“It’s important we ask women what’s actually happening on the ground. After all these strategies and initiatives, women are still giving birth on the floor. And they have to get their own water!” said Caroline Maposhere, a Zimbabwean nurse-midwife and civil society advocate, from the floor of the 5th Annual Breakfast for Accountability for Women’s and Children’s Health, September 18.
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Adama Sanogo is Monitoring and Evaluation Specialist for the FCI Program of Management Sciences for Health in Mali.
For years now, countries around the world have made pledges, built coalitions, and developed strategies to demonstrate their resolute commitment to maternal health. On the surface, it seems as though a lot is happening in the realm of reproductive, maternal, newborn, child and adolescent health (RMNCAH). But these statements fall flat if women and newborns are still dying from preventable causes and if women, including girls, still do not have access to sexual and reproductive health information and services to lead healthy lives. Achieving the commitment or the law is only part of the advocacy story; actually, it is really only the beginning. To see this story through, we have to follow the money. Continue reading “Moving beyond the budget line: Fundraising for family planning in Mali”
By Julia Marion and Rachel Hassinger
Julia Marion is a communications coordinator and Rachel Hassinger is an online communications specialist at Management Sciences for Health. This article originally appeared on MSH.org.
Amy Boldosser-Boesch recalls feeling fortunate to have interned with Family Care International (FCI) when studying for her Master’s in International Affairs at Columbia University. Founded in 1986, FCI was the first international organization dedicated to maternal and reproductive health. Little did she know, in those early days of her career, that she would one day lead the organization.
“I’ve been so honored to be a part of FCI and its long record of saving women’s lives,” says Amy. “FCI launched and led the global Safe Motherhood movement, hosted the first Women Deliver conference, was founding co-chair of the Partnership for Maternal, Newborn & Child Health, and so much more—it’s really an incredible history of impact.” Continue reading “Advocating for better health of women, newborns, children, and youth: FCI Program of MSH”
Amy Boldosser-Boesch is the Senior Technical Director for the FCI Program of Management Sciences for Health (MSH). To receive updates in your inbox from the FCI Program and other MSH programs, please subscribe here.
A lot has happened since we first announced, a couple of months ago, the exciting news that a new chapter has begun for FCI’s mission to save women’s lives!
Now a part of Management Sciences for Health, the FCI Program of MSH has hit the ground running. Continue reading “A new chapter for FCI’s lifesaving mission!”
By Catherine Lalonde and Kathleen Schaffer
Catherine Lalonde is the senior program officer for the Francophone Africa program, and Kathleen Schaffer is the senior program officer for the Anglophone Africa program.
Evaluating advocacy is far from simple. Advocacy is not straightforward, as advocates often need to readjust strategies to influence decision-makers when government leaders and policies change. So it’s often difficult to attribute a policy success to a specific advocacy effort. We are grappling with these challenges firsthand as we evaluate our advocacy project Mobilizing Advocates from Civil Society (MACS).
Catherine Lalonde is the senior program officer for the Francophone Africa program.
Saving the lives of women and children around the world is a team effort. It takes the voices of community and religious leaders, health professionals, concerned citizens, young people, and impassioned activists to effect change. Prioritizing women’s and children’s health requires sustained advocacy.
Yet, determining whether certain advocacy efforts are actually achieving desired results—evaluating an advocacy program—is challenging. Through the evaluation of our Mobilizing Advocates from Civil Society (MACS) project, which brings together civil society organizations and equips them with skills to be effective advocates, we are reflecting on what it means to evaluate advocacy.
Kathleen Schaffer is senior program officer for Anglophone Africa at Family Care International.
A dilapidated clinic, falling tiles, a never-ending leak. Barren and disorganized medicine shelves. An overcrowded maternity ward with desperate, soon-to-be mothers crying out for help. One nurse scrambling to meet the needs of the many patients who have come through the doors. When clients lament the clinic’s disrepair, or doctors request more supplies and personnel, they’re met with the same hopeless reply: “There’s no money.”
Through Family Care International’s (FCI) Mobilizing Advocates from Civil Society (MACS) project in Kenya, international, national and grassroots organizations as part of the Reproductive, Maternal, Newborn, and Child Health (RMNCH) Alliance are demanding better facilities, adequate and respectful maternity care, and especially, more health personnel. Kenya has only 11.8 health workers per 10,000 people–more than 40% fewer health workers than the World Health Organization’s minimum recommendation of 22.8 health workers per 10,000 people.
Of course any effort to increase the quantity and quality of health workers will have to be paid for, and that means dealing with the budget. For many of us, budgets seem abstract and intimidating, but it’s vital to engage with them since they reflect the government’s priorities and determine where the public’s money goes.
In order to make realistic demands, we need access to information about Kenya’s budget. However, over the last few years Kenya decentralized many decision-making processes, including budgeting, to the county-level. This recent decentralization has made it difficult for us to intervene effectively during the budget process.
But now, civil society organizations in Kenya can engage with budget decision-makers at the right moments thanks to a new Annual Budget Cycle Calendar, developed by the MACS project.
This new easy-to-read calendar shows the key dates for the Kenyan Annual Budget Cycle at both the national and county levels, enabling citizens to participate in both the setting of priorities and in accountability processes.
It is a great resource not only for maternal health advocates but also for the broader health community and county government officials, such as those from the Health and Finance Committees. The RMNCH Alliance will distribute the calendar in counties all over the country, and we hope to see it on many office walls as a constant resource for advocacy opportunities.
Ultimately, by being able to participate in and monitor the budget process more effectively, we will ensure that the government fulfills its commitments to maternal, newborn, and child health, and that the budget reflects the needs and priorities of the community and not just politicians.
By Manuela Garza
Manuela Garza is an independent consultant and is co-founder of Colectivo Meta. She is currently engaged as a consultant to FCI’s Mobilizing Advocates from Civil Society (MACS) project, on which she works to build the budget analysis skills of health-focused civil society organizations in Burkina Faso.
For the past seven years, it was my good fortune to work at a job that allowed me to work with brave and committed activists in interesting and beautiful places. As a staff member of the International Budget Partnership, I found myself in Mombasa, Kenya, where ordinary citizens conducted ‘social audits’ to claim their communities’ fair share of government financial resources; in Abbottabad, Pakistan, where 500 women and men voiced their priorities for spending of earthquake rehabilitation funds; in Beijing, where civil society groups were trained to pursue budget transparency and accountability in a context where silence rules; and in Abbra, a remote region in the Philippines, where rural villagers have advocated for and achieved truly participatory budgeting.
In recent months, FCI’s MACS initiative has been working in Burkina Faso to strengthen the capacity of civil society groups to effectively advocate for more and smarter spending of public funds to improve reproductive, maternal, newborn, and child health in their communities. Last October, I was engaged, together with my Malian colleague Boubacar Bougodogo and Burkinabé budget researcher Hermann Doanio, to develop and facilitate a weeklong workshop to train grassroots advocates to understand and engage with public budgets. We arrived in Ouagadougou, Burkina’s capital, on a calm and warm West African evening, all of us ready with our slides on the budgeting process, our spreadsheets, our budget calculation formulas, and our case studies. Business as usual, or so we thought.
Little did we know that, in the course of that week, the citizens of Burkina Faso would overthrow the dictator who had been ruling the country for the past 27 years. Thousands of people (young people, mostly) took to the streets with a very clear message for President Blaise Campaoré: they wanted him out, for good. They were no longer willing to tolerate corruption and abuse of power, they declared: Burkina is ready for democracy.
In the midst of these historic events, you may be wondering, what did our Burkinabé colleagues, who had put this week aside for budget training, do? Was the workshop still relevant during these revolutionary days? Of course, every participant was closely watching the dramatic events taking place outside the training venue; each participant was concerned and worried about what they would mean for their families and their country. At the same time, however, they remained committed to take full advantage of this unique opportunity to learn about a new tool that will enable them to carry out evidence-based advocacy. They stuck around, they learned, and they questioned; they talked about their country, about change, and about what these new skills could help them achieve. They discussed the potential for how things could change, including in the way that the government sets priorities and spends public money— that is, the people’s money!
Is budget accountability still relevant in a context of earthshaking change? My experience says that it is. Revolutions are tricky things: countries and their institutions can change either for better or for worse, and conditions may take a long time to stabilize. If change is managed wisely and stability returns quickly, as seems to be happening in Burkina, revolution can provide an opportunity for a fundamental shift in the balance of power—toward the people. This can vastly increase the possibility of reshaping inefficient and corrupt institutions, of fostering new structures that institutionalize transparency and accountability. In a country like Burkina Faso, accountability for public resources is an essential element of overall accountability.
In this context, investing in building the skills of civil society groups is crucial, because the significance and sustainability of positive change largely depends on a well-organized and well-prepared civil society. These are the times when advocates and grassroots organizations most need support, when citizens most need to develop new knowledge and skills in civic participation, when accountability and participation-related processes are more necessary than ever. The MACS project is doing just that, and FCI’s local partners in Burkina Faso will continue to arm themselves with new tools such as budget analysis, so that their advocacy has more impact, their voices are heard, and they can be effective forces for real, sustainable change.
Good luck to them and to Burkina Faso–a country that many people cannot even locate on a map but which has a lot to teach us when it comes to citizen power!
By Melissa Wanda
Melissa Wanda is Advocacy Program Officer for FCI Kenya. This article originally appeared on the blog for the Frontline Workers Health Coalition.
In a village in rural Kenya, a woman in labor travels miles along rutted dirt roads to get to the nearest health center. She wants to give herself and her baby the greatest possible chance of surviving childbirth and returning home to begin new and healthy lives. When she arrives however, the gates are locked; the nurse has gone home.
Kenya, with only 11.8 health workers per 10,000 people (more than 40% below WHO’s recommendation of 22.8 per 10,000), is one of 57 countries — including 36 in Sub-Saharan Africa — with a critical shortage of health workers.
Many local health facilities have only one health worker, often a nurse, to provide all patient care. This puts a heavy strain on the health worker, and means that many intended 24-hour health facilities are often closed for extended periods of time. Kenya’s news media has also reported recent health worker strikes in reaction to late or non-payment of wages.
The Government of Kenya has committed to strengthening human resources for health in the public health system. Several civil society organizations (CSOs) working to improve reproductive, maternal, newborn, and child health (RMNCH) have come together to advocate for the fulfillment of this urgently important promise. This alliance, co-led by Family Care International (FCI) and the African Women’s Development and Communication Network (FEMNET) under FCI’s Mobilizing Advocates from Civil Society (MACS) project, is conducting advocacy at the county level in Kenya, since counties are responsible for making many health spending decisions in Kenya’s recently decentralized administrative structure and health system.
With support from the MACS project, Deutsche Stiftung Weltbevoelkerung (DSW), a member of the advocacy alliance in Kenya, has surveyed community perceptions of the need for more health workers, and explored how effectively county governments have invested in addressing those needs. Working in two urban and two rural counties, DSW conducted research at various levels of the health system, including outpatient dispensaries, health centers, and hospitals. DSW found that counties are not budgeting or investing spending adequately enough to ensure that facilities have enough health workers to provide high-quality services. Although special funding has been set aside nationally to hire new health workers, counties have mainly been spending this money to pay current staff. DSW is sharing these findings with MACS and county health authorities, leading to one county already committing to hire an additional 72 nurses.
DSW also brought together community members and health facility staff to discuss the state of care at local health facilities. Community members complained that lack of staff meant an absence of essential services, especially at night and on weekends. Health workers expressed the frustrations of working alone, often lacking the drugs and supplies they need to treat their patients, and the low morale that comes from working under those conditions. For example, one nurse described a recent evening when she was the lone nurse caring for six women in labor!
These community meetings opened new channels of communication, fostering greater understanding and accountability between health workers and the communities they serve. This enabled health system users and health workers to join together in search of practical solutions.
Peter Ngure, DSW’s project lead, shared with me a story about one community in which participants said they prefer to come to the hospital — a long distance from their homes —in the afternoon, so they have time in the morning to travel there. In response, the hospital rearranged staff work schedules, deploying more nurses in the afternoon than morning hours. Similarly, community members learned that the hospital holds Monday afternoon staff meetings, helping to explain why appointments are often unavailable at that time, which had been a repeated source of frustration and confusion.
“This dialogue between community members and health workers helped to build much-needed goodwill during these very challenging times,” said Mr. Ngure.
FCI, DSW and the members of the civil society advocacy alliance will use these findings and experiences to hold county governments accountable for addressing the health worker shortage. When the Kenyan Ministry of Health releases its upcoming human resources for health strategy, which will provide specific guidance on exactly how many health workers should be assigned to each health facility, alliance members will work to make sure that counties follow that national policy, so that every Kenyan mother, seeking care for herself and her baby, will be greeted by open gates and a health worker with the skills and resources to ensure their survival and good health.
Shafia Rashid is a senior program officer for Global Advocacy at Family Care International.
Civil society organizations (CSOs) around the world are working to improve maternal health and make a difference in the lives of women, families, and communities. In many countries, CSOs play a critical role in the health sector by providing quality maternal health services, and by supporting advocacy to ensure government policies are implemented, funds invested and tracked, and health outcomes measured and published.
In 2013, with support from Merck Inc. through the Merck for Mothers Program, Family Care International (FCI) completed a comprehensive mapping of the maternal health advocacy environment in two countries, Uganda and Zambia. Data for the mappings were collected at the national level (and at the district level in Uganda) using a multi-dimensional methodology which triangulated data from key informant interviews, focus group discussions, and desk research.
The mapping examined each country’s maternal health policy framework, identified stakeholders working in maternal health advocacy, and analyzed opportunities and challenges for maternal health advocacy organizations. It also highlighted the potential for engaging the private sector on maternal health, and put forward a set of recommendations for strengthening maternal health advocacy efforts, and the role of CSOs in particular.
In Uganda, the mapping found that while there is a relatively active health advocacy sector and strong policy framework in place for maternal health, advocacy organizations are not coordinating efforts well, leading to a fragmented advocacy environment. In addition, maternal health advocacy organizations face critical resource constraints, and are not effectively measuring the impact of their advocacy work. For additional information, the full mapping report can be accessed here.
In Zambia, there exists a favorable policy environment for maternal health, and a strong evidence-based decision-making ethos in government. While Zambia is a signatory to a number of commitments to improve maternal health services, the maternal health advocacy environment is not particularly strong or robust. More information is available in the full mapping report here.
The findings from these mappings revealed a number of common themes and recommendations for supporting the critical role of CSOs in both countries:
- Establish or enhance a coordinating mechanism through which the growing and diverse body of advocacy organizations can work together and advance common messages, agendas, and strategies.
- Support local advocacy organizations, which often operate with limited resources, staffing, and capacity, to build their administrative, management, and planning capabilities in conducting effective advocacy.
- Strengthen monitoring and evaluation of maternal advocacy efforts by supporting maternal health advocacy organizations in the development of tools, indicators, and mechanisms for measuring advocacy outcomes and impact.
Sustained and long-term investments in supporting CSOs to conduct effective advocacy for maternal health are needed now, more than ever. Without these investments, we will continue to be far behind in reaching national and global commitments for maternal health.