Country Ownership and
Reproductive Health: The Role
of CSOs beyond Service
Delivery
MacBain Mkandawire
Executive Director
Youth Net and Counselling (YONECO)
Malawi
Youth Net and Counselling (YONECO)
- Malawi
• Youth Serving NGO that seeks to empower youth, women
and children, prevent the spread of HIV infection, mitigate the
impact of AIDS, promote human rights and democracy for
socio economic development
• YONECO work in HIV and AIDS prevention activities, sexual
and reproductive health and rights promotion and advocacy
• Sexuality education for youth and women
• Prevention of violence against women and children
• Life skills development for youth and women for the own
growth and development
• Advocacy for improved services for youth and women in
areas of education, SRH&R and GBV
YONECO Partners
• UNICEF, UNFPA, National AIDS Commission,
HIVOS, Interact Worldwide, COMIC, Nowergian
Church AID, USAID through the Bridge Project,
Government of Malawi
• Manages the National Youth/ child Helpline in
Malawi (secretariat) with huge component of
SRH&R for young people
• Coordinates a number of youth related initiatives
on SRH&R, youth leadership development and
provision of SRH services to marginalised groups
Presentation Outline
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Reflecting on Paris and Accra Declaration
Defining Civil Society Organisations
Civil society’ and ‘country ownership’
Challenges in CSOs meaningful
participation
• Recommendations for Action
Reflecting on Accra Declaration
• The Paris Declaration on Aid Effectiveness (2005) is “a
roadmap to improve the quality of aid and its impact
on development”
– Most recent agreement between donors and recipients
– Strongest commitment between donors and recipients
• Paris Declaration has five (5) Principles
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Ownership,
Alignment,
Harmonization,
Managing for Development Results
Mutual Accountability
The Accra Agenda for Action on
Aid Effectiveness
• High Level Forum (HLF3) in Accra, Ghana was meant to
assess progress towards Paris Declaration
• Accra Agenda for Action was adopted in 2008
• Country ownership was identified as a key component in
the implementation of the Paris Declaration.
• The question is: How far have we gone with the country
owner in particular in FP? Whose programmes are we
running? Donors programmes? Government’s
programmes? CSO’s programmes? Or People’s
programme?
Country Ownership Defined
• Country ownership requires
– broadening country-level policy dialogue on development
– Developing country governments working more closely with all
actors including CSOs.
– Donors supporting all development actors including CSOs to
take an active role in dialogue on development policy.
– Governments and donors’ policies and programmes are
consistent with their agreed international commitments on
gender equality, human rights, disability and environmental
sustainability.
– These need to apply to reproductive health as with other
development priorities
Civil Society Organisations
• “non-governmental and not-for-profit organizations that have a
presence in public life, expressing the interests and values of
their members or others, based on ethical, cultural, political,
scientific, religious or philanthropic considerations. Civil
Society Organizations (CSOs) therefore refer to a wide of
array of organizations: community groups, non-governmental
organizations (NGOs), labor unions, indigenous groups,
charitable organizations, faith-based organizations,
professional associations, and foundations”. World Bank
Definition
• For purposes of this discussion, CSO shall mean all of the
above including media and other social movement
organisations
Advocacy role of CSOs in
Country Ownership (1)
– Conducting advocacy for the increased support for family planning
services and commodities in the health facilities because sometimes
FP services and commodities are not government priorities
– (In Malawi supply of condoms is affected by this situation – where
preventive health services are a priority and condom supplies are not
leading to poor service delivery, in Uganda there was a Condom
Crisis because it was not seen as a priority (these are commodities)
– Continued advocacy with the government has resulted in the
government reviewing the position and seeking more support for the
provision of such supplies
– Family planning services should not be seen as luxury but rather
main issue in the health sector
– Advocacy is required to ensure this is achieved
Advocacy role of CSOs in
country Ownership (2)
– Advocacy to increase service delivery closer to the people for family planning
including quality services and user friendly
• Government have the existing policies on YFHS and yet small number of
young people access the services. Government claim that services are there
but are they close enough to young people
• YONECO and Scottish Government under a Project Called Yankhulani!
Speak Up! Piloted a model of taking the SRH&R services to young people in
6 health centres and 6 community based facilities (where youth, CSWs and
married adolescents meet and the response has been enormous
• CSWs and married adolescents are getting engaged in the comprehensive
FP as the services are at the door steps with their peers
• The need to advocate for the services to be closer to people that need the
services. Distance prevents people from accessing the services (YONECO
Drop in Centres are hub of condom distribution as opposed to YFHS points
in the hospitals
Advocacy role of CSOs in
Country Ownership (3)
• Budget tracking, monitoring and accountability for the effective
use of the resources for the family planning resources
• As a result of HIV and AIDS, less resources have been
allocated to FP leading to poor service delivery
• In Malawi, CSOs like BLM have been the centre of FP
provision as opposed to government because resource are
available
• In some instances, FP resources are diverted to other
preventive health services as FP is not a priority
• CSOs should monitor how resources are allocated, ensure
FP is a priority and how resources are utilised
CSOs can effectively Engage the
public on Family Planning Issues
• Is the public part of community ownership? Whose services are
the FP? What would be the role of CSOs in public engagement?
• Conducting education or awareness on the various methods of
family planning
• Providing space for networking, coordination and collaboration
among the key stakeholders
• Public engagement on FP and quality of the services
• Engaging the media to conduct public education and
awareness on Community ownership of FP
• Strengthening the Media to conduct advocacy and awareness
people on FP for increased demand of the commodities
Policy recommendations for better programmes
(bringing FP closer to the people)
• Thinks tanks for policy development and review for
the effective delivery of family planning services
delivery at community and national levels
• Engaging with policy holders for the development
and review of family planning policies and strategies
• Budget tracking, monitoring and accountability for
the effective use of the resources for the family
planning resources
• Conducting research into the effective use of family
planning services among different social groups and
why there are challenges in accessing these aspects
Identify and champion groups who are
missing out
• One size fits all (Standard FP Services) miss out
on number of key social groups
• YONECO uses out reach services and youth
corners or drop in centres to reach to groups
that are missing out
• CSOs can easily identify and champion the
groups that missing out
• Special group associations like commercial sex
workers groups, widows association etc can be
useful in identifying the special needs for these
groups
Capacity constraints for CSOs
participation
• CSOs are voluntary in nature and operate with limited
budgets but with passion, drive and commitment to the
cause
• CSOs are on the ground where sometimes government
is unable to reach, but sometimes have capacity gap to
collect data effectively to inform policy decisions
• CSOs do a lot of work and contribute to the changes at
various levels, but have challenges in documenting the
work to inform policy work
Inadequate recognition of CSOs
role in FP
– Poor policy frameworks that do not recognise the role
of CSOs in family planning beyond service delivery
– Cosmetic policy documents (CSOs are mentioned as
donor conditionality's and yet the practice is different
(Sector Wide Approaches in Health as an example)
– CSOs are not usually in government budgets as
actors in development (Fundamental questions of
whether the state should finance CSOs or if state
finances CSOs, will they play a watch dog role?)
Inadequate resources
• Inadequate resources for CSOs to conduct the various activities
beyond service delivery and the advocacy work seem not to produce
“results” as perceived in the development work
• Changes in international agenda recently with the global financial
crisis has made this more serious
• Lack of information flow from the services providers and research
institutes relating to family planning – for example it takes long
before CSOs are aware of international agreements that our
governments have signed making advocacy a huge challenge
• Most developing country CSOs government budgets does not
include the CSOs support and even government budgets that are
earmarked for CSOs often do not get spent on CSOs, (e.g. SWAP in
Malawi is supposed to support CSOs but not implemented)
Recommendations to Govt and the
international community on CSOs
engagement
• Transparency
• Engage with CSOs on policy dialogue
• Support capacity building
Improve Transparency
– Improve policy frameworks to include the role of CSOs in
Family planning beyond service delivery including the
government policies on sexual and reproductive health
– Policies should not be cosmetic for CSOs but should have
meaningful participation of the CSOs
– Enhance the coordination, collaboration and networking
activities among CSOs while also providing a forum for
networking and coordination
– Donors and government at country levels should provide
the space and resource for coordination and networking
Support Capacity Building
– Capacity building for CSOs in conducting evidence
based advocacy, research and policy analysis in
family planning sector
– Provide more resources for CSOs to do work outside
service delivery of family planning
– Enhance CSOs capacity to mobilise resources
beyond the traditional donors and resource providers
to include private sector, own income generation
through training, linkages and networking (the forum
in Addis now is an example of how to enhance
capacity)
Engage with CSOs in Meaningful
policy dialogue
– Enhance the coordination, collaboration
and networking activities among CSOs
while also providing a forum for
networking and coordination
– Support linkages and networks for
CSOs and governments to share and
compare notes
Thank you for your attention
• Contacts
– Email 1: macbainmkandawire@yoneco.org.mw
– Email 2: macbainmkandawire@yoneco.org
– Email 3: macbain.mkandawire@gmail.com