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Madagascar

Repositioning Family Planning in Africa

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Activity Dates

2005-2007

Activity Summary

HCP actively participated in the program and advocacy working groups formed to support the repositioning agenda. That involvement inspired HCP to not only participate at the working group level in Washington, but to attempt to help implement the working group’s strategies at the country level in countries where HCP and its partners have a presence in Africa.

HCP conceptualized this initiative as a two-year program to revitalize support for family planning. In the first year, HCP:

1. Consulted with USAID/Washington, Country Missions, and in-country repositioning working groups to select a country for intervention
2. Identified collaborating organizations in that country working on the repositioning agenda to ensure that HCP works in common purpose
3. Together with those collaborators, developed an advocacy and communication strategy to reposition family planning and create an enabling environment in that country
4. Addressed the challenge that managers of health systems and service providers are not all family planning advocates by adopting a peer approach, through pairing health system managers and service providers that are family planning "champions" with others and supporting dialogue and consultation between them
5. Adopted a "local leaders" approach in which men, in particular, traditional leaders, religious leaders, and local politicians are made true partners in family planning promotion
6. Worked through local partners to initiate the implementation of the strategy
7. Established an evaluation framework and tools for assessing success.

HCP staff launched repositioning activities in two of USAID's priority countries for FP repositioning: Madagascar and Mali. In Madagascar, that support took the form of a framework for repositioning FP promotion at the national level; in Mali it became an initiative at the District level to inspire providers in low-prevalence communities to become FP supporters. HCP made significant progress launching its repositioning initiative, consulting with USAID/Washington, country missions and in-country repositioning working groups to select countries for intervention. HCP then collaborated with those working groups in those two countries to craft repositioning strategies.

The Mali strategy focused on providers and the community--helping lukewarm service providers become leading FP advocates in the community, especially in women's community groups. The providers are lukewarm about working close to their clients--community groups--for lack of "know how" and logistical support. With a little help they can turn things around and get full participation of their clients in the health facility's work. The program was active in Kadiolo and Bandiaga Districts in Year 4. This approach repositioned FP in Mali in two ways: (1) positioning the articulation of FP needs in the hands of those with unmet need, rather than with policymakers at the national level and (2) positioning the locus of programmatic control in civil society (local women's groups) rather than the health system.

In Madagascar, HCP has also spent substantial time working on strategy with the national working group. We have helped national stakeholders to articulate a repositioning strategy that focuses on the "leading edge" of unmet need--targeting those families that are already favorable to FP but simply need a bit of encouragement to "walk-the-walk." Counterparts were quite motivated by this approach, and the Ministry of Health began designing a centerpiece component of what will become a broad-based campaign--a FP invitation card. The idea behind the card is that those who have unmet demand for FP and perceive social support for its use only need an invitation from a trusted friend to be inspired to take the step of going to the clinic.

Back to Madagascar

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