THE SPARHCS PROCESS GUIDE

1
THE SPARHCS PROCESS GUIDE

• A Planning Resource to Improve Reproductive
  Health Commodity Security

2
Acknowledgements

• United States Agency for International
  Development (USAID)
• United Nations Population Fund (UNFPA)
• USAID DELIVER Project
• USAID Health Policy Initiative
• (ACQUIRE) Project
• Engender Health

3
Purpose

• Provide guidance on the uses of the SPARHCS
  Diagnostic Tool
• Demonstrate and encourage the implementation of
  the SPARHCS Approach
• A set of activities from awareness raising and
  diagnosis, to monitoring the effectiveness of a
  funded and implemented strategic plan

4
Background

• Over 40 SPARHCS assessments in Africa,
  Asia/Pacific, LAC, Eurasia regions
• Limited documentation examining diagnostic
  methods, or guidance to adapt approach for
  objectives, resources, and constraints of country
• Focus on joint diagnosis and strategic planning
• Audience TA providers, donors, MOH officials

5
Supporting the Program Cycle
6
I. Getting Started Pre-Process Checklist
7
Examples of Key Decisions
THE COMMODITIES The implications of securing the
full range of essential RH medicines are
substantially different than a focus on
contraceptive commodities, and should be
carefully considered by stakeholders with regard
to available resources and political commitment.
TAKING ACTION Provide support for advocacy
workshops to sensitize decision-makers of the
importance of RHCS at national and local levels.
Encourage agreement by all that the assessment
findings will be used as the basis for concrete
RHCS action plans.
8
II. Awareness Raising Point of Entry for the
Process

• Helps obtain the needed political support for the
  process
• Involves regular communication with target
  audience
• Local data will make presentations more relevant
  and useful
• Emphasize SPARHCS approach should be part of, not
  displace existing systems
• Tools Workshops, the SPARHCS Framework,
  examples, country data analysis

9
III. The Joint Diagnosis

• Understand and document the RHCS status
  nationally, locally, or within a region
• Identify specific gaps/challenges
• Provide basis for strategic planning
• The Diagnostic Tool is flexible, intended to be
  customized.
• Example If RHCS gaps are known to be more
  prevalent in the supply chain, then adapt the
  diagnostic to focus specifically on logistics

10
The major steps of a Joint Diagnosis

• The Pre-Process Checklist?
• Form an RHCS Committee
• Desk-based research/data collection
• Stakeholder consensus on methodology
• In-country interviews, workshops
• Presentation and consensus on findings
• Agreement on strategic planning!

11
RHCS Committee

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

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

12
Desk-based Research/Data Collection

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

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

13
Stakeholder Consensus on Methodology

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

• Why
• Allows stakeholders the opportunity to ask
  questions and provide guidance.
• Raises awareness and strengthens buy in and local
  ownership of the process

14
Adapting the Framework

• Customizing the approach promotes country
  ownership by better aligning the process with
  local priorities and needs
• Stakeholders often elected to identify RHCS
  components using different criteria or to merge
  two or more components.
• Examples
• Madagascar - demography, policy, demand, service
  delivery, and finance
• Egypt - advocacy, finance, logistics, service
  delivery, collaboration coordination
• UNFPA RHCS Situational Analysis Tool (RHCSAT),
  which looks at all the SPARHCS components with a
  special focus on the supply chain

15
In-Country Interviews Workshops

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

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

16
Presentation and Consensus on Findings

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

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

17
IV. Strategic Planning

• The joint diagnosis identifies RHCS strengths and
  weaknesses, the strategic plan is the opportunity
  to address them
• Planning is based on the findings from the
  diagnosis CS experts
• CS committee meetings workshops required
• Why it is important
• Unify stakeholders around a common set of
  objectives
• Prioritizes challenges
• Catalyzes stakeholder commitment to action

18
The Essential Elements of a Strategic Plan
19
Defining the Elements

• Goal - broad, general statement of long-range
  purpose.
• Priority Issues
• Major barriers to RHCS
• Feasibility of addressing those issues within the
  plan
• Objectives One clear and measurable objective
  that address the priority issues (e.g., Capital
  increase and diversify sustainable funding for
  RH commodities.)
• Actions/sub-Actions specific tasks carried out
  to achieve the objectives

20
Defining the Elements (contd)

• Coordinating/Implementing Agencies Groups that
  manage and carry out the activities
• Budget component Bottom Up budgeting by
  estimating costs for each activity. Accuracy
  important for obtaining financial commitment
• ME Plan Develop output indicators and define
  expected outcomes to inform ME Plan
• Output - The intermediate result of the action
  and sub-actions
• Outcome - The (beneficial) effect on the targeted
  population

21
Notes on Strategic Planning Process

• Generally requires the RHCS Committee to meet
  several times to develop the elements
• A Technical Working Group (TWG) proven useful to
  carry out detailed planning
• Diverse group from all sectors, national and
  local experts needed to increase ownership
• Plans value is in implementation!

22
V. Implementation

• Achilles heal of RHCS is transition from planning
  to implementation
• Critical Factors
• Political Will the leadership factor. Public
  sector leaders demonstrating commitment to the
  implementation process
• Detailed Work Planning - help ensure that the
  strategic plan is easily embedded within the
  implementing institutions
• Program Integration included in national
  policy and operational documents, (e.g., PRSPs,
  SWAPs, MTEFs, and MOH work plans).

23
VI. Model Approaches

• Several options to implement SPARHCS Process
• Funding
• Available technical resources
• Scope of the problem
• Level of political support
• Three proposed models have been used in different
  environments that represent variations in cost,
  time, and results

24
Model 1
25
Model 2
26
Model 3
27
Conclusions

• Measure of success will not be in this process,
  but improvements in RH supplies to clients
• The Process Guide is a tool to help manage the
  complex process and define how the process should
  be adapted
• Evidence exists that the process works when
  backed by leadership and commitment