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Rationale
The countries of sub-Saharan Africa are at a
critical turning point in their efforts to address the dual challenges of
rapid population growth and poor reproductive health (RH). Annual population
growth of almost 3 percent has outpaced economic gains and improved food
production over the past 20 years, leaving Africans over 20 percent poorer,
in real terms, than in 1975. After doubling to 620 million in just 25 years,
sub-Saharan Africa's population is projected to double again in less than
three decades, further stretching the capacity of governments to provide
basic services.
Since the International Conference on
Population and Development (ICPD) held in Cairo in 1994, the Bank, its
client countries and other donors have been working to implement new
approaches to population whereby population policies will be linked to
broader poverty reduction and human development agendas; and RH programs
will be more fully integrated into national health systems. This requires
renewed emphasis on individual needs rather than demographic goals, and on
delivering RH services which are client-focused and financially sustainable.
Program managers are now striving to understand and apply the new approaches
and seeking practical guidance on what to do and how to do it in their own
countries.
In 1998, the Nairobi Learning Forum focused
on the integration of RH services within the context of health sector reform
and sector-wide development efforts. Discussions concentrated on ways to
design, cost and implement RH services within reforming health systems in
Africa, and addressed issues such as:
- the implications of RH service delivery;
- the modalities countries are employing to
achieve different delivery approaches;
- the cost implications of incremental
versus full-blown programs;
- the role of government versus NGOs and the
private sector; and
- the extent to which implementation may be
conditional on politics, culture, institutional capacity and stakeholder
collaboration.
Issues were examined against the backdrop of
socioeconomic and development challenges in Africa.
Objectives
The long-term objective of the Adapting to
Change program is to assist policy makers, health planners and service
providers adapt RH programs to the changing conditions and requirements of
health systems which are undergoing reform.
The immediate objectives of the Nairobi Forum
were to:
- identify lessons learned from other
countries' experiences of planning and managing essential RH/FP services
within reforming health systems;
- examine mechanisms for involving
stakeholders and bringing about needed changes in behavior based on
country experiences;
- equip participants with policy tools which
inform decision making and lead to more equitable and efficient RH
delivery;
- facilitate participants' understanding of
costing, finance and resource mobilization issues in relation to the
successful implementation of RH services; and
- review public and private roles in
delivery of RH services.
Learning Outcomes
- Through peer learning and practical
case-teaching methods, participants defined and learned best practices
in health sector planning and implementation. Learning was based on
country studies from West and East Africa with specific reference to the
delivery of RH services.
- Participants identified and discussed the
central pillars of health reform (service integration, costing and
sustainable financing, decentralization, and the public-private sector
mix). They also related these policy issues to reforms at play in their
own countries.
- Participants participated in practical and
interactive sessions aimed at reinforcing key messages related to RH
reform.
- Participants established a meaningful
network of contacts in the Adapting to Change network, through formal and
informal interaction with resource persons and country participants.
To join this network, please go sign up
for the Adapting to Change Newsletter.
- Participants identified learning resources
(print and web-based) that are available in this field.
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