Over a period of five years (1995 - 1999), in 10 urban areas within Guinea, Mozambique, Senegal, Zambia, and Zimbabwe, the Urban Initiative of the Family Planning Service Expansion and Technical Support Project (SEATS) assisted municipalities to implement projects and activities aimed at increasing the ability of municipal leaders to meet the growing demand for accessible, high-quality family planning and reproductive health services. While each country portfolio was unique, common elements included: data-driven planning; coordination of public and private-sector inputs; partnership with municipal officials; advocacy from all sectors, and different levels within sectors, to form coalitions to promote reproductive health; and “South-to-South” dissemination. The Urban Initiative developed innovative tools and replicable models for urban programming. The Best Practices Model and the Quick Study Model, each adapted to more than one urban context, proved to be flexible and effective approaches for obtaining improvements in access, quality, and sustainability. Each model produced increased support for reproductive health programs by municipal officials, greater knowledge and use of reproductive health data, and improved access to quality services. Results of the Urban Initiative included services to more than 81,000 new contraceptive users, 221,104 couple years of protection (CYP), and training for 1,702 service providers. SEATS’ partners leveraged at least $400,000 against SEATS’ funds from USAID.
As decentralization and democratization gain footholds in urban centers throughout Africa, the role of municipal officials in both planning and resource allocation for social services is growing. The Urban Initiative fostered partnerships with city health departments and elected officials and their staff. In some cases private and nonprofit groups were key players, and in other cases new coalitions of non-health and health authorities created new options for the future. The Urban Initiative processes also supported fledgling civil society institutions and reinforced the drive to improve community participation in the public decision-making process.
Decentralization and democratization are gaining footholds in urban centers throughout Africa. SEATS’ lessons learned from The lessons learned from these projects and activities provide insight into how to improve access to sustainable, quality reproductive health services in urban Africa and other regions. Some of the key lessons from SEATS’ Urban Initiative include:
ª Municipal governments--city health departments and mayors--can increase the efficiency and effectiveness of family planning service delivery programs.
ª Municipal officials can--at least partially--manage the impact of increasing urbanization on access to and quality of reproductive health services, but they cannot do it alone.
ª Key to maximizing access in urban areas are two strategies:
1) identify and mobilize underutilized existing resources; and
2) be creative in using new, even unconventional ones.
ª Urban decision makers are often unaware of research findings that could be used to better plan and allocate resources for expanded access.
ª Urban areas have more untapped resources available to support reproductive health programs than is commonly believed.
ª Women in leadership positions can play a key role in advocacy and expanding services, especially in cities where reproductive health issues are sensitive.
ª The high diplomatic cost of publicly exposing serious problems with quality of care needs to be weighed against the potential catalytic power this information holds.