Thursday, November 14, 2013 Session 2.1.

06 Let the Data do the Talking: Using Data to Advocate for Policy
The Missing Indicator: The use of a strategic advocacy approach to promote data-driven decisions on task-sharing in Kenya
Author(s): Rose Maina, Jhpiego, Marsden Solomon, FHI, ROADS, Stuart Merkel, Jhpiego, Isaac Matonyi Malonza, Jhpiego, Priya Emmart, Gates Institute Innovations in family planning monitoring, evaluation and research Significance/background Under Family Planning 2020 (FP2020), Kenya made a commitment to increase its contraceptive prevalence rate (CPR) from 46% to 56% by 2015. A demonstration project in Tharaka district from June 2009 to August 2010 established the effectiveness of community-based distribution (CBD) of injectable contraceptives to increase the CPR, but until this past year, such distribution was not permitted by Kenyas national family planning service provision guidelines. Previous efforts to change these guidelines had stalled, despite a new constitution that includes a right to health and family planning. Advance Family Planning (AFP), a multi-year advocacy initiative in eight priority program countries, partnered with Jhpiego in Kenya to employ a strategic advocacy approach that was designed to systemically identify and pursue the elements needed for an immediate policy change on the CBD of injectables. Not only did this approach result in the policy change sought, it has also laid the foundation for future family planning policy changes in Kenya, many of which will need to adapt to the countrys recently devolved political authority for health to its 47 county governments. Program intervention/activity tested AFP and its Kenya lead partner, Jhpiego, implemented the Smart ChartTM 3.0 tool for advocacy planning to determine the objectives, decision makers, and activities that were likely to result in implementation of a national policy for the CBD of injectables. The Smart ChartTM was developed by Spitfire Strategies and can be used by any organization to plan an advocacy campaign. It prescribes six sequential topics for discussion: (1) program decisions, or the actors and incremental objectives essential to an overall vision; (2) context, both internal and external to the advocacy group or organization; (3) strategic choices, or focused definitions of audience, concerns and messages; (4) communications activities; (5) qualitative and quantitative measurements of success; and (6) a final reality check that identifies hidden assumptions and ensures a logical flow. For the Kenya Smart

Abstract Type: Program/Best Practices Abstract Topic:

ChartTM process, AFP and Jhpiego invited those with an active interest in CBD policy changes, encouraged group facilitation by an AFP partner from a neighboring country and leadership by the key Kenyan Ministry of Health official for reproductive health, and insisted on activities that clearly led to the policy objective, such as the inclusion of nursing association representatives and collective drafting of the policy circular.

Methodology The AFP/Jhpiego team has been working at a national level in Kenya since November 2011 with the overall goal of reducing unmet need through the use of long-term family planning methods. In the absence of a national family planning policy that expressly allows CBD of injectable contraceptives, community-based family planning strategies are limited in the contraceptive choices that they can offer, particularly to rural women and the urban poor. Building on previous efforts that had been successful in generating evidence but not in linking that evidence with an effective ask for policy change, AFP/Jhpiego designed a strategic advocacy approach that was intended to articulate and achieve favorable policy statements on the CBD of injectables and improve future coordination of family planning advocacy activities. Results/key findings Within one year of beginning the Smart ChartTM approach, all key stakeholders agreed to amend Kenyas national family planning guidelines to allow the CBD of injectable contraceptives. The partnerships formed to attain this policy objective are continuing in the form of a national advisory group for county-level advocacy, to ensure uptake of the policy and the training of community health workers on injectables by county health systems. The years of advocacy and evidencegathering that preceded this process were essential to its success, providing well-defined program decision points and contextual understanding. The Smart ChartTM, however, enabled the catalytic step of creating common strategic choices, or policy asks, and tying them to the most influential evidence for the relevant decision makers, such as data from the demonstration project on increased family planning uptake, antenatal care attendance rates, and facility birth rates. As implemented by the AFP/Jhpiego team, the Smart ChartTM promoted local ownership and South-to-South leadership, but its sustainability for future advocacy efforts and applicability to other settings will depend on continued monitoring. Advocacy groups should use the AFP Results Cascade in concert with the Smart ChartTM to monitor policy momentum and forecast implementation steps most likely to lead to impact. Program implications/lessons Achievement of data-driven policy decisions in the family planning context might be accelerated by use of the Smart ChartTM or other strategic advocacy practices that involve government stakeholders in the development of a formalized advocacy plan. Such practices systematically identify the barriers to policy change and marshal existing evidence to address them. Advocacy groups that adapt the Smart ChartTM for family planning policy objectives should evaluate and document their results and attempt to measure the impact that policy changes have on the underlying public health goals, providing data on the utility of targeted investments in advocacy.