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Family Planning and Effective, Inclusive, and Accountable Governance: Lessons From Program Implementers

A recent PACE and Health Policy Plus (HP+) roundtable featured key takeaways from programs in Guatemala and Kenya.

A Dec. 7, 2021 roundtable hosted by PACE and Health Policy Plus (HP+) featured key takeaways from two regions on how investment in family planning can enhance effective and accountable governance.

The Evidence: Family Planning, Population Age Structure, and Governance

Elizabeth Leahy Madsen opened the panel presenting PACE’s Four Dividends analysis, which shows that among countries with a youthful population, a window of opportunity to achieve key development goals across four sectors―health, education, the economy, and governance―opens as fertility declines and the median age of the population increases. Across countries, this shift toward a more mature population age structure is associated with greater government effectiveness, political stability, and control of corruption. PRB’s analysis highlights an avenue of opportunity for policymakers and family planning programmers alike: family planning is one key factor that can contribute to effective and inclusive governance in the long term.

In Practice: Connecting Governance and Family Planning Outcomes in Guatemala and Kenya

Hermania Reyes Aguilar de Muralles of HP+ highlighted the potential of citizen participation to promote accountability and transparency as well as protect rights of family planning users. In Guatemala, the National Contraceptive Security Commission (CNAA) is a multisectoral body established by law to ensure access to family planning. CNAA operates in alliance with two civil society watchdog organizations, Observatoria en Salud Reproductiva (OSAR) (Reproductive Health Observatory) and OSAR-Juvenil (Youth). HP+ supports the OSARs to facilitate intersectoral dialogue across ministries of health, education, and financing; maintain a playbook of policy actors and legal mechanisms related to sexual and reproductive health and rights; and strengthen social accountability mechanisms to help citizens maintain their priority issues on the policy agenda. As Reyes Aguilar de Muralles noted, “Civil society actors are more permanent actors than government, so it is important to maintain strong ties.” Learn more about HP+’s work in Guatemala here: “Why Policy Matters: Strengthening Family Planning Services for Guatemala’s Indigenous People.”

Chrysantus Shem of PACE Kenya shared how family planning programs have promoted inclusive governance in Kenya in a context of devolution that transferred policy and budget decision-making responsibilities to subnational levels of government. Many county governments have faced capacity challenges in exercising their authorities, including planning and budgeting. To support locally prioritized health programs, PACE Kenya systematically strengthened individual and institutional capacity of policy decisionmakers and advocates; provided continuous partnership and mentorship to institutionalize best practices within county governments; and catalyzed participation by civil society, the media, and public for social accountability. This approach yielded increased county funding for health and family planning while also improving public participation in county budget forums, creating space for Members of County Assemblies to respond to community priorities, and improving subnational governments’ leadership in planning and budgeting. Increased accountability improves not only family planning outcomes but also governance norms.

Avenues for Collaboration in Governance and Health

To close the roundtable, David Jacobstein of USAID’s Center for Democracy, Rights, and Governance offered reflections pointing to paths forward in collaboration between the governance and health sectors. Jacobstein noted that in the governance space, the free-rider challenge can limit accountability efforts, because many governance approaches are so broad that responsibility can be passed around. Anchoring engagement on issues such as family planning can energize actors and lead to greater progress. Additionally, preparation for windows of opportunity is important, to take advantage of sudden shifts in programming. The Four Dividends analysis could help governance programs become more strategic in identifying potential windows of opportunity when advocacy and programming can be most impactful to generate change. Jacobstein illustrated lessons from the governance sector that are relevant for health, emphasizing the need for greater symbiosis between the two fields to facilitate mutual learning. Both fields benefit from analyzing the political economy to identify threats and opportunities that can be matched with accountability efforts and critically evaluating why particular efforts were successful in order to best translate them into successful efforts in other sectors. Increased accountability achieved through governance interventions presents opportunities for health programs to both adopt similar approaches and learn from their successes.

Positive impacts on accountability and governance are among the many benefits of family planning and reproductive health services. In addition to providing an avenue to promote citizen participation and social accountability in the short term, commitment to and investment in voluntary family planning can ease the pathway to inclusive and effective governance in the long term.