1 Comments welcome June 8, 2016 draft Concept Note for Learning Exchange: Transparency/accountability strategies & reproductive health delivery systems Victoria Boydell and Jonathan Fox 1 27 and 28 of June 2016 Butler Board Room School of International Service, American University, Washington D.C. Conveners: Accountability Research Center, School of International Service, American University The Evidence Project International Planned Parenthood Federation Reproductive Health Supplies Coalition, Advocacy and Accountability Working Group Problem Statement: Systemic weaknesses, vulnerabilities or biases at different points in health systems are often the reasons why reproductive health (RH) supplies fail to reach that all- important ‘last mile’ of women wanting to use modern contraceptives. These issues, sometimes called “wicked problems” because they lack both technical certainty and political agreement, are well known but are often complex and difficult to address (Hope and Hill, 2009). Global, national, and regional stakeholders undertake valiant efforts to coordinate and build local capacity for public sector RH supply forecasting, distribution, and monitoring; however, these technical approaches may not address the full range of underlying causes that limit citizens’ choices—including inefficiency, corruption, vested interests, stock-outs, informal fees, as well as social exclusion and bias. These larger systemic issues have been acknowledged by the public health community, but have been under-addressed due to their complexity, controversial nature, and the limited capacity of technical problem-solving approaches to address deeper governance challenges. Moreover, at least in development agencies and government ministries, “sectoral” divisions tend to separate public health issues (usually framed as technical) from governance agendas (which address how the public sector is organized, including public oversight institutions and citizen engagement). In this context, disentangling the symptoms from the causes of service delivery and supply problems is easier said than done. What do we mean by independent monitoring? Development organizations and government agencies have developed a range of monitoring systems to identify and address bottlenecks and challenges in the public sector supply chain – these can be large scale routine systems, project performance systems, grassroots monitoring etc. However, the scope of what these systems 1 Thanks very much to Derick Brinkerhoff, Abhijit Das, Rachel Sullivan Robinson, Marta Schaaf and Kelsey Wright for their very helpful comments on earlier versions.