Mapping maternal health advocacy in Uganda and Zambia

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.

A Zambian mother with her child © 2009 Arturo Sanabria, Courtesy of Photoshare
A Zambian mother with her child © 2009 Arturo Sanabria, Courtesy of Photoshare

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.

A health worker in Uganda counsels a client. © 1996 Center for Communication Programs, Courtesy of Photoshare
A health worker in Uganda counsels a client.
© 1996 Center for Communication Programs, Courtesy of Photoshare

 

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Budgeting for better maternal and child health

Catherine Lalonde is FCI’s senior program officer for Francophone Africa.

I just returned from a week in Senegal where I attended a regional workshop to train civil society, parliamentarians and the media on budget analysis and advocacy for maternal and child health.

For years now, countries across the globe have said that maternal health is one of their top priorities; they’ve made statements, built coalitions, and developed strategies. On the surface, it seems as though a lot is happening in the realm of reproductive, maternal, newborn and child health (RMNCH). Despite all the rhetoric, little progress has been made in improving the health of mothers and children, especially in the poorest countries in the world.

Since I started working at FCI a year ago, I have mainly been involved in advocacy projects aimed at keeping governments accountable to their commitments. In Burkina Faso, Mali and Kenya, we and our partners are constantly asking governments to invest in and implement programs that will improve RMNCH in their countries.  Whenever we question why contraceptives aren’t available in the villages or why health centers are not staffed with qualified personnel, we almost always gets the same answers: there’s no money, we don’t have the funding, and we can’t afford it.

A budget is the single best indicator of a country’s priorities and the best way to tell whether a country is putting its money where its mouth is and whether or not it has taken steps towards fulfilling its maternal and child health commitments.

Fatimata Kané
Fatimata Kané, FCI-Mali national director, explains the importance of budget advocacy in improving RMNCH outcomes.

Organized by Harmonization for Health in Africa, UNICEF, WHO, the Partnership for Maternal, Newborn & Child Health (PMNCH), Save the Children, the InterParliamentary Union and FCI, the three-day budget advocacy workshop brought together members of local NGOs and reporters, along with parliamentarians and representatives from the ministries of finance and of health from the Democratic Republic of the Congo, Niger, Mali, Burkina Faso and Senegal.

A budget is public property; it represents the money that belongs to each and every citizen of a country and therefore, the public should have a genuine say in how the money is distributed and spent. But the countries represented in the workshop had budgets that rank among the least transparent in the world, according to the International Budget Partnership’s Open Budget Survey, which reveals what information is made public and when, as well as who gets to contribute to the process and how often. Of the workshop’s participating countries, Burkina Faso’s budget had the best transparency score– a measly 23 out of a 100; Niger, with the least transparent budget, scored a depressing 4 out of 100, with zero meaningful opportunities for civil society to contribute to the country’s budgeting process.

The workshop facilitators emphasized the important role the budget plays in RMNCH and the financial costs of not investing in RMNCH. It also taught how good health policies are developed and costed, and provided options for increasing fiscal space – the money to fund these policies – within the existing budget. This workshop provided participants with an outline of the budgeting process, and all of the opportunities in which civil society should be able to contribute. At the end, each of the delegations developed advocacy objectives and strategies to improve civil society’s contribution to the budgeting process in order to prioritize health. For example, the Burkina Faso delegation chose to advocate for increased investment in information systems to better track health data while the Malian delegation chose to focus advocacy on ensuring that Mali meets the Abuja declaration pledge to dedicate 15% of its budget to health.

A good friend of mine who works in finance once told me that talking about money scares people, that people often feel as though they don’t have enough knowledge to contribute and are too embarrassed to say so. The organizers and I were afraid that the workshop would be too long, too technical and hard to follow, but we couldn’t have been more wrong. The participants lapped up every word on every slide, and were thrilled to be equipped with the knowledge of the role they can play in ensuring that their country’s budget prioritizes maternal and child health.

The presentation on increasing fiscal space even got a standing ovation!