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Transforming the health of women and girls for 25 years

In the last 25 years we have grown into a global team delivering transformative programmes across health systems in more than 60 low income countries.

23 November 2017
Jo Elms

2017 marks 25 years since Options was first established. To mark our anniversary, we’re telling the story of how Options grew from a small group of specialists to a global player that influences governments and helps transform the lives of disadvantaged people, in particular women and children, in over 60 countries.

This year, on a visit to Options’ Urban Health Programme in Bangladesh, I walked around some extremely poor neighborhoods and was reminded of my own introduction to international development, also 25 years ago, when I worked in overcrowded urban slums in Sri Lanka. It struck me how infrastructural shortcomings, like poor water and sanitation, are little improved today from those in the environments in which I worked in the early 90s. But change is happening; some less visible but nonetheless significant. In Bangladesh our programme is using digital mapping to inform the planning of health services, making sure that services are in the places where people need them. Technologies, used well, are bringing real change and that is one feature of Options’ story.

Another is about the political barriers that today still hinder the rate of change, just as they did in the 90s. Global strategies for addressing these advanced considerably when the UK Department for International Development (DFID) was formed in 1997. This was a key moment for all of us working in aid as it introduced a more strategic, sector-wide approach, including budget support. It was significant for Options too as, by setting up and running DFID’s first resource centre for Reproductive Health and Population, we advised governments’ health strategies and policies, and evaluated approaches to build aid effectiveness.

In the last decade, development assistance has evolved at a rapid pace. The transition of the eight Millennium Development Goals (MDG) into the 17 Sustainable Development Goals (SDG) with 169 targets is also reflected in the expansion of Options’ portfolio, which previously supported MDGs 4, 5 & 6, and now contributes to SDGs on healthy lives, nutrition, gender, water, and sanitation. Our focus on women, girls and social equity cuts across development agendas, particularly with the UN-led donor commitments to Universal Health Care, family planning, nutrition and leaving no-one behind.

Running through the years and across all these sectors, there is a consistent thread. Options’ approach, and indeed its great achievement, is about influencing change. At the heart of this are the partnerships with the people we work with: ministerial heads, local officials, service providers and the people and communities whose lives the work aims to improve. These partnerships can help to overcome political barriers, often through the use of packaged evidence to facilitate a process for effective and appropriate decision-making. This is powerfully demonstrated in the Evidence for Action (E4A) programme that started with DFID in 2010 and is now funded by the Bill and Melinda Gates Foundation.  I often proudly cite this programme as being truly catalytic, with its small teams in each African country – sometimes just three people – promoting accountability with simple scorecards that convey whether a clinic is “safe” for a woman to give birth and, when not, what actions would make it so. Using locally accepted evidence helps ensure the messages resonate in a way that wins the support of decision-makers at all levels. Where E4A works, services improve.

In compiling this report we have selected highlights which showcase effectiveness and results. We believe these, and the work that Options will go on to do, will contribute towards the SDGs and the principles of equity and social justice to enable some of the most vulnerable women and girls, and disadvantaged people everywhere to access quality healthcare.

Governance and Accountability Systems Thinking

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