PROGRAMME BUDGET 2018-2019 - Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of ...

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PROGRAMME BUDGET 2018-2019 - Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of ...
Department of Reproductive Health and Research including
Special Programme of Research, Development and
Research Training in Human Reproduction (HRP)
PROGRAMME BUDGET 2018-2019 - Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of ...
PROGRAMME BUDGET 2018-2019 - Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of ...
Department of Reproductive Health and Research including
Special Programme of Research, Development and
Research Training in Human Reproduction (HRP)
PROGRAMME BUDGET 2018-2019 - Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of ...

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PROGRAMME BUDGET 2018-2019 - Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of ...
ACRONYMS AND ABBREVIATIONS                                                   II

1.     INTRODUCTION                                                         1

1.1    HRP’s mandate in sexual and reproductive health and rights            1
1.2    Impact of HRP’s Work                                                  3
1.3    HRP’s theory of change and results framework                          4
1.4    Output indicators                                                     6
1.5    HRP Portfolio review, 2016                                            7
1.6    HRP programme budget and operational plan, 2018–2019                  8

1.7    Monitoring and accountability                                        11

2.     HRP THEMATIC AREAS                                                   12

2.1    Family planning and contraception                                    12
2.2    Maternal and perinatal health                                        14
2.3    Safe abortion                                                        16
2.4    Sexually transmitted infections and cervical cancer                  18
2.5    HIV–sexual and reproductive health and rights linkages               20
2.6    Fertility care                                                       22
2.7    Sexual health                                                        24
2.8    Violence against women and girls                                     26
2.9    Adolescent sexual and reproductive health and rights                 28
2.10   Female genital mutilation                                            30
2.11   Sexual and reproductive health and rights in humanitarian settings   32
2.12   Disease outbreaks and sexual and reproductive health and rights      34
2.13   Human rights, gender equality and social determinants                36
2.14   Digital innovations                                                  38
2.15   Measuring and monitoring indicators                                  40
2.16   HRP Alliance                                                         42

2.17   General technical and programme management activities                44

3.     HRP BUDGET TABLES                                                    46

Annex 1.    HO Department of Reproductive Health
           and Research (RHR) indicative budget tables                      46

REFERENCES                                                                  50

HRP PROGRAMME BUDGET, 2018-2019                                                   i
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     Table 1. O
               utput indicators and targets for 2018–2019                                          6
     Table 2.    H
                  RP programme budget and indicative programme development
                 for reproductive health (PDRH) budget (US$ thousands                               9
     Table 3.    F
                  amily planning and contraception: products and milestones                       13
     Table 4.    M
                  aternal and perinatal health: products and milestones                           14
     Table 5.    S
                  afe abortion: products and milestones                                           17
     Table 6.    S
                  exually transmitted infections (STIs) and cervical cancer:
                 products and milestones                                                           18
     Table 7.    H
                  IV–sexual and reproductive health and rights (SRHR) linkages:
                 products and milestones                                                           21
     Table 8.    F
                  ertility care: products and milestones                                          23
     Table 9.    S
                  exual health: products and milestones                                           25
     Table 10.    Violence against women and girls: products and milestones                       27
     Table 11.    A
                   dolescent sexual and reproductive health and rights (SRHR):
                  products and milestones                                                          29
     Table 12.   Female genital mutilation (FGM): products and milestones                         31
     Table 13.    S
                   exual and reproductive health and rights (SRHR) in humanitarian settings:
                  products and milestones                                                          33
     Table 14.    Disease outbreaks and sexual and reproductive health and rights (SRHR):
                  products and milestones                                                          35
     Table 15.    Human rights, gender equality and social determinants:
                  products and milestones                                                          37
     Table 16.    D
                   igital innovations: products and milestones                                    39
     Table 17.    M
                   easuring and monitoring indicators: products and milestones                    40
     Table 18.    HRP Alliance: products and milestones                                           43
     Table 19.    General technical activities: products and milestones                           44
     Table 20.    P
                   rogramme management: products, services and milestones                         45
     Table 21.    H
                   RP budget summary for 2018–2019, by budget section                             46
     Table 22.    HRP budget summary for 2018-2019, by budget section (products only)             46
     Table 23.    HRP budget summary for 2018-2019, by thematic area (products only)              47
     Table 24.    H
                   RP 2018–2019 budget compared with 2016-2017                                    47
     Table 25.    R
                   HR consolidated 2018–2019 budget compared with 2016-2017                       48
     Table 26.    RHR consolidated income requirements and sources of funds for 2018–2019*        49


     Figure 1.   HRP Results framework                                                             4
     Figure 2.    H
                   RP programme budget 2018–2019, by thematic area (product budget only)           8
     Figure 3.     RP budget 2016–2017 and 2018–2019,
                  by thematic area (product budget only)                                           10

ii                                                                     HRP PROGRAMME BUDGET, 2018-2019
PROGRAMME BUDGET 2018-2019 - Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of ...

AMR		         antimicrobial resistance
DMPA		        depot medroxyprogesterone acetate (injectable contraceptive method)
ECHO 		       Evidence for Contraceptive Options and HIV Outcomes Study
EMTCT		       elimination of mother-to-child transmission
FGM		         female genital mutilation
FHW		         front-line health worker
GRC		         Guidelines Review Committee
HPV		         human papillomavirus
HRP		UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research,
      Development and Research Training in Human Reproduction; also “Human
      Reproduction Programme”
HSV		         herpes simplex virus
ICD		         International Classification of Diseases
ICD-11		      International Classification of Diseases 11th revision
IPU		         Inter-Parliamentary Union
IUD		         intrauterine device
LGBTI		       lesbian, gay, bisexual, transgender and intersex
mHealth       mobile health
PCC		         HRP Policy and Coordination Committee
PDRH		        programme development for reproductive health (within RHR)
RCS		         research capacity strengthening
RCT		         randomized controlled trial
RHR		         WHO Department of Reproductive Health and Research
RMNCAH        reproductive, maternal, newborn, child and adolescent health
SDG		         Sustainable Development Goal
SRH		         sexual and reproductive health
SRHR		        sexual and reproductive health and rights
SRMNCAH       sexual, reproductive, maternal, newborn, child and adolescent health
STAG		        Scientific and Technical Advisory Group
STI		         sexually transmitted infection
UHC		         universal health coverage
UN		          United Nations
UNDP		        United Nations Development Programme
UNFPA		       United Nations Population Fund
UNICEF		      United Nations Children’s Fund
WHO		         World Health Organization

HRP PROGRAMME BUDGET, 2018-2019                                                      iii
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iv   HRP PROGRAMME BUDGET, 2018-2019
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Established in 1972, the UNDP-UNFPA-                   Agenda for Sustainable Development were
UNICEF-WHO-World Bank Special Programme                formally adopted by world leaders at an historic
of Research, Development and Research                  UN Summit, and these officially came into
Training in Human Reproduction (also referred          force on 1 January 2016. Several targets were
to as the Human Reproduction Programme                 established for SRHR issues, primarily within
or HRP) is the main instrument within the              Goals 3 (Ensure healthy lives and promote
United Nations (UN) system for research in             well-being for all at all ages) and 5 (Achieve
human reproduction, bringing together policy-          gender equality and empower all women and
makers, scientists, health-care providers,             girls); these targets provide countries, and HRP,
clinicians and community representatives to            with clear directions for the next 15 years.
identify and address priorities for research
to improve sexual and reproductive health.             At the same time, the UN Secretary-General
HRP is a cosponsored Special Programme                 launched an ambitious Global Strategy for
executed by the World Health Organization              Women’s, Children’s and Adolescents’ Health
(WHO) in the Family, Women’s and Children’s            (2016–2030) (4) to further the achievement
Health (FWC) Cluster. Since 1998, HRP has              of the SDGs. This is a roadmap for achieving
been embedded within WHO’s Department of               the right to the highest attainable standard of
Reproductive Health and Research (RHR) to              health for all women, children and adolescents,
ensure strong linkages between the evidence-           which will transform the future and ensure every
based outputs of HRP and the normative                 newborn, mother and child not only survives,
guidance and programme development roles               but thrives. In May 2016, at the World Health
of WHO. Indicative budget levels for RHR’s work        Assembly, delegates made a firm commitment
in programme development for reproductive              to take forward implementation of the Global
health (PDRH) are shown in Annex 1.                    Strategy, based on a robust accountability
                                                       framework including all relevant SDG indicators
The overall mandate for the work of HRP in             together with several other indicators to
sexual and reproductive health and rights              ensure countries focus on all aspects of SRHR.
(SRHR) is guided by the global Reproductive            Member States also endorsed the Global
health strategy (1), adopted by WHO Member             plan of action to strengthen the role of the
States at the World Health Assembly in 2004 (2).       health system within a national multisectoral
The critical role of this strategy in support of the   response to address interpersonal violence, in
efforts to achieve the Millennium Development          particular against women and girls, and against
Goals was subsequently reaffirmed by the               children (5), as well as the Global health sector
World Health Assembly in 2005 (3).                     strategy on sexually transmitted infections,
                                                       2016–2021 (6), thus providing clear guidance
The period 2015–2016 marked a watershed                for HRP’s future work on these issues.
for SRHR, with the adoption of several far-
reaching international agreements in support           These coordinated international agreements,
of universal access to sexual and reproductive         taken together, form a bold new roadmap
health. In September 2015, the Sustainable             for SRHR as they aim to keep women,
Development Goals (SDGs) of the 2030                   children and adolescents at the heart of the

HRP PROGRAMME BUDGET, 2018-2019                                                                            1
PROGRAMME BUDGET 2018-2019 - Department of Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of ...
sustainable development agenda, unlocking their vast potential for transformative change. These
    agreements provide a strong global mandate for rigorous research that can produce the empirical
    evidence needed by countries to both implement the Global Strategy and achieve the SDGs.

    In May 2017, the Member States of WHO elected Dr Tedros Adhanom Ghebreyesus as the new
    Director-General of WHO, beginning in July 2017. Previously, Dr Tedros has served as Minister
    of Foreign Affairs and as Minister of Health in Ethiopia; as chair of the Board of the Global Fund
    to Fight AIDS, Tuberculosis and Malaria (the Global Fund); and as co-chair of the Board of the
    Partnership for Maternal, Newborn and Child Health (PMNCH). Throughout, Dr Tedros has stressed
    the importance of improved sexual and reproductive health and family planning services:

        “Simply put, we cannot achieve the ambitious health and development targets in the SDGs
        unless we improve the health, dignity and rights of women, children and adolescents. In too
        many places, gender gaps, harmful cultural and social practices and gender-based violence
        are negatively impacting women, children and adolescents. They are unable to reach their
        full potential due to lack of access to maternal health, sexual and reproductive health
        and family planning services; adolescent mental health, early education and responsive
        parenting; malnutrition; sanitation issues, including menstrual hygiene management; and
        harmful traditional practices, such as child marriage and female genital mutilation” (7).

    Dr Tedros has been a strong advocate for gender equality and the empowerment of
    women, children and adolescents throughout his public health and political careers, and
    has pledged to make gender equality a priority of his tenure as Director-General.

2                                                                    HRP PROGRAMME BUDGET, 2018-2019
In 2015, UN Member States adopted the “2030 Agenda for Sustainable Development” and its
17 sustainable development goals (SDGs). This is a universal set of goals, targets and indicators
that Member States will use to frame their agendas and political policies over the next 15 years.
Since its inception, HRP has led ground-breaking work underpinning many of the SDG targets.
Through this programme of work, HRP aims to impact the SDG targets shown in Box 1.


   1. By 2030, reduce the global maternal mortality ratio to
      less than 70 per 100,000 live births (SDG target 3.1)
   2. By 2030, ensure universal access to sexual and reproductive
      health-care services, including for family planning, information
      and education, and the integration of reproductive health
      into national strategies and programmes (3.7)
   3. End all forms of discrimination against all
      women and girls everywhere (5.1)
   4. Eliminate all forms of violence against all women and girls
      in the public and private spheres, including trafficking
      and sexual and other types of exploitation (5.2)
   5. Eliminate all harmful practices, such as child, early and
      forced marriage and female genital mutilation (5.3)
   6. Ensure universal access to sexual and reproductive health and
      reproductive rights as agreed in accordance with the Programme
      of Action of the International Conference on Population and
      Development and the Beijing Platform for Action and the
      outcome documents of their review conferences (5.6)
   7. Enhance scientific research, upgrade the technological capabilities of
      industrial sectors in all countries, in particular developing countries,
      including, by 2030, encouraging innovation and substantially increasing
      the number of research and development workers per 1 million people
      and public and private research and development spending (9.5)
   8. End abuse, exploitation, trafficking and all forms of
      violence against and torture of children (16.2)

HRP PROGRAMME BUDGET, 2018-2019                                                                     3
    HRP’s work is guided by a theory of change,             which are produced through various processes
    which is expressed through a results framework.         and with a range of interrelated inputs. For
    Through this HRP results framework, which               each of the five outputs, specific products and
    was developed in 2014 (see Fig. 1) and is               milestones have been developed. HRP plans,
    periodically revised, HRP aims to improve sexual        prioritizes and produces outputs by taking into
    and reproductive health, in particular among            consideration their potential outcome and likely
    women and young people. This impact is to               impact. The link between outcome and impact
    be achieved through fostering and facilitating          is made on the assumption that if policies and
    sustainable change in national and international        programmes reflect the evidence base and
    policy and public health programmes that                there is enough technical capacity on a national
    deliver sexual, reproductive, maternal and              and international basis to implement them, then
    perinatal health services. This outcome will            sexual and reproductive health will improve.
    be achieved by producing five broad outputs,


                           Improved sexual and reproductive health and rights, in particular among
          IMPACT           young women and young people

                           Sustainable change in national and international policy and public health
          OUTCOME          programmes

                           1. Creation of new knowledge            5.	Development of evidence-
                           2. Synthesis of research evidence           based normative guidelines,
                           3.	Strengthening of research and           implementation tools and policy
                               technical capacity                      statements
                           4.	Strengthening of research/
                               policy dialogue

                           •	Undertake and support                •	Cordination of research
                              research                                institutions
                           •	Research reviews and synthesis       •	Research capacity strengthening
          PROCESSES        •	Scientific consensus generation      •	Leadership in developing and
                           •	Policy dialogue                         monitoring global goals and targets
                           •	Partnerships                         •	Advocacy and communications

                             • Funds                        • HRP/WHO infrastructure
          INPUTS             •	Human resources             •	HRP global reputation

    A fuller description of how HRP produces each its five main outputs follows.

4                                                                       HRP PROGRAMME BUDGET, 2018-2019
                                                       RESEARCH AND TECHNICAL CAPACITY
This will be achieved through HRP’s capacity
to support a wide variety of primary research,         A significant portion of HRP’s research budget
including biomedical, clinical, behavioural, social,   is dedicated to strengthening research and
epidemiological and implementation studies.            technical capacity in low- and middle-income
The creation of new knowledge about the                countries. Increasing technical capacity will
frequency and distribution of health problems,         result in a greater body of professionals who
the determinants of health status, and the             are able to conduct research and work with
effectiveness of various innovations, and health       evidence to make the appropriate policy
system and service-delivery implementation             decisions and programmatic interventions
models, will directly inform improvements in           to improve sexual and reproductive health
policies in individual countries and add to the        outcomes. HRP has created a global network
global evidence base for predicting improvement        of expertise and centres of excellence in sexual
in outcomes for specific populations. For              and reproductive health research, known as
example, an external evaluation of HRP’s work on       the HRP Alliance. See Chapter 2, section 2.16
medical abortion during 2003–2007 found that           for more information about the HRP Alliance.
the high-quality research from HRP, coupled with
its collaboration with medication manufacturers,       OUTPUT 4: DEVELOPMENT OF
enabled the registration and distribution of           EVIDENCE-BASED NORMATIVE
affordable commodities to the public sector in         GUIDELINES, IMPLEMENTATION
low- and middle-income countries, facilitating         TOOLS AND POLICY STATEMENTS
the translation of the results of clinical research
to changes in policy, and thus contributing            HRP supports the production of WHO-endorsed
to the reduction in maternal mortality (8).            guidelines and standards. These documents
                                                       facilitate the use of evidence to inform and
OUTPUT 2: SYNTHESIS OF                                 shape policy and practice through compiling and
RESEARCH EVIDENCE                                      synthesizing multiple sources of information,
                                                       recommending evidence-based approaches
The synthesis of existing evidence results             to achieve desired health outcomes, and using
in a robust body of knowledge regarding                WHO’s endorsement for global credibility.
the effectiveness of interventions and their
implementation methods, and it also assists            OUTPUT 5: STRENGTHENING OF
with identifying high-priority populations or          RESEARCH/POLICY DIALOGUE
countries for action. This evidence can then
inform policies and programmes and result              HRP has a strong role in facilitating and
in the expected improvements in sexual and             strengthening research and policy dialogues
reproductive health. For example, HRP has              with and among key decision-makers. Through
published global and regional estimates of             this role, HRP provides influential leadership and
unsafe abortions, indicating a rise between            ensures that sexual and reproductive health
2003 and 2008, which led to the development            research is highly visible and that the most up-
of UN global estimates on maternal mortality.          to-date evidence is considered during policy
This information helps to inform global policy         and programme development, and that these
and funding decisions, including decisions             efforts are coordinated among concerned
about which populations or countries to target         departments at WHO headquarters and with
with specific interventions and resources.             WHO regional and country offices. HRP actively
A synthesis of evidence from six countries             engages with key political stakeholders and
identified a number of strategies that have            platforms, including the Inter-Parliamentary
proved effective in reducing maternal deaths           Union (IPU) and the G7, facilitating dialogue
(9). A number of systematic reviews have been          between research and policy, and promoting
produced, which have directly informed guideline       an evidence-based approach to legislation
development, including information supporting          development in relation to SRHR.
recommendations on postpartum haemorrhage
and labour induction and on the types of
progesterones in combined oral contraceptives.

HRP PROGRAMME BUDGET, 2018-2019                                                                             5
    The HRP cosponsors (including WHO) and                                  1), is shown in Table 1. The HRP annual
    donors have varying reporting requirements,                             technical report 2015 (11) reported that the
    some of which require establishment of                                  programme reached or exceeded its targets
    measurable output indicators and targets.                               for the 2014–2015 biennium, and the interim
    In order to efficiently respond to these                                report prepared at the end of 2016 showed
    requirements, one harmonized list of output                             high achievement values. Therefore, more
    indicators is used, which was initially developed                       ambitious targets have been proposed for
    in 2013–2014 (10). The list of indicators,                              2018–2019, as also shown in Table 1.
    linked to the HRP results framework (Fig.

    TABLE 1. O
              UTPUT INDICATORS AND TARGETS FOR 2018–2019

     OUTPUT                    OUTPUT INDICATOR                                      TARGET FOR 2018–2019
     1.    REATION OF NEW
          C                    1.1 Implementation research and clinical trials on     320   Scientific publications issued
          KNOWLEDGE                 sexual and reproductive health published                 reporting new and improved
                                                                                             tools, solutions and strategies in
                                                                                             sexual and reproductive health

                               1.2 G
                                    lobal and regional estimates of reproductive,       6   Global/regional estimates published
                                   maternal and perinatal conditions

                               1.3 I nterventions developed, tested and                 3   New interventions developed,
                                    implemented to address unmet needs                       tested and disseminated
                                    in sexual reproductive health

                               1.4 New or ongoing research funded                      24   Research projects approved
                                                                                             (by WHO and HRP institutional
                                                                                             review boards) and initiated

                               1.5 Gender balance among principal                     50%   Proportion of women among PIs of new
                                    investigators (PIs) of new and                           and ongoing HRP research projects
                                    ongoing HRP research projects*

     2.   SYNTHESIS OF        2.1 Systematic reviews of key questions                 80   Systematic reviews published
           RESEARCH EVIDENCE        in sexual and reproductive health

     3.   STRENGTHENING       3.1 National research capacity strengthened             20   Research centres strengthened
           OF RESEARCH                                                                       through HRP grants
           AND TECHNICAL
                               3.2 Individual research capacity strengthened*         200   Individuals trained through grants
                                                                                             and activities of the HRP Alliance

                               3.3 Gender balance in individual capacity              50%   Proportion of women among
                                    of individuals strengthened*                             individuals trained

     4.   DEVELOPMENT         4.1 Technical, clinical and policy guidelines           20   New or updated guidelines issued
           OF EVIDENCE-             issued on sexual and reproductive health
           STATEMENTS          4.2 Gender, rights and equity considerations          100%   Proportion of technical, clinical and
                                    mainstreamed into guideline development*                 policy guidelines issued on sexual and
                                                                                             reproductive health in which gender
                                                                                             and rights are explicitly elaborated

     5.   STRENGTHENING       5.1 Policy options analysed and synthesized,            20   Evidence briefs and other
           OF RESEARCH–             derived from technical and clinical guidelines           guideline derivatives issued
                               5.2 National capacity to support and develop             9   National or regional consultations
                                    evidence-based policies strengthened*                    convened explicitly for the
                                                                                             systematic introduction or revision
                                                                                             of policy and programming options
                                                                                             based on HRP research

                                                                                                     * New or revised indicator for 2018-2019

6                                                                                      HRP PROGRAMME BUDGET, 2018-2019
In 2016, the Scientific and Technical Advisory   (NGOs) and national partners, civil society,
Group (STAG) and the HRP Policy and              WHO regional and country offices, research
Coordination Committee (PCC) recommended         partners at the global level, donors, HRP
that the RHR Department review and               cosponsors, and the members of the PCC,
prioritize its outputs and key areas of work,    STAG and Gender and Rights Advisory Panel
taking into account emerging issues and          (GAP). The results of the review, which were
the capacity of the Department to respond        compiled by thematic area (see Box 2), were
within the limits of the available human         presented to and endorsed by the STAG at the
and financial resources. To respond to this      annual meeting in February 2017, and then
recommendation, the Department initiated a       used to develop this programme budget and
broadly consultative portfolio review process    operational plan, which is also organized by
in July 2016, involving over 600 stakeholders,   thematic area (see Chapter 2) and which will
including nongovernmental organization           guide HRP’s work for 2018–2019 and beyond.


   1. Family planning and contraception
   2. Maternal and perinatal health
   3. Safe abortion
   4. Sexually transmitted infections and cervical cancer
   5. HIV-sexual and reproductive health and rights (SRHR) linkages
   6. Fertility care
   7. Sexual health
   8. Violence against women and girls
   9. Adolescent SRHR
   10. Female genital mutilation
   11. SRHR in humanitarian settings
   12. Disease outbreaks and SRHR
   13. Human rights, gender equality and social determinants
   14. Digital innovations
   15. Measuring and monitoring indicators
   16. HRP Alliance

HRP PROGRAMME BUDGET, 2018-2019                                                                 7
            OPERATIONAL PLAN, 2018–2019

    The HRP programme budget 2018–2019                  approved by the PCC in June 2017. Following
    includes a list of technical products, milestones   the structure of the portfolio review process,
    for achievement during the biennium, and            the budget is organized by thematic area
    planned contributions to the output indicators.     (see Box 1), which represents a more detailed
    As in the past, each product has been assigned      breakdown than in previous years, as shown in
    a priority level, which will determine the order    Figure 2. The data are also presented by budget
    of funding and implementation over the course       section in the budget tables in Chapter 3 of
    of the biennium. This budget was endorsed by        this document, in order to enable clear linkages
    STAG in February 2017, and the HRP Standing         with organizational and managerial structure.
    Committee of Cosponsors in May 2017, and was


                                      HRP PROGRAMME
                                     BUDGET 2018–2019

8                                                                  HRP PROGRAMME BUDGET, 2018-2019
The workplan and budget of HRP is fully                         Furthermore, the operational plans for HRP and
integrated within WHO’s programme budget                        PDRH are shown in this document, although
2018–2019 (12). Specifically, HRP’s outcomes                    funding remains separate. The source of funding
and outputs contribute to the results of                        for each product is indicated in the product
WHO’s Category 3, “Promoting health through                     and milestone tables presented for each
the life course”, in particular Programme                       thematic area in Chapter 2 of this document.
Area 3.1 “Reproductive, maternal, newborn,
child and adolescent health” (RMNCAH),                          The budget levels for HRP are shown in Table
alongside WHO’s work in programme                               2, alongside indicative budget levels for
development for reproductive health                             WHO’s work in PDRH, which are included for
(PDRH), which is also administered through                      completeness. In view of the 8.8% budget
the RHR Department. Beginning in 2016,                          growth the previous biennium, as well as the
in order to provide enhanced transparency,                      uncertain financial landscape in 2017, the
HRP has been budgeted under a distinct                          Standing Committee proposed a “no growth”
output, which includes all of HRP’s research                    budget for 2018–2019, and this budget has
outputs, to distinguish it from RHR’s work on                   been prepared on that basis. Detailed figures
PDRH. This arrangement highlights HRP’s                         are shown in the budget tables in Chapter
instrumental contribution to the outcomes                       3 of this report. The changes in product
and outputs of WHO’s Category 3 work.                           (activity) budgets are shown in Figure 3.


                                                         2016-2017                       2018-2019
                                                                                                                   PERCENT CHANGE
                                                   Budget US$   Percent of total   Budget US$   Percent of total
Programme of Research, Development and
Research Training in Human Reproduction (HRP)

Products                                             41,040         60.0%            41,040         60.0%              +0.0%

Staff positions                                      27,360         40.0%            27,360         40.0%              +0.0%

Subtotal HRP                                         68,400         100.0%           68,400         100.0%             +0.0%

WHO Programme Development in Reproductive
Health HQ (PDRH) (Indicative, for information)

Products                                             8,605          53.4%            8,105          50.3%              -5.8%

Staff positions                                      7,500          46.6%            8,000          49.7%              +6.7%

Subtotal PDRH                                        16,105         100.0%           16,105         100.0%             +0.0%

Grand total Department of Reproductive Health
and Research (RHR) (Indicative, for information)

Products                                             49,645         58.7%            49,145         58.2%              -1.0%

Staff positions                                      34,860         41.3%            35,360         41.8%              +1.4%

Grand total RHR                                      84,505         100.0%           84,505         100.0%             +0.0%

HRP PROGRAMME BUDGET, 2018-2019                                                                                                     9
FIGURE 3.   HRP BUDGET 2016–2017 AND 2018–2019,

                          2016 — 17

                          2018 — 19                       US$ Millions

10                                                         HRP PROGRAMME BUDGET, 2018-2019
The success of HRP’s work in sexual and             research proposal funded by HRP; it meets
reproductive health depends on its scientific and   annually to assess the review process.
ethical rigour, its sensitivity and commitment
to human rights and gender equality, and its        The work of the HRP Alliance is monitored
capacity to address global priorities that are      and evaluated at annual meetings of the HRP
also important for countries, particularly low-     Alliance Steering Committee. At these meetings,
and middle-income countries. This implies           progress is reviewed and evaluated, and plans for
continual monitoring of the programme               the coming year are developed. HRP research
outcomes and output indicators. Monitoring          capacity strengthening projects are reviewed
is carried out by a number of complementary         by the HRP Alliance Steering Committee.
advisory and governing bodies.
                                                    HRP is evaluated at the annual meetings
The Scientific and Technical Advisory Group         of the Policy and Coordination Committee
(STAG) meets annually to review progress in         (PCC), at biannual meetings of the
scientific studies, to recommend priorities         Standing Committee, and through periodic
and to advise on the allocation of resources.       independent external evaluations. The next
                                                    external evaluation will be carried out in
The Gender and Rights Advisory                      2018, covering the period 2013–2017.
Panel (GAP) reviews the work from the
perspective of gender and rights.                   Each of these bodies is in a position to
                                                    assess, from different points of view,
The Research Project Review Panel (RP2)             the achievement of the programme
provides an independent scientific and              processes, outputs and outcomes.
ethical review and approval for every

HRP PROGRAMME BUDGET, 2018-2019                                                                         11

     Contraception is one of the most effective and       product development process through pre-
     cost-effective public health interventions. Its      qualification and introduction by convening,
     use is increasing worldwide but remains very         guiding and supporting key stakeholders.
     uneven across regions; it is estimated that
     some 220 million women living in developing          To meet the increasing demand for services
     countries do not want to become pregnant but         in the context of an existing health workforce
     do not use effective contraceptive methods           that is limited in size/numbers, and in particular
     for a variety of reasons. Moreover, improving        to reach underserved populations, efforts
     access to contraception could decrease               must continue to ensure the provision of
     maternal mortality by a third worldwide.             services by the most appropriate cadre of
                                                          providers, at different levels of the health
     Ensuring high standards of quality of care           system and through integration with other
     across the wide variety of service-delivery          services. This task sharing/task shifting must
     settings remains a challenge. WHO’s range of         be achieved while maintaining a high level
     guidelines relating to family planning, which        of quality of care and full respect for human
     are developed with significant support of            rights. HRP’s contribution will be to synthesize
     HRP, are widely recognized as authoritative in       existing evidence from programmatic
     the field. To facilitate their use, HRP and the      research, coordinate the generation of new
     RHR Department will continue to develop              evidence and convene key stakeholders for
     consolidated guidelines and derivative tools         periodic review and dissemination of the
     that are easier to adapt and use by intended         evidence on task sharing and integration.
     audiences, and that improve service delivery.
                                                          From the perspective of health system
     This guidance needs to be kept up to date as         strengthening, HRP will coordinate the
     new scientific evidence becomes available            evidence base for cost-effective service
     and potential safety concerns emerge.                delivery and financing innovations through
     HRP will contribute to the global evidence           multi-site operations research, and
     base on safety, efficacy and utilization of          develop guidance for their implementation
     contraception through synthesizing existing          at scale through coordinating multi-
     evidence, coordinating generation of new             site implementation research.
     evidence and convening key stakeholders.
                                                          HRP has a key role to play in the process
     A wide variety of contraceptive methods are          of developing and reporting on sexual and
     available. In practice, however, many individuals    reproductive health and rights (SRHR)-
     have a limited choice and there is a need to         related indicators under the Sustainable
     continue to develop methods that are better          Development Goals (SDGs) and the Global
     suited to a wider range of health needs and living   Strategy for Women’s, Children’s and
     conditions. As new or adapted contraceptive          Adolescents’ Health. It will take decisive action
     technologies become available (e.g.                  to ensure that global agreement is reached
     subcutaneous depot medroxyprogesterone               on operational definitions and indicators for
     acetate [DMPA] self-injection, pericoital            measuring and monitoring contraceptive-use
     contraception, multipurpose prevention               dynamics, particularly when it comes to the
     technologies), HRP will ensure that there is a       estimation of unmet need for contraception
     clear and coordinated pathway to complete the        called for under SDG indicator 3.7.1.

12                                                                    HRP PROGRAMME BUDGET, 2018-2019

 ID    PRODUCT                                                            MILESTONES                                                          CLASSIFICATIONS

 A01   Evidence for Contraceptive Options and HIV                         1. Follow-up and analysis completed for a multicentre,                                    Priority A
       Outcomes (ECHO) Study –evidence of HIV incidence                      open-label, randomized controlled trial (RCT)                                          HRP/FP
       and contraceptive benefits for women using DMPA,                   2. Results disseminated
       LNG Implant, and copper intrauterine devices (IUDs)
                                                                          3. New guidance developed, as indicated

 A02   Evidence of impact of an intervention                              1. Expert consultation and study initiation                                               Priority A
       promoting community monitoring and social                          2. Study conducted                                                                        HRP/FP
       accountability of contraceptive programmes
                                                                          3. Results disseminated
                                                                          4. New guidance and manuals developed

 A03   Evidence of safety of combined versus progestogen-                 1. Double-blind RCT implemented; follow-up completed                                      Priority A
       only hormonal contraceptives for women who are                     2. Analysis completed                                                                     HRP/FP
       exclusively breastfeeding and for infant weight gain
                                                                          3. Results disseminated
                                                                          4. New guidance developed, if indicated

 A04   Acceptability, safety and effectiveness of pericoital              1. Consultation to define key research and development and                                Priority B
       contraception at varying levels of the health system                  pre-qualification pathways for pericoital contraception                                HRP/FP
                                                                          2. Protocol finalized and research initiated
                                                                          3. Study conducted
                                                                          4. Results disseminated

 A05   Health system strengthening for                                    1. Expert consultation on status of implementation,                                       Priority B
       implementation and scale-up of subcutaneous                           challenges and research gaps                                                           HRP/FP
       DMPA documented and shared                                         2. Development of implementation research protocol
                                                                          3. Research conducted, with feedback loops in the countries
                                                                          4. Results disseminated


 A06   Implementation at scale of WHO guidelines and                      1. Knowledge Gateway and website updated; evaluation                                      Priority A
       high-impact interventions through Implementing                        plan and baseline survey implemented                                                   PDRH/FP
       Best Practice (IBP) initiative partners                            2. Support provided to International Family Planning
                                                                             Conference implementation tracks
                                                                          3. Regional workshops held with key stakeholders
                                                                             (UNFPA, Family Planning 2020 [FP2020]) to support
                                                                             implementation and scale-up of tools and guidelines
                                                                          4. Case studies finalized documenting implementation of
                                                                             high-impact interventions and use of WHO tools

 A07   Normative WHO guidelines and derivative                            1. Guidance on duration of use of implants and IUDs if indicated                          Priority A
       products for family planning services                              2. Guidance based on the ECHO Study and postpartum                                        PDRH/FP
                                                                             family planning (PPFP) study results if indicated
                                                                          3. Guideline disseminated, guideline implementation supported
                                                                          4. Expert consultation to initiate the scheduled review of Medical
                                                                             eligibility criteria for contraceptive use (MEC) and Selected practice
                                                                             recommendations for contraceptive use (SPR) guidelines convened

 A08   Increased access to family planning services                       1. Training resource package modules revised                                              Priority A
       and information through workforce                                  2. Training resource package adopted for in-                                              PDRH/FP
       interventions including task sharing                                  service and pre-service training
                                                                          3. Various cadres of health workers trained to implement task sharing
                                                                          4. Training impact documented

 A09   Evidence generated on innovative                                   1. Implementation plan developed and priority activities identified                       Priority A
       financing mechanisms                                               2. Regional workshops to support country plan development                                 PDRH/FP

                                                                          3. Review evidence generation including evaluation of
                                                                             implementation process and lessons learnt
                                                                          4. Results and lessons learnt disseminated

 A10   Information to monitor the status of                               1. Data collection conducted and completed                                                Priority A
       national reproductive health policies                              2. Results disseminated                                                                   PDRH/FP

       DMPA: depot medroxyprogesterone acetate; FP: family planning, contraception and fertility; LNG: levonorgestrel; PDRH: programme development for reproductive health
                           *In the product and milestone tables throughout this document, each product is classified according to: (i) priority, as discussed in Chapter 1, section
                                               1.5, (ii) budget segment (HRP or WHO programme development for reproductive health) and (iii) budget section (see Chapter 3).

HRP PROGRAMME BUDGET, 2018-2019                                                                                                                                              13
           HRP strives to be an agent of transformation                             for antenatal care and intrapartum care at
           for maternal and newborn health. Its core                                scale, including as part of WHO’s “Quality,
           mission is to perform research and support                               Equity, Dignity” (QED) initiative to improve
           the development of WHO guidance and                                      the quality of maternal and newborn health
           implementation tools that not only ensure                                care. This guidance will be informed by multi-
           that pregnant women and newborn infants                                  site implementation research for health
           survive but which also enable the mother                                 systems strengthening, and, for antenatal
           and child to thrive. HRP’s work is guided by                             care, by developing, testing and validating
           strategic priorities for achieving the SDGs,                             indicators of quality antenatal care.
           in particular primary targets 3.1 and 3.2,
           and by the Global Strategy for Women’s,                                  Of the 303 000 maternal deaths that occur
           Children’s and Adolescents’ Health.                                      annually, it is estimated that over 10% are
                                                                                    due to sepsis. Sepsis is also the cause of 15%
           Three areas of work related to maternal health                           of newborn deaths. HRP will provide global
           have been prioritized by HRP: antenatal care,                            leadership in preventing and managing maternal
           intrapartum care and maternal sepsis. HRP                                and neonatal sepsis through coordinating
           will develop guidance tools to assist countries                          multi-site research to develop and test clinical
           in implementing WHO recommendations                                      innovations, and multi-site implementation


ID    PRODUCT                                                  MILESTONES                                                CLASSIFICATION
B01   Standards developed for fetal growth and development     1. Fetal growth study secondary analyses conducted                        Priority A
                                                               2. Guideline development meeting conducted                                HRP/MPH

                                                               3. Tool for customizing fetal growth curves developed
B02   Interventions for stillbirth reduction based             1. Research protocol on the use of continuous                             Priority A
      on Doppler screening developed                              wave Doppler screening developed                                       HRP/MPH
                                                               2. Data collection initiated in 2 countries
                                                               3. Systematic reviews of other key interventions conducted/updated
B03   Guidance for implementation of the 2016                  1. Research protocol finalized, decision-support tools developed          Priority A
      WHO Antenatal Care Model developed                       2. Formative research conducted                                           HRP/MPH
      through implementation research
                                                               3. Intervention designed and implementation initiated
B04   Implementation toolkit for the "Born Healthy"            1. Current antenatal care recommendations adapted                         Priority C
      intervention finalized and disseminated                     for the group antenatal care format                                    HRP/MPH
                                                               2. Toolkit finalized and disseminated
B05   Effectiveness of a novel magnesium sulfate regimen       1. Intervention designed and study design agreed                          Priority C
      for eclampsia prevention and treatment evaluated         2. Research protocol finalized                                            HRP/MPH

                                                               3. Trial data collection initiated
B06   Effectiveness of digital and wearable technologies for   1. Research protocol developed                                            Priority C
      prediction of pregnancy complications demonstrated       2. Data collection initiated                                              HRP/MPH

B07   Quality of care around the time of childbirth            1. WHO recommendations on non-clinical interventions for                  Priority A
      in high caesarean section settings improved                 reducing unnecessary caesarean sections developed                      HRP/MPH
      through testing interventions in multiple sites          2. Formative research protocol approved, implemented
                                                               3. Intervention designed and implementation
                                                                  initiated in at least two countries
B08   Global roadmap for improving experience of care in       1. WHO recommendations on intrapartum care for                            Priority A
      pregnancy and childbirth developed and tested               a positive childbirth experience developed                             HRP/MPH
                                                               2. Roadmap developed through evidence syntheses
                                                               3. Human rights integrated into study design and analysis of outcomes
B09   Guidance for implementing the WHO intrapartum care       1. Protocol for implementation research developed                         Priority A
      model developed through implementation research          2. Formative research conducted                                           HRP/MPH

                                                               3. Intervention phase design finalized and protocol approved
                                                               4. Implementation initiated in at least 1 country

                                                                                                                                  continued on next page

14                                                                                                  HRP PROGRAMME BUDGET, 2018-2019
research to support adaptation of WHO                                recommendations on interventions to reduce
recommendations on maternal sepsis.                                  unnecessary caesarean sections and by
                                                                     conducting multi-site implementation research
New technologies have the potential to                               for evaluating the effectiveness of interventions,
improve pregnancy and childbirth experience                          implementation frameworks and processes.
and health outcomes. HRP will coordinate
the development of digital and technological                         Over the years, HRP has developed a
innovations, including wearable technologies                         series of WHO clinical and programmatic
artificial intelligence and machine-learning tools.                  guidelines for maternal and perinatal care.
                                                                     It will ensure continuous review of these
HRP has long advocated for rational use of                           guidelines, undertaking revisions as required
caesarean section, performed exclusively for                         by new evidence, and developing consolidated
medically indicated reasons. It will pursue this                     guidelines and derivative tools that are easier
work and provide global leadership in optimizing                     to adapt and use by intended audiences.
the use of caesarean section by developing

 ID    PRODUCT                                                  MILESTONES                                                      CLASSIFICATION
 B10   Evidence of the effectiveness of an intrapartum          1. SELMA prototype integrated into a tablet platform                            Priority A
       decision-support tool - SELMA – Simplified,              2. Research protocol for randomized controlled trial (RCT) finalized            HRP/MPH
       Effective, Labour Monitoring-to-Action – to support
       front-line health workers in labour management           3. Formative research conducted
                                                                4. Intervention designed and implementation initiated
 B11   Evidence of the safety and effectiveness of a device     1. Research protocol for the RCT developed                                      Priority C
       for assisted vaginal delivery ("Odon" Device)                                                                                            HRP/MPH
 B12   Evidence of the effectiveness of room temperature        1. Analysis completed                                                           Priority A
       stable carbetocin for the prevention of postpartum       2. Results published and disseminated                                           HRP/MPH
       haemorrhage during the third stage of labour in
       women delivering vaginally (the "Champion Trial")        3. Secondary analysis initiated

 B13   Evidence of the effectiveness of room                    1. Research protocol finalized                                                  Priority C
       temperature stable carbetocin for the                                                                                                    HRP/MPH
       treatment of postpartum haemorrhage
 B14   Evidence of the quality of medicines used                1. Medicines identified                                                         Priority B
       during pregnancy and childbirth in field                 2. Research protocol finalized                                                  HRP/MPH
       settings (e.g. oxytocin, misoprostol)
                                                                3. Quality of two medicines assessed
 B15   Evidence of the safety and effectiveness of              1. RCT data collection initiated                                                Priority A
       corticosteroids for women at risk for preterm birth      2. Technical advisory committee and data safety                                 HRP/MPH
                                                                   monitoring committee meetings held
                                                                3. Recruitment completed in at least 1 of 5 countries
 B16   Evidence of the global burden of maternal sepsis         1. Analysis of the Global Maternal Sepsis Study completed                       Priority A
       generated and guidance for an intervention for           2. Formative research conducted for the active prevention                       HRP/MPH
       active prevention and treatment developed                   and treatment of maternal sepsis trial
       through implementation research
                                                                3. Secondary analysis of the cohort study conducted
                                                                4. Implementation research initiated
 B17   Digital platform for guideline derivatives on maternal   1. Guideline communication tools developed                                      Priority A
       and perinatal health (e.g. managing complications of     2. Guideline implementation tools developed                                     HRP/MPH
       pregnancy and childbirth, essential routine care)
 B18   Maternal and perinatal health recommendations            1. 40 existing recommendations prioritized for updating                         Priority A
       prioritized and continuously updated                     2. Planning proposal approved                                                   HRP/MPH

                                                                3. Guideline development meetings conducted
                                                                4. 40 updated recommendations approved,
                                                                   published and disseminated
 B19   WHO Recommendations on duration of                       1. Final guideline approved and published                                       Priority A
       bladder catheterization after surgical                   2. Guideline disseminated                                                       HRP/MPH
       repair of simple obstetric fistula
 B20   Maternal and perinatal health recommendations            1. Policy briefs developed with partners                                        Priority A
       disseminated through derivatives, including              2. Regional meetings convened                                                   PDRH/MPH
       policy briefs and meetings with partners

                                                                        MPH: maternal and perinatal health; PDRH: programme development for reproductive health

HRP PROGRAMME BUDGET, 2018-2019                                                                                                                           15
     Globally, an estimated 56.3 million abortions         data to measure trends in the magnitude
     take place each year. Over the past 25 years,         of unsafe abortion and its consequences.
     abortion rates declined markedly in developed         This will include documenting the impact of
     regions but have remained static in developing        inequalities in access to safe abortion care
     regions. Less than half of all abortions take place   as experienced by adolescents, poor women
     in circumstances that would be considered safe,       or women in humanitarian situations.
     and over the years 2003–2009, abortion-related
     deaths accounted for 7.9% of all maternal             As part of its technical support to countries,
     deaths. An estimated 7 million women seek             HRP will continue to guide progressive
     facility-based care for abortion complications.       policy development and reform in order
     Measurement of abortion-related events has            to increase access to safe abortion care
     always been methodologically challenging,             through documenting the impact of diverse
     but the complexity has increased manifold             interpretations and applications of abortion laws
     with the widespread informal use of                   and policies (both facilitative and restrictive)
     misoprostol outside of health-care facilities.        on access to and availability of services, and
                                                           on the incidence and safety of abortion.
     Eliminating unsafe abortion has been a strategic
     objective of HRP since its inception, placing         Over the past 15 years, HRP has been
     it in a unique position within the UN system          recognized for its leadership in the development
     to provide credible scientific information and        of WHO’s technical and policy guidance
     guidance to countries on understanding and            on safe abortion, which integrates clinical,
     interpreting abortion data. Recently, HRP             health system and human rights issues.
     introduced a reconceptualization of the way the       Evidence-based updates and revisions to
     definition of unsafe abortion is interpreted, and     the guidelines will continue. Scaling up the
     is developing global estimates of the distribution    use of these guidelines remains a challenge
     of safe and unsafe abortion along a continuum.        and HRP will develop implementation
     HRP will pursue this work and strengthen              research to facilitate this process.
     the global evidence base of population-level

16                                                                    HRP PROGRAMME BUDGET, 2018-2019

ID      PRODUCT                                              MILESTONES                                                 CLASSIFICATION
C01     Evidence of the effectiveness of decentralized       1. Research protocol finalized                                          Priority B
        models of providing medical abortion                 2. Feasibility/formative research conducted                             HRP/SA

                                                             3. Implementation under way
 C02    Evidence of effectiveness of anonymous third party   1. Research protocol for population-based study finalized               Priority A
        reporting as a new way to measure abortion safety    2. Study implemented in 2 sites                                         HRP/SA

                                                             3. Results published and disseminated
 C03    Evidence of abortion law and policy                  1. Country case studies (at least 3 countries) completed                Priority A
        application in countries, based on the               2. Three subregional dissemination/capacity-                            HRP/SA
        Global Abortion Policies Database                       building workshops conducted
                                                             3. Paper on impact of punitive sanctions on risk
                                                                perception and safety of abortion procedure
 C04    Facility-based evidence on the burden                1. Africa and Latin America surveys implemented; other regions          Priority A
        of abortion complications                               implemented depending on the results from Africa                     HRP/SA
                                                             2. PAHO/WHO Network of Care for Women in Abortion
                                                                Situations (MUSA) network strengthened in terms
                                                                of data collection and research methods
                                                             3. Survey implemented in selected countries in the
                                                                WHO South-East Asian, Western Pacific, Eastern
                                                                Mediterranean and European regions
                                                             4. Secondary analyses published and disseminated
 C05    Evidence of safety and effectiveness                 1. Randomized controlled trial initiated and completed                  Priority B
        of medical management of second-                     2. Results published and disseminated                                   HRP/SA
        trimester intrauterine fetal death
 C06    Evidence on application and scale-up of WHO          1. Research protocol finalized                                          Priority C
        safe abortion guidelines in 3–4 countries            2. Study initiated                                                      HRP/SA

 C07    Facilitation of in-country adaptation of             1. Fellows identified, managed and mentored through the process         Priority C
        guidelines using implementation research                of research question development and systematic reviews              HRP/SA
        through the fellowship initiative                    2. Proposal developed for in-country work for post-fellowship period
 C08    Safe abortion technical and policy guidance          1. Stakeholder survey and scoping completed                             Priority A
        developed (clinical, service delivery, human         2. Evidence syntheses completed                                         HRP/SA
        rights, quality, monitoring and measurement)
                                                             3. Third addition of the guideline published
 C09    Scale up availability and use of combi-              1. Strategy developed and logistics completed for                       Priority A
        packs for medical abortion                              international consultation on global scale-up of                     HRP/SA
                                                                combination-packs for safe abortion
                                                             2. Activity launched in up to 10 countries
 C10    Guideline on medical abortion                        1. Print, online and interactive versions of the                        Priority A
        developed, adapted and used                             medical abortion guideline launched                                  HRP/SA
                                                             2. One regional dissemination event held
                                                             3. Implementation and adaptation supported through partnerships

                                                                                                                                    SA: safe abortion

A powerful development in recent years has                        implementation research on task sharing and
been the increasing evidence base for moving                      self-management approaches for increasing
medical abortion care to the community level                      the availability of mifepristone and misoprostol.
and for women to self-manage all or parts of
the process. Conventional models of safety,                       Second-trimester abortion carries significantly
service delivery and quality of care do not apply                 higher risks of morbidity and mortality, yet it
in these settings and innovative interventions                    remains neglected in terms of service-delivery
and interventions to make accurate                                interventions. HRP will coordinate development
information, high-quality drugs and appropriate                   of a global evidence base on innovations in
back-up care available to women in these                          the safe and effective delivery of abortion
circumstances are needed. HRP will develop                        procedures during the second trimester.
models of care by coordinating multi-site

HRP PROGRAMME BUDGET, 2018-2019                                                                                                                17
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