October 2012

REPOSITIONING FAMILY PLANNING IN BURKINA FASO

A Baseline

This publication was prepared by Modibo Maiga and Aissatou Lo (consultant) of Futures Group.

Photo credits: Elizabeth McDavid/Futures Group Suggested citation: Maiga, Modibo. 2012. Repositioning Family Planning in Burkina Faso: A Baseline. Washington, DC : Futures Group and the William and Flora Hewlett Foundation. Futures Group gratefully acknowledges the support of the William and Flora Hewlett Foundation for this research.

Repositioning Family Planning in Burkina Faso: A Baseline

OCTOBER 2012
This publication was prepared by Modibo Maiga and Aissatou Lo (consultant) of Futures Group.

CONTENTS
Acknowledgments .................................................................................................................. iv Abbreviations ............................................................................................................................v Introduction ...............................................................................................................................1 Burkina Faso: Background .......................................................................................................3 Maternal and Child Health ........................................................................................................................ 4 Burkina Fasos Health System .................................................................................................................. 4 National Reproductive Health Policies ..................................................................................................... 5 Framework for Assessing the Repositioning FP Initiative........................................................7 Methodology ............................................................................................................................................. 8 Study Limitations ...................................................................................................................................... 9 Assessment Findings ...............................................................................................................10 SO: Increased stewardship of and strengthened enabling environment for effective, equitable, and sustainable FP programming ............................................................................................................. 10 Intermediate Result 1: Resources for Family Planning Increased, Allocated, and Spent More Effectively and Equitably.................................................................................................................. 12 Intermediate Result 2: Increased Multisectoral Coordination in the Design, Implementation, and Financing of FP Policies and Programs ............................................................................................ 14 Intermediate Result 3: Policies that Improve Equitable and Affordable Access to High-Quality FP Services and Information Adopted and Put into Place ...................................................................... 16 Intermediate Result 4: Evidence-based Data or Information Used to Inform Policy Dialogue, Policy Development, Planning, Resource Allocation, Budgeting, Advocacy, Program Design, Guidelines, Regulations, and Program Improvement and Management ........................................... 19 Intermediate Result 5: Individual or Institutional Capacity Strengthened in the Public Sector, Civil Society, and Private Sector to Assume Leadership and/or Support the FP Agenda ......................... 20 Recommendations for Repositioning Family Planning in Burkina Faso ..............................22 Annex 1: Persons Interviewed................................................................................................24 Annex 2: Repositioning Family Planning Results and Indicators for Burkina Faso ............. 25 References and Additional Resources..................................................................................35

iii

ACKNOWLEDGMENTS
The authors thank the William and Flora Hewlett Foundation, and particularly Margot Fahnestock, Program Officer, Global Development and Population Program, for providing the Futures Group with the funding, support, and guidance for this activity. Many colleagues at Futures Group also deserve thanks: Elizabeth McDavid for her instrumental management support, practical suggestions, and technical expertise; Karen Hardee for her support of all aspects of the studyfrom the questionnaire design to report writing; and Cynthia Green for her invaluable contributions to the report. The author particularly thanks Nicole Judice, who supported the development and pilot-testing (in Tanzania) of the Framework for Monitoring and Evaluating Efforts to Reposition Family Planning and provided our study team with technical assistance related to the framework. Thanks also to Laura McPherson and Sandra Duvall for their insights; and Lori Merritt, Ellen Smith, Molly and Jim Cameron, and Sarah McNabb for their editing of the report. Gratitude also goes to the head of the Directorate of Maternal and Child Health (DSME) in Burkina Faso, Dr. Djeneba Sanon. She provided indispensable assistance and facilitated our work through securing meetings with many family planning stakeholders, including her staff and important leaders at all levels. Finally, the author thanks Dr. Amde Prosper Djiguemd, of the General Directorate for Family Health (DGSF); Dr. Kant Mamadou, the representative of the United Nations Population Fund (UNFPA) Burkina Faso; and Norbert Coulibaly, Ousmane Ouedraogo, Rodrigue Ngouana, and Bahan Dalomi, who facilitated access to key informants.

iv

ABBREVIATIONS
ABBEF AFAFSI AFD AIDS ASMADE AWARE II BURCASO CAMEG Association Burkinab pour le Bien Etre Familial Burkinab Association for Family Welfare Association des Femmes Africaines Face au SIDA Association of African Women Facing AIDS Agence Franaise de Dveloppement French Development Agency acquired immune deficiency syndrome Association Songui Manegre Aide au Dveloppement Endogne Association Songui Manegre Help Endogenous Development Action for West Africa Region II (USAID-funded project) Burkina Council of AIDS Services Organizations Centrale dAchat des Mdicaments Essentiels et Gnriques et des Consommables Mdicaux Center for the Purchase of Generic Essential Medicines and Medical Supplies Conseil dAdministration du Secteur Ministriel Administrative Counsel for the Ministerial Sector community-based distribution Cadre de Dpense Moyen Terme Framework for Expenditures in the Medium Term community health worker Conseil National de Lutte contre le Sida et les Infections Sexuellement Transmissibles National Council for the Fight against AIDS and Sexually Transmitted Infections Comit Technique National National Technical Committee Conseil National de Population National Population Council contraceptive prevalence rate civil society organization Comit Technique Permanent de Concertation entre les Secteurs Priv et Public Permanent Technical Committee for Consultation between the Private and Public Sectors Direction de la Sant des Adolescents, des Jeunes et des Personnes Ages Directorate for the Health of Adolescents, Youth, and the Elderly Direction Gnrale de l'Information et des Statistiques Sanitaires General Directorate for Health Information and Statistics Direction Gnrale de la Sant de la Famille General Directorate for Family Health Demographic and Health Survey Direction de la Sant de la Mre et de lEnfant Directorate for Maternal and Child Health Equilibres et Populations Equilibria and Populations family planning Groupe dAppui en Sant, Communication et Dveloppement Support Group for Health, Communication and Development Deutsche Gesellschaft fr Internationale Zusammenarbeit Groupe Technique Sant de la Reproduction Technical Group for Reproductive Health human immunodeficiency virus
v

CASEM CBD CDMT CHW CNLS-IST CNT CONAPO CPR CSO CTPC DASPAJ DGISS DGSF DHS DSME E&P FP GASCODE GIZ GT/SR HIV

Repositioning Family Planning in Burkina Faso: A Baseline

INSD INSSA IPC IRSS ISSP IUD KFW MS MSI NGO PADS PIC PNDS PNP PNP/SR PROMACO PSSPSR RAJS RBOIPD RENCAP RH SCADD SOGOB SP/CONAPO STI TAC TFR UNDP UNFPA URCB USAID WAHO

Institut National de la Statistique et de la Dmographie National Institute of Statistics and Demography International NGO Safety and Security Association Initiative Prive et Communautaire de Lutte contre le VIH/SIDA Private and Community Initiative to Fight against HIV/AIDS Research Institute in Health Science Institut Suprieur des Sciences de la Population Higher Institute of Population Sciences intrauterine device Kreditanstalt fr Wiederaufbau Ministre de la Sant Ministry of Health Marie Stopes International nongovernmental organization Projet dAppui au Dveloppement Sanitaire Health Development Support Project Plan Intgr de Communication Integrated Communication Plan Plan National de Dveloppement Sanitaire National Policy for Health Development Politique Nationale de Population National Population Policy Politique Norme et Protocole en Sant de la Reproduction Policies, Norms and Protocols in Reproductive Health Programme de Marketing Social et de Communication pour la Sant Program of Social Marketing and Communication for Health Plan Stratgique de Scurisation des Produits de la Sante de la Reproduction Strategic Plan to Secure Access to Reproductive Health Commodities Rseau Africain Jeunesse Sant et Dveloppement au Burkina Faso African Network for Youth Health and Development in Burkina Faso Rseau Burkinab des Organisations Islamiques en Population et Dveloppement Burkinab Network of Islamic Organizations for Population and Development ONG de Renforcement de Capacits NGO for capacity building reproductive health Stratgie de Croissance Acclre et de Dveloppement Durable Strategy for Accelerated Growth and Sustainable Development Societ de Gyncologues et Obsttriciens du Burkina Society of Obstetricians and Gynaecologists of Burkina Secrtariat Permanent du Conseil National de la Population Permanent Secretariat of the National Population Council sexually transmitted infection Tableau dAcquisition des Contraceptifs Table for Contraceptive Procurement total fertility rate United Nations Development Program United Nations Population Fund Union des Religieux et Coutumiers du Burkina Union of Religious and Traditional Leaders of Burkina Faso United States Agency for International Development West African Health Organization
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Abbreviations

WHO

World Health Organization

vii

INTRODUCTION
Demographic pressures and lack of progress toward the Millennium Development Goals (MDGs) have encouraged countries and donors to take a new look at family planning (FP). Since 2001, the United States Agency for International Development (USAID), the World Health Organization (WHO), and other important partners have joined with national governments in sub-Saharan Africa in an initiative to raise the priority for FP programs, known as repositioning family planning. This initiative was established to ensure that family planning remains a priority for donors, policymakers, and service providers in subSaharan Africa in an era when HIV, malaria, and tuberculosis programs dominate the global health agenda and receive a majority of the resources. Although family planning is one of the most cost-effective, high-yield interventions to improve health and accelerate development, West Africa is lagging behind all other regions in FP use. With an average of 5.5 children per woman, the region has one of the highest fertility rates and fastest growing populations in the world. High fertility leads to many unplanned pregnancies that pose serious health risks for mothers and children. In Francophone West Africa, approximately two women die from maternal causes every hour (WHO, 2012c), and one child under age five dies every minute (UNICEF, 2011). There is substantial demand for family planning in Francophone West Africa. In six of the nine countries recently surveyed, an estimated one-third or more of currently married women have an unmet need for family planning (see Figure 1).
Figure 1. Unmet Need for Family Planning
40 35 30 25 20 15 10 5 0 32 35 28 27 29 24 22 16

Percent of Women

29

Source: Demographic and Health Survey data (accessed at: http://www.statcompiler.com/).

Community-based programming is showing promise for expanding access to family planning. Many African countries have community-based programs to provide contraceptive methods and information to under-served groups, such as rural residents and the urban poor.
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Repositioning Family Planning in Burkina Faso: A Baseline

There are vast regional inequalities in access to and use of contraceptives between urban and rural populations, with rural populations almost always having fewer options. Bringing FP services into these communities is an important strategy to improve access to family planning and satisfy unmet need. Several models for the provision of community-based services have been tested successfully in the region. In Francophone Africa, community-based distribution (CBD) for family planning is identified as an underutilized strategy to reach women in rural areas. Family planning is just one of the many health services that use CBD, and community health worker (CHW) training and supervision usually is integrated with these other services (child health services, malaria and diarrhea prevention and treatment, acute respiratory infections treatment, vaccinations, neonatal care, prenatal care, safe motherhood, as well as information on these and other health issues). Currently, in most Francophone West African countries, CHWs offer only condoms, refills on oral contraceptives, and referrals to health facilities. The goal of USAIDs Repositioning Family Planning initiative is to increase political and financial commitment to family planning in sub-Saharan Africa, which will lead to expanded access and help meet womens stated desires for safe, effective modern contraception. The initiative has identified three key approaches to achieving this goal: (1) advocating for policy change; (2) strengthening leadership; and (3) improving capacity to deliver services (USAID, 2006). At the February 2011 Ouagadougou conference, Population, Development, and Family Planning: The Urgency to Act (http://www.conferenceouagapf.org/), the eight participating Francophone countries drafted action plans for repositioning family planning and appointed focal persons to spearhead the implementation of these plans. 1 At a September 2011 conference on civil society involvement in family planning in Mbour, Senegal, additional focal persons were named from civil society organizations (CSOs), and the action plans were refined further. CBD features prominently in all of the action plans. While many activities are underway to reposition family planning, most countries lack a mechanism for assessing the success of their efforts (Judice and Snyder, 2012). In 2011, in response to this gap, the MEASURE Evaluation Population and Reproductive Health project developed a results framework to assess efforts to reposition family planning. The Framework for Monitoring and Evaluating Efforts to Reposition Family Planning can be used by international donors, governments, and health programs to evaluate their efforts; identify gaps in strategies to reposition family planning in countries; and inform funding decisions, program design, policy and advocacy, and program planning and improvement (Judice and Snyder, 2012). After MEASURE Evaluation conducted an initial pilot test in Tanzania, the Health Policy Project adapted and pilot tested the framework in Togo and Niger.2 In 2012, the Futures Group applied the framework to assess Burkina Fasos progress in repositioning family planning. This report presents the results of this application, which can serve as a baseline for future assessments.

The eight countries are Benin, Burkina Faso, Guinea, Mali, Mauritania, Niger, Senegal, and Togo. The results of the pilot test and assessment of policy and operational barriers to CBD in Niger and Togo also are available (visit www.healthpolicyproject.com).
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BURKINA FASO: BACKGROUND

Burkina Faso is one of the worlds poorest countries. Nearly half (47%) of the population lives on less than US$1 a day (UNSTATS, 2012), with a gross national income per person of US$1,250 in 2010 (Haub and Kaneda, 2012). In recent years, Burkina Faso has experienced rapid economic growth, with a 6 percent increase in gross domestic product in 2008, 3 percent in 2009, 8 percent in 2010, and 4 percent in 2011 (World Bank, 2012). About two-thirds of its people are employed in agriculture; mining is also an important source of income (INSD, 2012). Consistent with its economic indicators, Burkina Faso remains near the bottom of the United Nations Human Development Index, which is composed of life expectancy, educational attainment, and economic indicators: it ranks 181 out of 187 countries (UNDP, 2011). The majority of Burkinab adults are unable to read: only 37 percent of men who are age 15 or older and 22 percent of women in this age group are literate (World Bank, 2012). Burkina Fasos population has tripled in size since its independence in 1960 (Guengant et al., 2011). The most recent census, conducted in 2006, reported Burkina Fasos total population to be 13.8 million people (INSD, 2007). The government estimated its total population in 2009 to be 15.2 million (INSD, 2012); its 2012 population is estimated to be 17.5 million people (Haub and Kaneda, 2012). The potential for continued rapid population growth already exists, since nearly half (45%) of Burkina Fasos people are under age 15 (Haub and Kaneda, 2012). Further, Burkina Fasos fertility rate of six children per woman (INSD, 2012) is among the highest in the world. Because of these two factors, Burkina Fasos population is projected to grow to 25.5 million people by 2025 (Haub and Kaneda, 2012) and could reach between 42 and 52 million by 2050 (UN Population Division, 2011). Burkina Fasos population is distributed among 13 regions. It is largely rural, with four in five (79%) of its people living in rural areas as of 2005 (UN Population Division, 2011). Burkina Faso is also becoming rapidly urbanized. The proportion of the population living in urban areas has grown from 6 percent in 1975 to 12 percent in 1985, 15 percent in 1995, and 22 percent in 2005 (UN Population Division, 2011). According to a Burkinab survey on living conditions in 2003, 46 percent of the total population is poor, including 52 percent of the rural population and 20 percent of the urban population (INSD, 2009). Burkina Fasos total fertility rate (TFR) has exhibited only a slight downward trend over the past two decades. The most recent Demographic and Health Survey (DHS), conducted in 2010, showed a TFR of 6.0 children per woman, down from 6.2 in 2003, 6.8 in 1998/99, and 6.9 in 1993 (INSD, 2012). Contraceptive use has increased only slightly in the past decade. The contraceptive prevalence rate was 12 percent of married women ages 1549 in 1998/99 (INSD, 2000), 14 percent in 2003 (INSD, 2004), and 16 percent in 2010 (INSD, 2012). According to the 2010 DHS, 15 percent of married women were using modern contraceptive methods and 1 percent were using traditional methods. Injectables are the most popular contraceptive method, followed by implants and oral contraceptives. These methods are provided mainly in government health centers and hospitals (INSD, 2012). Despite the low use of contraceptives, many Burkinab women express a desire to limit and space their pregnancies. According to the 2010 DHS, one in four (24%) Burkinab women ages 1549 in unions had an unmet need for family planning. This means that they did not want to have another child, either at all or in the near future, but were not using any form of family planning. Of the married Burkinab women surveyed, 17 percent said they would like to wait at least two years before having another child and 7 percent of women did not want another child (INSD, 2012).
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Repositioning Family Planning in Burkina Faso: A Baseline

Maternal and Child Health

Burkina Faso has made considerable progress in making childbirth safer. The maternal mortality ratio has been halved over the past two decades, dropping from a ratio of 700 maternal deaths per 100,000 births in 1990 to 300 in 2010 (WHO, 2012c) (see Box 1). Burkina Faso now has the lowest maternal mortality ratio in the West Africa region, ahead of countries such as Ghana and Senegal. In contrast, infant and child mortality rates have declined modestly and remain higher than those in neighboring countries. Nearly one in 10 infants (9%) dies before their first birthday. This high mortality rate continues throughout childhood, with nearly 18 percent of children dying before their fifth birthday (UNICEF, 2011).

Box 1: Maternal and Child Health Indicators Maternal mortality ratio: 300 deaths per 100,000 births (WHO, 2012c) Lifetime risk of maternal death: 1 in 55 women (WHO, 2012c) Women who received prenatal care from a health professional: 95% (INSD, 2012) Births attended by a skilled provider: 67% (INSD, 2012) Infant mortality rate: 93 deaths per 1,000 births (UNICEF, 2011) Mortality rate for children under five: 176

Even with the recent progress in safe motherhood, Burkina Faso faces many challenges in improving overall health status. One in 55 women has a life-long risk of dying due to pregnancy and childbirth (WHO, 2012c).

Burkina Fasos Health System

Burkina Fasos government spends 6 percent of its gross domestic product on health annually, which averages to US$88 per person (WHO, 2012a). Foreign assistance accounted for 26 percent of total health expenditures in 2008 (MS, 2009). Despite these investments, Burkina Fasos health infrastructure is inadequate to meet the existing needs of its population. According to the Ministry of Health (MS), the country has 1,443 health and social welfare centers, 44 medical center surgical units, nine regional hospital centers, three university hospitals, and one national hospital. The country has just four hospital beds per 10,000 people (WHO, 2012b).
Box 2: Ratio of Health In addition, Burkina Faso has a severe shortage of trained Professionals to Population, 2011 health providers, with one doctor per 22,017 people and one nurse per 5,056 people (see Box 2). The WHO Doctors 1: 22,017 in 2011 recommends that countries have an average of 2.28 health Nurses 1: 5,056 in 2011 professionals per 1,000 people (2006). However, the Source: MS, 2012b; WHO, 2012b. estimates of health professionals in Burkina Faso in 2004 totaled less than one health professional per 1,000 people. In 2004, there were 0.06 doctors per 1,000 people, 0.41 nurses per 1,000 people, and 0.13 midwives per 1,000 people (WHO, 2006). Even if the country had adequate numbers of health professionals, many health workers are based in urban areas, leaving rural and remote districts with limited health services.

Burkina Faso: Background

National Reproductive Health Policies

Burkina Faso adopted its first National Population Policy in 1991, led by the National Population Council (CONAPO). A second National Population Policy, known as PNP 2000, was adopted in December 2000 (Ministre de lEconomie et du Developpement, 2000). PNP 2000 has six objectives:
1. Contribute to the improvement of the health of the population, especially reproductive health. 2. Improve knowledge surrounding issues of population, gender, and development. 3. Promote a more balanced spatial distribution of the population, especially in policy planning,

taking into account migration.

4. Promote the integration of population, gender, and sustainable development programs at national,

regional, and local levels.

5. Develop human resources. 6. Ensure effective coordination and better monitoring and evaluation of the PNP implementation.

In July 1996, Burkina Faso adopted a National Pharmaceutical Policy to ensure that essential medicines are safe, of high quality, and available throughout the country at low cost. This policy integrates contraceptive purchasing into the broader health commodities system. Burkina Faso also adopted a 10year Strategic Plan for Reproductive Health for 19982008. This plan called for all major governmental planning to include the reproductive health (RH) objectives set out in the national plan. It also called for a rapid increase in contraceptive use, with a quadrupling of the contraceptive prevalence rate (CPR) by 2008. Another policy, the National Health Development Plan 20012010 (PNDS), also set a goal for increasing the CPR, but this goal was not reached. The PNDS was revised in 2006 to cover the years 20062010. It set an even higher CPR goal by 2010, which was not reached. Burkina Faso adopted the Reproductive Health Law in December 2005. This law was drafted to fill the legal vacuum regarding sexual and reproductive health and to amend the Act of 1920 that banned family planning. Based on the principles adopted at the 1994 International Conference on Population and Development held in Cairo, the RH Law guarantees the right of individuals and couples to reproductive health; equitable access to RH care; and respect for the physical integrity of women and girls, including elimination of female genital cutting, rape, sexual abuse, and incest. It contains the definitive statement contained in several international agreements: Couples and individuals should freely decide the number of children and the spacing of their births. The newly issued National Plan to Reposition Family Planning 20132015 sets the most ambitious goal yet, which is to increase contraceptive prevalence from 15 percent of married women in 2010 to 25 percent in 2015. To support this goal, the government, technical and financial partners, and representatives of civil society have worked together to develop a repositioning family planning plan that focuses on eight priority actions to be implemented without delay:
1. Increasing demand for family planning by conducting rural outreach 2. Increasing demand among urban residents using mass media campaigns 3. Educating adolescents and youth in family planning 4. Reducing contraceptive stockouts by improving primary data collection and information

management
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Repositioning Family Planning in Burkina Faso: A Baseline 5. Improving the quality of training in primary healthcare services 6. Improving the coverage of people in suburban and rural areas using mobile units and innovative

strategies
7. Improving coverage of rural populations by strengthening community-based services 8. Monitoring and evaluating implementation of the plan.

To facilitate the implementation of this plan, the priority actions have been specified for each region and contraceptive prevalence goals specific to each region were defined with the support of McKinsey & Company, Futures Group, and Futures Institute. High-risk births are a main driver of maternal mortality. The Department of Family Health, under the aegis of the MS, has elaborated three strategic plans to lower maternal mortality rates (19941998, 1998 2000, and 20042008). In reference to the Millennium Development Goals, in 2006, Burkina Faso adopted the Plan to Accelerate the Decrease in Maternal and Neonatal Mortality for the years 20062015. According to this plan, the CPR was to reach 20 percent in 2006 and 30 percent in 2015. A Strategic Plan to Secure Contraceptive Commodities (PSSPC) 20062015 is currently being implemented. This plan was introduced in the context of frequent contraceptive shortages, insufficient training in their use, limited private sector provision of contraceptives, and weak monitoring and supervision. A Strategic Plan to Secure Access to Reproductive Health Commodities (PSSPSR) for 2009 2015 was adopted in 2010. This plan integrates the existing plan for contraceptive commodities and aims to ensure a steady and reliable provision of contraceptives, as well as to meet clients needs for essential RH services throughout the country. In February 2011, Burkina Faso hosted an international conference with the theme Family Planning in the Context of Population and Development: The Urgency to Act, attended by representatives of 12 ECOWAS (Economic Community of West Africa) countries. These Francophone West African countries reaffirmed their commitment to addressing population and FP issues as top development priorities. The Burkinab President, Blaise Compaor, was the opening speaker of the conference. Burkina Faso also sent a delegation to the Summit on Family Planning, held in London in July 2012.

FRAMEWORK FOR ASSESSING THE REPOSITIONING FP INITIATIVE

The overall strategic objective (SO) of the Framework for Monitoring and Evaluating Efforts to Reposition Family Planning (hereafter referred to as the M&E Framework) is Increased stewardship of and strengthened enabling environment for effective, equitable, and sustainable FP programming. Under the SO, there are three illustrative indicators:
1. Instances of a government-led council, coalition, or entity that oversees and actively manages the

FP program
2. Instances of documented improvement in the enabling environment, using a validated instrument 3. Evidence of FP policies implemented and resources allocated and subsequently used in relation to

the same FP policies Each IR has specific indicators that contribute to overall achievement of the IR (see Figure 2).
Figure 2. Results Framework for Strengthening Commitment to and Increased Resources for Family Planning

SO: Increased stewardship of and strengthened enabling environment for effective, equitable, and sustainable FP programming

IR1: Resources for FP increased, allocated, and spent more effectively and equitably

IR2: Increased multisectoral coordination in the design, implementation, and financing of FP policies and programs

IR3: Policies that improve equitable and affordable access to high-quality FP services and information adopted and put into place

IR4: Evidence-based data or information used to inform advocacy, policy dialogue, policy development, planning, resource allocation, budgeting, program design, guidelines, regulations, program improvement, and management

IR5: Individual or institutional capacity strengthened in the public sector, civil society, and private sector to assume leadership and/or support the FP agenda

Source: Judice and Snyder, 2012.

Repositioning Family Planning in Burkina Faso: A Baseline

Methodology
After the M&E Framework was field tested in Tanzania in 2011 and finalized, Futures Group staff reviewed the tools developed for Tanzania and subsequently adapted them for use in West Africa and translated them into French. The Futures Group then tested the M&E Framework in Togo and Niger with funds from the Health Policy Project. In preparation for the application of the M&E Framework with Hewlett Foundation funding, Futures Group proposed a different methodology for working in six countries of Francophone West Africa. 3 In Mali, a four-person Futures Group team tested a more participatory and interactive methodology, which produced excellent results. The change in methodology consisted of holding a meeting of stakeholders and collecting information to complete the framework questionnaire as a group, rather than conducting individual interviews and then compiling the findings. After holding the initial meeting, the team then filled out missing or incomplete information through interviews with key informants. This new methodology was more efficient in terms of gathering the necessary information and helped to identify topics for which more information was needed. After the Mali application, the Futures Group team decided to continue to use the Mali methodology for the five remaining countries.
Document Review and Key Stakeholder Interviews

A Futures Group staff member, Modibo Maiga, conducted the study in Burkina Faso. Field work took place in Burkina Faso from May 30 to June 10, 2012. First, the Futures Group representative reviewed policies, strategies, program materials, and other information related to the framework and policy. Next, he met on June 7 with the main FP stakeholders in Burkina Faso and collected information on each intermediate result and indicator. He then conducted interviews with key informants recommended by the various stakeholders. The key informants were identified through contacts with Dr. Djeneba Sanon, the director of the Directorate for Maternal and Child Health (DSME); Ousmane Ouedraogo, the civil society focal point for family planning; Bahan Dalomi and Rodrigue Ngouana from Equilibres & Populations; local documents; and subsequently, other informants. Those interviewed included two of the four focal persons for the Repositioning Family Planning Initiative; government and donor focal persons identified and nominated at the Ouagadougou FP conference in February 2011; and CSO focal persons identified at the Mbour, Senegal, conference for CSOs held in September 2011. As shown in Table 1, 24 stakeholders either participated in the meeting or were subsequently interviewed.
Table 1. Affiliation and Sex of Key Informants Interviewed in Burkina Faso Government Officials
Men Women Total 2 1 3

Donors
1 1 2

CAs/CSOs
13 6 19

CHWs
0 0 0

Local Leaders
0 0 0

Total
16 8 24

The six countries are Benin, Burkina Faso, Guinea, Mali, Mauritania, and Senegal. 8

Framework for Assessing the Repositioning FP Initiative

Once the group had completed a draft of the indicator table, the Futures Group representative sent it to the participants of the working meeting for their feedback and received additional input from three individuals. He then drafted the report after obtaining feedback from the participants.
Ethical Considerations

The protocol and data collection instruments for both components of this study were submitted to the Futures Group Research Ethics Committee and were deemed exempt from review by an Institutional Review Board.

Study Limitations
The work was focused on key informants and participants in the meeting to prepare the framework. All information gathering took place in Ouagadougou. The Futures Group representative was unable to collect information and views among regional representatives.

ASSESSMENT FINDINGS
This section presents the findings from the pilot test of the M&E Framework. The findings are presented according to the SO indicators and intermediate results, as delineated in the framework. Annex 2 summarizes the findings in table format.

SO: Increased stewardship of and strengthened enabling environment for effective, equitable, and sustainable FP programming
Indicator 1: Instances of a government-led council, coalition, or entity that oversees and actively manages the FP program

Burkina Faso has several entities that guide FP programs. DSME oversees FP programs under the aegis of the MS. The General Directorate for Family Health (DGSF); the Directorate for the Health of Adolescents, Youth, and the Elderly (DAPSAJ); CONAPO; and the Department for Community Health are further examples of government bodies actively involved in FP activities. The Health Development Support Project (PADS) and the Center for the Purchase of Generic Essential Medicines and Medical Supplies (CAMEG) work to improve access to RH services. Following the 2011 conference on Population, Development and Family Planning in Francophone West Africa: The Urgency to Act, held in Ouagadougou, FP leaders prepared a strategic plan. Several documents, including the National Population Policy, clearly indicate support for FP programs. Several civil society organizationsthe Association Burkinab pour le Bien Etre Familial (ABBEF), EngenderHealth, and Marie Stopes International (MSI)are also implementing FP activities throughout the country. The Steering Committee for the Reproductive Health Commodity Security Strategic Plan, which includes all FP key stakeholders, is the unifying framework for the orientation, development, and monitoring of all strategies for repositioning family planning in Burkina Faso.
Indicator 2: Evidence of documented improvement in the enabling environment for family planning, using a validated instrument

Data from two validated instruments are available to assess the enabling environment for family planning in Burkina Faso. The Family Planning Program Effort Scores were developed as an international measure to gauge key areas of each countrys FP program. The scores are based on the average scores submitted by 1015 local experts on 30 indicators that cover a countrys FP program in terms of policies, services, evaluation, and access to FP methods. Burkina Fasos score has fluctuated greatly in the past decadefirst rising sharply from 46.0 in 1999 to 58.3 in 2004, and then declining to 45.6 in 2009 (Ross and Smith, 2010). As the highest score is 100, the scores indicate considerable room for improvement in Burkina Faso. The Contraceptive Security Index uses a rating system that assigns points to 17 indicators related to the supply chain, finance, the health and social environment, access to family planning, and use of FP. The scores for Burkina Faso have improved over the years, with a score of 39.5 in 2003, 49.9 in 2006, and 53.2 in 2009 (out of a possible 100 points) (USAID | DELIVER, 2003, 2006, 2009). The improvement is encouraging, although the scores still indicate a relatively low level of contraceptive security.
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Assessment Findings

Policymakers and program managers need to increase efforts to ensure that adequate contraceptive supplies are widely available. Burkina Faso adopted the Reproductive Health Law in December 2005. This law was drafted to fill the legal vacuum regarding sexual and reproductive health and to amend the Act of 1920 that banned family planning. Based on the principles adopted at the 1994 International Conference on Population and Development held in Cairo, the RH Law guarantees the right of individuals and couples to reproductive health; equitable access to RH care; and respect for the physical integrity of women and girls, including elimination of female genital cutting, rape, sexual abuse, and incest. Key informants report that some aspects of the RH Law are not applied. Nevertheless, it is an important indicator of support for access to RH services. The National Population Policy, revised in 2010, provides clear evidence of a favorable environment for family planning. It also contains a Strategic Plan to Secure Contraceptive Health Commodities 2006 2015. Key government documents (policies, laws, and strategies) also refer to data taken from reliable sources. The main sources for FP indicators in Burkina Faso are the health statistics and the Demographic and Health Surveys (the statistical annual report of the MS, results from assessments and specific surveys such as the annual survey on the availability of RH commodities). The MS produces an annual statistics report with a chart including primary reproductive health indicators. Other sources of reproductive health data include an index of initiatives, a Table for Contraceptive Procurement (TAC), an annual survey of the availability of reproductive health commodities, and various other assessments. These data support an increased role for family planning within the various national planning policies for health, even if FP interventions are often subsumed by reproductive health or family health. Most of the key stakeholders (including civil society organizations) that promote family planning in Burkina Faso use data from the DHS. There are no official national surveys that deal specifically with family planning. Such surveys would help decisionmakers to better understand policy priorities and investments in this field.
Indicator 3: Evidence of FP policies implemented and resources allocated and subsequently used in relation to the same FP policies

The challenge in assessing this indicator is that, as indicated above, few policies focus entirely on family planning. However, guidelines for the various policy prescriptions and national strategies indicate that FP programs are receiving funding. FP resources are allocated to contraceptive commodities, as well as logistics and strengthening of the human resources capacity for FP services. Health clinics have qualified health providers and field staff who can provide FP services. However, Burkina Faso has a serious shortage of health professionals, as shown in Box 2. Given the shortage of health providers, key informants have suggested that task shiftingdelegating additional tasks to existing personnelcould help to ease the burden of highly skilled providers. For example, community health agents could be trained to provide oral contraceptives and injectables safely. Private sector companies and CSOs such as ABBEF and Marie Stopes International allocated their funds to FP service delivery and contraceptive commodities.

11

Repositioning Family Planning in Burkina Faso: A Baseline

Operational action plans for reproductive health commodities exist at the district, regional, and central health department levels. Financing workshops for these action plans are organized each year as part of a decentralized management policy based on results-based financing (an approach that rewards healthcare providers for performance, rather than supporting operational costs). A new World Bank-funded Reproductive Health Project will apply results-based financing to improve the delivery and quality of a package of RH services. The project will be implemented through PADS in five treatment districts, which will be matched with five control districts. The project will support staff, equipment, pharmaceutical products, and the costs of community health groups, known as health mutuals. The maximum funding provided to each district is US$300,000 annually. With support from the United Nations Population Fund (UNFPA), DSME will evaluate several additional policies, including the Strategic Plan for Health among Youth 20042008, Norms and Standards for Health Services for Youth, and the Framework for Expenditures in the Medium Term (CDMT). Other relevant documents are the policies, norms, and procedures in reproductive health and strategic plans produced by nongovernmental organizations (NGOs), the private sector, ABBEF, MSI, and the Program of Social Marketing and Communication for Health (PROMACO).

Intermediate Result 1: Resources for Family Planning Increased, Allocated, and Spent More Effectively and Equitably
The M&E Framework has four indicators related to resources for family planning: IR1.1: Total resources spent on family planning (by source and activity/program area) IR1.2: Number of new financing mechanisms identified and tested IR1.3: Total resources allocated to family planning (by source and activity) IR1.4: New and/or increased resources are committed to family planning in the last two years
IR1.1: Total resources spent on family planning (by source and activity/program area)

It is not always easy to find the full amount of financial resources allocated to family planning, especially given the dearth of national reports focused on this field. It is, however, important to highlight the existence of a specific budget line for the purchase of contraceptive commodities, which have been regularly supplied by the government since 2008. Several partners support FP programs in Burkina Faso, including the UNFPA, USAID, Kreditanstalt fr Wiederaufbau (KFW), the World Bank, and several international NGOs. Through a line item in the budget, the Burkina Faso government provided 359,000,000 West African CFA Franc (FCFA) toward the purchase of contraceptive commodities in 2007. It has increased its funding since then (see Table 1). This table represents the data that the Futures Group representative collected from various sources; it is incomplete and hence the total amounts are likely to be greater.

12

Assessment Findings

Table 2. Funding Allocations to FP/RH Programs, 20092012

Funder 2009 FCFA (millions) 2010 FCFA (millions) 2011 FCFA (millions) 2012 FCFA (millions) Total FCFA (millions) Total $US

Support for FP/RH Services UNFPA for FP/RH services ABBEF/ IPPF (for FP services and commodities) MSI (for FP services) 174.0 129,489.0 405.0 5,435.5

114,616.0 475.3

244,105.0 730.5

488,210.0 3,569.8

975,493,225 7,132.9

Funding for Contraceptive Commodities Government UNFPA USAID KFW/ WAHO 600.0 791.9 204.6 300.0 800.3 135.1 500.0 235.3 0 175.0 500.0 (planned) 1,794.9 475.4 190.0 3,622.4 815.1 175.0 379,639 7,215,391 1,629,459 349,668

Resources leveraged for family planning have increased in recent years. MSI is scheduled to nearly double its funding in 2013, to 1, 428,969,831 FCFA. Agence Franaise de Dveloppement (AFD) has announced that it will fund FP activities in 2013. CSOs such as ABBEF, MSI, and EngenderHealth also receive various forms of assistance for FP programs from their donors.
IR1.2: Number of new financing mechanisms identified and tested

In late 2011, the World Bank initiated a reproductive health project with a budget of US$28.9 million over four years. The project will provide a package of RH services through results-based financing in five regions of the country. A second component financed by an International Development Association grant will support three activities: (1) training of nurses, skilled birth attendants, and doctors; (2) provision of drugs and equipment to improve obstetric and neonatal services; and (3) strengthening demand for FP and RH services. Marie Stopes International is launching a social franchising network to partner with private health providers to offer FP services. MSI has a central clinic that offers comprehensive FP/RH services, as well as outreach teams that provide intrauterine devices (IUDs) and implants to women in remote areas.
IR1.3: Total resources allocated to family planning (by source and activity)

As indicated above in IR1.1, the amount of resources (of all kinds) allocated to FP is difficult to assess. A national budget line item to purchase modern contraceptives has existed since 2008. This line item pays for 30 percent of the total costs of contraceptives. Refer to IR1.1 and Annex 2 for more detailed resource allocation figures.

13

Repositioning Family Planning in Burkina Faso: A Baseline IR1.4: New and/or increased resources are committed to family planning in the last two years

New donors such as UNFPA, KFW, ABBEF/IPPF, the World Bank, MSI, and the RESPOND project (Responding to the Need for Family Planning through Expanded Contraceptive Choices and Program Services) have emerged during 2011 and 2012. Further, the announcement from the AFD that it will fund FP programs has been encouraging to local stakeholders.

Intermediate Result 2: Increased Multisectoral Coordination in the Design, Implementation, and Financing of FP Policies and Programs
This IR assesses the extent to which various disciplines, such as health, education, agriculture, and the environment, as well as the public and private sectors, are involved in FP policymaking and implementation. In general, the Futures Group representative found numerous examples of multisectoral coordination, which will be reported under the various sub-IRs.
IR2.1: Evidence of FP programs incorporated into strategic national and development plans

Most health policy documents include family planning, usually as part of maternal and child health. Examples are the Plan to Prevent Mother-to-child Transmission of HIV, the Strategic Plan to Secure RH Products 20092015, the Plan to Accelerate the Reduction of Maternal and Neonatal Mortality in Burkina Faso, the PNDS 20112015, and the Reproductive Health Protocols issued in Box 3. Key National Policies and Plans that Include Family May 2010 (see Box 3).
Planning

Family planning is also taken into account in the Strategy for Accelerated Growth and Sustainable Development (SCADD) 20112015, the Strategic Framework on HIV/AIDS and STIs 20112015, the National Health Policy, the National Population Policy 20112030, and within the policy statement for the National Gender Policy for Burkina Faso adopted in 2009.
IR2.2: Evidence of governments engaging multiple sectors in FP activities

National Policy for Health Development (20112015) Plan to Accelerate the Reduction of Maternal and Neonatal Mortality in BF (20062015) Integrated Coverage of Childhood Diseases/Coverage Plan (20052010) Strategic Plan to Secure RH Products (20092015) National Plan for Health Development (20112020) Reproductive Health Protocols 2010 Strategy for Accelerated Growth and Sustainable Development (SCADD) 20112015 Strategic Network on HIV/AIDS and STIs 20112015

Under the leadership of the government, through the MS, Burkina Faso has adopted a participatory approach to drafting several policy documents and has designed frameworks to facilitate consultation and the involvement of various sectors in steering committees, including the private sector and NGOs. Through a multisectoral approach, the government included the community and private sector in the planning and implementation of the National Health Policy. In implementing the 20082012 extension phase of the Support Program for Developing the Health Sector, the government involved NGOs/CSOs and the private sector in contracting out some health services. NGOs are active in the Steering Committee for the Reproductive Health Commodity Security Strategic Plan. Since the 2011 Ouagadougou conference, the Technical Group

14

Assessment Findings

Box 4. Decrees and Minutes from Multisectoral Committees Decree # 2006062 to nominate members of the Permanent Technical Committee for Consultation (CTPC) between the Private and Public Sectors Report drafted by the Committees and by the Steering Committee for the Table for Contraceptive Procurement (TAC) Law # 20110361/MS/CAB regarding the creation, composition, duties, and work of the Steering Committee to Implement the Plan to Secure Reproductive Health Products

on Reproductive Health (GT/SR), including NGOs working for family planning/reproductive health, has been actively involved with DSME in the design of a plan to reposition family planning. While there are opportunities to involve civil society in consultative bodies, some stakeholders are concerned that such involvement may make it more difficult to reach a consensus. These stakeholders suggest that the current RH consultative mechanisms be restructured to allow for efficient participation. Such a change would allow capable spokespeople to share their concerns and provide useful feedback.
IR2.3: Evidence of multisectoral structures established or strengthened to promote FP policy

Meetings of the Technical Committee (once per trimester) and the Steering Committee for the Reproductive Health Commodity Security Strategic Plan (once every six months) indicate that national multisectoral mechanisms to promote and implement RH programs are in place (see Box 4). Within these mechanisms, under the leadership of the MS, other sectors are mobilizing to become more involved in the national processes to design FP policies and coordinate program interventions. Such Box 5. Existing laws and conventions with is the case with the Network of Parliamentarians, the regards to the participation of NGOs and Group of Partners led by AFD, the Coalition of the private sector in FP policy Private Sector Organizations, the Network of Decree # 2005-398 /PRES/PM/MS Religious and Traditional Leaders, and the Technical regarding private health practices Group for Reproductive Health, including NGOs and national RH networks. These civil society groups Law # 2006-061 regarding the design and launch of private health facilities actively promote family planning and are especially active in advocacy to mobilize additional resources National multisectoral plan to fight for FP programs. against STD/HIV/AIDS 2012
IR2.4: Evidence of government support for private sector participation in family planning
Protocols for partnership between the MS and the NGO RENCAP and Community-based implementing organizations Reports drafted by the sessions of the National Technical Committee (CNT) Committees minutes and the steering committees reports Law #10 /92/ADP December 15, 1992 portant libert de cration dAssociations

There is ample proof of the governments willingness to support and involve the private sector in promoting family planning. The multisectoral approach adopted long ago has served as a base to involve several sectors in promoting reproductive health (see Box 5). For example, since 2008 the government has issued many contracts to national NGOs to build their capacity. It has integrated the activities of CSOs in

15

Repositioning Family Planning in Burkina Faso: A Baseline

the national FP action plan since the 2011 conference in Ouagadougou. Also, the private sector has participated in the negotiation structures and in the Administrative Counsel for the Ministerial Sector (CASEM). As part of the new World Bank RH project implemented during 20112016, the private sector coalition is implementing an action plan to strengthen the use of social franchising in the provision of FP services.

Intermediate Result 3: Policies that Improve Equitable and Affordable Access to High-Quality FP Services and Information Adopted and Put into Place
IR3.1: Existence of national or subnational policies or strategic plans that promote access to FP services and information

The country has many national strategic policies and plans at the national and subnational levels to increase access to services and information about family planning. PNDS, the Strategic Plan to Secure RH Products, and the Integrated Communication Plan (PIC) are national structures that give priority to promoting family planning. The National Population Policy and the National Gender Policy also take RH issues into account. The adoption of specific laws (the Reproductive Health Law and the Law on HIV) and the existence of several implementation policies for these two laws also contribute to the national politico-legal environment that supports reproductive health. The fundamental issue remaining is the efficient implementation of the RH Law to meet the needs of all individuals and couples who wish to have access to affordable, equitable, and quality FP services. This requires design and implementation. An innovative strategy to meet the unmet need for family planning is still lacking.
IR3.2: Existence of national or subnational policies or strategic plans that promote access to FP services and information for under-served populations

For several years, national FP policies and plans have designated youth as a priority group. Burkina Faso has a National Reproductive Health Policy among Youth and Teenagers, Norms and Standards for Services to Youth, and a Strategic Plan for RH for Youth supported by UNFPA (see Box 6). The Ministry for Social Action and NGOs have created youth centers (youth clubs), which provide RH services in urban and semi-urban centers. In the formal sector, the Ministry of Education has undertaken several initiatives to integrate reproductive health in the teaching modules at the secondary school level. Several other initiatives are designed to assist under-served groups:

Box 6. Documents pertaining to policy and strategy Document on Policies, Norms and Procedures (PNP) Reproductive Health Policy among Youth and Teenagers List of legal and regulatory documents pertaining to Reproductive Health and Family Planning in Burkina Faso

Some NGOs and associations are providing FP/RH services for vulnerable groups, such as sex workers, students, and hawkers (street sellers). Several projects are assisting mental health patients, people living with handicaps, and indigent groups.
16

Assessment Findings

NGOs such as PROMACO and ABBEF target men but they remain very marginal. The government is developing community-based FP/RH services to reach remote populations and groups who have difficulty in accessing FP/RH services. While these initiatives are encouraging, the Futures Group representative noted the lack of specific and innovative strategies to engage men in FP programs in a constructive manner. National agencies are paying more attention to meeting the needs of key populations at high risk of HIV infection. This interest could lead to concrete actions and could inspire HIV programs to give more attention to people with an unmet need for FP services.
IR3.3: Documentation of instances in which a formal implementation or operational directive or plan is issued to accompany a national or subnational FP policy

Several plans and guidelines are in place to support FP policy. The Futures Group representative identified action plans that focus on population issues: the Strategic Plan to Secure RH Products and the operational plans of several NGOs. The Consolidated Action Plan for Family Planning (20112015), which resulted from the 2011 Ouagadougou and Mbour conferences, is in the process of being finalized. The Ministry of Health has taken the initiative to implement several policies. These policies include a draft to harmonize the cost of contraceptive methods, a national guide to apply financing based on the results in the health sector in September 2010, guidelines for providing and distributing contraceptives, and national guidelines to supervise reproductive health activities, including family planning. The costs of contraceptive services remain a barrier for adolescents, youth, and poor women, especially in peri-urban and rural areas. As shown in Table 3, FP clients must pay for FP services offered by both public and private providers. The governments circular letter No. 0754/MS/SG/DGS/DSF of April 7, 2011, states that female patients are exempt from paying for the insertion and removal of implants and IUDs. However, the existing system requires patients to pay 1,000 FCFA for the implant and 800 FCFA for the IUD; these prices include the cost of the commodity. It appears that the governments circular letter/order is not being implemented in many public health facilities.
Table 3. Price of Contraceptive Services Charged to Clients by Major Providers (in FCFAs) Contraceptive Method
Tubal ligation Vasectomy IUD Insertion Implant Insertion Injectables 800 1,000 500

Public Services

Marie Stopes International

Mobile Teams 500 500 500 600 Health Facilities 5,000 2,000 1,000 3,000 800

ABBEF

PROMACO

1,000 800

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Repositioning Family Planning in Burkina Faso: A Baseline

Contraceptive Method
Pill Male Condom Female Condom Emergency Contraception (EC) IUD Removal Implant Removal Copper T380 IUD Ovrette pill Microgynon pill No-sampoon vaginal tablets Noristrat Injection Prgnon (EC) Standard Days Method (Collier/Cycle Beads)

Public Services
100 10 100

Marie Stopes International

Mobile Teams Health Facilities 100 10 100 500 500 750 2,000 1,500 3000

ABBEF

PROMACO

200 10 100 19 100

1,000 100 100 200 500 1,000

500

IR3.4: Evidence that policy barriers to accessing FP services and information have been identified and/or removed

The passage of the RH Law in 2005, which nullified the 1920 law forbidding the provision of FP services, removed a major obstacle to promoting family planning. The inclusion of national capacity initiatives on family planning and reproductive health in annual action plans will help to improve access to FP/RH services. Provision of community-based services will help to broaden access to contraceptives and FP information. The government also plans to introduce two new contraceptive implantsSinoimplant and Implanon. Despite the efforts of partners and the government, several other obstacles to FP access remain, including unnecessary medical requirements, negative attitudes among some health providers, and some sociocultural beliefs. The obstacles posed by the cost of FP services remain and make access to services
18

Assessment Findings

more difficult for indigent groups. The RH Law has not been fully applied, and many peopleeven some health providersare unaware of its provisions.
IR3.5: Evidence of the implementation of policies that promote FP services and information

The government of Burkina Faso has undertaken several initiatives to make FP services and information widely available. FP services are offered in all health centers throughout the country and at the community level by CSOs and a few private clinics. The government has committed itself to purchase contraceptive commodities using national funds. Campaigns for family planning have been conducted with the support of UNFPA as part of PIC. NGOs are also permitted to import contraceptive commodities without paying taxes. A national Family Planning Week was launched in 2012.

Intermediate Result 4: Evidence-based Data or Information Used to Inform Policy Dialogue, Policy Development, Planning, Resource Allocation, Budgeting, Advocacy, Program Design, Guidelines, Regulations, and Program Improvement and Management
IR4.1: Evidence of data or information used to support repositioning FP efforts

FP specialists are using a variety of data sources, including data from DHS and other surveys, analyses based on the Spectrum policy modeling software suite, and service delivery and program reports from various stakeholders. Data collected regularly include the quantity of contraceptive commodities per FP method, the number of new users of each method, the number of former users seeking advice, new clients seeking advice in each health district, the rate of use of FP services, the level of acceptability for family planning, the coverage level for contraceptive commodities, providers attitudes about long-term methods, and the RH needs of teenagers and youth. Several advocacy tools based on these data sources have been developed. The RAPID model and materials designed for religious leaders have been presented to high-level policymakers, including the Minister of Health. The advocacy tool Burkina Faso en Marche was presented to the President of Burkina Faso and Members of Parliament as well as at the regional level to support repositioning family planning initiatives.
IR4.2: Evidence of international best practices incorporated into national health standards

The following best practices have been applied in Burkina Faso: Promotion of long-term methods in health centers and mobile units Involvement of men through communication campaigns Involvement of civil society, the private sector, religious leaders, and Members of Parliament Design of a strategy to encourage peer education, especially among youth Computerization of information to manage RH commodities and supplies Installation of an alert system to track the status of RH commodities With the planned strengthening of FP programs, the country can apply these best practices more widely and ensure that FP services and information are widely available.
IR4.3: Evidence of a defined and funded research agenda in family planning

Examples of research-related activities conducted in research and training centers include the following:
19

Repositioning Family Planning in Burkina Faso: A Baseline

Operational research supported by Deutsche Gesellschaft fr Internationale Zusammenarbeit (GIZ) regarding community-level distribution channels Creation of the General Directorate for Health Information and Statistics (DGISS) to oversee health research Involvement of the Research Institute for Health Sciences in RH research Review of the FP program through the Strategic Plan to Secure RH Commodities Strengthening documentation and dissemination of best practices and lessons learned in FP/RH In general, the Futures Group representative concluded that research efforts are inadequate to meet the needs of FP programs. Neither the donors nor the government give sustained attention to research.
IR4.4: Evidence of in-country organizational technical capacity for the collection, analysis, and communication of FP information

Many agencies in Burkina Faso have benefited from capacity-building workshops on data collection, analysis, and communication in family planning. These agencies include the DGISS, the National Institute for Statistics and Demography (INSD), the Research Institute in Health Science (IRSS), the Higher Institute of Population Sciences (ISSP), CONAPO, and the General Directorate for Family Health. All of these agencies contribute to the analysis of the health information system, planning for the DHS, dissemination of results drawn from studies and evaluation reports, and the use of Spectrum for demographic projections.

Intermediate Result 5: Individual or Institutional Capacity Strengthened in the Public Sector, Civil Society, and Private Sector to Assume Leadership and/or Support the FP Agenda
IR5.1: Evidence of entities provided with donor assistance that demonstrate capacity to independently implement repositioning FP activities

Donors have provided funding to implement annual action plans at the central and regional levels, with a substantial amount allocated to capacity building of technical and management skills. Several national and international NGOs (MSI, ABBEF, Initiative Prive et Communautaire de Lutte contre le VIH/SIDA [IPC], Equilibres et Populations [E&P], PROMACO, and RENCAP) are active in mobilizing resources and implementing programs promoting family planning. Moreover, there is a coalition of CSOs that support family planning through the RH Technical Group, Rseau Burkinab des Organisations Islamiques en Population et Dveloppement (RBOIPD), and Union des Religieux et Coutumiers du Burkina (URCB).
IR5.2: Evidence of government departments or other entities established or strengthened to support the FP agenda

DSME was created with a clear mandate and well-defined responsibilities; it is the governmental entity that supports the FP agenda. It provides central direction and coordinates the FP initiatives of the collaborating agencies, including the private sector, and monitors their activities by reviewing regular reports. DSME liaises with other ministries for any question pertaining to family planning in Burkina Faso. The various collaborating agencies provide feedback to DSME so it can coordinate all of the initiatives to reposition family planning. DSME manages the Annual Review of the TAC to ensure that demand for contraceptives is met. The General Department for Family Health; the Department of Health among Youth, Teenagers, and the Elderly; the General Department for Pharmaceuticals, Medicine, and

20

Assessment Findings

Laboratories (pharmaceutical policy, provision of medicine and monitoring of safety); and the National Laboratory for Public Health (quality control of commodities) also collaborate to support FP programs. Burkina Faso has many professional associations and networks that work to strengthen FP programs. The professional associations include the Societ de Gyncologues et Obsttriciens du Burkina (SOGOB), Doctors Registries, Midwives Registries, and the Midwives Association. Training schools include Unit de Formation et de Recherche en Science du Dveloppement (UFR/SDS), the International NGO Safety and Security Associations (INSSA), Ecole Nationale de la Sant (ENSP), and Ste Edwige, as well as training sites for nurses and midwives. Groups working on youth-oriented programs include the Directorate for the Health of Adolescents, Youth, and the Elderly (DASPAJ) and the youth center Social Action. National networks that are mainly focused on AIDS are the Rseau Africain Jeunesse Sant (RAJS), Burkina Council of AIDS Services Organizations (BURCASO), and Association des Femmes Africaines Face au SIDA (AFAFSI). There is also a network of journalists, a network of Parliamentarians, religious networks such as URCB, GT/SR, and the coalition of the private sector. International NGOs include MSI, E&P, ABBEF, PROMACO, and EngenderHealth.
IR5.3: Evidence of targeted public and private sector officials, faith-based organizations, or community leaders publicly demonstrating new or increased commitment to family planning

In Burkina Faso, several leaders have made public statements about family planning; they can be considered FP champions. Most importantly, President Blaise Compaor gave the keynote speech on family planning at the 2011 Ouagadougou conference. The First Lady, the Prime Minister, and the Minister of Health have all made public statements regarding family planning. Several civil society organizations have also helped launch FP initiatives. Groups of Parliamentarians have focused their advocacy efforts on population, gender, and development. The religious coalition (URCB) and RBOIPD have both been very active in their advocacy efforts. The URCB benefited from training in advocacy strategies provided by AWARE II (Action for West African Region) and has three effective advocacy tools based upon Islamic and Christian teachings and traditions. URCB provided advocacy training in family planning to local leaders and potential champions; members also showed enough open-mindedness to talk about family planning within communities. Other active groups include the NGO Technical Group for Reproductive Health, a youth network in RH, and a private sector coalition. As a result of these advocacy campaigns, many traditional and community leaders have increased their commitment to family planning.
IR5.4: Number of regional/national centers or collaboratives for shared education and research in family planning

While the Futures Group representative did not identify a reference center focused exclusively on family planning, there are research centers that work on FP issues. These include the IRSS, the Health Research Center in Nouna, the Superior Institute for Population Studies, the Research Institute for Development, the Muraz Center, and international research offices such as the West African Health Organization (WAHO).

21

RECOMMENDATIONS FOR REPOSITIONING FAMILY PLANNING IN BURKINA FASO

Burkina Faso has made considerable efforts in recent years to expand access to modern FP methods. However, given the objectives the country has set for itself in its policies, much remains to be done to improve the repositioning of family planning. The process of refining its action plan currently underway represents a major opportunity to implement priority innovative actions that can increase access to FP services and information by using best practices. The main recommendations suggested by key informants are the following:
Strengthen coordination. The General Directorate for Family Health and the Directorate for Maternal

and Child Health must improve their coordination at the national level to better support civil society initiatives and also to generate more enthusiasm among donors. The MS has several steering and monitoring committees. Key informants recommend that the ministry strengthen the Steering Committee for the Reproductive Health Commodity Security Strategic Plan so that this group can take on responsibility for the monitoring and implementation of the FP action plan. This greater coordination can also entail revising the PSSPSR, since its strategies have not always been consistent with efficient actions to reposition family planning.
Promote public-private partnerships. Strengthening the dialogue between the public and private sectors could effectively reinforce this partnership. A true demonstration of a public-private partnership would be to launch a parity-based Ministry of Health/NGO entity. Civil society could advocate that this entity be created through the Technical and Financial Partners group, which is composed of the major donors. Design innovative strategies to better target youth and populations with limited access to family planning. Young people under age 25 group remain an important part of the population that does not yet

have access to FP services. Youth who are especially vulnerable are those who are not in school, female domestic workers, travelling saleswomen, and young women living apart from their families or without both of their parents.
Experiment with delegating FP tasks. Burkina Faso has an acute shortage of trained midwives, with one

midwife per 27,000 inhabitants instead of the proportion of one midwife per 3,000 people recommended by the WHO (2006). However, the country has many delivery attendants, who are professionals trained at the National School for Public Health. These delivery attendants are located in all health facilities and assist with most of the deliveries in rural and semi-urban areas. Key informants recommend that some tasks associated with provision of FP services be delegated to delivery attendants until more trained midwives are available at peripheral health centers. Such a delegation of tasks could include pilot testing provision of injectables at the community level by community health agents.
Scale up best practices. Innovative programs in the subregion and in Burkina Faso have been

successful in increasing contraceptive use. Examples are social franchising via setting up networks of clinics and community agents and initiatives to engage men in family planning. Applying these practices in Burkina Faso could help to increase contraceptive use and prevent unintended pregnancy.

22

Recommendations for Repositioning Family Planning in BURKINA FASO Reinforce leadership by strengthening organizational capacity and recruiting more FP champions. Civil society groups are well structured and organized through the Technical Group for

Reproductive Health. Strengthening the capacity of these stakeholders would enable them to play key roles as effective FP champions and as watchdogs who monitor policy and program implementation and track funding commitments and expenditures.
Disseminate the RH Law widely. The Reproductive Health Law passed in 2005 remains poorly known among the general public. Key informants recommend that it be disseminated in local languages to improve public knowledge and attitudes about sexual and reproductive rights and health.

The 2010 DHS indicates that Burkina Faso has made remarkable progress in repositioning family planning. The CPR has increased by 1 percent annually from 2006 to 2010. With a CPR of 15 percent of married women in 2010, Burkina has the highest CPR of all West African countries except Ghana (Haub and Kaneda, 2012). Building on the dynamic partnership of the Ouagadougou conference, Burkina Faso has prepared an excellent Plan of Action for Family Planning. The plan sets a goal of achieving a CPR of 25 percent by 2015. This goal may seem ambitious, but it can be achieved if the plan is actually funded and implemented with the full participation of all stakeholders, including the private sector and NGOs.

23

ANNEX 1: PERSONS INTERVIEWED

Name
Dr Djiguemd Amde Prosper Dr Djeneba Sanon Dr Milton B. Amayun, MD, MPH Kathy Webb Dr Mamadou Kant Dr Norbert Coulibaly BA Youssouf BADOLO Ousmane BAHAN Dalomi BONOU Nicole CHINNICI Daniela COMPAORE Alizata COULIBALY T. Georges KABORES. Sylvia Z. KABORE Michel KOULA Etienne LOPEZ-COTARELO Teresa OUEDRAOGO Ousmane OUEDRAOGO Boureihiman OUEDRAOGO Nicolas OUEDRAOGO Acha OUEDRAOGO Elie RODRIGUE Ngouana SAWADOGO Om Koulsoum SINKONDO Y. Isidore SOME Paul Andr

Title, Organization
General Direction of Family Health, Ministry of Health Direction of Mother and Child Health (DMCH), Ministry of Health Family Health Team Leader, USAID USAID Representative of UNFPA, Burkina Faso Focal Point, UNFPA, DMCH of the MS ABBEF Johns Hopkins Program for International Education in Gynecology and Obstetrics Consultant IPC Medicus Mundi Andawcia Fondation Rama MSI/BF Association Songui Manegre Aide au Dveloppement Endogne (ASMADE) SOS Souli & Dveloppement SOS/JD Medicus Mundi Andawcia BURCASO ABBEF PROMACO RAJS/BF GASCODE E&P MDF-F BURCASO RESPOND Project

24

ANNEX 2: REPOSITIONING FAMILY PLANNING RESULTS AND INDICATORS FOR BURKINA FASO
Repositioning Family Planning Results and Indicators for Burkina Faso
Indicators Information Indicator Source

Strategic Objective: Increased stewardship of and strengthened enabling environment for effective, equitable, and sustainable FP programming SO.1: Instances of a governmentled council, coalition, or entity that oversees and actively manages the FP program Existence of DSME, DGSF, DASPAJ, CONAPO, Steering Committee for the Reproductive Health Commodity Security Strategic Plan, a Department for Community Health, PADS, and CAMEG. Decree N2011 -156/PRES/PM/Ministry of Health (MS), dated March 24, 2011, regarding organization of the MS Structure of the MS in 2011 Decision regarding the composition, responsibilities, and daily work of the CONAPO and Steering Committee for the Reproductive Health Commodity Security Strategic Plan Family Planning Program Effort Scores: 46.0 out of 100 in 1999 58.3 in 2004 45.6 in 2009 Contraceptive Security Index: 39.5 out of 100 in 2003 49.9 in 2006 53.2 in 2009 There is clear evidence of a favorable environment for the National Population Policy, which was revised in 2010. Its key strategy is FP. It contains PSSPSR for 20092015. The MS produces an annual book of statistics that includes a chart on the main RH indicators and an index of initiatives; an annual survey of the availability of RH commodities is also part of this context, as well as various assessments conducted. Ross and Smith, 2010

SO.2: Evidence of documented improvement in the enabling environment for FP, using a validated instrument

USAID | DELIVER, 2003, 2006, 2009

SP/CONAPO, DGISS, DSME

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Repositioning Family Planning in Burkina Faso: A Baseline

Indicators
SO.3: Evidence of FP policies implemented and resources allocated and subsequently used in relation to the same FP policy

Information
Operational action plans exist at the district, regional, and central health department levels. Financing workshops for these action plans are organized annually as part of the decentralized management policy based on performance-based financing, which was implemented through PADS. DSME will be evaluating the Strategic Plan for Health among Youth 2004 2008; Norms and Standards for Health Services for Youth; CDMT; and the strategic plans produced by NGOs, the private sector, ABBEF, MSI, and PROMACO.

Indicator Source
General Department for Family Health, MS PADS DGISS

IR1: Resources for FP increased, allocated, and spent more effectively and equitably IR1.1: Total resources spent on FP (by source and activity/program area) This indicator is hard to measure because of its complexity. Contributions were as follows: Contribution of the government for the purchase of contraceptive commodities: 2007: 359,000,000 FCFA 2008: 600,000,000 FCFA 2010: 300,000,000 FCFA 2011: 500,000,000 FCFA 2012: 500,000,000 FCFA (planned) UNFPA : 2009: $1,582,313 USD 2010: $1,599,153 USD 2011: $470,265 USD 2012: $3,031,838 USD USAID : 2009: $408,741 to purchase implants 2010: $270,762 to purchase implants 2012: $589,924 to purchase implants, $318,412 for injectables, and $41,620 for male condoms KFW/WAHO: 175,000, 000 FCFA in 2011 ABBEF/IPPF to purchase contraceptive commodities and support FP Annual reports Thematic funding

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Annex 2: Repositioning Family Planning Results and Indicators for Burkina Faso

Indicators
activities: 2010: $258,731,529 USD 2011: $229,015,083 USD 2012: $487,746,613 USD

Information

Indicator Source

MSI : 2009: 174,039,867 FCFA 2010: 405,048,504 FCFA 2011: 475,318,799 FCFA 2012: 730,516,112 FCFA 2013: 1,428,969,831 FCFA (planned) IR1.2: Number of new financing mechanisms identified and tested IR1.3: Total resources allocated to FP (by source and activity) RH Project of the World Bank/ private sector financing: US$28.9 million over four years. Social franchise of MSI. RENCAP/Number, zones and Coulibaly financing for the social franchise (including the project for social franchise) Prospect/See, ASMADE/PROMACO, and army services Available information presented in IR1.1. Evaluation of the situation regarding FP and future perspectives (DSME, Draft du Plan National de Relance de la Planification Familiale 20132015, September 2011) SP/PNDS Department for Research and Health Planning Framework for Expenses in the Mid-Term Annual reports Joint thematic funding UNFPA

27

Repositioning Family Planning in Burkina Faso: A Baseline

Indicators
IR1.4: New and/or increased resources are committed to FP in the last two years

Information
New donors, such as UNFPA, KFW, ABBEF/IPPF, World Bank, MSI, and RESPOND, have emerged these last two years, as well as the AFD.

Indicator Source
Ouagadougou Action Plan and report on the roundtable

IR2: Increased multisectoral coordination in the design, implementation, and financing of FP policies and programs IR2.1: Evidence of FP programs incorporated into strategic national and development plans Inclusion of FP in strategic plans, Plan for Prevention of Mother-to-Child Transmission of HIV 20112015 (as a pillar for prevention of transmission); the Strategic Plan to Secure RH Products 20092015; the Plan to Accelerate the Reduction of Maternal and Neonatal Mortality in Burkina Faso; PNDS 2011 2020; and the RH Protocols dated May 2010. FP is also included in SCADD 20112015, the Strategic Framework on HIV/AIDS and STIs 20112015, the National Health Policy, the National Population Policy 20112030, and in the policy statement for the National Gender Policy in Burkina Faso, adopted in 2009. The government has involved the community and the private sector in the planning and implementation of the National Health Policy. There is also a strategy in place to involve NGOs/CSOs in implementation of the extension phase (20082012) of the Support Program for Developing the Health Sector. NGOs are also active in the Steering Committee for the Reproductive Health Commodity Security Strategic Plan and the Technical Group on Reproductive Health. DSME SP/CONAPO SP/PNDS SP/CNLS-IST (Conseil National de Lutte contre le Sida et les Infections Sexuellement Transmissibles)

IR2.2: Evidence of governments engaging multiple sectors in FP activities

Decree N2005 -398 /PRES/PM/MS on conditions for private work in health services Law N2006-061 regarding the conditions to create and open private healthcare clinics National multisectoral plan to fight against STI/HIV/AIDS 2012 Protocols regarding partnerships with ENCAP and community-based implementing organizations Reports of the sessions held by the CNT; reference terms for GT/SR

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Annex 2: Repositioning Family Planning Results and Indicators for Burkina Faso

Indicators
IR2.3: Evidence of multisectoral structures established or strengthened to promote FP policy

Information
The organization of meetings of the Technical Committee (once per trimester) and the Steering Committee for the Reproductive Health Commodity Security Strategic Plan (once per semester). The existence of the Network of Parliamentarians, the Group of Partners led by AFD, the Coalition of Private Sector Organizations, the Network of Religious and Traditional Leaders, and the Technical Group for Reproductive Health.

Indicator Source
Law N2006-062 on nominating members of the CTPC between the private and public health sectors Report of the committees and reports of the pilot committees regarding TAC Receipts of Law 2011-0361/MS/CAB regarding the creation, composition, and duties of the Steering Committee for the Reproductive Health Commodity Security Strategic Plan Conventions Documented plans Legal documents Re-creation of entities Reports

IR2.4: Evidence of government support for private sector participation in FP

Contracts issued to national NGOs to build their capacity, integration of CSO activities in the national action plan for FP since 2011, and CSO participation in the coordination framework. The private sector has participated in the negotiation structures and in CASEM. As part of the new World Bank RH project implemented during 20112016, the private sector coalition is implementing an action plan to strengthen the use of social franchising in provision of FP services.

IR3: Policies that improve equitable and affordable access to high-quality FP services and information adopted and put into place IR3.1: Existence of national or subnational policies or strategic plans that promote access to FP services and information PNDS, Strategic Plan to Secure RH Products, PIC National Policy on Population National Policy on Gender Law on Reproductive Health Law on HIV Implementation documents for the RH Law and HIV Law Sites of MS, Ministry of Economy and Finance, and Promotion of Women

29

Repositioning Family Planning in Burkina Faso: A Baseline

Indicators
IR3.2: Existence of national or subnational policies or strategic plans that promote access to FP services and information for under-served populations IR3.3: Documentation of instances in which a formal implementation or operational directive or plan is issued to accompany a national or subnational FP policy IR3.4: Evidence that policy barriers to accessing FP services and information have been identified and/or removed

Information
National Reproductive Health Policy among Youth and Teenagers, Norms and Standards for Services to Youth, and a Strategic Plan for RH for Youth. Youth centers created by the Ministry for Social Action and NGOs. The Ministry of Education is integrating RH into secondary schools. Several projects for mental health patients, people living with handicaps, and indigent groups. Actions by PROMACO and ABBEF to target men.

Indicator Source
Document regarding Policies, Norms, and Protocols in Reproductive Health (PNP/SR) Reproductive Health Policies for Youth and Adolescents List of legal and regulatory documents in reproductive health and family planning in Burkina Faso

Action plans that focus on population issues, the Strategic Plan to Secure RH Products, and the operational plans of several NGOs. The National Plan to Reposition Family Planning (Plan National de Relance de la Planification Familiale) (20132015) Circular Letter N0 0754/MS/SG/DGS/DSF of April 7, 2011 on the service delivery cost for the insertion and removal of implants and IUDs. Draft policy to harmonize contraceptive costs; national guidelines to supervise RH activities, including FP.

Documents, PNP/SR, decree, and official guidelines for annual planning Needs assessment in Urgent Obstetrical Care for Newborns (Soins Obsttricaux Nonataux dUrgenceSONU) and regional surveys Annual surveys regarding the availability of RH Circular Letter N0 0754/MS/SG/DGS/DSF of April 7, 2011 on the service delivery cost for the insertion and removal of implants and IUDs Assessment of FP in 2010 led by the Department for Mother and Child Health; study by Engender Health/UNFPA; ministerial decree regarding setting costs for generic essential medicines; guidelines for annual planning, PNP/SR Document, SG/MS 2011 on the alignment of insertion and withdrawal costs for implants and IUDs

Cancellation of the 1920 law forbidding provision of FP services. Inclusion of national capacity initiatives on FP and RH in annual action plans. Provision of community-based services. Government plans to introduce new contraceptive implantsSino-Implant and Implanon. Remaining obstacles to FP access are unnecessary medical requirements, negative attitudes among some health providers, some sociocultural beliefs, cost of FP services, and lack of awareness of the RH Law.

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Annex 2: Repositioning Family Planning Results and Indicators for Burkina Faso

Indicators
IR3.5: Evidence of the implementation of policies that promote FP services and information

Information
Provision of FP services in all health centers in the entire country, as well as at the community level by CSOs. FP campaigns supported by UNFPA as part of the PIC. Removal of taxes on imported contraceptive commodities for all CSOs. State commitment to purchase contraceptives out of the national budget. Launch of a national FP week in 2012.

Indicator Source
Annual Statistics of MS, 2010 and 2011 (MS, 2012b) and reports drafted by partners Certificate to remove import duties for contraceptives for NGOs Reports on national FP campaigns Budget line since 2008 for the purchase of modern contraceptive (30% of total costs) Vouchers Annual action plans, 2012

IR4: Evidence-based data or information used to inform advocacy, policy dialogue, policy development, planning, resource allocation, budgeting, program design, guidelines, regulations, program improvement, and management IR4.1: Evidence of data or information used to support repositioning FP efforts Use of data from the DHS and other surveys; analyses based on Spectrum policy modeling software suite. The RAPID model for advocacy presented to high-level policymakers, including the Minister of Health. Advocacy tool Burkina Faso en Marche presented to the President of Burkina Faso and to Members of Parliament, as well as at the regional level. Promotion of long-term methods in health centers and mobile units. Involvement of men through communication campaigns. Involvement of civil society and the private sector, religious leaders, and Members of Parliament. Design of a strategy to encourage peer education, especially among youth. Computerization of information to manage RH commodities and supplies. Installation of an alert system to track the status of RH commodities. Provisional results of the DHS IV Report on FP campaigns Reports on the activities of CONAPO, Balance, and population on the presentation of the advocacy tool Burkina Faso en Marche

IR4.2: Evidence of international best practices incorporated into national health standards

PNP/SR PIC FP Action Plan Civil Society Organization URCB Strategic Plan ABBEF RENCAP

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Repositioning Family Planning in Burkina Faso: A Baseline

Indicators
IR4.3: Evidence of a defined and funded research agenda in FP

Information
Operational research supported by GIZ regarding community-level distribution channels. Creation of DGISS to oversee health research. Involvement of IRSS in RH research. Review of the FP program through the Strategic Plan to Secure RH Commodities. Strengthening documentation and dissemination of best practices and lessons learned in FP/RH.

Indicator Source
Protocols Decree on creation Reports Dissemination of studies and evaluations

IR4.4: Evidence of in-country organizational technical capacity for the collection, analysis, and communication of FP information

Many agencies in Burkina Faso have benefited from capacity-building workshops on data collection, analysis, and communication in FP, including DGISS, INSD, IRSS, ISSP, CONAPO, and the General Directorate for Family Health. All of these agencies contribute to the analysis of the health information system, planning for the DHS, dissemination of results drawn from studies and evaluation reports, and the use of Spectrum for demographic projections.

Report on training for capacity building, communication Reports on the DHS and other surveys

IR5: Individual or institutional capacity strengthened in the public sector, civil society, and private sector to assume leadership and/or support the FP agenda IR5.1: Evidence of entities provided with donor assistance that demonstrate capacity to independently implement repositioning FP activities Regular financing of annual action plans at the central and regional levels for health and of health districts, with a substantial proportion of capacity building of technical and management skills. Several national and international NGOs (MSI, ABBEF, IPC, E&P, PROMACO, and RENCAP) are mobilizing resources and implementing FP programs. A coalition of CSOs that support FP through the Technical RH Group, RBOIPD, and URCB. Annual action plans for health structures Reports on the initiatives of various NGOs Coalition of CSOs/FP Reports on activities

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Annex 2: Repositioning Family Planning Results and Indicators for Burkina Faso

Indicators
IR5.2: Evidence of government departments or other entities established or strengthened to support the FP agenda

Information
General Department for Family Health. General Department for Maternal and Child Health. DASPAJ. General Department for Pharmaceuticals, Medicine, and Laboratories (pharmaceutical policy, provision of medicine and monitoring of safety). National Laboratory for Public Health (quality control of commodities). Professional associations and learned societies (SOGOB, doctors registries, midwives registries, midwives associations). Training schools (UFR/SDS, INSSA, ENSP, Ste Edwige). Training sites for nurses and midwives. National networks (RAJS, BURCASO, AFAFSI, journalists' networks, the Network of Parliamentarians, Technical Group for Reproductive Health, private-sector coalition; ONG de Renforcement de Capacits (ONG RENCAP); ABBEF, youth centers organized by RAJS and lABBEF; Youth Center Social Action; thematic group in RH; religious networks (URCB); international NGOs (MSI, E&P, ABBEF, PROMACO, ENGENDER).

Indicator Source
Decree organizing the MS Documents produced by the National Assembly of NGOs

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Repositioning Family Planning in Burkina Faso: A Baseline

Indicators
IR5.3: Evidence of targeted public and private sector officials, faith-based organizations, or community leaders publicly demonstrating new or increased commitment to FP

Information
Public speech of President Blaise Compaor at the 2011 FP conference held in Ouagadougou. Public statements on FP by the Prime Minister, First Lady, and Minister of Health. There are few champions but CSOs have launched several initiatives. Groups of Parliamentarians are advocating on population, gender, and development. The religious coalition (URCB) and RBOIPD are active advocates. Other active groups are the NGO GT-RH Group, youth network in RH, and the private sector coalition. Increased commitment from customary and community leaders in favor of FPthanks to advocacy campaigns targeting them.

Indicator Source
Presidents speech Religious tool RAPID Burkina Faso en Marche Various reports Annual reports Thematic funds Reports in mass media Report on the FP situation in 2010

IR5.4: Number of regional/national centers or collaboratives for shared education and research in FP

IRSS, Health Research Center in Nouna; Superior Institute for Population Studies; Research Institute for Development; the Muraz Center; and international research offices, such as WAHO.

Institutes Websites Bulletins

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REFERENCES AND ADDITIONAL RESOURCES

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INSD, Ministry of Economy and Finances, and MEASURE DHS/ICF Macro. 2011. Demographic and Health Survey IV and Multiple Indicators (MICS) 2010: Preliminary Report. Ouagadougou, Burkina Faso. Judice, N., and E. Snyder. 2012. Framework for Monitoring and Evaluating Efforts to Reposition Family Planning. Washington, DC: Futures Group. Accessed at: http://www.cpc.unc.edu/measure/publications/SR-12-63 Ministre de lEconomie et du Developpement. 2000. Cadre Stratgique de Lutte contre la Pauvret (20002002). Ouagadougou, Burkina Faso. Ministre de lEconomie et du Developpement. 2003. Cadre Stratgique de Lutte contre la Pauvret (20032006). Ouagadougou, Burkina Faso. Ministre de lEconomie et du Developpement. 2009. Stratgie de Croissance Acclre et de Dveloppement Durable (SCADD) 20112015. Ouagadougou, Burkina Faso. Ministre de lEconomie et du Developpement, and Ministry of Economy and Finance. 2000. National Population Policy of Burkina Faso. Ouagadougou, Burkina Faso. Ministre de la Recherche Scientifique et de lInnovation. 2011. Evaluation des Besoins en Soins Obsttricaux et Nonataux dUrgence, Couple la Cartographie de lOffre de soins en Sant de la Reproduction au Burkina Faso. Ministre de la Sante (MS). 2000a. Document de Politique Sanitaire Nationale. Ouagadougou, Burkina Faso. MS. 2000b. Plan National de Dveloppement Sanitaire 20012010. Ouagadougou, Burkina Faso. MS. 2003. Programme National dAssurance Qualit en Sant. Ouagadougou, Burkina Faso. MS. 2004. Plan Stratgique pour une Maternit Moindre Risque 20042008. Ouagadougou, Burkina Faso. MS. 2005a. Normes et Protocoles en IEC/Sant. Ouagadougou, Burkina Faso. MS. 2005b. Plan Stratgique de Scurisation des Produits Contraceptifs 20062015. Ouagadougou, Burkina Faso. MS. 2005c. Politique Nationale dInformation, dEducation et de Communication pour la Sant. Ouagadougou, Burkina Faso. MS. 2006. Plan dAcclration de Rduction de la Mortalit Maternelle au Burkina Faso (Feuille de Route). Ouagadougou, Burkina Faso. MS. 2007. Plan National de Dveloppement Sanitaire 20062010. Ouagadougou, Burkina Faso. MS. 2009a. National Health Accounts. Ouagadougou, Burkina Faso.

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United States Agency for International Development (USAID). 2006. Repositioning Family Planning in sub-Saharan Africa: An Issue Brief. Retrieved July 23, 2012 from http://transition.usaid.gov/our_work/global_health/pop/techareas/repositioning/briefs/repo_subafr.pdf. USAID | DELIVER Project. 2003. Contraceptive Security Index 2003: A Tool for Priority Setting and Planning. Arlington, VA: USAID | DELIVER Project. Retrieved on September 9, 2012 from http://deliver.jsi.com/dlvr_content/resources/allpubs/factsheets/CSInde_2003_Book.pdf. USAID | DELIVER Project. 2006. Contraceptive Security Index 2006: A Tool for Priority Setting and Planning. Arlington, VA: USAID | DELIVER Project. Retrieved on September 9, 2012 from http://deliver.jsi.com/dlvr_content/resources/allpubs/factsheets/CSInde_2006_Book.pdf. USAID | DELIVER Project, Task Order 1. 2009. Contraceptive Security Index 2009: A Tool for Priority Setting and Planning. Arlington, VA: USAID | DELIVER Project, Task Order 1. Retrieved on September 9, 2012 from http://deliver.jsi.com/dlvr_content/resources/allpubs/factsheets/CSIndex_WallChart_WebBklet.pdf World Bank. 2012. World Development Indicators. Retrieved on September 11, 2012, from http://databank.worldbank.org/ddp/editReport?REQUEST_SOURCE=search&CNO=2&country=BFA&s eries=&period= . World Health Organization (WHO). 2006. Working Together for Health: The World Health Report 2006. Retrieved from http://www.who.int/whr/2006/whr06_en.pdf. WHO. 2012a. Burkina Faso Country Profile. Geneva: WHO. WHO. 2012b. Global Health Observatory Data Repository: Country statistics: Burkina Faso. Retrieved on September 12, 2012, from http://apps.who.int/ghodata/?vid=4700&theme=country#. WHO. 2012c. Trends in Maternal Mortality: 19902010. WHO, UNICEF, UNFPA and the World Bank Estimates. Geneva: WHO. Retrieved July 23, 2012 from http://whqlibdoc.who.int/publications/2012/9789241503631_eng.pdf.

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For more information, contact: Futures Group One Thomas Circle, NW, Suite 200 Washington, DC 20005 Tel: (202) 775-9680 Fax: (202) 775-9694 Email: policyinfo@futuresgroup.com