 Good morning, everyone. It's great to be here this morning. My name is Margot Faunestock. I'm a program officer at the William and Floor Hewlett Foundation in Palo Alto, in California. And Madame Lemonise, thank you so much for making the journey this morning to be here with us. It's an honor to have the Minister of Health of Senegal with us for this discussion. And Dr. Daff, I want to salute you as well, that he is and his minister have shown tremendous leadership in Senegal and really are one of the main reasons that we're sitting here today to talk about the recent success. And another huge factor in the success in Senegal, as has already been alluded to, has been the role that some of the key funding agencies has played. And so this morning, we're here to talk to several of the important funders and funder collaborators. And so I just want to introduce the panelists. And then we'll give them each some time to talk, say a few points about their role in Senegal. And then as with the previous panel, we'll have time for each of them to answer a question for me and then time for you to ask questions of them as well. So I'll start here first to my right is Madame Fatimata C. Fatimata is the director of the coordinating unit for the Ouagadougou partnership. And the partnership has been referred to many times already this morning. And Fatimata will be able to share with you all what that is and what it's doing in the region. Give us more details. It's got a very intriguing name for those of you who haven't heard it. We can tell you where that comes from. And to Fatimata's right is Katie Taylor. Katie, thank you so much for being here today. Katie is the deputy assistant administrator for the Bureau of Global Health, the United States Agency for International Development, USAID. And to Katie's right is Nomi Fuchs Montgomery, who recently joined the Bill and Melinda Gates Foundation as the deputy of family planning. So Nomi, thank you so much for being here today as well. So I'm going to start with Katie. And Katie, I know that your agency's role in family planning in Senegal has already been highlighted. And I learned that the agency has been funding in family planning since the late 1970s. So this is a very, very long-term commitment on behalf of the US government to this issue in Senegal. And that you played a particularly important role starting around 2009 in helping the ministry to revise and review its family planning program and progress and several of the themes that you've already heard this morning about de-medicalizing services, about decentralizing services. Those are themes that were picked up by the government and by Madame Colsec when she took office in 2012 that have really been some of the critical components for success in Senegal. So Katie, I wonder if you could just share some thoughts about why this is an important issue for the agency and how it fits more broadly into your priorities for the government. Sure, thank you, Margo. And let me say first what an honor it is to be here with Her Excellency Minister Alamari Colsec. I also have the pleasure of serving with Minister Colsec on the Gavi board. So I continue to be inspired by your words of wisdom and your thoughts, not just representing Senegal but representing all countries who seek to be actors and shaping their own destiny in this way. So it's an honor to be here. And Dr. Duff, not only do I admire your leadership and that of your team in Senegal, but when I met you, you told me you didn't speak English. So if you put in child survival and family planning and nutrition and you're English, go in the same direction. I can't wait to hear you speak a year or two from now. So, and I'm also delighted to be here with my dear friends, Fatimata, Nomi, and Margo. So thank you, and thanks to CSIS and Janet in particular for organizing this. It's terrific. I want to talk about I guess three things. Why family planning and reproductive health? Why Senegal? And some of the challenges, the ongoing challenges. So why family planning and reproductive health? I mean first, just to contextualize it, for USAID, there are three fundamental rationales. That an individual and a couple have the right to choose the timing and spacing and number of their children. Secondly, the extraordinary impact that family planning reproductive health programs have on the health of women and children. And thirdly, what others already alluded to the impact on economic development on sustainability of resources even on state stability. So the rationale for supporting family planning reproductive health in Senegal is absolutely a part and parcel of how we do this in a number of countries. And then the second is one of our priority health goals at USAID is ending preventable child and maternal deaths. And we sometimes in the family planning space don't always think about the extraordinary role that these programs have in potentially reducing by up to 30% of the 289,000 maternal deaths every year. Or in the 24 priority countries where we were, we could reduce deaths of children under five by 1.4 million per year, that's huge. So we don't look at it only in and of itself, although that is vital, but also as connected to everything we do in maternal newborn child health and in nutrition, these are all in our life. And that's how we present our budget to Congress. So as well as malaria, it's all part of the ending preventable child maternal deaths. So because ultimately the funding that we are able to provide through USAID is of course always appropriated by our friends and colleagues on the Hill. Secondly, why Senegal? Senegal, so over the last six, seven years, USAID has refocused our resources on 24 countries that represent over 70% of maternal and child mortality. Senegal is one of those. But if you look at that period of time as we've been focusing on countries that needed it the most, but also where we felt the most could be done, it's been a marvelous partnership to work with this government, with Minister Kozak, Dr. Daff and all of our partners. Senegal is on track to meet MDG-4. Have you focused on the extraordinary increase of usage of modern contraceptive prevalence? I mean, we've gone from 12, is it 12 to 20% in usually one percentage point increase or improvement per year is considered really good. This has been two plus per year. So the rate of improvement that you've seen in Senegal has been really terrific, both in child survival, in family planning, in nutrition. And the ability to look at one plan. USAID contributes, I think we support about to the tune about 80% of family planning, a national plan and about 50% of the child survival national plan. But ultimately it is one single national plan and our ability to contribute to that across all our partners, be it intra health or Adidas or many others who are here, our ability to do that together and to do it with other funders is fundamental. Because again, it's not like a single disease state. When you're talking about family planning like when you're talking about child and maternal health, it is everything to do with social norms, with behaviors and with societies. So we absolutely need to expand beyond just thinking about things in intervention terms. And finally, what are some of the challenges? So there at least, one challenge is financing and that's the topic of this panel. Many of the countries, the 24 countries that we focus on are on thank goodness, on a very positive route of economic development and growth. But that means they're gonna be graduating from different types of overseas development assistance, be it Gavi or others. So as countries move on a path to graduation from OBA, and yet you have governments who are responsible for an ongoing birth cohort, millions of women. You need to be able to ensure that there is sustainable domestic financing that we'll be able to meet that. So we're supporting a number of different platforms, the Global Financing Facility, ongoing support to Gavi and others, to look at how do we help countries. And Minister Kosek, you were very vocal about this at the Gavi board retreat in March of saying, help us map out our financial needs for introducing a new vaccine, for instance. Help us understand the true sustainable cost of that over the next 30 years, not just the co-financing cost. And this goes back to what Pop and others were saying, domestic resource mobilization is not just national government and taxes. It is all forms of financing. The private sector and civil society and NGOs play a fundamental role in ensuring that we get there together. And that, of course, there needs to be support for it, which goes back to other issues alluded to already, the extraordinary work being done with religious leaders by Catherine and others, the work with youth. I mean, it's fundamental to get alignment across the society. Thank you, Katie, great. You've already teed up, I think, a number of themes for our discussion a bit later. Nomi, I wanna pass it to you. I know the Gates Foundation has been funding in Senegal and family planning since 2009. So you play a critical role of this recent story that we've been talking about this morning. And as Katie highlighted, the incredible success, really the huge jump in the contraceptive prevalence rate in Senegal. So I wonder if you could offer some thoughts about how the Foundation thinks about your support to Senegal and what it really means within your context. Thank you, thank you, Margo. And I'd like to thank CSIS and really reflect back to the video that we saw in the beginning. I think Michael was mentioning the woman. And seeing that image, I think, gives us so much hope for sustaining the momentum of the conversations today. You will hear probably time and time again throughout this panel and the previous panel the role of the government. And really, it is just an extraordinary pleasure to have met the minister last night at the dinner. And Dr. Daff, I had the pleasure of meeting in Senegal a year or two ago. But they're really just incredible leadership to carry this work forward. And it's an honor to have you here. And I hope that all of us will take advantage of their presence in continuing the dialogue and the discussions. Dr. Daff, in fact, was mentioning about the role to Janet's question of donors. And I was reflecting probably one of the most important things that we can do as donors is to listen. And to really listen not just to the government, to civil society, to the women themselves, the communities, and then to figure out how we can best align our investments. There's not one player that's gonna solve all of these issues. And in fact, it's our coordination and our collaboration that's really going to move the agenda forward. I don't have to go into the London summit. I think everyone here in the room knows about the launch of Family Planning 2020 and the great work that's moving forward. And as part of that effort, the foundation has identified Francophone West Africa as a priority. And I'd like to acknowledge Perry Sutton, who you had heard from earlier, a program officer for the foundation who's been really leading the work. And in fact, just returned last night from Niger with Margo. And of course, Monica Kerrigan for all of your tremendous leadership. Within West Africa, the foundation is taking a role, a regional role with a specific focus in Senegal, which I'll talk about in a minute, and Niger by testing innovative ideas both on demand and supply side, which Pat mentioned. And then seeing how we can leverage those results and best practices and those impactful investments to have a further reach within the region through the Wagadugo partnership with Fatima Teval go into in much greater detail. We've heard that the region has lagged behind and I think that many people have sort of written off, really, Papua's talking about this, that there was a period where it was a forgotten region. And a lot of people had a pretty dismal outlook that there would be no hope for success. The total fertility rate sometimes averaged in the region at six women, six children for women. There's still a CPR of 16% average. There is a lot of work to do and it's hard to kind of maintain the energy when you have such great challenges. And yet the tide is turning and we've seen the success. In fact, the increase is a four point increase this past year, which really, those of us working in family planning, it is extraordinary. We cannot say enough. We'll talk about Rwanda, Ethiopia, but we haven't had this ability to measure year on year results with this kind of achievement. And the government needs to be congratulated for just the really extraordinary leadership to move that far in a given year. So thank you actually. I want to give you an applause. So as Marco mentioned, the foundation began work in 2009 through the Urban Reproductive Health Initiative that really is bringing demand and supply side interventions to the urban poor. This intervention package has increased modern contraceptive prevalence in two of the poorest quintiles by nearly four percentage points and from baseline to midpoint and we're expecting even greater results by the endpoint. And Perry I'm sure can go into much greater detail but this really is a phenomenal success in terms of an innovative package. It includes a lot of what you saw in the video of a mobile outreach, community engagement, engagement with the religious leaders that are all being now those components are adapted into the national plan. I also want to take a moment to talk about the foundation's role in supply chain and we've had several conversations about the informed push model. And so for those of you who are maybe not familiar, I want to go back to a study that was done in 2011 and I was looking at the data last night and just reflecting it is an innovation. It created such a positive change. And I think when you look back at that study that was done in 2011, 33 sites, it showed that this is within Dakar, that stockouts were happening with injectables and implants from 43% for injectables and 83% per year for implants which is just incredible. And 60% of those stockouts occurred despite having stock available at the national level. What an unbelievable challenge. The stock was there and yet the supplies were not reaching the women. Through a partnership with the government and with the Urban Reproductive Health Initiative, this very innovative model was developed and the stockouts were virtually eliminated. And really if you have a moment and you can go through the data, it's just, when you see 83% down to zero, it is an incredible achievement. So the question now as Priya was saying, foundation is working with Merck for Mothers, there's interest in Togo, what are we doing to kind of learn from these innovation and pop to your point, I think that it's not a static replication. We've done a lot of that of like, here's the model, this is what we learned, let's pick it up and try it somewhere else. But we need to continue to iterate and to learn and to listen and to find out what are those success stories, what were the challenges and how do we kind of sustain that momentum by constantly improving the model. We've all talked tremendously about the successes that's happened, we are now at 20.3% married women with CPR, this is an increase from 16% in 2013. So it is really a phenomenal result. Not in addition to the work in Senegal, the foundation is also supporting work in Niger. And I know that Pathfinder is here in support of the country, the Cost of Implementation Plan and then rolling out the components of that plan through mobile outreach and work with the community both on injectables and expanding access for long-acting, reversible contraceptive prevalence. The most important part, which Fatimata will talk about in a moment is just how throughout the region that we're collaborating, that we are working together to take these best practices and figuring out as donors how we can each play a critical role. And in fact, all nine of the Waguduga partnership countries now have Cost of Implementation Plans, which is really a phenomenal result. And I would be remiss and I hope I can emotionally keep it together to just acknowledge Valerie de Filippo. You know, I think that this is, we're in these real lifetime moments with Valerie's passing where we have a moment to come together and to reflect on everything that she's done. And I think it would put such a huge smile on Valerie's face as I was going through the list of participants. We have activists here. We have advocates. We have religious leaders. We have government officials. We have people from the country all coming together. And really, and many of us have worked globally, there is not a region that I can think of that has this type of kind of camaraderie for the West Africa region. So it is an absolute pleasure to be here. So I wanna end very quickly on three quick points. The first is leadership. And we've said it again and again, but I think as donors, we need to do all we can to continue to foster that leadership. The second is partnership. And we've talked about the demographic dividend. We know that for every dollar spent on family planning, there's a savings of six dollars. We absolutely have to widen the tent to pop's point. We need the role of the private sector. We've been talking about resiliency funding. There are many other actors that can play a role in the work that we're doing. And we need to collectively figure out how we can bring them on board. And the last P I want to kind of think about and close with is passion. And I think I've mentioned perseverance. And then you talked about passion at the end. And we need that passion to sustain. This is an amazingly well attended meeting for Washington DC, which is a tribute to itself to have so many people here. But we must not let this be the end of the day. That to just show up for a meeting and be inspired by the speakers, it is not enough. And there are so many women in Senegal who still need these services and particularly adolescents. And I would like to close and just acknowledge that we need to be bold. We are not doing enough for young people. And that really they are the future of the sustained success. So collectively, we need to keep that vision in place as we go forward. Thank you. Thanks, Nomi. Thanks so much. Thank you. And thank you for your passion. I'm gonna pick up on that point because I want to acknowledge this one to my right who has become a real friend. And she is a colleague, but she's also a friend and she is a passionate supporter of this issue in Senegal and in the region. She is coming off what we called the Caravan. She made visits to four Francophone West African countries in the span of two weeks. And with West African travel, those of you who've done it, that is not an insignificant feat. Many of us were tripped up by travel glitches but Fatimata visited Senegal first two weeks ago and then she flew to Burkina Faso and then she was in Mali and then she was in Niger. And now she is in Washington, DC with us this morning without going home. So thank you, Fatimata Si. It is your leadership for the Waga Dugu Partnership has really been tremendous. And I wanna congratulate you and thank you for holding us the core donors that you work with and the country members together. And it's going to be exciting to hear you say in your own words what you think the Waga Dugu Partnership is and how, what promise you think it holds for Francophone West Africa. Madame Fee. Yeah, thank you very much, Margo. And I would like also to echo the others who spoke before me to thank CSIS for gathering today. You know, all of you here because you are all the champions of the West Africa Francophone countries. And to express to you how those countries are very grateful, grateful to you all for the tremendous work that you are doing not only in Senegal but also in Benin, in Burkina Faso, in Côte d'Ivoire, in Guinea, in Mali, in Mauritania, in Niger, in Togo, and also in Senegal. So thank you for all of you what you are bringing to this region. Margo, I'm sitting with donors and largest donors for family planning, reproductive health. Representing here the Waga Dugu Partnership while the Waga Dugu Partnership is not a pool of funding. It's not also a service delivery organization. Waga Dugu Partnership is a movement. It's a movement that are gathering countries. And when I say countries is government, civil society, private sector, along with the donors to voice for family planning for this region that was for a while lagging behind and negligating what we are talking about family planning. Waga Dugu Partnership is a regional platform that facilitates the exchange between countries so that they can learn from each other about their bad practices. And I'm saying bad practices, but also because we used to talk about good practices. They are learning from each other about their good practices as well as about their bad practices. This is a platform also where we are facilitating the collaboration between donors. And I think when we are talking about accelerating the family planning intervention, that means that countries, but as well as government, governments as well as donors, they have also to do business, not as usual. We need to innovate. We need to see how we can things all through more in a normal way because family planning intervention have been being implemented in somehow in our countries but with a slow improvement in contraceptive prevalence rate, 0.8% one person per year. And now suddenly we wake up and say, we would like to double the contraceptive prevalence rate within three years. That means that we need to do things not as usual. And I think this is all about this platform is to see donors facilitating the collaboration, discussion between donors and to have donors also to align more and better on the country's priorities. And I think this is very important and very well voiced by the country. Regional platform for funding, yes. This is what we are trying to do all together to attract more donors through this country. New donors, but also traditional donors to intensify their intervention and funding for this region. And I think we are seeing a bit of progress coming along with that because looking at the traditional donors, the six core donors for the Wagardu partnership, their investment during the two past year from 2012 to 2014 that have increased for over 35%. And I think this is a good signal that things are moving and family planning is becoming more and more a priority for all of you. The Wagardu partnership also, as vocal, becoming more and more vocal because we did recognize that our countries alone, each of them alone, they have a small size of population. It's making it very difficult for them to advocate. But getting, coming together and being a kind of bloc can make it a major case in terms of play Dwaye or Advocacy for more resources, more attention to the region. So this is all what it is about, the family planning, the Wagardu partnership. I think we are seeing progress in terms of funding, but funding is still a big issue. You said it, they have, countries have now very strong costed implementation plan. We are seeing a lot of progress being done but still we are also facing with gaps in terms of funding. So I think this is a big issue that we need to keep working on for the coming years. We are trying in this platform to work and to work with new donors, to work with private sector, to work with the civil society organization, as you said it. But still there is, it's very, very difficult and it's a long way to go and I hope that we all can make it, you know, forget it. Great. Thank you, Fatimata. Great, well we've heard, let's give her a hand, sorry. I'm going to deprive you of that. Thank you, thank you again. So I'm going to just, because of time, I think I'll ask our panelists one question of mine and then I'm going to open it up to you, so start thinking of your questions now. I think I'll start with you, Katie. You alluded to this earlier in your remarks. So how does USAID think about making family planning sustainable or sustaining the successes that you've had so far in Senegal and then how do you evaluate when you think that the program is ready to be sustained and we have success in family planning? So we've actually published papers on graduation strategies that worked well, particularly in Latin America and elsewhere so we're happy to make those available. I think though you can't think about funding family planning in isolation. Senegal and Minister Kudsek has been very vocal about having a package of essential services and the cost of that package of essential services is unfortunately doesn't stay static so there's inflation, there are all sorts of things. So how do you think about ensuring, because right now the relative, because of the high proportion of overseas development assistance, the relative proportion of what the government contributes is actually quite low and out-of-pocket contributions are I believe in the order of 30 to 34%. So then the question becomes as you look at a country that will become richer over the next 10, 15 years, then how do you incentivize not just this wonderful minister but the minister of finance and others to ensure that the right fiscal allocations are made but at the same time that we have other ways of funding. Now I think the Mutuelle plan of expanding Mutuelle I think from 6% today to possibly three quarters, 75% is a wonderful and very creative way of getting there. The social franchising model that you have that Marie Stopes, so how do we then expand on programs like that that are increasing the quality and availability of services to also find ways to increase the possibility of funding those services. At the dinner yesterday we had Dakar, the city of Dakar, USAID supported with a loan guarantee a municipal bond issue for the city of Dakar. It wasn't in health specifically, but it could be. So how do we bring these very creative tools that are out there but we may not have applied them to help to help a very forward thinking country in supporting and building up these other types of revenue streams because it can't forever come from donors. Right, great. Thanks, Katie. Nomi, I wonder if you could talk about why the Gates Foundation would collaborate in a partnership like the Wagatagu partnership and what benefits you see and what challenges, frankly, you see from that collaboration just in terms of thinking about making your dollars go further. Thank you. To start, I would say just reflecting on the earlier comments that there's no one donor that can do it alone. And in fact, the greatest strength is our ability to work together in following the national governments and aligning against those costed implementation plans. And that really is a critical piece in the way in which we can play a role. I think also just reflecting on the comparative advantage of different donors and being savvy at using donors in different ways. So looking at the informed push model, that's a great example. The foundation may be more willing to take risks. They may be able to move faster, be a bit more nimble. And so how do you piece all of those things together to then take the learning through that, partner with groups like Merck for Mothers, apply the lessons with USAID, bring in UNFPA. And so I think the more that we can think about the different comparative advantage and the roles of each of the different donors and how we kind of stagger and build the results is important. And I know you didn't ask this question, but I'm also going to add in for the foundation the role of voice. And so while particularly within the Waguadugo partnership, there are great dollars, which are so clearly needed, that the more that we can bring in to this partnership, the more donors that we can attract, the better. And one way of doing that, that's not actually financial, is leveraging voice. And I think that we've seen just such tremendous support among the co-chairs, both Bill and Melinda, in supporting family planning. And Melinda particularly, who's visited Senegal twice, and knows about the Waguadugo partnership, is following the progress and is tweeting about it and continuing the dialogue. And we want to leverage that, whether it's at the World Health Assembly or on social media, that we continue to use that voice to attract more players to help support the region. Great, thanks, Kimmy. Fatimata. Yes. So Senegal at the London Summit committed to double the funding that it's committing from its own government resources for purchasing contraceptives. And we know that that was a very exciting commitment, it was a very important commitment, and one that we hope that the other Waguadugo partnership countries will make. So just aside from Senegal, how realistic do you think it is that the other Waguadugo partnership countries, and you named them earlier, they all have varying levels of resources available for family planning? How realistic do you think it is that they will commit to their own government funding for investing in family planning? If that's possible? All the nine countries made commitments to the Waguadugo partnership in 2011 to contribute very significantly in the family planning area. And all of the nine countries, again, made it to FP 2020. And among the commitments to FP 2020, there is a specific commitment to increase the domestic and the government contribution to the family planning. And as you said, we are seeing a bit of move. They are coming and trying hard, despite the very difficult situation, to meet this commitment. Senegal did it. We were together recently, as you said, in this mini-Caravan to some of the Waguadugo partnership countries. And we noticed that in Niger, Niger being one of the poorest countries of the world, where also they are challenging a lot with family planning and reproductive health issues. You all know that this is the countries with the highest fertility rate of the world. But we are seeing a lot of commitment also from that country. And we have been told that in that country, in Niger, they have tripled their contribution to family planning, despite all the priority that they are facing with. Same thing in Burkina Faso. Burkina also, since during the past two years, they have doubled their contribution also to the family planning area. So, and the other countries are trying in somehow, seeing that last year in Mauritania, they committed about $50,000 for it. Yeah, but this is the first time, even it's a signal. And to show that they will make it. I think despite of those increase and shown from the countries in terms of investing of family planning, they still have a long way to go to meet those commitments. And again, I'm saying that all the nine countries are not in the same level in terms of funding, even internally and externally. If you take a country like Togo, so few donors in these countries, so few investment in this country, go to Mauritania, it's the same thing. So, and I think if we want to go along as a block for this partnership, and this is something that I'm not saying, but this is coming from the countries, equity, they are asking about it all the time. So why some countries did receive more than us than the others? So I think we need also to think about how to help the other countries to do so. And this is really my vocal advocacy for the countries. They are very committed to the family planning. They are trying to implement the high level interventions, impact interventions, high impact interventions, but many of them are of need of financial funding and I support. And I think this is really my advocacy to have also that you think of the other countries are trying, can make it, because Senegal have shown that it is possible. Just getting back when early we developed those cost implementation plan. When the nine countries come together and say from 2012 and 2050, we would like to put one million additional women on the modern contraceptive. So what that means in terms of weight, looking at the objective of FP 2020, 120 million versus one million. That was like peanuts. And we kept saying, this is our ambitious goal. And people are looking at me and said, Fatima, what are you talking about? One million additional women, I said, yes, it's ambitious because to reach, to get this one million additional women, most of the countries, almost all of them, they have to double their contraceptive prevalence rate within one year. And many of people were very skeptical about the feasibility and the duality of that. But Senegal is now demonstrating that it's possible. And you talked about the successes, the factors that lead to the successes. It's being all the high impact intervention, being implemented at the same time, combined with the political will and the leadership in Senegal. And I think if we can take those lessons and do the same in maybe three, four countries, maybe not all the nine, I think we will make a tremendous difference in this West Africa region. And this is also what I'm calling on these origins, to think about what we can do and have. Great, thank you. So in the interest of time, I'm gonna throw it open to the audience, but I just wanna underscore that we heard a number of different themes here in funding. There's the idea that we need better private sector involvement and some creative financing mechanisms, KDE reference bonds. I think that's a really intriguing idea for this community to look at. And then NOMI highlighted the role really of what we at Hewlett call beyond the grant dollars or what are the assets that these organizations can bring to bear on this issue in Senegal. And then I think Fatimata really highlighted the role of the government's own financial contributions. Not only its leadership and its political engagement, but some financial engagement as well and what some of the challenges are for doing that. But what even $50,000 from the government of Mauritania really does symbolize in this context. And we have to keep it all in its specific context. So I think we have time for we'll get three questions and then so the panelists can each be prepared to answer at least one of those three I hope and we'll take some closing remarks and I think we'll wrap up from there. So let's see a show of hands. Okay, I think you had your hand up first. Please introduce yourself as well. Jill Gay, what works association? Question for the four of you. How do you plan to collaborate with the Senegalese government, both the ministries of education as well as the ministries of health to address the needs of adolescent girls under the age of 18, both married and unmarried to access sex education, family planning, HIV prevention as well as meeting the needs of adolescent girls living with HIV and gender equality. Okay. Thank you. I'll see. Another question, Roy. Oh, why don't you? Hi, Roy Jacobson, InterHealth. I, speaking for the family planning community, you know, we're a very evidence-based community and one bit of data that wasn't mentioned yet that I think would be very interesting to people, not only has, have these rises in contraceptive prevalence the last two years been among the highest recorded anywhere but there is an indicator, the percent of the demand for family planning that is being met by modern contraception and in 1993, Senegal was, this is a kind of an additional compliment to our friends here from Senegal. In 1993, the program was only meeting one out of eight women's needs. It's now meeting almost one out of two. In addition, there are a number of mega, I'm gonna get to a question but these are things worth thinking about. There are a number of mega trends that are driving increased demand for family planning that are predictably going to continue. So we've heard, we saw in the lovely movie about women's agency, urbanization. There are a number of driving factors that we know it's going to increase. On the other hand, some, I think Pop mentioned the Asian tigers, they're at over 70% prevalence. So Senegal has made tremendous progress. It's at 20% prevalence. So we don't wanna pull out too soon from donor support. We definitely wanna advocate with ministries of finance and make the case that you will never become an Asian tiger if you don't invest in family planning. It's a fact, so you really need to do that more. My one observation about West Africa, so this is a question for the previous panels as well as current ones, is we've been talking about funding but we haven't talked really about the cost of the client. And in East and Southern Africa, in Asia, when they were at 20%, it was very much seen as something the government needed to do. So while we do need to advocate getting greater private sector involvement, I think we have not focused enough on the cost of the client and what we can do to make sure that either services are free or highly subsidized. So I wonder what your observations are. Thanks Mike, great. One more question please, you have to go ahead. Hi, my name is Gina Bradford. I'm president and CEO of my firm BMG3 Enterprises. I have been working with the Senegalese government on the Emerging Senegal Plan. And my question is, as an investor, as a construction developer, how can I get involved on the ground and donate? Is there a hub? I heard what you said as far as the Wagadu-gu... Bob Parsh. Okay, I'm sorry. NGO, but is there a hub where I could donate or be involved with the government or with NGO? How would that work? Great question. Okay, why don't we start with that one? That's kind of fun. We've got a new audience member, Ms. Bradford. You've got, there's a lot of work going on in construction in the region and infrastructure development. And it may be that this is an opportunity to engage, as we've just said, some private sector investment, since this is an issue critical to development more broadly. So given that the Wagadu-gu partnership is not a pooled fund and it's not a project, it's a movement, what are the opportunities if someone like Ms. Bradford would like to invest locally to do so? And maybe this is also a challenge to us to think about ways to engage someone like her. So Fatimata, do you have any thoughts? You are based in Dakar. Maybe you'd like to invite her for coffee or tea the next time she's here. Yeah, I think I'm gonna give you, I'm gonna give you my business card. Because as I said in my words, the role of the coordination unit for the Wagadu-gu partnership is to attract more donors and then many of the new donors who want to invest in family planning in this region contact us and then discuss with us about their interests. We can give you an overview of the region but country by country. We have also this tool that is the constant implementation plan that helps you to see exactly what are the priorities set in this document and then put you in touch with the government of that country, the given country you might be interested in investing in too and then facilitate your discussion, collaboration with that country. As I said, this is not a pool for funding but it's facilitating and also helping to direct new funders and new donors to given and specific countries based on their interest, comparative advantages and so on and so on. So we welcome you in this region that is in need and you will see how it is exciting to work with these wonderful people who are very committed and to make difference and to show in the face of the world that they can make it. Thank you. So maybe we'll take, we'll start with the first question from our colleague from What Works about how we as donors think about meeting the needs of this adolescent population and I know this has been highlighted already this morning but I wonder if I could hear from both USAID and the Gates Foundation if you both have been thinking about this topic how you think we can meet the needs of this population given that it's a sensitive topic in Senegal and in the rest of the region. I think it's a sensitive topic anywhere. My son turns 15 today, it's his birthday and if there's one thing he does not want to do it's to talk about sex with his mother. So speaking with that target group no matter how close you are to them is always going to be tricky and complicated. It's particularly complex in societies that may be more traditional and that's where I go back to why it's so important not just to continue to engage use directly in youth programs but because of these sensitivities and difficulties also to ensure you engage societal leaders like the whole religious and faith infrastructures that exist. I mean the Conférise in Senegal are the brotherhoods are both religious and societal structures that are meshed and so can you leverage and engage with these leaders and structures that have youth groups and have women's groups more proactively in such a way that you can bring these conversations in trusted settings to youth who need it. I mean I go back to voice, you mentioned voice. It's not just the voice of the government, the Senegalese government or of a donor but engaging the voices of the various Senegalese parts of society that can have that impact. And I would tie it, actually there are emotions and real voices but there are also intellectual voices. I think the other question over there from, was it Roy? On the ensuring that, it was a financial question ensuring that we continue to subsidize and support. I mean I absolutely agree with family planning at the same time there's also an intellectual voice, the rapids, the rapids that were developed in the 1970s, we need to refresh them. We now have the rapide religieux for family planning, the religious rapid but that, nutrition today is probably doing a better job. Sometimes we talk about demographic dividend that nutrition will say well it can contribute 11% to your GDP, that's a sexier number. So how do we make these various levels of voices intellectual and youth accessible and add up to something? Naomi do you want to pick up a little bit about, I know you've got a recent focus at the foundation on adolescent regular for health and maybe talk about if it is playing out in Senegal and Niger and in the region for the foundation and if not will it and what will that look like? So it's all very new in December we had, actually before I started I had the opportunity to be there with the conversation with Melinda and I think in large part to many people in the room who were saying after the summit where's the role of the foundation with adolescents and youth and there was a big effort within the foundation to really dive deep into looking at the data and understanding what the potential of role of the foundation could be in addressing the needs of adolescents and in fact we are now moving forward with from that conversation continuing to develop the approach. So I think a big part of it is stay tuned but specifically to Jill's question around young people under the age of 18 and I was referring to this in the sense that there are many adolescents we can think of the girls at the university that Micah's program is servicing but there are many girls under the age of 18 who are married and in fact we often hear about the incredible campaigns to end child marriage but those young women need family planning services and they may not be feeling comfortable or welcome they may be facing incredible provider bias and there's a huge opportunity to space which is really I think in some ways the most easiest thing that we can do is increase our ability to address postpartum family planning with a specific lens to adolescent of course we wanna be able to also delay the age of first pregnancy of first birth but we have a tremendous amount of opportunity within the space of working with adolescents among young people who are married to do a better job of reaching and servicing them and then of course to work on those harder issues among the unmarried and the foundation will be working on support of testing and developing models and figuring out ways that we can continue to be innovative and of course those partnerships across the board young people are coming in as Micah saw in her clinic not to say well I want you to talk about my contraceptive needs but I have STI needs or HIV screening needs it's the whole person and we need to continue to do better around collaborating for time I just wanna quickly respond to Roy to say I'm becoming very obsessed with understanding the cost of each delivery and of service provided and I think we need to continue to drill down and get much smarter about the actual cost and then understand those opportunities for efficiencies so that's one piece of moving forward it's just a small piece but recognizing that your question that and in fact then understanding those costs will help us know how much we need to leverage to have heavily subsidized are we working through insurance schemes ways in which we're involving other people but we can't do that well until we really understand the cost per per contraceptive method right it's gonna take longer to counsel someone for an IUD than it is to give a cyanopress and so the smarter that we can all be and that we can all collectively share that information I think we'll increase our efficiencies and let the dollars stretch further Okay thanks so much to you all I know we've put a lot of issues on the table and I apologize that we don't have time to do another round of questions but I encourage all of you if you can have time at lunch to find our speakers and follow up on some of these points so I think I'll just give each of them a final word if you will and if you want if there's anything you haven't shared with us if you wanna leave us with some words of hope and optimism that's always a good thing so I will start with Fajmata to my right if you will just wrap us up please Yeah I think this discussion will never end and will continue so I'm saying just a few words to end this session Yeah we are seeing a lot of commitment a lot of progress in the countries and putting the spotlight on Senegal today is really important for us but also for the other countries because as I said countries are to learn from each other and I think Senegal has a lot to show to the other countries something that we would like to see happening maybe starting tomorrow is to see professor Eva Marikosek you know her honorable ministers her excellencies you know Ministers of Health and Social Welfare to be one also of the advocate among the ministers of health of the West Africa region so that they also you know do as she did in Senegal so this is something that we would like you know to see happening more and more the second thing that I would like to say is that yes we are making progress but those progress are very fragile and need to be also you know be accompagné not you know to demonstrate that something is working somewhere and then leave it you know the year after without you know the all the sustainability discussion that we have had is really very very important and also you know talking about the equity in terms of funding the countries of the Wagarduk partnership I know that sometimes you know there is some political issue that made you know donors to go in such a country versus another countries but you should think that we collectively are engaged in improving the life of woman and girl not only in one country but in all the countries and I think you know there is something to do for that so West Africa region is ready there is a readiness and I think with a bit of support we will make it Great, Katie. So first of all I want to give a shout out to two of our USAID team Rama here raise your hand Rama and Carmen Tull Rama's because when I say that USAID is absolutely committed to continuing to support Senegal and the Wagarduk partnership in its family planning objectives it's all of USAID and first and foremost the person, the voice leading that charge in Senegal for our agency is Rama with support from Carmen and many others here in Washington so it's where we're a team we work with all our partners but without you guys we can't sustain that support and we are hoping that the government of Senegal will meet its goal of 27 MCPR and whatever goal you set for after 2015 we want to be as supportive of you as we can with our voice with our funding with our programs with our partners we believe in the political will that you have demonstrated and that that can be transformational and we hope that you will continue to be a voice in Senegal and beyond in this space because we we are committed to improving the family planning reproductive health results and programs because those are so transformational for the society so we're here let us help Great, I know who you want to wrap this up for maybe just quickly in closing again thanking the Minister of Health and Dr. Duff for being here it is such a pleasure and I really do hope that the lunch break people can have an opportunity to talk to you and to recognize Margo your leadership and I think for everyone who has been involved in the region that your champions within your own agencies and I know that about so many people in this room and then that's what's bringing in more so Margo you have done just an outstanding job for a long time Thank you, thank you and we're looking forward we're not going to get tired we're going to keep it up collectively and keep the kind of the finger on the pulse for the region and make these successes continue to shine Great, well let's just thank this panel thank you guys very much I want to thank you all for again for being with us today it's been a fantastic opportunity to engage with you all and I think as Nomi said we should see this as the opportunity to be moving forward on these issues and not see this as a one-time opportunity to be looking at the issues of family planning in Senegal and in the sub-region so we look forward very much to keeping this momentum moving forward and staying in touch with all of you so now it is my pleasure to reintroduce to you the Minister of Health Madame Le Ministre Minister Colsec to give us her closing keynote and final thoughts thank you thank you Janne I think it will be as I said at the beginning more keen not a keen, not addressed but more maybe some ideas on Senegal and maybe on what you have said already but let me first congratulate all the panellists I think that all of us it was a great pleasure to listen to you panellists, moderators and also to all those who have taken the floor and have the opportunity to ask questions or to contribute and I would like really to have a round of applause for them I would like to thank the Centre for Strategic because I forget always a strategic one international studies for putting Senegal on the spot I can say some people are saying spotlight kind of I was thinking maybe it will not be a spot dark or something like that but finally it was a spotlight and I think that it was very important for us to have this opportunity to share with you and to have your inside and your ideas on some topics and I will come back to that later because I agree with you I have seen a focus on maybe the issue of men that we didn't tackle but also other theme I would like to add to our discussion in Senegal we have set ambitious goals and we are fighting really every day to achieve them our objective is to increase contraceptive prevalence rates for women from 12% in 2012 to 27% in 2015 I am confident that we will reach it because we want that and as you say if you want something always I think that we can do that we want it we will do that but we will do that together because the government alone cannot do and cannot achieve this goal we need to continue to work together as we have done it in a coordinating manner and I am sure that we will have results we must give to our population men and women access to information they need to understand things I have heard from our friends from Marihop that at the university some young people were not very well informed this is a shame we cannot change things increase our prevalence coverage if people are not informed I think this is the first step how to do that is another story but we need to have the way to speak with people and to inform them without information you cannot have any change but we need also not to inform only people but to make sure that services are accessible to all but especially to the more vulnerable the most vulnerable of the population because if you look at our countries you have privileged people who can do everything they have access to what they want if our program need to succeed we need to reach the vulnerable one the poor one those who cannot have normally access to things to reach these objectives the government has has committed to increase its budget for processing contraceptive by 200 percent and to double the budget for management of reproductive health program in addition the government opened the door to multiple partners ready to support our family planning programs I it was my honor to represent his excellency the president Makisal at the London summit in July 2012 and I make this commitment of reaching and doubling and things like that and when I went back home I called Dr. Daff and the team and I say I don't know if you are ready for that but I have committed myself and I have committed Senegal to do things now who is ready to go with me they all say we are ready okay if we are already we will try to do that but it was a commitment I spoke also with the president I told him I'm sorry I don't know if you have who are ready to say all this but I say this and I hope you will be supporting me continuing to support me and he was he say of course I think this is very important and we need to really push this agenda if you are here today with some successes as you say is because of the partnership we had but also because of the leadership at the highest level possible you can understand my enthusiasm in defending such a cause given my activism in women's rights and my role as a mother because I am also a mother and a grandmother and also as a medical doctor but also by after listening people men and women in my own country but also in many corners of Africa and it is why we are supporting really this partnership the Wagadugu partnership because this is not a story of Senegal alone it's a story of all Africa but at least let us do something clear for the West African countries with all these voices we and I heard and you heard I think that we understood better the desire for better life and better future for the family of our people but happily this perspective correspond also to the global vision we have today in the world concerning family planning so it was very important to commit ourselves very important to have this in line also with the global commitment and to have it in line with the leadership in the country in our country we need to show really leadership this is also very important we cannot sit in a country and wait for people to come and do the job we need to show our leadership but to show also that we are open to work with people it's not because you have partners coming to support you and helping you that you are not putting in place your leadership some can think that the leadership is only when you are alone to do things this need to be open but the leadership also need to define clear policy but also define clear strategy and have a very clear plan this need to be adapted to our social and cultural environment we cannot have the same strategy the same plan all over the world each country has its own reality and need to look at the global but also to see when you go to operation how to do that because you need to take into account your realities and try if the realities also are not in line with what you want you need to see how to change also behavior to change the mind of people but you cannot just come and say what I have been done in the US or in France or in Burkina Faso is the same thing I will do to Senegal this is something important we understood and I think that all the partners really have understood the same thing family planning is a complex subject that needs the involvement of religious leaders civil society leaders and the private sector we need active and inclusive participation by all parts of the community our vision is that each Senegalese woman needs to take control of her own health and therefore have access to family planning if she wants it we cannot impose family planning too and if people understand that this is good for them it is a way to go and they want it and we give it to them because we have the services necessary accordingly we must encourage all actors to remain to maintain this momentum okay we are all happy because things are improving but we don't have to stop here we have a lot of things to do and we need to maintain this momentum and we are in April in December you will have to count and to see if we are reach our 27% and this is a big challenge if we already what we have done I have discussed with some people who told me that you have one or two countries who have been able to do this game in a very short time but what we need to do this year is more than what we have done it is why it is a big challenge and we need all of you to be with us to be able to achieve these results I would like to highlight specific challenges for African countries because it's not only Senegal I would like us to look at it broad this is about the importance of targeting adolescent and taking care of their sexual and reproductive health needs and linking this question to the country development by investing in health for youth we are able to deploy our resources in development project that will allow our country to grow economically the impact of such a youth policy also impact the security of our region by reducing the young people dependency that lead to illegal migration you have heard recently what happened in the Mediterranean Sea where almost 1000 of people died because of this issue of migration if they had things at home they will not go anywhere this is why I just it's a digression but I want to say that this issue of migration is a global issue is not an issue of the African country or the Asian etc because everywhere you have a problem of equity of security of an unpriming people will want to go elsewhere and this is very important we will be discussing this in another forum but I wanted just to highlight this here but when we say also illegal migration we need also not to forget terrorism all these young people who have nothing to do are very vulnerable to any of the information they have or people who want to put them in a way which was not what they thought at the beginning this is also one of the issue and I think it is why the entry point of family planning and we can go very far in the discussion given all the benefit of family planning I am sure and you will agree with me that this contribute to greater human capital increase productivity economy gains and environmental conservation family planning can contribute to the economic growth of Senegal by realising the demographic dividend I heard this discussion on that also family planning can do more because can resolve problem in the short term but also in the long term though it is more global but it is something we need to put on the table and I think that with the effort we have and which are ongoing today with all of you we will be able really to put this demographic dividend with content and something concrete this is why we need to have family planning at the heart of our national development strategies and I say that already and I repeat it improving human capital is a priority for the plan Senegal emergent and huge investment have been made and will be made in the area of education and health because without that we cannot have economic growth this was a fight also because economists who started this process of the plan Senegal emergent was looking more in sectors you can have quick return and for them economic growth and we have been fighting to say no, no, no you cannot speak only of agriculture, infrastructure etc you need to speak of health and education the people are key if we want to have something happening in Senegal and after all this discussion finally in the plan the human capital is center and we are working now to push a lot health everywhere to ensure that it will not be only an economic plan but it's also a human plan I want to go quicker because I don't want to take your time but I want to also raise another issue which is the issue of coordination because it has been also discussed here but Senegal is proud on the way it has coordinated with its partners the partners coordinate among themselves but also with us to optimize resources utilization and avoid duplications because I think that in the discussion people said that we have put a lot of money on health and family planning for a long time it's not new the money was there maybe it was not enough but the money was there but the partners also were there some of them a lot I can say working alone without link without coordination long this is very important and I think in Senegal we are proud because I have this discussion with other Minister of Health who are complaining but I say in Senegal seriously I am very happy because the partners are working together and we are seeing result in a lot of programs we have also consultative forum about increasing demand and security of contraceptives these forums are regular and people are meeting almost every month or three months and I think this participatory system helps resolve problems we value also the Wagadoo partnership to share experiences and we are very happy maybe three, four, five months ago we had a meeting to evaluate our program and the people from different countries of the sub-region was there and I think this has been very successful because they learn from what we were doing but we also learn a lot from them this is a way also to increase what we are doing another point is one of our major challenge reduce our dependency on external resources we have a lot of support and we thank you all but our political will must be accompanied by domestic resource mobilization and innovative financing we are today trying to create a sort of health fund by from the government by also using some taxes on tobacco on alcohol on sugar drinking also because we know all the diabetes and everything happening we say why not there too and a lot of people are drinking it why not the small money can help a lot of people and also using transaction all this we are working on that because we don't want to always waiting for good people like you to give money at the end of the day your own people will ask you if it is not enough but until now and until the time we will have this money I think that we need to agree and to agree on the fact that we need the partners we need you because the transition time between now and the time we will have all this in place if the partners are not continuing to support us I think that we will lose this momentum and we will lose also all the results we have because all this is fragile it's the same for all the disease for all the programs just two days ago I was speaking for the World Malaria Day and Senegal is doing very well but I say okay but if we are not continuing the work and if we don't have the support particularly of the USA the global fund all this we will be in trouble we have decreased seventy percent of the prevalence of malaria in Senegal because we are using all these nets we are using indoor reviewers praying in some region we are having a community involvement etc etc but all these are the costs and we need to continue really to have your support let me because it is the opportunity I have also because I have said that to people in the field but I would like to use the opportunity of today to say to thank all our partners and these partners some are giving financial support or the technical support or the give us a platform I would like to thank everybody because at the end of the day we value all your support and particularly I need to insist on USAID UNFPA the Bill and Millen de Gates Foundation the Wallet Foundation but also their executive agencies because a lot of things are done in the field with these agencies like NGOs like Entrahels Ademas Child Fund Merckham and Mothers I think this is also a group I need to to highlight FHC 360 ABD Associates Maryshop and Senational but also the UN agencies because for their technical support it's also very important often WHO or UNICEF World Vision a lot of people are there now that I have given names I am in trouble but I want to tell you that I thank you all and I would like all of you to continue to support us in our work but let me we are here in the US and because the US is one of our main partners and I can say our main partner and in a lot of programs on health in Senegal I cannot just group everybody like this I want to highlight the US beyond family planning the US is supporting us in other areas and a lot of them like malaria, HIV AIDS reproductive health in general but the recent Ebola outbreak has been an opportunity to transform and strengthen the health system in our country and really I would like to thank the US for that the US is one of our primary partners and I would even say our primary partner when it comes to financing reproductive health and in particular family planning I hope this exemplary partnership will be strengthened more and more each day I take this opportunity also to express my deep appreciation and thanks to the government and the people of the United States for their continuing and increasing support thank you to our host and convener to this meeting I hope that this example will be followed by others and that leaving going back home we will all say this is what we need to do sometimes not every day because we have to work in our countries but I think that this is very important to put all this expert all this mind together and try really to change the world because if with family planning we are able to empower women we are able to decrease maternal mortality we are able to focus on adolescents our future I think that we will do a lot for our countries our continent and the world thank you very much there's really nothing left to say after that passionate final remarks from Madam Minister what an honor and a privilege to have her here in Washington and I hope that her words will stay with us and the example of Senegal not only one that we looked at briefly today but that will carry forward in the work we're doing in partnership with the opportunities that all of us have from our different vantage points to make sure that these kinds of this progress goes forward and that the leadership is supported and that the broader sets of issues that Senegal is tackling will be done with a broad community supporting them so please join me in thanking the minister