HSAannualreflectionreport 2018final

Annual Reflection Report 2018
Health Systems Advocacy Partnership

Table of contents
List of abbreviations ....................................................................................................................................................... 3

1. Introduction .................................................................................................................................................................... 4
2. Programmatic progress ................................................................................................................................... 6

2.1 Capacity strengthening for lobby and advocacy ......................................................................... 6
2.1.1 Capacity strengthening of civil society organizations ............................................ 6
2.1.2 Building of platforms and networks .................................................................................. 9
2.1.3 Media engagement ......................................................................................................................... 11
2.1.4 Amplifying community voices ................................................................................................. 13
2.2 Lobby and Advocacy ....................................................................................................................................... 15
2.2.1 Human Resources for Health ................................................................................................... 15
2.2.2 Sexual Reproductive Health Commodities. .................................................................. 18
2.2.3 Health Financing and Governance ...................................................................................... 20
2.2.4 Lobby and Advocacy outcomes in summary .............................................................. 23

3. Enabling environment ......................................................................................................................................... 24
4. Gender and inclusivity ........................................................................................................................................ 27
5. Linking, learning and strategising ................................................................................................................ 30
6. Working with the ministry ................................................................................................................................ 32
Concluding remarks and follow up .................................................................................................................. 33
2 Annual Reflection Report 2018

ABBREVIATIONS
ACHEST African Centre for Global Health and Social Transformation

AMAMI Association of Malawian Midwifes
AMCOA Association of Medical Councils of Africa
CBO Community-Based Organisation
CHW Community Health Worker
CSO Civil Society Organisation
DHO District Health Office
FP Family Planning
GFF Global Financing Facility
GHD Global Health Diplomacy
HAI Health Action International
HEPS Coalition for Health Promotion and Social Development
HRH Human Resources for Health
HSA Health Systems Advocacy
HSS Health Systems Strengthening
HW4All Health Workers for All
LGBTQI Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex
MeTA Medicines Transparency Alliance
MTR Mid-term review
M&E Monitoring and Evaluation
MoH Ministry of Health
MoFA Dutch Ministry of Foreign Affairs
MP Member of Parliament
NGO Non-Governmental Organisation
SDG Sustainable Development Goal
SRH Sexual and Reproductive Health
SRHC Sexual and Reproductive Health Commodities
SRHR Sexual and Reproductive Health and Rights
ToC Theory of Change
TWG Technical Working Group
UHC Universal Health Coverage
WHO World Health Organisation

Introduction
The Health Systems Advocacy (HSA) Partnership has had a very impactful 2018. We
continued our investments in the strengthening of civil society organisations’ (CSOs)
capacity and built coalitions, platforms, and movements which – bolstered by research
– advocate for strong and resilient health systems that contribute to the attainment of
sexual and reproductive health (SRH) and rights (see the infographic of our approach on
page 5). This report presents our reflections on the key results achieved in 2018 by the HSA
Partnership, our response to the changing environments in the countries where we work,
and how we are using successful strategies and lessons learned in our future planning.
• Expanded civil society networks: In 2018 the HSA partners collaborated with over 400
CSOs to create a strong civil society voice that advocated for increased investments
in sexual reproductive health. One example is the newly established Medicines
Transparency Alliance (MeTA) in Tanzania, which is supported by partner Health Action
International (HAI). Based on the success in Kenya, Zambia and in particular Uganda,
where MeTA activities contributed to the doubling of the national SRH commodities
budget in 2018, MeTA Tanzania brings actors together to improve the availability and
affordability of sexual reproductive health commodities (SRHC).
• Capacity strengthening inspires organisations and communities to demand rights

to SRH: In 2018 the HSA Partnership strengthened the lobby and advocacy capacity
of 190 CSOs, media organisations, and communities. In this report we illustrate how
this inspired CSOs and communities to stand up for their rights to SRH. For example,
in 2018, using the skills gained during a Global Health Diplomacy (GHD) workshop
organised by the African Centre for Global Health and Social Transformation (ACHEST),
the Uganda Youth Adolescent Forum joined the advocacy ranks for a regional East-
African bill that guarantees SRH rights.
• Our fight for a well-financed and governed health systems with a strong workforce
and access to SRH commodities continues: Through research, developing and sharing
knowledge products, organising events and regular meetings with decision-makers, the
HSA Partnership remained tenacious in our struggle for results in 2018. For example,
as a result of intense advocacy with the Global Financing Facility (GFF) for the health
of women, children and adolescents, the GFF management based at the World Bank
publicly announced plans to review and improve CSO engagement, address health
worker shortages and the possible negative consequences of their financing model.
• The HSA Partnership successfully holds decision-makers accountable for strong

policies and the implementation of their commitments: In 2018 our advocacy
initiatives contributed to the improvement, adoption, and enactment of 43
different policies at the sub-national, national and international level. Amref’s social
accountability model yielded several concrete results in Ugandan districts. In response
to citizen hearings, where the results of community scorecard exercises were discussed
with community leaders and health officials, vacant staff positions were filled,
absenteeism rates decreased, infrastructure problems were resolved and stock-outs of
family planning (FP) commodities were addressed.

The results in the HSA Partnership’s eight focus contexts – Kenya, Uganda, Tanzania,
Malawi, Zambia, African region, Globally, and the Netherlands – were achieved amidst an
increasingly conservative environment where it has become harder to fight for SRH rights.
The HSA Partnership’s focus on health systems is relevant and appropriate for navigating
this environment and, where possible, finds alternative dialogue, dissent, and action spaces.
For example, HSA partners successfully advocated for resource allocation for FP at the sub-
national level in Tanzania where there is a hostile national environment towards this topic.
2018 was also the year in which the HSA partners conducted their external mid-term review
(MTR). The review showed that we are on right track towards creating and maintaining
space for dialogue and dissent. The MTR also triggered internal discussions on where to
improve our efforts. This report presents the successes and lessons learned from the HSA
Partnership in 2018 by building upon the MTR’s conclusions, reflecting adjustments in our
focus contexts, and, most importantly, discussing the annual results.
Methodology
2018 was the first year in which the HSA Partnership used ‘outcome harvesting’ as the
core methodology to gather project results. The initial outcomes were discussed during
workshops organised in March 2019 in all eight of the focus contexts in which HSA
Partnership operates. During these workshops, all HSA partners operating in the context
were present, and in Malawi, several other CSOs also participated. Partners reflected on
their outcomes in relation to the Theory of Change (ToC), shared capacity strengthening
approaches, collaborations and the enabling environment for civil society. In a final
session, partners looked at the priorities set and lessons learned for 2019 and discussed
opportunities for further alignment and collaboration between partners in 2019. The
workshop report and outcome harvesting logbook are the core data sources used in
generating this reflection report, and they have been triangulated with other data sources
such as CSO capacity assessment data, a partnership collaboration survey, and a policy
tracker tool that monitors the progress of policies and budgets that have been influenced
by HSA partners.
OUR APPROACH
PUBLIC AWARENESS RAISING
AVAILABLE &
WELL-EDUCATED
AFFORDABLE SEXUAL AND
AND -PAID HEALTH
REPRODUCTIVE HEALTH
WORKERS
MEDICINES & DEVICES
LOBBY & ADVOCACY RESEARCH

STRONG HEALTH SYSTEM
STRONG
WELL-FINANCED HEALTH CARE
HEALTH CARE GOVERNANCE
& LEADERSHIP
CIVIL SOCIETY COLLABORATES WITH GOVERNMENTS AND KEEPS THEM ACCOUNTABLE
STRENGHTENING CIVIL SOCIETY

2. Programmatic progress
2.1 Capacity strengthening for lobby and advocacy

Strong citizen engagement is critical to attaining improved health system policies and
ensuring effective policy implementation. Therefore, in 2018, the HSA Partnership focused
on strengthening the capacity of the following target groups: CSOs, multi-stakeholder
platforms and networks, media outlets and practitioners and communities.
GHD workshop organized by Achest in Entebbe, Uganda, September 2018
2.1.1 Capacity strengthening of civil society organizations

One of the HSA Partnership’s core strategies is to increase CSOs’ lobby and advocacy
capacity at the local, national, regional and global levels. In 2018, the HSA Partnership
engaged with 430 CSOs in different ways: 190 were strengthened through training and
mentoring trajectories, almost 50 received financial support to implement their context-
specific lobby and advocacy activities and 200 engaged in information sharing and
alignment. Figure 1 details the number of CSOs that the HSA Partnership engaged with per
each of the eight context areas.
Figure 1: Nr of CSOs engaged with HSA Partnership per context (2018)

When our 2018 CSO capacity strengthening activities are analysed and compared with
previous years, several conclusions can be drawn.
Capacity strengthening is yielding results. In the first couple of years the HSA Partnership
focused on identifying the right CSOs and strengthening their capacity. In 2018, the third
year of the HSA Partnership, these CSOs are improving social accountability and policy
implementation in their countries, districts and communities. The HSA Partnership’s capacity
strengthening results in 2018 also show how CSOs and Community-Based Organisations
(CBOs) are better able to advocate with impressive outcomes on improved sexual
reproductive health and rights (SRHR). Table 1 details several examples of key outcomes that
resulted from the HSA Partnership’s work strengthening the CSO’s capacity.
Kenya Youth CSOs ask attention for SRHR

MeTA Kenya trained youth CSOs in the Lake Basin region on
evidence-based advocacy and effective communication. The youth
CSOs subsequently used these skills during campaigns on world
contraception day and Universal Health Coverage (UHC) day to
demand SRH rights such as youth-friendly corners and emergency
contraceptives.
Zambia Community Health Workers (CHWs) set up their own associations

Amref provided technical assistance to CHWs on how to establish a
CHW association. As a result, two associations are now established
in the Copperbelt region and they are both engaged in advocacy
efforts for standardised training and a career path for CHWs.
Malawi CSO platform advocates for improved clinic
Amref provided lobby and advocacy training to the CSO Platform
in Ntchisi district, which successfully advocated for district health
authorities to connect a health centre to the electricity grid. This
now enables caesarean sections to be performed at the health
centre.
Uganda Health staff appointed through evidence-based advocacy
Kabale Women in Development, a Ugandan CBO mentored by
Amref in evidence-based advocacy on health services, campaigned
for more health staff to be recruited in Kabale District and
presented data from 34 health facilities to the district health office
(DHO). The health office acted upon the CSO’s report and appointed
more nurses and midwives at the health clinics.
African Region Global Health Diplomacy workshop inspires academic action
ACHEST organised a GHD workshop for all African Region partners.
As a result of this workshop, Scheme, a CSO mentored by ACHEST,
successfully lobbied for the introduction of a GHD module as part
of a 2019 Public Health Master’s degree course at the University of
Zambia. Newly appointed diplomats of the Ministry of Health (MoH)
participated in the first course.
Table 1: Examples of CSO capacity strengthening outcomes in 2018

The HSA Partnership’s network has grown, but we have also intensified relationships.
The number of CSOs that the HSA Partnership engages with is growing. This can be
attributed to our investment in meetings and information sharing through online and other
platforms, and our networks with a broad range of civil society actors. On top of this,
our relationship with many CSOs is deepening. From 2016-2017 our capacity trajectories
focused mainly on training, in 2018 this expanded to more intense forms of support such
as coaching and mentoring, and tailor-made technical support. Additionally, some CSOs
are now being given financial support to implement context-specific advocacy activities.
This was a lesson learned from previous years where we found that training is not always
enough when CSOs do not have access to funds for advocacy.
African voices make a difference at the international level. In the African region, Global,
and Netherlands contexts, the HSA Partnership takes on a mentoring role and provides
hands-on support for African CSOs to participate at the international level. In 2018, ACHEST
submitted a request to the East African Community Secretariat for the representation
of more indigenous African CSOs on the health policy technical working groups (TWGs).
This aimed at CSO empowerment and participation in shaping the regional health agenda.
In 2018, ACHEST also supported East African CSOs to advocate for the resumption of a
debate on the stalled Regional SRHR Bill at the East African Legislative Assembly. Despite
these small steps in the right direction, CSO representation and coordination at the African
regional level remains limited and requires significant effort, advocacy, and financial
investments. African perspectives and experiences are collected locally and incorporated
by Wemos in their knowledge products that are then presented at global events and in
the Netherlands. However, it is also about making sure community voices are heard in
global debates, empowering community members to speak up to their Ministers at global
meetings and ensuring that their Ministers can be held accountable to their promises.
CSOs represent community needs. In 2018, a CSO capacity assessment took place.1
Amongst the strengths CSOs self-identified, one was their ability to represent community
needs. When asked to what extent they involve the community in the design and
implementation of advocacy, around 90 percent of the CSOs stated that they usually or
always involve affected communities and leaders in their advocacy strategy planning and
integrate their views. Community meetings, dialogue days and questionnaires are just
a sampling of the many methods used to involve communities in the identification of
advocacy issues. In Uganda, for example, CBOs are engaged in advocacy working groups
in six districts, which were set up and trained by Amref in 2018. These groups influenced
budget processes and as a result, FP funds were included in all of the district’s budgets.
One of the key lessons from the HSA Partnership’s work with CBOs is that by strengthening
CBOs’ capacity, they are capable of making unheard voices and the voices of hard to reach
communities heard in national debates.
There is a need to invest more in organisational capacity strengthening. Support for

CSOs has mainly focused on thematic and advocacy capacity strengthening. In 2018,
both an external MTR and a CSO capacity assessment took place. The findings showed
that individual CSOs, as well as the networks and platforms that engage with the HSA
Partnership, believed that capacity strengthening support had enhanced CSOs’ ability to
advocate for change. However, some partner CSOs indicated that the HSA Partnership can
improve the link between the capacity strengthening that is provided, and CSOs’ needs.
1
62 CSOs participated in the 2018 capacity assessment survey

These needs are not only thematic but are also at an institutional and organizational level
and involve areas such as corporate governance, financial management, monitoring and
evaluation (M&E), human resources and fundraising. Financial sustainability is one of the
core concerns of CSOs as they want to be able to continue advocacy activities after the
HSA Partnership. In 2019, we plan to involve CSOs more in the design and follow-up of
training sessions to make sure that our capacity strengthening activities are sustainable.
The positive impact of capacity strengthening in Tanzania (Box 1), illustrates how capacity
strengthening can also enhance the financial sustainability of CSOs.
BOX 1: THE ORGANIZATIONAL IMPACT OF CAPACIT Y STRENGTHENING IN TANZANIA

Mustapha Isabuda, CEO of AGAPE, Aids Control Programme, Shinyanga DC Tanzania: “I
am really grateful to the HSA project. After attending Advocacy and M&E Trainings from
Amref, formulating advocacy activities and an M&E framework has been a much smoother
exercise and, as a result, I have applied this knowledge, which has won us new funding for
two proposals, one funded by UNWOMEN, and another by SIDA. Prior to the training most
of the advocacy proposals I had written to funders were not successful. I guess this was
due to the way that I formulated the activities and the M&E framework; I used the regular
indicators instead of milestones which are more appropriate for advocacy interventions."
2.1.2 Building of platforms and networks

As well as strengthening the capacities of individual CSOs, the HSA Partnership improves
the links between organisations working on SRHR and helps to create spaces for dialogue
and dissent in contexts where there is insufficient multi-stakeholder representation on
SRHR issues. Through platforms, CSOs have more opportunities for engaging in joint
advocacy that often means that they have a stronger, common voice than if they had
engaged in policy debates as individual organisations.
Existing coalitions strengthened or revitalized by HSA partners

The HSA Partnership’s work in 2018 reaffirmed our belief that,
in some cases, space for dialogue and dissent can be most
effectively created by working with and strengthening existing
networks. Investments in terms of time, expertise and costs are
lower compared to creating new fora. An example of this is HSA Partnership’s work with
the Human Resources for Health (HRH) CSO coalition in Malawi. The coalition had been
relatively dormant in recent years; however, it was revived by the Association of Malawian
Midwifes (AMAMI) and Amref in 2018 (i.e., AMAMI acting as founding leader and Amref
hosting their meetings). Given their interest on the broader health workforce, Amref
helped to expand the coalition’s remit this past year to include different health worker
associations beyond nurses, as had previously been the sole focus. The coalition went on
to play an active and coordinated role in the HRH TWG. Through the TWG they submitted
recommendations to the MoH, several of which were incorporated into the Ministry’s
2018-2022 HRH strategy. This included the need for specialised training of health staff and
increased absorption rates of graduates in the health sector.
In the Netherlands, in March 2018, the HSA Partnership helped to revive the Multiparty
Initiative on SRHR. Six new Dutch Members of Parliament (MP) committed to the initiative
following Amref’s work within the SRHR alliance – there now exists a new cohort of SRHR
advocates in the Dutch government.

Multi-stakeholder platforms convened by HSA partners
With leadership from HAI’s in-country partners, multi-stakeholder
MeTA councils2 have been formed over the past years in Kenya,
Uganda and Zambia that come together to work on policy priorities
and share evidence. In addition in May 2018, MeTA Tanzania was
established. Significantly, this marked the first time in Tanzania that stakeholders from
across the MoH, the President's Office for Regional Administration and Local Government,
civil society, the private sector, pharmaceutical companies, academia, and manufacturers
have had a forum for discussing issues concerning Sexual and Reproductive Health
Commodities (SRHC).
HSA partners observed that the policymakers involved in MeTA councils took greater
ownership of the evidence discussed in these fora during 2018. For example, following his
involvement in council meetings where MeTA Zambia shared evidence from their SRHC
study,3 the MoH’s Permanent Secretary used their findings in his presentations and made
commitments that echoed MeTA’s recommendations. In 2018, we also saw stakeholders
from the private sector using MeTA councils as a space to engage in policy dialogue. For
example, the private Zambian Pharmaceutical Business forum used the MeTA platform to
successfully advocate against an increase in statutory fees.
In the Netherlands, Amref Flying Doctors and Wemos continued to facilitate the debate
on global health issues through the organisation of ‘Global Health Cafes’ throughout
2018. These are held in collaboration with Cordaid, the Royal Institute for the Tropics,
KNCV Tuberculosis Foundation and ViceVersa, and were widely attended by students,
policymakers and other Dutch NGOs working on SRHR. As well as creating a space
for dialogue and dissent, a network has been created from the group of Dutch non-
governmental organisations (NGOs) that regularly attend the Global Health Cafes. In 2018,
HSA partners and this network teamed up to deliver a session at the private sector event
‘World of Healthcare’.
At the international level, Wemos, ACHEST and Medicus Mundi International established
the Health Workers for All (HW4All) Coalition, hosted by Wemos, to carry forward the work
of the former Health Worker Advocacy Initiative. After its launch at the 4th Global HRH
Forum in Dublin in 2017, and a follow-up meeting at the World Health Assembly in May
2018, international and national CSO membership of the HW4All Coalition grew steadily to
29 members by the end of 2018. By providing a new avenue for targeted engagement with
policymakers working on workforce issues at the global level, it is hoped that this coalition
will help push the HRH agenda. This is pertinent because, compared to issues such as UHC,
this issue received less attention in global fora in 2018.
Finally, in May 2018 at the World Health Assembly, Amref and five global CSO partners
agreed to jointly launch "Communities at the heart of UHC".4 This is a global campaign to
ensure the integration of community health as a priority in global and national UHC agendas
and strategies. Since the launch of the campaign at the United Nations General Assembly in
September 2018 and at the Astana Global Conference for Primary Health Care in October
2
Medicines Transparency Alliance (MeTA) is a model for improving access to medicines, tested and developed
by HAI and WHO (Vivan & Kohler, 2016). MeTA councils (multi-stakeholder steering committees) meet
throughout the year and MeTA forums (national open events) occur annually.
3
The study can be accessed at: http://haiweb.org/wp-content/uploads/2018/02/SRHC-Data-Collection-
Report-Zambia.pdf
4
For more information on Communities at the Heart of UHC, see: www.uhc4communities.com

2018, more than 120 organisations and individuals became active members or endorsers of
the campaign. This included organisations such as The Elders, the Rockefeller Foundation,
and the World Bank. The campaign is currently being accelerated both at the global and
country level in the run-up to the UN High-Level Meeting on UHC in September 2019. In
this way, the HSA Partnership not only convenes power and strengthens alignment at the
global level, but also facilitates strong linkages and exchange between the work of the
HSA Partnership at the national and sub-national level and the current global momentum
around UHC and primary health care.
Alliances formed by CSOs that engage with the HSA Partnership

In 2018, there were also cases where CSOs formed new alliances
after they received capacity strengthening interventions from HSA
partners, or as a result of their engagement with MeTA councils. By
combining strengths, exchanging knowledge and sharing capacities
across a single theme, the fragmentation of CSOs can be decreased. It is often the case that
CSOs share interests but are unaware of each other's work or knowledge. Following the first
MeTA forum in Kenya in 2018, 24 county officers from the lower eastern region formed a
CSO platform to exchange ideas and formulate strategies on issues related to SRHC in their
region. Similarly, health committees were established by district CSO fora in Malawi, which
will hopefully contribute to more effective planning and joint advocacy as highlighted in Box
2: Kondwani Mamba: The HSA Partnership’s positive impact in Malawi.
BOX 2: KONDWANI MABA: THE HSA PARTNERSHIP’S

POSITIVE IMPACT IN MAL AWI
Kondwani Mamba, Chair of the Malawi Environmental

Health Network, which is supported by Amref, explains
the positive impact that the HSA Partnership is having in
Malawi. “For example, at a district hospital in Mangochi,
each NGO active in the area separately conducted HIV
tests, or implemented maternal health projects, without
taking into account the work already done by other
organisations. Through the HSA Partnership, the work of
different organisations is taken into account and included
in the District Programme. This prevents multiple
organisations providing the same services. This way, we
will probably also spend less of the budget.”
Picture: Jeroen van Loon
2.1.3 Media engagement

To enhance public awareness around health, and more specifically SRHR around challenges,
HSA partners strengthen the capacity of media outlets and practitioners. The assumption
held by HSA partners is that by improving the journalists’ health reporting capacity we
contribute to more evidence-based, solution-focused media publications on health system
strengthening (HSS) and SRHR. These publications help to create public demand for SRH
services and are a direct avenue for advocacy that stimulates decision-makers to act. Within
the HSA Partnership’s MTR, the partners’ engagement with media outlets and organisations
was evaluated positively, and in our 2018 reflection, we harvested outcomes that showcase
the impact of strengthening the capacity of media outlets and practitioners, while also
noting areas for further improvement.

One of the capacity strengthening activities that has brought health journalists together
is strengthening of the African Media Network on Health. Media outlets were invited to
HSA research publication workshops, and at the same time, journalists proactively reached
out to HSA partners to get input for their publications. As a result of the various capacity
strengthening activities, partners observed evidence-based and solution-oriented SRHR
and health systems reporting increased by members of the media network in the five HSA
countries in 2018. Table 2: Overview: Capacity strengthening of Media in 2018, presents an
overview of the findings in this area.
Member journalists of the Africa Media Network on Health

312
Capacity strengthening • Classroom training on health systems and SRHR

methodologies reporting for journalists
• Media excursions to HSA partner target districts
• Training of media editors, to grow commitment for
the publication of SRHR issues
• Relation building between CSOs and media
Number of SRHR related publications reported by journalist of the network
147
Table 2: Overview: Capacity strengthening of Media in 2018
There are several examples of the positive impact that strengthening the capacity of
journalists and media outlets had in 2018. For instance, after a training session for
journalists on pre-eclampsia (high blood pressure during pregnancy) two articles were
published in Uganda’s most important newspapers (New Vision and Monitor). The articles
sparked Parliament’s interest and resulted in a commitment to increase the budget for
magnesium sulphate that is needed to treat the condition.
While media attention triggers a response from decision-makers, it also represents a vehicle
for creating or increasing public demand for health services, such as FP. In rural areas, radio

stations are typically the best way to reach communities. In 2018, radio shows followed our
capacity strengthening activities and allowed community members called in to express their
views. In one case, a radio publication triggered a direct community response – a Zambian
pastor sponsored a pregnant girl, thereby ensuring that she can go back to school after
giving birth.
Besides strengthening journalists’ capacities, in 2018, HSA partners also actively engaged
with media outlets, provided journalists with access to stories and produced publications
themselves to increase awareness around our advocacy themes. For example, in Uganda,
ACHEST, Amref, and HAI/the Coalition for Health Promotion and Social Development
(HEPS) actively engaged the media through television talk shows, press conferences and
interviews, which popularised UHC and took advantage of international celebratory days.
Furthermore, HSA partners published blogs and ACHEST took over ownership of the Africa
Health Journal,5 which has a wide readership and active online dialogue. The journal is
a powerful vehicle for the dissemination of health-related messages to frontline health
workers and policymakers in and outside Africa.
The HSA Partnership is cognisant of the importance of sustaining our capacity strengthening
efforts concerning journalists and media outlets beyond the lifetime of the HSA partnership
and, in 2018, the Amref International University in Nairobi set up a curriculum for health
journalists. This course, which is the first of its kind in sub-Saharan Africa, will continuously
strengthen the capacity of media practitioners to generate compelling narratives and
to interpret health in political, socio-economic and medical contexts in ways that serve
the public interest. Furthermore, the course provides journalists with a set of skills and
competencies to research and analyse health-related materials for reliability, thereby
improving the accuracy of their reporting.
In addition to these successes, several lessons have been learned regarding how to improve
the HSA Partnership’s capacity strengthening efforts with media practitioners. One of
the risks identified concerning media engagement is that negative stereotypes about
sensitive topics, such as the availability of FP for youth, might accidentally be reinforced.
The participation and presence of health experts in the studio can help to address these
stereotypes so that publications can have a positive effect on demand creation for SRH
services and the discourse around sensitive SRHR topics. Finally, to address possible
underreporting about the HSA Partnership’s media engagement, further attention needs
to be paid to monitoring media publication outcomes by tracking responses to written
publications, and through active follow-up on television and radio publications.
2.1.4 Amplifying community voices

A fourth capacity strengthening strategy that was further enhanced in 2018 was the
strengthening of rural communities so that they can demand their right to SRH. The HSA
Partnership achieves this in several different ways. On the one hand, we collaborate with
CSOs, CBOs, and networks that are directly connected to a specific community and include
these communities in the design and implementation of their advocacy work. In 2018,
examples of actors taking these approaches included three district CSO networks in Malawi,
women’s groups and faith-based CBOs in six target districts in Uganda and the youth
parliament in Siaya, Kenya. HSA partners continue to support the capacity of these CSOs
and networks in the use of locally applicable social accountability methods that engage
5
The African Health Journal can be viewed at: https://africa-health.com/

communities to identify challenges and demand improvements in the local health system
from duty bearers.
On the other hand, the HSA Partnership also uses specific methods that give community
members the possibility to interact with local government representatives directly and
claim their issues. An important method that Amref developed in 2016 and 2017 – and
continued to use in 2018 – is community dialogues. During these dialogues, representatives
of the of community members (including women and youth) and decision-makers engage
in a participatory conversation aimed towards reaching a common understanding and
a workable solution for health or SRHR problems. As the HSA Partnership is now in our
third year, we have implemented many dialogues with several results, such as improved
youth-friendly services, a decrease in the absenteeism of health workers and the repair
of broken facilities. We continue to learn how to make these community dialogues more
effective, for example how to engage the right stakeholders and how to address sensitive
topics. In the second half of 2018, based on these lessons learned, we started to implement
‘intergenerational dialogues’. In these dialogues, there is a specific emphasis on bringing
youth and local leaders (including religious leaders) together to discuss issues like FP and
teenage pregnancy. There have already been some positive first results. For instance, at an
intergenerational dialogue in Uganda religious leaders committed to sharing SRH messages
(including on contraceptives) in their church sermons. The method will be further extended
and evaluated in 2019, and the HSA Partnership will continue to explore the best ways to
reach rural and marginalised youth and communities and to give them a voice at the local
and national level.
CBO partner Kabale Women In Development (KWID) promotes the objectives of HSA at the Women's day
celebrations in Kabale district, Uganda
To effectively demand changes and hold decision-makers accountable, communities should

be well informed about their health and SRH rights, pertinent political commitments as
well as resource allocations. Therefore, throughout 2018, a method that HSA partners
frequently employed was scorecards in community meetings. With these tools’
communities can assess factors such as resource allocation to health, minimum staffing
levels, and commodity availability standards, that determine the quality of health services.
An example of the effectiveness of this approach is the community dialogue in Amach,
Lira District, Uganda in May 2018. During the dialogue community members shared their
frustration about the absence of FP services at their health centre and identified the lack of
qualified health staff in the local health centre as its cause. In response, the DHO committed
to having staff posted in one month. The community dialogue was followed up with other
strategies: Amref offered technical support to the DHO to develop a recruitment plan and
media practitioners were involved to report about the issue. Eventually, the community was
heard, and new health staff were recruited.

In 2019, the HSA Partnership will invest in sharing community engagement approaches
between HSA Partnership countries and work on connecting community demands to
sub-national, national and international advocacy activities, for example through social
accountability around UHC.
2.2 Lobby and Advocacy

As shown in the previous sections, in 2018, the HSA Partnership strengthened the capacity
of CSOs, supported platforms and increased media engagement on SRHR. These efforts
were complemented by our lobby and advocacy strategies, which include working with
advocacy champions, active involvement in legislation processes, research for evidence-
based advocacy and budget advocacy (introduced last in 2018). This section presents
the fruits of our lobby and advocacy work, in 2018, in the areas of HRH, SRC, financing
and governance, as well as some of the challenges encountered. Box 3: HSA Partnership
initiatives, details the varied advocacy initiatives that we supported.
BOX 3: HSA PARTNERSHIP ADVOCACY INITIATIVES
During 2018, the HSA Partnership contributed to over

1000 advocacy initiatives of which:
• 350 meetings were held with policymakers that
partners co-organised themselves.
• 150 meetings were held on invitation by policy makers.
• 360 different knowledge products were disseminated
among external stakeholders. These included blogs,
policy briefs, factsheets, press releases, reports, etc.
• 150 events were organised by the partners which
Ms. Atuswege from Achest partner promote SRH outcomes.
Sikika, Tanzania
2.2.1 Human Resources for Health

Qualified health workers such as doctors, nurses, midwives, and CHWs are essential for
effective SRH service delivery such as antenatal care, safe delivery, FP, ending sexually
transmitted infections including HIV and promoting healthy sexuality. Within our HRH
advocacy, ACHEST, Amref, and Wemos focus on addressing health worker shortages and
their unequal distribution. Related to this, partners advocated for improved working and
living conditions (including fair remuneration) for health workers to tackle the root causes
of national and international health worker migration. Complimentary to this is Amref’s
advocacy for the recognition of the importance of CHWs, which serve as a linchpin between
communities and the formal health system. CHWs play a crucial role in prevention and
health promotion, including information on safe delivery, FP and other SRHR topics.
Recognition and remuneration of CHWs

In 2018, Amref and partner CSOs made significant contributions to increasing the
recognition and remuneration that CHWs receive in several African countries. Positive
results were primarily achieved at the country level through connections with policymakers
and membership of TWGs or committees. Furthermore, at the international level, partners
organised several events that built on the 2018 release of the ‘WHO guideline on health
policy and system support to optimize CHW programmes’. Through the establishment of
a global campaign that involves CHWs as advocacy champions, Amref and another 120

organisations are jointly pushing countries and global actors to recognise CHWs and support
the sustainable financing of community health programs as key strategies for achieving
UHC. Table 3 details some of the key outcomes of the 2018 CHW campaign:
Strengthening In Malawi, Amref has been mentoring and supporting

CHWs associations MeHA, the national association of CHWs, with a
and platforms national CHW conference and a campaign to hold
the Malawian government accountable for the
implementation of the Community Health Strategy.
As a result, by the end of 2018, the MoH endorsed the
strategy and renewed its commitment.
Formalizing CHW roles In Tanzania, Amref has been an active member of
and responsibilities the CHWs Technical Advisory Council. Following the
persistent advocacy efforts of Amref, Sikika/ACHEST
and other NGOs in this TWG in 2018, the MoH
embarked on a process of developing a CHW Scheme
of Service, which is an important prerequisite towards
CHW absorption and remuneration.
Recognition by law In Kenya, the CHW campaign successfully pushed for
county governments to include CHW salaries in their
health budgets in 2016 and 2017. From 2018, to ensure
budget sustainability, Amref Kenya is advocating for
the inclusion of CHWs in county and national laws. As
a result, Kajiado and Siaya county governments have
approved legislation that officially recognises and
remunerates CHWs. Key stakeholders also endorsed
a national CHW Bill and, in October 2018, this was
finalised for introduction to Parliament.
Advocacy for implementation In 2017, as a result of several years of advocacy by
of CHW strategy and training Amref Uganda, the Ugandan MoH launched the
curriculum national Community Health Extension Worker strategy.
In 2018, Amref advocated for an official national
training curriculum for Community Health Extension
Workers, which was developed and approved.
However, unfortunately, there was a backlash in
early 2019. The Ministry of Finance took measures to
stop the implementation of the strategy due to “cost
implications” and all planned activities were cancelled.
In 2019, the HSA team in Uganda is continuing its
advocacy campaign through national dialogues and
engagements with the Ministry of Finance.
Table 3: Key 2018 CHW Advocacy outcomes
A strengthened health workforce and improved working conditions

In 2018, the research and advocacy of HSA partners in national TWGs continued to bring about
significant improvements in national and sub-national policies regarding health worker staffing
levels and the working conditions of the formal health workforce. Core results are highlighted
in Table 4 below.

New HRH strategies developed In Zambia and Malawi, the Ministries of Health
approved a new national HRH strategy: a roadmap
towards more and better-paid health workers.
Partners actively contributed to these strategies in
TWGs.
Recruitment of health workers Following massive layoffs of unqualified health
workers in the past two years, in 2018, Tanzania’s
MoH decided to recruit 7,618 health workers for
primary health care facilities in rural and hard to
reach areas. Active lobbying by civil society, which
included a presentation of a health worker workload
study based on WHO standards and a budget analysis
by ACHEST’s partner Sikika, contributed to this
change.
Better health Technical input provided by the HRH TWG and
worker incentives coalition by the HSA partners (KOGS, ACHEST, and
Amref) supported the county government of Kajiado
in Kenya to develop and launch a health worker
incentive guideline to strengthen the motivation of
health workers to deliver quality services.
Community demands heard In six Ugandan districts, district governments acted
after citizen hearings and intergenerational dialogues
by Amref-mentored-CBOs and filled key healthcare
staffing positions like nurses, midwives, and clinical
officers. Many of which had been vacant for a long
time.
Table 4: Strengthened health workforce and working conditions in 2018
Advocating for better working conditions and increased financing for HRH is linked to the
advocacy work of HSA partners to reduce health worker migration. To ensure that health
workers are available to deliver quality SRH services for all, it is important to aim to ensure
equal distribution of health workers between rural and urban areas and, at the international
level, to avoid a drain of health workers from low- and middle-income countries to middle-
and high-income countries. In the African region, in 2018, HSA partners undertook advocacy
efforts and capacity support to the Association of Medical Councils of Africa (AMCOA). Kenya,
Uganda, and Zambia have started to use the jointly developed Health Worker Migration data
collection tools and presented their results at the Annual AMCOA conference in Ghana in July
2018. As a result of this work, the Ugandan MoH committed to developing a health worker
migration policy.
On the global level, Wemos and ACHEST have advocated for CSOs to submit their reports for
the third round of reporting on the WHO code of practice on the international recruitment of
health personnel. This has resulted in fourteen submissions to the WHO secretariat, including
from HSA partner countries. ACHEST also supported all HSA member country governments in
their reporting to the WHO. The WHO asked Wemos to support the analysis of these reports.
Wemos was invited to chair a session on “Striking issues on Health Worker mobility and
migration from Civil Society perspective” at the first International Platform on health worker
mobility in September 2018. Subsequently, Wemos also co-authored the report “Global Skills

Partnerships & Health Workforce Mobility: Pursuing a Race to the Bottom?”, which was
presented during pre-sessions of the Global Pact on Migration meetings in Marrakech in
December 2018. This work secured Wemos position at the table of global level discussions
on health worker migration issues in 2019.
Throughout 2018, to achieve lasting results in relation to the above-mentioned outcomes,

HSA partners advocated for HRH financing. The Malawi research report ‘Mind the funding
gap; who is paying health workers’ was published by Wemos and ACHEST’s partner AMAMI
in October 2018, and sparked attention from media outlets at both the national and
international level. This resulted in a request to present the report to the parliamentary
committee for health in Malawi to integrate the lessons learned for implementing the
newly adopted HRH strategy. Internationally, the publication was quoted by the Lancet
in an editorial calling for sustainable investments for the health workforce. The HSA
Partnership’s complementary lobby and advocacy strategies for HRH aim to assure that
remote communities have access to health workers for safe referrals in case of delivery and
that young people have access to information on SRH.
2.2.2 Sexual Reproductive Health Commodities

A crucial second health systems building block on which the HSA Partnership focusses is
increasing the accessibility and affordability of essential SRHC, including FP. Within the
partnership, HAI and Amref use complementary strategies to achieve this objective. HAI’s
partners conduct evidence-based advocacy using the MeTA model and Amref’s advocacy
focuses on FP budgets and policy development at the district level using approaches like
budget tracking and public dialogues.
Evidence-based advocacy to improve SRHC supply

One of MeTA’s core strategies is using the evidence from ‘Measuring Price, Availability
and Affordability’ studies (SRHC studies) that are conducted annually by MeTA’s in Kenya,
Tanzania, Uganda, and Zambia. These studies provide a robust, multi-year evidence base on
the level of access to SRHC, and this evidence base is used in dialogue with health facilities
and policymakers. The study also provides a basis for counties, for example in Kenya, to
compare themselves against each other and, therefore, use as leverage in discussions with
local decision-makers about improving access to SRHCs.
In 2018, stockouts of SRHCs remained a persistent issue that HSA partners worked to
combat. In Uganda, evidence-based advocacy by MeTA and the capacity building of its
members by HEPS led the MoH to introduce an alternative supply chain for SRHC in April
2018; the Uganda Medical Stores. One of the activities leading up to this was a collaboration
with female MPs during International Women’s Day, who used HEPS/MeTA’s study to call
upon the government to increase the budget allocation for SRH supplies and to streamline
the commodity supply chain. At the district level in 2018, CBOs which had been trained by
Amref presented evidence on the stock-outs of FP commodities that they had collected
from 34 health centres in Kabale district to the DHO. As a result of this, the DHO issued an
immediate order to distribute Depo Provera, the FP method used most in Kabale, to all
6
The report can be accessed at: http://world-psi.org/sites/default/files/attachment/news/web_2018_mig_
report_marrakesh.pdf
7
The report can be accessed at: https://www.wemos.nl/wp-content/uploads/2018/11/Wemos_Country-
report-Malawi-2018.pdf
8
The editorial can be accessed at: https://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(18)32973-8/fulltext

health centres experiencing stockouts. In Tanzania, UMATI/MeTA used the findings from
their study to draw the MoH’s attention to issues with the management and supply of
SRHCs that were leading to stockouts. Through this intervention, the MoH committed to
strengthening the supply chain by working with district medical officers through zonal
medical store departments. These outcomes demonstrate how HSA partners were able to
effectively combine the creation of evidence, capacity strengthening of CSOs and the direct
lobby and advocacy of policymakers, to achieve improved SRHC supply outcomes at local
and national levels in 2018.
MeTA also used evidence from the ‘Measuring Price, Availability and Affordability’ studies
when lobbying high-level officials and representing civil society in TWGs. MeTA Zambia
escalated the agenda on SRHC in 2018 by using the findings from their SRHC study, which
led to the MoH taking on a key recommendation made by MeTA regarding the need to
incorporate procurement in the new draft "Zambia Medical Stores Agency Bill". This bill will
mean that medicine procurement in Zambia moves from a push to a pull system. In 2018,
MeTA Kenya pushed their recommendations during the review of national FP guidelines.
This included the implementation of the Adolescent Sexual and Reproductive Health policy
that supports the provision of FP services by adolescents without parental consent, the
safe provision of contraceptives for women living with HIV and the appropriate training
of Community-Based Distributors on injectable contraceptives. These were important
outcomes which addressed access to SRHC both in hard to reach areas and for hard to reach
populations that might have otherwise become marginalised.
Part of the success of the MeTA forum is that is

has helped to bridge the gap between the end
user, CSOs and government agencies in ensuring
availability, accessability and affordability
of medicinds and health supplies. Specially,
reproductive health commodities.
Dr Fred Sebisubi, Principle Pharmacist,
Ministry of health, Uganda
Evidence-based advocacy to increase SRHC and FP budgets

Advocacy to improve the supply of and access to SRHC are complemented by advocacy for
the financing of SRHC, including FP. An example of budget advocacy is the active support
provided to the TWG at the district/county level in 2018. This resulted in a costed FP
implementation plan being developed in Siaya County, Kenya, and the inclusion of FP funds
in the budget framework of the six HSA focus districts in Uganda. Similar results were also
evident in Tanzania, where Amref’s concerted advocacy efforts in three districts mean that
resources are being allocated to FP. This is a particularly significant outcome due to the
current attitude towards FP in Tanzania, which, fuelled by statements from the president,
became increasingly negative in 2018. In Tanzania, there was also traction with the private
sector in 2018. Following a targeted lobbying session by Amref in October, three private
health insurance companies (Strategies, Resolution and Britam Insurance), committed to
including FP in their health benefits packages. This demonstrates that despite a challenging
enabling environment, in 2018, HSA partners were able to make progress with the sub-
national government and private sector actors.

2.2.3 Health Financing and Governance
A well-financed and governed health system is an essential precondition to achieve
and sustain policy outcomes on the health systems building blocks for HRH and
SRH commodities. Through budget advocacy, the HSA Partnership aims to influence
governments to increase their funding. In 2018, we accelerated this strategy at all levels and
across all eight contexts. This section of the report provides an overview of key financing
results. This is followed by reflections on how HSA partners engage in national and
international spaces for health financing and governance. The overview below provides an
insight in the key health financing and governance results in 2018.
Kenya
As a result of Amref’s lobby and advocacy, Siaya county
increased the budget allocation from Ksh 2,500 (€22.00) to
KSh3,500 (€30.00) per CHW per month.
Malawi
A network of local CSOs, which received lobby and
advocacy training from Amref, convinced Mangochi and
Chitipa district councils to include an FP budget line in their
2019/2020 district health budgets.
Tanzania
As a result of advocacy efforts by Amref and UMATI/MeTA,
Bahi, Msalala, Kishapu and Shinyanga districts committed
to allocate between three and 15 percent of their budgets
towards SRH, including commodities in the 2019/2020
plans and budgets.
Zambia
Advocacy by MeTA, which used the 2017 Measuring Price,
Availability and Affordability of SRHC study, convinced
the Zambian government to contribute USD 1.5 million
(€1.3 million) towards the SRHC budget for 2019. This
contributes to a general health budget increase, from 8
percent to 9.3 percent of the total 2019 national budget.
Uganda
As a result of ACHESTs mentorship and support, the
Reproductive, Maternal, Neonatal, Child and Adolescent
Health (RMNCH) coalition and the Uganda Medical
Association undertook successful lobby and advocacy
efforts with MPs, and this resulted in the Human Resources
for Health budget increasing from UGS 364.3 Billion (€86
million) to UGS 400.8 Billion (€94 million) from the financial
year 2017/18 to 2018/19.
Due to lobbying and advocacy from HEPS/MeTA as well
as other HSA Partners, which utilised evidence from their
research, the SRH commodities budget increased from
UGS 8 billion (€1.9 million) to UGS 16 billion (€3.8 million)
in 2018.

Netherlands
As a result of the joint lobbying of Amref, Wemos and
other Dutch CSOs, the Multi-Party Initiative on SRHR and
HIV/AIDS was reinstalled. After the annual development
budget was published, the HSA Partnership analysed
the budget and strategised together to lobby the
Multi-Party MPs for the parliamentary debate on the
budget. Overall, while there were signs of a decrease
in SRHR funding in the long-term, the budget was
maintained and included SRHR as a priority. Additionally,
the importance of investing in SRHR was emphasised
by several MPs during the debate and an amendment
was raised for an increase of €10 million for earmarked
funding for access to contraceptives.
Global
ACHEST made submissions to lobby for the inclusion
of an indicator on community participation and health
promotion for UHC. An article was published in the
British Medical Journal led by ACHEST, and 18 global
health leaders signed this. During the global Primary
Health Care conference in Astana, Kazakhstan (at the
40th anniversary of the “Health for all declaration”),
ACHEST circulated a policy brief and mobilised national,
regional and global institutions and delegations to
support the call for the inclusion of this new indicator in
UHC and SDG 3. WHO’s Director General has constituted
a Task Force to respond to this call.
The financing results presented above are successful examples of how HSA partners
managed to sustain, specify or increase health-related budgets in 2018. These successes
require follow-up and are expected to become a more important part of our work in the
coming years. However, there are also challenges. This is illustrated by the cancellation of
the budget for the Community Health Extension Worker policy by the President and Cabinet
in Uganda. The budget increase of SRH commodities in Uganda is under a similar threat
because the Ministry of Finance is raising serious questions about the MoH’s proposed
need to raise the budget for essential medicines. These examples show the importance
of adopting a multi-sectoral approach in our lobby and advocacy work. The ACHEST HSA
learning research focuses on how to go about multi-sectoral collaboration, so in 2019,
partners expect to strengthen their strategy based on the research outcomes.
Besides ensuring that budget allocations are released for policy implementation, a second
challenge is ensuring that budgets are available and efficiently used at the sub-national
level. HSA partners, therefore, invested in capacity strengthening for budget tracking in
2018. Moving forward, partners intend for these skills to be utilised in various community
and social accountability models such as the Youth Parliament work in Kenya, community
hearings in Uganda, and by district health management teams in Malawi.

International health financing and governance work
In addition to the HSA Partnership’s contribution to increased financing and improved
accountability at the local and national level, we also engage in international advocacy.
Our international work in the African region and at the global stage focuses on creating a
global movement to invest in HSS in relation to the SDG 3 agenda and on following up on
the commitments made by countries in regional bodies or global institutions. The following
examples highlight two of our major financing and governance advocacy processes in 2018
globally and in the African region.
Wemos increased its focus on the GFF. GFF is a multi-donor trust fund to financially support
the UN’s ‘every woman every child’ strategy which is focused on Reproductive, Maternal,
Neonatal, Child and Adolescent Health, and Nutrition. Engagement with GFF was intensified
through direct discussions with GFF’s CSO coordinating body and through international
and national CSOs. Three country case studies were conducted by Wemos in collaboration
with local HSA partners in Kenya, Tanzania and Uganda, and these helped to form a better
understanding of GFF based of experiences at the country level. Additionally, several key
issues were identified. These included a lack of meaningful engagement with civil society,
potential negative effects of GFF’s blended finance model and insufficient financial support
to address the severe health worker shortages.
The assessment findings and recommendations for policy change were shared with several
levels of policy- and decision-makers, including the Dutch MoFA at the EU-level and back
to GFF. In advance of GFF’s replenishment meeting in 2018, Wemos sent an open letter to
the Investment Group and GFF Secretariat, in collaboration with Oxfam and Médecins Sans
Frontières. The letter was endorsed by over 52 international and local CSOs and outlined
the critical issues facing GFF as well as recommendations for change. This letter was a
major step towards opening the door for a more in-depth dialogue with MoFA, as well as
the GFF Secretariat. GFF provided a response to this letter during a side event organised by
Wemos, in collaboration with Médecins Sans Frontières, at the 2019 International Monetary
Fund/World Bank spring meetings in Washington, DC. GFF acknowledged that they are
still learning about the best approaches for engagement. The role of CSOs is considered
important, and GFF is taking steps to improve coordination and engagement at the country
level as well as linking CSOs to central governance bodies.
At the African region level, advocacy continued around the stalled East Africa SRHR
bill,9 which showed that decision-making processes at this level requires long-term
advocacy investments. In 2018, ACHEST made submissions through a formal process for
the resumption of the debate on the East Africa SRHR bill legislation at the East African
Legislative Assembly. Some of the issues ACHEST pushed for in the SRHR bill include SRH
education for children, use of registered medical practitioners for safe abortions, and
the provision of tailored health services to young persons living with chronic diseases
arising from sexually transmitted diseases besides HIV. Advocacy efforts for the East Africa
SRHR bill continued, and these were particularly strong in Uganda where the Ministry of
Education remains engaged with other sectors to agree on a common position with regards
to packaging the contents of the bill. The Tanzanian government also raised several issues,
especially on access to FP Commodities by young people. Hence, to ensure progress both
countries require close following by the HSA partners in 2019.
9
The East Africa SRHR bill aims to provide a common framework for the protection and advancement of SRH
rights for all, safe motherhood, prevent bad practices and ensure quality sexuality education for all citizens
in the East African Community. This regional law should be domesticated in national laws, ensuring policy
coherence in the region.

2.2.4 Lobby and Advocacy outcomes in summary
In summary, throughout 2018 the HSA Partnership and local partners contributed to
decision-makers’ increased commitment to improving the situation around HRH and
SRHC. In several cases, these commitments were translated into actual policy changes,
the adoption of new policies, and budget increases. The HSA Partnership also engaged in
improving governance at different levels by increasing the role of CSOs and communities in
decision-making processes. However, we also encountered situations where policymakers’
commitments had not (yet) led to formal decisions or where commitments between
ministries, especially Health and Finance, were not aligned. Overall, the Partnership and
its local partners have contributed to the improvement, adoption, and enactment of 43
policies or budgets. Furthermore, two policies were implemented in 2018. Below, Figure 2
provides an overview of the policies/budgets improved per context, and Figure 3 details the
level of improved policy/budget.
Figure 2: Policies/budgets improved (per context)
Figure 3: Level of improved policy/budget

3. Enabling environment
In 2018, the HSA Partnership witnessed a mixed picture consisting both positive and
challenging developments in regards to the space available for civil society to advocate for
stronger health systems and SRHR. In general, there seems to be increasing space for CSOs
to lobby and advocacy for strong health systems; however, partners observe that there is a
declining space for a rights-based approach to SRH.
In several countries, there is a general decline in the space available for CSOs to enter
dialogue or dissent with the government, or the already restricted space has not improved.
In Uganda, some CSOs and media outlets involved in ‘governance and democracy
issues’ were raided by the police, which contributes CSOs being fearful of opposing the
government. The arrest of an upcoming opposition leader is another example of the
declining space for dissent in Uganda. Similar developments are seen in Tanzania, and
these are further complicated by the move of major government institutes from Dar es
Salaam, where most CSO headquarter offices are based, to the capital Dodoma in which an
increasing number of policy meetings take place.
Civic space to address the right to sexual reproductive health

Amidst growing global conservatism largely led by the US government, there is an overall
decline in the space available for dissent and for CSOs to advocate for the right to SRH. The
global SRHR debate does not sufficiently address controversial topics such as access to safe
abortions, contraceptives for youth, or LGBT rights. Major pushbacks have determined the
outcome of the UN Commission on the Status of Women and the further restrictions of
the Mexico City Policy will create additional restrictions for CSOs. Conservative voices are
also pushing back on SRHR language in current global health policies such as the Astana
declaration for Primary Care, the WHO guideline on CHWs and the UHC resolution. Another
concern is that GFF does not sufficiently address the ‘rights’ component in its country
investments. The HSA Partnership sees an opportunity to collaborate more closely with the
Netherland’s MoFA to ensure that the progressive language on SRHR and women’s rights
remains included in the above-mentioned policies. Furthermore, global CSOs need to push
the GFF to take on a stronger stewardship role in their discussions with recipient countries.
Additionally, at the country level, examples from Uganda and Tanzania show that it has
become increasingly difficult to use a rights-based approach towards SRH. Partners in
Uganda observe that advocacy activities are increasingly perceived as promoting LGBT
rights for which there is significant resentment from both the Ugandan government and
religious actors. This complicates the general debate about SRH. In Tanzania, the negative
statements made by the President on FP make it difficult to engage in dialogue at the
national level around this topic. Consequently, some partners are working at the sub-
national level as there are more opportunities for bringing about changes ensuring SRHR
At the African regional level, there is again a mixed picture; relations with regional bodies
have somewhat improved, but progress on sensitive topics remains slow. In 2018, Amref co-
developed a MoU with the African Union that should facilitate contacts and cooperation on
SRHR topics such as female genital mutilation, CHW, the youth agenda on SRHR, and early
marriages. This is a step forward towards facilitating collaboration.

The HSA Partnership observes growing political sensitivity towards advocacy and lobby
efforts for SRH rights in 2018. However, partners in Uganda, Malawi, Kenya, and Zambia
recognise that in general, a majority of national and local policymakers support change in
the areas of HRH, SRH commodities, health financing and governance, and in many cases,
they actively approach HSA partners and CSOs to share their knowledge.
Civic space to address health system strengthening

Civil society is regularly invited to global consultations around the broader health systems
agendas, such as SDG 3 ‘Ensure healthy lives and promote well-being for all, at all ages’
and, more specifically, UHC (SDG 3.8). An example of this is the Civil Society Engagement
Mechanism for UHC2030. This input is crucial to setting the stage for further policy
development at the country level.
An example of the influence of these global health systems agendas is that, in 2018, the
Kenyan government made UHC one of the four pillars of its political agenda for 2018-2022
and has started a UHC pilot phase in four counties. Within these policy developments, CSOs
appear to be viewed as development partners that can provide evidence and technical
expertise. In 2018, Amref developed a social accountability tool to track progress on UHC in
the four Kenyan counties and to strengthen CSOs in holding governments accountable for
progressing UHC. Additionally, in 2018, CSOs were trained on social accountability tools to
track UHC progress and to facilitate community voices in UHC policy developments. ACHEST
is actively advocating for, and simplifying key components of, UHC through the Africa Health
Journal, blogs and policy briefs.
The 3Gs (GAVI the Vaccine Alliance, the Global Fund and GFF) as the main funders of
health systems worldwide are becoming the primary international entry points for CSO
engagement on health systems issues. Under pressure from civil society, GFF has developed
CSO engagement structures; however, in practice, these do not sufficiently capture the wide
range of civil society voices and do not give CSOs any decision-making powers on funding
allocation. The MoFA’s recent membership in the GFF Trust Fund Committee provides a new
opportunity for Dutch CSOs to influence GFF decision making.
Space for social accountability

The work of the HSA Partnership becomes more complicated and contentious when it
shifts towards advocacy for increased resource allocation and mechanisms used to hold
governments accountable for public spending. At the global level, although the private
sector’s influence is expanding, decision-making on health funding is still confined to a
small group of decision-makers at global health institutions. Traditional OECD donors like
the European Union and the Netherlands are also losing ground to new players such as
China, which provide large capital investments without imposing conditions such as good
governance. Civil society needs to expand and adjust its advocacy and lobby strategy to
take into account the influence of private actors and new financiers such as the Chinese
government on the global debate around HSS and SRHR.
Additionally, throughout 2018, at the national and sub-national levels partners experienced
tensions in keeping governments accountable for their health resource allocations and
expenditures. For example, in Malawi CSOs have noted that budget tracking is becoming
increasingly sensitive around the upcoming 2019 national elections. CSOs involved in
social accountability are often portrayed as ‘pro-opposition’ by government officials. As
highlighted in chapters 2.1.4 and 2.2.3, HSA partners are increasingly investing in social

accountability and are often yielding successful results from activities such as community
hearings. When CSOs work in collaboration with community members and provide them
with the skills to advocate for the right to health and quality healthcare, community voices
are strengthened and amplified. However, decision-makers do not always appreciate the
use of these skills. For example, community members from Mangochi district in Malawi
decided to organise a protest for the opening of a health centre after an advocacy training
session organized by Amref and a network of local CSOs. The health centre had been
constructed but was never opened by the government. Community members decided to
jointly share their demands at the DHO. After the protest, Amref received a call from the
district government and needed to re-convince the local government about the relevance
of the HSA Partnership’s activities. Simultaneously, the government committed to opening
the health centre. This example shows the potential but also the consequences of operating
in spaces of dialogue and dissent, and especially when using social accountability tools. The
HSA Partnership will continue to explore ways how to navigate within these spaces.
Navigating political and civic space developments

The national and international political and civic space developments around SRHR and
HSS illustrates that HSS represents a good starting point for lobby and advocacy activities
because it is often a more neutral entry point for discussing negative SRH outcomes
(when compared to a more rights-based approach). This does not mean that HSA partners
avoid all sensitive issues in the SRHR debate. This is exemplified by the work of HSA’s
partners with religious actors. In 2018, dialogue around the SRHR commodities research
has contributed to a growing willingness from mission facilities in Zambia to actively refer
clients for FP services to other clinics. Furthermore, despite negative national tendencies,
Amref successfully convinced local Tanzanian district officials to commit local budgets to
FP. These examples demonstrate that successfully discussing more sensitive SRH ‘rights’
issues is influenced by factors such as aiming for sub-national change and strengthening
collaboration with religious actors such as ‘Faith in Action’ in Kenya and the ‘Churches
Health Association’ in Zambia.
The HSA Partnership’s progress shows inspiring examples of how social accountability
contributes to change through citizen hearings, community scorecards and
intergenerational dialogues. Moving forward, partners aim to stimulate learning and
exchange around the use of these models as well as study how to navigate between
dialogue and dissent.

4. Gender and inclusivity
The HSA Partnership aims to strengthen health systems for improved demand and supply
of SRH services. When strengthening health system building blocks, it is important to be
inclusive, and consider that different population groups (for instance, women, youth and
people living with HIV/AIDS) have different health needs and challenges. The only way
to make inclusive health systems that cater to the specific needs of different population
groups a reality is by empowering these groups to stand up for their rights. There are
several elements of gender and inclusivity that the HSA Partnership took up in our
programme in 2018.
Internal capacity and policy development

Although the HSA Partnership organised sessions on gender in 2016 and 2017, many HSA
context teams remained unsure of how to operationalise gender and inclusivity. To address
this, in 2018, Amref collaborated with a Kenyan human rights and gender expert, who
provided training and coaching to Amref country teams. HSA partners are committed to
scale-up this practice and, as a result, context ToCs and work plans have become more
gender inclusive and feature a stronger emphasis on strengthening marginalised groups.
The HSA Partnership will continue this collaboration throughout 2019 with the development
of a gender definition paper and the scaling-up of the coaching trajectory.
BOX 3; DORCUS INDALO,

HSA PROJECT MANAGER KENYA
“The gender mainstreaming and social inclusion training

trajectory was an eye opener. It enhanced my skills in
looking for gender aspects in legislative drafting as well as
in the activities that we carry out. I realised [that] in my
day to day activities I have been incorporating gender, but
it was not well highlighted. With this new knowledge we
are now assisting devolved governments to have a gender
lens when drafting legislation for better inclusivity of all
its citizen, especially women and marginalised groups like
youth, disabled and LGBTQI.”
In response to the 2018 Global Health 50/50 report, HAI developed and implemented a new
gender policy, which reflects and promotes already established core values on gender and
inclusivity in transparent and outward-facing documents. As a result, HAI was championed
in the 2019 50/50 report as having made ‘significant improvements across a range of
domains’. HAI’s Gender Policy now defines specific commitments to gender equality within
the organisational culture, as well as the work programmes that HAI implements and
supports. For example, the HSA/MeTA ‘Measuring Price, Availability and Affordability of SRH
commodities’ research protocol now has an integrated gender assessment.
Strengthening the advocacy power of people living with HIV/Aids

In 2018, the HSA Partnership continued to invest in strengthening CSOs and CBOs that

represent women and marginalised groups in order to address the challenges regarding
HRH, SRH commodities, health financing and health governance that affect their lives. One
group that we specifically targeted was people living with HIV/AIDS. For example, in 2018,
in Zambia MeTA worked with two CSOs, and, in Uganda ACHEST and HEPS trained seven
CSOs that represent people living with HIV/AIDS including youth CSOs. In our health systems
work, HSA Partnership’s see that people living with HIV/AIDS are particularly affected
by commodity stockouts and budget cuts, but often lack the skills to do good budget
tracking and policy advocacy. Many other CSOs also lack these skills. Therefore, we have
strengthened their capacity to gather evidence and hold national and local governments
accountable for the implementation of HIV/Aids budgets.
Woman receives an injectable contraceptive during a practical. Picture; MeTA, Zambia
Addressing gendered framing of SHR commodities in the media and advocacy messages
When advocating for an increase in SRHCs, HSA teams noticed a need to address underlying
gender stereotypes. One of these stereotypes is that SRH commodities are a women’s
issue and, as a result of this, they are often not considered a priority for male policymakers.
This is especially harmful because in both the public domain and in most households’
decisions on healthcare are made by the men that hold power. Therefore, in 2018, Amref
Kenya deliberately engaged male and female members of county assemblies as champions
of FP during legislation and budget discussions. In Uganda, HEPS started to intentionally
encourage journalists to shed light on SRHC issues with a gender perspective. As a result,
on pre-eclampsia day, which is often considered as a ‘women’s issue’, an article came out
where the impact and roles for both men and women were highlighted. Similar examples
can be found in our community engagement approaches. In Kabale district, Uganda, male
involvement in FP was one of the topics discussed during a series of community dialogues
facilitated by Amref, and this had a direct positive effect on FP uptake in the community. A
lesson learned is that changing the gender-frames of media practitioners and community
actors is not easy and that CSOs need proper training as ‘facilitators’ to correctly guide
these discussions. Therefore, in 2019, gender training sessions for CSOs and media outlets
and practitioners are planned in several HSA countries.
Strengthening the youth’s voice

When talking about SRHR, youth have the right to participate in discussions on their health
and access to services, as it is often said: Nothing about us, without us! In 2018 the HSA

Partnership made a significant improvement in youth engagement compared to 2017. In
the first place, the HSA Partnership has revised context specific ToCs and assumptions to
become more youth inclusive and recognise the different needs of the youth versus older
groups.
Secondly, in most contexts concrete actions were taken to strengthen youth groups,
youth organisations and youth champions in their SRHR advocacy in 2018. For example, in
Kenya, Amref strengthened the Siaya youth parliament, which successfully advocated for
youth-friendly services. Another example comes from the African Region, where ACHEST
mentored a Ugandan youth-led CSO during their participation in the African Youth SDG
summit and their campaign to hold the Ugandan government accountable for regional
commitments on youth. Furthermore, Amref spurred the recent launch of the #Youth4UHC
movement representing over 1,000 youth from across Africa. The objectives of this
movement are to foster meaningful youth engagement in policymaking processes, with
a focus on government commitments to achieving UHC, and to hold government leaders
accountable to the commitments that they made to improve access to SRHR information
and services. After a successful #Youth4UHC conference in Kigali in March 2019, the
movement is now preparing for the UN High-Level Meeting on UHC in September 2019.
Finally, throughout 2018, partners took deliberate actions to integrate youth voices in
their campaign messages and materials. One concrete example of this is the work of HEPS
in Uganda, which worked with district officials to organise meetings with adolescents to
jointly develop age-appropriate messages on SRH. These messages have been revised at
the national level and converted into an SRH information manual by the MoH. In Zambia,
together with young people, MeTA developed a youth-engagement strategy that will be
implemented in 2019.
A lesson learned from the HSA Partnership’s work in 2018 is that HSA teams sometimes
struggle with how to operationalise meaningful youth participation. This was especially
true in the two ‘new’ countries Malawi and Tanzania, which started their HSA programme
towards the end of 2017. Therefore, in 2019, the HSA Partnership will map out the several
youth engagement models that are to be used in the partnership, and initiate cross-learning
on meaningful youth participation during joint meetings and exchange visits.

5. Linking, learning and strategising
Strong and dynamic partnership relations are the foundation of the HSA Partnership’s ToC,
and they require continuous investment. Besides our regular exchange meetings, linking
and learning was stimulated throughout 2018 through our joint learning research and
the development of a learning tender. Furthermore, HSA partners invested in outcome
harvesting that enabled us to proudly celebrate and showcase results, which, in turn,
allowed us to engage in further reflections on our progress in relation to the ToC.
Learning through exchange

Like in previous years, the 2018 annual Joint Action Planning meeting provided an excellent
platform for exchange and mutual learning. At the 2018 meeting, partners reflected on
the MTR findings and focused on gender inclusion and creating a mutual understanding of
partners advocacy agendas such as work focused on CHW and other health worker cadres.
Besides physical meetings, learning and knowledge exchange also took place between
partners online. In 2018, several well-attended webinars were organised on programmatic
topics such as public financing for UHC and SRHR, pharmaceutical promotion and global
policies on HRH. HSA partners also used webinars to strengthen internal planning,
monitoring and evaluation capacity about outcome harvesting. Reports on the exchanges
and lessons learned were shared in the HSA newsletter as well as on Twitter with an HSA
hashtag; #HSApartners.
Valeria Huisman (Wemos, left) en Dona Ayona (Amref HQ, right) sharing ideas about gender inclusion at HSA
Joint Action Planning, November 2018, Tanzania
Building on the 2018 exchanges, in 2019 HSA partners aim to stimulate learning with a
greater emphasis on strategic linkages between local, national level and international
work. A successful example of bringing national issues under international attention is the
close collaboration between Wemos and ACHEST’s partner AMAMI. The organisations
jointly published a case study on funding levels for a strong health workforce (see footnote
7). The findings of the report gained attention nationally, and AMAMI was invited to the
Malawian Parliament and the HRH TWG in the Netherlands where AMAMI director Dr. Ann

Phoya shared the findings in a meeting with Dutch parliamentarians. Moving forward, HSA
partners intend to build on these kinds of local-national-international linkages. The HSA
Partnership also strengthens advocacy linkages in different advocacy campaigns such as
‘Communities at the Heart of UHC’ and our work around GFF. In capacity strengthening,
HSA partners aim to exchange learning around gender mainstreaming and methods for
youth and community engagement. Additionally, context teams are also able to finance
their linking and learning priorities through the launch of a tender early 2019.
Learning research
In 2018, each HSA partner developed research proposals aimed at testing our core
assumption that the HSA Partnership’s approaches for HSS contribute to the attainment of
SRHR. Within the different research areas partners explore different elements of the health
systems in relation to our intervention strategies. The results of the research projects
are expected in mid-2019 and will be used to publish a paper on our core assumptions
that brings together all of the individual research projects. The paper is expected
towards the end of 2019 and it will share lessons learned with the intention of inspiring
future investments at the intersection between SRHR, health systems, and civil society
engagement.
Strengthening documentation of results

One lesson learned from 2017, which was confirmed by the MTR, is to strengthen our
capacity for documenting our results. Outcome harvesting is the lead method that we use
to document our results, and it was rolled out to all contexts at the end of 2018 and early
2019. Outcome harvesting has helped us document more of our results, and it is helpful to
see the progress that is being made reflected on paper. Some of the key-outcomes shared
in this report will be further substantiated and validated through the development of
outcome stories in 2019. These stories will use photos and videos to give a face to the daily
struggles in our advocacy work.
Adapting our ToC

The lessons learned and harvested outcomes are used to reflect on our ToC and (re)
strategise our work. During the annual reflection sessions in March 2019, partners from
all contexts reviewed on which sub-outcomes the greatest progress was made and where
the ToC needs adjustment to reach our objectives. Many context teams specified the
multilateral and private sector actors that the HSA Partnership should and should not
focus on to achieve our objectives. For instance, in Tanzania, the private sector partners
identified as critical actors were insurance companies whereas in Malawi partners decided
to focus their work on the Malawian government since private sector investments in
health are limited. Finally, in most contexts ToCs partners stressed the importance of using
more explicitly inclusive language, asserting the importance of gender mainstreaming and
the involvement of youth in planning and reviewing the HSA Partnership’s activities. In
conclusion, the combination of outcome harvesting and mapping the harvested outcomes
on the ToC in 2018 has proved to be useful in terms of reflection and strategising.

6. Working with the ministry
The relationships with the MoFA in The Hague and the embassies in Kenya and Uganda,
which have a specific strategy on development cooperation and SRHR, continued to be
constructive in 2018. In Uganda, embassy staff participated in the GHD workshop, a national
intergenerational dialogue, and in Kenya embassy staff visited HSA partners to learn about
the progress of our work. Vice versa, HSA partners participated in events organised by the
Ugandan and Kenyan embassies such as the annual event for all Strategic Partnerships.
Participating in each other’s events helps to align priorities and share information. However,
HSA partners feel that collaboration becomes more valuable when it has a strategic
objective. The engagement of the Netherlands Embassy in an intergenerational dialogue in
Uganda in February 2019 is an excellent example of how collaboration can become more
strategic. During the intergenerational dialogue, the Netherlands embassy positioned
itself as a strong advocate for SRHR, by signing a petition developed by youth demanding
for sexuality education and youth-friendly health services and pledging increased support
for Ugandan SRH services. The event helped the embassy to express its support to work
with the Ugandan government on SRHR and amplifying youth voices engaged by the HSA
partners. As a partnership, HSA would like to develop more of these strategic collaborations
where partners can tap into the embassy’s relevant networks, such as donors and
government, and where the embassy can benefit from our evidence and local knowledge.
HSA partners will continue to explore these opportunities, but we are realistic that further
strategic collaboration might be challenging due to limited staff capacity at embassies.
Within the Netherlands, partners experience a growing strategic collaboration with staff
from the Health and AIDS department at the MoFA. Exchanges around GFF, in which
the ministry actively follows up on the HSA partners’ evidence and reflections, and the
facilitation of a lecture by a Kenyan CHW by the ministry, showcase strategic collaboration
between the HSA Partnership and the MoFA. The lecture by the Kenyan CHW sparked
an internal discussion within the ministry around the link between SRHR and community
health. Another example is the Global Health Café that was organised – at the request
of the MoFA – with Peter Salama, Deputy Director General of WHO, on Ebola and health
systems in November 2018. HSA partners also appreciate how the civil society department
promotes learning and exchange and actively involves the ‘Dialogue and Dissent’ partners
in developing and reflecting on processes and events. According to the HSA partners, these
are inspiring examples of how strategic partnership relations with the ministry can be
shaped.
Moving forward, the HSA partners, including the ministry, are reflecting on their
collaboration in relation to the ‘Investing in prospects’ policy note published by the ministry
in May 2018. Within this policy, the SRHR agenda seems to shift from a more health-focused
strategy to a strategy which addresses gender equality. Anticipating these changes, the
ministry and partners explored possibilities for collaboration during the policy dialogue
in February 2019. Opportunities include strategic exchange around GFF, joint exploration
on how the UHC, SRHR and gender debates can be linked and more collaboration around
UN annual events. HSA partners are committed to shaping further strategic collaboration
around these topics.

Concluding remarks and follow up
In 2018, HSA partners successfully managed to maintain and create space for dialogue and
dissent in an increasingly conservative environment where it has become harder to fight for
the right to SRH. By building on the national and international momentum for UHC, and by
being flexible enough to find alternative avenues, the HSA Partnership has been successfully
navigating the political environment as showcased by our 2018 capacity strengthening and
advocacy results. Our annual reflection has resulted in the following key messages and
lessons learned, which we aim to take forward to improve our work further:
• Through the HSA Partnership’s engagement with media outlets and practitioners, we
have seen an increase in the number of articles on SRHR by several journalists and media
networks; however, there is also a risk of persisting negative stereotypes around SRHR.
The participation of health experts and courses on SRHR for journalists can help to
address these stereotypes.
• Social accountability interactions between communities and their governments yielded
results, but can also be risky for community members and CSOs. The HSA Partnership
aims to exchange best community engagement practices and continue to ensure that
communities are informed about policy developments and that their demands are taken
up to higher levels. This also means navigating in spaces where dialogue and dissent are
increasingly dangerous, and it is important to safeguard advocates at the community,
national and international levels.
• Budget tracking and budget advocacy gained traction during 2018 as the HSA Partnership
contributed to several increased budgets at both the national and local level. However,
follow-up on actual spending levels and collaboration between Ministries of Health and
Finance might be necessary to arrive at a satisfying final budget allocation and release.
Hence, the HSA Partnership will invest in the capacity strengthening of CSOs for budget
tracking and advocacy.
• There is an increased understanding of how to operationalise gender due to training
sessions and the coaching of HSA staff. The efforts to make partner activities and
advocacy initiatives more gender inclusive will continue to be intensified throughout
2019. The HSA Partnership will set up a gender task force, produce a definition paper and
incorporate a gender indicator in the M&E framework. Changing the gender-frames of
media practitioners and community actors is not easy, hence gender training sessions for
CSOs and media practitioners are planned in several HSA countries for 2019.
• HSA partners have become better at engaging youth in our work in several contexts
in 2018. We aim to scale this success and initiate cross-learning on meaningful youth
participation during joint meetings and exchange visits. This will involve a special focus
on increasing the voice of rural youth and making sure that unheard voices are listened
to in national and subnational policymaking.
• Besides thematic and advocacy capacity strengthening, there is a need to strengthen
organisational capabilities to sustain advocacy efforts beyond the lifetime of the HSA
Partnership.
Building on the HSA Partnership’s improved documentation, we plan to publish more

insights on lessons learned throughout 2019. These include several detailed stories about
our outcomes, which will showcase: the challenges that we address, the struggles we face in
our work, and the reflections on our efforts by decision-makers. Finally, the HSA Partnership
plans to publish the results of our research, which assesses the core assumption of our ToC:
That our approach to HSS improves SRHR. This publication aims to inspire future investments
at the intersection between SRHR, HSS and civil society engagement.

For more information about the HSA Partnership, please contact:
HSA Partnership Desk

Schuttersveld 9
2316 XG Leiden
The Netherlands
Tel: +31 71 5793175

Email: info@HSAPartnership.org
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Annual Reflection Report 2018

Health Systems Advocacy Partnership

List of abbreviations ....................................................................................................................................................... 3

2. Programmatic progress ................................................................................................................................... 6

4. Gender and inclusivity ........................................................................................................................................ 27

5. Linking, learning and strategising ................................................................................................................ 30

6. Working with the ministry ................................................................................................................................ 32

Concluding remarks and follow up .................................................................................................................. 33

2 Annual Reflection Report 2018

ACHEST African Centre for Global Health and Social Transformation

3 Annual Reflection Report 2018

• Capacity strengthening inspires organisations and communities to demand rights

• The HSA Partnership successfully holds decision-makers accountable for strong

4 Annual Reflection Report 2018

PUBLIC AWARENESS RAISING

LOBBY & ADVOCACY RESEARCH

CIVIL SOCIETY COLLABORATES WITH GOVERNMENTS AND KEEPS THEM ACCOUNTABLE

STRENGHTENING CIVIL SOCIETY

5 Annual Reflection Report 2018

2.1 Capacity strengthening for lobby and advocacy

GHD workshop organized by Achest in Entebbe, Uganda, September 2018

2.1.1 Capacity strengthening of civil society organizations

Figure 1: Nr of CSOs engaged with HSA Partnership per context (2018)

6 Annual Reflection Report 2018

Kenya Youth CSOs ask attention for SRHR

Zambia Community Health Workers (CHWs) set up their own associations

Table 1: Examples of CSO capacity strengthening outcomes in 2018

7 Annual Reflection Report 2018

There is a need to invest more in organisational capacity strengthening. Support for

8 Annual Reflection Report 2018

BOX 1: THE ORGANIZATIONAL IMPACT OF CAPACIT Y STRENGTHENING IN TANZANIA

2.1.2 Building of platforms and networks

Existing coalitions strengthened or revitalized by HSA partners

9 Annual Reflection Report 2018

10 Annual Reflection Report 2018

Alliances formed by CSOs that engage with the HSA Partnership

BOX 2: KONDWANI MABA: THE HSA PARTNERSHIP’S

Kondwani Mamba, Chair of the Malawi Environmental

2.1.3 Media engagement

11 Annual Reflection Report 2018

Member journalists of the Africa Media Network on Health

Capacity strengthening • Classroom training on health systems and SRHR

Table 2: Overview: Capacity strengthening of Media in 2018

12 Annual Reflection Report 2018

2.1.4 Amplifying community voices

13 Annual Reflection Report 2018

To effectively demand changes and hold decision-makers accountable, communities should

14 Annual Reflection Report 2018

2.2 Lobby and Advocacy

BOX 3: HSA PARTNERSHIP ADVOCACY INITIATIVES

During 2018, the HSA Partnership contributed to over

2.2.1 Human Resources for Health

Recognition and remuneration of CHWs

15 Annual Reflection Report 2018

Strengthening In Malawi, Amref has been mentoring and supporting

Table 3: Key 2018 CHW Advocacy outcomes

A strengthened health workforce and improved working conditions

16 Annual Reflection Report 2018

Table 4: Strengthened health workforce and working conditions in 2018

17 Annual Reflection Report 2018

Throughout 2018, to achieve lasting results in relation to the above-mentioned outcomes,

2.2.2 Sexual Reproductive Health Commodities