Sixth Annual Report 2014
The Safe Abortion Action Fund is supported by the governments of Denmark, the Netherlands, Norway and the United Kingdom and an anonymous donor, and is administered by the International Planned Parenthood Federation
Safe Abortion Action Fund • Annual report • 2014
Acronyms
D&C Dilation & curettage
IEC Information, education, and communication
IPPF International Planned Parenthood Federation
IWAC International Congress on Women’s Health and Unsafe Abortion
MVA Manual vacuum aspiration
NGO Non-governmental organisation
SAAF Safe Abortion Action Fund
UK United Kingdom
This report was prepared by the SAAF Secretariat (Maïté Matos-Ichaso, Hanna Lindley-Jones and Andre Deponti) and the chair of the SAAF board (Manuelle Hurwitz) in March 2015. The report covers the period November 2013 – December 2014.
Please contact [email protected] for any questions or comments on the report
Image on cover of countries where we have a Round 3 grantee project
- Page 2 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Table of Contents
Acronyms ...... 2 Executive Summary ...... 4 Background ...... 5 Theory of change ...... 6 Our Vision ...... 6 SAAF Activities...... 7 Round Two Projects ...... 8 Advocacy Achievements ...... 10 Service Delivery Achievements ...... 11 Research Achievements ...... 13 Long-term capacity building ...... 13 Round Three Projects Inception ...... 14 Proposal development support ...... 14 Commencement of projects ...... 15 Round Three projects annual results ...... 17 Outcome indicators results ...... 17 Advocacy output results ...... 20 Evidence output results ...... 22 Services output results ...... 23 Hot topics and other ...... 25 Fund Management ...... 25 Fund management indicators results ...... 26 Financial Status ...... 28 SAAF System Strengthening ...... 29 Grantee Support ...... 31 Risk Management ...... 34 Fund Monitoring and Evaluation ...... 36 SAAF logframe indicators ...... Error! Bookmark not defined. Evaluation Framework ...... 36 Conclusion & Next Steps ...... 37 Appendices ...... 38 Appendix One: SAAF Board Members ...... 38 Appendix Two: SAAF Round Two Grantees ...... 39 Appendix Three: SAAF Round Three Grantees ...... 42 Appendix Four: SAAF Logframe 2013-2017 ...... 1
- Page 3 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Executive Summary
The Safe Abortion Action Fund (SAAF) was established in 2006 as a multi-donor mechanism to support global abortion-related programming. SAAF provides small grants to projects that promote safe abortion and prevent unsafe abortion through advocacy and awareness raising, service delivery and research activities. Since the Fund’s inception, there have been three rounds of funding to non- governmental organisations, supporting projects of up to three years in length. SAAF is overseen by an independent governing board, with a small secretariat based in the London offices of the International Planned Parenthood Federation (IPPF).
This annual report details the activities of SAAF from November 2013 to December 2014. During this period, the last few projects supported under Round Two of funding finished, and 103 new projects started under Round Three. In accordance with the new SAAF strategy, funding is focused on supporting local and national organisations, with the SAAF secretariat playing an increasing role in the identification and coordination of technical support to grantees.
The Round Two projects have now all finished and have shown great achievements, having led to legislative and policy reform in seven countries, providing safe abortion services to over 286,000 women and girls, improved the quality of care of services provided and responding to national and international gaps in evidence for service provision with a total of twenty research studies having been undertaken.
The Round Three projects had staggered starts in each quarter of 2014. This was a decision made to ensure ease of management, particularly with in relation to the analysis of reports, and also to provide necessary support as required to develop and finalize quality proposals.
In a few countries, such as Uganda, Nepal, Bangladesh or Kenya, the high number of grantees (6-9) allows for peer collaboration and support.
The SAAF board and secretariat continue to support and oversee the Fund. Key activities during the period of this annual report included webinars and workshops on proposal development, development of a quality of care checklist and monitoring and support visits to grantees.
- Page 4 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Background The Safe Abortion Action Fund (SAAF) was established in 2006 within the International Planned Parenthood Federation (IPPF) as a funding mechanism to support NGOs able to make a contribution to reducing unsafe abortion. At that time many organisations committed to addressing unsafe abortion were deprived of funding as a consequence of the implementation by the United States government of the Mexico City Policy (known as the ‘Global Gag Rule’). This policy prevented any non-governmental organisation (NGOs) receiving United States government funds from performing or promoting abortion services, even with their own funds.
In 2005, the Government of the United Kingdom asked IPPF to document evidence related to unsafe abortion1 and this was followed by the creation of SAAF in 2006, with the aim to specifically support abortion-related work by NGOs. The initial donors to the Fund were the Governments of the United Kingdom (DFID), Norway (NORAD), Denmark (DANIDA), Sweden (SIDA) and Switzerland (SDC). Additional funding was provided in later phases by the Government of the Netherlands, Hewlett Foundation and an anonymous donor.
The premise of SAAF is that focusing on expanding and strengthening the base of support for safe abortion is critical in order achieve momentum and sustained long-term change. SAAF supports many diverse organisations, including community activists, service providers, advocates, researchers, lawyers and medical experts; often multiple organisations are supported within one country. This approach allows SAAF to effectively address barriers to access safe abortion at the national level, and facilitates large-scale service delivery initiatives by the public, private and not-for profit sectors.
SAAF operates under the guidance of an independent governing board representing donors, activists and international NGOs (members listed in Appendix One).
Since the inception of SAAF there have been three funding rounds: Round One (2007-2010): USD $15 million, supporting 50 projects in 30 countries Round Two (2011-2014): USD $9 million, supporting 35 projects in 26 countries Round Three (2014-2017): USD $19 million, supported 103 projects in 50 countries
External evaluations of SAAF were conducted in 2009 and 2011, concluding that SAAF had made a significant contribution to promoting action on abortion globally.
This report covers the activities of SAAF from October 2013 to December 2014 as the dates for the annual report have been moved to match the calendar year. It includes results from projects supported under Round Three as well as the final results from projects in Round Two. It also contains details of overall Fund management, including the support provided to grantees, as well as monitoring and evaluation of the Fund.
1 Death and Denial, IPPF, 2006 http://www.ippf.org/resources/publications/death-and-denial-unsafe-abortion- and-poverty
- Page 5 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Theory of change
During the reporting period the Board and Secretariat, supported by a consultant, updated the Theory of Change developed during the Board retreat in May 2012. Our Vision
An environment where: Liberal abortion policies and laws support the right of women to decide the outcome of their pregnancy, and provide them with the social support they need, including from government; Abortion is not stigmatized; and Women have easy access to information and high quality safe abortion services, regardless of their socio-economic status or physical location.
Focus on safe abortion SAAF only funds safe abortion activities: This ensures dedicated funding, attention and mutual support for an issue which is otherwise controversial, risky and easily neglected – by both donors and implementing organisations. SAAF is able to distribute funds according to safe abortion need or opportunity – including to countries with high needs that are often excluded from development funding, such as middle-income countries in Latin America.
Focus on the base of support SAAF focuses on expanding and strengthening the base of support for safe abortion, to achieve momentum and sustained long-term change. SAAF supports many diverse organisations, including community activists, service providers, advocates, researchers, lawyers and medical experts; often multiple organisations are supported within one country. This approach tackles diverse barriers in the enabling environment, and facilitates large-scale service delivery initiatives by the public, private and not-for profit sectors.
Focus on local ownership The barriers to safe abortion vary widely by country. SAAF believes that governments, health providers and communities are best placed to identify local barriers and to find acceptable, creative, context-specific solutions. SAAF has chosen to work through national and local non- governmental and community based organisations, which sit at the crossroads between these groups. These organisations are often unable to access funding from other sources such as international donors, because they often lack the necessary skills and size.
The light touch, low cost SAAF funding mechanism offers donors a funding channel which avoids the prohibitively high administrative burden of directly supporting smaller local organisations. Building up local expertise is also crucial to build momentum, ensure continuity and sustain achievements beyond the end of individual project grants.
- Page 6 of 54 -
Safe Abortion Action Fund • Annual report • 2014
SAAF Activities Overseen by an independent board and managed by a small secretariat, SAAF provides:
Small project grants SAAF provides small grants (currently up to USD $160,000 per grantee) for a wide variety of safe abortion projects including: advocating for policy and legal change; raising public knowledge and awareness; provision of abortion services; improving quality of abortion services; and evidence generation and dissemination.
Smaller grants are more easily absorbed and managed by smaller organisations, and can encourage risk-taking, innovation and collaboration, as grantees seek greater leverage and catalytic impact. Smaller grants also mean that more organisations can be supported by SAAF, which broadens the base of organisations working to expand access to safe abortion.
Technical support to grantees SAAF provides technical support to grantees with lower capacity, to enable them to develop and manage a SAAF grant, and in the future to expand their funding base to include other international donors. SAAF also builds grantees’ technical skills in abortion related programming.
Networking opportunities SAAF believes that greater momentum, leverage and impact can be achieved when the safe abortion community collaborates, rather than working in isolation. SAAF provides grantees with secure online and physical networking opportunities at local, national, regional and global levels. These bring grantees together for mutual support, training and peer-to-peer sharing of ideas, resources and lessons. SAAF also encourages and supports grantees to engage with and mobilise the wider safe abortion community.
- Page 7 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Round Two Projects
In 2011, there were thirty five projects in 26 countries funded under Round Two of SAAF (see Appendix Two for full project list). Fourteen of these projects continued into 2014 with the final project completed by October.
Of the thirty-five projects from Round Two, two had to be stopped early due to organizational issues and lack of project implementation while the other projects were implemented as planned with: Thirteen projects in 16 countries2 focusing on advocacy Twenty-six projects in 20 countries focusing on service delivery Eight projects in eight countries focusing on research
Project achievements for Round Two were monitored under the SAAF logframe for 2011-2014. Table 1: Round 2 Results against SAAF logframe indicators (next page) displays the results against the indicators that were tracked throughout the implementation phase. As can be seen from the table, under Round Two, SAAF achieved or exceeded all but three of the indicators. Against the outcome on achieving ‘locally led changes to the legislative, policy and service delivery enabling environment for safe abortion’, Round Two was a great success having achieved all the set targets and surpassing the target for number of women and girls receiving abortion services by 26% with 286,798 women and girls receiving safe abortion services from SAAF supported projects.
In terms of outputs, SAAF exceeded or met the advocacy targets related to media and other public reports and shared position/consensus statements with NGOs as well as the research targets related to number of research studies undertaken and results disseminated.
SAAF was not able to meet the targets set related to ‘the number of official documents citing/including research results (policy, guidelines etc.)’. This was likely due to the rationales for conducting the studies (not all were specifically aiming to be cited in this way) and time-lag between the end of the project and publications. The indicator relating to the number of staff trained in new techniques was also not met. This may be partly due to under-reporting, as the log-frame for Round Two was finalized after projects had commenced and not all indicators were included in project monitoring and evaluation plans.
The remainder of this section highlights key achievements under advocacy, service delivery and research components of Round Two projects.
2 One project worked across five countries
- Page 8 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Table 1: Round 2 Results against SAAF logframe indicators3
Number of Indicator projects Percentage Indicator counting Result Target of target Focus towards this achieved 4 indicator Outcome: Locally led changes to the legislative, policy and service delivery enabling environment for safe abortion Number of countries where increased public Advocacy, 19 visibility for abortion or steps taken to 166 19 countries 100% research countries improve national, federal or local legislation5
Number of women and girls receiving safe Service 23 286,798 228,393 126% abortion services or post-abortion care delivery
Proportion of women and girls in receipt of Service safe abortion/post-abortion services adopting 208 85% 65% 131% delivery post abortion contraception7 Output 1: Locally led strategic initiatives raising awareness of and addressing legislative, policy and service delivery barriers to safe abortion Number of countries where NGOs achieve shared positions/consensus on approach to Advocacy 12 12 12 100% abortion law or policy reform9 Number media reports/interviews/political speeches or documents raise awareness of Advocacy 12 357 125 286% barriers to safe abortion and/or consequences of unsafe abortion Output 2: Knowledge and research gaps to inform an improved enabling of service delivery environment for safe abortion addressed and disseminated
Number of research/studies conducted Research 10 20 16 125%
Number of articles shared with partners Research 10 20 16 125% (official launch) or published in journals
Number of official documents citing/including Research 610 3 8 38% research results (policy, guidelines etc.)
Output 3: Strategic local initiatives improve access to comprehensive safe abortion care (where permitted) and/or post abortion care especially for poor and marginalised women and girls Number of staff trained in new abortion Service technologies and techniques (MVA and 27 1,377 1,557 88% delivery medical abortion)
3 Only includes indicators tracked on an ongoing basis. 4 Due to the diversity of activities supported under SAAF, not all indicators apply to all projects 5 Includes development and maintenance of advocacy networks and coalitions, dissemination and use of research studies and media reports 6 Indicator applies to 16 projects working in 19 countries (as one project works in five countries and other countries have more than one project contributing to this indicator) 7 Uptake rate calculated by individual project; median of these uptake rates is reported here 8 Not all service providing grantees were able to report against this indicator 9 As a result of SAAF projects i.e. baseline is zero 10 Does not apply to all projects as some research studies aim to measure changes service provision rather than influence policy
- Page 9 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Advocacy Achievements
The 13 projects that included an advocacy focus resulted in: The creation or further development of 39 advocacy networks or coalitions The instigation of 226 media reports/interviews covering abortion issues
Engaging with government The grantee in Armenia completed its project in 2014 and was instrumental in ensuring that the government made a number of commitments to improving SRHR.
These included a government commitment to address the needs of vulnerable women to access high quality comprehensive abortion services, post-abortion contraception and other SRH services. They also committed to removing legislative barriers that young women faced when trying to access safe abortion services and to include safe abortion and post-abortion contraception Figure 1: Youth members of the Family Health Social into the state insurance coverage for vulnerable women. Support Network that was created during the project The grantee achieved this through building strategic partnerships with relevant governmental officials, policy makers, opinion leaders and key professional groups and using evidence-based advocacy and promotion of best practices.
Raising Awareness In Mozambique the grantee was instrumental in working to raise awareness of the issues surrounding unsafe abortion in the country and launched a prestigious journalism award given to journalists who had written strong stories highlighting the issue.
The inaugural first prize was awarded to a journalist who had interviewed the minister of health who then supported opening up access to safe abortion by allowing providers to perform safe abortion at central and provincial hospitals under certain circumstances. Since then, Mozambique has gone even further in liberalizing the law on abortion in the country. Figure 2: Dr Pascoal Mocumbi presenting the first place award to Boaventura Mandlate
- Page 10 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Raising voices The Round Two grantee in the Philippines was able, as part of a coalition, to ensure that the new reproductive health law was passed, allowing for greater access to contraception. However the issue of abortion is still extremely controversial in the country.
One of their activities under their SAAF project was to hold a number of round table discussion meetings with other like- minded organizations to synthesize advocacy activities and campaigns.
A campaign event that came out of the final meeting was a play called Breaking the Silence that contained a collection of monologues and true stories about Filipino women who have had an abortion. Its aim was to break the silence and remove the stigma on a taboo topic. This activity along with others undertaken during the project succeeded in elevating the public discourse on abortion in the Philippines, using evidence-based arguments on reproductive rights including access to safe abortion. This was a positive development for it allowed space, no matter how limited, for further discussion with possible gatekeepers.
Service Delivery Achievements
According to grantee’s reports, the 25 service delivery projects supported by SAAF in Round Two provided: 286,798 comprehensive abortion and post-abortion care services With a median of 85% of women voluntarily taking post-abortion contraception
In addition, 1,377 service providers were trained in newer abortion technologies (manual vacuum aspiration (MVA) and/or medical abortion).
Creating youth friendly services In South Africa, the grantee was very successful in their outreach efforts to connect with young people. They found that one of the reasons why young women did not come for abortion services was because nurses in the public sector clinics often belittled abortion seekers – especially younger women – for being sexually active, irresponsible and/or for choosing abortion rather than continuing the pregnancy. However the project trained abortion providers on Youth/Adolescent friendly services, which assisted in changing their attitudes towards young clients coming for abortion services. Following this training, clients who came to the project -supported sites praised the attitudes of the nurses and said that they were treated with respect by the abortion providers and felt comfortable to ask questions.
- Page 11 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Extending reach into communities Through successful support to under-served women, grantees were able to get feedback on their services and share this with others as this story from one of the grantees in Bangladesh shows.
Story of Karimon: A rural women of Bangladesh
‘Karimon’ is a twenty year old woman living in a rural area. She is the mother of a 14 months old baby. She had previously had three children but all had died before they turned one. Her present child was born by caesarean section at the district hospital as the labour was prolonged and obstructed. This caused an obstetric fistula for which she later received corrective surgery. When she noticed that her menstruation had stopped again she went to a local pharmacy where she was offered some oral tablets to terminate her pregnancy, however she was undecided and confused about whether she should take the tablets or not.
She had heard about BWHC and its services through her participation in courtyard session by BWHC community health volunteers and so decided she would go to them. She visited the reproductive health centre focusing on safe abortion and was told that she was 8 weeks pregnant. Karimon opted for a termination of her pregnancy as she could bear no more. She received counselling and underwent the procedure safely by trained paramedic. She was given options of post abortion contraception which she took along with other services. Karimon felt relieved and was very happy to receive these services close to home. She supported BWHC and was eager to tell the women in her community of her story.
Expanding access to medical abortion One of the SAAF grantees in Nepal that continued implementation into 2014 was the Center for Research on Environment Health and Population Activities (CREHPA). A great achievement of this project was that due to their advocacy work, the government of Nepal approved the establishment of medical abortion services Figure 3: ANMs at the SAAF supported training on medical abortion at outreach health facility level and prioritized the training of Auxiliary Nurse Mid-Wives (ANM) from the SAAF project districts. During the extension to the project CREHPA were able to train thirty-nine ANMs in providing safe abortion with combined mifepristone and misoprostol.
- Page 12 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Research Achievements
Of the eight SAAF Round Two research projects, three were solely research-focused, with the other five included research in addition to other activities.
Among those eight projects, there were: 16 studies that were initially planned but in the end 20 were completed as some of the grantees were able to use unspent funds to undertake some small studies to support the implementation of their projects 20 instances of publications and sharing of results with policy-makers, the media, health providers and other NGOs. Two instances of research results being included within official policy and guidance documents
Methods for second trimester abortion One of the grantees, Ibis in South Africa, which finished implementation in 2014 compared the regimen of mifepristone-misoprostol for 2nd-trimester medical abortion to the misoprostol-alone regimen. During their project, they ensured that the protocol was well-established at two public hospitals with over 700 second trimester abortions performed. The findings of the study were then presented at the Department of Health meeting on maternal mortality and covered in the press.
As a result, mifepristone was added to the South African National Essential Drug List for use in second trimester abortion and approval was granted to use mifepristone in public hospitals in the Western Cape Province for 2nd-trimester medical abortion.
Long-term capacity building Throughout Round Two, SAAF was able to help build the capacity of grantees which helped many build on their experience and submit strong proposals under Round Three, ensuring that thirteen of the Round Two grantees continued with SAAF into Round Three. Others were able to mobilise funds from other sources or integrate their project into their core activities.
SAAF grants were also used as a tool to build capacity of partner organisations. Following a shift in criteria for Round Three which specified that only local organisations were eligible to apply, it was noted that having been sub-grantees of previous SAAF grants, eight local organisations were then able to successfully apply for a grant in their own right under Round Three.
- Page 13 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Round Three Projects Inception
Following the initial review process and shortlisting of concept notes organized in 2013, 113 organisations were invited to submit a full proposal and 106 did so. These applications were reviewed by the SAAF secretariat and by consultants, with the expectation that projects would be able to start between November 2013 and March 2014.
Proposal development support
A substantial proportion of these proposals to SAAF required extra support. Many organisations struggled with designing appropriate indicators while some less experienced applicants needed more support around the proposal development process itself. The SAAF secretariat put in place various strategies to support grantees with these issues.
Webinars on indicator development In November and December 2013, the SAAF secretariat held webinars to build capacity on the development of indicators, including the provision of improved templates for monitoring and evaluation. All grantees were encouraged to attend. These were followed by project induction webinars in English, Spanish and French which were provided for all grantees shortly before or after signing the grant agreement. Eighty-one grantees attended these webinars and the videos of the webinars were shared online for those who could not attend in person.
Proposal development workshops For the weakest proposals, SAAF then coordinated proposal development workshops and remote support to grantees. Twenty- one organisations participated in three regional workshops:
December 2014 in Bujumbura, Burundi – for grantees from Francophone Africa February 2014 in Nairobi, Kenya – for grantees from Figure 4: Attendees of the proposal development workshop in Nairobi Anglophone Africa March 2014 in Dhaka, Bangladesh – for grantees from Asia
- Page 14 of 54 -
Safe Abortion Action Fund • Annual report • 2014
The four day workshops covered the various steps in developing a strong project plan including how to develop SMART objectives and strong indicators and how to write a realistic budget. While the prime objective was to strengthen and finalize the project proposals, it was also an opportunity for the participants to be able to situate their work within the bigger picture of SAAF globally or at the regional level, as well as to develop synergies with other SAAF Round 3 grantees. Another important aspect was the opportunity to clarify the SAAF Round Three grantee obligations.
The post-workshop evaluation results indicated that they were highly appreciated by all participants. In particular, participants highlighted the valuable capacity building opportunity offered by SAAF. One of the participants later commented on the SAAF Virtual Community:
“I was amazed by the enthusiasm, motivation and level of commitment displayed by all SAAF partners during the Nairobi workshop… I never realized that so many other people in very many other countries in my region shared the same passion for SRHR, and particularly abortion work. As we met and shared views, experiences and plans, I realized that I was part of a struggle shared with so many other fellows regionally and globally. And as we discussed our proposals, SAAF helped us to frame our arguments for safe abortion, and sketch strategies to address different levels of obstacles against recognition of women's right to safe and legal abortion. We came out of the workshop feeling we are part of a movement, not just an isolated grantee returning to some remote part of the world. This feeling was very rewarding.”
SAAF drew on the feedback given at each initial workshop to improve those held later. Thus, the workshop duration was increased for the Nairobi and Dhaka workshops (feedback from Bujumbura) and more time was given to developing the budget in the Dhaka workshop (feedback from the two previous workshops).
Remote support for proposal development and impact As well as the webinars and workshops, thirty-eight organisations (some of which attended the workshops and some which couldn’t) received direct support to develop their proposals. This remote support was provided by consultants, including the facilitators of the proposal development workshops.
As a result of the support provided, the quality of the proposals being submitted to SAAF improved significantly. This helped to ensure that grantees were better placed to successfully implement and monitor their projects over the coming years.
Commencement of projects
Due to the high number of grantees supported in the third round, the SAAF secretariat organized staggered starts for the 103 projects in four waves: Wave 1 = 33 projects in 21 countries started in January 2014
- Page 15 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Wave 2 = 4411 projects in 30 countries started in April 2014 Wave 3 = 23 projects in 19 countries started in July 2014 and Wave 4 = the remaining 4 projects started in 4 countries in October 2014
Grantee Handbook and Induction webinar During the proposal development phase, the SAAF secretariat developed a grantee handbook as a reference guide for the grantees. It explains in details what are the main SAAF processes and provides explanations in relation to: The SAAF grant agreement Key financial processes such as payments, financial management and audits Communication and support Reporting SAAF branding including the use of the logo The handbook is an important tool which is being updated on a regular basis.
Figure 5: Still from project induction webinar
11 This figure excludes a project in North Korea which was unable to commence as intended as the SAAF secretariat was and is still unable to identify a practical route to transfer project funds due to international banking sanctions.
- Page 16 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Round Three projects annual results
The results for all the SAAF logframe indicators (except for Output 4 where results are presented in the Fund management section) are presented in the table three below.
Please note that due to the staggered starts of the projects, not all data for 2014 is captured in this table. The results do not include data from the twenty-three Wave 2 projects and four Wave 4 projects for the period October-December 201412.
Table 3: SAAF Programme Results vs. targets 2014
Indicator Targets 2014 Results 2014 % from target Outcome 1 17 13 76% Outcome 2 41,580 40,597 98% Outcome 2a 10,757 11,801 110% Outcome 2b 30,823 28,796 93% Outcome 3 64% 55% 86% Outcome 3a 67% 65% 97% Outcome 3b 33% 35% 107% Advocacy 1 8 6 75% Advocacy 2 53 44 83% Advocacy 3 564 675 120% Evidence 1 17 13 76% Evidence 2 39 33 85% Services 1 120,593 103,098 85% Services 2 1,386 1,350 97% Services 3 414 395 95%
The following sections will take a closer look at the achievement for each indicator. Outcome indicators results Outcome 1 - Number of countries where new steps have been taken towards improved legislation, policy and services Seventy-six per cent of this milestone has been achieved without taking into account the data from the final twenty-seven projects yet to report. Grantees in seven countries reported new steps taken towards improved legislation related to safe abortion. These are grantees based in Bolivia, Dominican Republic, El Salvador, Kenya, Mozambique, Nepal and Perú.
12 Their six-monthly reports covering the period October 2014-March 2015 are due by the end of April 2015.
- Page 17 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Further grantees in Argentina, Indonesia, Moldova, Thailand, Uganda and Uruguay have also reported improved service provision guidelines.
A further 10 grantees are still to report on this indicator for the period October-December 2014, but it is unlikely that the milestone of 17 countries will be reached, as improvement in legislation or policies generally requires ground work for a prolonged period of time.
In Mozambique, SAAF has been supporting over the years efforts to foster an enabling environment for the approval of the revised penal code and a less restrictive law on abortion. The current SAAF grantee Women in Law in Southern Africa (WLSA) is working in partnership with Pathfinder International and the Coalition for the Defence of Sexual Rights (formed in 2011 under Round Two of SAAF) advocating for safe abortion at national and provincial levels. They have also been supporting the Mozambican Ministry of Health to continue the provision of safe abortion within the restrictive context.
The years of advocacy work Figure 5: The Coalition for the Defence of Sexual and Reproductive Rights conducted by civil society in Mozambique celebrating September 28th was finally successful when the Mozambique parliament approved a revised penal code on 11th July 2014. The approved provisions will allow access to safe abortion before the 12th week of pregnancy by doctors or accredited health providers in official health facilities, or those officially authorized, and later in pregnancy in cases of danger of the pregnancy to the physical or mental health of the woman or foetal abnormalities.
In Peru, following years of pressure from civil society organisations, a bill proposal has been developed (Proyecto de Ley 3839- 2014-IC) to decriminalise abortion in cases of rape and this is currently being discussed in Congress. This came about in part due to the actions of a SAAF grantee in Peru that collected 64,261 signatures for the campaign and is at the forefront of the campaign in support of this new bill. Figure 6: The campaign logo and slogan
- Page 18 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Outcome 2- Number of women and girls receiving quality clinical abortion services (disaggregated by age)
Targets % from Indicator Results 2014 2014 target Number of women and girls receiving quality 41,580 40,649 98% clinical abortion services Outcome 2a: Aged 19 and under 10,757 11,810 110% Outcome 2b: Aged 20 and over 30,823 28,839 94%
In 2014, 40,649 women and girls received quality clinical abortion services – treatment for incomplete abortion or safe abortion services. Age disaggregated data was available for nearly all (96% - 40,147) clients. Of these 29% (11,810 girls) were aged 19 or younger. The remaining 71% (28,839) were aged 20 or over.
This does not include women and girls referred for clinical services via SAAF funded hotlines due to difficulty in tracking such data.
Thirty-one projects in Waves 2 and 4 will report against this indicator by the end of April and it is expected that this milestone will be exceeded.
Figure 7: SAAF funded peer educators in school in rural Uganda In Uganda, a SAAF grantee was successful in targeting young people by creating Family life clubs in schools: these clubs enable the organisation to provide reproductive health information (including on unintended pregnancies and unsafe abortions) and channel contraceptives to students through peer-to-peer activities.
- Page 19 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Outcome 3- Proportion of women and girls in receipt of quality clinical abortion services voluntarily adopting a modern method of contraception (disaggregated by short and long term methods)
Targets Results % from Indicator 2014 2014 target Proportion of women and girls in receipt of quality clinical abortion services voluntarily 64% 55% 86% adopting a modern method of contraception Proportion of short-term methods 68% 65% 96% Proportion of long-term methods 32% 35% 109%
The grantees for which we have data reported a post-abortion contraception uptake of 55% in 2014, which is below the target of 64%. Results vary greatly between grantees with some grantees reporting near 100% uptake and others reporting lower uptake. The grantees performing poorly on this indicator will be followed and supported more specifically by the secretariat.
A successful example of high uptake of post-abortion contraception is from a grantee providing menstrual regulation (MR) services in Bangladesh, which reported that clients who received MR at their clinics were provided with post-MR contraception from the clinic, local pharmacies or government FP clinics and all clients were followed up to ensure that they were able to access the method of their choice.
Advocacy output results
Advocacy 1: Number of SAAF grantees leading a coalition with a shared position on approach to abortion law or policy reform This milestone has been exceeded with nine grantees (seven national level and two local level) in seven countries (Uganda, Benin, Peru, Nigeria, Kenya, Nepal and Senegal) leading a coalition with a shared position on, or approach to, abortion law and/or policy reform.
In Senegal, the SAAF supported grantee is leading a taskforce pushing for the decriminalization of abortion in case of rape or incest.
In Uganda several of the SAAF grantees are the co-founders and contributors to the work of the ‘Coalition to Stop Maternal Mortality due to Unsafe Abortions’ (CSMMUA). Their work consists in trying to clarify the legal framework on Figure 8: Members of the Ugandan networks on the 28th September abortion and they influenced and supported the development of new abortion standards and
- Page 20 of 54 -
Safe Abortion Action Fund • Annual report • 2014 guidelines which have just been approved by the Ministry of Health. In addition, a network of civil society organisations is also advocating for legal reforms. Both groups retain their separate focus but work together on key issues; for instance for the 28th September global day of action for safe and legal abortion where they held a candlelight memorial and press conference.
Advocacy 2: Number of SAAF grantees newly engaging different groups in advocacy and awareness related activities The milestone of 83% has been achieved, with up to 92% expected on receipt of the final reports. Forty-four grantees (83% of the expected 53) have reported engaging different groups in advocacy efforts.
A further five grantees are due to report against this indicator for 2014. However, six grantees who have submitted final reports for 2014 have not achieved their milestones: one project in Afghanistan has been suspended, and projects in Palestine, Bolivia, India, Bangladesh and Congo (Brazzaville) have been delayed in their activities.
The target can therefore only be achieved at a maximum of 92% (49 of the expected 53 grantees).
In Benin, the grantee is co-leading a new advocacy coalition in support of the decriminalisation of the abortion law. Although still in its infancy, the coalition is engaging with new and different organisations who have not been involved in the issue before including representatives from the Ministry of Health, civil society, religious leaders and UN agencies. The members have received training on strategic advocacy and have created an action plan. Future activities include the creation and diffusion of a TV programme highlighting the dangers of unsafe abortion.
Advocacy 3: Number of publically visible statements in support of abortion attributable to SAAF grantees This milestone was exceeded with 671 (119% of the expected) statements having been reported by grantees.
The grantee in Senegal, is leading a taskforce pushing for the decriminalization of abortion in cases of rape or incest. They collected support statements from various high-profile citizens such as mayors, MPs and high court judges, some making public statements in national newspapers.
The MP Moustapha Diakhaté stated in the press: Figure 9: 'The meaning of motherhood is based on a happy, ‘’we need a law allowing safe abortion in healthy life that comes from love not violence’ Senegal. This will prevent girls and women victims of rape or incest becoming pregnant ending up in jail or in cemetery”.13
13 http://www.seneweb.com/news/Societe/projet-de-loi-sur-l-rsquo-avortement-med_n_144505.html
- Page 21 of 54 -
Safe Abortion Action Fund • Annual report • 2014
In Peru, as part of a campaign run by the SAAF grantee, MPs, journalists, political leaders and artists are being photographed with the logo of the decriminalisation ‘let her decide’ campaign Dejala decidir.
The grantees in Ghana have also been successful in getting the issue of unsafe abortion into the public discourse with one grantee, GLOMEF mentioned in a number of media pieces. They also succeeded in getting the Minister of Health to speak publicly about the issue of unsafe abortion in Ghana as can be seen in one article here.
Figure 10: Article in Ghanaian newspaper Evidence output results Evidence 1: Number of new studies initiated Thirteen of the seventeen studies have so far been initiated but we are still waiting for annual reports from eight grantees so the achievement is expected to increase. In South Africa, SAAF is supporting a study into the feasibility of replacing in-person follow-up for early medical abortion with a low sensitivity pregnancy test, symptom checklist and text messages in the public sector setting. This was implemented because ‘the clinic follow-up requirement is frequently unnecessary and increasingly defaulted as it presents a cost and time burden to women as well as to service providers. Providing a safe alternative which also improves knowledge of contraception is expected to strengthen medical abortion provision.’
- Page 22 of 54 -
Safe Abortion Action Fund • Annual report • 2014
In Bolivia, a SAAF grantee produced a sociological study conducted in five major cities looking at the ‘Spiral of Silence’ around the right to choose and how women are socially stigmatised when it comes to their right to abortion. The results are being used for a national campaign on the right to choose.
In Nepal, one grantee is testing the use of text messaging systems to increase compliance with an appropriate medicine regimen, provide links to post-abortion care and improve uptake of post- abortion contraception for women who purchase drugs directly from pharmacies for self- medication.
Evidence 2: Number of knowledge dissemination activities conducted This milestone is likely to be achieved or largely achieved, subject to final grantee reports. Thirty dissemination activities have been reported in Kenya, Senegal, Haiti, Peru, Thailand, Burundi, and Indonesia and the milestone is likely to be achieved once all grantees have reported.
In Haiti, the grantee conducted a situational analysis on SRHR in 6 clinical setting in Port-Au-Prince. Results were presented in a national radio programme on promoting SRHR and safe abortion.
In Senegal, a study on the incidence of unsafe abortion in the Dakar region was conducted along with an analysis of the legal context around abortion. Results were shared during a workshop attended by a wide range of stakeholders (including NGOs, human rights organisations, legal and medical professional bodies) which then joined the taskforce seeking the decriminalization of abortion in cases of rape or incest.
In Kenya one of the grantees conducted a secondary analysis of data from the Magnitude and Incidence of Induced Unsafe Abortion Study. The Unsafe abortion among adolescent and young women in Kenya manuscript reported in the January to June report was submitted to BMC Women’s Health in November. One policy brief (Unsafe abortion among adolescent girls and young women in Kenya: Urgent Action Needed) was developed and shared during a stakeholders’ meeting held in December.
Services output results Services 1: Number of clients receiving quality counselling on abortion and related services This milestone has been largely achieved with 103,098 (85%) women and girls receiving counselling on safe abortion and related services. A further 20 grantees are yet to report against this indicator for the latter months of 2014 so this is expected to increase.
While hotlines clients are not counted towards the abortion service indicator, there are included in this counselling indicator.
In Bangladesh, a grantee is implementing a harm-reduction strategy and has set up a call centre to support women choosing medical menstrual regulation. By working with pharmaceutical companies,
- Page 23 of 54 -
Safe Abortion Action Fund • Annual report • 2014 the grantee has managed to get three companies to include the call centre number in the insert/user guidelines of their medicine packs.
In Lebanon, the SAAF grantee has developed a hotline for SRHR and pregnancy counselling as well as a website www.theaproject.org. They have also created partnerships with NGOs working in refugee camps to increase access to this hotline by refugee women and girls.
In Thailand, in order to reach marginalised populations, including those with low-literacy Figure 11: The A project website with information about levels, a SAAF grantee is developing a comic book abortion as part of its harm reduction materials.
Services 2: Number of service providers trained in safer abortion technologies and techniques This milestone has been largely achieved at 97% with 1,335 providers trained in safer abortion technologies in 2014. With 19 grantees from Wave 2 and 4 still to report it is expected that this milestone will be exceeded.
In Kenya, five of the grantees have included training of providers in their projects. These trainings have ranged from low level providers such as community health-workers and pharmacists, who have been trained in medical abortion and given access to referral mechanisms, to nurses and midwives in public health facilities who have been trained in MA and MVA for post-abortion care.
In Pakistan, a SAAF grantee trained 42 providers in local service delivery points in treatment for incomplete abortion using safer techniques. This grantee also works with the local Nursing School to ensure that trainee nurses develop skills in safe abortion/post-abortion counselling and services.
Services 3: Number of service points providing quality abortion services In 2014, the grantees who reported on this indicator stated that 390 service points are newly offering abortion services either post-abortion care or comprehensive abortion care. This represents 94% of the expected target for the year. A further 24 grantees will report against this indicator by the end of April 2015 and the milestone is expected to be exceeded.
In the Democratic Republic of Congo (DRC), a SAAF grantee established a clinic based on IPPF comprehensive abortion care guidelines which is now providing safe abortion services to women in an extremely restrictive setting with high levels of sexual violence and unwanted pregnancy.
- Page 24 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Hot topics Grantee to grantee technical support As part of the peer-to-peer support and learning, countries with several SAAF supported projects have initiated collaboration. As an example, in Uganda one of the grantees which had recently trained its staff on the harm-reduction strategy provided the same training for another SAAF grantee.
The need for such collaboration was highlighted during a secretariat monitoring visit in Uganda and followed-up by the grantees. This type of peer-to-peer learning is encouraged by the secretariat when possible and will be further supported in the future.
Anti-choice activities To better understand the context in which grantees are working, we have asked them to report on anti-choice activities: 56 out of 98 organisations reported such activities in their country. The significance and impact of these activities varies greatly from country to country, but can significantly impede the implementation of the projects.
In Pakistan, two grantees mentioned the following cases:
“During the camp, a villager became irritated about medical abortion; they were saying it was un-Islamic and sinful activity. They misbehaved and threatened to set our vehicle on fire. It was unexpected. Our team visited this village two times and found four cases of medical abortion so we organized the camp with the permission of notable landlord of the village.”
“However, things got fearsome when our field team visited the area and the men and women expressed extreme hostility. The women especially were very distrustful and afraid. Later, my female team members were indirectly threatened with bombs being planted under their car and kidnapping. The men also started accusing the community mobilizers of being foreign agents (this is common) and that family planning and abortion are sinful agendas of the west. Though this mind-set is frequently encountered, the team has never been threatened with this intensity before. Even after we had finished the field, mobilizer’s family continued to be terrorized and my own office was visited by government agency personnel wishing to know our line of work and why we are working on abortion.”
In Peru, a social media campaign initiated by a youth “pro-life” network and called “Salvemos a las 2” (“Let’s save them both”) has received great attention and is directly positioning itself against the attempted legal reform. Fund Management
SAAF operates under the direction of an independent governing board representing donors, activists, international NGOs and a professional body. To date the board consists of nine members
- Page 25 of 54 -
Safe Abortion Action Fund • Annual report • 2014 and is chaired by IPPF. The names and affiliations of board members are listed in Appendix One. The board provides strategic direction and oversight of the fund, sets policy and guidelines, considers, discusses and approves applications for funding and mobilizes resources.
During the period of this annual report, the SAAF board met three times, in November 2013 (in London), May 2014 (via teleconference) and in September 2014 (in London). The November meeting focused on the new logframe (see page 28) while the remote meeting in May was used as an update opportunity. Finally, the September meeting focused on governance (board Terms of Reference), the theory of change and the evaluation framework (See page 35).
The SAAF secretariat is based in the central London office of IPPF, and is responsible for day-to-day management of the fund. The secretariat currently comprises the following members of staff: Senior Programme Officer – Maite Matos Ichaso (100% FTE) For October 2013 – September 2014 Judy Gold was covering this position Programme Officer - Andre Deponti (100% FTE) Project Coordinator- Hanna Lindley-Jones (100% FTE) Donor Reporting Accountants - Grace Neburagho and Elizaveta Mercer (total of 50% FTE) In order to strengthen the due diligence process and better support grantees with financial management, the secretariat is in the process of recruiting a member of staff to provide full time financial management support to the grantees and undertake regular financial monitoring visits. A candidate has been identified and it is expected that he will be in place by mid-2015.
Fund management indicators results
Fund management is included within the SAAF logframe (see Appendix Four) and the table below summarizes progress towards these indicators.
As can be seen from the table, SAAF is mostly on track with all indicators.
Table 2: Progress towards SAAF logframe fund management output
Indicator 2014 Target 2014 Result
M1. Proportion of SAAF project funding a) disbursed to and b) expended by a)45% disbursed a)44.9% grantees b) 28% expended b)27%
M2. Proportion of grantee reports received on time and complete 80% 81%
M3. Number of discussions on SAAF virtual community resulting in 10 or 6 7 more responses
M4. Proportion of SAAF grantees reporting satisfaction with support 80% 92% provided by SAAF secretariat
3% (and 5% M5. Proportion of overall SAAF funds expended for fund operating costs 10% overheads)
- Page 26 of 54 -
Safe Abortion Action Fund • Annual report • 2014
M1. Proportion of SAAF project funding a) disbursed to and b) expended by grantees In 2014, 44.9% of total SAAF project funding was disbursed. The shortfall was due to the inability to transfer funds, in a secure way, to the grantee in North Korea. This represents 90% of all grant Year 1 budget.
The grantee financial reports submitted indicate that 27% of SAAF project total funding was expended and accounted for. With more grantees reports expected for the period October- December 2014, the target will then be achieved.
M2. Proportion of grantee reports received on time and complete Out of the 133 reports received (six-monthly and annual reports), 108 (or 81%) have been received on time and complete.
All grantees reported and the vast majority of the 19% recorded under “not received complete and on time” were actually received on time but required additional information – in particular with the budget amendment part of the financial report. The SAAF secretariat does not approve reports until all areas are properly completed, which often involves significant exchanges between grantees and secretariat staff. It is expected that the level of support provided will enable improved reporting during 2015.
Table 3: Reports submission timing for Waves 1 and 2 in 2014 Average time Reports Reports Reports not for first Number of submitted submitted Report period submitted on feedback by projects complete on complete and time Secretariat (in due date* on time* days)
Wave 1 0.5 report 33 17 (52%) 27 (2782%) 6 (18%) 19
Wave 2 0.5 report 44 21 (48%) 37 (84%) 7 (16%) 12
Wave 3 0.5 report 22 10 (45%) 20 (91%) 2 (9%) 22
Wave 1 Year one 33 13 (39%) 25 (76%) 8 (24%) 11 report
Total so far 132 61 (46%) 109 (83%) 23 (17%) 16
*”Due date” is defined as within one month of period completion **”On time” is defined as within two weeks of due date (The reports might have been submitted on due date but incomplete, or submitted complete after the due date)
- Page 27 of 54 -
Safe Abortion Action Fund • Annual report • 2014
M3. Number of discussions on SAAF virtual community resulting in 10 or more responses In 2014, 49 discussions and announcements (e.g. sharing of new technical publications or calls for funding announcements) were made on the virtual community. Ten were instigated by the SAAF secretariat and seven discussions resulted in more than 10 responses (including the SAAF grantee handbook, discussion on harm reduction, 28th of September Day of action and International Woman’s Day). The SAAF secretariat has observed that discussions that blend technical and practical/real-life experiences are more appealing than purely technical discussions – especially to the less experienced grantees. Based on the grantees’ reports and the findings from monitoring visits, the secretariat has shortlisted topics for discussion in 2015 including developing IEC/advocacy messages, referral systems, community awareness raising and harm-reduction strategies.
M4. Proportion of SAAF grantees reporting satisfaction with support provided by SAAF secretariat The satisfaction of the grantees is measured via the narrative report where a section explicitly requests feedback on the secretariat and asks about any future support required. To date, 92% of grantees have expressed positive or neutral feedback towards the SAAF secretariat. In total, 3 grantees expressed negative views which mainly related to delays in receiving the first tranche of funds as well as some confusion about the reporting templates – one change to a reporting template was made in response to this. Seven grantees did not respond to the question.
M5. Proportion of overall SAAF funds expended for fund operating costs In 2014, the operating costs represented 3% of total expenditures (this is in addition to 5% overhead costs). It is likely that this proportion will increase in the future with the hiring of an extra staff member and the relative decrease of grant levels as projects progressively finish implementation.
Financial Status
The total expenditure for SAAF in 2013 and 2014 was respectively USD $1.5 million and USD $7.9 million. The majority of this expenditure was project funding to grantees ($7.1 million in 2014). Grantee learning14 and technical support in 2014 was $198,000 of the total expenditure while fund operating costs15 totalled $240,000.
For the period 2015-2017, SAAF has a total pool of funding of USD $11.89 million from three donors: the Governments of the Netherlands, Norway and the UK. Funding from the Government of Denmark and an Anonymous Foundation ended in 2014. The vast majority of this funding (USD $9.2 million, 77%) is allocated as grants to implementing organisations. Other main expected expenditures for 2015-2017 are: Technical support for grantees: USD $485,000
14 Grantee learning includes conference participation, grantee meetings, publications and the online virtual community 15 Fund operating costs include personnel, board meetings, and other charges
- Page 28 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Grantee learning: USD $240,300 External evaluation: USD $520,000 Fund operating costs: USD $844,000
Funds are released to grantees on an annual basis following approval of the annual report. Normally, 90% of the estimated annual budget is transferred, with 10% held approval of the next annual report. For projects that are underspent and/or experiencing substantial implementation delays, a lower percentage of funds (or none) may be transferred, with the remainder transferred once evidence of increased spending and/or progress has been obtained e.g. in the following six monthly report.
SAAF System Strengthening
Building up on the work done during the previous reporting period to strengthen systems within SAAF, the secretariat has updated existing, and developed new systems to help supporting the management of the large number of grants. Having stronger internal systems also allows for the grantees to be better supported and monitored throughout project implementation. This has included: updating the new version of the logframe, a new reporting system for the grantees and a new quality of care checklist for grantees.
New version of the SAAF logframe Following the complete revision of the programme logframe, each grantee developed specific project level indicators and these were linked to the SAAF logframe indicators. These targets were then added to the SAAF logframe as can be seen in the logframe below.
New reporting process Following the development of a project induction process, the secretariat developed a new reporting process to ensure both better reporting from the grantees and better monitoring from the secretariat.
The new reporting templates developed have three components (narrative, indicators and financial) and are individualized and pre-populated with grantee’s project information. This new system generated work upfront to prepare the templates, but makes monitoring a lot easier with a single file for each report component being used throughout the life of the project.
To support the grantees with this new system, the secretariat organized webinars in English, Spanish and French for each wave of grantees. The goal was to highlight the rationale behind the system, explain in details the information contained in the templates and how to complete them. This was followed by a Q&A session. Twenty grantees attended the reporting webinars and the video of the webinar has been viewed 51 times.
So far the vast majority of grantees (99) have used these new templates and their feedback has been positive:
- Page 29 of 54 -
Safe Abortion Action Fund • Annual report • 2014
“It [the indicator spreadsheet] not only allowed us to analyse our activities in more detail, but also made us conclude that different needs exist than those we anticipated”. “The indicators template allows one to access the performance in real time with the colour codes that have been introduced.” Projects supported under Round Three are required to report every six months to the SAAF secretariat. The secretariat reviews the narrative and financial reports and the indicators results spreadsheet, responding with queries, comments and suggestions to grantees.
Table 4: Round Three reporting timeframe for 2014 and 2015
Project First semester Report 1 due date Second semester Report 2 due date wave
Wave 1 January-June 2014 31 July 2014 July-December 2014 31 January 2015 Wave 2 April-September 2014 31 October 2014 October 2014-March 2015 31 April 2015 Wave 3 July-December 2014 31 January 2015 January-June 2015 31 July 2015 Wave 4 October 2014-March 2015 31 April 2015 April-September 2015 31 October 2015
SAAF Quality of Care checklist
In our aim to better support grantees in implementing their activities, we are developing tools whenever the need arises. An essential aspect of the service delivery activities is the notion of ‘quality’. This can encompass various different definitions, but we decided to focus on the clinical aspect of the services. We worked with a consultant to develop a tool by which SAAF grantees can self-assess the quality of their services, and the SAAF secretariat can use during monitoring visits to SAAF projects involving clinic-based service delivery.
This self-assessment process is based on the premise that SAAF´s grantees would like to identify what could be improved in their work – therefore they will conduct an honest and thorough self- appraisal. Results will be provided to the SAAF secretariat once a year as part of the annual reporting process. However grantees may want to implement this tool in a more regular basis to support continuous quality improvement efforts (e.g. every quarter). It is also important to highlight that this tool does not aim to replace the implementation of more comprehensive and detailed quality of care tools already developed by grantees.
The Quality of Care checklist has been translated into Spanish and French and webinars were held in early February 2015 to support grantees with its implementation.
The standards The standards included in the quality of care checklist will provide detailed information about what SAAF considers as quality clinical services. Below, are some of the key principles that guide the design of quality clinical services:
- Page 30 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Services are rights-based: they are offered in a way that addresses client´s rights, including their right to information, access to services, choice, safety, privacy, confidentiality, dignity and comfort when receiving services, continuity of care, and opinion. Services are free of stigma: Clients should feel comfortable in talking freely about their health needs and choices. Services should be provided in a caring, supportive and non- judgmental environment. Services are client-centred: Quality services are tailored to client´s social circumstances and individual needs. Women are offered a comprehensive abortion care framework – which includes abortion services (i.e. surgical abortion and medical methods of abortion), pre-and post-abortion counselling, post-abortion follow-up and contraception as well as linkages to other reproductive health services. Provider´s needs are addressed: Provides require training and sensitization, information, adequate physical and organizational infrastructure, supplies and supportive supervision to provide quality services.
Grantee Support Virtual Community The SAAF virtual community which is hosted on the knowledge gateway platform (https://knowledge- gateway.org/) enables both discussions and online document sharing.
The SAAF site has increased in popularity throughout the year with 187 members spread across 54 countries. Membership of the community is now mandatory for at least one person from each grantee as resources and announcements are shared through the site.
As of January 2015, 90 of the 103 grantees have at least one member of the community and we are working on getting 100% membership. 2014 was a particularly vibrant time for the community with 49 discussions and announcements made. The secretariat was able to facilitate a popular discussion about what grantees were planning for the 28th September day of action. This discussion garnered 28 responses with grantees sharing what their plans were for the day such as using the day to launch a hotline in Nigeria, starting a social media campaign in Argentina, holding awareness raising among staff in Bangladesh and holding advocacy capacity building training in Tanzania.
- Page 31 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Support Visits As part of its support to grantees, the SAAF secretariat undertook 14 grantee monitoring visits in 2014 to Nepal (six grantees), Uganda (eight grantees) and Zambia (one grantee).
The grantee visits aim to monitor progress of the SAAF supported activities, provide technical support where needed, enable financial support and oversight and encourage collaboration between grantees (when several grantees are supported in one country). During these trips the SAAF team visit grantees’ headquarters and project sites (service delivery points, community sites etc.) hold discussions, observe work and review documentation – including verification of results reported. The SAAF team share these findings with Figure 12: Meeting with a grantee in Kampala, Uganda the grantees in a debriefing meeting, followed by a monitoring visit report and action plan.
For 2015, a further 26 grantee visits in 11 countries are planned (including Guinea Bissau, Kenya, Burundi, Guatemala and Sudan).
Monitoring visit to Nepal In July 2014, the senior programme officer visited six grantees in Nepal: two Round Two grantees continuing into Round Three and four new grantees for Round Three. The projects were generally on track (some minor details clarified) and the main learning point was the fact that the grantees were well coordinated. They organized regular grantee meetings and planned to jointly develop and brand IEC materials.
This trip was also an opportunity to develop a set of monitoring questions in order to develop a standardize process of grantee monitoring visits.
Monitoring visit to Zambia In November, the programme officer visited the grantee in Zambia where he was able to take part in a safe abortion MVA and MA training that they were holding for the providers as well as monitor their progress with the SAAF project and offer suggestions for improvement.
Monitoring visit to Uganda In November 2014, the senior programme officer and project coordinator visited the eight grantees based in Uganda and observed that there were varying levels of capacity amongst the organisations. The team provided support and oversight on quality of services as well as advice on messaging being developed for IEC materials.
- Page 32 of 54 -
Safe Abortion Action Fund • Annual report • 2014
It was found that although grantees were generally involved in the local SRH networks, there was still room for a more cohesive coordination. This was facilitated, among other actions, by a grantees’ working dinner that was arranged as an opportunity for all to meet and share their experience and lessons learnt.
Webinars As already mentioned, in 2014 webinars mainly focused on the proposal development and inception stages. In the future, it is expected that technical issues will be addressed such as the use of the quality of care tool, awareness raising and behaviour change related to abortion in the community, high level political advocacy around abortion, financial management and harm reduction.
- Page 33 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Risk Management As a fund focusing on expanding access to safe, legal abortion, working in a wide variety of countries and with a large number of grantees with varying capacity, identifying the potential internal and external risks, and strategies to mitigate these, is a priority.
The risks associated with SAAF and their impact weights are:
Risk Description Probability Potential Impact Hard-line movements and initiatives in opposition to women's and girl's rights gain Growing opposition greater momentum and introduce language at High Medium the international level, which further limits access to safe abortion services. Limited number of governments able and Funding for abortion willing to fund safe abortion/prevention of Medium Medium related work unsafe abortion and thus limited number of projects able to be funded by SAAF. Low across SAAF Country context changes, such as conflict or Changes in country portfolio but high change of government effect project Medium contexts in individual implementation and results. settings SAAF funds not used for their intended Fraud and financial purpose by SAAF grantees and the SAAF Medium Medium-High mismanagement secretariat.
In 2014, two risks evolved and needed further considerations: the funding for abortion related work and the fraud and financial mismanagement risk.
Funding for abortion related work Although funding is secured for SAAF until the end of 2017, it is important to ensure that the abortion issue remains high on the donors’ agenda. In 2014, the establishment of a new mechanism, Amplify Change, was seen by the SAAF board as very positive news for the sector, but also a potential risk for SAAF has the two funds share the same base of donors. A discussion has been initiated with the Director of Amplify Change to identify ways of cooperation between the funds. It is important for the SAAF board and secretariat to work on a funding strategy and better analyse the SAAF portfolio, its niche and, based on the experience from previous rounds, identify its future priorities.
Fraud and financial mismanagement Since inception in 2007, SAAF has established strong financial control mechanisms. Grantees are required to conduct annual financial audits and provide six monthly progress reports (financial and narrative) to the SAAF secretariat. Failure to comply with reporting requirements will result in grant
- Page 34 of 54 -
Safe Abortion Action Fund • Annual report • 2014 suspension. In addition, initial concept notes for Round Three funding were assessed by experts who were familiar with many of the organisations and individuals seeking funding, and financial viability of proposals and organisations was assessed during this review.
Moreover, the SAAF secretariat is hosted by IPPF, which has a Fraud Response Strategy which includes prevention, detection and management of fraud. The strategy aims to raise awareness of fraud, provides guidance on how suspected fraud should be reported and investigated, and the IPPF mechanisms to prevent and detect fraud. SAAF is fully compliant with the IPPF Fraud Response Strategy.
In 2014, two instances of fraud by two grantees were reported and dealt with. The SAAF secretariat organised an audit in one case and recouped the funds in the other and both projects were terminated. As a consequence, an action plan to further strengthen financial controls has been developed and discussed with donors. It includes:
Extra checks with current grantees The SAAF secretariat will work closely with the IPPF finance department to develop and implement a list of due diligence checks with current grantees.
Extra finance staff time allocated to the fund This will help the SAAF secretariat to strengthen financial controls and monitoring and provide financial management support to some grantees with very low capacity.
Changes to the process for future round of funding A number of measures have been added to the risk management strategy, including:
Assessment of funding applications: the audit firm will be contacted by phone to assess their very existence and credibility; Creation of a risk rating system with every single short-listed organization; Project reporting: grantee performance on each report will be categorized by the SAAF secretariat, with those judged as performing poorly (both poor activity implementation and/or poor reporting) receiving increased supervision (monitoring visits and spot checks) These measures will be implemented in 2015 for the current round and will also apply to any future rounds.
- Page 35 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Fund Monitoring and Evaluation
Since the last annual report, two main actions have been taken to better monitor and evaluate the fund: the new SAAF logframe has been finalized and an evaluation framework has been developed.
SAAF logframe
The aim of the revised logframe (see Appendix Four: SAAF Logframe 2013-2017 ) is to provide a more relevant framework for monitoring of projects funded under round three of SAAF. It is a part of the overall SAAF evaluation framework to measure the impact of SAAF.
Some keys elements include:
Each SAAF grantee has an individual indicator spreadsheet. . Not every indicator in grantee’s projects counts towards the SAAF logframe . Indicators that count towards the SAAF logframe are clearly identified in the spreadsheets Grantee’s must report quarterly data (in every six monthly report, they inform results for the previous two calendar quarters). . Because the projects start dates were staggered in quarters (projects began in the beginnings of Q1, Q2, Q3 and Q4 in 2014), the secretariat needs quarterly data in order to be able to accurately aggregate results from projects with different start dates.
Targets for grantees were set for each project year (which varies depending on when each project started). . In order to allow a comparison between aggregated targets and indicators, a calculation method was designed by the secretariat to estimate quarterly targets . All calculations are done in an indicators worksheet, and then transposed into the formal SAAF logframe template. The finalized logframe document includes detailed definitions and calculation method for each individual indicator.
Evaluation Framework
During 2013, the SAAF board decided to commission an independent overall evaluation of SAAF, with a view to conduct a prospective evaluation of SAAF Round Three 2014-17. In May 2014, a consultant was asked to prepare this evaluation framework to provide the SAAF board with options for evaluation questions, designs and costs (i.e. an evaluability assessment). Over the following months, this framework evolved, after discussion and peer reviews, and additional supporting documents were developed, including an improved SAAF theory of change and full spreadsheet of potential evaluation questions. These documents served as background information for the board to further discuss the focus and scope of an evaluation of the fund.
- Page 36 of 54 -
Safe Abortion Action Fund • Annual report • 2014
This piece of work has been delayed due to the difference in expectations from various partners and the need for the secretariat to focus on the inception of Round Three grantees. It should be rolled out in 2015. Conclusion and Next Steps
The period covered by this annual report, October 2013 to December 2014 has been challenging but productive for the fund. The shift towards supporting locally-led organisations has been demanding and required more support than anticipated, leading to delays in the inception of some of the projects. However this also came with stronger systems and checks to better monitor and support projects, which will have a beneficial impact in the future.
All Round Three projects have been launched and initial results have been promising, with the results of most of the SAAF logframe indicators being on track. Stronger systems to better monitor the grantees results and the fund performance have been finalised and implemented. More support to grantees has been provided, through a vibrant virtual community, webinars and inception of project visits.
In the coming year, SAAF will focus on further supporting grantees through regular monitoring visits, strengthening financial controls and financial management support, and encouraging peer-to-peer learning via the virtual community and grantees’ meetings. The SAAF secretariat and board will also work on prepare to face challenges ahead, by redefining the Board role and mission, implementing the evaluation framework to better inform the design of a future round of funding and focusing on a fundraising strategy to gather donors support around this new vision.
- Page 37 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Appendices Appendix One: SAAF Board Members Chair Manuelle Hurwitz, Senior Adviser Abortion, IPPF
NGO Representatives Liz Sime, International Operations Director, Marie Stopes International Giselle Carino, Deputy Director of Programs - Universal Access to Sexual and Reproductive Health, IPPF Western Hemisphere Office Leila Hessini, Director, Community mobilization and Youth leadership, IPAS Monica Oguttu, Executive Director KMET, Kenya
Activist Representative Suchitra Dalvie, Coordinator Asia Safe Abortion Partnership (ASAP)
Professional Organisation Representative Friday Okonofua, Program Officer, Ford Foundation-West African office [on behalf of International Federation of Gynecology and Obstetrics (FIGO)]
Donor Representatives Nina Strøm, Senior Adviser, Global Health and AIDS Department, NORAD Sandra MacDonagh, Health Adviser, Sexual and Reproductive Health, AIDS and Reproductive Health Team, DFID
- Page 38 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Appendix Two: SAAF Round Two Grantees All Round Two grantees included – those still implementing during this period are highlighted
Project Project Country Organization Project title end length
Africa
Institut Supérieur des Sciences Avortements et santé des femmes au Burkina Faso Jun-14 2.5 Year de la Population (ISSP) Burkina Faso, II
Société des Gynécologues et Renforcement des soins d’avortement Burkina Faso Obstétriciens du Burkina Oct-13 2 Year au Burkina Faso (SOGOB)
Renforcement de l'accès à des soins Association Burundaise pour le d’avortement de qualité et prévention Burundi Jun-14 3 Year Bien-Etre Familial (ABUBEF) des grossesses non désirées chez les femmes et filles vulnérables.
Soins complets d’avortement dans les Association Ivoirienne pour le activités de santé sexuelle et de la Cote d'Ivoire Sep-14 3 Year Bien Etre Familial (AIBEF) reproduction dans les zones d’intervention de l’AIBEF
Democratic Accès de femmes affectées par les Republic of ANONYMOUS conflits aux services d’avortement Jun-12 1 Year Congo médicalisé (AFESAM)
Reducing Maternal Mortality Through Ghana Pathfinder International Ghana Expansion of CAC Service in the Northern Dec-12 1.5 Year Regions of Ghana
Integrated Social Development Ghana Global Doctors for Choice (GDC)/Ghana Aug-14 3 Year Centre (ISODEC)
Planned Parenthood Federation Expanding access to safe abortion and Kenya of America International (PPFAI) Jun-13 2 Year post-abortion care in Kenya Kenya
Kisumu Medical and Education Male Involvement in Safe Abortion Kenya Jun-13 2 Year Trust (KMET) (MISA)
Our Bodies, Our Choices: Kenyan Women Kenya ANONYMOUS Organizing for Choice: Making Medical Jun-13 2 Year Abortion Safer and More Accessible
Associação Moçambicana para Prevention of Unsafe Abortion for Mozambique Desenvolvimento da Família Jun-13 2 Year Adolescents & Youth (AMODEFA)
Expanding Safe Abortion Services through Pathfinder International provision of an integrated package of Mozambique Apr-13 1.8 Year Mozambique care, treatment and prevention services in Gaza and Inhambane Provinces
- Page 39 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Project Project Country Organization Project title end length Expanding access to safe abortion and Planned Parenthood Federation post-abortion care, especially medication Nigeria of America International (PPFAI) Jun-13 2 Year abortion through community based Nigeria providers
Promoting safe abortion through Association Rwandaise pour le awareness-raising of people working in Rwanda Bien-Etre Familial (ARBEF) / Hope Jul-14 3 Year civil society organizations concerned with for living women’s health and welfare in Rwanda.
Scaling up youth-friendly comprehensive Pathfinder International South South Africa abortion care services in Eastern Cape, Jul-13 2 Year Africa South Africa.
Improving access to safe second- trimester abortion in South Africa: South Africa Ibis Reproductive Health Oct-14 3 Year research on the mifepristone- misoprostol regimen
Planned Parenthood Federation Sudan - of America International (PPFAI) Access through Provider Network Jun-13 2 Year Darfur Sudan
Reducing maternal mortality caused by Tanzania ANONYMOUS Feb-13 1.5 Year unsafe abortion in Zanzibar, Tanzania
Kyetume Community Based Emergency Post Abortion Care Project, Uganda Jun-13 2 Year Health programme Kyetume – Mukono District – Uganda
Asia and Pacific
Bangladesh Women Health Women’s Reproductive Rights- Access To Bangladesh Jun-14 3 Year Coalition (BWHC) Quality Safe Abortion Care
Research, Training and Operations Research to Improve Quality Bangladesh Management (RTM) Jun-14 3 Year of MR Services in Bangladesh International
Bangladesh Association for Access to safe Menstrual Regulation Bangladesh Prevention of Septic Services and Reduction of Unsafe Jun-14 3 Year Abortion(BAPSA) Abortion
Expanding access to safe abortion options and post-abortion family planning for Cambodia Marie Stopes International Jun-13 2 Year poor and marginalized women in Cambodia.
Enable Project: Advocacy and Center for Research on empowerment to enable marginalized Nepal Environment Health and and vulnerable women to access safe Jul-14 2 Year Population Activities (CREHPA) abortion and post-abortion family planning services in Nepal
- Page 40 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Project Project Country Organization Project title end length Increase awareness and access to informed choices of safe abortion and Nepal Sunauva Parivar Nepal Sep-14 3 Year post abortion family planning services in Nepal
Improving Young Women’s access to Pakistan Aware Girls / ASAP/ WoW Jun-14 3 Year Safe Abortion
The Women’s Health and Thailand Reproductive Rights Foundation Community clinic for safe abortion service Jun-13 2 Year of Thailand
The Grounding Abortion Law and Policy ANONYMOUS Oct-13 2 Year Philippines Reform Advocacy in Restricted Settings
Increasing access to Safe Medical Abortion and Comprehensive Abortion Center for Community Vietnam Care through the Center for Community Dec-12 1.5 Year Reproductive Health in Vietnam Reproductive Health in Vietnam healthcare network.
Latin America and the Caribbean
Anis – Institute of Bioethics, Conscientious objection in legal abortion Brazil Jun-14 3 Year Human Rights and Gender services in Brazil
Modelo de servicio para la intervención Ecuador ANONYMOUS del Embarazo no deseado y el Aborto Jun-14 3 Year Seguro
Centro de Promoción y Defensa Acceso aborto legal y seguro en el Perú: Peru de los Derechos Sexuales y Reduciendo el estigma y fortaleciendo el Jun-13 2 Year Reproductivos – PROMSEX debate.
Eastern Europe and Central Asia
Access to comprehensive abortion care “For Family and Health” Pan- Armenia and post-abortion contraception for Jun-14 3 Year Armenian Association vulnerable women in Armenia
Kazakhstan Association on sexual Kazakhstan Only wanted pregnancies” Jun-13 2 Year and reproductive health (KMPA).
Multi-Country
Tanzania, Nigeria, The Women’s Global Network for Abortion Advocacy and Campaign Project Pakistan, Jun-13 2 Year Reproductive Rights (AACP) Malaysia, Nepal
- Page 41 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Appendix Three: SAAF Round Three Grantees
Country Organization Project Title
Africa Prévention des avortements à risque, plaidoyer et offre de Association Béninoise pour la Benin services complets d’avortement dans les limites de la loi au Promotion de la Famille (ABPF) Bénin
Botswana Family Welfare Building Momentum for Reduction in Maternal Morbidity Botswana Association and Mortality
Solidarité des Femmes burundaises pour la Lutte contre le Sida et le Bâtir, au Burundi, une société où chaque femme jouit d’une Burundi Paludisme au Burundi (SFBLSP bonne santé sexuelle et reproductive. Burundi)
Congo, Association Congolaise pour le Bien Prise en charge des complications post abortum dans 4 (Brazzaville) Etre Familial (ACBEF) hôpitaux partenaires de l’ACBEF
Projet d’amélioration des conditions de travail et de prise en charge des cas d’avortement des jeunes filles et jeunes Congo, (DRC) CEIFD - SUD KIVU femmes auprès des sages-femmes affectés dans les maternités des aires de santé de Kimbi Lulenge en Territoire de Fizi au Sud Kivu en République Démocratique du Congo
Santé reproductive et pratiques d’avortements dans les Congo, (DRC) ANONYMOUS zones de crise (SAREPRA)
Projet De Création D’un Centre D’encadrement Médical Pour SOS FEMME ET ENFANT EN Lutter Contre Les Grossesse, Les Avortements clandestins, La Congo, (DRC) CATASTROPHE Régularisation des Naissances Et Le Dépistage Volontaire de VIH/Sida
Improving access to quality Comprehensive Abortion care & Family Guidance Association of Ethiopia FP services among rural, young women and men in Northern Ethiopia(FGAE) Ethiopia
Safer Reproductive Choices Ethiopia Save Your Generation Ethiopia for University Students
Study of Conscientious Refusal to Provide Abortion in Ghana Ghana Global Doctors For Choice - Ghana with a Subsequent Plan for Intervention
ADVOCATING FOR THE MAINSTREAMING OF ABORTION Ghana Global Media Foundation (GLOMEF) SERVICES INTO THE PUBLIC HEALTH SYSTEM IN GHANA
Sustainable Aid Through Voluntary Reducing Maternal Mortality Through access to information Ghana Establishment (SAVE-GHANA) and Abortion Service in the Upper West Regions of Ghana
- Page 42 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Country Organization Project Title
Guinea-Bissau AGUIBEF Prévention et traitement des complications d'Avortement
Deepening understanding of abortion and post abortion care African Population and Health Kenya and improving the provision of modern post-abortion family Research Center, Inc. (APHRC) planning to adolescent women in Kenya
Increasing access to Medical Abortion Drugs and Information Kenya ANMA-Kenya through Pharmacies, Service Providers and Women in Kenya
Kenya ANONYMOUS The Safe Choice
Kisumu Medical & Education Trust TETEA UZAZI SALAMA (TUS)- (Advocacy for Safe abortion Kenya (KMET). Services and Rights)
NATIONAL NURSES ASSOCIATION OF SCALING UP ADVOCACY ON COMPREHENSIVE ABORTION Kenya KENYA CARE TO NURSES AND MIDWIVES IN PUBLIC INSTITUTIONS
Making Healthy Choices: Realizing our Reproductive Rights Kenya ANONYMOUS and Making Medical Abortion Safer and More Accessible
Youth Alliance for Leadership and Decriminalization of Abortion in Kenya: New Dawn Towards Kenya Development in Africa (YALDA) Saving Mothers’ Lives
From Policy to Action: Expanding Safe Abortion Access in Mozambique Women in Law in Southern Africa Mozambique
Nigeria G I W Y N ADVOCACY AND ABORTION STIGMA IN NIGERIA (A S T I N )
Strengthening community-provider partnerships for Nigeria Women Friendly Initiative (WFI) increased access to Safe Abortion (SA) and Post Abortion Care (PAC) services in Federal Capital Territory (FCT), Nigeria.
Women’s Health and Action Building capacity for task shifting on medication abortion Nigeria Research Centre (WHARC) care in Nigeria
Association Sénégalaise pour le Bien- Senegal Plaidoyer-Recherche et Soins Après Avortement (PRSAA) Etre Familial (ASBEF)
Using a low sensitivity urine pregnancy test combined with Women’s Health Research Unit South Africa support SMSs and a self-assessment as an alternative to a University of Cape Town follow-up clinic visit after medical abortion
Improving Safety of in and out of Hospital Abortion Services Sudan ANONYMOUS in Khartoum State
Sudan Sudan Family Planning Association Incomplete Abortion Care
Family Life Association of Swaziland Swaziland Lilungelo Ngelakho (The choice is yours) (FLAS)
- Page 43 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Country Organization Project Title
Reducing barriers to accessing comprehensive post-abortion Tanzania Marie Stopes Tanzania care services for vulnerable young women in Zanzibar, Tanzania
WOMEN’S PROMOTION CENTRE Tanzania Tanzania Safe Abortion Advocacy Project (TSAAP) (WPC)
CENTER FOR HEALTH, HUMAN Clarifying Uganda’s Legal and Policy Environment on Uganda RIGHTS AND DEVELOPMENT Abortion (CUL‐PA) (CEHURD)
Kyetume Community Based Health Uganda Emergency Post Abortion Care (EPAC) Project Care Programme
Night mobile forums in 8 Cities and 3 border towns of Uganda aiming to reduce the rampant engagement of life threatening local abortion procedures among sex workers Uganda Lady Mermaid’s Bureau together with know-how safety information kits, study on the problem and advocating for post abortion reprieve at local councils level
Uganda Reproductive Health Uganda (RHU) Responding to Unsafe Abortion in Uganda (RESPOND Project)
Uganda TUSITUKIREWAMU GROUP Better Reproductive Health, Better Communities project
Volunteers for Development Strengthening Community Response against Unsafe Uganda Association in Uganda (VODA Abortion (SCORE Unsafe Abortion) Uganda)
Reproductive Rights for All! Providing comprehensive Planned Parenthood Association of Zambia abortion care Zambia information and services to save lives in Zambia
Asia and Pacific
Public Private Partnership for improving the quality of MR Association for Prevention of Septic Bangladesh and PAC services in one Upazila of a Selected District of Abortion, Bangladesh(BAPSA) Bangladesh.
Bangladesh Women’s Health Scale Up of Preventing Unsafe Abortion in Selected Bangladesh Coalition (BWHC) Areas of Bangladesh
Family Planning Association of Enhance Access to Safe MR Service to marginalized women Bangladesh Bangladesh (FPAB) in rural areas in Bangladesh
A Harm Reduction Approach to Improve Access to MRM through selected pharmacies in 2 districts (Sylhet, Bangladesh Marie Stopes Bangladesh Chittagong) of Bangladesh (MRM = Menstrual Regulation through Medication akin to Medical Abortion)
- Page 44 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Country Organization Project Title
Reproductive Health Services, Access to Safe MR and Reproductive health for Youths and Bangladesh Training and Education Program Adolescents (ASRYA) (RHSTEP)
Research, Training and Management Establish Linkage Between Community and Facility to Reduce Bangladesh (RTM) International the Incidence of Unsafe MR in Selected Areas of Bangladesh
(Integration Menstrual Regulation ( MR) and Post Abortion Bangladesh Shimantik Care (PAC) in Mother & Child Clinic of Shimantik
Reproductive Health Association of Improving Access to Safe Abortion Among Poor and Cambodia Cambodia (RHAC) Vulnerable Population
Abortion, Gender and Rights Institute for Activists, Creating Resources for India Practitioners Empowerment in Action (CREA) and Service Providers to Improve Access to Safe Abortion
Improved Access to Safe Abortion Services in the context of India SAMYAK Sex Selection using the updated WHO Safe Abortion Guidance for training Heath care providers
Implementation Of The Safe Abortion Services : How To Indonesia ANONYMOUS Solve Barriers
BREAKING THE SILENCE: Improving access to safe abortion Indonesia IPPA Yogyakarta Chapter for vulnerable women who have experienced rape in Yogyakarta province, Indonesia
Indonesia SAMSARA Safe Abortion Hotline in Indonesia
Support of research, advocacy and the development of Malaysia RRAAM advocacy materials related to unsafe abortion in Malaysia
Provision of comprehensive abortion care through MFWA’s MONGOLIAN FAMILY WELFARE three static clinics and increase accessibility of safe abortion Mongolia ASSOCIATION (MFWA) services to vulnerable women and young girls.
Increase access to safe abortion and to Family planning for Nepal Action Works Nepal (AWON) 5’687 women in remote, uncovered and underserved areas in the Karnali Region-Nepal
Breaking the Barriers: Marginalized Women and Girls access Nepal CREHPA safe abortion information and services in Nepal
Nepal ANONYMOUS Combating Unsafe Abortion Services in Nepal
Healthy Society and Environment Nepal Safe Comprehensive Abortion Care (SCAC) Project Protection Center (HSEPC)
- Page 45 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Country Organization Project Title
Transforming Access to Safe Medical Abortion in Nepal - Nepal Sunaulo Pariwar Nepal Piloting a franchise model to inform and secure policy change
Strengthening and Mobilising Alliances to Institutionalise Nepal ANONYMOUS Safe and Accessible Abortion Practices in Nepal
Pakistan Aahung Institutionalizing Safe Abortion Services
REDUCING UNSAFE ABORTIONS IN SINDH USING Pakistan Peace Foundation INNOVATIVE STRATEGIES: HOTLINES, MOBILE CLINIC AND MHEALTH
Fighting the Stigma Through Champions: Addressing Unsafe Pakistan Shirkat Gah Abortion in Pakistan
Papua New ANONYMOUS Laik blong ol Meri (Her Choice) Guinea
Extension Phase of the Introduction of the Medical Thailand Concept Foundation Termination of Pregnancy in Health Service Systems, Thailand
Safe Abortion Referral and Harm Reduction Among Burmese Thailand Mae Tao Clinic Migrants and Ethnic Minorities in Two Areas Along the Thai/Burma Border
Vanuatu Family Health Association Promoting the right to quality Sexual and Reproductive Vanuatu [VFHA] Health in Vanuatu
Increasing access to Comprehensive Abortion Care for young Centre for Community Reproductive female migrant workers through the establishment of a Vietnam Health in Vietnam (VNCRH) Reproductive Health Centre in the Tan Tao industrial area of Ho Chi Minh city, Vietnam
Institute for Reproductive and Family Promoting comprehensive safe abortion action for Youth and Vietnam Health (RaFH) Adolescents in Vietnam in Hanoi and Hoa Binh city
Enhance capacity in implementing and quality of safe Vietnam Vietnam Family Planning Association abortion services providing
Eastern Europe and Central Asia
Raising awareness how to avoid unintended pregnancy and improve access for safety abortions for women of Kyrgyzstan ANONYMOUS reproductive age and girls aged 12 – 13 years old in rural areas of Osh oblast
Kyrgyzstan ANONYMOUS Sustainable development of Safe Abortion clinics
- Page 46 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Country Organization Project Title
Increasing the quality of abortion care within a Moldova, Reproductive Health Training Centre comprehensive package of reproductive health services in (Republic of) (RHTC) Transnistria - the post-conflict area of the Republic of Moldova
Population are aware about Safe abortions and able to Tajikistan Tajik Family Planning Alliance (TFPA) request the qualitative services
Latin America and Caribbean
Catolicas Por el Derecho a Decidir Estrategias para mejorar el acceso de mujeres y niñas al Argentina (CDD) aborto no punible en Argentina
Tejiendo redes: estrategias para mejorar el acceso al aborto Argentina CEDES legal para mujeres víctimas de violencia en Argentina
LEGITIMANDO EL DEBATE SOBRE LOS DERECHOS SEXUALES, ASOCIACIÓN CATÓLICAS POR EL DERECHOS REPRODUCTIVOS Y EL DERECHO A DECIDIR: UNA Bolivia DERECHO A DECIDIR-BOLIVIA CONTRIBUCIÓN A LA GENERACION DE NORMATIVA JURÍDICA QUE GARANTICE SU EJERCICIO.
Asociación Médica Privada Ejerciendo nuestros Derechos sexuales y Derechos Bolivia Voluntaria “Wiñay” reproductivos
Garantizando el aborto legal, seguro y efectivo en el marco más amplio posible de la salud y los derechos sexuales y Bolivia Colectivo Rebeldía reproductivos que reconoce la Nueva Constitución Política del Estado Plurinacional de Bolivia
Circuito Promocional de Aborto Seguro y Salud Sexual de las Chile Línea Aborto Chile Mujeres
Estrategias de acceso a servicios de aborto seguro y Fundación Unidad de Orientación y Colombia restitución de derechos sexuales y reproductivos a mujeres Asistencia Materna - Oriéntame víctimas del conflicto armado en Colombia
El Salvador Colectiva Feminista y Agrupacion Por la despenalización del aborto en El Salvador
Guatemala ANONYMOUS ACCESO A ABORTO SEGURO
Centro de Investigación Implementación del Cuidado de la Atención PostAborto en el Guatemala Epidemiológica en Salud Sexual y primer nivel de atención de salud en población indígena, Reproductiva rural y pobre del norte de Guatemala.
Initiative pour un Développement Promotion de la santé sexuelle et reproductive et de Haiti Equitable en Haïti (IDEH) l’avortement sécurisé
Balance Promoción para el Mexico Fondo de Aborto para la Justicia Social MARIA Desarrollo y Juventud AC
- Page 47 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Country Organization Project Title
Promoting the use of anti-contraceptive methods and access Semillas - Sociedad Mexicana Pro Mexico to safe abortion in marginalized, indigenous communities in Derechos de la Mujer, A.C. Mexico.
AMPLIACION DE SERVICIOS DE PREVENCION DE ABORTO Y Peru ASOCIACION FAMILIA SANA SERVICIOS DE ABORTO SEGURO PARA LA POBLACION INDIGENA DE CAJAMARCA, PERU
Centro de la Mujer Peruana Flora Despenalización del aborto en casos de violación: Cuestión Peru Tristán de derecho, cuestión de vida
Centro de Promoción y Defensa de Acceso al aborto legal y seguro en el Perú: Reduciendo el Peru los Derechos Sexuales y estigma y Reproductivos - PROMSEX fortaleciendo el debate
St. Lucia Planned Parenthood Saint Lucia Real Options Project Association
Centro de Comunicación Virginia Red de vigilancia de las mujeres para la implementación de la Uruguay Woolf (Cotidiano Mujer) Ley de Interrupción Voluntaria del EmbarazoN° 18.987
ACCESO A ABORTO SEGURO EN URUGUAY Y DEFENSA DE LA Uruguay MYSU – Mujer y Salud en Uruguay SALUD Y LOS DERECHOS SEXUALES Y REPRODUCTIVOS.
Asociación Civil de Planificación Programa de Reducción de riesgos y daños de PLAFAM Los Venezuela Familiar - PLAFAM Teques en el Estado Miranda
North Africa and Middle East
Egypt ANONYMOUS Saving Mothers’ lives
Lebanon ANONYMOUS The A project
Palestinian Family Planning Together we stand to empower women's right to have Palestine Protection Association (PFPPA) access to safe abortion services and information.
Multi-Country
Women’s Global Network for Abortion Advocacy and Campaign Project – ACCP (Phase Kenya, Uganda Reproductive Rights (WGNRR) Two)
Implementando y ampliando el acceso al aborto seguro en Ecuador, ANONYMOUS poblaciones vulnerables a través de prestadores de servicios Guatemala no médicos
Consorcio Latinoamericano Contra el Fortaleciendo nexos para ampliar el acceso al aborto seguro Latin America Aborto Inseguro - CLACAI en la Región
- Page 48 of 54 -
Safe Abortion Action Fund • Annual report • 2014
Country Organization Project Title
Enhancing access to information and services on medical African Network for Medical Africa abortion to women, including young and vulnerable women Abortion (ANMA) in Kenya, Ethiopia, Ghana, Zambia and Uganda
Asia Asia Safe Abortion Partnership Creating Youth Champions as advocates for safe abortion
- Page 49 of 54 -
Appendix Four: SAAF Logframe 2013-2017
PROJECT TITLE Safe Abortion Action Fund Round Three 2013- 2017
GOAL Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target
Africa 14% Reduce maternal mortality and Asia 12% improve women's and girls' lives % of maternal deaths due LAC 12% through increased access to to unsafe abortion in SAAF comprehensive safe abortion and funded regions Source post abortion care services, and prevention of unwanted (NB: wider SAAF evaluation pregnancies, especially for poor, framework will measure WHO unsafe abortion estimates young and otherwise vulnerable improvement in lives) Baseline figures listed are for 2008 estimates (published in 2011);
women and girls WHI currently (2015) working on updated data with new methodology
OUTCOME Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target Assumptions
0 17 18 17 6 22 O1. Number of countries where new steps have been taken towards Source improved legislation, policy Absence of natural Six monthly reports from grantees and services disasters or SAAF external evaluation (n=28 grantees) Improved enabling environment security Milestones are cumulative for safe abortion and post- threats/conflict in
abortion care countries/localities Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target where projects O2. Number of women and 0 41,580 68,357 56,619 8,076 174,631 funded girls receiving quality clinical abortion services 0 a) 10,757 a) 18,264 a) 16,920 a) 2,656 a) 48,597 (disaggregated by age: a) 0 b) 30,823 b) 50,093 b) 39,699 b) 5,420 b) 126,034 19 and under and b) 20 Source and over )
Page 1 of 54
Six monthly reports from grantees (n=63 grantees)
Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target i) 71%** 0 64% 76% 77% 80% ii) 80%** O3. Proportion of women and girls in receipt of a) i) 69%** 0 a) 67%* a) 71%* a) 69%* a) 58%* quality clinical abortion ii) 58%** services voluntarily adopting a modern b) i) 31%** 0 b) 33%* b) 29%* b) 31%* b) 42%* method of contraception ii) 42%** (disaggregated by % of a) short and b)long term Source methods) Six monthly reports from grantees (n=61 grantees)
*Please note that the sum of a) and b) will always be 100%. Therefore, an increase in one will always be accompanied by a decreased in the other
**Target i) is the average throughout the project life, while target ii) is the latest achievement
OUTPUT 1 - Advocacy & Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target Assumptions awareness raising
A1. Number of SAAF 0 8 8 5 3 8 grantees leading a coalition with a shared Source National position on approach to institutional/legal Locally led advocacy initiatives to abortion law or policy Six monthly reports from grantees (n=8 for this indicator)
framework increase public visibility and reform Milestones are cumulative permits NGO debate of abortion-related issues Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target advocacy activities
A2. Number of SAAF grantees newly engaging 0 53 53 34 16 55
Page 2 of 54
different groups in Source advocacy and awarness raising activities Six monthly reports from grantees, (disaggregated by type of SAAF external evaluation (n=55 grantees) group) Milestones are cumulative
IMPACT WEIGHTING Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target
A3. Number of publically 0 564 951 822 161 2498 visible statements in 25% support of safe abortion Source RISK RATING attributable to SAAF
grantees Six monthly reports from grantees (n=38 grantees) Medium
OUTPUT 2 - Evidence Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target Assumptions
Local knowledge developed and 0 17 6 4 0 27 evidence gaps filled and E1. Number of new studies strategically shared to inform an Source National ethical
initiated improved enabling environment review
committees for safe abortion Six monthly reports from grantees (n=19 grantees) approve research protocols in timely IMPACT WEIGHTING Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target manner
0 39 62 41 7 149 E2. Number of knowledge 20% dissemination activities Source RISK RATING
conducted Six monthly reports from grantees (n=20 grantees) Medium
OUTPUT 3 - Services Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target Assumptions
Page 3 of 54
0 62,843 110,208 74,601 14,163 261,815 S1. Number of clients receiving quality Source counselling on abortion
and related services Local initiatives improve access to Six monthly reports from grantees (n=47 grantees) comprehensive safe abortion and post abortion care services, Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target especially for young women and girls 0 1,386 1,570 885 159 4,000 S2. Number of service providers trained in safer Source abortion technologies and
techniques Six monthly reports from grantees (n=47 grantees)
IMPACT WEIGHTING Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target RISK RATING
0 413 624 490 15 1,542 S3. Number of service 25% points providing quality Source Medium
abortion services Six monthly reports from grantees (n=56 grantees)
OUTPUT 4 - Management Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target Assumptions 0 a) 45% a) 80% a) 97% a) 97% a) 97% M1. Proportion of SAAF 0 b) 28% b) 66% b) 88% b) 95% b) 95% project funding a) Source SAAF grants are efficiently disbursed to and b) managed and grantees supported expended by grantees IPPF continues to SAAF secretariat financial records host SAAF
Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target
Page 4 of 54
i) 87%* 80% 80% 85% 90% 95% ii) 95%* M2. Proportion of grantee reports received on time Source
and complete SAAF project records (connect site)
Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target
0 6 12 12 12 42 M3. Number of discussions on SAAF virtual community Source resulting in 10 or more
responses SAAF virtual community usage statistics
Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target i) 87%* N/A (not asked) 80% 85% 90% 95% M4. Proportion of SAAF ii) 95%* grantees reporting satisfaction with support Source provided by SAAF
secretariat SAAF grantees reports
IMPACT WEIGHTING Indicator Baseline Milestone 2014 Milestone 2015 Milestone 2016 Milestone 2017 (Jan-Sept) Target
10% 10% 10% 10% 10% 10% M5. Proportion of overall 30% SAAF funds expended for Source RISK RATING
fund operating costs SAAF financial records Low
*Target i) is the average throughout the project life, while target ii) is the latest achievement
Page 5 of 54