to Increase Access Marie Stopes International
Women don t lease their bodies from the state or church, they own them. Founder, Tim Black (1937 2014) Almost all of the health services we provide throughout our global partnership are affected by over-regulation and over-medicalisation. These unnecessary legal or regulatory restrictions exacerbate the existing cultural, economic, religious and social barriers that prevent women and girls from seeking and receiving the care and services they want. Our 2020 Strategic Plan recognises that providing services alone will not secure universal access to contraception or safe abortion services, and that to deliver results at scale and achieve greater sustainability we need to transform the environment in which we operate. by doing Our recommendations are based on the needs of our clients and on innovations we ve shown can work. Through provision of services, we are able to generate data and evidence about what works and where change is needed. Our research and analysis of this data then helps us to identify the barriers and system failures hindering service uptake, before determining the policy 1 solutions that will help remove these barriers. From policy to practice Our voice is critical in ensuring that policies are supportive of access to contraception and safe abortion. Likewise, our contribution helps ensure that policies are fit for purpose and informed by the latest medical guidance. By focussing on the policies and issues that affect the frontline of service delivery, we can streamline our advocacy efforts to achieve the maximum return on investment for our programmes. Our goal is to generate advocacy changes that translate into increased access to services on the ground. We refer to this entire approach as results based advocacy. 1 The term policy refers to legislation, budgets and resourcing, guidelines, protocols and the regulatory environment. Policy change includes anything that requires intervention by the national, state or local government to evoke change, and to ensure that these changes are then operationalised and implemented. 2
Results based Through our results based advocacy, we aim to: advocacy Change the laws, policies and practices that restrict access and find solutions to constructively and creatively remove restrictions; Ensure that the progressive policies and commitments that do exist are understood, implemented and resourced; Safeguard existing supportive policies and commitments; Increase global and national investments and resources for contraception and safe abortion services this includes public, donor and private support; Track results to continuously strengthen our advocacy efforts over time, ensuring that we communicate our contribution to tangible changes. Leveraging our role as a service provider As health service providers, we are often the most credible and authoritative advocates for achieving change. By tailoring our efforts to specific policy changes and then implementing these policies in practice, we are saving and improving lives. Our role as service providers also gives us access to the inside track with ministries and technical working groups. We use this access to work with decision makers behind the scenes to encourage debate and to share promising practises about what works. We leverage participation in these technical spheres to build political will for removing policy barriers and to expand our operational environment. This typically involves illustrating the wider benefits of services, piloting innovations, documenting the results of the pilot and conducting operational research to prove concepts. The evidence and recommendations generated are then disseminated, used to mobilise support and to make the case to remove restrictions. Likewise, if there are supportive policies already in place but they are threatened, we work with partners to safeguard them. This inside track approach means that we rarely lead on public campaigns or mass mobilisation. However, we are part of wider advocacy networks or partnerships with other agencies, donors, professional organisations and other stakeholders. For more sensitive or controversial issues, we may find it useful to work with others who are able or willing to take a more public stance. In these instances, our role typically involves providing technical and discrete support behind the scenes. 3
Recent successes Our inside track approach to advocacy has yielded some recent successes throughout the global partnership, including: Nigeria A wide-reaching Task Shifting and Sharing Policy for Essential Health Services, extending the right for Community Health Extension Workers to deliver a broad range of health services including implants and IUDs. Sri Lanka and Myanmar New Post-Abortion Care guidelines developed and approved by national Ministries of Health. Ethiopia New guidelines permitting abortions to be carried out at primary health clinics, including authorisation of nurses to perform medical abortions. Bangladesh New regulations that permit the use of misoprostol for Menstrual Regulation. Medical Menstrual Regulation will also be included as a service covered under the government s national family planning programme. Afghanistan Progesterone-only pill added to the Essential Drug List; with the Ministry of Public Health approving MSI Afghanistan to use misoprostol for post-abortion care in MSI clinics. A pilot project secured for mid-level providers to insert implants. Sierra Leone Mifepristone (Mediprist) was registered for use. 4
Thematic areas Potential strategies to address thematic areas Increasing access to contraception, with a focus on reaching the most marginalised and excluded groups. Task sharing to remove restrictions on the services authorised for provision by different cadres of health workers (authorisation or approval, amending curricula or guidelines) informed by WHO s Global Guidance. Registration and supply of commodities; including import tariffs or obstructing customs procedures. Removal of age restrictions or third party consent. Increasing access to safe abortion and postabortion care, with a focus on reaching the most marginalised and excluded groups. Increasing indications for safe abortion. Safe abortion/post-abortion care guidelines. Removal of third party consent. Registration and supply of safe abortion commodities. Holding governments and donors to account for commitments made and pushing for increased recognition and prioritisation of SRHR. Revising and updating national policies. Securing specific budget lines. Influencing government funding decisions. Roll-out of costed implementation plans or other national action plans (e.g. Global Financing Facility, Ouagadougou Partnership, FP2020, etc). Ensuring equitable, efficient and sustainable financing for services. Building confidence, skills and willingness of governments to contract out services. Advocating for inclusion of services within basic UHC packages (e.g. contraception counselling and supplies). 5
Our added value Our advocacy goes beyond influencing alone. We use our expertise and existing country programmes to support governments to operationalise policy. Through pioneering practices informed by WHO global guidance, we strengthen health systems by working with governments to roll out, scale up and implement policy, thereby increasing sustainable access to services. Our unique institutional strengths make us an effective and strategic partner, with core strengths including: 9Capacity 9 to bridge the public and private sectors; 9A 9 reputation for expertise and impact in client-focussed service delivery; 9Knowledge 9 of international best practices and guidance; 9Existing 9 relationships with government and medical professional associations; and 9A 9 strong research and evidence base. As a service provider, we have a duty to shape and protect our operating environment for the benefit of our clients. Our unique blend of working on the inside track and in partnership to influence and pioneer change ensures that our advocacy has real impact. Conceptualising our approach to advocacy Universal access to SA and FP services Improved supply Increased demand Evidence based advocacy Policy implementation, piloting innovations, strengthening health systems by scaling up Evidence generation Removing policy restrictions Protecting good policy 6