DECENTRALIZATION IN ACTION

Decentralization is a watchword in Senegal. It is a guiding philosophy for the government and a driving goal in development. Empowering local actors to set their own agendas—deciding what needs to be done and how—ensures that priorities are aligned with real needs on the ground.

Senegal’s approach to family planning is encapsulated by “the 3 Ds”: democratize, demedicalize and decentralize. This framework was developed by Senegal in the context of the Ouagadougou Partnership and has been adopted by other countries in the region as well. It ensures that family planning interventions are participatory, unencumbered by policy barriers and effectively managed at the regional, district and community levels.

So when Senegal decided to develop a new national family planning strategy, decentralization was built in from the start. It was understood, of course, that high-level policy would be set at the national level, and that the Ministry of Health would assume responsibility for coordination across all the regions of the country. But it was also expected that each region, and each district within each region, would develop its own implementation plan. With the technical assistance of FHI360, working through the Advancing Partners and Communities Project, that is exactly what happened.

The National Family Planning Action Plan 2012-2015 was launched by the Ministry of Health in November 2012. From December 2012 to April 2013, regions and districts throughout the country held meetings to decide how to implement the policies outlined in the new national plan. Each district established its own goals and benchmarks for expanding contraceptive access, improving service delivery, and raising awareness. A data measurement template was developed so that districts could track and report their progress as they implemented their plans.

In November 2013, the districts and regions began a second round of meetings, this time to evaluate their progress. The data from the measurement templates showed where the plans were succeeding, where they were falling short and where there were gaps. At the regional meetings, district representatives compared notes and talked through resource issues. The whole process became a rolling collaboration, with everyone sharing ideas and lessons learned.

In the Saint-Louis region, for example, representatives from the Pété district described their great success with TutoratPlus, an on-the-job training program for health providers. TutoratPlus is offered through IntraHealth with funding by USAID, and is designed to improve provider skills on a range of contraceptive methods. One of the nurses in Pété who received the IUD training went from performing only three IUD insertions per year to performing 12 per month. When the other districts in Saint-Louis learned of this, they decided they should implement the program as well. The result: IUD insertion rates are now up throughout the region.

The district and regional meetings also led to much-needed funding realignments. The Kédougou region, for example, initially had few development partners and very little funding for reproductive health. But the region came up with a compelling, detailed implementation plan for the new family planning initiative, showing clearly what activities were needed. That enabled the Ministry of Health to work with partners such as WHO, Agence Française de Développement (AFD) and the Muskoka Initiative to redirect funds toward Kédougou’s new goals.