THE SPARHCS THE SPARHCS PROCESS GUIDEPROCESS GUIDE

A Planning Resource to Improve A Planning Resource to Improve Reproductive Health Commodity SecurityReproductive Health Commodity Security

Acknowledgements Acknowledgements

United States Agency for International United States Agency for International Development (USAID)Development (USAID)

United Nations Population Fund (UNFPA)United Nations Population Fund (UNFPA)

USAID | DELIVER ProjectUSAID | DELIVER Project

USAID | Health Policy Initiative USAID | Health Policy Initiative

(ACQUIRE) Project (ACQUIRE) Project

Engender HealthEngender Health

PurposePurpose

Provide guidance on the uses of the Provide guidance on the uses of the SPARHCS Diagnostic Tool SPARHCS Diagnostic Tool

Demonstrate and encourage the Demonstrate and encourage the implementation of the SPARHCS implementation of the SPARHCS ApproachApproach A set of activities from awareness raising and A set of activities from awareness raising and

diagnosis, to monitoring the effectiveness of a diagnosis, to monitoring the effectiveness of a funded and implemented strategic planfunded and implemented strategic plan

BackgroundBackground

Over 40 SPARHCS assessments in Africa, Over 40 SPARHCS assessments in Africa, Asia/Pacific, LAC, & Eurasia regionsAsia/Pacific, LAC, & Eurasia regionsLimited documentation examining diagnostic Limited documentation examining diagnostic methods, or guidance to adapt approach for methods, or guidance to adapt approach for objectives, resources, and constraints of objectives, resources, and constraints of countrycountryFocus on joint diagnosis and strategic Focus on joint diagnosis and strategic planningplanningAudience: TA providers, donors, MOH Audience: TA providers, donors, MOH officialsofficials

Supporting the Program CycleSupporting the Program Cycle

I.I. Getting Started: Pre-Process ChecklistGetting Started: Pre-Process Checklist

Consideration Description

Rationale (or impetus) for SPARHCS

Example rationales are: high unmet need, low CPR; design for new donor assistance, donor scale-back; perceived problems in service delivery or logistics

Product focus Determine category of products for which stakeholders are seeking to strengthen RHCS

Short and long term expectations and results

Achieve consensus on what is expected in the next two and then ten years

Available resources Estimate potential funding levels and human resources for the process

Examples of Key DecisionsExamples of Key Decisions

THE COMMODITIES

The implications of securing the full range of essential RH medicines are substantially different than a focus on contraceptive commodities, and should be carefully considered by stakeholders with regard to available resources and political commitment.

TAKING ACTION

Provide support for advocacy workshops to sensitize decision-makers of the importance of RHCS at national and local levels. Encourage agreement by all that the assessment findings will be used as the basis for concrete RHCS action plans.

II.II. Awareness Raising – Point of Awareness Raising – Point of Entry for the ProcessEntry for the Process

Helps obtain the needed political support for the Helps obtain the needed political support for the processprocess

Involves regular communication with target Involves regular communication with target audienceaudience

Local data will make presentations more Local data will make presentations more relevant and usefulrelevant and useful

Emphasize SPARHCS approach should be part Emphasize SPARHCS approach should be part of, not displace existing systemsof, not displace existing systems

Tools: Workshops, the SPARHCS Framework, Tools: Workshops, the SPARHCS Framework, examples, country data analysisexamples, country data analysis

III.III. The Joint DiagnosisThe Joint Diagnosis

Understand and document the RHCS Understand and document the RHCS status nationally, locally, or within a regionstatus nationally, locally, or within a region Identify specific gaps/challengesIdentify specific gaps/challenges Provide basis for strategic planningProvide basis for strategic planning

The Diagnostic Tool is flexible, intended to The Diagnostic Tool is flexible, intended to be customized. be customized. Example: If RHCS gaps are known to be more Example: If RHCS gaps are known to be more

prevalent in the supply chain, then adapt the prevalent in the supply chain, then adapt the diagnostic to focus specifically on logisticsdiagnostic to focus specifically on logistics

The major steps of a Joint DiagnosisThe major steps of a Joint Diagnosis

The Pre-Process Checklist?The Pre-Process Checklist?

1.1. Form an RHCS CommitteeForm an RHCS Committee

2.2. Desk-based research/data collectionDesk-based research/data collection

3.3. Stakeholder consensus on methodologyStakeholder consensus on methodology

4.4. In-country interviews, workshopsIn-country interviews, workshops

5.5. Presentation and consensus on findingsPresentation and consensus on findings

6.6. Agreement on Agreement on strategic planning!

RHCS Committee RHCS Committee

WhatWhat

AA multi-sectoral group of multi-sectoral group of technical and policy-level technical and policy-level stakeholders supporting stakeholders supporting the assessment and the assessment and strategic planning. strategic planning. If an RHCS Committee If an RHCS Committee does not exist, one does not exist, one should be formed before should be formed before the diagnosisthe diagnosis

WhyWhy

Identifies a group that is Identifies a group that is an essential resource, an essential resource, facilitator, and advocate facilitator, and advocate for assessment and for assessment and strategic planning.strategic planning.Builds ownership among Builds ownership among stakeholders of the stakeholders of the assessment, its results, assessment, its results, and of the subsequent and of the subsequent strategic planning. strategic planning.

Desk-based Research/Data CollectionDesk-based Research/Data Collection

WhatWhat

The assessment team should The assessment team should collect and analyze existing collect and analyze existing RHCS data. Existing data may RHCS data. Existing data may include DHS and RHS include DHS and RHS surveys, economic and health-surveys, economic and health-related statistics available from related statistics available from the World Bank, WHO, and the World Bank, WHO, and other international other international organizations, and in-country organizations, and in-country sources.sources.A request should be made to A request should be made to in-country stakeholders for in-country stakeholders for technical reports, policy papers technical reports, policy papers and related assessments. and related assessments.

WhyWhy

Data collected from desk-Data collected from desk-based research allows the based research allows the diagnostic process to begin diagnostic process to begin early, early, Take advantage of existing Take advantage of existing data to help lower assessment data to help lower assessment costs, and costs, and Identify early issues and areas Identify early issues and areas where further investigation will where further investigation will be necessary. be necessary.

Stakeholder Consensus on MethodologyStakeholder Consensus on Methodology

WhatWhat

Present the objectives, Present the objectives, expected outputs and expected outputs and proposed methods to key proposed methods to key stakeholders, and obtain stakeholders, and obtain their feedback. their feedback. Discussion on key RHCS Discussion on key RHCS issues should take place issues should take place and assessement and assessement methods should be methods should be adapted accordinglyadapted accordingly

WhyWhy

Allows stakeholders the Allows stakeholders the opportunity to ask opportunity to ask questions and provide questions and provide guidance. guidance.

Raises awareness and Raises awareness and strengthens buy in and strengthens buy in and local ownership of the local ownership of the process process

Adapting the FrameworkAdapting the Framework

Customizing the approach promotes country ownership Customizing the approach promotes country ownership by better aligning the process with local priorities and by better aligning the process with local priorities and needsneeds Stakeholders often elected to identify RHCS components Stakeholders often elected to identify RHCS components using different criteria or to merge two or more using different criteria or to merge two or more components. components. Examples:Examples:

MadagascarMadagascar - demography, policy, demand, service delivery, and - demography, policy, demand, service delivery, and finance finance

EgyptEgypt - advocacy, finance, logistics, service delivery, collaboration & - advocacy, finance, logistics, service delivery, collaboration & coordinationcoordination

UNFPA UNFPA – RHCS Situational Analysis Tool (RHCSAT), which looks at all – RHCS Situational Analysis Tool (RHCSAT), which looks at all the SPARHCS components with a special focus on the supply chainthe SPARHCS components with a special focus on the supply chain

In-Country Interviews & WorkshopsIn-Country Interviews & Workshops

WhatWhat

Interviews provide in-depth Interviews provide in-depth feedback from individuals with feedback from individuals with policy and program policy and program experience. experience. The workshop can be used in The workshop can be used in place of or in combination with place of or in combination with interviews depending on time interviews depending on time and availability of informants. and availability of informants. This setting allows informants This setting allows informants to compare and share to compare and share experiences that may be experiences that may be missed in individual interviews. missed in individual interviews.

WhyWhy

The interviews promote more The interviews promote more open discussion about existing open discussion about existing issues. Data may also be issues. Data may also be easier to obtain in an interview easier to obtain in an interview setting.setting.Different interpretations of the Different interpretations of the RHCS situation can be RHCS situation can be identified and clarified in a identified and clarified in a workshop setting. Participants workshop setting. Participants can also work in groups to can also work in groups to identify preliminary identify preliminary approaches to the issues they approaches to the issues they identify. identify.

Presentation and Consensus on FindingsPresentation and Consensus on Findings

WhatWhat

A half or full day A half or full day workshop can be workshop can be used to present and used to present and validate the draft validate the draft findings with the findings with the

RHCS CommitteeRHCS Committee

WhyWhy

Builds consensus and Builds consensus and acceptability of the acceptability of the findings; presents a findings; presents a rationale for and builds rationale for and builds commitment to develop a commitment to develop a strategic plan to strategic plan to strengthen RHCS strengthen RHCS

IV. Strategic PlanningIV. Strategic Planning

The joint diagnosis identifies RHCS strengths and The joint diagnosis identifies RHCS strengths and weaknesses, the strategic plan is the opportunity to weaknesses, the strategic plan is the opportunity to address themaddress them

Planning is based on the findings from the Planning is based on the findings from the diagnosis; CS expertsdiagnosis; CS experts

CS committee meetings & workshops requiredCS committee meetings & workshops required

Why it is important:Why it is important: UnifyUnify stakeholders around a common set of objectives; stakeholders around a common set of objectives; PrioritizesPrioritizes challenges; challenges; CatalyzesCatalyzes stakeholder commitment to action stakeholder commitment to action

The Essential Elements of a Strategic PlanThe Essential Elements of a Strategic Plan P

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THE STRATEGIC PLANNING PROCESS FOR REPRODUCTIVE HEALTH COMMODITY SECURITY

GOAL (sample): Inc reased ability of people to choose, obtain,

and use quality RH products when they need them

Defining the ElementsDefining the Elements

Goal - broad, general statement of long-range purpose. Goal - broad, general statement of long-range purpose.

Priority Issues – Priority Issues – Major barriers to RHCS;Major barriers to RHCS; Feasibility of addressing those issues within the planFeasibility of addressing those issues within the plan

Objectives – One clear and measurable objective that Objectives – One clear and measurable objective that address the priority issues (e.g., “Capital: increase and address the priority issues (e.g., “Capital: increase and diversify sustainable funding for RH commodities.”)diversify sustainable funding for RH commodities.”)

Actions/sub-Actions – specific tasks carried out to Actions/sub-Actions – specific tasks carried out to achieve the objectives achieve the objectives

Defining the Elements (cont’d)Defining the Elements (cont’d)

Coordinating/Implementing Agencies – Groups that Coordinating/Implementing Agencies – Groups that manage and carry out the activitiesmanage and carry out the activities

Budget component – “Bottom Up” budgeting by Budget component – “Bottom Up” budgeting by estimating costs for each activity. Accuracy important for estimating costs for each activity. Accuracy important for obtaining financial commitmentobtaining financial commitment

M&E Plan – Develop output indicators and define M&E Plan – Develop output indicators and define expected outcomes to inform M&E Planexpected outcomes to inform M&E Plan

Output - Output - The intermediate result of the action and sub-actionsThe intermediate result of the action and sub-actions Outcome - Outcome - The (beneficial) effect on the targeted populationThe (beneficial) effect on the targeted population

Notes on Strategic Planning ProcessNotes on Strategic Planning Process

Generally requires the RHCS Committee to Generally requires the RHCS Committee to meet several times to develop the elementsmeet several times to develop the elements

A Technical Working Group (TWG) proven A Technical Working Group (TWG) proven useful to carry out detailed planninguseful to carry out detailed planning

Diverse group from all sectors, national and local Diverse group from all sectors, national and local experts needed to increase ownershipexperts needed to increase ownership

Plan’s value is in implementation!Plan’s value is in implementation!

V. ImplementationV. Implementation

Achilles heal of RHCS is transition from planning Achilles heal of RHCS is transition from planning to implementationto implementation

Critical Factors:Critical Factors: Political Will – the leadership factor. Public sector Political Will – the leadership factor. Public sector

leaders demonstrating commitment to the leaders demonstrating commitment to the implementation process implementation process

Detailed Work Planning - help ensure that the Detailed Work Planning - help ensure that the strategic plan is easily embedded within the strategic plan is easily embedded within the implementing institutionsimplementing institutions

Program Integration – included in national policy and Program Integration – included in national policy and operational documents, (e.g., PRSPs, SWAPs, operational documents, (e.g., PRSPs, SWAPs, MTEFs, and MOH work plans). MTEFs, and MOH work plans).

VI. VI. Model ApproachesModel Approaches

Several options to implement SPARHCS Several options to implement SPARHCS ProcessProcess Funding Funding Available technical resourcesAvailable technical resources Scope of the problemScope of the problem Level of political support Level of political support

Three proposed models have been used in Three proposed models have been used in different environments that represent different environments that represent variations in cost, time, and resultsvariations in cost, time, and results

Model 1Model 1

MODEL 1 COST: $ OF $$$Key ElementsAdaptable for programs with limited financing.Effective when there is widely available RH/FP program data.Focuses on strengthening RHCS within existing programs.Useful when there are widely accepted priorities.

Example of a joint diagnosis: Malawi: Contraceptive Security Desk Assessment

Model 2Model 2

MODEL 2 COST: $$ OF $$$Key Elements

More resource intensive; involves efforts that are directed toward increasing awareness of RHCS prior to beginning the joint diagnosis.

Detailed joint diagnosis based on desk analysis and in-country data collection

A Strategic plan is developed, but needs to be balanced with need to limit expenditures on activities.

Example of a joint diagnosis: Madagascar: Joint RHCS Evaluation

Model 3Model 3MODEL 3 COST: $$$ OF $$$Key Elements

Activities are included to increase awareness of RHCS and to form or engage an RHCS committee prior to the joint diagnosis. The committee will facilitate a more in-depth assessment

Detailed joint diagnosis based on desk analysis and multiple forms of data collection

Increased resources for joint diagnosis and strategic planning to ensure a comprehensive, detailed process leads to funded implementation

Focus on the RHCS committee or technical working group and local organizations actively participating and leading the process

High visibility launch of RHCS strategic plan

Example of an awareness raising exercise: The Use of the SPARHCS in Ukraine (POLICY, 2006)

ConclusionsConclusions

Measure of success will not be in this process, Measure of success will not be in this process, but improvements in RH supplies to clientsbut improvements in RH supplies to clients

The Process Guide is a tool to help manage the The Process Guide is a tool to help manage the complex process and define how the process complex process and define how the process should be adaptedshould be adapted

Evidence exists that the process works when Evidence exists that the process works when backed by leadership and commitmentbacked by leadership and commitment