Intervention Summary
Title: Programme Partnership Arrangement with Marie Stopes International (MSI)
What support will the UK provide?
The UK, through the Department for International Development (DFID), will invest in a 3 year Programme
Partnership Arrangement with MSI between 2011 and 2014. An initial investment of £4,353,052 for 2011-12 has
been agreed. Subsequent disbursements will be performance-based; as assessed through robust monitoring and
evaluation mechanisms.
Why is UK support required?
Civil society plays a vital role in supporting citizens to improve their lives. Civil Society Organisations are central
to delivering services, enabling citizens to be more active in their own development and ensuring that policies
benefit ordinary people – especially the poorest.
In order to achieve DFID’s priorities, as set out in its Business Plan (Structural Reform Plan), a multi-sectoral and
multi-pronged approach to delivery is required. CSOs, along with governments and the private sector, play a
pivotal role in helping poor people to improve their lives.
The PPA is one of DFID’s main support mechanisms to CSOs. In line with a commitment by the Secretary of
State to support another round of PPAs and following a robust selection process and implementation of a
Resource Allocation Model, partners have been identified for a 3 year PPA to begin in April 2011. MSI is one of
these.
What are the expected results?
1. Increased access to quality Family Planning (FP) services for the poor and underserved through the private
health sector (private health sector includes non-governmental organisations (NGOs) and for-profit commercial
health providers such as doctors, nurses, midwives and pharmacists).
 22,805,104 CYPs (Couple years of protection) generated over the life of the project
 2,490,997 unsafe abortions averted over the life of the project
 3,238,239 long acting or permanent family planning methods delivered over the life of the project
(estimate that in addition to the 3,238,239 direct PPA beneficiaries, there will be over 2.6 million indirect
PPA beneficiaries as a result of MSI’s service delivery work.
 3,327 sites in rural and urban slum areas reached by high quality MSI mobile clinical outreach teams
 75% of clients reached with MSI family services are defined as poor or underserved
2. Expanded FP and Post Abortion Care1 (PAC)/Comprehensive Abortion Care2 (CAC)3 choice through the
innovative use of new technologies and service delivery options.
 8 country programmes distributing new, registered and less expensive, high quality contraceptive
1
Post Abortion Care (PAC) focuses on life-saving care to treat complications from unsafe abortion
or evacuate the uterus following miscarriage. PAC is critical in environments where abortion is highly
restricted, due to medical complications which results from unsafe abortion.
2 Comprehensive abortion care (CAC) encompasses safe induced abortion (including elective
procedures), treatment for abortion complications, post-abortion contraception, and appropriate
linkages to other reproductive health care services such as screening, counseling and treatment for
sexual violence, sexually transmitted infections including HIV and linkages to resources at the
community level.
3 Any work to improve access to safe abortion using funds provided by this PPA will be strict
accordance with DFID’s policy as outlined in Safe and unsafe Abortion, Practice Paper, DFID Policy
2010.
methods by the end of the project
3. Contribution made to improved aid effectiveness for FP and PAC/CAC through increased collection and use of
evidence by MSI.
 MSI country programmes implementing a new, standardised Management Information System to
increase the SRH evidence base by the end of the project (with agreed annual milestones for progress).
4. Ensure that 8 PPA supported country programmes will impact the work of 120 national and international
organisations in relation to services, advocacy, knowledge sharing or technical work
Business Case for: Programme Partnership Arrangement with MSI
Strategic Case
A. Context and need for DFID intervention
Civil Society Organisations (CSOs) are accepted as an essential part of the global partnership to
deliver the MDGs and public goods. Internationally, the role of civil society4 is widely recognised - the
Accra Agenda for Action specifically mentioned the need to ‘deepen engagement with civil society
organisations’i. In the UK, the Government has stressed the importance of strengthening the ‘Big
Society’ and developed a ‘Compact’ to shape the relationship between government and civil society.
The National Audit Office states that “Civil society organisations can play a variety of vital roles” and
are “important partners for DFID”ii. The Public Accounts Committee praised CSOs for often
performing better than developing country governments in providing benefits for the poorestiii. Other
donors also emphasise the importance of the sector, such as the European Commission, DANIDA
and SIDA.
Civil society plays a vital role in supporting citizens to improve their lives. CSOs are central to
delivering services, enabling citizens to be more active in their own development and ensuring that
policies benefit ordinary people – especially the poorest. CSOs can extend governments’ and official
donors’ reach with hard to reach groups - such as disabled people, vulnerable children, female
headed households and people living with HIV AIDS - and in hard to reach areas or where, for
example, DFID has no programmeiv.
The Review of DFID’s Support to Civil Societyv and other recent research provide additional evidence
to support the view that Civil Society is an important contributor to poverty reduction and can
demonstrate impact towards achieving the MDGs.
In order to achieve DFID’s priorities, as set out in its Business Plan (Structural Reform Plan), a multisectoral approach to delivery is required, one in which CSOs, along with governments and the private
sector, play a pivotal role in helping poor people to improve their lives.
DFID objectives for its work with CSOs:
(i) Deliver goods and services effectively and efficiently;
(ii) Empower citizens in developing countries to be more effective in holding governments to
account and to do things for themselves;
(iii) Enable civil society to influence national, regional and international institutions including
improving aid effectiveness;
4
Civil society includes a wide range of non state actors such as non-governmental organisations
(NGOs), faith and Diaspora groups, community based organisations and others. Some are large and
well established, whilst others are small and informal with limited capacity.
(iv) Build and maintain capacity and space for active civil society;
Benefits of PPA strategic funding
To achieve its objectives, DFID has a broad and flexible range of funding mechanisms for CSOs;
both centrally and through country programmes. In contrast to other donors, it does not exclusively
favour UK-based CSOs. These mechanisms enable DFID to balance a longer-term commitment to
civil society with instruments which allow more opportunistic, flexible and creative approachesvi .
How does DFID support Civil Societyvii:
•
•
•
•
Unrestricted grants: 25% of total portfolio
In-Country Funds: 53% of DFID’s total funding to CSOs
Central Funds: 4 centrally run schemes plus humanitarian funds (47%) – including PPAs
Indirect funding: through joint funds such as the Common Ground Initiative (Comic Relief)
and Disability Rights Fund (AusAid)
• Pooled funds: increasing use especially in fragile countries
• Via multilaterals: £160 m through the World Bank, European Commission and UN agencies
The Programme Partnership Arrangement (PPA) is one of DFID’s main support mechanisms to
CSOs. The PPAs are strategic level agreements based around mutually agreed outcomes and
individual performance frameworks against which the organisations report on an annual basis.
Critically, PPAs, subject to performance, provide the CSOs with 3-4 year funding which enables them
to better plan and deliver programmes, including in more difficult, higher risk environments. PPAs
are aimed at CSOs with a global reach and leaders in their field who can add value to DFID’s
portfolio, support realisation of its objectives, achieve real results in terms of poverty reduction and
provide good Value for Money (VfM) as demonstrated through a competitive selection process.
In particular, PPAs contribute to the delivery of the MDGs by playing a vital role in supporting citizens
to improve their lives, delivering services to specific groups of poor people, and holding governments,
donors and others to account. The PPAs have contributed in practical ways to: improving the lives of
women and girls, helping adaptation to and mitigate climate change, and strengthening partnerships
with the private sector in development, evidence of which can be found in the PPA MetaEvaluationviii.
Following NAO recommendations, DFID has strengthened areas such as baseline development and
performance frameworks. An independent external evaluation manager is contracted to oversee the
development of results frameworks, robust baselines, mid term and final evaluations. In the interest
of transparency, DFID will publish all PPA reviews and requires PPA holders to publish too, together
with a management response, as a condition of funding.
Current projections for the PPA budget allow a total allocation of £360m for 2011-2014. For the first
time, funding is performance based. Following the mid-term review, individual allocations to PPA
agencies will increase, decrease or remain the same based on their relative performance
In line with a commitment by the Secretary of State to support another round of PPAs and following a
robust selection process and implementation of a Resource Allocation Model, 39 partners have been
identified for a 3 year PPA to begin in April 2011, from 430+ initial applications and a shortlist of 109.
MSI is one of the selected PPA partners, and has been assigned £4,353,052 by DFID for the first
year 2011-12. Subsequent disbursements will be performance related.
B. Impact and Outcome of the MSI PPA
Impact: Contribute to accelerating the achievement of MDG 5 to improve maternal health
Outcome: Increased use of family planning and decrease the number of unsafe abortions in subSaharan Africa and Asia, with an emphasis on fragile states.
MSI will target poor and vulnerable people, especially women and adolescent girls. The theme of this
PPA is the improvement of reproductive and maternal health. The primary focus of activities to
be carried out will be the provision of quality modern methods of contraception to underserved
populations in order to improve access to family planning. While a full choice of modern contraceptive
methods will be offered to all beneficiaries, increased demand for long acting and permanent
methods among in target populations is expected.
Geographically, this PPA will focus primarily on sub-Saharan African and South Asian countries
exhibiting high levels of unmet need for family planning services and hosting MSI programmes with
recognised capacity to deliver immediate and significant results. Some programming will also occur
in South East Asia where unmet need and capacity to deliver results are equally apparent.
For the purposes of reporting5, MSI proposes a defined group of country programmes in which to
distribute its PPA allocation in order to maximise the potential to generate results and contribute
towards improved maternal health. These countries are:
Burkina Faso
Ethiopia
Ghana
Kenya
Madagascar
Malawi
Mali
Nigeria
Sierra Leone
South Africa
Tanzania
Uganda
Zambia
Zimbabwe
Afghanistan
Pakistan
Bangladesh
Burma
Nepal
Papua New Guinea
MSI will select eight countries out of this universe to receive PPA funds each year, and those
recipient countries may change over the life of the project.
Appraisal Case
A. Feasible options
There are two options for this intervention:
1. Fund MSI through a centrally managed PPA
2. Reject MSI’s proposal
5
There will be no overlap in reporting on activities and results funded through the PPA and activities
and results funded though the Prevention of Maternal Death from Unwanted Pregnancy programme.
B. Appraisal of options
Option 1. Fund MSI through a centrally managed PPA
Costs: DFID will invest £4,353,052 in the first year (2011-12) of the PPA with MSI. Funding
represents 4% of MSI’s total income and can play a key role in shaping how MSI uses its non-
DFID resources.
.
Subsequent performance-based allocations are provisionally set as:


2012/13
2013/14
£4,353,052 (provisional)
£4,353,052 (provisional)
PPA round 2011-14
The new PPA round, 2011-14 and for which MSI has been selected, challenged CSOs to show
greater effectiveness, results and Value for Money.
2011-14, Key criteria for selection included:
-
Niche, expertise, leadership
Strategic fit with DFID objectives and priorities and complementarity
Vision and Impact (what will be achieved)
Transparency & Accountability
Results delivery (demonstrated impact)
Value for Money
Partnership (structure and reach)
Monitoring, evaluation & learning
In addition the selection process included a Resource Allocation Model (RAM). The 2011-14
RAM ensured that appropriate funding levels were attributed to each selected partner. Annual
income, as stated in the CSO's Annual Audited Accounts, was selected as the starting point
(base). In addition, the RAM made full use of the PPA offer document which all applicants were
asked to complete. Offers were scored against specific criteria. Each criterion was allocated a
score, which was used to calculate building blocks. These were added to the base to calculate the
appropriate funding level. It was agreed that in order to reduce dependency, PPA funding should
be capped at 40% of an organisation’s income.
Evidence base for the selected option (PPA with MSI):
Benefits:
MSI works towards universal access to modern methods of contraception and a world where all
children are born by choice, not by chance. MSI is committed to upholding the fundamental right of
women and couples to decide freely, and without coercion, the number and spacing of their children,
thereby directly contributing to improved sexual and reproductive health (SRHR) and reducing
maternal mortality (Millennium Development Goal 5).
MSI works in 43 countries around the world, including in 36 developing countries. In 2009, MSI
provided family planning and reproductive health care services to 6.3 million clients. 99% of MSI’s
health impact is in developing countries and 60% of the protection from unwanted births they provide
is delivered for free or at heavily subsidised prices through mobile clinical outreach programmes.
These are dedicated to reaching hard-to-reach communities in rural areas and urban slums that
would otherwise have very limited access to modern family planning methods. MSI engages with
governments, NGOs and international policy makers to catalyse the integration of SRHR into their
work.
MSI has over 30 years’ experience in delivering quality reproductive health services, and remains in
the vanguard of innovation and best practice in the field. MSI provides family planning, safe abortion
(to the extent allowed by national law) and post abortion care services directly through its own
network of over 600 clinics, more than 1300 social franchise providers, social marketing programmes
and over 1,000 clinical outreach teams. There is strong evidence that better access to modern
contraception and safe abortion reduces maternal mortality: addressing global unmet need for
modern contraception could reduce maternal mortality by one third as well as improving child health;
unsafe abortion accounts for an estimated 13% of all maternal deaths.
In addition to the scale and reach of its service delivery, MSI is an innovator in achieving results
through embracing the public and private health sectors, operationalising pay for performance
strategies and catalysing governments and other NGOs to improve their work in the area of SRHR.
Many of MSI’s clinical innovations are now used across the sector including by International Planned
Parenthood Federation, Intrahealth and UNFPA.
In the UK’s Framework for Results for improving reproductive, maternal and newborn health in the
developing work, DFID commits to double its efforts for women’s and children’s health. By 2015, MSI
aims to contribute to increased Contraceptive Prevalence Rates (CPR) of greater than 1 percentage
point in 10 countries and, through the services it provides, contribute to averting at least 50,000
maternal deaths..
Indeed; MSI’s proposal demonstrated its strength in reaching out and supporting the poorest groups,
aiding countries most in need, and providing good value for money.
At the highest level of impact, PPA activities will contribute to sustainable improvement in the lives of
poor and vulnerable groups through progress in Improved maternal health (MDG 5) and Gender
Equality (MDG3).
Relevant indicators appear in the MSI PPA logframe.
In particular, the investment under a PPA with MSI will support innovative programming models
across MSI in the following thematic area:

Maternal Health
Work will focus on a small number of priority countries where MSI’s programmes are best placed to
benefit from strategic support and have the potential to scale up to reach large numbers of
beneficiaries. It also aims to affect change beyond the reach of MSI through its links and existing
partnerships with a broad range of institutions (CSOs, governments, INGOs etc). Investment in a
PPA with MSI has the potential of (directly and indirectly) reaching a high number of resource-poor
beneficiaries, includingix:
MSI provided a significant proportion of the modern family planning services available. In 2009 MSI
provided:

40% of the modern methods delivered in Malawi,

24% of those in Tanzania,

20% of those in Uganda and 14% of those in Afghanistan.
In addition, benefits of funding through the PPA mechanism include:
 Reduced administrative burden
 Shared management resources across all PPAs
 Opportunity to achieve economies of scale by supporting interventions best placed to
Leverage results across MSI, its partners and beyond
 Enhanced DFID reach and results on shared strategic areas
 Enhanced DFID reach in countries where the MSI works
Strengths and capacity of MSI to implement a PPA
Vision: MSI has a clear vision and has recently developed an ambitious new strategy (‘The Power of
Ten’) which frames its work. These fit well within DFID’s Business Plan objectives related to a)
supporting actions to achieve the MDGs and; b) improving the lives of girls and women. MSI is also
investing improving the skills and capacities of its staff and recruiting new staff with practical and
specialist skills.
MSI strategic objectives:
1. expanding contraceptive choice and channels to bring FP and safe abortion
services as close to the client as possible,
2. strengthening organisational capacity to further enhance clinical standards and
quality of care,
3. forging connections to influence policy, connect with national health systems and
increase partnerships with international donors.
.
Governance:
MSI is led by a small executive team and governed by an experienced Board of Directors. An internal
audit function reports directly to the MSI Board. MSI’s structure has evolved in recent years to reflect
the growth of the organisation and the scope of its work. The London support office is comprised of
five departments, each led by a member of the executive team. An additional support office in
Melbourne, Australia, provides support to countries in Pacific Asia. MSI’s major departments and
functions include:
 Health Systems, which houses MSI’s technical expertise in research, M&E and includes the
Medical Development Team responsible for clinical protocols and quality assurance.
 External Relations, which leads MSI’s fundraising, advocacy and partnership activities including
engagement with stakeholders such as international donors and policy makers.
 Programme Support, which is dedicated to directly supporting overseas activities such as donor
project monitoring and reporting, country budget and performance monitoring, development of
business plans and annual targets, strategic planning, risk assessment and management.
 Finance, which is responsible for the financial tracking and accountability of the organisation as a
whole.
 People and Development, which is responsible human resource policy, procedures, recruitment,
and developing talent within MSI.
MSI also maintains regional technical hubs that bring technical expertise closer to country
programmes and manage regional initiatives. Advocacy teams in Brussels and Addis Ababa focus
on engagement with the European and African Unions respectively, and offices of regional technical
experts in social franchising, demand generation, research, training, and clinical quality assurance
are based in Nairobi and New Delhi. Country programmes are led by a Country Director and a senior
management team presiding over teams of clinicians, technical experts, project managers and
support staff.
In 2009, MSI had over 7,500 staff in 43 countries. A significant proportion of these team members
have either clinical service delivery or technical leadership skills and responsibilities. Globally, 99%
of MSI’s team members are nationals of the country in which they work. MSI prides itself on
efficiency, productivity, and empowers its Country Directors and those ‘closest to the client’ to make
decisions. MSI supports this global operation with 130 staff based in its London and Melbourne
Australia support offices.
MSI has invested extensively in its human resources capacity and will continue to prioritise
professional growth and development in its 2011-2015 strategic plan implementation and during the
PPA period. Strategies include expanding the skills and expertise of existing (especially national)
staff through training, secondments and exchanges in order to take on new challenges and
responsibilities. For example, MSI recently recruited a Country Director for its programme in
Zimbabwe from its Ethiopia senior management team. MSI also maintains policies and procedures
that support and provide guidance to team members on equal opportunity and diversity, child
protection, whistle blowing, prevention of harassment, performance reviews and grievance
procedures.
Results, Monitoring and Evaluation (M&E):
MSI’s monitoring and evaluation (M&E) practices seek to build capacity across its country
programmes to ensure that internal minimum M&E standards are met. In addition to standardised
data collection on clients and services, MSI’s minimum M&E standards also encompass quality
assurance and client feedback in order to provide a strong evidence base for decision making.
Internal clinical quality monitoring is performed by in-country teams and the MSI support office
Medical Development Team (MDT) beginning at the service delivery level and includes all service
delivery channels – clinics, social franchises, and outreach teams. Quality monitoring is set against
established organisational clinical protocols and standards-of-care underpinned by regular training.
Annual quality assurance audits are coupled with technical assistance provided by the MDT to
immediately address recommendations and ensure that MSI standards are adhered to in all countries
in which it works. Additional quality accountability and oversight is provided through a system of
clinical governance including Medical Advisory Councils.
A newly expanded MIS collects data against a core set of indicators that includes client numbers,
type of service provided, client age group, client gender, service delivery location and is used
consistently across all MSI country programmes. Quality assurance, MIS data and regular client
feedback captured through client exit surveys allow MSI’s programmes to quickly identify areas
requiring attention and improve forward planning. In larger country programmes, MSI employs
additional research methodologies such as operations research and knowledge, attitudes and
practices surveys. In these larger country programmes, MSI has developed a ‘dashboard’ which
tracks top-line indicators from the MIS and other surveys to further support decision making and
programme monitoring. In certain country programmes, MSI is also adopting mobile phone
technology such as SMS to speed up the transfer of user data collected by researchers and mobile
outreach teams in the field.
In 2009 MSI developed two tools to estimate the impact of its work on broader health outcomes.
MSI’s Impact Estimator integrates several validated third party models and formulae to calculate the
positive effect of SRH services at a community, national, regional or global level. For example, by
entering the number of FP services delivered, the Impact Estimator is able to project the number of
maternal deaths that will be averted as a result. The REACH Estimator uses MSI’s internal FP
service delivery numbers alongside external statistics – such as population size and contraceptive
use – to estimate the contribution that MSI is making to increasing national CPR. This approach to
calculating health impact is being adopted by others, for example the Reproductive Health Supplies
Coalition is now using the Impact Estimator in its work. MSI has shared its Impact Estimator and data
sources openly in order to foster debate, identify improvements, and promote best practice by the
wider SRH community.
Recent improvements to MSI’s internal knowledge management has enhanced its ability to identify
caches of expertise – both in its people and country programme innovation – and led to an increase
in south-to-south technical assistance and more effective cross-fertilisation of successful approaches.
By testing new approaches, consolidating and sharing learning, several MSI initiatives have acted as
incubators for innovations that have improved service delivery. Using door-to-door community based
distributors to reach target populations in areas falling outside of the catchment areas of MSI’s clinics
and social franchises was pioneered by MSI in the Philippines. Clear systems for collecting and
sharing evidence, both internally and externally, allows the lessons learnt by MSI to be disseminated
for the benefit the SRH sector as a whole. Examples of MSI research scheduled for peer-review and
publication in 2011 include a seven country evaluation of MSI’s mobile clinical outreach model and
an assessment of MSI’s results based financing initiative for maternal and child health services in
Sierra Leone, in partnership with the WHO. MSI also actively participates in research and evaluation
studies by others and is currently a member of a steering group alongside KfW, USAID, DfID and the
Gates Foundation for the Population Council’s evaluation of results based financing projects. MSI will
also continue to utilise external research and data, such as national census data, Demographic
Health Surveys and other population based surveys, and data and information anticipated from the
DfID-funded Evidence for Action Programme to Save Mothers and Newborns in Africa.
Transparency & Accountability:
MSI is committed to ensuring that information on how aid money is used is available to stakeholders,
including to donors, communities and host country governments, aligning it with the principles of the
International Aid Transparency Initiative. MSI is prepared to adhere to DfID’s standards and
requirements for transparency such as those outlined in the UKaid Transparency Guarantee.
MSI values transparency and accountability and routinely publishes its data, results, and research
information freely available through its website and other fora. MSI engages external institutions
(such as the London School of Hygiene and Tropical Medicine and the Population Council) to
evaluate its programmes, input into its service delivery models, and validate its results and impact.
MSI also participates in reviews conducted by other organisations, such as Family Health
International’s 2009 review of LAPM discontinuation in Ethiopia.
One of the cornerstones of MSI’s work is strong clinical governance and accountability. MSI has a
global clinical audit team which ensures the highest standards of clinical care and safety for all its
clients. Clinical governance is led by a Medical Advisory Committee (MAC) in each country
programme. The MAC’s responsibilities include oversight on major and minor complications levels;
reviewing clinical incidents and quality assurance audits; monitoring client satisfaction and ensuring
appropriate action and planning is employed in order to provide the highest level of accountability to
both clients and the donors who fund MSI’s work. MSI created its first MAC to fulfil the requirements
of its UK National Health Service (NHS) contracts. MSI has since instituted MACs at the country
programme level, modelled the UK approach, as well as convened a global MAC which meets a
minimum of three times per year and provides an annual report to the Board of Directors. MSI
involves external experts in its MAC, from the UK and overseas, which underscores its commitment
to quality and transparency.
Financial audits, both internal and external, play an important role in transparency, accountability, and
risk management. Several years ago, MSI launched a global internal audit team that reports directly
to the MSI Board. MSI’s largest country programmes also have an internal audit function which
reports to a local Board of Directors and/or to MSI in London. MSI also has global external audits
every year, which are published on its website and each of MSI’s country programmes has an
external audit from a reputable firm, and these external audits are shared with key stakeholders.
Donor-funded projects are independently audited and reported on as required.
MSI employs multiple strategies to ensure effective and consistent feedback loops and engages
stakeholders at all levels to ensure that its activities are appropriate and accountable to beneficiaries,
clients, constituents, and key stakeholders.
 At the beneficiary level, MSI’s programmes employ several methods – from simple to state-ofthe art – to collect client feedback. In all MSI clinics, client feedback is solicited through suggestion
boxes and feedback forms. In Pakistan, MSI’s call centre was originally established to handle client
complications and referrals, but it has now evolved into an important source of client feedback. MSI
in Pakistan now has a complete system in place to categorise client feedback, share feedback with
the appropriate managers and teams, and established turn-around times for following up.. This
honest feedback loop illustrates MSI’s commitment to addressing challenges such as provider bias or
negative health worker attitudes, thus making MSI more responsive to meeting the needs of those
who may already feel stigmatised (for example, adolescents or HIV-positive women). MSI also
regularly undertakes discrete research activities such as client exit interviews and mystery client
surveys.
 MSI works closely with host country governments to assure that transparency and
accountability are a priority. Indeed, MSI’s Public Private Partnerships with host governments are
predicated on sharing of results, information, and transparency. For example, MSI in Tanzania
(MST) provides SRH services on a results-based contract with district level authorities who regularly
scrutinise MST’s records to verify service numbers. In addition, a steering committee made up of
government staff approves all of MST’s contractual rates. In Ethiopia, as many countries,
government officials are regularly involved in monitoring and evaluating MSI activities.
MSI ensures that its research and many of its evaluations (subject to donor approval) are available to
the public and to donors through its website. MSI has an ‘open source’ ethos, believing that any
knowledge, best practices, evidence, tools, and even failures are global ‘public goods’ which can help
other agencies to improve their own programming and avoid any mistakes that MSI have made in the
honest pursuit of its mission of Children by Choice not Chance.
Cross cutting issues (Gender, Private Sector)
GENDER
Women in all of the countries where MSI operates typically struggle to have their voice heard and
there are low levels of gender equality. This inequity exacerbates the problem of unsafe abortion and
is also evidenced by high levels of violence against women, including female genital mutilation, weak
decision-making power in families and communities, low levels of education among poor women and
severe poverty. There is significant risk of being socially ostracised for both the women needing care
and the health workers who provide it. For example, women suffering from unsafe abortion in Sudan
are sometimes "punished" by health providers who make them wait all day for treatment, while other
obstetric patients are served.
Care and household responsibilities are known to limit the women's participation in the workforce and
the growth of women owned microenterprises. Since sexual and reproductive health and rights
impacts on girls education and is essential for the implementation of
MDG3 (Gender equality), it is clear that poor SRHR can inhibit economic growth, especially where
there is a need for a skilled workforce. Access to safe abortion and contraception is particularly
important for MDG 3, gender equality and women's empowerment. There is wide consensus that
women's ability to regulate their own fertility is fundamental to autonomy and choice in other areas of
their lives.
PRIVATE SECTOR
SRH needs are often met through private sector avenues in developing countries. Recognising this,
MSI operates social franchises throughout the world. Their clinics are recognised as the 'gold
standard' in their countries and serve as a model for quality. MSI provides a critical bridge to the
private sector through social franchising and other quality-driven networks that engage local private
and NGO health providers by offering training, accreditation, branding, quality assurance, continuity
of supplies and promotion in order to increase client volume and drive-up quality FP/RH service
provision. MSI has established locally owned social franchise networks, typically branded BlueStar, in
Ethiopia, Ghana, Kenya, Malawi, Pakistan, Sierra Leone, the Philippines, Madagascar and Vietnam.
MSI estimates that in 2009 its 1,000 social franchisees delivered approximately 100,000 LAPM (Long
Acting and Permanent Methods of contraception) services, including over 40,000 IUDs (intrauterine
device) in Pakistan. Furthermore, social franchisees in Ethiopia delivered over 90,000 injectables.
Social franchising is fast becoming a major service delivery channel and contributes 10-25% of CYPs
in established programmes and is expected to grow. With funds from the PPA, MSI will grow and
strengthen its social franchise networks.
Alternative Option 2 (no PPA for MSI): Reject MSI’s offer
The choice not to provide PPA funding will limit the capacity of MSI to deliver its poverty reduction
priorities and to influence other CSO partners. The rigorous assessment of MSI’s proposals against
the agreed commitment to fund CSOs through PPAs makes a good case for the fit with MSI’s
objectives over other CSO PPA applicants.
Summary - Value for Money Justification:
For the reasons summarised below, Option 1 offers good value for money and is proposed for
approval.
The overall theory of change for the PPA investment with MSI, is that by providing strategic support
for MSI to test and refine its most promising evidence-based development models, connect this
evidence to policy-makers to influence best practices and attract funds from other donors, and
support governments and other agencies to adopt innovative approaches where they prove relevant
and effective, the PPA will leverage the local-level impact of MSI’s best initiatives to influence
national and international development policy and effect much wider change in the lives of poor
people. MSI’s logframe reflects how the intended activities link to outcomes.
MSI’s choices of specific programmes to support and report on under the PPA reflect its areas of
expertise well, and have been carefully assessed by MSI as the most promising in relation to scaling
up and learning. The benefits outlined earlier, past evaluations of MSI’s work and its broad reach
beyond the scope of programming alone all contribute to a strong case for supporting a PPA with
MSI and it providing good VfM.
Due diligence checks have been carried out on MSI. DFID is confident that in addition to yielding
results on the ground, MSI has strong and efficient mechanisms in place for monitoring and
evaluating its work, focusing on results and delivery, and ensuring good Value for Money and
transparency in all decision making. Due diligence checks help to show how each organisation is
approaching value for money.
Through performance monitoring, DFID will assess that MSI’s organisational systems are used to
deliver value for money of the PPA investment (see next section). DFID will emphasise the
importance of learning lessons and disseminating these more widely through the partnership to
reflect innovative programming aspects of MSI’s approach. MSI’s efforts to share learning would
benefit from regularly assessing impact on its and partners’ work. DFID will encourage this through
its learning and management support to PPA partners.
In addition we are also supporting Bond’s Effectiveness Programme which will have a major focus on
improving value for money within UK CSOs.
Cost:



2011/12
2012/13
2013/14
£4,353,052
£4,353,052 (provisional)
£4,353,052 (provisional)
D. Measures to be used or developed to assess value for money
Value for Money
The PPA mechanism is efficient, as set out in previous sections (administratively efficient 0.2%,
pooled resources on monitoring and evaluations, outreach, scaling up etc).
MSI’s well-established global infrastructure, ready expertise in deciding where and how to focus
resources for maximum impact, current momentum in scaling-up FP and PAC/CAC services, bottomline results orientation, efficient and cost-effective operations and sound financial control systems
offer DfID exceptional value for money in the PPA.
Family planning is recognised as one of the most cost effective ways to reduce maternal
mortality. In 2009 alone, MSI’s FP and PAC/CAC services saved national health systems and
individuals an estimated £850 million in curative health care costs. In MSI’s developing country
programmes, this is equal to £18 saved for every £1 spent by MSI.
MSI systematically tracks key performance indicators across its country programmes to ensure value
for money. For example, MSI holds itself to:
 Maintaining low costs per CYP delivered. In 2009 MSI was able to protect one couple from
unwanted pregnancy for a year for only £2.67, which makes MSI one of the most cost-effective FP
NGOs in the world.
 Productivity. Every MSI programme tracks its output (CYPs) per full time equivalent (FTE)
employee. MSI has experienced a period of tremendous growth over the last 5 years but has
remained a lean organisation. In 2005, MSI was delivering 9 million CYPs a year, or 2,205 CYPs per
FTE. By 2009, MSI delivered 18 million CYPs, and productivity improved to 2,366 CYPs per FTE.
Only 130 of MSI’s 7,500 staff work in its support offices in London and Melbourne.
 Tracking overhead (administrative) and operating costs for each MSI clinic, business unit and
programme. MSI tightly manages its global administrative costs during its annual business planning
process, which takes place in each country programme and is then aggregated globally.
For donor and unrestricted funds that are managed at MSI’s discretion, it has a well-established
annual application process and awards internal contracts to its country programmes on a
competitive, results basis. MSI country programmes submit proposals that detail their cost per IUD
insertion or tubal ligation, for example, estimating the number of services they can provide during a
calendar year. MSI’s executive team reviews all applications and uses cost efficiency and projected
results to guide their decisions on discretionary funding. Internal contracts are signed which stipulate
expected results and the agreed rate of reimbursement per service. Reimbursements are made on a
regular basis for services. Each year an internal audit is conducted to verify service numbers and
costings. By allocating £8.5 million of discretionary funding in this way in 2009, MSI country
programmes produced 12 million CYPs.
MSI contains costs where possible in its day-to-day activities and implementation, such as bundling
procurements to obtain the lowest price possible from suppliers, open tendering processes, flying
economy class, and conducting periodic benchmarking exercises for both consultants and permanent
staff to ensure that salaries and rates are competitive. All MSI country programmes have competitive
hiring practices and solid financial management that are MSI, host government and donor compliant.
MSI engages in south-to-south technical assistance to save on consultancy costs, for example
utilising local staff from one country programme to participate in clinical audits, help launch a new
initiative, or to undertake training.
One aim of the PPA is to influence and change policy environments so that services can be delivered
less expensively. MSI uses demonstration and advocacy to encourage task shifting by host country
governments. In Malawi in 2009, MSI research demonstrated that clinical officers could safely provide
tubal ligation services to the same standard as doctors. This evidence was shared with the
government and the resulting shift in policy has allowed thousands of rural women who would
otherwise have faced barriers and delays in a country suffering from a shortage of doctors have been
able to access this service. In the Philippines, MSI successfully task shifted IUD insertions from
doctors to midwives. This has resulted in significant increases in IUD insertions and is more costeffective. Providing IUDs to rural and hard-to-reach communities in the Philippines now costs
approximately £5 insertion and MSI expects to provide 200,000 IUDs there in 2010.
MSI’s service delivery models leverage existing resources and infrastructure to offer value for
money as described below:
 MSI’s mobile clinical outreach brings trained medical staff to existing public health centres, where
these services are not otherwise available, to provide free LAPM services (along side the short-term
contraceptives available through the public sector) in hard-to-reach rural and urban slum areas. Using
host government infrastructure and staff in a public private partnership saves substantial funds and
promotes sustainability.
 MSI’s social franchising programmes work with existing independent private sector and NGO
nurses, midwives, doctors and pharmacists who already have their own equipment and facilities. This
allows MSI to focus its intervention on training and quality assurance while making limited
infrastructure investments.
 MSI’s social marketing makes reproductive health (e.g. contraception) commodities widely
available through existing pharmaceutical outlets without requiring any infrastructure investment.
MSI’s own clinics operate on a partial cost recovery model. Clients who can afford to pay are
charged for services while poor clients are charged on a sliding scale or receive services for free
through a subsidised treatment fund. MSI is committed to ensuring that clients seeking FP and
PAC/CAC services will never be turned away due to inability to pay.
Details on procurement can be found in the following section.
At the 18 months point of the PPA with MSI, an external mid term evaluation will be carried out. It will
be reviewed by DFID’s external evaluation managers and used as the basis upon which to decide
future funding allocation. The Value for Money of the PPA with MSI for DFID will be reassessed and
performance related funding released accordingly.
Commercial Case
Indirect procurement
A. Choice of funding mechanism that demonstrates value for money
through procurement
As part of the application process for a Programme Partnership Arrangement (PPA) all applicants
were asked to provide evidence to show how they ensured value for money in their day to day
operations. Using a pre-determined scoring system each applicant was marked between 1 and 4
(with 4 being the strongest scoring) for the response they provided. Each was asked to provide
concrete examples to support the narrative provided. This score was then added to scores allocated
to other issues such as transparency and accountability and results delivery. These scores were
then added together to provide an overall score for the applicant and a decision taken on PPA
partners based on this overall score and the level of funding calculated using the scores.
All of the successful applicants for PPA had to be able not only to describe how they achieved value
for money but also to say how they would achieve further value for money savings over the lifetime of
the PPA funding.
Each PPA partner was asked to complete a Procurement Questionnaire which posed a wide range of
questions aimed at giving a detailed overview of each organisation’s procurement practises and
policies. This completed questionnaire was forwarded to KPMG who were contracted to undertake a
Due Diligence check of all successful PPA partners.
The reports which KPMG produced focused on each PPA partners Internal Governance, their
Financial Management and other areas and included a substantial section entitled ‘Value for money
and procurement capacity and effectiveness’. This section described each PPA partner’s primary
measures of value for money and its baseline procurement capacity in relation to its organisation.
The section tabled the PPA partner’s Primary Objectives, Key performance indicators, set a baseline
for performance for the start of the PPA and set targets for improvements over the lifetime of the
PPA.
Each PPA partner, once finalised, was issued with a Memorandum of Understanding (MOU) which
laid out the generic terms and conditions of the PPA support but also included any specific conditions
which arose as a result of the Due Diligence checks. All of these conditions were allocated
timescales within which agreed improvements had to be made.
Only if we were confident that the PPA holder either already had the relevant processes, systems,
staffing and practices in place to deliver value for money or had agreed to timed conditions relating to
improvements in these areas, would we agree to continue with PPA funding.
Section B: Value for Money through Procurement
MSI described the following as its primary measures of value for money and its baseline procurement
capacity in relation to its organisation:
.
Description of
Primary Objectives
Standardise and
improve Supply
Chain Management
(“SCM”) and fleet
management
Key Performance
Indicators
Number of countries
adopting the SCM
global manual and
toolkit.
Baseline at start of the
proposed grant
This has not yet been started
therefore the baseline is that
no countries currently adopt
the manual.
Targets and dates
Re-launch and review of MSI
SCM and fleet management
with revised global manual
and toolkit which is easily
accessible by the end of
2011
Standardising drugs
and equipment
across the
partnership
Number of countries
applying the
standardised
equipment list.
Improve sustainability
through donated
commodity
Value of Direct
Relief International
(DRI) funded
commodity
donations.
This has not yet been started
therefore the baseline is that
no countries currently adopt
the standardised formulary
and recommended equipment
list.
2010 – USD 1 million
Standardised MSI formulary
and recommended
equipment list across the
organisation by the end of
2011
Increase DRI funded
commodity donations, with
certain focuses, to USD 1.5
million in 2011
MSI has a commercial / profit focused approach to procurement and value for money.
MSI’s head office in London is seeking to foster better visibility and consistency of what is happening
across country programmes. At present there remains a large reliance on programme directors and
those below them to ensure that staff are following good practice and that robust policies are being
developed and enforced. A series of visits through Internal Audit, Finance Capacity Building and
Medical Quality reviews ensure significant weakness are identified and addressed. Standard policies
and procedures are in the process of development for roll out in late 2011.
Financial Case
A. How much it will cost?
The overall PPA budget for the three year period beginning 1 April 2011 has been set at £120m per
financial year (April to March). Of this amount £20m has been ring-fenced for applicants requesting
support under our Humanitarian and Conflict criteria with the balance of £100m per year available to
support CSOs active in any other area of the development arena.
Approval for this overall funding allocation was agreed at ministerial level following a submission to
Ministers on the future of strategic level unrestricted support to CSOs.
To set appropriate funding levels, the Resource Allocation Model (RAM) took account of the size of
the successful CSO (in terms of annual income) as well as the scores allocated to produce a final
breakdown of the PPA budget amongst all successful applicants.
In the case of MSI the RAM produced a proposed PPA funding level of:



2011/12
2012/13
2013/14
£4,353,052
£4,353,052(provisional)
£4,353,052 (provisional)
The level of funding for year one is set but the exact funding level for years two and three will be
dependant on the outcome of an independent evaluation of the MSI PPA after 18 months.
B. How it will be funded: capital/programme/admin
All of the funding for the PPAs will be paid from programme funds.
Over the three year period of PPAs £300m will be paid from Civil Society managed programme funds
with a further £60m paid from CHASE managed programme funds.
C. How funds will be paid out
All of the PPA holders are civil society organisations who do not, as a matter of course, hold large
reserves of funding. To address this issue DFID has secured Treasury approval to pay CSOs in
advance for up to three months. In order to receive this advance payment approval all PPA holders
will be required to, when returning their signed Memorandum of Understanding, request that they be
paid in advance and explain why an advance payment in necessary.
All PPA holders who provide this request and justification for advance payment will be paid quarterly
(in advance) on receipt of a signed request for release of PPA support. Those not requesting
advance payment or providing no supportable justification for such a payment will be paid quarterly
in arrears.
All payments will be made by the Civil Society Department.
D. How expenditure will be monitored, reported, and accounted for
The funding provided through PPA is unrestricted. This means that when DFID transfers the funds to
the PPA holder they are free to use them for any purpose in support of their objectives. As a result
DFID does not ask them to say where the funds were actually used nor is DFID able to trace them
through accounting systems.
However, DFID asks that the PPA holder provide a copy of their certified Annual Audited Accounts
(AAA) and that they clearly show the PPA funding as a distinct line of income.
DFID holds the right, at any time, to access the PPA holder’s financial records through either its own
Internal Audit team or the National Audit Office (NAO).
The MSI PPA will follow these same arrangements.
Management Case
A. Oversight
Before entering any formal agreement with MSI DFID carried out a full due diligence check to ensure
that MSI has both the systems and process and staffing at an appropriate level to successfully
manage the funding being provided.
MSI) will provide the oversight for the PPA support. The PPA Manager, within DFID’s Civil Society
Department, retains oversight of all PPA partnerships within DFID.
DFID contracted an external evaluation manager to work with all PPA holders to ensure robust
logframes, which have achievable outcomes, realistic and measurable milestones and sensible
baselines against which progress can be measured. A logframe has been produced for the MSI PPA
covering the full 3 year period and can be found with other published documents on DFID’s website.
B. Management
Within DFID, Civil Society Department (CSD) will be responsible for the day to day management of
this partnership with MSI. More specifically it will be the Relationship Managers within the CSD team
who will have lead responsibility.
The relationship manager will work closely with MSI, to ensure that it is given support to achieve the
agreed outcomes and to act as a broker to help foster relations between MSI and any relevant DFID
country offices and policy teams. The relationship manager will be responsible for ensuring the terms
and conditions as laid down in the MSI PPA Memorandum of Understanding (MOU) are adhered to
by both partners.
The MOU is the official signed document which lays down the terms and conditions which govern
DFID PPA support to MSI. The MOU covers all areas of the partnership including details on payment
processes, audit requirements, financial commitments and fraud.
In order to maximise learning and knowledge from the PPA partners, Civil Society Department has
allocated one member of staff the role of Learning and Knowledge Adviser for the PPA portfolio.
Through this role the Adviser will work closely with all PPA partners in order to ensure that lesson
learning is shared widely amongst the PPA portfolio of partners, wider civil society and across DFID.
C. Monitoring and Evaluation
The monitoring strategy for each PPA grantee is individually designed (underway) as a response to
their specific logframe requirements for indicator evidence collection.
Monitoring and Evaluation will be integrated into PPA partners’ approach to managing the funding
they receive through the PPA mechanism. There is a strong onus on each PPA to develop a Results
Framework which will allow for a transparent evidence-based assessment of the results and value for
money achieved through the grant they receive. An externally contracted Evaluation Manager has
been put in place to ensure that the monitoring and evaluation strategies adopted by the
organisations are adequate for providing such information and to allow for an overarching fund-level
evaluation to take place.
A Results Framework has been designed by MSI, including a comprehensive logframe, which will be
assessed against the theory of change and throughout the evaluation cycle. To date, the evaluation
manager has assessed the logframe as very clear, and showing that the PPA will be used to support
innovative programming models within selected thematic areasx. Specific technical advice and
guidance has been provided to MSI with a view to strengthen the framework in so far as possible.
The MSI logframe will provide the core framework for monitoring progress against the planned results
for the grant. A baseline will be collected for each indicator articulated in the logframe (at the latest
baseline information will be included 3 months after funding has been agreed, unless otherwise
agreed). This will articulate, either qualitatively or quantitatively, the situation at the outset in the
areas in which MSI proposes to use PPA funding. For advocacy work it is likely that the indicators
and baseline information will be qualitative and provide descriptions of current knowledge,
awareness, understand, attitudes and behaviours.
Monitoring information will be collected regularly by MSI and updated on an Annual basis; it will also
be disaggregated by gender where appropriate.
MSI will commission independent mid-term and final evaluations of its PPA spend. A template Terms
of reference for the mid-term and final evaluations will be developed by the Evaluation Manager for
the Fund and agreed by DFID. These independent reviews will form an evidence base for the midterm and final evaluations of the PPA fund as a whole. The evaluation will use the milestones and
proposed outcomes within the agreed MSI PPA logframe to measure success.
Indicatively the mid-term and final evaluation focus will be to undertake an overall assessment of
MSI’s progress towards Outputs, Outcomes and Impact (where data is available). They will also seek
to make an assessment of the effectiveness and efficiency of delivery, the Value for Money, test the
theory of change and identify key lessons learnt and applied.
D. Risk Assessment
 Risks have been preliminarily assessed, and mitigation will be further addressed throughout
logframe development. As they stand, risks to the programme appear manageable.
Better Aid – Civil Society and Aid Effectiveness (2009) OECD, p 151
Committee of Public Accounts – HC 64 – 22 March 2007
iii
ibid.
iv
REVIEW OF DFID SUPPORT FOR CIVIL SOCIETY- Paper to DFID Development Committee, London (March 2010),
Andrea Ledward, Roy Trivedy
v
REVIEW OF DFID SUPPORT FOR CIVIL SOCIETY- Paper to DFID Development Committee, London (March 2010), Andrea
Ledward, Roy Trivedy
vi
REVIEW OF DFID SUPPORT FOR CIVIL SOCIETY- Paper to DFID Development Committee, London (March 2010),
Andrea Ledward, Roy Trivedy
vii
Supporting results, value for Money and Transparency: DFID’s work with Civil Society, Presentation to Funding the Future,
London (March 2011) Nick Dyer, Director of Policy DFID
viii
PPA Meta-evaluation, London (January 2010), Neil MacDonald
ix
PPA Information Request, 2011,
x
Feedback on Logframe MSI UK, London March 2011, Coffey International Development
i
ii