Alliance Online - December 2007

Leveraging and measuring: how a small foundation can push a global agenda

Suzanne Petroni

Universal access to reproductive health. In 1994, those five words became the centrepiece of a global consensus document, the so-called Cairo Consensus, garnering the support of 179 countries at the International Conference on Population and Development in Cairo, Egypt. Since that time, an international community of organizations and individuals has referred to the Cairo Consensus as the basis for increasing attention to, and funding for, sexual and reproductive health services around the world. Yet while these groups work diligently towards the goal of universal access, there is no agreement, some 13 years later, on what, precisely, universal access means.

The Summit Foundation, a family foundation based in Washington DC, learned this distressing fact when we established a new goal for our Global Population and Youth Leadership programme in 2005. As we sharpened our programme focus on the lives of young people throughout the developing world, we decided that our ultimate goal is to achieve universal access by young people to comprehensive sexual and reproductive health information and services. In simple terms, we believe that every young person who needs and wants such information and services should be able to access them.

We knew that achieving this would not be easy, nor could it be accomplished through the lone efforts of one small donor. We therefore saw our role as encouraging others into action, using our funds to help grantees advocate for increased support from governments around the world. While our own contribution might not be easily measured, we are asking all our grantees to map their own efforts towards our shared goal, while at the same time trying to assess whether, globally, we are making significant collective progress towards it.

As we began to consider how to go about defining and assessing such progress, we came to realize just how difficult our task would be. We found not only that there is no consensus on the meaning of universal access, but also that no one had considered what it would mean for young people, who comprise a quarter of the world’s population – 1.6 billion people between the ages of 10 and 24 – to have such access.

And so it was that we found ourselves, a small private foundation, working with the global reproductive health community to forge a new consensus around what exactly those 179 countries had agreed upon back in 1994.

What does success look like?

The Foundation’s search to measure progress stems from a core question that has driven Summit’s co-founder, Roger Sant, throughout his life and career: ‘What does success look like?’

Sant brought the same entrepreneurial spirit, belief in the power of individuals, and goal of transforming communities to the Foundation as he had to AES, the company he founded over 25 years ago. These translated into three core values that reflect the philosophy of the founders, Sant and his wife Vicki. These are:

Shifting the context We believe that shifting the context in which problems are viewed can reveal innovative solutions.
Achieving results We seek results that go beyond stopgap measures to delve into the systemic sources of problems and achieve deeply rooted change.
Investing in people We believe that people are capable of extraordinary accomplishments when they have the right tools to achieve their goals and are fully empowered to give their best to the world.

These values underlie the mission of the Foundation, to ‘promote the health and well-being of the planet – its people and its natural environment – by achieving a sustainable global population and protecting the earth's biodiversity.’ It’s a lofty mission, but the Foundation concentrates on empowering young people and protecting the Mesoamerican Reef Ecoregion.

For the population/youth programme, Sant’s question involves better defining the universal access goal and developing appropriate indicators to measure progress towards it.

Defining universal access

Starting with longtime grantees in the reproductive health arena, and working our way up through academia to the largest international health agencies, we asked the questions, ‘How will we know if the world is making progress toward our goal?’ and, of course, “What will success look like?”

Time and again, we were surprised by the lack of an adequate response. In the course of our inquiry, we found that two separate and similar processes were just beginning to get under way. The World Health Organization (WHO) was working to measure coverage of young people by HIV services. Close, but not quite the comprehensive set of factors we were seeking to assess. And the United Nations Population Fund (UNFPA), fresh from its success in securing universal access to reproductive health as a target for the Millennium Development Goals, was pairing up with yet another unit of WHO to define and measure this new target. An enormous first step, but unfortunately youth were not a specific focus.

Nudging the system, and finding answers

Determined to ensure attention at the global level to a critical population, and convinced that an understanding of countries’ progress would encourage greater advancement toward the universal access goal, Summit continued to pursue a consensus around defining and measuring its goal.

After identifying key global experts on both measurement and youth reproductive health, Summit invited a group of representatives from multilateral agencies, NGOs, philanthropy and academia[1] to participate in a meeting last December to hash this all out. We believed that by taking the discussion outside the confines and constraints of the UN system, and keeping everyone focused on the big picture, we could find a consensus.

As a start, we provided the group with an outline of indicators of youth health that were available from various sources. We then set to work through a facilitated session held at the Ford Foundation in New York. Just four hours later, we reached agreement on a set of indicators that will provide the most reasonable available proxies for defining and measuring universal access by young people to comprehensive sexual and reproductive health information and services.

We had our first answers and we got them in half a day, for the cost of a few phone calls, a handful of plane tickets, a facilitator, videoconference and lunch. The experts willingly gave half a day of their time to advance this work because they all recognized their own professional desire for such indicators as well as the global need for them. They also realized that without an outside, neutral entity pushing the agenda forward, we might never have been able to drive past the bureaucratic forces that would otherwise drag such a process deep into the weeds (or into the basement of the UN building).

In addition to being able to measure progress towards our own goal, we are now better equipped to share with those concerned with youth health a way to track how countries are progressing towards a goal to which they are all committed.

With the 12 key indicators at hand (see box below), Summit has collected data from existing sources and is working to present them in a manner that will be useful to service providers, advocates, governments and fellow philanthropists. In the end, the questions that this small foundation asked have led UNFPA and WHO to expand their own efforts to more comprehensively address young people in their formal measurement processes. Indeed, WHO is currently finalizing a set of indicators for ‘Access to Health Services for Young People for Preventing HIV and Improving Sexual and Reproductive Health’ (emphasis added) globally, thereby taking this exercise to a much larger scale than Summit could have imagined.

Conclusion

The Summit Foundation comes out of this process armed with the confidence that one small actor can play an important role in helping larger ones to advance a shared global agenda. ‘Leveraging’ can happen. But we are also reminded how challenging it is to measure progress and impact in grantmaking programmes. Whether seeking ecosystem health, human health, or any other social change goal, it is critical for funders and grantees to be able to understand, articulate and measure their stated goals.

At Summit, we continue to recognize that many of the efforts and organizations we support are achieving successes along the way, and we know that they will have long-term impacts that will be difficult to measure. We will continue to press all of our grantees to answer the key question, ‘What does success look like?’ Whatever the particular answer, for all of us, success as agents of social change hinges on not losing sight of this ultimate vision.

1 The meeting involved participants from UNFPA, Unicef, World Bank, World Health Organization (by videoconference in Geneva), International Center for Research on Women, Youth Coalition, Population Council, Population Reference Bureau, Columbia University School of Public Health, Moriah Fund, Ford Foundation, and Summit Foundation.

Suzanne Petroni is Senior Program Officer at the Summit Foundation. She can be contacted at SPetroni@summitfdn.org

For more information
www.summitfdn.org

Indicators of youth access to sexual and reproductive health

Condom use by young people
HIV testing behaviour of young people
Adolescent fertility rate
Adolescent contraceptive prevalence rate
Knowledge by young people of contraceptive methods
Knowledge by young people of correct ways to prevent HIV
Births by young women attended by a skilled health care provider
Antenatal care among young mothers
Median age at marriage for females
Difference in age at marriage between men and women (typically, the larger the difference, the greater the inequity)
Age at first intercourse
Secondary school enrolment

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