See analysis for the individual years.

Value: During 2017, in total over 500 advocacy initiatives have been undertaken by the HSAP partners and their counterparts. Of these initiatives, 13 cases were extracted from the annual reflection reports. The HSA partners had in total 201 meetings with policy makers which they co-organised themselves, as well as 166 meetings on invitation. In total, 67 knowledge products have been disseminated among external stakeholders by the HSA Partnership. The HSA partners have organised in total 110 events which promote SRH health outcomes. Note: the annual reporting over 2018 led to clarifications on advocacy initiatives which were not accounted for in 2017, hence these are added retro-actively to make the data better reflect reality. For Amref, the numbers also include advocacy initiatives by its sub-contracted CSOsAnalysis: A selection of examples illustrates the type of advocacy initiatives undertaken in the different contexts. For example, two state ministers of Finance and Health of Uganda were invited at the global HRH forum (WHO sponsored their participation due to lobby by HSAP). As a result the State Minister of finance got more aware of how issues of finance affect HRH and SRHR commodities in particular, and the Minister of Finance committed to become an advocate for HRH funding in cabinet the coming years. In Zambia, activities were undertaken with journalists and they documented how community health workers add value in the health care system. This was documented and a story came out about the need to remunerate and appropriately recruit them. In the Netherlands, Wemos specifically targeted the global financing facility (GFF) and is feeding the Ministry with information on thissuch as about the development, direction of the GFF and the possible involvements of the Ministry. Within the context of the African region, in 2017 the partners had a meeting with CSOs and the AU where the Maputo plan of action was discussed. We e.g. discussed some articles in-depth and came up with a joint communication strategy that details the Maputo plan of action, analysing the success that countries have done implementing the Maputo plan of action, and where there are gaps.

Value: During 2018, around 1000 advocacy initiatives were undertaken by the HSA partners and their counterparts. This is a large increase compared to 2017, due to the number of knowledge products disseminated and the number of meetings (co-)organised with policy makers in 2018. The HSA partners had in total 363 meetings with policy makers, some of which they co-organised themselves, as well as 152 meetings on invitation by policy makers. In total, around 358 different knowledge products have been disseminated among external stakeholders by the HSA Partnership including blogs, policy briefs, fact sheets, press releases, reports. The HSA partners have organised in total 152 events, including forums, seminars, demonstrations, public debates, round-table discussions. Note: for Amref, the numbers also include advocacy initiatives by its sub-contracted CSOs.Narrative: (Co-)Organising meetings with policy makers, disseminating evidence, and organising events took place at local, national and international levels. Local engagement with policy makers took place through meetings and citizen hearings. For example, Amref mentored CBOs in six districts in Uganda, after which they participated in citizen hearings and intergenerational dialogues. Other CSOs trained by the HSA Partnership on research for advocacy in Uganda, submitted data from 34 health facilities to the district health office and spoke about health worker migration at district level following the training they received. In Kenya, CSOs that had been trained by MeTA on effective communication and policy advocacy strategies went on to organise local events on World Contraception Day and UHC Day. At a national level, HSA partners and CSOs participated in coalitions, multi-stakeholder forums, and technical working groups in which they presented evidence and provided technical input into national plans and policies. In Tanzania, Sikika (a counterpart of ACHEST) shared a study on the workload of health workers with policy makers and findings from studies on the price and availability of SRHR commodities were shared with government representatives during MeTA platform meetings in Uganda, Kenya, Tanzania and Zambia. At the international level, the HSA Partnership participated in conferences and events in order to bring African voices concerned with HSS for SRHR to international decision makers. For example, Wemos, Amref and Achest participated in forums and co-organised (side) events whereby CSOs in the Partnership focus countries contributed by amplifying advocacy messages and stories. We also were invited to chair sessions and contributed to reports by other organisations which are then presented at international meetings. The 2018 Annual Reflection report provides more examples of the advocacy initiatives carried out by CSOs in collaboration with the HSA Partnership.

Value: The baseline is set in 2016 at 0. Analysis:Capacity building activities in 2016 mainly targeted the HSA partner organisations in the African countries. This capacity building was considered important in order to become a dynamic partnership and to be able to achieve the outcomes set.

Value: In 2017, CSOs have been trained in the African countries totalling up to 53. Individual scores/remarks of CSOs are not shared due to confidentiality.Analysis:The CSO self-assessment focused on lobby and advocacy skills, and research skills. The following topics were addressed: preparation, strategies and agenda, research and analysis, respond and address community needs, advocacy partners and coalitions, communication and media relations, influencing decision makers, advocacy avenues, organizational commitment, funding advocacy, decision-making structure and process, human and financial resources management, PMEL.In Uganda, CSOs received capacity building in operations, financial management, the meaning of advocacy and what tactics can be used in their various contexts to yield results. These tactics included although were not limited to how to conduct citizens hearing, how to write policy briefs, how to dress up for a meeting, how to package and address advocacy issues in a meeting, how to develop structured advocacy plans (as opposed to only conducting advocacy activities ad-hoc). The Uganda context team could see that the district CBOs improved their capacity: they came up with joint advocacy strategies, and they gained more confidence to engage duty bearers. For example, one of the CBOs managed to task the district to include a family planning budget in the next financial year budget 2018/19. In Zambia, capacities strengthened included packaging common messages for specific audiences. The team used post and pre-tests to see whether capacity building was effective. It helped to show gaps, define advocacy, know more about the mind-set of CSOS, and these tests provided a platform for discussions.

Value: During 2018, 191 CSOs received some form of capacity strengthening from the HSA Partners working in the African countries. 62 CSOs completed the online self-assessment in early 2019. Of those that completed the survey, only 6 CSOs completed the assessment in both 2018 and 2019, therefore the capacity of CSOs cannot be compared over time. Instead the survey data provides a snapshot of the capacities of CSOs, namely the key strengths and challenges of CSOs that the HSA Partnership worked with in each African country. Individual scores/remarks of CSOs are not shared due to confidentiality.Narrative: While in 2016 and 2017 our capacity strengthening interventions were mainly delivered through trainings. This was expanded in 2018 to include various forms of collaboration with CSOs, field visits, technical assistance, advice, coaching and mentoring. In this way, CSOs are increasingly seen as our advocacy partners. In the African region, Global, and Netherlands contexts, the HSA Partnership takes on a mentoring role and works with African CSOs to bring their voices into SRHR debates occurring on the African region and international levels. The 2018 Annual Reflection report provides more detail on the outcomes that resulted from initiatives with CSOs initiatives and analyses how the Partnership undertook capacity strengthening of individual CSOs, platforms, coalitions and networks in 2018.When looking at the combined results for all CSOs who completed the survey, working with advocacy partners and coalitions, organizational commitment, and being able to respond and address community needs were the top 3 strengths. CSOs indicated they have strong partnerships, are good at networking and they cooperate closely with partners in coalitions. Most CSOs who completed the survey defined their organisation as an advocacy organisation. In line with this, several CSOs said that all their projects include an advocacy component. Others said that they primarily work on governance or policies, while others said they represent community needs and therefore do advocacy on behalf of the community. When asked to what extent they involve the community in the design and implementation of their advocacy work, they stated that communities help them with identifying issues for advocacy, for example through dialogue days or questionnaires. During implementation, communities are involved in advocacy efforts and they also directly engage with decision makers. This is done through, for example, community score cards, social audits, radio shows, and social events. Several CSOs also mentioned that communities are involved in the planning and monitoring of their advocacy work. Again when looking at the combined results for all CSOs who completed the survey, their top 3 weaknesses were communication and media relations, funding advocacy, and human and financial resources management. Concerning communication, CSOs state they have good general relations with the media, but that there are obstacles in terms of sufficient financial resources to stimulate media coverage of certain events or topics. Some CSOs indicated that not having a specific staff member dedicated to working with the media hampers their ability to gain publicity for their work. Other CSOs mentioned that they work closely with local media (if present), but do not yet engage with mainstream media effectively at national level. Also, some CSOs are much more active on social media compared to in the mass media and consequently feel that their outreach is limited. Regarding funding advocacy, CSOs reported that financial resources to implement advocacy plans were particularly lacking. Whereas in general, they scored better on fostering long-term relationships with individual donors and foundations. Several CSOs indicated that donor support for advocacy projects was rare, as donors were seen to be interested in different things. Some CSOs stated that there was no specific finances dedicated to advocacy, they mainstreamed advocacy goals within their projects. One CSO stated that it crowdfunds for advocacy. It is important to note that the survey does not differentiate between financial resources in general or specifically for advocacy. Hence we do not know if the lack of finances for advocacy reflects the general financial situation of the CSOs. Regarding HR and financial management, the CSOs on average classify themselves as somewhat strong. There are big differences between the CSOs: some CSOs have a few core staff and work with volunteers, others have financial policies and systems in place but need to become more effective or are in need of updating, or staff needs more training.

Value: 60 CSOs completed the online self-assessment in early 2020. Of those that completed the survey, only 4 CSOs completed the assessment in all 2018, 2019 and 2020, therefore the capacity of CSOs cannot be compared over time. Instead, the survey data provides a snapshot of the capacities of CSOs, namely the key strengths and challenges of CSOs that the HSA Partnership worked within each African country. Individual scores/remarks of CSOs are not shared due to confidentiality.Narrative: Engaging communities and civil society remain key to the work of the Partnership. In 2019 HSA Partners continued to strengthen the capacity of a wide range of other partners, including our organizations, other CSOs, networks, community-based organizations (CBOs), and health stewards, including (local) government officials. Depending on the needs, the collaboration and support varied from training, mentorship and coaching, mutual learning and information sharing as well as the joint implementation of activities. The 2019 Annual Reflection report will provide more context and nuance to the activities which were undertaken throughout the year, as well as the successes in collaboration and learning.When looking at the combined results for all CSOs who completed the survey, a strong and clear organizational strategy and structure; collaborative and inclusive decision-making and implementation processes; and identifying and working with like-minded partners were the top 3 ranked strengths. CSOs indicated practical experience, technical know-how and community an understanding. Also, they highlighted their ability to include their target groups and at-risk populations in all aspects of their activities, as an important part of their success. CSOs who completed the survey reported a high score when identifying advocacy as an integral part of their organisation, as most CSOs said that all their projects include an advocacy component.When asked to what extent they involve the community in the design and implementation of their advocacy work, CSOs overwhelmingly corroborated that communities were one of the main drivers of their advocacy work. They do this by identifying and developing key advocacy issues, consequently analyzing at the target audience and devising the tactics used to engage them and packaging the information to deliver to the key decision-makers.How CSOs ensured communities were involved and had a relevant voice, was by engaging them through training, lobby meetings, interface meetings, public presentations of findings, forums, participatory action research, etc. During implementation, communities champions are found and become involved in advocacy by acting as an entry-point and voices with decision-makers.

Value:In 2020 only a limited amount of CSOs we engaged with at the country-level received training as a means of capacity-building. The last year was strategically devoted on mentoring, financing and advocating together with trained CSOs, as they continued putting new skills and knowledge into practice. In total 54 improved their capacity further.Narrative:In 2020, we continued to assist CSOs to help improve their capacity in the field of: lobby, advocacy, SRHR, HRH, SRHC, governance and health finance and research. Although we scaled down actual training workshops and focused on mentoring CSOs as they put their skills and knowledge into practice whilst facing the COVID-19 pandemic. Wherever possible we accompanied CSOs in their work (or were available to provide remote support), provided (financial) resources, gave input or feedback where requested, opened doors and facilitated linking and learning opportunities. We were proud to note that the CBOs/CSOs we have collaborated with indicated their continuing improvement in both their programmatic and organisational skills. They indicated improved practical experience, technical know-how and ability to meaningfully engage with communities, and duty-bearers at all levels. The development and use of evidence- and needs-based materials in their advocacy and awareness-raising interventions also further improved. This included developing materials with communities themselves (key populations), to be able to identify key advocacy issues. Their ability to collaborate with other like-minded CSOs, and thus amplify their voices and create a movement was also highlighted as an improved strength. CSOs shared that the COVID-19 pandemic, particularly the measures and their consequences, at first hampered community-engagement and advocacy with duty-bearers. However, as time grew CSO/CBOs (like HSAP partners) were able to adjust their approaches and were able to utilise the newfound focus on health issues to push for health system strengthening and the fulfilment of SRHR.

Value: At the end of 2017, 197 local CSOs/CBOs (excluding HSA partners and counterparts) were included in the HSAP in Kenya, Uganda, Zambia, Malawi, and Tanzania. When also including HSA partners (4) and counterparts (14), and northern and global partners, the total number is 289. Note: the CSO mapping over 2018 led to clarifications over CSOs listed for 2017 whereby the number of CSOs at the end of 2017 has been reduced from 304 to 289 by early 2019. Numbers are adjusted retro-actively to make the data better reflect realityAnalysis: Apart from the CSOs that are directly engaged by the HSA programme, many other local CSOs were involved through coalitions or networks. In Uganda, the team worked with in total 67 local CSOs/CBOs, and in Zambia the HSAP cooperated with 33 local CSOs, while in Kenya we worked with 59 CSOs. Malawi and Tanzania, who joined the HSAP in 2017, respectively worked with 22 and 15 CSOs. In the Netherlands and at global level, the HSAP partnered or linked up with many organisations including northern and southern NGOs (respectively 22 and 52 NGOs). Capacity building of local CSOs did not take place at these two levels.

Value: At the end of 2018, 319 local CSOs/CBOs (excluding HSA partners and counterparts) were working with one or more of the HSA partners in Kenya, Uganda, Zambia, Malawi, and Tanzania. When also including HSA partners themselves (4) and counterparts (14), as well as northern, regional and global partners (93), the total number of CSOs involved in the programme is 430. Narrative: In 2018, we intensified our capacity strengthening and work through coalitions, in order to support our advocacy efforts. In line with this, there was an increase in the number of CSOs that we worked with in 2018 versus 2017 across all the African countries in which THE HSA PARTNERSHIP works. The 2018 Annual Reflection report includes further examples and analysis of our engagement with CSOs.-In Uganda, the team worked with in total 69 local CSOs/CBOs. -In Zambia the HSA Partnership saw an increase in the number of CSOs worked with, reaching a total of 62.-In Kenya we doubled the number of CSOs we worked with, working with 112 in total. -In their second year of being involved in the partnership, Malawi and Tanzania also increased their engagements with CSOs to 39 and 37 respectively. -The Netherlands and Global teams worked with 26 and 47 NGOs respectively, including northern NGOs, southern NGOs and 20 African regional partners.-To note: these numbers do not represent unique relationships with CSOs. In some cases, the same CSOs have worked with THE HSA PARTNERSHIP through our context teams in African countries as well as having collaborated with HSA Partners working at the level of the African region or global context.Of all the CSOs we engage with, 4% (16 CSOs) of them were sub-granted (or signed a memorandum of understanding) by one of the HSA partners in the African contexts. Of those sub granted CSOs, almost all organisations received some form of financial support and they participated in capacity strengthening. In total, around 12% of the CSOs (48 CSOs) were financially supported with some of their activities. Almost half of the CSOs we engage with (191 CSOs) received some form of capacity strengthening support. This also means that we collaborated with around 200 CSOs where capacity strengthening engagements were limited to exchange of knowledge and ideas through for instance the collaboration in networks and alliances, teaming up in events or conferences, or by undertaking joint advocacy towards governments.

Value: At the end of 2019, 223 local CSOs/CBOs (excluding HSA partners and counterparts) were working with one or more of the HSA partners in Kenya, Uganda, Zambia, Malawi, and Tanzania. When also including HSA partners themselves (4) and counterparts 14, as well as northern, regional and global partners 110, the total number of CSOs involved in the programme is 351. Narrative: In 2019, we continued with our capacity strengthening activities focusing on L&A with an added focus on sustainability. There was an overall decrease on the number of CSOs we worked with in 2019 versus 2018, but well above the average of the preceding 3 years. The 2019 Annual Reflection report includes more in-depth examples and overall analysis of our engagement with CSOs.-In Uganda, the team worked with in total 68 local CSOs/CBOs, keeping a steady number in relation to 2018. -In Zambia the HSA Partnership saw a decrease in the number of CSOs worked with, reaching a total of 34.-In Kenya the number of CSOs we worked with was cut by half, working with 55 in total. - Malawi 35 kept in good pace with the number of CSOs worked with.- Tanzania saw a slight decrease, dropping to 31 CSOs worked with. -The Netherlands worked with 21 and Global saw a substantial increase by totaling 65 NGOs.- African regional partners totaled 24 in 2019.-To note: these numbers do not represent unique relationships with CSOs. In some cases, the same CSOs have worked with THE HSA PARTNERSHIP through our context teams in African countries as well as having collaborated with HSA Partners working at the level of the African region or global context.

Value:At the end of 2020, 396 unique local, national and international CSOs were working with one or more of the HSA Partners. When including the HSA partners themselves (4) and counterparts (14) we arrive at 410. When looking at the specific contexts the break-down is as follow: African Region: 36, Global: 198, Kenya: 41, Malawi 25, the Netherlands: 21, Tanzania: 22, Uganda 50, Zambia 12. These numbers include duplications, i.e. African Region and Global have often worked with the same partners, as those in-country.Narrative:In 2020, we shifted our focus from capacity strengthening towards mentoring, financing, advocating and collaborating with CBOs and CSOs. A notable increase of collaborations can be noted in the Global context (65-198). As the world turned to virtual means of collaboration and advocacy the reach of the global context extended, while the number of in-country collaborations were hampered as they often relied on physical engagements. In-country partners mainly collaborated with their existing network as they pushed for improved SRHR.-In the African Region regional partners increased from 24 to 36-In-country significant decreases occurred: Kenya 55 (2019) to 41 (2020), Malawi 25 to 25, Tanzania 31 to 22, Uganda 69 to 50, Zambia 34 to 12 and the Netherlands 65 to 21.

See analysis for the individual years.

Value: This was not measured hence the value is 0.Analysis: During 2016, the main focus of the HSAP was the creation of a dynamic partnership. Although advocacy initiatives started at the end of 2016, we have not measured this indicator at the time and cannot state if any policies were improved or adopted, and our role in this. Hence the value of 0.

Value: During 2017, the HSAP contributed to 2 policies being implemented. Note: the annual reporting over 2018 led to clarifications on the status of policies reported on earlier for 2017, hence these are adjusted retro-actively to ensure more precise monitoring and a better reflection of the reality. These are now included in DD indicator 2 instead.Analysis In Kenya, the HSA Partnership contributed to the Community Health Worker remuneration included in County Integrated Development Plans (CIDP) for 2018-2022. The CIDPs are county level policy documents which prepare the roadmap of county investments for five years. Due to advocacy in 2017 in 2 counties, county governments have already included planned activities for remuneration of Community Health Workers in the CIDPs (even though the bills are not yet approved).

Value: The HSA Partnership contributed to 1 new policy being implemented in 2018. Of the policies which were already targeted during 2017, we contributed to 1 policy which now has the status of being effectively implemented. Narrative: In Kajiado county in Kenya, a HRH incentive framework has been implemented at sub-county level. Following the launch of the incentive framework, there were systemic promotions, employment of new staff, ongoing re-designations and also provision of staff development opportunities at all levels of service delivery. An example of a policy that the HSA Partnership played a role in drafting in 2017 and was implemented in 2018 is the recruitment of thousands of new health workers in Tanzania. They have now also started working at primary health care facilities. The 2018 Annual Reflection report provides more examples of developments in policies and budgets.

See analysis for the individual years.

Value: This was not measured hence the value is 0.Analysis: During 2016, the main focus of the HSAP was the creation of a dynamic partnership. Although advocacy initiatives started at the end of 2016, we have not measured this indicator at the time and cannot state if any policies were improved, or adopted. Hence the value of 0.

See analysis for the individual years.

Value: In 8 cases, the HSAP partnership and/or local CSOs succeeded in creating space for CSO demands. As not all cases were documented in the Annual Reflection reports, we estimate this number to be higher in reality.Analysis: During 2016, the main focus of the HSAP was the creation of a dynamic HSA partnership. Although advocacy initiatives started at the end of 2016, we have not measured this indicator at the time. However, there are examples of CSOs successfully sharing their demands and positions with policy makers, private sector and/or other CSOs. In Kenya, advocacy at county level resulted in separate budget lines for CHWs in the health budget of certain counties and newspaper articles advocated for the same through influencing public opinion. In the Netherlands, Amref and Wemos have successfully advocated jointly for a health systems strengthening approach in Dutch development policy, through inputs to two political parties who included these in their political manifestos (with a view to the elections in 2017). The country team in Zambia (and Kenya) was invited to participate in policy review groups, which are important entry points for the lobby and advocacy strategies that the HSA Partnership aims to pursue