Evaluating our International Reproductive Health Strategy

A mobile clinical outreach team from Marie Stopes International, a specialized sexual reproductive health and family planning organization, on a site visit to Laniar health center, a rural area, where they offer many sexual reproductive health services and counseling. Photo credit: Jonathan Torgovnik/Getty Images/Images of Empowerment

Our International Reproductive Health (IRH) team kicked off a strategy refresh process back in March 2020. We began with a retrospective evaluation of Hewlett’s contributions to the IRH field over the past five years and a landscape analysis of global and regional trends in sexual reproductive health and rights (SRHR) and related fields. Though we are still reviewing and consolidating the landscape findings, we have now begun to consider the implications of what we have learned on our future grantmaking. Here are some things that are informing our thinking.

Who we heard from

The evaluation was led by Evaluating for Equality in partnership with Afton Bloom, and the landscape scan was a collaborative effort between Afton Bloom and Niyel. The strategy refresh is also guided by an advisory committee made up of peer donors, grantees, thought leaders, and members of relevant global and African regional institutions, which offers expert input at key points in the process.

The intent of the retrospective evaluation was to offer key insights into where the IRH strategy has made progress, where it has not, and develop a better understanding of how, why, and for whom progress was achieved. The evaluation included findings from four narrower evaluations conducted over the past five years,  including evaluations of our two sub-strategies on Francophone West Africa (FWA) and local advocacy as well as on our two areas of innovation in SRHR service delivery: human-centered design and behavioral economics. We aimed to triangulate findings across the portfolio and fill strategic data gaps to further inform how we understand our contributions to progress in the field.

Because we felt it was critical that our current grantees have the opportunity to provide input into this process, we launched with a survey distributed to 75 IRH grantees, complemented by 55 in-depth interviews with grantees and sub-grantees. The survey and interviews were grounded in an in-depth literature review of proposals, reports, and additional documentation shared by IRH grantees over the past five years.

We had to rethink our original stakeholder engagement plan for the landscape scan and evaluation in light of COVID-19 restrictions. We had hoped to host a series of in-person convenings in Dakar, Abidjan, Kampala, and Nairobi because it is important for us to create an open and dynamic dialogue with a diverse set of stakeholders. We shifted most of these conversations to virtual platforms but tried to maintain an interactive approach to the research, often using tools such as Mural to make it easier for participants to interact in real-time. The landscape scan included extensive secondary research of global and African regional sources and interviews with 80 global and regional experts and leaders across the SRHR field.

What we learned

There were several aspects of the evaluation findings that we are thinking deeply about in the context of our future grantmaking.

  • Relevance: Hewlett’s positioning in the SRHR space in Africa has been strongly framed by its sub-strategies that focus on (a) employing a regional approach to grantmaking in Francophone West Africa and (b) strengthening local SRHR advocacy capacity across the region. Our support is seen to play a catalytic role in the region, and stakeholders indicated that the foundation serves as a “unique ally” to partners that are driving the work. In particular, our support for and participation in the Ouagadougou Partnership has been noted as particularly catalytic for the FWA region.
  • Effectiveness: The current strategy aimed to contribute to three outcomes – (a) to ensure that no woman has an unwanted pregnancy; (b) to ensure that no woman dies from an unsafe abortion; and (c) to make family planning and reproductive health an integral part of broader development goals. Important progress has been made for each of the three outcomes, although more slowly for safe abortion than contraceptive use and integration into development goals. Grantees, sub-grantees, peer donors, and other SRHR ecosystem actors have contributed to these achievements at various levels and in different ways. While Hewlett’s direct contribution to each outcome is difficult to establish, the following were important levers.
  • Catalyzing progress through regional approaches: Hewlett contributed to doubling voluntary contraceptive use in the nine participating Ouagadougou Partnership countries through its participation and leadership in the partnership. Hewlett also enabled several service delivery and advocacy organizations to expand into or deepen existing operations in the region and supported region-specific research. Finally, despite a complex and in some cases restrictive environment, abortion advocacy has begun to make progress in FWA, especially in Burkina Faso and Benin, but there’s more room to explore new approaches to supporting abortion access in the region.
  • Building a supportive enabling environment: As noted in recent local advocacy sub-strategy evaluation findings, our principled approach has started to shift decision-making power to African civil society organizations and build local leadership and ownership of advocacy agendas. The strategy has also had some success in linking African organizations with each other to gradually build a stronger “ecosystem,” which grantees and sub-grantees see as essential for sustainable change in increasing SRHR policies and funding.
  • Efficiency: Hewlett’s approach to grantmaking is predicated on its guiding principles. Grantees largely reported that Hewlett’s principles are well translated into practice. In particular, humility and respect for others; openness, transparency, and learning; and readiness to stay the course for meaningful socially beneficial change. Our partners appreciated that the majority of IRH grantmaking is in the form of flexible grants – either general operating support or flexible program grants that have limited parameters around the grant objectives. There are minimal reporting requirements associated with these grants, which allow grantees to spend their time and resources as they deem most appropriate. A number of grantees expressed that they would appreciate more time with Hewlett program staff to capture learning and communicate results and challenges.
  • Sustainability: The impact of Hewlett’s general operating support is difficult to capture based on the intentionally light reporting requirements. However, Hewlett’s balanced attention to process along with outcomes has enabled some global SRHR service providers to grow, innovate, and expand to new regions, including FWA. These grants also support organizational-level sustainability that allows grantees to remain relevant and agile, manage crisis and leadership transitions, take time to reflect and strategize, and focus on financial sustainability and institutional growth.

Looking ahead

Currently, we are considering new strategic directions based on our learnings from the evaluation and landscape and new inputs from global and regional stakeholder interviews, focus groups, and additional secondary data analysis. We will test the resonance of Hewlett’s strategic focus and framing with key stakeholders in the African region.

Ultimately, our decision making for the new strategy will be based on (a) opportunities to drive continued and sustained progress; (b) opportunities to make meaningful contributions relative to other actors and funders; (c) opportunities to contribute to equitable systems and practices; (d) fit with Hewlett’s guiding principles; (e) fit with Hewlett’s assets and levers (as articulated above from the evaluation); and (f) feasibility given Hewlett’s resources and capacities.

You’ll hear from us over the next few months as we test out emerging ideas, share our full evaluation report, and prepare to release our new strategy in the first half of 2021. We are eager to engage in continued dialogue and welcome your questions and ideas at IRHstrategy@hewlett.org.

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