3. CONSIDERATIONS

Section 2 focused on country context and other aspects of assessing the family planning situation. The checklist pointed towards interventions for consideration. Implementing these selected programmatic options may require additional technical skills, financing, partnerships and even risk mitigation measures. 

In Section 3, UNFPA staff are guided to consider factors that can facilitate or hinder the implementation of the programmatic options.  Expertise, technical guidance and tools are available to support this work. Staff in UNFPA Country Offices are encouraged to consider what UNFPA is doing globally, regionally and in partnership with other organizations to create an enabling environment for successful family planning programming. Understanding country office strengths and limitations is a first step. Once resource gaps are clear, look at how to strengthen capacities and skills, improve sustainable financing, build partnerships to support implementation and work collectively to mitigate risks.

3.1 Strengthening capacity and skills

UNFPA leadership on family planning requires that staff have the knowledge, understanding and experience to lead global, regional and country strategic dialogue and interventions to deliver on the organization’s ambitious vision of zero unmet for family planning. The importance of strengthening staff capacity was most recently highlighted in the UNFPA Human Resources Strategy (2014-2017), which sets forth a vision for human resource management reform centred around three overarching principles: agility, high performance and shared responsibility. The ambition is “to transform the way UNFPA responds to changing needs, particularly at the country level – with a focus on reshaping organizational skills mix, culture, design and collective performance.” 

The human resources strategy reflects the new business model where country context drives the modes of engagement. UNFPA should not be trying to do everything everywhere. Rather, modes of engagement are based on comparative advantages, strengths and opportunities:

• UNFPA leads strategically where the country office has the capacity

• UNFPA partners to benefit from others' expertise (particularly when it exists locally or in the region) 

• UNFPA encourages others to lead in domains outside of UNFPA’s core areas of expertise. For example, the human resource strategy highlights the increasing role that partnerships play in how UNFPA delivers its programmes, including in particular other United Nations agencies and development partners. 

To deliver on the family planning strategy, UNFPA must respond to dynamic country realities. Needs may change, funding realities may impinge and partnerships may evolve. In response, UNFPA can make the most of new ways of engaging, leveraging and partnering to catalyse additional resources that may currently appear out of reach. This process may require making hard decisions when choosing between legacy programming approaches versus new evidence-based intervention strategies, some of which require skills beyond what is currently available in the office. Skills around influencing, communications and resource mobilization will be increasingly important. Start by designing programmes that are appropriate for the office structure, budget and mix of skills.

To accelerate progress on family planning, the office must be “fit for purpose”. UNFPA is taking steps to build capacity across the organization with a focus on: a) family planning policy dialogue, strategy and advocacy, b) sustainable financing and c) ensuring contraceptive method mix and choice. Capacity development tools are available to enhance staff skills in key areas including planning, programming, measurement and financing.

UNFPA has made great strides in creating capacity building tools that optimize processes to strengthen programming for results-based management, yet more work needs to be done. UNFPA has initiated processes of internal optimization and strengthening/innovating management capabilities. UNFPA is building staff capacity in field offices on South-South and triangular cooperation.

UNFPA Country and Regional Offices are encouraged to assess internal strengths and gaps in the capacities required to be more agile, innovative and skilled as we deliver on this acceleration plan for family planning.

Considerations for capacity strengthening:

• Map the functional areas required to accelerate implementation of the UNFPA mandate in family planning and assess areas for improvement. 

• Introduce courses under the priority action areas to strengthen organization-wide family planning programming. Consider mandatory e-learning courses in family planning for all staff, brown-bag events on thematic issues and webinars with technical panels. Course topics might include public financing management, supply chain management, strategies for community empowerment and engagement, and planning to ensure contraceptive method mix and choice.

• Perform a diagnostic/capacity assessment to fully understand current skills and capacities in family planning within UNFPA. 

• Analyse findings from any recent UNFPA capacity assessments in financing capacity, supply chain management, community engagement and leaving no one behind. 

• Explore resources from partners that can help build staff capacity for family planning programming. Examples include the Human Resources for Health Optimization Tool for Family Planning (HOT4FP): A Tool for Optimizing Human Resources to Reach Family Planning Goals by the United States Agency for International Development (USAID) and Using Reality Check and PipeLine for Contraceptive Forecasting and Supply Planning by EngenderHealth and USAID.

• Develop organization-wide capacity strengthening courses under priority areas, where tools and training are not available within UNFPA or among partner organizations. Course topics might include public financing management, supply chain management, strategies for community empowerment and engagement, and planning to ensure contraceptive method mix and choice. 

• Develop and/or improve UNFPA internal expertise and accountability in cross-cutting areas such as the human rights-based approach to programming, gender transformative approaches, data analysis and regular use of monitoring and evaluation (M&E) indicators, and the documentation and sharing of good practices through South-South and triangular cooperation.

• Strengthen advocacy and leadership skills among UNFPA managerial and selected technical staff to facilitate targeted engagement in policy dialogue and reform. Maximize the use of existing partner resources such as the Family Planning Advocacy Resource Hub from the Population Reference Bureau.

• Consider using the UNFPA roster of external consultants for technical and specialized expertise, where capacity does not exist.

3.2 Sustainable financing for family planning

Shifting from funding to financing will accelerate progress in family planning. It is essential to increase sustainability through nationally-driven financing mechanisms as the responsibility for realizing reproductive rights remains at the country level. Only States ensure rights. Advancing towards zero unmet need for family planning requires the increasing and continued involvement of governments in promoting access to family planning services, including modern contraceptives. The role of international cooperation is to collaborate, facilitate and accelerate. 

The UNFPA Strategy for Family Planning proposes fundamental changes in the way the organization envisions financial sustainability over the next decade. UNFPA will focus its efforts on gradually galvanizing political and financial commitment from governments towards family programmes and commodities. UNFPA has committed to allocating at least 40 per cent of its programme resources towards ending the unmet need for family planning annually from 2022–2025. These resources support governments and partners to do more to sustain family planning locally. 

The financial transition to domestic resources for family planning is key. UNFPA supports action that can gradually bring about more sustained and predictable funding for family planning programmes: (i) Expanding the pool of available funding sources, through a combination of domestic resources allocation and external funding; (ii) Maximizing the efficiency in the use and allocation of existing resources, through better procurement and market shaping initiatives as well as financial protection and improved accountability mechanisms; and (iii) repositioning family planning as a development best buy, increasing government's commitment to invest in family planning as a multisectoral investment.   

Considerations for sustainable financing for family planning: 

• Survey the national response to efforts to promote access to family planning and modern contraceptives. Monitor the financial sources and fiscal space and measure the performance of allocated investments in contraceptives. An assessment of public investments in contraceptives and family planning could be a key piece for promoting an evidence-based policy dialogue, to strengthen national capacities to get value from the domestic money invested.

• Improve procurement. Frequently, countries that assume commitments for expanding coverage in family planning face challenges in procuring supplies in an efficient time and manner. On the one hand, national laws for procurement tend to incorporate restrictions on using international procurement mechanisms. On the other hand, the registration of products is usually another bottleneck that limits the offer of supplies at competitive prices. UNFPA and partners must assume flexible and assertive technical assistance to countries looking to improve their procurement processes.

• Explore and promote innovative financing mechanisms and tools. UNFPA, along with international partners will continue to undertake critical analysis of the financing landscape at the global level. They will explore innovative financing opportunities that will not only assist in expanding the funding sources but also support the integration of flexible financing instruments to ensure financial protection to the most underserved.

• Make the case for expanding domestic investments in family planning. Using the Family Planning CIP Costing Tool and the Costing Toolkit for the Transformative Results for preparing ex-ante evaluations of how by increasing domestic allocations, the country could reach outcomes in reproductive health. Demonstrate the synergistic impact of investing in this area. Consider partner tools that may be helpful such as the Family Planning Investment Impact Calculator from the Guttmacher Institute.

• Promote an evidence-based policy dialogue aimed at mobilizing government commitments. Effectively advocate for evidence-based policy dialogue and reform that can increase government commitments towards domestic resource allocations and expenditures for family planning.

• Strengthen alignment and harmonization among different donors and key stakeholders. Sustainable domestic resource mobilization is more likely when the key donors are on-board. In many countries, misalignment among donors has made it difficult to hold governments to account on domestic financing commitments, and the donation of commodities has disincentivized governments from committing public funds.

• Develop multiyear financial sustainability plans.  UNFPA  will work together with the Ministry of Health, the MInistry of Finance, donors and development partners in identifying fiscal space current and future opportunities to increase budget allocations for procurement of contraceptives and provision of family planning services. 

• Build capacity in financing. UNFPA will expand its own financial literacy and capacity across the organization. This will be done by focusing efforts on strengthening effective advocacy skills and public financial management capacities. The aim is to expand political influence and engage in policy dialogue for increased resource mobilization both domestically and externally. 

3.3 Partnerships

The UNFPA Strategy for Family Planning recognizes the importance of partnerships to achieve the goal of zero unmet need. The family planning community at the global, regional and country levels can have greater success in accelerating family planning progress by working through multi-stakeholder partnerships and innovative collaborations. Strategic engagement with a broader network of public and private stakeholders at all levels is critical to progress. Strategic engagement contributes to transformative social movements and builds on the voluntary national commitments made in the context of the 25th anniversary of the International Conference for Population and Development (ICPD25) and commitment made through Family Planning 2030 (FP2030). Partnerships are at the centre of the 2030 Agenda for Sustainable Development.

UNFPA provides leadership and plays a central role within global partnerships for family planning. Several examples among many are noted here:

• As a core partner in Family Planning 2030 (FP2030), UNFPA works with the global community to support voluntary modern contraceptive use by everyone who wants it, achieved through individuals’ informed choice and agency, responsive and sustainable systems providing a range of contraceptives, and a supportive policy environment.

• The Reproductive Health Supplies Coalition (RHSC) works closely with the Commodities Security Branch to reduce supply stock-outs, assist governments in achieving their reproductive health goals and improve the market for contraceptive supplies. RHSC is a global partnership of over 500 public, private and non-governmental organizations dedicated to ensuring that all people in low- and middle-income countries can access and use affordable, high-quality supplies to ensure their better reproductive health.

• Avenir Health partnered with the UNFPA Supplies Partnership programme to construct an innovative resource known as the “FP Opportunities” tool. The tool generates reports with the latest data in order to help countries to identify areas for impactful investment.  This tool is useful for evidence-based advocacy.

Such partnership structures, mechanisms, networks and alliances offer an important opportunity. UNFPA and local and regional stakeholders to benefit from the expertise, tools and materials globally available, and learn from and share experience and promising practice as we collectively work towards global goals.

Other important partners for UNFPA to advance family planning in low and middle income countries:

The Ouagadougou Partnership is a joint regional effort between the governments of eight francophone West African countries, and other international development organizations including UNFPA. The Ouagadougou Partnership promotes the integration of voluntary family planning and reproductive health programmes into national development plans in West Africa, a region with high rates of fertility and unmet need for contraception.

USAID and UNFPA collaborate on several programmatic and technical initiatives related to family planning and reproductive health. The collaboration is focused in six thematic areas at the global and country levels: gender, population and development data, youth, total market approach, commodity security and high-impact practices. UNFPA and USAID support national governments in their efforts to step up ownership and sustained financing for their family planning programmes.

UNFPA is a member of the World Health Organization’s Implementing Best Practices Network (IBP network)  that convenes partners to share best practices, experiences and tools to support family planning and reproductive health programming. IBP has over 100 member organizations representing international non-governmental organizations (NGOs), local civil society organizations (CSOs), academia and others to support knowledge exchange, documentation and implementation research efforts to improve reproductive health outcomes around the world.

UNFPA also collaborates with the International Youth Alliance for Family Planning (IYAFP), a global organization that exists for youth, entirely led by youth to advance the family planning agenda. IYAFP leverages youth energy, creativity and expertise to improve advocacy, and set a fully youth-led agenda for building a youth movement around the fundamental human right of all youth to access their sexual and reproductive health, rights and justice.

Partnership for accountability

UNFPA has a critical role to play in facilitating national, regional and global accountability to deliver family planning in countries. UNFPA and international partners support government actors to deliver on global, regional and national family planning commitments. Government accountability for delivering on family planning promises requires monitoring delivery of services and availability of commodities (among other actions) through robust health service data collection, and transparent reporting to national stakeholders including beneficiaries the status of their efforts. Given the numerous commitments and obligations the government has made, delivering on all such promises can become mutually exclusive. UNFPA can leverage partnerships globally and regionally, and catalyze national stakeholders and beneficiaries to support and stimulate government accountability. 

Programmatic options in the acceleration plan build on evidence-based proven practices to support social accountability actions by stakeholders for holding governments to account for their family planning commitments. This includes the Family Planning High-Impact Practices (HIPs). One HIP finds that by engaging communities and health sector actors in a collaborative process to jointly identify problems, and to implement and monitor solutions, partners can facilitate holding each other accountable for improvements in the quality and responsiveness of family planning services. UNFPA has the opportunity to leverage its partnership to increase accountability at all levels to accelerate family planning.

Partnership to accelerate progress on family planning in countries

The Acceleration Plan encourages UNFPA staff to look for opportunities to strengthen programming by strengthening existing partnerships, and building new ones in countries and sub regions, including programmes delivered through the UNFPA Supplies Partnership. Actions, however, will require more support and expertise than one organization can deliver. UNFPA must continue to coordinate and lead collective action to accelerate progress on family planning. UNFPA should identify actions it will lead on, seek to leverage partnerships where the action requires broader expertise or investment, and also broker support and encourage others to implement in areas outside of the UNFPA mandate. Programme countries will benefit from UNFPA efforts to foster South-South learning, build partnerships and organizational competencies in family planning and related areas, including sustainable financing and data, through the development of tools, training resources, and capacity-building opportunities.

UNFPA Country Offices that have made significant progress often credit their partnerships and the catalytic role UNFPA played in joint efforts. To support the implementation of the Acceleration Plan, consider both existing partnerships as well as opportunities for new collaborations to achieve the country’s family planning goals.

Considerations for building, expanding or reinforcing partnerships:

• Develop and expand new collaborations with traditional and non-traditional partners, including a broader network of public and private stakeholders and the general public. Create momentum for family planning, harness high-value partnerships and build robust ecosystems of private strategic partners. Engage with actors outside of our traditional orbits and connect with corporate, philanthropic, innovation and scientific actors within larger ecosystems of partnerships. 

• Work at multiple levels – global, regional, national and subnational – with governments, civil society, academia, donors, the private sector and others to expand existing partnerships, and create new one in under-resourced regions. 

• Use the trusted position UNFPA enjoys in countries to partner with academia and professional organizations among others on evidence generation and validation for proven and promising practices, particularly from country-level implementation and support countries to undertake bottleneck and opportunity analysis. 

• Develop reports and briefs that showcase successful partnerships and hold partners accountable for their commitments to family planning. Analyse data and share findings generated by the partnership through evidence-based advocacy materials. 

• At the country level, invest in partnerships with academic institutions and professional associations to strengthen capacity building of health workers on family planning and family planning formative/exploratory research and data analysis. 

• Work closely with civil society, youth and women-led and feminist organizations and networks in partnerships for advocacy, and social accountability. 

• Engage with traditional community leaders and religious and faith-based actors to reach communities and accelerate changes in attitudes and practices. 

• At regional level, seeks partnerships with civil society networks, women's health and rights networks, and the private sector. Utilize South-South and triangular cooperation to encourage learning from similar contexts promising practices. 

• Encourage countries to make national commitments to advance family planning by joining the global family planning movement, FP2030. 

3.4 Risk and risk management

The UNFPA Strategic Plan, 2022–2025 identifies two types of risks: (a) programmatic risks; and (b) operational environment risks. For the purposes of this Acceleration Plan, risks identified in the strategic plan have been adapted for the family planning programming context. 

• Programmatic risks are those associated with programme implementation and usually involve institutional and partnership challenges that can limit the effectiveness of even well-designed programme interventions. 

• Operational environment risks are those associated with the contexts that occur due to social, economic, environmental, political or other factors affecting the setting where UNFPA operates in countries or regions.  

To mitigate risks, UNFPA Country Offices work to understand and identify the risks associated with the national and subnational contexts, to know how these risks are affecting family planning programming. This should be done in Section 1, in the assessment phase, when you are reflecting on your specific contextual needs and challenges. Once gaps are identified, consider priority actions and programmatic options to fill them, as described in Section 2. However, it must be noted that some of the interventions come with risks that need to be mitigated before the selected approach can be implemented successfully. Addressing risks may require UNFPA Country Offices also develop and participate in joint initiatives with United Nations organizations and other entities that work in these areas.

The achievement of outputs is influenced by several other determinants outside of the outputs proposed in the UNFPA Acceleration Plan for Ending the Unmet Need for Family Planning, 2022–2025. These other determinants may be situated outside of UNFPA capacity or may not lie within the priority areas of the plan. Not achieving these output-level determinants is going to be a risk factor for attaining the outcomes of the strategic plan. In many instances, these external determinants are supported by other United Nations organizations or key global partners.

Common risks and mitigation strategies are known. Others will be encountered, and then solutions need to be found. Many of the programmatic options, derived from evidence-based practices including the HIPs, acknowledge and address risks in their implementation strategy. UNFPA Country Offices will need to include a risk analysis within the assessment phase of planning, and then seek solutions through the programmatic options to overcome them. Risk and solutions will be context specific – but learning from evidence-based practice, as well as from partner experiences can help. Resources such as the IBP network and other sharing platforms are also useful for this purpose. Within UNFPA, there are specific assessment tools and risk and mitigation overviews that may be helpful. 

Table: Programmatic risk and operational risk: Examples and suggestions

PROGRAMMATIC RISK

Programme risk: Expand partnerships to advocate and support an enabling legal and policy environment for FP, particularly for adolescent girls and young women; Promote a multisectoral approaches towards achievement of the three transformative results; Ensure that national supply plan is in place and functioning

Mitigation strategy: Continue training and skills-building for providers, while putting in place accountability mechanisms to ensure quality services are being delivered to all women, including adolescent girls and young women; Work with the Ministry of Health and professional associations to innovate around task shifting to involve community health workers, NGOs and the private sector to increase access to FP

Programme risk: Siloed FP and youth programming have not scaled up interventions that create economic empowerment of women and young people 

Mitigation strategy: Expand integrated programming that includes economic opportunity within SRH programming for young people to engage and link life opportunities, health (including planning one’s childbearing)  and well-being in life projects of young people 

OPERATIONAL RISK

Operational risk: Malfunctioning Supply Chain for Family Planning Commodities 

Mitigation strategy: Functioning Last Mile Assurance system in place; Support capacity of national counterparts to manage FP commodities throughout the supply chain

Operational risk: Social, cultural or political norms that support the desire for large families, stigmatize use of FP, and fuel opposition at community and family level against family planning 

Mitigation strategy: Scale up its advocacy and communications initiatives; Expand alliances with community and religious leaders in countries and across regions to counter opposition and false narratives

Operational risk: Equation of family planning with false narratives including myths (associated with contraceptive products, side effects, and social consequences of use) and population control limiting advocacy for choice and self-determination (especially in low fertility contexts).

Mitigation strategy: Scale up its advocacy and communications initiatives; Expand alliances with community and religious leaders in countries and across regions to counter opposition and false narratives