Table 3 Key challenges and solutions [7]

Who’s in the driver’s seat?

While the Mechanism has worked hard to ensure that the TA requests are country-owned and driven, MOH leadership and continued engagement has been a challenge in some countries (e.g. with staff changes and competing priorities)

• Be explicit from the start that the TA is for the MOH and that the MOH is in the driver’s seat

• Create space for the MOH to decide on the TA team, as long as it includes a Partner Organization

• Identify clear roles and responsibilities for the MOH and provide contracts/budgets to support activities for which the MOH is responsible (e.g. the roles that JKP is playing in the Kenya TA)

• Specify necessary data to support the TA and request assistance from MOH to obtain it (e.g. county-specific data)

• Provide periodic updates to MOH about the TA (e.g. findings, requests for support, etc.)

• Request feedback from MOH on specific activities/outputs

• Seek permission from MOH staff to contact them directly, if needed

• Identify the “movers-and-shakers” in the country who can provide alternative channels of communication and insider-perspectives

• Expand/nurture the role of the RO and WCO with the legitimacy/political clout to nudge progress

• Establish a TA steering/coordination committee with relevant stakeholders in-country

• Agree on focal points/decision-makers and their preferred ways of working (e.g. phone calls not emails)

• Agree on timelines and regular check-in points, including realistic pause/restart (or pull-the-plug) timelines

• MOH to be encouraged to propose potential partners, capacity development needs

Too many cooks in the kitchen

While collaboration between partner organizations was consistently noted as something positive and useful, it introduces challenges for leadership, coordination, and efficiency of the TA

• Spend time early in the process to develop clear roles and responsibilities, expectations, and timelines

• Support creation of a “responsibilities matrix” (e.g. the planning process in Afghanistan, Malawi and Kenya)

• Encourage regular (e.g. weekly) meetings to review progress/timelines/outputs (e.g. Malawi and Kenya)

• Find a balance between having equitable partners in the TA response and having one partner lead so that there is a “decision-maker”

• The Secretariat to lean in to support collaboration for the TA but not to take on the routine facilitation role for ongoing activities

• TORs to be drafted by TA Mechanism and agreed upon by TA team, with a clear responsibilities-matrix for all involved (i.e. Partner Organizations, MOH, youth organizations and other national stakeholders)

• Find an effective balance between group consensus and individual productivity

• Make sure that the different components of the TA are coordinated/integrated

• Allow partnerships at the call for applications/expression of interest stage i.e. applicants can seek partnerships among the Partner Organizations

• Explore systems for quality control of non-TA Mechanism partners/consultants

Everything takes sooooo long

While it is helpful to spend time up front to co-create and build consensus among stakeholders about the objectives and workplans, the preparatory work is sometimes too long and complicated for the relatively small awards

• Wait to request detailed proposals from Partner Organizations for a TA response until the TA team is formalized (e.g. Liberia)

• Support creation of a “responsibilities matrix” (e.g. Afghanistan, Malawi, Kenya)

• Have started the process for WHO Requests for Proposals (RFPs) which will allow for pre-qualification and higher budget ceiling (submissions will be requested from all Partner Organizations)

• Developing a more flexible funding mechanisms, to counteract the budget limitations and allow more comprehensive thinking/strategy (in process)

• Use standard templates for workplans/budgets, while avoiding being too prescriptive

• Share expected (and realistic!) timelines for project preparation and contracting – and stick to them!

• Include risk assessment/mitigation planning in order to be aware of likely bottle-necks/delays: include ways to adapt to crises and competing responsibilities/timelines

• Review TA Mechanism materials/SOP: are there opportunities to make the processes more flexible/streamlined

• Be clear about the levels of detail that are required during initial assessments

• identify "carrots and sticks" in relation to timelines

• Consider having examples of methods for carrying out situation assessments, landscape analyses, programme reviews, etc. that can be adapted

• Find an effective balance between group consensus and individual productivity!

Acting Beyond tokenism

While individual TA responses have incorporated elements of meaningful youth engagement, the Mechanism could and should do more

• Encourage Partner Organizations to identify opportunities for meaningful youth engagement (MYE) in the individual TA responses (e.g. consultation with young people as part of the prioritization exercise in Afghanistan, the involvement of youth committees in Kenya and Senegal)

• Engage IYAFP as a Partner Organization and issue formal contract for their support to review/vet new TA requests and propose options for MYE in the responses

• Identify young people as consultants who could be engaged throughout the TA as part of the broader team - leveraging local or regional YP networks or committees already engaged with Partner Organizations

• Use the TA to support MOHs to strengthen their partnerships with young people (capacity development) and build accountability mechanisms/frameworks into MOH activities

• Bring young people into decisions about the development of their TA needs - the Partner Organizations who respond to TA requests also need to indicate clearly how young people are/will be involved in the delivery of the TA

• Partner Organizations to include young people working in their organizations (e.g. affiliated youth champions/advocates, etc.) at the application and TA design stage, and engage the youth representative in national TWGs (where these exist)

• Share preliminary findings of the TA with youth councils, youth-led organizations to see if we are missing any points that they believe are important

Teaching people to fish

While capacity development is an explicit objective of the TA Mechanism and has occurred to some extent, the types of capacity development and the outcomes of capacity development that are feasible and appropriate through TA provided over different periods of time should be further interrogated and systematically integrated in TA responses

• Encourage engagement from individuals at different levels of partner organizations: global, regional and national (e.g. Sierra Leone, Kenya, Senegal)

• Engage local organizations/consultants as part of the TA team (e.g. Malawi)

• Offer blended-learning courses on AYSRHR to country stakeholders (e.g. the Afghanistan MOPH participating in the Geneva Foundation for Training and Research MENA course)

• Encourage engagement from individuals at different levels of Partner Organizations: global, regional and national (e.g. Sierra Leone, Kenya, Senegal)

• Engage local organizations/consultants as part of the TA team (e.g. Malawi)

• Consider carrying out a needs assessment for capacity development at different steps of the TA during the initial planning phase (what is the capacity, what needs to be done by whom?)

• Identify the key capacity gaps in order to target mentorship and sensitization sessions.

• Capacity development/building needs to be intentional (a capacity transfer plan) - it should be a deliverable and it needs resources if it is to be done effectively

The point of the spear:

While the TA Mechanism tries to use adolescent contraception as the entry point to addressing AYSRHR more broadly, countries often want to do more and there have been challenges in defining the problem and/or the scope of the TA

• Support the MOH to clarify and confirm the problem(s) and objective(s)

• Onboarding/introductory calls with various stakeholders at the start to reach consensus

• Include key issues that go beyond but are related to ASRHR (e.g. nutrition in Afghanistan, HIV in Malawi)

• Identify opportunities to link with other on-going processes in countries

• Support the MOH to better formulate the problem(s) and objective(s) and identify ways to include other adolescent health problems (e.g. mental health)

• Onboarding call with all relevant parties (including the WHO country and regional team) to reach consensus

• Where possible, include and/or link to other related areas (e.g. GBV) – but not too many of them!

• Be clear about links between TA and other in-country processes for AYSRHR and adolescent health more generally