1. Regional Framework for Sexual and
Reproductive Health (SRH) Best
Practice Documentation and Sharing
in the SADC Region
Findings from Desk Review & Proposed Framework
Rouzeh Eghtessadi (MPH)
Southern Africa HIV and AIDS Information Dissemination Service
(SAfAIDS)
Email: rouzeh@gmail.com

2. Thrust of Assignment
Consultancy expected to produce:
• A Report (combining data collated in the desk review
report and data from the administered questionnaires) on
Practices, Progress on implementation, Guidelines and
Protocols on sexual reproductive health in the SADC
Region; and
• Regional Guidelines (including specific criteria) for
Identifying, Documenting and Exchanging (sharing)
experiences and Best Practices on Sexual and
Reproductive Health, to be adopted by Member States

3. Consider….
• While analysis of Member State responses is ongoing,
available data from desk review is ample evidence to
systematically inform direction of SRH Best Practice
Documentation and Sharing within a SADC framework
• Methodology would ideally needed to enable in-country
visits to do on-site data collection and observation
• Timeframe - rapid methods, though thorough and
comprehensive , were conducted within stringently short
period of time
• However has created a strategic springboard and body of
evidence - for consolidation and further research

4. Background (1)
• Multiple commitments to SRH universal access and SRHR
(International – ICPD; Continental – MPoA; and regional –
SADC Gender & Development Protocol)
• Despite omission of SRH from the MDGs, recent evidence
highlights universal access to SRH as keystone to meeting
MDGs and a key investment in sustainable development
• SADC Sexual and Reproductive Health Strategy
(2006-2015) objective 4 speaks to best practice agenda:
“To enhance sharing of information, experiences and best
practices among Member States”

5. Background (2)
• SADC Secretariat resolved to develop Regional Guidelines
for Documentation and Exchange of Best Practices in SRH
in the SADC Region, to:
– Serve as a tool for consensus building among Member States (MS)
on what constitutes a ‘best practice’ within SRH practice
– Catalyse repositioning if SRH practices in the region
– Guide MS in identification, systematic documentation and strategic
dissemination and uptake (adaptation and replication) of SRH best
practices (BPs)
– Define criteria for SRH BPs that will ensure harmonised approach
to BP documentation by Member States
– Facilitate mitigation interventions around SRH in the region

6. Background (3)
• In recognition of the rich repository of experiences
in the SADC region - relevance of BPs to SRH
– Commitments translated into national policies, laws,
guidelines, strategic plans, roadmaps and protocols
– These guide practices and service delivery in SRH at
national, provincial/district and community levels
– Lessons learnt, sharing of ‘working’ practices in SRH
core areas leads to adoption of improved, cost-effective,
effective and sustainable practices and approaches
– Improved quality of SR health among women, men and
adolescents
– MDG targets met, beyond just 4,5 and 6 – informing
policy decision-making (financial, human capacity etc)

7. Defining…
• 9 Core SRH areas: family planning, STIs (HIV), safe motherhood,
sexual violence, reproductive cancers, abortion, infertility, adolescent and
youth SRH (AYSRH), interpersonal counseling, comm and health education
• Best Practices: no universal definition “…. a technique or methodology
that, through experience and research, has proven reliably to lead to a desired
result. In the context of health programmes and services, a practical definition
of a “Best Practice” is “knowledge about what works in specific situations and
contexts, without using inordinate resources to achieve the desired results, and
which can be used to develop and implement solutions adapted to similar
health problems in other situations and contexts”
• A best practice can be anything that ‘works’ to produce
results without using immoderate resources, either in full or
in part, and that can be functional in providing lessons
learned
• UNFPA, WHO, UNESCO, Global Health Council, UN
interagency committee on women & gender equality

8. Processes … towards generating
information for regional SRH framework
for BPs
• Dual Methodology:
– Regional Desk Review (27th August – 9th Sept 2010) on practices,
progress made by Member States, guidelines and protocols and
related documents (roadmaps, strategic plans etc)
– Administered questionnaires to Member States (analysis in
progress)
• Data sources: SADC Secretariat, 14 Member States, UN
agencies and partners, online databases and resources
• Themes :
– Practices, guiding documents related to, and progress made the 9
core SRH areas
– Status of BPs

9. Findings

10. • Drawn from SADC documents; ICPD +15 report; MDG
Goals Report (2010); WHO work in the Africa region
biennium report (2010) and progress report RH strategy
2010 and World Health Statistics (2010); Member States
MNH Roadmaps, UNFPA Country Profiles (2009) and
African MNH Profiles Roadmap Assessment Report
(2010); amongst over 90 other resources (international,
regional and national)
• Best Practice specific findings:
– Definitions
– Institutionalising into programming
– Status of SRH BP documentation, mapping and sharing
– Sample Profiles of SRH BPs: analysed for criteria building
– Existing Criteria for BP documentation and dissemination
(sharing)

11. Status of SRH BP Documentation,
Mapping and Sharing (1)
• Limited systematic documentation and sharing of SRH
related best practices within the SADC region, and an
absence of standardized guidelines and criteria that steer
the identification, documentation and sharing of SRH best
practices within a methodical fashion, by Member States
• The Implementing Best Practices (IBP) Knowledge
Gateway
– is a global electronic communication tool, users of this platform
(including those outside the IBP network) increased six-fold in 2009,
to approx 175 000 user
– works closely with the WHO–UNFPA Strategic Partnership
Programme (SPP) to increase the use of evidence-based guidelines
and tools in family planning, maternal health and STIs towards the
goal of universal access

12. Status of SRH BP Documentation,
Mapping and Sharing (2)
• The WHO Reproductive Health Library (RHL); conducts research on
strategies for implementation of evidence-based practice; with building
capacity, to facilitate informed decision-making based on generated
evidence base.
• While the RHL repository does not explicitly coin its outputs as ‘best
practices’, it presents a vital pool of information on SRH practices that
are evidenced to ‘work’, and can be a strategic link for sharing of SADC
Member State generated SRH best practices.
• The Special Programme of Research, Development and Research
Training in Human Reproduction (HRP) is the main instrument within the
UN (UNDP,UNFPA, WHO, World Bank) system responsible for
research in reproduction. In scaling-up antenatal care in southern Africa,
linked to HIV services and violence against women programmes, the
HRP is implementing an intervention (Malawi, Mozambique, and South
Africa) to improve maternal and newborn health (MDGs 4 and 5) and to
strengthen health systems through integration of related vertical
services with ANC packages based on the WHO Antenatal Care Model

13. Sample Profiles of SRH BPs:
analysed for criteria-building
Where there is a will there is a way: nursing and midwifery
champions in HIV/AIDS care in southern Africa
In 2003 UNAIDS and the Southern African Development Community (SADC)
AIDS Network of Nurses and Midwifes (SANNAM) documented a series of best
practice interventions[1] as part of the UNAIDS Best Practice Collection, covering
Botswana, Lesotho, Namibia, South Africa and Zambia.
Commonly underscoring these practices was the recognition that education and
specialist training in HIV is hugely empowering to nurses and midwives, and is
often the catalyst for taking personal action; networking and adding on to what
already exists makes better sense than creating new structures; communities
have ideas and skills that should be respected and harnessed; and programmers
should focus their efforts on transferring skills and building the capacity of the
family and community, rather than doing everything themselves.
Best practice criteria-related facets:
integrated training, drawing on technical expertise, skills transfer
for sustainability, community involvement and empowerment
[1] http://data.unaids.org/publications/IRC-pub02/jc900-midwives_nursing_en.pdf

14. From Inception to Large-scale: promoting adolescent SRH [1]
The Geração Biz ("busy generation") programme in Mozambique (with support from
UNFPA), has been credited with contributing to improved communications and
interactions among government institutions and sectors within the adolescent SRH
(ASRH) domain. The programme design has prompted continuous investment in
capacity-building, that expanded to integrate advocacy and management skills, which led
to increase in internal policies, strategic planning, and public policy development.
Its multi-sectoral approach beyond only improving health services, has engaged referrals
from adolescent centres, schools, and peer educators in the community, and resulted in
increase in ASRH access. Scaling up monitoring and coordinating systems within referral
structures has contributed to increased motivation of service providers and peers, and
enabling data generation that informs cost-effective implementation.
The intention for scale-up was part of the programme design from the start, and thus
accelerated implementation, and was complemented by producing tools and guidelines
for cascade use in new facilities of service provision. The programme design facilitates
that selected sites become modes for development new protocols of practice, and the
flexible nature of design allows for adaptation as per community trends and changes in
culture of needs for ASRH. Youth involvement, in particular young PLHIV, has resonated
with the programme design and roll-out, and been evident in increase in youth influencing
policy, providing types of SRH services/support, and community mobilization towards
SRH. Specific integration of VCT for HIV, HIV care and support, has proven to serve as a
strategic entry point for young men to come to youth friendly SRH facilities.
Best practice criteria-related facets:
strong surveillance systems, modeling for replication, flexibility, community
(target ) involvement, displays multi-sectoral approach, scale-up integration
[1]From Inception to Large-scale: The Geração Biz programme in Mozambique (Pathfinder, WHO, 2009)
http://whqlibdoc.who.int/publications/2009/9789241598347_eng.pdf

15. Existing Criteria for SRH Best
Practice Documentation
• Documentation criteria:
– SADC Framework for Developing and Sharing Best practices on
HIV and AIDS (2006): effectiveness, sustainability, cost-
effectiveness, relevance, innovativeness, replicability, and ethical
soundness
– WHO Guide for Documenting and Sharing “Best Practices” in Health
Programmes (2008)
– FHI/UNAIDS Best Practices: HIV/AIDS Prevention Collection (2001)
– SAfAIDS BP criteria for HIV, culture and gender programmes (2008)
– IPPF, UNFPA, WHO, UNAIDS, GNP+, ICW, Young Positives The
Rapid Assessment Tool for Sexual and Reproductive Health and
HIV Linkages (2009) offers a useful springboard to developing BP
criteria and relevant tools for documenting
– Family planning practices ABCDs can be considered ‘working’
criteria
– Client-provider interactions (CPI) offer 6 criteria

16. Existing Criteria for SRH Best
Practice Dissemination (sharing and
exchange)
• Dissemination criteria and platforms:
– Advance Africa/USAID Reproductive Health Best Practice
Compendium (online platform) submission form enables verification
– UNAIDS Best Practices collection (online)
– WHO programme to Map Best Reproductive Health Practices,
sharing evidence based clinical practices through annual electronic
journal and the Reproductive Health Library (RHL), as well as via
worldwide workshops to ensure health-care workers access
– WHO has proposed 3 major ways for health related BPs:
• African Regional Best Practice Series
• Africa Regional Office Website
• Distribution of CD-ROMs containing BPs during WHO Regional
Committee meetings, conferences, workshops to reach those with
limited internet access

17. Recommendations
• SRH policy and practice/service delivery - in response to challenges
identified, these areas should continue to be considered at national
and regional levels. And will inform decisions on areas to focus on
when generating best practice documents and sharing for cross-
learning
• SRH Best Practice Framework – proposed structure, criteria and
cycle of systematic steps to institutionalise

18. Policy and practice related (1)
• Adopt comprehensive integrated SRH programmes
versus vertical programmes. The diversion of resource-attention to HIV
had taken away some attention from SRH; there is indications of a shift
back to SRH and this repositioning needs persistent attention.
Establish integration-supporting mechanisms: optimize and
mobilize resources to implement SRH services reciprocally integrated
with HIV programmes. Invest in skilled personnel who can provide
quality integrated services including emergency obstetric care (EmOC)
services, STI management and family planning in communities
• Task-shifting in human resources , especially in response
to maternal survival, be explored to counter lack of availability and use
of quality skilled care during pregnancy, childbirth and the immediate
postnatal period, and in family planning[1] . Linked to this, build on the
growing debate on the use of Traditional Birth Attendants (TBAs) in rural
and hard to reach communities. Thus counter current weak human
resource development and management systems, and continuing brain
drain of skilled personnel within and outside the SADC region. Also
learn from Non-physicians clinicians (NCPs) programme.
[1] Task shifting is expanding the roles of family planning providers- Allowing lower-level providers to take on some of the responsibilities of higher-level providers could improve
services (FHI, 2009)

19. Policy and practice related (2)
• Leverage policy to accelerate the promotion of evidence-
driven SRH and programming based on operational research and the
scale-up of BP documentation and sharing, and commit resources to
practices proven to work effectively and sustainably
• Seek systematic technical assistance , to support
governments’ and national bodies’ capacity to provide leadership in
determining country priorities around: funding, coordination and
harmonization, and surveillance and M&E of implementation of SRH
programmes
• Community involvement in SRH has increased in many
countries, and structures and mechanisms need to be set-up to ensure
continued and scaled-up community participation, especially of
vulnerable groups such as women, adolescents and youth and PLHIV

20. Policy and practice related (3)
• Meet SRH needs of men adequately, and not in ‘pockets’,
by design interventions for enhanced participation in the provision
of SRH and family planning information and service
• Innovatively empower adolescents and youth so
they can overcome vulnerabilities to SRH ill-health, by ensuring that
adolescent sexual and reproductive health concerns are well
integrated into other interventions such as education, skills
development, gainful employment and participation in decision-
making, sports and culture; and programmes addressing adolescent
substance abuse
• Establish functional referral systems linking SRH
integrated services (primary health care with maternal, child and
neonatal health services) with services addressing poverty
alleviation and financial investment for women

21. Policy and practice related (4)
• Speak to unsafe abortions , in line with the MPoA, by
compiling and disseminating data on the magnitude and
consequences of unsafe abortions, enacting and disseminating
policies and laws to protect women and adolescents; and offering
guidelines and appropriate training to service providers in the
provision of comprehensive abortion care services
• Accelerate access and availability of, and
investment in, new prevention technology ,
especially female controlled modes such as female condoms
(commodity access), and microbicides, as well as medical male
circumcision, in view of STI/HIV response integration
• Invest in strengthening infrastructure , at national
level, to facilitate access to EmOC.

22. Policy and practice related (5)
• Address harmful socio-cultural beliefs
and practices valiantly, and integrate this approach
in existing SRH approaches that focus on increasing
male involvement, and addressing the low status of
women and compromised status of adolescents, and
unmarried young women.

23. Proposed Structure of SADC SRH
BP Framework (Guidelines)
• Introduction
• Purpose
• Definitions
• Essential Criteria
• Integration into Programming (including coordination and
management systems, costing, monitoring and tracking)
• Cycle of BP Documentation
• Dissemination Strategies
• Monitoring & Evaluation (M&E) and Reporting - Surveillance
(of documentation, uptake and progress)
• Resources and Tools
• References

24. Proposed Criteria
• Effectiveness (intervention design, community involvement,
M&E)
• Cost-effectiveness
• Sustainability (intervention sustainability, fiscal sustainability,
demand creation)
• Innovativeness (how unique is it!)
• Replicability
• Relevance
• Infrastructural competence
• Integrated (technical reliability, referral mechanisms)
• Ethical soundness (rights-based approach, intervention
transparency)
• Political backing evident

25. Cycle for Best Practice Documentation
Refer to page 23 in Document

26. Proposed Dissemination
• Strategies ( 1) SRH Best Practice Online
Establish a SADC
Portal, which is linked to other relevant regional, international and national
portals. Hosted by the SADC Secretariat, while coordination of national portals
would be done by relevant Ministry in Member States. Best practices would be
placed on the online platform, upon completion and endorsement, for easy
access by partners across the region and beyond. A tracking mechanism may
be integrated into the platform’s interface to enable monitoring access to the
BPs, offering a picture of which areas of SRH best practice are most frequently
accessed, and by geographical access. This platform can link to the IBP, RH
Compendium, WHO RHL, amongst other related online stages
• Collaborate with technical expertise , can be sought from
UN agencies, CS, private sector and other regional and national partners with
experience in documenting and sharing best practices, to share the
documented BPs via their meetings, conferences and workshops. Link
collaboration with mobilization resources towards best practices
• Host SRH Best Practice Sharing Forums , to enhance
cross-sharing between MS on experiences of BP documentation - could be held
back-to-back with annual SADC meetings, established within existing
institutional mandates.

27. Proposed Dissemination
• Strategies ( 2) Member States’ SRH Annual
Incorporate in SADC
Reports , allocate section in the SRH Annual Report mechanism of
reporting as it is adopted
• Integrate into Materials for Advocacy and
Programme scale-up , such as newsletters, policy briefs, position
papers, research briefs, programming briefs, CD ROMs and similar printed
materials, either generated by SADC Secretariat, Member States national SRH
information sharing materials, or existing material development programmes
(CS) for advocacy/programme
– policy briefs on a specific best practice to lobby donors and policy makers to mobilize
relevant resources towards a working approach as verified by the documented BP
– programming packages to inspire replication of working practices for frontline health
workers and managers, towards scale-up of effective interventions
• Infuse into Physical Sharing Platforms , such as
conferences, policy roundtables, research forums and workshops, where large
numbers of like-minded people are present, for discussion and to influence
adoption, as well ad decision-making as relevant. Sharing at thematic meetings
would enable enhanced understanding of specific area of SRH

28. Evidence-based Information…….
…… power to make a difference !!