RHSC Strategy (25/35)

Publication date: 2024

1 COVER 21 ACKNOWLEDGEMENTS Over the past year (June 2023 to June 2024), many individuals, almost all from RHSC member organizations, contributed their time, ideas, and perspectives toward developing Strategy (25/35). This largely occurred by serving as key informants who participated in one of the 86 open-ended interviews and/or by being one of 289 individuals who responded to an online members survey. In addition, a number of regularly scheduled RHSC meetings provided venues to discuss and react to preliminary findings relevant to the future strategy. These meetings included several sessions with both the RHSC Executive Committee and the RHSC Secretariat, as well as two interactions with the VAN Steering Committee. In addition, a plenary session at the recent General Membership Meeting in Accra elicited and gathered input from some 200 members in attendance. Garnering insights and reflections from these various sources shaped formulation of RHSC’s strategy for the next decade. Special appreciation is extended to the Strategy Redesign Advisory Group. Convened during three multiday sessions specifically for the purpose of designing/developing Strategy (25/35), Advisory Group members gave much time and energy toward shaping what RHSC aims to accomplish in the next decade. The resulting strategy owes much to these advisors. Their inputs and insights produced substantive as well as structural breakthroughs for the strategy subsequently produced. A small team of external consultants was engaged to collect, organize, and analyze a vast amount of information in preparation for and resulting in an initial draft strategy. For their inspired, painstaking participation throughout this strategy development journey, RHSC expresses enormous gratitude to Kate Rademacher, Don Lauro, Funmilola OlaOlorun, and Gillian Martin Mehers. Finally, appreciation to all those who engaged with the formulation of RHSC Strategy (25/35) will be best shown by how well it is now implemented. OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 STRATEGIC OBJECTIVES, PATHWAYS, AND OUTCOMES . . . . . .5 LEVERS OF CHANGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 PRINCIPLES AND PRINCIPAL COMMITMENTS . . . . . . . . . . . . . . . 17 TRANSFORMATIONAL LEADERSHIP . . . . . . . . . . . . . . . . . . . . . . . 18 MEASURING PROGRESS ON STRATEGY (25/35) IMPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 ABBREVIATIONS ESG environmental, social, and governance LMIC low- and middle-income country LNG-IUS levonorgestrel-releasing intrauterine system NGO nongovernmental organization OOP out of pocket R&D research and development RH reproductive health RHSC Reproductive Health Supplies Coalition SSA sub-Saharan Africa STI sexually transmitted infection VAN Global Family Planning Visibility and Analytics Network WHO World Health Organization OVERVIEW 1 RHSC uses the phrase “low-resource setting” instead of “low- and middle-income country (LMIC)” when describing the geographies in which it works. In the strategy development process, RHSC members expressed a concern that the term “LMIC” obscures both commonalities and important differences across country contexts; they also questioned the phrase “LMIC” both in terms of its utility and its implications in perpetuating inequity to sexual and reproductive health access. A Renewed RHSC Strategy Founded in 2004, the Reproductive Health Supplies Coalition (RHSC or the Coalition) currently comprises 560 member organizations. It is the largest worldwide membership organization advancing expanded access to reproductive health (RH) supplies, with particular attention to low-resource settings.1 In 2023–2024, the Coalition completed an ambitious redesign of its operational strategy for the coming decade. The process relied on an independent contextual analysis of the RH ecosystem and significant input from Coalition members and the RHSC Executive Committee. The resulting ten-year strategy details how RHSC will achieve its vision, mission, and strategic objectives. The new strategy is: Evidence driven and member led at the global, regional, national, and subnational levels. Grounded in what has worked well—levers of change and operating principles. Responsive to current needs, challenges, and opportunities, including the elevation of equity and an emphasis on collaborative interconnectivity and transformational leadership to engage all members. Informed by continuous tracking of outcomes that capture changes that RHSC expects to have contributed to in ten-years’ time. Clear on how RHSC will operate toward achieving its aims, address emerging issues, and ensure a vibrant, effective collective effort to achieve the priorities presented here. Our Vision All people have equitable access to a broad choice of safe, effective, affordable supplies needed to ensure their sexual and reproductive health throughout their lives. Our Mission RHSC increases equitable access to a full range of safe, effective, affordable supplies that meet the sexual and reproductive health needs and desires of individuals living in low-resource settings by harnessing the Coalition’s unique combination of expertise, ingenuity, and collective action of its members and partners. While many in the RH community share depictions of a future similar to that of RHSC’s vision, its mission statement expresses what RHSC is uniquely positioned to accomplish. Similarly, the four strategic objectives (Availability, Affordability, Quality, and Choice) described below are widely shared across the RH community. However, the outcomes and pathways (see strategy map on page 7-8) delineate the special niche that RHSC occupies toward achieving these strategic objectives. 43 65 STRATEGIC OBJECTIVES, PATHWAYS, AND OUTCOMES Four strategic objectives–Availability, Affordability, Quality, and Choice—anchor the RHSC Strategy (25/35). Each serves as a guidepost to reach a shared vision. The strategic objectives broadly articulate what is needed to achieve RHSC’s vision and mission. Each objective defines a sphere where members collectively and collaboratively apply their knowledge, expertise, and energy toward capturing RHSC’s expected contributions over the next ten years. However, the aspirations encompassed within each objective are shared with many others active in RH and vastly exceed what the Coalition could ever undertake on its own. 2 See page 16 for an elaboration of RHSC’s levers of change, the unique attributes that RHSC brings to bear to deliver results. The levers of change are neutrality, brain trust, convening power, brokering partnerships, flexible resource base, and respected name. Specific RHSC contributions are provided by delineating each strategic objective into pathways. The pathways are at the core of the strategy. These pathways define areas of work that are within RHSC’s mandate interest and comparative advantage. They single out those actions by which RHSC, as a coalition, can offer meaningful and attributable impact. However, these pathways do not reflect all that is required to achieve the objectives. They are necessary but not necessarily comprehensive. Furthermore, specific pathways toward reaching an objective are not mutually exclusive; connecting pathways within and across objectives may yield synergistic advances. Finally, RHSC’s contributions toward achieving these objectives occur by applying its levers of change, the unique approaches and attributes RHSC has systematically used over the years to deliver success.2 What is consequently within RHSC’s manageable interest and comparative advantage are further specified through the outcomes under each pathway. By further delineating and illuminating the pathways, these outcomes specify a future state in the RH ecosystem that RHSC and its members, engaging with one another, expect to achieve. The outcomes emerged out of the strategy redesign process. They capture RHSC’s contributions to the most important change areas for the Coalition and its members to focus on and effectively address in the next decade. These change areas include: transforming markets through improved data visibility and use; mobilizing global and domestic funds for RH supplies; bolstering manufacturing capacity in low-resource settings; driving price reductions in RH supplies; increasing the supply and demand for safe and effective products; advancing country and regional ownership of supply chains; and championing gender equality. Lastly, the outcomes show this community’s recognition that no single institution or sector can ever meet the supply challenges alone. They also reflect this community’s conviction of the utility of a global coalition with 20 years’ experience cultivating transformational partnerships in service of a common vision—ensuring that every person can choose, access, and use high-quality supplies at every stage of their reproductive lives. The strategy map figure on pages 7-8 presents a comprehensive overview of this new construct. RHSC’s contributions to each objective are then described and delineated in detail in the sections that follow. The text boxes included in these subsequent sections illustrate how RHSC has in the past and will in the future achieve selected outcomes as contributions toward reaching particular strategic objectives. Each objective defines a sphere where members collectively and collaboratively apply their knowledge, expertise, and energy toward capturing RHSC’s expected contributions over the next ten years . All people have equitable access to a broad choice of safe, effective, affordable supplies needed to ensure their sexual and reproductive health throughout their lives. 7 PA TH W A YS ST R A TE GI C O B JE CT IV ES O U TC O M ES AVAILABILITY RH products are widely and readily available throughout the market, from manufacturers to point-of-access provision. 1.1 Make supply chains resilient to safeguard RH for all people 1.2 Facilitate more reliable access to the full range of existing RH products 1.1.1 Global and country actors use quality and timely RH data to make supply chain and financial decisions 1.1.2 RH market actors adopt climate- friendly supply chain actions 1.1.3 Young supply chain managers, have increased access to educational opportunities that raise their profile and skill base 1.2.1 RH supplies manufacturers enter markets to reduce countries’ vulnerability to crises 1.2.2 More governments finance and procure RH supplies in demand level quantities 1.2.3 Donors and governments use diversified financing approaches to expand RH product availability across points of access AFFORDABILITY People have increased access to their preferred RH supplies, unimpeded by cost barriers. 2.1 Remove cost barriers that hinder availability, effective use, and choice 2.2 Promote coordinated action on financing for RH supplies procurement 2.1.1 Governments access more favorable procurement terms for RH products through use of joint supply planning and/or pooled procurement 2.1.2 Governments, market actors, identify appropriate price points for RH products using willingness to pay and OOP expenditures data 2.1.3 Governments adopt policies to reduce upstream cost drivers for RH products 2.2.1 Institutional financing and donor agencies design global financing mechanisms to support sustainable markets 2.2.2 Governments integrate RH supplies costs into universal health care coverage policies 2.2.3 Private-sector companies finance RH activities in return for ESG credits QUALITY People obtain safe and effective RH supplies that meet high-quality standards. 3.1 Improve the regulatory environment for safe and effective RH products 3.2 Increase the recognition for safe and effective RH products 3.1.1 Regulatory mechanisms reduce expenses and timelines for achieving registration 3.2.1 Community- wide consensus exists around the technical definition of quality for RH product types 3.2.2 Consumers recognize and demand safe and effective RH product CHOICE People choose from a broad range of RH supplies options that fit their preferences. 4.1 Facilitate coordinated new product innovation, procurement, entry, and program operationalization of RH supplies options not yet available in markets 4.1.1 Market actors coordinate investment in the full research and development pipeline for RH products 4.1.2 Market actors coordinate the efficient procurement and introduction of new RH products in local markets 4.1.3 Governments, with implementing partners, coordinate the introduction and scale-up of new RH products 8 ST R A TE GY M A P V I S I O N 109 To have a full range of RH supplies widely and readily available in low-resource settings, RHSC brings added value to achieve the following: • Increased supply chain visibility to enable market actors to address the barriers that hinder product flow. • Strengthened supply chains to withstand climate- related shocks and other disruptions. • Expanded opportunities to raise the skill base of supply chain managers. • A healthier and more diversified supplier base for RH supplies in sub-Saharan Africa. • Adequate domestic, including private-sector, international, and out of pocket (OOP) financial resources for RH products across points of access. To achieve results in these areas, RHSC will pursue two pathways: (1) Make supply chains resilient to safeguard access to RH supplies by leveraging data, technology, and human resources; and (2) facilitate more reliable access to the full range of existing RH products. 1. Make supply chains resilient to safeguard RH for all people RHSC is uniquely positioned to strengthen both access and use of data responsive to the RH community’s needs and augment market actors’ decision-making capacity. Governments, procurers, social marketing organizations, manufacturers, and shippers all require accurate and timely data to make effective decisions, estimate needs for supplies production and distribution, and make a strong advocacy case for public and private investment. RHSC will address the often insufficient or incorrect data that compromise production; create funding gaps, stockouts, and expirations; and ultimately deny products to providers and people. This will be accomplished by the Coalition’s ability to leverage advances in technology and data production and visibility. Ensuring the availability of RH supplies also requires more resilient supply chains able to withstand 3 In 2019, RHSC launched the VAN, a one-of-a-kind collaborative supply chain management platform that enables more than 130 member organizations, including 36 governments in low-resource settings, to track more than 10,000 shipments of 83 products across 159 countries in real time. Empowered with reliable data, members work together to arrange product transfers, drive new procurement, and rush deliveries when needed. climate-related shocks and other disruptions. Resilience hinges on access to technology and timely and accurate data. Understanding where supply chain adaptations may be necessary to support equitable access, especially for populations most impacted by environmental or humanitarian crises, is critical. Also, by leveraging people and data within the Global Family Planning Visibility and Analytics Network (VAN),3 the Coalition can promote “greener” products and supply chains. Supply chain management forms an essential component of a country’s health system. In a world with a growing demand for RH supplies, a well- trained human resource base is an essential building block of this ecosystem. Also needed is support for the entry and professional growth of women within what continues to be a largely male-dominated field of expertise. The Coalition commits to cultivating tomorrow’s supply chain managers by encouraging young people in low-resource settings, and women in particular, to pursue careers in supply chain management. Critical to providing such opportunities is the identification of educational opportunities, provision of financial assistance, and community-wide conversations to illuminate women’s contribution to the field of RH supply chains. 2. Facilitate more reliable access to the full range of existing RH products Recent years have seen new commitments to address the lack of RH supplies manufacturing in sub-Saharan Africa (SSA) and to diversify the supplier base for RH supplies. Such a healthy and diverse supplier base is vital, both to prevent prolonged supply disruptions and to promote resilient and equitable supply chains. Regional manufacturing, in certain circumstances, has the potential to both shift greater ownership of supply chains to countries and regions, and to strengthen supply chain resilience against shocks. While there are many challenges to establishing and growing regional manufacturing to scale for high- quality RH products, achieving economic viability is especially critical. Regional manufacturers must be able to generate sustainable profits, attract a sufficient base of buyers, and compete with experienced and high-volume international manufacturers producing high-quality products. However, limited data exist to support the business case for market entry and guide manufacturers to enter new country markets. To promote equitable access to health supplies in the coming decades, RHSC can increase understanding of the economic viability of regional RH supplies manufacturing and support regional manufacturers where sound business opportunities exist. This includes, for example, efforts that aim to: • Build the knowledge base on how to strengthen the enabling environment for supply chain regionalization (e.g., with countries placing more of their purchase orders or managing more of their supply chain operations). • Align donors, implementing partners, and global and regional entities on RH priorities; advocate for the inclusion of RH supplies in strategic discussions and policy frameworks promoting locally driven production in the SSA region. • Together with regional actors and institutions in SSA, provide manufacturers with up-to-date information on harmonization efforts, policy reforms, and pathways to overcome barriers to market entry and participation. RHSC is critically positioned to help ensure adequate financial resources for RH supplies. The resources needed to finance RH supplies derive from three sources: domestic resources (including the private sector), international donors, and consumers. The distribution of this funding varies significantly across RH commodity areas. For example, family planning products are largely funded by international donors and end users, while maternal health commodities are typically funded by domestic governments. Menstrual health products are almost fully funded by consumers. Addressing this inequity will involve, for example, increased visibility into country-level financing flows. In turn, this would inform country stewardship of RH supplies financing, enabling more governments to finance and procure RH supplies in demand-level quantities. RHSC members, specifically country-level advocates and decision-makers, are well-positioned to collaboratively address commodity financing gaps by leveraging RHSC-hosted data platforms and connections with RHSC members and partners. Such contributions are oriented toward country-level and regional-level decision-making and ownership of RH supplies financing. This leverages RHSC’s role as a neutral entity, aggregator of data, and convener of a diverse array of stakeholders. A full range of RH supplies is widely and readily available throughout markets, from manufacturers to point-of-access provision Global and country actors use quality and timely RH data to make supply chain and financial decisions Since its inception, RHSC has expanded access to high-quality, standardized market data, significantly improving procurement, financial, and production decisions. Over the past two decades, RHSC has launched nearly every major diagnostic tool and data analysis group in the RH supplies space—from RH Interchange in 2004 to the VAN in 2017. By providing a trusted, neutral forum for aligning RH data standards and governance, RHSC has delivered essential leadership, coordination, and stewardship. RHSC-hosted tools, including the VAN, continue to promise progress toward this goal. OUTCOME 1 .1 .1 RH supplies manufacturers enter markets to reduce countries’ and regions’ vulnerability to crises COVID-19 revealed long-standing deficiencies and disconnects between where commodities are produced and where they are consumed. Global and regional entities (e.g., Global Financing Facility and African Medicines Agency) are bringing needed attention to address this issue. RHSC’s Manufacturers Group is the only entity that brings together manufacturers across RH products. This brain trust—in combination with RHSC’s convening power, neutrality, and trusted name—will be deployed to ensure that RH products are included within finding and forging solutions. OUTCOME 1 .2 .1 AVAILABILITY STRATEGIC OBJECTIVE 1 https://www.rhsupplies.org/gfpvan/ 1211 The Coalition has a demonstrated ability to negotiate lower prices, support volume guarantees, and promote innovative financing options to increase prospects for more affordable RH products. It aims for all people to have increased access to their preferred RH products, unimpeded by cost barriers. Achieving this rests on two pathways to which RHSC brings value: (1) removing the cost barriers that hinder availability and choice; and (2) supporting more coordinated action around financing for RH commodities procurement. 1. Remove cost barriers that hinder availability, effective use, and choice RHSC is well positioned to support collaboration among governments, NGOs (including local civil society organizations), and commercial sectors to address cost barriers to RH supplies access. Strategies to lower OOP expenditures on RH products for underserved and lower-income groups will involve supporting research to identify appropriate price points for RH products. This will include end-user feedback on OOP expenditures and willingness-to-pay thresholds. RHSC-hosted collaborative data platforms and tools, together with regional partnerships, also position the Coalition to support efforts by governments and their partners to test joint supply planning and/or pooled procurement mechanisms. Leveraging these improves purchasing power, provides the ability to negotiate lower prices for products, and reduces OOP expenditures for end users. The Coalition has a long history with data analytics and data visibility, thereby generating new business intelligence and delivering market analyses to inform decision-making with a view to the total market. However, a lack of visibility into private-sector data and other key market data remains a barrier to country governments’ efforts to transform markets in a way that benefits all participants. Drawing on the strength of RHSC as a brain trust, as well as inroads that the VAN has made within several countries to strengthen contraceptive supply management, the Coalition is able to mobilize local members to advocate with their governments to adopt policies to reduce upstream cost drivers of RH products. These include taxes, levies, and/or other fees. The aim is to lower costs for wholesalers and distributors—and ultimately reduce out-of-pocket expenditures for end users. 2. Promote coordinated action on financing for RH supplies procurement among global players, the private sector, and governments RHSC is well placed to facilitate more coordinated action on financing for RH procurement among global and country decision-makers. Yet there are ongoing challenges: The current donor-dependent resource base for RH supplies is insufficient to meet global demand, and financing mechanisms are complex, fragmented, and frequently opaque. RHSC’s multifaceted inroads to donors, governments, and manufacturers enable efforts to address critical funding gaps and ensure that global investments supplement and incentivize domestic resource mobilization efforts. RHSC will use its global and local connections to prioritize and support the needs and stewardship of country decision-makers. Hence, ensuring that there is adequate financing for RH supplies depends upon increased synergy among donors, governments, and in-country expertise and experience. RHSC would support bringing this about by applying its convening power and neutrality to reinforce adoption of more diversified and innovative financing strategies, including those that leverage the private sector to sustain investments in RH supplies. RHSC can also increase country decision-makers’ data visibility into the country-level financing flows. Doing so would help expand the resource base for RH supplies, ensuring that these supplies are not only available but also affordable. Working through its network, as has already been initiated in a number of countries where the VAN is operational, the Coalition can also support country-led advocacy to address national financing gaps and, where relevant, include RH supplies costs in their plans for universal health care policies. RHSC will also continue to foster public- private partnerships to lower OOP expenditures on RH products. Similar RHSC initiatives have been successful in Latin America and could be adopted in other regions seeking to overcome cost barriers that limit access to the RH products people need. To unlock new financing for RH commodity security, RHSC can play a unique role in creating opportunities for the private sector to invest in RH programming in exchange for environmental, social, and governance (ESG) credits. Institutional financing and donor agencies design global financing mechanisms to support sustainable markets RHSC provides a neutral convening platform for a diverse set of RH supplies financiers to collectively problem-solve around the current tensions that limit effective financing across RH products. The Coalition’s proven history in catalyzing resource mobilization for RH supplies, ability to broker difficult conversations, and strength in generating market and financial data for decision-making are conducive to playing this important catalytic role. The Coalition has a demonstrated ability to negotiate lower prices, support volume guarantees, and promote innovative financing options to increase prospects for more affordable RH products. OUTCOME 2 .2 .1 People have increased access to their preferred RH supplies, unimpeded by cost barriersAFFORDABILITY STRATEGIC OBJECTIVE 2 1413 Good sexual and reproductive health depends on people’s ability to obtain safe and effective RH supplies that meet high-quality standards. The Coalition positively contributes to this reality by ensuring that high-quality RH supplies are available in country markets; improving the recognition of safe and effective RH products; and supporting efforts to streamline the efficiency of regulatory procedures at global, regional, and country levels. In the coming decade, RHSC’s work under Quality will build on this work to: • Improve the regulatory environment for high-quality supplies. • Ensure that people are able to trust in the quality of the RH products they buy or use. 1. Improve the regulatory environment for safe and effective RH products While it is not within the Coalition’s manageable to directly support manufacturers to navigate product registration and introduction, RHSC is adept in engaging with regulatory mechanisms, donors, implementing partners, and other regional actors to improve the regulatory environment for manufacturers. In this fragmented and complex RH market and regulatory environment, manufacturers are faced with navigating market entry, product registration, and scale-up in each country, with little harmonization or standardization of requirements across settings. Together with an already limited business case to support entry into new country markets, many manufacturers of high-quality RH products are deterred from greater expansion or entry into low-resource settings. Even prior to COVID-19, the business case was becoming increasingly unsound for RH manufacturers to achieve sustainable levels of country-level market engagement. RHSC will focus on regional harmonization as a pathway for reducing expenses and timelines for achieving registration. Efforts already underway in West Africa toward improving family planning procurements provide experiences to build upon. Through participation in regional forums and discussions with regional actors, RHSC can provide suppliers within its Manufacturers Group with up- to-date information on progress at regional levels, policy reforms, and pathways to overcome barriers to market entry and participation. It can also ensure that RH products and the interests of manufacturers are being considered within significant emergent and related initiatives taking shape, such as those involving the African Medicines Agency, which coordinates the harmonization of medicine regulation across Africa. Lastly, the Coalition can encourage supply chain players and regulators to leverage digital transformation work underway across health areas (e.g., vaccines, malaria, and HIV) to support regional efforts to track RH product movement and product quality. Ultimately, much of the work under this sub-domain aims to ensure that the number of manufacturers of high-quality RH products in national markets increases over the next decade. Community-wide consensus exists around the technical definition of quality for RH product types RHSC is well positioned to help the RH community align around technical definitions of quality. In 2017, RHSC helped forge consensus around the issue of quality oxytocin. Under the umbrella of the Maternal Health Supplies Caucus, technical consultations brought together scientists, researchers, manufacturers, and health experts to formulate simple, concise messaging around quality oxytocin. Moving forward, RHSC will continue to galvanize efforts to raise the profile of and access to safe and effective RH products. OUTCOME 3 .2 .1 2. Increase the recognition for safe and effective RH products The RH supplies community does not have a shared common definition of quality. The Coalition’s neutrality offers a safe space where these diverging views can come together and forge a way forward. As an example, some donors and other RH actors require approval by a stringent regulatory authority or WHO prequalification for products—but governments, social marketing organizations, pharmacies, and other procurers regularly procure RH supplies that do not meet these specific quality-assurance standards. Additional coordination and dialogue are very much needed to better align the community around definitions of quality for RH product types. Discussions and a few initiatives are already underway to refine the definition of quality with regard to maternal health products. With more and more countries doing their own procurements for previously donated commodities, arriving at consensus on quality-assurance definitions has become especially important. Ensuring the quality of all RH supplies also depends on making sure that procurers and product users recognize and demand safe and effective RH products and reflect these preferences in transmitting purchase requirements upward along the supply chain. Working with and through its members on the ground, the Coalition can encourage end users, program managers, and policymakers to demand high-quality products by framing quality as a health concern and a solid business decision. The RH supplies community does not have a shared common definition of quality. The Coalition’s neutrality offers a safe space where these diverging views can come together and forge a way forward. People obtain safe and effective RH supplies that meet high-quality standardsQUALITY STRATEGIC OBJECTIVE 3 1615 Within reproductive health, choice typically means that people are able to choose from a range of RH supplies options that accord with their needs and preferences. RHSC, however, purposively focuses choice on meeting a more precise need: expanded access to new products not yet available in a country’s market. Within the Coalition, choice focuses on more coordinated investment in new product research, product development pipelines, and improved coordination around new product procurement, introduction, and scale-up. This distinguishes Choice from the Availability objective, which more broadly promotes reliable access to the full range of existing RH products, including downstream supply chain disruptions that limit access to already-introduced products. From the user’s perspective, both Choice and Availability may remedy access to a range of supplies options. 1. Facilitate coordinated new product innovation, procurement, entry, and program operationalization of RH supplies options not yet available in markets Inadequate or stagnated funding for research and development (R&D) may impede at critical junctures innovation, sufficient suppliers, and product diversity. This may lead in turn to insufficient access to a broad choice of affordable and high-quality RH products in country markets. RHSC is well placed to promote more coordinated, fluid, and targeted R&D investments for RH commodities. For example, mapping the R&D pipeline for RH products on the horizon would illuminate the state of funding for R&D and increase understanding of what this means for the future of RH supplies access. The Coalition can also offer actionable insights to bolster advocacy for more coordinated investment in the full R&D pipeline for RH products. As products near market readiness, the Coalition can also support product introduction and market development efforts. By leveraging its New and Underused Reproductive Health Technologies Caucus and other members, RHSC can disseminate learnings from new product introduction and scale-up, including lessons learned and linkages across regions or country contexts, to support successful product launches. Once new products are registered and on Essential Medicines Lists, RHSC can work with its members and partners to help channel funding to support governments and their partners to coordinate the introduction and scale-up of new RH products. Such efforts are already underway with the Coalition’s Maternal Health Supplies Caucus, which through small grants is increasing access to new and lesser-used medicines for preventing and treating postpartum hemorrhage. LEVERS OF CHANGE RHSC’s strategy converges on two key building blocks: strategic objectives and levers of change. Strategic objectives constitute the main supports—Availability, Affordability, Quality, and Choice—which are central to achieving the Coalition’s vision and mission. The levers of change define the attributes that RHSC, as a coalition, can bring to bear to produce results. Together, these two elements yield a strategy that is comprehensive, within RHSC’s manageable interest, and time-tested. Market actors coordinate the efficient procurement and introduction of new RH products in local markets With support from an RHSC Innovation Fund grant in 2015, FHI 360 conducted market research on the potential for introduction of a levonorgestrel-releasing intrauterine system (LNG-IUS) into the Kenyan market. This paved the way for Kenya, among others, to add LNG- IUS to its method mix. FHI 360 partnered with Medicines360 and Marie Stopes International to develop an introduction strategy to roll out LNG-IUS, including agreed-upon price ceiling guidelines for LNG-IUS in both the private and public sectors. To ready new products for country-level acceptance and use, RHSC will continue to support members to conduct market research and develop implementation strategies. OUTCOME 4 .1 .2 NEUTRALITY RHSC’s neutrality offers a safe space where individuals from many backgrounds can leave their institutional hats at the door. Members and partners are invited to address sensitive issues, think outside the box, and respect differences of opinion, while remaining focused on common objectives. BRAIN TRUST RHSC’s large and diverse membership brings together the best and the brightest from across many sectors and specializations. Through its implementing mechanisms, this brain trust reflects its intellectual capital, incubates new ideas, and supports innovative, cutting-edge solutions. It also intentionally incorporates the experience and hardship of end users in low- resource settings. CONVENING POWER Through the diverse network of its members and partners, the Coalition is able to rapidly assemble a critical mass of stakeholders and champions, leveraging their comparative strengths, forging a common course of action, and achieving results no single partner could accomplish alone. BROKERING PARTNERSHIPS RHSC has a proven track record of brokering partnerships across sectors and regions. In doing so, the Coalition puts to strategic use its neutrality and convening power. By tapping the connectivity of its members, the work is based on trust and a common purpose. FLEXIBLE RESOURCE BASE The Coalition’s diverse core funding base makes it possible to pursue necessary activities that, for many reasons, may fall outside the remit of a single donor or organization. This flexibility, in addition to the strong volunteerism and in-kind support from its members and partners, makes it possible to act quickly, pursue evidence- based solutions that are custom- designed to address problems and bottlenecks, and respond to the diverse needs and priorities of the global membership. RESPECTED NAME Though small compared to many other global health networks, RHSC’s respected brand, the commitment of its members, and the global visibility of its platform give credibility and weight to its continued work as a global, member-based coalition. People are able to choose from a broad range of RH supplies options that fit their preferences CHOICE STRATEGIC OBJECTIVE 4 1817 Add value to the activities of member organizations and associated partners. Avoiding duplication of work by members and partners is accomplished by concentrating on outcomes that no single entity could otherwise achieve on its own. RHSC does not compete with members for funding. Rather it seeks to leverage comparative strengths and funding sources, especially those amplifying the power and decision-making of members and partners located in the Global South. Prioritize country and regional leadership while also leveraging RHSC’s role as a global coalition. “Country leadership” means prioritizing country- defined needs, supporting country-driven strategies to address those needs, and leveraging the support of the global community on behalf of country-generated agendas. In addition, forging connections across a range of settings, including at regional and global levels, supports collective action to address market- and systems-based barriers that impede underserved populations having equitable access to RH supplies. Sexual and reproductive health and rights are fundamental to ensuring equitable access to, and use of, RH supplies. All individuals have the right to access and use RH supplies without fear of discrimination, coercion, or violence. Recognizing that individuals’ preferences and needs change over time and vary by the individual user, all people, including gender-diverse individuals, have the right to make their own decisions and choices about what options to use or not to use. Access to RH supplies is necessary but not sufficient to achieve better sexual and reproductive health. To ensure the availability and affordability of a broad range of high-quality RH supplies, other significant contributions are necessary. These include strengthened service delivery, greater awareness and demand creation, and conducive policy environments. As a result, the Coalition advocates for health systems strengthening and inclusion of a full range of RH supplies as part of universal health care. Prioritize work to advance gender equality. Powerful social and cultural realities define identities and ability to access and use a range of RH supplies. These include laws, policies, and politics, as well as cultural, community, and family norms. In support of transforming social norms around gender and ending all forms of gender- based discrimination, RHSC promotes a person- centered, responsive approach to ensuring that quality, affordable RH supplies get to where they need to be in a way that is both equitable and sustainable. Through its work, RHSC ensures that end users have the RH supplies they need to manage their RH; supports the entry of more women into supply chain roles; and breaks down the stigmas and taboos that often characterize conversations on RH. Trust has the power to drive collective action across diverse actors and in diverse settings. Experience shows that building trust is key to creating effective, multi-sectoral partnerships. Within RHSC, trust is facilitated by sharing information, articulating mutual goals, and applying the Coalition’s levers of change to mobilize diverse groups to work collaboratively to achieve meaningful change across sectors. The Coalition abides by and adheres to the following: PRINCIPLES AND PRINCIPAL COMMITMENTS FACILITATIVE Participatory decision-making creates safe spaces for all voices, especially those most distant and disenfranchised, while also providing clear pathways for efficient decision-making and collective action. This approach emphasizes listening, empowerment, and collaboration among diverse groups. TRANSFORMATIONAL LEADERSHIP largely codifies and makes explicit several approaches already embedded in how RHSC operates. Specific components especially applicable to RHSC as it launches this redesigned strategy are the following: ADAPTIVE RHSC recognizes the need for responsive, flexible solutions to respond effectively within a fast- changing, complex, and volatile environment. By investing in improved systems and processes, RHSC promotes a culture of continuous learning based on high-quality data. The Coalition learns from its successes and failures, experiments and innovates, and adapts its tactics to respond to a rapidly evolving landscape. TRANSFORMATIONAL LEADERSHIP Revitalizing RHSC’s approach to leadership has been a complementary component within developing Strategy (25/35). Alternating between “leading from behind” and “leading from the fore” throughout its first 20 years, this strategy redesign led to adopting Transformational Leadership to more fully delineate the pathway forward. This sector-changing approach will galvanize member participation throughout the Coalition. As one example, the review of RHSC’s implementing mechanisms, already well underway, began by first looking at where members are located, what they may need, and how they expect to gain from participating in the Coalition. As a membership organization, RHSC’s approach centers on the needs and priorities of its members. It is the members who work together to identify problems, define shared goals, and implement coordinated action plans to achieve lasting impact. For RHSC, Transformational Leadership is an intentional, collaborative approach to engage individuals and organizations across diverse sectors and settings to advance a shared agenda through collective action. RHSC’s vision is the point of departure. The four strategic objectives and associated pathways provide substantive detail within which members will organize for collective, collaborative discussion, activities, and action. By applying existing evidence and emerging data, RHSC uses its unique levers of change to achieve progress toward outcomes as described in the strategy map (see page 7). 2019 MEASURING PROGRESS ON STRATEGY (25/35) IMPLEMENTATION The approach for measuring progress on strategy implementation is guided by the intersection of two conceptual frameworks: one aspirational (Strategy 25–35) and the other operational (RHSC program of action). 4 BetterEvaluation: www.betterevaluation.org/methods-approaches/approaches/outcome-mapping. RHSC embarks on its next ten-year strategy within the context of an initial program of action that coincides with a four-year funding cycle. Set to launch in 2025, RHSC’s initial program of action comprises four-year indicators that map to the outcomes in the strategy map shown on page 7, enabling the Coalition to generate the data needed to assess progress along the four strategic objectives—Availability, Affordability, Quality, and Choice—and their respective pathways. The outcomes in the strategy map crystallize what RHSC members, engaging with one another, expect to deliver in ten years’ time. To advance toward such outcomes, the Coalition works with and through its members, applying RHSC’s unique levers of change, to take on transformations across the four strategic areas it sees as foundational to the achievement of RH commodity security. RHSC is adding outcome mapping to the suite of monitoring and evaluation approaches it applies to capture results. Outcome mapping is “a methodology for planning, monitoring, and evaluating development initiatives in order to bring about sustainable social change.”4 As such, this approach is particularly well suited for organizations that aim to positively change large, complex systems, where multiple changes often happen concurrently and where success may not be readily attributable to one single organization or one set of inputs. Outcome mapping recognizes that multiple, nonlinear events lead to change. It looks at the logical link between interventions and outcomes and identifies when, where, and how contributions, often by multiple organizations as well as through other concomitant factors, have occurred. RHSC’s adoption of outcome mapping will help institutionalize the learning process and support open exchange among members, especially those who engage in RHSC’s implementing mechanisms. It will enable members to review, discuss, and reflect on progress, and subsequently incorporate findings into work plans. It will also allow for the identification of opportunities and emerging priorities in the RH supplies landscape. Lastly, the responsibility for measuring progress on Strategy (25/35) implementation lies at all levels of the Coalition’s structure, from the Secretariat to the implementing mechanisms. The Secretariat will report annually to the Coalition’s Executive Committee and membership, and, together with them, identify critical lessons, decide on course corrections, and plan new paths forward. POWER-SHARING RHSC supports locally led development. It is committed to addressing the historic power imbalances causing underrepresentation and exclusion of marginalized groups facing barriers to accessing and using safe, effective, and affordable RH supplies. As a coalition, RHSC can assess who holds power in decision-making, how problems are defined, and how funding is allocated. It is also well positioned to interrogate power systems. SELF-REFLECTIVE The Coalition works together to test assumptions and promote learning exchanges between regions and public- and private-sector actors. Advocacy is grounded in evidence, and it facilitates ongoing research, analysis, and knowledge-sharing among diverse stakeholder groups. BOLD Through its rich and diverse brain trust, RHSC finds unique, creative solutions for expanding equitable access to RH supplies in low-resource settings. RHSC creates a safe space for diverse individuals and organizations to collaborate. It leverages collective strengths to overcome persistent barriers to RH supplies access. The Coalition works with and through its members, applying RHSC’s unique levers of change, to take on transformations across the four strategic areas. VISIONARY RHSC recognizes the need to be proactive and visionary to move the RH supplies agenda forward to help create a more equitable world for future generations. To maximize reach and impact, the Coalition builds and strengthens effective, cross-cutting collaborations within and beyond the RH supplies ecosystem. ACCOUNTABLE As a global coalition, RHSC is accountable to the millions of individuals around the world who need and want safe, affordable, and effective RH supplies but may be underserved or marginalized due to inequitable systems. RHSC is accountable to its member organizations and partners who make the work possible. RHSC appreciates the many contributions of its members and partners, and takes time to celebrate their successes and amplify their results.

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