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PFI as a Grant Making Agency_ Innovation and Impact in Family Planning Services |
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PFI as a Grant Making Agency
Innovation and Impact in Family Planning Services
Alok Vajpeyi,
Sona Sharma,
Chandni Tandon,
Population Foundation of India
An Innovative
Approach to
Grant Making Priorities
Grantmaking
PFI’s priority is on Re-positioning family The important areas would include
planning. This refers to advancing family evidence building, research, capacity
Significance/Background
planning in the national, state, and building, and advocacy with an underlying
Population Foundation of India (PFI) was
community agendas with enhanced theme of innovation.
established in 1970 by a group of socially
visibility, availability, and quality of The issues of right-based family planning
committed industrialists led by late Mr
family planning services for increased approaches and promoting quality care
JRDTata and Dr Bharat Ram.They wished
contraceptive use and healthy timing and would need to be considered.
to address the critical issue of population,
spacing of births, and ultimately, improved
health and sustainable development for
quality of life. The purpose of these Geographic Priorities
a better quality of life through increased
‘re-positioning’ efforts is to re-engage The following criteria have been used to
access to quality family planning
stakeholders at all levels so that they; determine the geographical focus states in
services and information. PFI’s long-
(1) ensure that adequate resources are India for working towards PFI’s goals:
term goal is to reposition family planning
available for FP; (2) take action to minimize (i)The need for programs in these
within the women’s empowerment and
FP barriers; and (3) act as visible champions
thematic areas as indicated by trend
human rights framework for national
for FP. This has been a neglected area
indicators.
development and Maternal and Child
and would be the priority for future grant (ii)Th e potential for progam
Health policies and programmes in India.
making. This would also be the priority for
implementation as indicated by the
PFI has a long history of giving grants
the institutional grant-making.
presence of quality institutions/NGOs.
to civil society organizations and other
PFI’s strategic plan over the next (iii)The efficiency in managing the
institutions. Over the last 40 years, PFI has
five years will address three drivers of
program.
funded over 350 projects and continues
population growth – namely, unmet need
to make grants focusing around PFI’s
for family planning; high desired fertility; PFI focuses its grant-making on national
priority areas. The focus of grant making
and population momentum and attempt as well as grants within the Empowered
has been to support innovations in
to shift (‘re-position’) the discourse Action Group (EAG) states, especially
family planning, reproductive and
from ‘population control’ to ‘population Bihar, Uttar Pradesh, Madhya Pradesh and
adolescent health programmes meeting
stabilization.’
Jharkhand where the indicators related
PFI’s programme priorities.
PFI plans to focus on re-positioning to socio-economic status, population and
family planning within a reproductive family planning are poor. Also crucial,
Programme Intervention
health and human rights framework so are districts with poor RCH and sex ratio
PFI gives grants to small organizations
that every family is a planned family and indicators. Grantmaking is focused on
which are implementing innovative
every child is a wanted, healthy child. PFI reaching the most marginalized, hard
project interventions in family
advocates working closely with the Central to reach, poor youth, women, men and
planning, reproductive and adolescent
Government, as well as State Governments, communities.
health programmes meeting PFI’s
and partner with civil society organizations
six thematic priorities (delaying age
and other stakeholders. Also important Types of grants
at marriage, delaying age at first
would be sustained advocacy initiatives PFI would fund organizations a) directly for
pregnancy, promoting spacing between
with parliamentarians, locally elected implementation, policy, research related
births, improving quality of care of
representatives, religious leaders, the activities; b) fund alliances, networks or
family planning and reproductive
media (both print and audio visual), health coalitions; c) fund linked organizations
health programmes, preventing sex
workers, NGOs, and local communities. to cover a larger geographic area or
selection and promoting non-coercive
Another key aspect would be building organizations of different specialities
programmes, policies and strategies).
evidence and research on the key focus for example, implementation, research,
The projects supported aim to reach
areas, expanding the basket of choices and advocacy, media etc. PFI can function
the most marginalized, vulnerable and
repositioning family planning into MCH as a donor and a times function in a
underserved communities in eight
policies and national development and partnership mode.
Empowered Action Group states in
programs at the state and at the national
India, where the demographic and
level. It will also include policy and program What does PFI Support
socio-economic indicators are poor.The
reviews to identify gaps and strategies to ● A lliances, Networks and Coalitions on
focus is on innovation with a scalability
bridge them. Advocacy at the state level will Relevant Themes/Issues.
plan from the beginning. PFI works in
the field with local NGOs, academic
Case Studies I
also be informed by efforts at the district ● Link Organizations that cover large
level; where-in convergence with existing geographical areas or have different
and research institutions and corporate
partners. Typically, the projects include
Karuna Trust, Bangalore, Karnataka
in Karnataka – is implemented brings together the civil Impact
government programs will be encouraged. specialties.
a strong component of community
Repositioning Family Planning at Primary Health society, the government and the community to achieve the The Karuna Trust PPP model for managing PHCs has seen
mobilisation and are linked to the
Centres in Karnataka through Public Private project objectives.
spectacular success over the past few years.
government service delivery system.
Partnership (PPP)
● T he objective is to provide round the clock health services, ● As per the Sample Registration System (SRS 2008), the
Persons from the local community get
In view of poor public service provision in many low/ maintain and manage the primary health centre and its Infant Mortality Rate (IMR) for India in 2008 was 53 per
trained in outreach, behaviour change
middle income countries, a strong move to partner with the sub-centres.
1000 live births overall, 58 in the rural areas and 36 in
communication, counselling on basic
private sector is often advocated as a simple and obvious ● All patients are provided free diagnostic and curative urban areas. Karuna Trust took over the management of
health and family planning methods.
solution. Public Private Partnership entails participation and services, including drugs.
the Gumballi PHC in 1996 when the IMR recorded for the
partnership of the Government (Public) with the Not for ● The government (Both Centre and State) provides the population served by this PHC was high as 75 per 1000 live
Profit/Voluntary Organizations or For Profit Organizations guidelines and materials required for the project, financial births. KarunaTrust medical staff and management practice
where the partners strive towards a common goal.
support towards salaries of the PHC staff and for PHC enabled it to dramatically reduce the IMR for the Gumballi
maintenance.
PHC to under 30 in 2008. Gumballi’s IMR now compares
Background
● P FI is the Funding Partner for the Repositioning Family favourably with the IMR for urban India.
PFI provides support to the KarunaTrust to strengthen seven Planning at Primary Health Centers in Karnataka through ● T he same year in 2008-09, the Karuna Trust managed
government Primary Health Centres (PHCs) in six backward Public Private Partnership and also monitors the progress Sugganhalli PHC which has a stellar record in institutional
districts of Karnataka, to make them model centres. The of the project.
deliveries and ensured that almost all births in the
project also focuses on repositioning family planning in 14 ● Additional health services like eye care, dental care, mental community were institutional deliveries.
Primary Healthcare Centres in Karnataka.
health and family planning services have been integrated ● Gumballi is the first PHC in South India to get accredited
The project reaches over 300,000 beneficiaries and aims into the primary health care in the PHCs managed by with National Accreditation Board for Hospitals and
to empower men and women to lead healthy lives by being Karuna Trust.
Healthcare Providers.
able to regulate their own fertility through family planning ● T he focus is on improving the quality of Reproductive ● Infant Mortality Rate (IMR) is often used to signify the status
services at the village level.
and Child Health and Primary Health Care programmes of healthcare facility. According to SRS bulletin December
through accreditation, continuous review and monitoring 2011, IMR of Karnataka rural is 43. In KarunaTrust catchment
Highlights
mechanisms.Karuna Trust has partnered with the Institute areas the IMR is as low as 11, a significant achievement.
● The PPP model, through which the current project – of Health Management and Research (IHMR), Bangalore to ● PHCs run by the Karuna Trust in partnership with PFI show
Repositioning Family Planning at Primary Health Centres enable quality accreditation.
zero stock outs of contraceptives.
Methodology
PFI’s grant making is managed by
a dedicated programme team. This
involves review of project proposal from
grant-seeking NGOs by a project review
Case Studies II
committee consisting of PFI staff members
and external domain experts. PFI helps
Centre for North East Studies and Policy (CNES) ● Enable Behaviour Change through a need-based ● Currently married women receiving follow up services after
NGOs to develop the project, identify
Mobilizing the Unreached: Using Behaviour Change comprehensive communication package.
accepting certain family planning methods has jumped
objectives and establish an effective M&E
Communication and Ensuring Quality Family Planning ● B uildsustainablecapacitiesininterpersonalcommunication from 9% at baseline to 68%.
system. The project has to be approved
Services through Boat Clinics in Assam
including counselling skills, in delivering quality family ● 4 2% project women in experimental districts received at
by PFI’s Governing Board. PFI supports
The Centre for North East Studies and Policy (C-NES), Assam planning services and in effective documentation.
least three ante natal care (ANC) as against 10% reported
the NGO partners through building staff
has been providing basic health care to the vulnerable ● Improve availability of and accessibility to modern under the baseline.
capacity, regular review and feedback
communities living on the islands, or saporis, of the contraceptives for eligible couples including services ● Children with full immunization rose from 20% at baseline
on performance and strengthening
Brahmaputra river in Assam. The project aims to ensure for IUD insertion, injectables and establishing effective to 50% at end line.
advocacy and communication activities
improvement in the Family Planning/RCH status of the island linkages/referrals.
under the project.
communities.
● Document learnings, processes and best practices for The Results Show:
In 2009, PFI partnered with C-NES to introduce and support scaling-up.
● A dding a Family Planning Counselor to the boat clinic is an
Programme Implications/Lessons
a family planning component in the existing boat clinics
effective strategy.
Experience has shown that there is a
need to leverage resources by working
Propor*on
of
popula*on
covered
under
in five districts of Assam - Dibrugarh, Tinsukia, Dhemaji, Impact
● Enabling partnerships ensure sustainable and
Sonitpur and North Lakhimpur.
● The proportion of currently married women aware of any responsible solution to public health needs. Partnerships
in partnership with NGOs and the
family planning method had increased from 50% at the are successful when there are clear demarcations of
different
interven*ons
2011
to
2013
Distribu/on
of
grants
by
thema/cD
foiscturisb
1u9.9o6n
t
oof
grants
by
thema.c
focus
2011
to
government to encourage innovative
approaches. There is lack of evidence of
Objectives
baseline to 75%. The increase justifies the usefulness of responsibility and equity in decision-making. Thus
● Increase awareness on reproductive health and family appointing family planning counselors.
C-NES with enabling support from PFI and the National
successful family planning approaches
as these have not been evaluated. In
2010
2013
planning issues among eligible couples (women in the age ● The proportion of women currently using any family Rural Health Mission was able to transform challenges
group 15–49 years and their husbands).
planning method increased from 47% at baseline to 59%. into opportunities.
order to help NGOs and the government
scale
need
up
to
sbuecciensdsefuplenadpepnrotlaycheevsa,luthaetesFdeP
Health
IMR
Migra/on
Popula/on
Stabiliza/on
PRI
RCH
FP
RCH
CSR
and the evidences documented and
Distribution of Grants by Thematic Focus
Distribution of Grants by Thematic Focus
RCH
FP
CSR
Proportion of Population Covered Under
Key focus areas for the institutional ● Research and Documentation
grant making
♦ Primary Research
shared widely. There is also need for
1996 to 2010
2011 to 2013
Different Interventions 2011 to 2013
PFI’s long-term goal is to re-position family ♦ Secondary Research
constant capacity building of partners in
planning within women’s empowerment ♦ Policy Research
effectively planning and implementing
and human rights framework in India’s ♦ Action Research
the projects along with advocacy to
bring about the intended changes.
13%
development and MCH policies and ♦ Media/Communication Research
programs – both at the national, state and ♦ Documentation of Best Practices
PFI realises that for its grant making to
effectively address the issue of improving
access and quality of family planning
services, it needs to closely monitor
35%
13%
26%
district levels. Interventions would need to
focus on family planning as it relates to the
drivers of change and reach out to young
people, particularly girls and women.
♦ Systematic Review
● Program Implementation and Provision
of Health Care and Related Services.
● Scaling Up of Pilot Interventions/Models.
the field reality as well as remain open
49%
Applicant organisations could partner ● A dvocacy and Communication Strategy
to periodic reviews of its objectives,
processes and achievements to meet the
52%
with diverse stakeholders to create and Development and Implementation.
promote a favorable policy, program, and ♦ Workshops, consultations, seminars,
field’s changing requirements. Keeping
social environment by concentrating on 5 round tables etc.
this in mind, PFI has kept pace with the
key focus areas:
♦ Documentaries, films, spots, audio-
times, always relevant to the lives of the
people.This understanding and flexibility
74%
22%
(i) delaying age at marriage;
(ii) delaying age at first pregnancy;
visual aids, etc.
♦ IEC, BCC materials, tool kits, strategies,
has led to PFI making a significant impact
through funding successful innovations
5%
4%
3%
(iii) promoting spacing between births;
etc.
(iv) improving quality of care of family ♦ Campaigns, public hearings etc.
aimed at improving access to family
planning services.
1%
3%
FP Health IMR Migration
RCH
FP
CSR
planning and RH programs; and
(v) prevention of sex selection.
● Capacity Building and Institutional
Development.
Population Stabilization PRI RCH
FP
RCH
CSR
Total Population covered by core grants: 1859605
Legal Interventions Improve the Life of the Homeless
The partnership between Socio Legal
Information Centre (SLIC) over the past
one year has focused on: Initiating legal
interventions, undertaking fact-findings
to support legal interventions, connecting
important stakeholders to bring about
better access to ante- and neo-natal health
care, availability of sexual health education,
the implementation of the Pre Conception
Pre-Natal Diagnostic Techniques and Child
Marriage Acts, the proper functioning of
nutrition and shelter schemes for pregnant
women in urban areas, and access to safe
birth control methods.
Priya Kale is a 25-year-old homeless
woman living in Delhi with her husband,
Dharma Kale, and her two children, Sunni,
who is five, and Appi, who is two. Priya
and her family lived in a Delhi public park
with other families until January 2011, when
the Delhi Government evicted everyone
living there. Priya was in her last trimester
of pregnancy with Appi when paramilitary
Home Guards chased and badly beat
her while overseeing the eviction. As a
consequence, Priya went into premature
labour, delivering Appi in the park with only
her mother-in-law’s assistance. Priya was
forced to deliver Appi in public and in broad
daylight, without medical care or dignity.
The Delhi Commission of Human Rights
found the Government of Delhi guilty of
violating Priya’s rights to life and health. The
Government was ordered to compensate
Priya Rs 1,00,000 for her suffering. In the
aftermath of Priya’s case, the Government
established Motia Khan Shelter to house the
families that had been evicted from the park.
Priya’s compensation cheque was not
issued to her until December 2012, by
which time she had given birth to her third
child, a daughter named Prithi. During her
pregnancy, Priya had only one antenatal
checkup, provided by a NGO, and received
no government benefits under any of India’s
maternal health schemes. Priya went into
labour on November 25, 2012 at Motia
Priya Kale and her son,
Appi, at Motia Khan
Khan and, again, only had her mother-in-
law’s assistance.
After Prithi’s birth, Priya attempted to
access her court-ordered compensation.The
cheque was issued to “Priya,” not “Priya Kale”
and when she tried to deposit the cheque, her
bank rejected it due to the discrepancy. For
weeks, Priya took Prithi with her as she tried
to get the government or the bank to cash her
compensation cheque. Every evening, Priya
and Prithi returned to Motia Khan, which
did not provide its residents with heating
or bedding. Moreover, it did not provide its
residents with access to nutritional or health
services, and the building with its broken
windows and lack of heaters or geysers,
offered its residents little protection from the
cold. On January 5, 2013, Prithi died, likely of
malnourishment and exposure. On January
14, Priya’s bank finally agreed to deposit the
cheque and issued her Rs 50,000 cash.
Motia Khan is a 24/7 family homeless
shelter opened in 2011 housing over 296
permanent residents in five rooms. It has
an additional room that is used exclusively
by single men as a temporary night shelter.
The shelter remains unfit for habitation and
affords its residents little privacy or security.
Due to Motia Khan’s lack of security, women
are especially vulnerable to attacks from both
temporary and permanent male residents.
Several cases of sexual assault have been
reported. Motia Khan’s family rooms have
neither curtains nor walls offering the
A family room at Motia Khan
showing the resident’s lack of
privacy and cramped and dirty
living conditions
families no privacy or protection.
Programme Intervention
In January 2013, following Prithi’s untimely
death, Priya Kale and SLIC’s Reproductive
Rights Initiative initiated legal proceedings
against the Government of Delhi. On
February 1, 2013 the Delhi High Court
heard opening arguments in Priya Kale
vs. Government of NCT Delhi and Ors.1
The case is concerned with the terrible
conditions at Delhi government homeless
shelters, particularly for pregnant and
lactating women.The petition argues for the
proper functioning of nutrition and shelter
schemes for pregnant and lactating women
and children living in urban shelters.
Outcome
In February 2013, the Delhi High Court
ordered the Delhi Government to provide
Motia Khan’s residents with three meals
per day, maternal health care services,
and heaters and geysers.2 After the order’s
issuance, SLIC activists visited Motia Khan
and found that the Government had failed to
comply with the Court’s interim orders. SLIC
subsequently filed a contempt petition.3
At the contempt petition hearing, the
Court again directed the Government to
comply with the interim orders. Although
subsequent visits to Motia Khan revealed
1 W.P.(C)641 of 2013.
2 Interim orders issued in Priya Kale vs. Government
of NCT of Delhi and Ors., dated 01.02.2013.
3 Priya Kale vs. Deepak Spolia and Ors., Cont. Cas.
(C)197 of 2013.
that the Government provided Motia Khan
residents with geysers and heaters and
arranged for a mobile medical van to visit
the shelter, it found that the Government
was still not providing Motia Khan’s
residents with three meals a day.
On March 16. 2013, the Government
began providing Motia Khan’s residents
with three meals per day. Simultaneously,
the Government filed a Motion to Vacate
the Court’s interim order to provide Motia
Khan’s residents with three meals per
day arguing that it was unduly onerous.
After hearing the motion, the High Court
dismissed it.
Programme Implication
SLIC’s legal intervention has meant a
positive and necessary change for Motia
Khan’s residents. The intervention has also
signalled future fact-findings and petitions
in other Indian urban centres.
SLIC has learned several important
lessons from its intervention:
● the value of interim orders; their ability to
make positive, sweeping changes, even if
only for a predetermined time.
● the importance of community involvement
in a petition’s success. Such cases
create the biggest change when there is
commitment both from the community
and the advocates and social activists.
● P riya’s case highlights that no issue exists
in isolation. Motia Khan’s residents’
problems involved several human rights
violations including, but not limited to,
the right to life, health, shelter, and food.