Managing new funding modalities: Lessons and Best Practice The ‘Mini SWAp’ Experience of MSI’s partner Banja La Mtsogolo in Malawi
MSI’s Strategic Focus MSI’s Mission – Children By Choice Not Chance We aim to contribute to: • eliminating unplanned pregnancy and unsafe abortion, especially among the underserved • revolutionising sexual and reproductive health service delivery • reducing the barriers to SRH services and supplies • strengthening health systems
Geographic Focus and Impact • MSI has 6500 staff in 43 offices and country platforms • 6 million clients and 13. 4 million Couple Years of Protection (CYPs) in 2008
MSI’s Business Model MSI clinics = our core self-sufficient infrastructure Ethiopia
Health Service Delivery in Malawi Public Sector • Over 840 public health facilities • Public facilities comprise 60% of health care delivery outlets Banja La Mtsogolo (BLM) • 31 static clinics (5% of overall health system infrastructure) and outreach sites in hard-to-reach areas • Provides 35% of modern contraception in Malawi
SWAp Context in Malawi • 2002/2004 MOU Donors and Government • Health SWAp (2006 -2011) • Donors: DFID, Norway, and SIDA • Initial poor results in districts: donor funds lost
BLM’s ‘Mini SWAp’ in Malawi • BLM was funded directly by DFID and Norway/SIDA from 2001 -2006 with drugs/supplies procured privately • BLM participated in and was included in the Plan of Work (Po. W) for the 2006 -2011 Health SWAp • Donors agreed to directly fund BLM through a Joint Financing Agreement (or “mini-SWAp”) between DFID, Norway, Mo. H, and BLM 2006 -2009
Transition to full SWAp • Drugs and supplies were to come from Government starting in 2006 • Full integration of BLM’s Po. W into the SWAp to happen by July 2009 • A BLM SWAp Transition Plan was developed to highlight the steps required of all stakeholders before BLM could be integrated into the SWAp -Consistent supply of commodities -District agreements functioning
What Worked ü Aligned strategy and policy with Government ü DFID and Norway funding: Both free and costed services, critical to long-term sustainability ü Joint reviews and reporting ü BLM strengthened at district and regional levels ü BLM became organisation in 2008 sub-vented
What Didn’t Work • Funding and supplies from the Government were inadequate and slow (no supplies during the initial 5 months - BLM and MSI had to allocate resources intended for other activities and Norway had to add funds) • After several months funds were released but World Bank procurement procedures meant further delays • Districts not able to supply family planning commodities and other drugs for outreach as agreed; No agreements
What Didn’t Work • Now funds given monthly but insufficient to order in bulk • Opportunity of management time spent lobbying and sourcing commodities • Significant resources required for SWAp working groups, meetings and consultants (50% of executive management time)
Impact • Stock outs negatively affected STI, general health and family planning outcomes: » » » STI and general health drugs erratic No Pills: 3 months then had to buy locally 9 months No IUDs: 6 months No Implants: 14 months No Injectables: 4 months and erratic throughout No condoms: 8 months • Tens of thousands of clients turned away annually • BLM served over 730, 000 clients and provided over 670, 000 CYPs in 2008
Lessons New phase 2009 -2015: Mini SWAp continues • Mini-SWAp pooled funding for reproductive health with commodity provision makes sense especially for largeimpact organisations while government capacity is built (particularly if RH is not a country priority) • Brings best of budget support (joint policy and strong government role in coordination) and direct funding approaches whilst moving towards budget support • Engaging private sector whilst transforming health systems
TE SY S TH AL HE G IN CATALYTIC Rights S Neglected issues (family planning), populations (adolescents), contraceptive methods (LTPM), and technologies LT Fragile States and emergencies SU RE OR M D SF AN AN RY VE LI TR DE FP/HIV integration Supply Side - Franchising - Contracting out - Contracting in Choice E Demand Side - Financing - OBA - BCC, call centres IC Improving method mix and choice (esp. LTPM) RV SE MS MSI - Strategic Directions
Lessons • Donors should have safety nets and back up action plans in place for drugs and commodities: earmarks good but not enough • Longer-term view should have been taken from beginning, that it would take years to build Government capacity needed for full budget integration
Women like Rachel have been waiting for change, and the right to control the size and spacing of their family
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