Regional Framework for Regional Framework for Sexual and Reproductive Sexual and Reproductive

Health (SRH) Best Practice Health (SRH) Best Practice Documentation and Sharing Documentation and Sharing

in the SADC Regionin the SADC Region

Findings from Desk Review & Proposed Findings from Desk Review & Proposed Framework Framework

Rouzeh Eghtessadi (MPH)Rouzeh Eghtessadi (MPH)Southern Africa HIV and AIDS Information Dissemination Southern Africa HIV and AIDS Information Dissemination Service (SAfAIDS)Service (SAfAIDS)Email: rouzeh@gmail.com Email: rouzeh@gmail.com

Thrust of AssignmentThrust of Assignment

Consultancy expected to produce:Consultancy expected to produce:• A Report (combining data collated in the desk A Report (combining data collated in the desk

review report and data from the administered review report and data from the administered questionnaires) on Practices, Progress on questionnaires) on Practices, Progress on implementation, Guidelines and Protocols on sexual implementation, Guidelines and Protocols on sexual reproductive health in the SADC Region; andreproductive health in the SADC Region; and

• Regional Guidelines (including specific criteria) for Regional Guidelines (including specific criteria) for Identifying, Documenting and Exchanging (sharing) Identifying, Documenting and Exchanging (sharing) experiences and Best Practices on Sexual and experiences and Best Practices on Sexual and Reproductive Health, to be adopted by Member Reproductive Health, to be adopted by Member StatesStates

Consider….Consider….• While analysis of Member State responses is ongoing, While analysis of Member State responses is ongoing,

available data from desk review is ample evidence to available data from desk review is ample evidence to systematically inform direction of SRH Best Practice systematically inform direction of SRH Best Practice Documentation and Sharing within a SADC framework Documentation and Sharing within a SADC framework

• Methodology would ideally needed to enable in-country Methodology would ideally needed to enable in-country visits to do on-site data collection and observation visits to do on-site data collection and observation

• Timeframe - rapid methods, though thorough and Timeframe - rapid methods, though thorough and comprehensive , were conducted within stringently comprehensive , were conducted within stringently short period of timeshort period of time

• However has created a strategic springboard and body However has created a strategic springboard and body of evidence - for consolidation and further researchof evidence - for consolidation and further research

Background Background (1)(1)• Multiple commitments to SRH universal access and Multiple commitments to SRH universal access and

SRHR (International – ICPD; Continental – MPoA; and SRHR (International – ICPD; Continental – MPoA; and regional – SADC Gender & Development Protocol)regional – SADC Gender & Development Protocol)

• Despite omission of SRH from the MDGs, recent Despite omission of SRH from the MDGs, recent evidence highlights universal access to SRH as evidence highlights universal access to SRH as keystone to meeting MDGs and a key investment in keystone to meeting MDGs and a key investment in sustainable developmentsustainable development

• SADC Sexual and Reproductive Health Strategy SADC Sexual and Reproductive Health Strategy (2006-2015) objective 4 speaks to best practice (2006-2015) objective 4 speaks to best practice agenda: agenda: “To enhance sharing of information, “To enhance sharing of information, experiences and best practices among Member experiences and best practices among Member States” States”

Background Background (2)(2)

• SADC Secretariat resolved to develop SADC Secretariat resolved to develop Regional Regional Guidelines for Documentation and Exchange of Best Guidelines for Documentation and Exchange of Best Practices in SRH in the SADC RegionPractices in SRH in the SADC Region, to:, to:– Serve as a tool for consensus building among Member Serve as a tool for consensus building among Member

States (MS) on what constitutes a ‘best practice’ within States (MS) on what constitutes a ‘best practice’ within SRH practiceSRH practice

– Catalyse repositioning if SRH practices in the regionCatalyse repositioning if SRH practices in the region– Guide MS in identification, systematic documentation and Guide MS in identification, systematic documentation and

strategic dissemination and uptake (adaptation and strategic dissemination and uptake (adaptation and replication) of SRH best practices (BPs)replication) of SRH best practices (BPs)

– Define criteria for SRH BPs that will ensure harmonised Define criteria for SRH BPs that will ensure harmonised approach to BP documentation by Member Statesapproach to BP documentation by Member States

– Facilitate mitigation interventions around SRH in the regionFacilitate mitigation interventions around SRH in the region

Background Background (3)(3)• In recognition of the rich repository of experiences In recognition of the rich repository of experiences

in the SADC region - relevance of BPs to SRH in the SADC region - relevance of BPs to SRH – Commitments translated into national policies, laws, Commitments translated into national policies, laws,

guidelines, strategic plans, roadmaps and protocolsguidelines, strategic plans, roadmaps and protocols– These guide practices and service delivery in SRH at These guide practices and service delivery in SRH at

national, provincial/district and community levelsnational, provincial/district and community levels– Lessons learnt, sharing of ‘working’ practices in SRH Lessons learnt, sharing of ‘working’ practices in SRH

core areas leads to adoption of improved, cost-effective, core areas leads to adoption of improved, cost-effective, effective and sustainable practices and approacheseffective and sustainable practices and approaches

– Improved quality of SR health among women, men and Improved quality of SR health among women, men and adolescentsadolescents

– MDG targets met, beyond just 4,5 and 6 – informing MDG targets met, beyond just 4,5 and 6 – informing policy decision-making (financial, human capacity etc)policy decision-making (financial, human capacity etc)

Defining…Defining…• 9 Core SRH areas:9 Core SRH areas: family planning, STIs (HIV), safe motherhood, family planning, STIs (HIV), safe motherhood,

sexual violence, reproductive cancers, abortion, infertility, adolescent and sexual violence, reproductive cancers, abortion, infertility, adolescent and youth SRH (AYSRH), interpersonal counseling, comm and health youth SRH (AYSRH), interpersonal counseling, comm and health educationeducation

• Best Practices:Best Practices: no universal definition “ no universal definition “…. a technique or …. a technique or methodology that, through experience and research, has proven reliably methodology that, through experience and research, has proven reliably to lead to a desired result. In the context of health programmes and to lead to a desired result. In the context of health programmes and services, a practical definition of a “Best Practice” is “knowledge about services, a practical definition of a “Best Practice” is “knowledge about what works in specific situations and contexts, without using inordinate what works in specific situations and contexts, without using inordinate resources to achieve the desired results, and which can be used to resources to achieve the desired results, and which can be used to develop and implement solutions adapted to similar health problems in develop and implement solutions adapted to similar health problems in other situations and contexts”other situations and contexts”

• A best practice can be anything that A best practice can be anything that ‘works’ to ‘works’ to produce results without using immoderate resourcesproduce results without using immoderate resources, , either in full or in part, and that can be functional in either in full or in part, and that can be functional in providing lessons learned providing lessons learned

• UNFPA, WHO, UNESCO, Global Health Council, UN UNFPA, WHO, UNESCO, Global Health Council, UN interagency committee on women & gender equalityinteragency committee on women & gender equality

Processes …Processes …towards towards generating information for generating information for regional SRH framework for BPsregional SRH framework for BPs• Dual Methodology:Dual Methodology:

– Regional Desk Review (27Regional Desk Review (27thth August – 9 August – 9thth Sept 2010) on Sept 2010) on practices, progress made by Member States, guidelines and practices, progress made by Member States, guidelines and protocols and related documents (roadmaps, strategic protocols and related documents (roadmaps, strategic plans etc)plans etc)

– Administered questionnaires to Member States (analysis in Administered questionnaires to Member States (analysis in progress)progress)

• Data sources: SADC Secretariat, 14 Member States, Data sources: SADC Secretariat, 14 Member States, UN agencies and partners, online databases and UN agencies and partners, online databases and resourcesresources

• Themes : Themes : – Practices, guiding documents related to, and progress Practices, guiding documents related to, and progress

made the 9 core SRH areasmade the 9 core SRH areas– Status of BPsStatus of BPs

FindingsFindings

• Drawn from SADC documents; ICPD +15 report; Drawn from SADC documents; ICPD +15 report; MDG Goals Report (2010); WHO work in the Africa MDG Goals Report (2010); WHO work in the Africa region biennium report (2010) and progress report region biennium report (2010) and progress report RH strategy 2010 and World Health Statistics RH strategy 2010 and World Health Statistics (2010); Member States MNH Roadmaps, UNFPA (2010); Member States MNH Roadmaps, UNFPA Country Profiles (2009) and African MNH Profiles Country Profiles (2009) and African MNH Profiles Roadmap Assessment Report (2010); amongst over Roadmap Assessment Report (2010); amongst over 90 other resources (international, regional and 90 other resources (international, regional and national)national)

• Best Practice specific findings:Best Practice specific findings:– DefinitionsDefinitions– Institutionalising into programmingInstitutionalising into programming– Status of SRH BP documentation, mapping and sharingStatus of SRH BP documentation, mapping and sharing– Sample Profiles of SRH BPs: analysed for criteria buildingSample Profiles of SRH BPs: analysed for criteria building– Existing Criteria for BP documentation and dissemination Existing Criteria for BP documentation and dissemination

(sharing)(sharing)

Status of SRH BP Status of SRH BP Documentation, Mapping Documentation, Mapping and Sharing and Sharing (1) (1)

• Limited systematic documentation and sharing of SRH Limited systematic documentation and sharing of SRH related best practices within the SADC region, and an related best practices within the SADC region, and an absence of standardized guidelines and criteria that absence of standardized guidelines and criteria that steer the identification, documentation and sharing of steer the identification, documentation and sharing of SRH best practices within a methodical fashion, by SRH best practices within a methodical fashion, by Member States Member States

• The Implementing Best Practices (IBP) Knowledge The Implementing Best Practices (IBP) Knowledge Gateway Gateway – is a global electronic communication tool, users of this is a global electronic communication tool, users of this

platform (including those outside the IBP network) increased platform (including those outside the IBP network) increased six-fold in 2009, to approx 175 000 usersix-fold in 2009, to approx 175 000 user

– works closely with the WHO–UNFPA Strategic Partnership works closely with the WHO–UNFPA Strategic Partnership Programme (SPP) to increase the use of evidence-based Programme (SPP) to increase the use of evidence-based guidelines and tools in family planning, maternal health and guidelines and tools in family planning, maternal health and STIs towards the goal of universal access STIs towards the goal of universal access

Status of SRH BP Status of SRH BP Documentation, Mapping Documentation, Mapping and Sharing and Sharing (2)(2)• The WHO Reproductive Health Library (RHL)The WHO Reproductive Health Library (RHL); conducts research ; conducts research on strategies for implementation of evidence-based practice; on strategies for implementation of evidence-based practice; with building capacity, to facilitate informed decision-making with building capacity, to facilitate informed decision-making based on generated evidence base.based on generated evidence base.

• While the RHL repository does not explicitly coin its outputs as While the RHL repository does not explicitly coin its outputs as ‘best practices’, it presents a vital pool of information on SRH ‘best practices’, it presents a vital pool of information on SRH practices that are evidenced to ‘work’, and can be a strategic practices that are evidenced to ‘work’, and can be a strategic link for sharing of SADC Member State generated SRH best link for sharing of SADC Member State generated SRH best practices. practices.

• The Special Programme of Research, Development and The Special Programme of Research, Development and Research Training in Human Reproduction (HRP) is the main Research Training in Human Reproduction (HRP) is the main instrument within the UN (UNDP,UNFPA, WHO, World Bank) instrument within the UN (UNDP,UNFPA, WHO, World Bank) system responsible for research in reproduction. In scaling-up system responsible for research in reproduction. In scaling-up antenatal care in southern Africa, linked to HIV services and antenatal care in southern Africa, linked to HIV services and violence against women programmes, the HRP is implementing violence against women programmes, the HRP is implementing an intervention (Malawi, Mozambique, and South Africa) to an intervention (Malawi, Mozambique, and South Africa) to improve maternal and newborn health (MDGs 4 and 5) and to improve maternal and newborn health (MDGs 4 and 5) and to strengthen health systems through integration of related vertical strengthen health systems through integration of related vertical services with ANC packages based on the WHO Antenatal Care services with ANC packages based on the WHO Antenatal Care Model Model

Sample Profiles of SRH BPs: Sample Profiles of SRH BPs: analysed for criteria-analysed for criteria-buildingbuilding

Where there is a will there is a way: nursing and midwifery Where there is a will there is a way: nursing and midwifery champions in HIV/AIDS care in southern Africachampions in HIV/AIDS care in southern Africa

In 2003 UNAIDS and the Southern African Development Community In 2003 UNAIDS and the Southern African Development Community

(SADC) AIDS Network of Nurses and Midwifes (SANNAM) documented a (SADC) AIDS Network of Nurses and Midwifes (SANNAM) documented a series of best practice interventionsseries of best practice interventions[1][1] as part of the UNAIDS Best Practice as part of the UNAIDS Best Practice Collection, covering Botswana, Lesotho, Namibia, South Africa and Collection, covering Botswana, Lesotho, Namibia, South Africa and Zambia. Zambia.

Commonly underscoring these practices was the recognition that Commonly underscoring these practices was the recognition that education and specialist training in HIV is hugely empowering to nurses education and specialist training in HIV is hugely empowering to nurses and midwives, and is often the catalyst for taking personal action; and midwives, and is often the catalyst for taking personal action; networking and adding on to what already exists makes better sense than networking and adding on to what already exists makes better sense than creating new structures; communities have ideas and skills that should be creating new structures; communities have ideas and skills that should be respected and harnessed; and programmers should focus their efforts on respected and harnessed; and programmers should focus their efforts on transferring skills and building the capacity of the family and community, transferring skills and building the capacity of the family and community, rather than doing everything themselves. rather than doing everything themselves.

Best practice criteria-related facets:Best practice criteria-related facets: integrated training, drawing on technical expertise, skills integrated training, drawing on technical expertise, skills

transfer for sustainability, community involvement and transfer for sustainability, community involvement and empowermentempowerment

[1][1] http://data.unaids.org/publications/IRC-pub02/jc900-midwives_nursing_en.pdfhttp://data.unaids.org/publications/IRC-pub02/jc900-midwives_nursing_en.pdf

From Inception to Large-scale: promoting adolescent SRHFrom Inception to Large-scale: promoting adolescent SRH[1][1] The Geração Biz ("busy generation") programme in Mozambique (with support from The Geração Biz ("busy generation") programme in Mozambique (with support from

UNFPA), has been credited with contributing to improved communications and UNFPA), has been credited with contributing to improved communications and interactions among government institutions and sectors within the adolescent SRH interactions among government institutions and sectors within the adolescent SRH (ASRH) domain. The programme design has prompted continuous investment in (ASRH) domain. The programme design has prompted continuous investment in capacity-building, that expanded to integrate advocacy and management skills, which capacity-building, that expanded to integrate advocacy and management skills, which led to increase in internal policies, strategic planning, and public policy development. led to increase in internal policies, strategic planning, and public policy development.

Its multi-sectoral approach beyond only improving health services, has engaged Its multi-sectoral approach beyond only improving health services, has engaged referrals from adolescent centres, schools, and peer educators in the community, and referrals from adolescent centres, schools, and peer educators in the community, and resulted in increase in ASRH access. Scaling up monitoring and coordinating systems resulted in increase in ASRH access. Scaling up monitoring and coordinating systems within referral structures has contributed to increased motivation of service providers within referral structures has contributed to increased motivation of service providers and peers, and enabling data generation that informs cost-effective implementation. and peers, and enabling data generation that informs cost-effective implementation.

The intention for scale-up was part of the programme design from the start, and thus The intention for scale-up was part of the programme design from the start, and thus accelerated implementation, and was complemented by producing tools and accelerated implementation, and was complemented by producing tools and guidelines for cascade use in new facilities of service provision. The programme guidelines for cascade use in new facilities of service provision. The programme design facilitates that selected sites become modes for development new protocols of design facilitates that selected sites become modes for development new protocols of practice, and the flexible nature of design allows for adaptation as per community practice, and the flexible nature of design allows for adaptation as per community trends and changes in culture of needs for ASRH. Youth involvement, in particular trends and changes in culture of needs for ASRH. Youth involvement, in particular young PLHIV, has resonated with the programme design and roll-out, and been young PLHIV, has resonated with the programme design and roll-out, and been evident in increase in youth influencing policy, providing types of SRH evident in increase in youth influencing policy, providing types of SRH services/support, and community mobilization towards SRH. Specific integration of services/support, and community mobilization towards SRH. Specific integration of VCT for HIV, HIV care and support, has proven to serve as a strategic entry point for VCT for HIV, HIV care and support, has proven to serve as a strategic entry point for young men to come to youth friendly SRH facilities.young men to come to youth friendly SRH facilities.

Best practice criteria-related facets:Best practice criteria-related facets: strong surveillance systems, modeling for replication, flexibility, community strong surveillance systems, modeling for replication, flexibility, community

(target ) involvement, displays multi-sectoral approach, scale-up integration(target ) involvement, displays multi-sectoral approach, scale-up integration

[1][1]From Inception to Large-scale: The Geração Biz programme in Mozambique (Pathfinder, WHO, From Inception to Large-scale: The Geração Biz programme in Mozambique (Pathfinder, WHO, 2009) http://whqlibdoc.who.int/publications/2009/9789241598347_eng.pdf2009) http://whqlibdoc.who.int/publications/2009/9789241598347_eng.pdf

Existing Criteria for SRH Existing Criteria for SRH Best Practice Best Practice Documentation Documentation

• Documentation criteria:Documentation criteria:– SADC SADC Framework for Developing and Sharing Best practices on Framework for Developing and Sharing Best practices on

HIV and AIDS HIV and AIDS (2006): effectiveness, sustainability, cost-(2006): effectiveness, sustainability, cost-effectiveness, relevance, innovativeness, replicability, and ethical effectiveness, relevance, innovativeness, replicability, and ethical soundnesssoundness

– WHO WHO Guide for Documenting and Sharing “Best Practices” in Guide for Documenting and Sharing “Best Practices” in Health Programmes Health Programmes (2008)(2008)

– FHI/UNAIDS FHI/UNAIDS Best Practices: HIV/AIDS Prevention CollectionBest Practices: HIV/AIDS Prevention Collection (2001) (2001)– SAfAIDS BP criteria for HIV, culture and gender programmes SAfAIDS BP criteria for HIV, culture and gender programmes

(2008)(2008)– IPPF, UNFPA, WHO, UNAIDS, GNP+, ICW, Young Positives IPPF, UNFPA, WHO, UNAIDS, GNP+, ICW, Young Positives The The

Rapid Assessment Tool for Sexual and Reproductive Health and Rapid Assessment Tool for Sexual and Reproductive Health and HIV LinkagesHIV Linkages (2009) offers a useful springboard to developing BP (2009) offers a useful springboard to developing BP criteria and relevant tools for documenting criteria and relevant tools for documenting

– Family planning practices Family planning practices ABCDsABCDs can be considered ‘working’ can be considered ‘working’ criteria criteria

– Client-provider interactions (CPI) offer 6 criteria Client-provider interactions (CPI) offer 6 criteria – Community-based distribution (CBD) models offer 6 criteria Community-based distribution (CBD) models offer 6 criteria

Existing Criteria for SRH Existing Criteria for SRH Best Practice Dissemination Best Practice Dissemination (sharing and exchange)(sharing and exchange)

• Dissemination criteria and platforms:Dissemination criteria and platforms:– Advance Africa/USAID Reproductive Health Best Practice Advance Africa/USAID Reproductive Health Best Practice

Compendium (online platform) submission form enables Compendium (online platform) submission form enables verificationverification

– UNAIDS Best Practices collection (online)UNAIDS Best Practices collection (online)– WHO programme to Map Best Reproductive Health Practices, WHO programme to Map Best Reproductive Health Practices,

sharing evidence based clinical practices through annual sharing evidence based clinical practices through annual electronic journal and the Reproductive Health Library (RHL), as electronic journal and the Reproductive Health Library (RHL), as well as via worldwide workshops to ensure health-care workers well as via worldwide workshops to ensure health-care workers accessaccess

– WHO has proposed 3 major ways for health related BPs:WHO has proposed 3 major ways for health related BPs:• African Regional Best Practice SeriesAfrican Regional Best Practice Series

• Africa Regional Office WebsiteAfrica Regional Office Website

• Distribution of CD-ROMs containing BPs during WHO Regional Distribution of CD-ROMs containing BPs during WHO Regional Committee meetings, conferences, workshops to reach those with Committee meetings, conferences, workshops to reach those with limited internet access limited internet access

Recommendations Recommendations

• SRH policy and practice/service delivery - in response to SRH policy and practice/service delivery - in response to challenges identified, these areas should continue to be challenges identified, these areas should continue to be considered at national and regional levels. And will inform considered at national and regional levels. And will inform decisions on areas to focus on when generating best decisions on areas to focus on when generating best practice documents and sharing for cross-learningpractice documents and sharing for cross-learning

• SRH Best Practice Framework – proposed structure, criteria SRH Best Practice Framework – proposed structure, criteria and cycle of systematic steps to institutionaliseand cycle of systematic steps to institutionalise

Policy and practice related Policy and practice related (1)(1)

• Adopt comprehensive integrated SRH programmesAdopt comprehensive integrated SRH programmes

versus vertical programmes. The diversion of resource-attention to versus vertical programmes. The diversion of resource-attention to HIV had taken away some attention from SRH; there is indications of a HIV had taken away some attention from SRH; there is indications of a shift back to SRH and this repositioning needs persistent attention. shift back to SRH and this repositioning needs persistent attention.

Establish integration-supporting mechanisms: Establish integration-supporting mechanisms: optimize and optimize and mobilize resources to implement SRH services reciprocally integrated mobilize resources to implement SRH services reciprocally integrated with HIV programmes. Invest in skilled personnel who can provide with HIV programmes. Invest in skilled personnel who can provide quality integrated services including emergency obstetric care quality integrated services including emergency obstetric care (EmOC) services, STI management and family planning in (EmOC) services, STI management and family planning in communitiescommunities

• Task-shifting in human resourcesTask-shifting in human resources, especially in response , especially in response to maternal survival, be explored to counter lack of availability and to maternal survival, be explored to counter lack of availability and use of quality skilled care during pregnancy, childbirth and the use of quality skilled care during pregnancy, childbirth and the immediate postnatal period, and in family planning[1] . Linked to this, immediate postnatal period, and in family planning[1] . Linked to this, build on the growing debate on the use of Traditional Birth Attendants build on the growing debate on the use of Traditional Birth Attendants (TBAs) in rural and hard to reach communities. Thus counter current (TBAs) in rural and hard to reach communities. Thus counter current weak human resource development and management systems, and weak human resource development and management systems, and continuing brain drain of skilled personnel within and outside the continuing brain drain of skilled personnel within and outside the SADC region. Also learn from Non-physicians clinicians (NCPs) SADC region. Also learn from Non-physicians clinicians (NCPs) programme. programme. [1] Task shifting is expanding the roles of family planning providers- Allowing lower-level providers to take on some of the responsibilities of higher-level providers could [1] Task shifting is expanding the roles of family planning providers- Allowing lower-level providers to take on some of the responsibilities of higher-level providers could improve services (FHI, 2009)improve services (FHI, 2009)

Policy and practice Policy and practice related related (2)(2)

• Leverage policy to accelerateLeverage policy to accelerate the promotion of the promotion of evidence-driven SRH and programming based on operational evidence-driven SRH and programming based on operational research and the scale-up of BP documentation and sharing, research and the scale-up of BP documentation and sharing, and commit resources to practices proven to work effectively and commit resources to practices proven to work effectively and sustainablyand sustainably

• Seek systematic technical assistanceSeek systematic technical assistance, to support , to support governments’ and national bodies’ capacity to provide governments’ and national bodies’ capacity to provide leadership in determining country priorities around: funding, leadership in determining country priorities around: funding, coordination and harmonization, and surveillance and M&E of coordination and harmonization, and surveillance and M&E of implementation of SRH programmesimplementation of SRH programmes

• Community involvementCommunity involvement in SRH has increased in in SRH has increased in many countries, and structures and mechanisms need to be many countries, and structures and mechanisms need to be set-up to ensure continued and scaled-up community set-up to ensure continued and scaled-up community participation, especially of vulnerable groups such as women, participation, especially of vulnerable groups such as women, adolescents and youth and PLHIVadolescents and youth and PLHIV

Policy and practice related Policy and practice related (3)(3)

• Meet SRH needs of menMeet SRH needs of men adequately, and not in adequately, and not in ‘pockets’, by design interventions for enhanced ‘pockets’, by design interventions for enhanced participation in the provision of SRH and family planning participation in the provision of SRH and family planning information and serviceinformation and service

• Innovatively empower adolescents and Innovatively empower adolescents and youthyouth so they can overcome vulnerabilities to SRH ill-so they can overcome vulnerabilities to SRH ill-health, by ensuring that adolescent sexual and reproductive health, by ensuring that adolescent sexual and reproductive health concerns are well integrated into other interventions health concerns are well integrated into other interventions such as education, skills development, gainful employment such as education, skills development, gainful employment and participation in decision-making, sports and culture; and participation in decision-making, sports and culture; and programmes addressing adolescent substance abuseand programmes addressing adolescent substance abuse

• Establish functional referral systemsEstablish functional referral systems linking linking SRH integrated services (primary health care with maternal, SRH integrated services (primary health care with maternal, child and neonatal health services) with services addressing child and neonatal health services) with services addressing poverty alleviation and financial investment for women poverty alleviation and financial investment for women

Policy and practice Policy and practice related related (4)(4)• Speak to unsafe abortionsSpeak to unsafe abortions, in line with the MPoA, by , in line with the MPoA, by

compiling and disseminating data on the magnitude and compiling and disseminating data on the magnitude and consequences of unsafe abortions, enacting and consequences of unsafe abortions, enacting and disseminating policies and laws to protect women and disseminating policies and laws to protect women and adolescents; and offering guidelines and appropriate training adolescents; and offering guidelines and appropriate training to service providers in the provision of comprehensive to service providers in the provision of comprehensive abortion care servicesabortion care services

• Accelerate access and availability of, and Accelerate access and availability of, and investment in, new prevention technologyinvestment in, new prevention technology, , especially female controlled modes such as female condoms especially female controlled modes such as female condoms (commodity access), and microbicides, as well as medical (commodity access), and microbicides, as well as medical male circumcision, in view of STI/HIV response integrationmale circumcision, in view of STI/HIV response integration

• Invest in strengthening infrastructureInvest in strengthening infrastructure, at , at national level, to facilitate access to EmOC.national level, to facilitate access to EmOC.

Policy and practice Policy and practice related related (5)(5)

• Address harmful socio-cultural beliefs Address harmful socio-cultural beliefs and practicesand practices valiantly, and integrate this valiantly, and integrate this approach in existing SRH approaches that focus approach in existing SRH approaches that focus on increasing male involvement, and addressing on increasing male involvement, and addressing the low status of women and compromised status the low status of women and compromised status of adolescents, and unmarried young women. of adolescents, and unmarried young women.

Proposed Structure of Proposed Structure of SADC SRH BP Framework SADC SRH BP Framework (Guidelines)(Guidelines)

• IntroductionIntroduction• PurposePurpose• DefinitionsDefinitions• Essential CriteriaEssential Criteria• Integration into Programming Integration into Programming (including coordination and (including coordination and

management systems, costing, monitoring and tracking)management systems, costing, monitoring and tracking)

• Cycle of BP DocumentationCycle of BP Documentation• Dissemination StrategiesDissemination Strategies• Monitoring & Evaluation (M&E) and Reporting - Monitoring & Evaluation (M&E) and Reporting -

Surveillance (Surveillance (of documentation, uptake and progress)of documentation, uptake and progress)

• Resources and ToolsResources and Tools• ReferencesReferences

Proposed Criteria Proposed Criteria • Effectiveness Effectiveness (intervention design, community (intervention design, community

involvement, M&E)involvement, M&E)

• Cost-effectivenessCost-effectiveness• Sustainability Sustainability (intervention sustainability, fiscal (intervention sustainability, fiscal

sustainability, demand creation)sustainability, demand creation)

• Innovativeness Innovativeness (how unique is it!)(how unique is it!)

• ReplicabilityReplicability• RelevanceRelevance• Infrastructural competenceInfrastructural competence• Integrated Integrated (technical reliability, referral mechanisms)(technical reliability, referral mechanisms)

• Ethical soundness Ethical soundness (rights-based approach, (rights-based approach, intervention transparency)intervention transparency)

• Political backing evident Political backing evident

Cycle for Best Practice Cycle for Best Practice DocumentationDocumentation

Refer to page 23 in DocumentRefer to page 23 in Document

Proposed Dissemination Proposed Dissemination Strategies (Strategies (1)1)• Establish a SADC SRH Best Practice Online Establish a SADC SRH Best Practice Online Portal,Portal, which is linked to other relevant regional, international and which is linked to other relevant regional, international and national portals. Hosted by the SADC Secretariat, while coordination of national portals. Hosted by the SADC Secretariat, while coordination of national portals would be done by relevant Ministry in Member States. national portals would be done by relevant Ministry in Member States. Best practices would be placed on the online platform, upon completion Best practices would be placed on the online platform, upon completion and endorsement, for easy access by partners across the region and and endorsement, for easy access by partners across the region and beyond. A tracking mechanism may be integrated into the platform’s beyond. A tracking mechanism may be integrated into the platform’s interface to enable monitoring access to the BPs, offering a picture of interface to enable monitoring access to the BPs, offering a picture of which areas of SRH best practice are most frequently accessed, and by which areas of SRH best practice are most frequently accessed, and by geographical access. This platform can link to the IBP, RH Compendium, geographical access. This platform can link to the IBP, RH Compendium, WHO RHL, amongst other related online stagesWHO RHL, amongst other related online stages

• Collaborate with technical expertiseCollaborate with technical expertise , can be sought , can be sought from UN agencies, CS, private sector and other regional and national from UN agencies, CS, private sector and other regional and national partners with experience in documenting and sharing best practices, to partners with experience in documenting and sharing best practices, to share the documented BPs via their meetings, conferences and share the documented BPs via their meetings, conferences and workshops. Link collaboration with mobilization resources towards best workshops. Link collaboration with mobilization resources towards best practicespractices

• Host SRH Best Practice Sharing ForumsHost SRH Best Practice Sharing Forums , to enhance , to enhance cross-sharing between MS on experiences of BP documentation - could cross-sharing between MS on experiences of BP documentation - could be held back-to-back with annual SADC meetings, established within be held back-to-back with annual SADC meetings, established within existing institutional mandates.existing institutional mandates.

Proposed Proposed Dissemination Dissemination Strategies (Strategies (2)2)

• Incorporate in SADC Member States’ SRH Incorporate in SADC Member States’ SRH Annual ReportsAnnual Reports,, allocate section in the SRH Annual Report allocate section in the SRH Annual Report mechanism of reporting as it is adoptedmechanism of reporting as it is adopted

• Integrate into Materials for Advocacy and Integrate into Materials for Advocacy and Programme scale-upProgramme scale-up, such as newsletters, policy briefs, , such as newsletters, policy briefs, position papers, research briefs, programming briefs, CD ROMs and position papers, research briefs, programming briefs, CD ROMs and similar printed materials, either generated by SADC Secretariat, similar printed materials, either generated by SADC Secretariat, Member States national SRH information sharing materials, or existing Member States national SRH information sharing materials, or existing material development programmes (CS) for advocacy/programme material development programmes (CS) for advocacy/programme – policy briefs on a specific best practice to lobby donors and policy makers to policy briefs on a specific best practice to lobby donors and policy makers to

mobilize relevant resources towards a working approach as verified by the mobilize relevant resources towards a working approach as verified by the documented BPdocumented BP

– programming packages to inspire replication of working practices for programming packages to inspire replication of working practices for frontline health workers and managers, towards scale-up of effective frontline health workers and managers, towards scale-up of effective interventions interventions

• Infuse into Physical Sharing PlatformsInfuse into Physical Sharing Platforms, such as , such as conferences, policy roundtables, research forums and workshops, conferences, policy roundtables, research forums and workshops, where large numbers of like-minded people are present, for discussion where large numbers of like-minded people are present, for discussion and to influence adoption, as well ad decision-making as relevant. and to influence adoption, as well ad decision-making as relevant. Sharing at thematic meetings would enable enhanced understanding of Sharing at thematic meetings would enable enhanced understanding of specific area of SRHspecific area of SRH

Evidence-based Information…….Evidence-based Information……. …… power to make a …… power to make a difference !!difference !!