An estimated $8 billion is needed annually to provide appropriate contraceptive services to all women in the developing world. But money is only half of the equation. Sound policies and effective programs must be in place to make sure the money is well spent—that is, spent efficiently, on sound interventions informed by the best and latest evidence.
Focusing on how organizations spend funds requires understanding how resource allocation decisions and policy choices play out on the ground at the country level. For a U.S.-based foundation with limited staff capacity and no physical presence in the developing world, this is no easy feat.
A few years ago, the Hewlett Foundation realized that supporting national or sub-national advocacy within the Global South required a new grant-making strategy and partners. The foundation worked with the Tides Foundation to launch the Money Well Spent initiative in 2009. The initiative was intended to support advocacy and policy-related activities to solve specific problems that hinder the efficiency and effectiveness of spending in the family planning and reproductive health sector.
From the 151 initial letters-of-interest received, Hewlett selected six projects for funding in August 2009. The projects shared a focus on sub-Saharan Africa, but represented a wide diversity of scale, context, and approach. Three of these projects inform this essay: Pathfinder International’s Tanzania office’s work to encourage districts to fund family planning and reproductive health services; Gender Action’s advocacy to eliminate user fees based on evidence of their impact on women’s access to services in Cameroon and Uganda; and Ipas’s projects in Malawi and Nigeria to demonstrate the cost savings associated with shifting from treating complications of unsafe abortion to providing safe abortion care. These three best illustrate the issues we wish to explore here: the relationships between a US-based funder, international non-governmental organizations (INGO) intermediaries, and local NGOs, and the use of locally generated evidence in support of advocacy.
Work plans are not holy writ.
A savvy advocate knows that success requires constant adjustment. But savvy advocates need room to maneuver. Hewlett’s flexibility and learning focus gave grantees “permission” to move quickly to take advantage of opportunities and adapt to changing contexts. Hewlett chose the Aspen Planning and Evaluation Program as an evaluation partner because of its focus on helping clients adapt and learn. Ongoing developmental evaluation—an assessment that evolves along with the project evaluated—can help organizations determine when a shift in tactics may be necessary and present their analysis to funders for approval. Funders’ own understanding of the context, gathered for example through site visits, can make them more willing to approve or even recommend changes in work plans.
Learning may be the primary objective of a developmental evaluation, but accountability remains essential. The funder’s flexibility alleviates but does not eliminate the tension between the two.
For country-level advocacy, local knowledge is critical.
Effective in-country advocacy requires a certain level of analytical capacity, the ability to identify what organizations need to do or improve, and the judgment to determine who needs to hear that evidence—from which spokespeople—to influence positive change. Few organizations have all those capacities.
Recognizing that success in advocacy is rarely, if ever, the result of a single organization or individual, the Hewlett Foundation encouraged grantees to collaborate with other advocacy partners—especially those thoroughly familiar with the local political and cultural context. Successful advocacy requires understanding the relative strengths of each partner and how best to use those strengths.
Locally generated evidence, and local contacts and credibility were central to the advocacy strategy. For example, Ipas’ headquarters in North Carolina could identify credible research protocols and oversee rigorous cost analysis research in Malawi and Nigeria, but local allies were better positioned to transform data into politically appropriate arguments. Gender Action also relied on credible local partners for its data collection and advocacy work in Cameroon and Uganda.
If a project is going to invest in gathering evidence, some on-the-ground work to prepare for dissemination of that evidence can be a smart tactic. Facts—however compelling—are rarely enough to sway decision-makers. Getting buy-in from decision-makers early on about research and advocacy plans can help advocates gain better access to critical information, identify “insider” champions who can open doors, and find more receptive audiences for their eventual research results and advocacy messages.
Here, too, local knowledge is critical. Pathfinder’s local office in Tanzania, for example, met on and off the record with health officials and others to identify influential allies.
“Think globally, act locally”—but how local?
We have praised the role of local knowledge and expertise. But how do we define “local”?
In the examples highlighted here, Ipas, Pathfinder International, and Gender Action defined the problem they needed to address, and set (or at least planned) the initial advocacy agenda through their successful proposals to Hewlett. These INGOs sought out local partners to help fill the evidence gap and place the advocacy strategy in the proper local context. Such international organizations are a congenial match for most funders, of course: They are attuned to international funding opportunities and accustomed to international norms of proposal writing and project design, assessment, and reporting.
How can we balance or shift the power dynamic more toward local institutions, given the typical current mode of support? Building up the capacity of organizations can help, but the process is labor- and time-intensive; funders need to be willing to stay in it for the long haul.
Even this limited sample set of projects suggests that long-term policy change efforts require local advocacy knowledge. A flexible approach to grantmaking and evaluation can help. Funders need to invest in capacity to ensure that local organizations can set their advocacy agenda, identify advocacy opportunities, develop advocacy strategies, and secure support to implement these advocacy plans.