Sparking change through the Innovation Fund: Successes and lessons learned for reproductive health supplies

Publication date: 2011

Sparking change through the Innovation Fund: Successes and lessons learned for reproductive health supplies ii | Sparking change through the Innovation Fund: successes and lessons learned for reproductive health supplies Reproductive Health Supplies Coalition Coalition Secretariat Rue Marie-Thérèse 21 1000 Brussels Belgium + Copyright © 2011, the Reproductive Health Supplies Coalition. All rights reserved. The material in this document may be freely used for educational or noncommercial purposes, provided that the material is accompanied by an acknowledgment line. Photo on page 2 © EPA/ImageGlobe. Photo on the inside back cover © 2005 Ericka L. Moerkerken, Courtesy of Photoshare. Executive summary | 1 e x e c u t i v e s u m m a r y Since its creation in 2008 through a grant from the Bill & Melinda Gates Foundation, the Innovation Fund of the Reproductive Health Supplies Coalition has provided seed money for a range of promising ideas to help ensure people can choose, access, and use affordable, high-quality reproductive health supplies. The Innovation Fund’s first two years of grants have helped launch a number of important new strategies and contributed to advancing this crucial development issue, though it is too early to measure the fund’s full impact. Beyond the scope of the grants, the Innovation Fund has created additional benefits by strengthening collaboration among Coalition members, intensifying cross-sector partnerships at the local and global levels, generating new knowledge, and improving access to information and training. The projects supported by Innovation Fund grants include: • Initiatives to increase contraceptive prevalence in Honduras and Madagascar by encouraging greater public- and private-sector collaboration, and a separate project that highlighted the need for quality-assured reproductive health supplies in developing markets. • Projects to improve access to and awareness of training opportunities for logistics and supply chain managers and to identify and disseminate best practices in supply chain management, increasing access to family planning services and products. • An analysis of business practices by manufacturers of reproductive health supplies, and an assessment of challenges faced by agencies delivering reproductive health supplies in three African countries in the midst of instability and crisis. • Efforts to build awareness of reproductive health supplies issues, including an advocacy campaign coinciding with the 2010 G8 summit, the translation of Coalition materials into French, and the creation of an award-winning advocacy film that puts a human face on the issue of reproductive health supplies in sub-Saharan Africa. New funding will be required to replenish the Innovation Fund and to continue crucial work in the area of reproductive health commodity security. The Coalition intends to seek new investments in the fund to build on these initial successes. 2 | Sparking change through the Innovation Fund: successes and lessons learned for reproductive health supplies Reproductive health supplies matter in emergency settings. Introduction | 3 i n t r o d u c t i o n Every minute, 190 women worldwide face unintended pregnancies, 650 people contract a sexually transmitted infection including HIV, and 1 woman dies in childbirth, according to the United Nations Population Fund (UNFPA). The resulting health, social, and economic burdens profoundly affect women, their families, and their communities. Reproductive health supplies such as condoms, birth control pills, and essential medicines are fundamental building blocks in the effort to improve global health. Yet more than 215 million women globally still lack access to any means of modern contraception, a number that has remained constant for decades. Reproductive health commodity security is a crucial development issue. The Reproductive Health Supplies Coalition is an international, voluntary partnership of more than 130 diverse organizations working to ensure that all people in low- and middle-income countries can choose, access, and use affordable, high-quality reproductive health supplies. The Coalition’s Working Groups have committed themselves to addressing this issue in three vital areas: market development approaches, systems strengthening, and resource mobilization and awareness. The Innovation Fund provides much-needed funding for this pressing issue. The fund was created in 2008 through a generous grant from the Bill & Melinda Gates Foundation to support innovative projects developed by the Working Groups and their members. Since then, the fund has provide approximately US$1.7 million to 15 projects (ten of which are represented in this report as they were well underway with implementation at the time of writing). To gauge the impact of the fund’s grants in 2009 and 2010, Coalition staff surveyed more than 80 stakeholders and conducted more than 30 in-depth interviews to identify success stories, lessons learned, and opportunities for improvement. An impressive pattern of innovation emerged, although the ultimate impact of the Innovation Fund will only become clear in future years as many projects are still ongoing. What is innovation? “What is innovation?” was a question that arose in many of the interviews conducted for this report. The Coalition defines innovation broadly as a promising novel idea or process with the potential to bring about positive change. This does not mean that innovation needs to be a complete departure from previous practice. Instead, it can be limited to a new approach within a segment of an existing process expected to have far-reaching consequences. Innovation also can apply to systems or processes. Sometimes, a proposal in itself may not be considered innovative, but its impact is expected to change how issues are addressed. Innovation, therefore, can extend to generating knowledge, increasing access to information, or training and developing the people and tools necessary to foster change. The Coalition also supports the idea that implementing an existing strategy in a new context for the first time can be innovative, shedding light on how to replicate new approaches at the country level as well as opportunities for scale-up. (The Millennium Development Goals) “can only be achieved if innovation and capacity development to generate, review, and implement appropriate interventions are enforced.” Dr. Gladys Norley Ashitey, Deputy Minister of Health, Accra, Ghana “No other donor would have funded a similar activity because of the political turmoil at the time, despite it being urgent and very relevant. The Innovation Fund provided the necessary funding at an opportune moment.” Soumitro Ghosh, Marie Stopes International 4 | Sparking change through the Innovation Fund: successes and lessons learned for reproductive health supplies What difference has the fund made? The Innovation Fund enables member organizations of the Coalition’s three Working Groups to explore new ideas and strategies to enhance reproductive health commodity security. The fund’s unique focus, design, implementation process, and leadership structure firmly connect the Working Groups as opportunities arise to support the strategic objectives of the Coalition. The Coalition has great confidence in the expertise and innovative capacity of the Working Groups to pinpoint promising approaches, develop relevant activities, and advance its goals and vision. The fund’s impact is not limited to the successes of the specific projects undertaken by Working Group members. The themes outlined below illustrate how the value of the Innovation Fund’s work often exceeds the scope of the individual project and therefore creates additional institutional value. Creating global collaborative networks. Collaboration within and between the Working Groups can overcome challenges that are too difficult or complex for one organization or sector to navigate alone. The fund makes it possible to leverage and capitalize on complementary strengths and expertise and promote transparency and stronger ties, particularly at the country level. Of the ten Innovation Fund activities reviewed, seven drew heavily on multiple Coalition partners in development and implementation. Building local partnerships. Broad-based partnerships can leverage resources and strengths, enhance processes, and increase understanding. Several projects relied on comprehensive stakeholder networks to ensure that strategies reflected local circumstances and maximized the comparative advantage of different sectors, including those not typically involved in reproductive health supplies issues. Country ownership and leadership in reproductive health issues are vital, and government is thus a key player to ensure both legitimacy and continuity. Improving access to information. Asking the right questions lies at the heart of problem- solving. The Working Groups provide a safe backdrop for challenges to be identified, ideas to take shape, and new approaches to develop. For some problems, the solutions may be known but not adequately accessible or in use. In other cases, new solutions are found and conclusions broadly disseminated. Many projects have yielded new insights that have in turn jump-started reflection and inspired further action. Increasing awareness. Raising the profile of reproductive health supply issues is important to inspire action among key constituencies. Raising awareness ranges from rallying the support of the Working Groups to securing political support. Important new findings based on Innovation Fund projects have been taken up by experts, enhancing the credibility of Coalition members and their activities. Supporting sustainability. The fact that many activities supported by the Innovation Fund have continued beyond program completion is a testament to the value of investing seed money in promising ideas. Eight of ten projects evaluated have either continued or are expected to continue beyond the initial grant period. Many projects have been replicated or integrated within organizations. In addition, more than 40 percent of projects have leveraged new funding to expand or follow up on project activities. The rest of this report spotlights the innovations under way and proposes next steps for the future of the fund. “The fund gave us a fantastic opportunity to shine a spotlight on the supplies issue in emergencies.” Louise Lee-Jones, Marie Stopes International Innovation Fund projects | 5 i n n o v at i o n f u n d p r o j e c t s This section takes an in-depth look at the first ten projects supported by the Innovation Fund across the Coalition’s three Working Groups: Market Development Approaches, Systems Strengthening, and Resource Mobilization and Awareness. m a r k e t d e v e l o p m e n t a p p r o a c h e s Providing quality-assured reproductive health supplies Reproductive health supplies must be both affordable and safe for people to use. There is a need for a global competitive mechanism that can ensure stable supplies and affordable prices of hormonal contraceptives that meet international quality-assurance standards. This project clearly defined the issue and its relevance for developing markets, influencing the international agenda and raising the awareness and interest of key donors. The issue was included on the broader Coalition agenda, with a global four-year strategy currently being finalized. Funding discussions with major donors look promising. At the country level, the project has increased the potential for dialogue among a wider range of stakeholders involved in procurement, from ministries of health to procurers and manufacturers. The work also highlighted a critical liability issue related to contraceptive procurement without assurances of product quality, and it revealed the need for urgent attention to the issue of certification of active pharmaceutical ingredients (API). The World Health Organization (WHO) has now launched a general prequalification process for API that has, in turn, led to fierce lobbying to include reproductive health supplies on the list. Lastly, the project showed great potential to impact a variety of products beyond hormonal contraceptives. The strategy currently under development builds on the work to include maternal health products, including oxytocin, misoprostol, and magnesium sulfate, and will involve all three Coalition Working Groups. award: us$198,000 to the concept foundation This project established a roster of prequalified hormonal contraceptive manufacturers with good manufacturing practices and the capacity and data to acquire market authorization. The project raised understanding and awareness of the WHO prequalification programme for reproductive health supplies manufacturers and the potential benefits of becoming prequalified. The work led to greater insight into this complex issue and identified three key areas for further work: manufacturer compliance, bioequivalence, and the quality of active pharmaceutical ingredients. “The API (active pharmaceutical ingredients) issue is a completely new area that came to light as a result of Innovation Fund work.” Lester Chinery, Concept Foundation 6 | Sparking change through the Innovation Fund: successes and lessons learned for reproductive health supplies Total Market Initiative, Madagascar The Total Market Initiative (TMI) Madagascar project is a clear example of the value to be derived from close collaboration among Coalition members at the country and global levels. The Futures Group’s methodological approach, along with Marie Stopes’ local expertise in market segmentation and the enthusiastic support of UNFPA and the Ministry of Health, led to broad acceptance of the total market approach in Madagascar despite initial political uncertainty. The project demonstrated the adverse long-term effects of a government policy to provide free contraceptives, showing how this policy encouraged unnecessary reliance on public funds and services by clients with the means to pay. Furthermore, it showed that the costs of transporting commodities to service-delivery points, once covered by user fees, were being borne by resource-poor districts, forcing them to compensate by cutting back on procurement. Through a strong participatory process, the study’s recommendations were adopted by the Ministry of Health, which then made the case before the country’s Council of Ministers. This political ownership forms the basis for continued engagement and the development of joint strategies and guidelines. Total Market Initiative, Honduras The TMI Honduras project stands out for having forged new connections and building broad-based local partnerships across the public and private sectors. TMI Honduras secured Ministry of Health leadership of a total market approach, helping to overcome initial mistrust of the private sector. The comprehensive process drew together a diverse and sometimes unexpected group of collaborators for the first time. This group included private laboratories, Ministry of Health drug regulation authorities, national statisticians, the local society for obstetricians and gynecologists, and the country’s college of medicines. The project also led to the re-establishment of the country’s Contraceptive Security Committee, which has since taken on the role of coordinating new efforts in contraceptive financing, procurement, and distribution. TMI Honduras work forged new connections, defused personal animosities, led to new insights, and prepared the ground for further action. TMI work in both countries has informed similar work in Paraguay. Furthermore, the Market Development Approaches Working Group is identifying new opportunities for scaling up the work and analyzing the needs of other under-resourced countries, including Chad, Mali, and Niger. In both Madagascar and Honduras, implementing agencies have continued to engage stakeholders to ensure that the recommendations guide future work. award: us$148,306 to marie stopes international, the futures group, and unfpa This grant funded a project that built public support for a total market approach to increase contraceptive prevalence for the poor and vulnerable in Madagascar through Ministry of Health leadership and the involvement of the private sector. The project illuminated the adverse effects of the government’s free contraceptive policy and led to a clearer understanding of gaps in the country’s contraceptive coverage, unearthing opportunities for private- and public- sector collaboration. award: us$188,000 to abt associates inc. and john snow, inc. Through its market segmentation work, this initiative provided important new insights into neglected consumer groups and market niches. It also solicited Ministry of Health leadership and buy-in, leading to the implementation of sector-specific strategies. Opportunities for replication of this powerful approach in other settings are being pursued. “To everybody’s surprise, we managed to quash the assumption that the commercial sector would not be interested. As it turned out, they were very positive about their involvement and satisfied.” Dawn Crosby, Abt Associates Inc. “We were very successful in making the Ministry of Health the main advocate in the process. They were the ones who eventually ensured the recommendations were accepted by the Council of Ministers. This was a real game-changer.” Soumitro Ghosh, Marie Stopes International Innovation Fund projects | 7 S Y S T E M S S T R E N G T H E N I N G Manufacturer input into procurement mechanism One of the key benefits of the Innovation Fund is its ability to respond quickly to emerging opportunities or issues. This project illustrates how the fund adds value through its flexibility and responsiveness. AccessRH, developed under the auspices of the Coalition, is a new way to manage product procurement, information, and inventory. Ultimately, clients will be able to order products online at prices negotiated by UNFPA for delivery around the world. The grant allowed AccessRH to explore opportunities and options for collaboration with the manufacturing sector as well as gain insight into business practices and market behaviors. The timing of the results, coinciding with the launch of the program, ensured that the findings could inform the early evolution of AccessRH. Commodity security in crisis settings Reproductive health needs are too often forgotten in emergency responses to unrest. Through the assessment of service delivery in three African countries, this project shed light on the challenges of supply delivery in crisis settings and helped identify approaches to address them. The results prompted the implementing agencies to install logistics coordinators at two sites and add logistics management to the job description of a program manager at a third site. Results of the assessment also prompted Marie Stopes International to begin providing reproductive health commodities to its partners in the study countries. Although this was clearly not a long-term solution, it did address a pressing need. The activity also led to a new partnership between the International Dispensary Association and Marie Stopes. The two groups are currently collaborating to include comprehensive commodities on the standard International Dispensary Association list of emergency essential medical supplies. Lastly, at the global level, the findings were incorporated into the strategic planning of the Reproductive Health Access, Information, and Services in Emergencies (RAISE) initiative, a broad partnership of humanitarian and development agencies, United Nations agencies, advocacy agencies, and academic institutions. award: us$23,000 to john snow, inc. AccessRH is an innovative procurement mechanism to improve access to high-quality, affordable contraceptives with favorable delivery terms. It also enhances supply chain visibility and supports country ownership. To strengthen the effectiveness of AccessRH, the grant enabled the implementing agency to explore factors that drive manufacturers’ business practices and market behaviors and shape successful buyer-supplier partnerships. award: us$66,000 to marie stopes international With assistance from the Innovation Fund, a study was undertaken to examine commodity security at the service- delivery level in the Democratic Republic of the Congo, South Sudan, and Uganda. The study resulted in a better understanding of the challenges facing agencies that deliver emergency reproductive health supplies. For example, it highlighted the absence of a logistics coordinator at the sites and the low priority given to the availability of reproductive health supplies by agencies and governments. This information directly informed subsequent advocacy efforts. “We weren’t expecting to be confronted with this ‘stock-outs are a fact of life, accept it’ attitude.” Louise Lee-Jones, Marie Stopes International 8 | Sparking change through the Innovation Fund: successes and lessons learned for reproductive health supplies Professional development opportunities for logistics and supply chain managers The critical role of logistics and supply chain managers in ensuring commodity availability has received increased attention in recent years. Yet this attention has not been matched by increased support and training opportunities. Although training opportunities for supply chain managers exist, they do not always address existing needs, and information about them is scattered. Responding to an explicit demand from the reproductive health community, the project gathered information on relevant programs and identified gaps in the training offerings. The comprehensive search included English, French, and Spanish offerings and resulted in a database of more than 100 training opportunities. To increase visibility and uptake, a user-oriented online data base with an interface on the Coalition website is currently being developed. Supply chain management for community-based distribution programs Community-based distribution programs provide an important opportunity to address the “last mile” of the supply cycle, the critical final steps of the journey reproductive health supplies take from production to actual use. Through the development of a program manager’s guide to the design of efficient supply chain management systems, this project drew much-needed attention to the critical issue of supply chain management for community-based distribution programs. The project also conducted a global survey of community-based distribution programs, helped catalyze program activities for subsequent budget cycles, and attracted new funding. Upon completion, the project became institutionalized, with the findings incorporated into subsequent activities. Within weeks of the guide’s publication, its recommendations were being applied in Ethiopia. Furthermore, the Innovation Fund’s flexibility and expediency meant that results were in the field one year earlier than the usual budget cycle would permit, according to the project lead. award: us$189,000 to john snow, inc. This project compiled a comprehensive inventory of training programs in English, French, and Spanish for logistics and supply chain managers. It also surveyed training needs and identified gaps. It is an important step toward the professional development of public-sector supply chain managers in developing countries. A second round of funding will dramatically expand access to more than 100 professional development opportunities for commodity managers, facilitating linkages between those requesting and offering training opportunities. award: us$58,000 to john snow, inc. John Snow, in collaboration with Population Services International, WHO, and other partners, conducted an exercise to identify, develop, and disseminate best practices in supply chain management for community-based distribution programs. This resulted in a program manager’s guide for the design of supply chain management systems in community-based distribution programs as well as a global survey of such programs. “The flexibility was great and allowed crucial expansion at the right time.” Carolyn Hart, John Snow, Inc. “As a result of the community-based distribution work, ‘last-mile issues’ were readily taken up and incorporated into program activities in the budget cycle that followed.” Erin Hasselberg, John Snow, Inc. Innovation Fund projects | 9 R E S O U R C E M O B I L I Z AT I O N A N D A W A R E N E S S Advocating for reproductive health supplies at the G8 The advocacy effort surrounding the 2010 G8 summit in Canada illustrates how the Innovation Fund can help leverage an important advocacy opportunity. More than 60 Coalition member organizations signed letters to Canadian Prime Minister Stephen Harper, host of the June 2010 G8/G20 summit, calling for funding “to improve maternal health.and to ensure that the systems are in place to effectively procure and distribute much- needed reproductive health supplies.” The Resource Mobilization and Awareness Working Group positioned itself squarely behind this approach, allowing the call for action to go global and viral. The Canada G8 project drew upon broad-based local partnerships and enlisted the support of five country partners. Working Group members helped shape the proposal and provided a rallying mechanism and sounding board. The campaign educated parliamentarians and led to broad media coverage, with more than 100 interviews given to local and international media. Parliamentarians from more than 20 countries reacted, and many civil society organizations such as Save the Children, Amnesty International, and Oxfam France supported the effort. The issue was adopted by the broader development arena, including the environmental lobby. Empty Handed Documentary Reproductive health commodity security is a challenge that too often gets lost in numbers. The award-winning advocacy film Empty Handed: Responding to the Demand for Contraceptives put a human face on the issue—the client who goes away empty-handed, perhaps to come back pregnant next time. Its compelling story forges an emotional connection and inspires action. The screening at the ministries of health for Zambia and Malawi, for example, led to high-level national support. The Malawi Minister of Health has made commodity security a theme in his public discourse. Empty Handed also was lauded at the 2010 Women Deliver conference in Washington, DC. The film has been distributed to 150 US congressional offices and will be screened at a high-level European Union event on reproductive health supplies ahead of the Millennium Development Goals summit in 2011. Although the film was initially targeted at policymakers and civil society organizations, it has been adopted by John Snow, Inc. as part of its training program for logisticians and other field staff as it has proven to raise awareness and commitment to reproductive health issues. In addition, new funding was raised to support additional activities to leverage energy and commitment generated following screenings. These have been used in Kenya, Malawi, and Namibia. award: us$72,000 to action canada for population and development (acpd) The fund allowed ACPD to leverage Canada’s presidency of the G8 to heighten global awareness of commodity security and to increase Canadian government support for the issue and for the work of the Coalition. The results put commodity security in the public eye, on the media radar, and in the political arena. award: us$173,000 to population action international (pai) PAI, with input from Coalition members, produced and promoted an advocacy film on the issue of access to reproductive health supplies in sub-Saharan Africa. The film showcases the work of Coalition members and partners and provides advocates with a powerful means to communicate key advocacy messages to a global audience. “You cannot have maternal health without reproductive health, and reproductive health includes contraception and safe abortion.” Hillary Rodham Clinton, US Secretary of State, G8 Foreign Minister’s Meeting “It is a very valuable tool. For the first time, it has managed to rephrase and shed new light on the issue of commodity security.” Jane Hutchings, PATH 10 | Sparking change through the Innovation Fund: successes and lessons learned for reproductive health supplies Strengthening ties with French-speaking Africa In 2011, the seminal Ouagadougou conference in Burkina Faso re-emphasized the importance of addressing commodity security as part of the effort to improve access to family planning in West Africa and accelerate progress in reducing maternal mortality. The conference allowed the Coalition to take a key step by capitalizing on new interest generated by the conference and extending the reach of its activities. This project laid the foundation for strengthening connections with French-speaking parts of Africa by making Coalition materials available in French, thus supporting the development of a French-speaking network of West African nations within the Coalition. The translations also will help ensure that the results of proposed training workshops in Benin, Burkina Faso, Mali, Niger, and Senegal are incorporated into national advocacy plans and lead to broad-based awareness and collaboration among technical experts, civil society organizations, and parliamentarians. While the resulting regional advocacy work may not be branded as innovative in itself, it is a clear example of how an existing strategy can add value in a new local context. award: us$140,000 to equilibre et population The grant supported the translation into French of the Coalition’s advocacy toolkit and a considerable part of the Coalition website. This led to an increase in the visibility of the Coalition in a priority region. By increasing access to and use of existing knowledge and tools, these two activities contributed to building awareness and advocacy capacity in French-speaking Africa and strengthened regional networks within the Coalition. “West African leaders committed themselves to reducing maternal mortality by 25 percent in the coming four years. Evidence will inform our action, and language should not be a barrier to success.” Participant, Ouagadougou family planning conference Implications for the future | 11 i m p l i c at i o n s f o r t h e f u t u r e The Innovation Fund’s focus on providing seed money to fuel innovation in reproductive health commodity security has clearly demonstrated its worth. The activities supported by the fund have challenged existing patterns and led to new approaches to ensure the availability and security of reproductive health supplies. Based on the successes of the fund’s first two years, the Coalition seeks to encourage new investments in the Innovation Fund. Future activities will profit from lessons learned in the following key areas: Involving country partners. Collaboration among Coalition members has been critical to the quality and reach of Innovation Fund activities. More can still be done to leverage members’ expertise and promote collaboration with partners at the country level. Next steps could include pairing countries so they can learn from each other, increasing the reach of advocacy efforts, strengthening processes, building capacity, gaining insight, and fostering change. Building partnerships with multiple stakeholders. Extending the reach of the Coalition’s activities requires initiatives that focus on and drive change at the country and regional levels. Deliberate partnership approaches with multiple stakeholders have been successful in the past and need to be further developed. Disseminating findings. An impressive archive of knowledge has been created with support from the fund. This wealth of knowledge is not always optimally communicated among Coalition members or the wider development community. Going forward, it will be important to develop a more focused knowledge-dissemination effort to ensure that lessons learned are shared with diverse stakeholders. Translating new knowledge into concrete action. Many Innovation Fund proposals have resulted in new knowledge and insights. A process capable of supporting the translation of these new findings into concrete action must be put in place to inform country-level approaches. Ensuring continuity. Ensuring that promising activities do not end at project completion is fundamental. Opportunities for replication at the country level, as well as translating theory into action, should be a focal point. The grant process can champion sustainability, and the Secretariat can play a greater technical support function. Responding to opportunities. Increased responsiveness is a new theme highlighted by Coalition members. This would entail designing the fund to offer greater flexibility in responding to new opportunities or pressing needs in the field. This could be achieved by reserving part of the Innovation Fund for rapid dispersal. 12 | Sparking change through the Innovation Fund: successes and lessons learned for reproductive health supplies We would like to thank the following people for their willingness to provide feedback and input on this report: Marieke Boot, Alan Bornbush, Gloria Castany, Lester Chinery, Dawn Crosby, Neil Datta, Suzanne Ehlers, Soumitro Ghosh, Antoinette Gosses, Carolyn Hart, Erin Hasselberg, Matthew Havlik, Karen Hoehn, Anthony Hudgins, Jane Hutchings, Guillaume Jaskula, Sandra Jordan, Steve Kinzett, Louise Lee-Jones, Ben Light, Katherine McDonald, Martha Merida, Shannon Mills, Maaike van Min, Dhaval Patel, Kevin Pilz, Nicolas Rainaud, Gregory Roche, John Skibiak, Wendy Thurnbull, and Mimi . In addition, we thank all those who agreed to take part in the Innovation Fund survey. Acknowledgments Innovation Fund projects | ii Reproductive Health Supplies Coalition Coalition Secretariat Rue Marie-Thérèse 21 1000 Brussels Belgium +

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