Reproductive Health Strategy

In 2019, the Buffett Foundation set out to build a multi-sector funding strategy for increasing safe abortion access across Nepal. I had joined the Global Programs team as a grant analyst a few months prior. We were a very lean team (I was the eighth hire!) managing a $300M annual portfolio across dozens of countries. It was all hands on deck, and a remarkable place to learn the field from the inside.

The team held one clear conviction: lasting public health strategies have to be built with government leadership and a real understanding of the local system, never imposed as a parallel funder agenda. The senior program officer leading the work had just completed Stanford’s Executive Design Bootcamp and wanted to bring what she learned into how the strategy itself got made. That decision shaped everything that followed.

As we dove into Nepal’s funding strategy formation, I first turned to the data. I synthesized data from sources like WHO, World Bank, and Global Financing Facility, conducted health service delivery cost effectiveness modeling, and traced funding between partner organizations in the country. Equipped with the data, we traveled to Nepal, where these analyses fed into a series of design sprints with health providers and NGOs across the country. We asked folks what they thought could revolutionize access and availability of maternal health services. We imagined what a world would look like with no constraints, and how we could move forward together given the vast cultural and geographic makeup of Nepal.

The product of these sprints was an $8 million, six-year funding strategy for safe abortion services across Nepal’s seven provinces, with objectives staged in two-year increments so the government could progressively absorb responsibility. We frontloaded all of the design work with in-country partners so that by the time we brought it to the Ministry of Health, the “vision of success” was already in a strong place. The Ministry reviewed, recalibrated, and validated the work, endorsed the vision, and took ownership of coordinating the partners who would carry it out. The strategy lived inside Nepal’s national reproductive health framework instead of beside it.

It was one of the first country strategies of its kind at the Foundation, and it became a model other program teams followed. It also gave me the opportunity to work directly with our emerging Government Engagement team, which focused specifically on providing technical support directly to Ministry of Health officials.