Health rights, women's
leadership, and the work of delivery.
RFLD's flagship Health programme operates at the intersection of community mobilisation, advocacy on health rights and financing, operational research on care-seeking behaviour, and regranting to grassroots organisations addressing malaria and maternal, newborn, and child health across francophone West and Central Africa.
RFLD's Health work is anchored in two continental commitments. Article 14 of the Maputo Protocol establishes women's right to health, including reproductive health, and obliges states to provide adequate, accessible, and affordable health services. The Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, adopted by African Heads of State in 2001, committed AU member states to allocating at least 15% of national budgets to the health sector.
Most AU member states have not yet met the Abuja target. Most have not yet fully domesticated Maputo Article 14. The work of this programme is to build the community demand, the rights literacy, and the political pressure that hold states to commitments their citizens have already been promised; delivering clinical services remains the mandate of states themselves.
What RFLD actually implements.
RFLD implements community mobilisation, advocacy, regranting, and operational research. Clinical service delivery is the work of ministries of health, WHO, UNFPA, and the clinical NGOs we partner with. The four pillars below describe what we deliver and how it complements the clinical actors we work alongside.
Two burdens, one set of root causes.
Francophone West and Central Africa carries some of the highest malaria and maternal mortality burdens in the world. The technical interventions that would prevent most of these deaths exist. The systems to deliver them, the financing to sustain them, and the rights frameworks to make states accountable for them remain incomplete. Both burdens have the same root causes: weak health systems, gender inequities in care-seeking, and chronic underinvestment.
Malaria
Sub-Saharan Africa accounts for roughly 95% of global malaria cases and deaths each year, with the highest burden in West and Central Africa (WHO World Malaria Report). Children under five and pregnant women bear most of the mortality. The clinical tools to prevent malaria deaths exist and are inexpensive: insecticide-treated nets, intermittent preventive treatment in pregnancy, seasonal malaria chemoprevention, rapid diagnostic tests, and effective antimalarial treatment. The persistent gap is last-mile delivery and the behavioural systems that determine whether the technology reaches the women and children who need it.
Maternal, newborn, and child health
The maternal mortality ratio across much of West and Central Africa remains among the highest in the world: in several countries, more than 500 maternal deaths per 100,000 live births (UN Maternal Mortality Estimation Inter-Agency Group). Newborn mortality and under-five mortality remain similarly high. As with malaria, the clinical interventions that would prevent most of these deaths are well-established: skilled birth attendance, emergency obstetric and newborn care, postnatal care, immunisation, treatment of childhood illness. The gap is access, and access is shaped by both systemic factors (functioning health facilities, trained staff, available commodities) and gendered factors (whether a woman has the agency, the money, and the social permission to seek care).
The clinical interventions that would prevent most malaria and maternal deaths in West Africa exist and are not expensive. What is missing is the system around them: the demand, the financing, the political accountability, and the agency of the women whose lives depend on access.
Demand, agency, and health-seeking behaviour.
Most of RFLD's direct programmatic work on health is mobilisation: the trained community leaders, women's groups, and grassroots organisations who, in their own communities, advance the awareness, agency, and care-seeking behaviour that turn clinical interventions into lives saved. Our role is to make sure women in our network reach clinical care in time, with the information they need, and with social and economic conditions that allow them to use it.
Malaria mobilisation
Standard clinical guidelines on malaria prevention work when women receive accurate information, when they can act on that information without family veto, and when the commodities are present in their local clinic. RFLD's community work addresses each of these conditions through trained women community leaders and partner grassroots organisations.
- Education on insecticide-treated net use, household installation, and proper nightly utilisation
- Promotion of intermittent preventive treatment in pregnancy (IPTp) at antenatal visits
- Awareness of seasonal malaria chemoprevention (SMC) for children during high-transmission periods
- Recognition of febrile illness in children and the 24-hour care-seeking window
- Community-level distribution support during ITN and SMC mass campaigns led by Ministries of Health
MNCH mobilisation
The conditions for safe pregnancy and childbirth are set long before labour begins: in nutrition, in antenatal care attendance, in birth planning, and in the social agency women have to refuse the birth practices that endanger them. RFLD's MNCH mobilisation engages women, families, and community leaders on the full continuum.
- Antenatal-care attendance and the WHO-recommended schedule of contacts
- Birth planning, recognition of danger signs, and decisions about facility-based delivery
- Postnatal care for mother and newborn in the first six weeks
- Exclusive breastfeeding for six months; complementary feeding thereafter
- Routine immunisation coverage and integrated child-health management
- Family planning as part of the post-pregnancy continuum
Engaging men and male health activists
Across many of RFLD's countries of operation, decisions about whether a woman seeks antenatal care, whether a child is taken to a clinic for a fever, or whether household money is spent on health are decisions in which men hold significant weight. RFLD's mobilisation engages men as partners: not gatekeepers to be circumvented, but decision-makers whose support changes the calculus.
- Male health activists trained alongside women community leaders
- Engagement with fathers on the value of antenatal care, skilled birth attendance, and child immunisation
- Engagement with husbands on family-planning decisions as joint decisions
- Religious-leader engagement on health-seeking as care, not as transgression of authority
Adolescent health
Adolescent girls, those between 10 and 19, face the highest health risks from early pregnancy, the lowest rates of contraceptive use, and the steepest care-access barriers. RFLD's adolescent health mobilisation works specifically with this population through schools, youth groups, and adolescent-friendly entry points.
- Menstrual health management: sanitary products, school sanitation, ending menstrual stigma
- Adolescent SRHR information and access to contraception where legally available
- Prevention of early pregnancy and re-entry support for adolescent mothers
- HIV prevention, including PrEP awareness and STI screening
- Recognition of gender-based violence as a health issue affecting adolescent girls
Holding states to their own commitments.
Health systems improve when governments fund them adequately, when the laws governing them are enforced, and when civil society has the data and the platform to insist on both. RFLD's health advocacy is the long-term work that makes mobilisation gains durable. Six lines of advocacy structure the work.
Domestication and implementation
The right to health under Maputo Article 14 is implemented through national health legislation, ministerial policy, and budget allocation. RFLD tracks domestication via the Maputo Protocol Hub and engages national parliaments on legislation that gives effect to it.
15% health spending target
Most AU member states have not met the Abuja target of 15% of national budgets to health. RFLD trains civil society partners and parliamentarians to track health budget allocations against the Abuja commitment and to make the gap politically visible.
Beyond donor dependency
External health aid alone cannot sustain health systems. RFLD advocates for domestic resource mobilisation, including health insurance schemes, sin taxes, and the gender-responsive budget allocation that protects MNCH and reproductive-health line items.
Promise to reality
Many countries have declared free maternal and under-five care policies. Implementation often falls short: informal fees persist, drugs are unavailable, women still pay. RFLD supports civil society monitoring of these policies and advocacy where implementation gaps emerge.
UHC with gender equity
Universal Health Coverage frameworks risk leaving informal workers and rural women behind. RFLD engages national UHC processes to ensure that women in informal employment, rural areas, and displacement settings are not excluded by design.
Women in health leadership
Health systems are staffed largely by women but led largely by men. RFLD's broader Participatory Governance work intersects with the Health programme on the question of women's leadership in ministries of health, professional associations, and continental health bodies.
Why interventions fail at the last mile.
Most health-research investment in Africa goes into clinical efficacy questions: does this drug work, does this vaccine work, does this technology work. Far less goes into the operational and behavioural questions that determine whether a working intervention reaches the woman who needs it. RFLD's research focus is the second category. We work with academic and clinical partners to investigate the systems and behaviours that stand between an intervention and its impact.
Behavioural and systemic barrier mapping
Why do some women not complete the recommended IPTp schedule? Why are insecticide-treated nets sometimes used for purposes other than sleeping under them? Why do mothers delay seeking treatment for febrile children? Each question has answers, usually multiple and intersecting, and RFLD's research generates evidence on those answers in the specific contexts where they matter.
- Anthropological mapping of IPTp uptake barriers in francophone West Africa
- Behavioural studies of ITN use and household norms shaping utilisation
- Gender analyses of care-seeking decisions and household power dynamics
- Studies of provider-patient interaction and respectful maternity care
- Documentation of stockout patterns and last-mile commodity access failures
Working with academic and clinical partners
Operational research that influences policy requires the credibility of academic methods and the access of community networks. RFLD's research model combines our community access with the rigour of partnerships with universities, national institutes of public health, and clinical implementation partners. This is the model under which our research feeds Ministry of Health planning rather than sitting on a shelf.
- Research partnerships with francophone African universities and institutes of public health
- Co-authorship with clinical implementation partners and continental research networks
- Research that feeds Ministry of Health planning processes, not only academic literature
- Open data publication through the DƆNÙESÈ Data Center where appropriate
- Member organisation involvement in research design, data collection, and dissemination
Capital that reaches the frontline.
Even when health-portfolio funders want to support grassroots health-rights organisations, the institutional and compliance overhead of direct grantmaking to small organisations across multiple countries is prohibitive. RFLD's West African Francophone Feminist Fund (the WAFF Fund) exists to bridge this gap. The fund takes on the compliance burden, vets and accompanies grantees, and moves capital directly to grassroots organisations whose work would otherwise remain unfunded.
How the WAFF Fund supports the Health programme
Within the broader WAFF Fund, which regrants across all of RFLD's fields of intervention, health-rights work is one of the supported thematic areas. The fund's role on health complements the Global Fund, GAVI, and other major health-financing mechanisms: it funds the community-level organisations and women-led grassroots groups whose work is the precondition for those larger investments to reach women and children.
RFLD handles the institutional compliance, including NGOsource Equivalency Determination for direct US grantmaking, audited financial systems, and PSEAH safeguarding standards. Grantees focus on delivery in their own communities. The compliance and accountability that institutional funders require is real; the friction that compliance imposes on small organisations is also real. The WAFF Fund resolves that contradiction by taking the friction onto itself.
What the WAFF Fund supports in health-rights
- Community-based malaria and MNCH mobilisation by grassroots women's organisations
- Adolescent SRHR and youth-led health-rights work
- Health-rights monitoring and accountability work by local CSOs
- Documentation of barriers to care, contributing to operational research
- Rapid response in health-crisis or displacement settings within RFLD's network
Why this model works for funders
- NGOsource ED enables direct grants from US foundations without expenditure responsibility
- Independent annual audits available to institutional partners on request
- Single accountability point for grants flowing to dozens of grassroots organisations
- Grantee accompaniment, not just disbursement, improving capacity and impact
- Public learning from the network: what works, what doesn't, in francophone contexts
Full information on the WAFF Fund, eligibility, application cycles, and current cohort, is available at rflgd.org/waff-fund.
What RFLD does, and what others do better.
Health systems strengthening is not the work of any single organisation. The honest framing of RFLD's contribution is this: there is a layer of work, community demand, advocacy, rights literacy, regranting, behavioural research, where RFLD is well-placed to lead. There are other layers, clinical training, facility infrastructure, commodity supply, information-system architecture, where the right partners are Ministries of Health, WHO, UNFPA, UNICEF, the Global Fund, and clinical implementing organisations. Our model is to be a credible, complementary actor in the first layer while supporting and learning from the partners who lead the second.
Where RFLD leads
Community-level work that requires deep relationships with grassroots organisations, women's networks, and local leaders. Advocacy work that requires sustained presence and political relationships. Research that requires community access. Regranting that requires both compliance capacity and proximity to small grassroots organisations.
- Community mobilisation and demand generation through 670 member organisations
- Maputo Article 14 and Abuja Declaration advocacy
- Operational research on behavioural and systemic barriers
- Regranting to grassroots health-rights organisations through the WAFF Fund
- Open data through the DƆNÙESÈ Data Center
Where we partner with others
Clinical training, facility infrastructure, commodity supply, and health-information-system architecture are the work of specialised actors. RFLD partners with, and refers to, the organisations that lead in those domains, while contributing the community and advocacy components that complement their work.
- Ministries of Health for national policy implementation
- WHO and UNFPA for clinical guidance and continental coordination
- UNICEF for child health and immunisation programmes
- Clinical implementing partners for facility-level training and quality improvement
- Global Fund / GAVI / PMI mechanisms for commodity supply and primary financing
DƆNÙESÈ tools linked to this work.
Three open-access tools maintained by RFLD as public goods, anchoring this programme in continental data and policy infrastructure.
Maternal Health Tracker
Maternal, newborn, and child health data across francophone Africa with intervention mapping and policy reference.
Explore →Ending Malaria platform
Health and MNCH data focused on malaria prevention, IPTp coverage, and last-mile delivery patterns.
Explore →My Health, My Right
Francophone SRHR resource hub for community organisers, youth peer educators, and grassroots health workers.
Explore →Why this work, now.
Two observations frame RFLD's Health programme. The first: the technical interventions that would prevent most malaria deaths and most maternal deaths in West and Central Africa already exist. They are well-established, comparatively inexpensive, and deployed daily by clinical actors across the continent. The second: those interventions continue to fail to reach the women and children who most need them, at scale and with consistency. The reason is not clinical. The systems around clinical practice, community demand, financing, accountability, gender equity in care-seeking, remain incomplete in ways that no clinical strategy alone can resolve.
Most global-health investment over the past two decades has focused on the clinical layer. That investment has produced real gains. It has also encountered a ceiling: the ceiling created by the fact that even the most effective intervention does not save a life if it does not reach the woman in time, with information, and with the agency to use it. The work above the ceiling is the work of community, advocacy, regranting, and rights, and it is the work RFLD is built to do.
The honest framing of our contribution is therefore complementary. We do not propose to replace the clinical and financial actors whose work fills hospitals and clinics across the continent; we propose to do the work that allows their work to land: building the demand, the financing pressure, the rights literacy, and the grassroots organisational capacity through which clinical interventions become lives saved. Clinical efficacy without community demand is not delivery; it is unused capacity.
The Maputo Protocol gave African women the legal framework. The Abuja Declaration gave African states the financing commitment. RFLD's role is implementation: not of clinical services, but of the community, advocacy, research, and regranting work that turns those frameworks and commitments from text into lived experience.
Get in touch.
For partnership opportunities, programme enquiries, member organisation collaboration, research partnerships, or donor due diligence, please reach the appropriate channel below.