ABOUT DESIP
AN OVERVIEW
The United Kingdom, through the Foreign, Commonwealth & Development Office (FCDO) was designed to provide £36 million over five years (January 2019-January 2024) to strengthen reproductive health in Kenya through the Delivering Sustainable and Equitable Increases in Family Planning programme (DESIP). DESIP was built on the success of DFID’s Delivering Increased Family Planning Across Rural Kenya (DIFPARK) programme that invested £36 million over seven years (2012-2018) with the next phase of the programme placing greater emphasis on reducing inequities and promoting sustainability. The programme complemented the support provided by other donors, namely United States Agency for International Development (USAID), Danish International Development Agency (DANIDA), United Nation Population Fund (UNFPA), Bill and Melinda Gates Foundation (BMGF), and Clinton Health Access Initiative (CHAI) Foundation. This programme was initially implemented in 19 of Kenya’s 47 counties where less than 45% of women use a modern contraceptive method.
COMPONENTS OF DESIP PROGRAMME
The DESIP Programme included five components that were implemented by different partners:
Technical support to the national Ministry of Health (MoH) and County Health Management Teams (CHMTs) on FP financing, leadership, and coordination
Provision of comprehensive FP services across 19 counties through innovative public and private sector service delivery approaches.
Piloting an innovative development impact bond (DIB) for the reduction of unintended pregnancies in adolescents through a partnership agreement between the Children’s Investment Fund Foundation (CIFF) and FCDO. This component began in September 2020.
Procurement of FP commodities for the public sector to fill gaps, implemented by UNFPA. The MoU was agreed in April 2020 for an initial period of eight months.
Independent third-party monitoring (TPM), process evaluation and learning implemented by the Health Research for Action (HERA) consortium from April 2020.
The programme Component 1 and 2 were implemented through a consortium led by Population Services Kenya (PS Kenya) in partnership with six other organisations: Africa Medical and Research Foundation (AMREF), Options Consulting Services (Options), Faith to Action Network (F2A), Health Rights International (HRI), Population Services International (PSI), and Voluntary Service Overseas (VSO). The consortium accountable grant arrangement began in June 2019. The service delivery was supported by PS Kenya, HRI, F2A, HRI and AMREF while the health system strengthening support was undertaken by Options, VSO, and PSI.
The goal of DESIP was to ensure that women and girls can safely plan for their pregnancies in line with sexual and reproductive health and rights especially the rural women of reproductive age, including rural adolescents, poor women (< $1.90/day) and people with disabilities. The expected impact of DESIP is a reduction in maternal, new-born and child, and reduce unmet need for family planning through greater and more equitable access and uptake of family planning (FP) in Kenya. This was achieved through four key outputs: Output 1– Improved availability and quality of family planning services and commodities, Output 2– Increased awareness and acceptance of family planning and benefits of family planning, Output 3– Sustainable involvement of the private sector in family planning, and Output 4– Strengthened public sector capacity to plan, finance and coordinate family planning. At inception, the programme intended to reach 322,000 FP additional users, provide 2.3 million couple years of protection (CYPs), and avert 2,221 maternal deaths by 2024.
Multiple changes that occurred in the course of implementation resulted in key decisions and alterations in the programme. For example, the official development assistance (ODA) cuts in year 2 (2020/2021) period led to FCDO internal re-prioritization as result of covid-19 economic impacts which subsequently led to scaling down of activities, revision of year 2 work plan and budget, and reduction in geographical scope from 19 to 12 counties at the beginning year 3 (April 2021). The reduced geographical scope also meant that log frame targets needed to be revised to reflect the new coverage of 12 counties. However, no changes were made to the theory of change. In year 3, further reductions in budgets from £3 million to £2.8 million resulted in revision of the theory of change and log frame in Feb to March 2022. The revision of the log frame and the theory of change also led to changes in key programme outputs as follows:
Output 1– Increased awareness and acceptance of family planning;
Output 2– Improved availability of family planning services;
Output 3– Improved quality of family planning; and
Output 4– Increased capacity to plan, finance, and coordinate family planning.
Additionally, in year 4, ODA cuts led to reduction in budget from £3 million to £2.8 million at the beginning of year 4, then to £2.24 towards the end of year 4 necessitating the exit of five consortium partners in quarter 4 of year 4 with the exception of PS Kenya and PSI who continued to run the programme. The revised log frame and theory of change was utilized in year 5 and 6 of the programme.
As a result of annual review of year 4 (2022/2023), DESIP was extended by one year as per the 2024 annual review to strengthen sustainability and work with counties to increase allocation of FP resources. It was also recommended that the programme should consider onboarding a new partner to operationalize advocacy at the county level. PS Kenya went ahead to re-engage Options to join the sixth and the final year of the programme. An additional £300,000 were injected into the programme in year 5 to enhance equity especially in the marginalized and hard to reach areas. Since the scope of the programme was more focused on health system strengthening and advocacy, the log frame was revised at the start of year 6 while the theory of change remained the same. The expected programme results were also adjusted upwards to the following: 365,233 FP additional users, 2.8 million couple years of protection (CYPs), and aversion of 2,715 maternal deaths by March 2025. Overall, the value of programme was reduced from £36 million to £27.5 million following recurrent reductions in the ODA.
