual needs. Accountable: We are accountable for our actions and focus on results, ensuring long term sustainability and increasing the impact of the Partnership. Courageous: We recruit and nurture talented, passionate and brave people who have the courage to push boundaries, make tough decisions and challenge others in line with our mission. Core behaviours Work as One MSI > You contribute, share, and utilise accurate data and evidence to improve understanding, insight and decision-making. > You share relevant knowledge, coordinating expertise and resources to strengthen teamwork and prevent duplication of effort. > You actively work as part of a team, providing support and flexibility to colleagues, demonstrating fairness, understanding and respect for all people and cultures. Show courage, authenticity and integrity > You hold yourself accountable for the decisions you make and the behaviours you demonstrate. > You are courageous in challenging others and taking appropriate managed risks. Develop and grow > You seek feedback to enable greater selfawareness and provide the same to others in a way which inspires them to be even more effective. > You manage your career development including keeping your knowledge and skills up to date. Deliver excellence, always > You strive to consistently meet and exceed expectations, putting clients at the centre of everything. > You implement smarter, more efficient ways of performing your role. > You build and maintain long-term working relationships with stakeholders, and serve as a true ambassador for MSI. Leadership behaviour (for management/ leadership roles only) Inspire, motivate and develop > You inspire individuals and teams, through situational leadership, providing clear direction. > You seek and provide opportunities which motivate team members, helping to develop skills and potential whilst strengthening our talent and succession pipeline. > You demonstrate strategic insight about emerging developments in our sector, our clients and business and encourage this in your team. > You articulate a vision of the future which inspires and excites others. Annex 2: Behaviour change framework What is MSI s new behaviour change framework and how can you use it? > A model that MSI staff globally can use to identify the stage a women or community has reached in their journey towards adoption of a particular behaviour in this example we have used the adoption and use of a family planning method as the desired behaviour change. > The guidelines for the framework will guide you in how to use the data sources available to you including DHS surveys, CLIC data and client exit interview data to assess where a population or person is at on their behaviour change journey. The guidelines will also highlight where further quantitative and qualitative research may be required. > Once you have identified which stage a population or individual woman is at along the behaviour change pathway, you will be better placed to identify the barriers and motivating factors that influence a woman s progression to the next stage of behaviour and develop messages and demand creation activities to target them.

18 What are the different stages of behaviour change? Stage Not aware Behaviour Is not aware of any modern family planning methods Aware Accept/Intend Is aware; has some knowledge of a range of family planning methods, but not all knowledge may be accurate. Does not yet have any intention to use modern contraceptives Accepts the concept of family planning as positive and/or intends to use a family planning method in the next three months. Trial Has been using a modern family planning method for three months or under Adopt Has been using the same modern family planning method for over three months Advocate Is a modern contraceptive user and has encouraged friends, relatives or community members to use a modern family planning method in the last three months The diagram below outlines the steps that you will need to go through in using the model, as well as the different stages of behaviour change that an individual woman or population passes through. Below the model are listed some factors which may influence a woman s transition from one stage of behaviour to the next these are examples only as these will vary between different contexts. Stages of family planning use MSI Family Planning Behaviour Change Model 1. Identify your target group or audience 2. Identify which stage the individual or target group audience is at 3. Identify the priority factors to move your target audience to the next stage 4. Design activities to impact selected factors 5. Evaluate impact of activities on target audience Not aware Aware/Know Accept/Intend Trial Adopt Advocate Potential Factors influencing transition Access to correct and comprehensible information Family/peer knowledge about modern FP Community knowledge /experience of modern FP Sex education in school Individual's perceived risk of pregnancy/ childbearing desires Perceptions of method safety/side effects/effect Peer experience of FP Family/spousal attitudes on use of modern FP Community norms around pre-marital sex/family size Community norms on use of modern FP Knowledge of available services Perceptions of method safety and side effects Access to funds for FP Peer experience of FP Location and opening hours of services Availability of FP stock Cost of FP services Pregnancy desires Satisfaction with service and method Family/spousal support Quality of FP counselling Cost of services Ability of desired FP method Satisfaction with service and FP method Self-efficacy to give advice to others Perceived need amongst peers/community Community attitudes towards modern FP Provider capacity to provide FP methods Individual Interpersonal Community Institutional 17/18

19 Annex 3: Channel Strategy 1. MSI Centres These personify the MSI brand equity and are of the highest standard, quality and client care. These should be run sustainably and generate surpluses across the country. Service provision must be based on core services with complementary services run for surplus. Curative or other services must maintain the mission of MSI to work with clients in SRH services and not patients. We will test market-entry into surplus-generating maternity services with higher-quality outcomes for low-middle income clients. 2. Social franchising BlueStar We will re-package our BlueStar franchises with focus on extending MSI core services beyond the reach of our own Centres and especially in peri-urban and rural areas, at MSI-accredited quality and with focus on safe abortion (MVA and MA) and family planning. This channel is not expected to be fully-sustainable but we will focus on fewer, better franchisees with fees paid to partially offset costs and for the added value differentiation that being part of the franchise operation provides. We will invest in client information systems to improve network management. Ineffective franchisees will be removed from the network. 3. Outreach Our outreach provision is intended to provide high impact CYP s for unmet need, especially in difficult to reach areas and we will continue to perfect this model to provide the best practice for donor or government sponsored programmes. Our objective is to become the only choice for Outreach provision in Sub-Saharan Africa via highly cost-effective and measurable service provision. We will invest in client information systems and fleet management to drive down cost and increase accountability. 4. Social marketing We will reconfigure and revitalise our social marketing business to fuel the expansion of distribution and sales of medical abortion. We will operate as a business/distributor with a complementary range of products intended to support the business model, with small surpluses. Our target is a modest one to double turnover to 20mn with a net operating profit goal of 10% by 2020, whilst doubling our MA provision to 6mn per annum. 5. Marie Stopes Ladies The provision of services within the community is still under test but we are exploring different routes one a form of urban outreach, targeting hard-to-reach clients in urban areas, and one a pure entrepreurial non-donor model to extend reach to local communities and we will look to further explore this channel to increase participation with years olds. 6. New channels In an evolving world of client needs, products and ways to communicate we will explore/develop new routes and ways to generate demand and to deliver services. Call centres will become increasing integral to all our channels and where applicable, may offer telemedicine for safe abortion and SRH services in addition to building awareness of the full MSI offer and helping to translate a client contact into a client service. Annex 4: Development of our strategy has been a two year journey The strategy process began in 2013, when we gathered feedback on our previous strategy The Power of 10 through its mid-term review. More specific feedback was gathered at our 2014 Global Retreat, a biennial gathering of senior leaders from across the partnership We then took a deep dive into the latest data, mapping macro trends in populations, funding, and operating environments, to build a clear picture of the world in which we will operate between now and We used this, along with the feedback gathered, to create a draft strategic framework. From June August 2015, senior leaders took on the challenge of using the framework to build their own strategic plans. Through this process, we gained a deeper understanding of the emerging themes that would become critical components of our new strategy Scaling Up Excellence. The remaining months of 2015 were focused on streamlining the strategy in line with feedback received through country plans, resulting in a clearer, more focused, and easier to communicate document. We also conducted several rounds of external consultations to ensure synergy between our global and country level thinking In February 2016, Scaling Up Excellence was launched at our Global meeting in Johannesburg.