Workshop on Financial Tracking and Advocacy for Contraceptive Security Month Year

USAID DISCLAIMER USAID | DELIVER PROJECT, Task Order 4 The USAID | DELIVER PROJECT, Task Order 4, is funded by the U.S. Agency for International Development (USAID) under contract number GPO-I-00-06-00007-00, order number AID-OAA-TO-10-00064, beginning September 30, 2010. Task Order 4 is implemented by John Snow, Inc., in collaboration with PATH; Crown Agents Consultancy, Inc.; Eastern and Southern African Management Institute; FHI360; Avenir Health; LLamasoft, Inc; The Manoff Group, Inc.; IMPERIAL Health Sciences; PRISMA; and VillageReach. The project improves essential health commodity supply chains by strengthening logistics management information systems, streamlining distribution systems, identifying financial resources for procurement and supply chain operation, and enhancing forecasting and procurement planning. The project encourages policymakers and donors to support logistics as a critical factor in the overall success of their healthcare mandates. USAID DISCLAIMER

Introductory Activity First: Find the partner whose card completes yours to make the phrase “contraceptive security” Introduce yourselves to each other Discuss what you each think “contraceptive security” means Describe your role in ensuring contraceptive security Then: Introduce your partner to the group

Definition of Contraceptive Security Contraceptive security exists when everyone is able to choose, obtain, and use quality, affordable contraceptives whenever they want or need them.

Global Picture: Financing for Contraceptives Low- and middle-income countries need ~ $1 billion/year for contraceptives Slightly more than ½ of funding is expected to come from government or donor sources (with the rest funded by individuals or private companies) Contraceptive costs = ~1/4 of all spending on FP programs

Current and Future Environment Contraceptive funding needs will rise (with WRA and FP use) Government spending for health has been increasing, but absolute levels remain low Donor support for health is rising at a much slower rate than before Spending on FP requires strong advocacy since needs are growing and FP competes with other priorities

Finance for Procurement Data from Contraceptive Security Indicators 2015 (FY 2014) The bulk of contraceptive funding not covered by government funding comes through in-kind donations from various donors, for instance UNFPA and USAID. Rwanda and Zambia also utilized Global Fund grants for contraceptive procurement. Nigeria, Bangladesh, and Yemen funded all contraceptive procurement through other government funds- those given to a country government for its own use. Africa Blank = incomplete data

Finance for Procurement Data from Contraceptive Security Indicators 2015 (FY 2014) 18 countries indicated there was insufficient funding for contraceptive procurement for the public sector 13 countries covered 100% of the quantified need 12 countries covered more than 100% of the quantified need 6 countries did not provide information to determine if there was a funding gap >100% The previous figures show only the funds spent on contraceptives, but don’t reflect the total need for public-sector contraceptives. Although government expenditures may constitute a large percentage of total spending on public-sector contraceptives, contributions may still represent a small percentage of actual need. The survey tool compared the year’s financing for contraceptives with the value of the amount quantified as needing to be procured. Where this information was not available, respondents were asked to indicate if there was a funding gap. In some countries, the variance found between the amount quantified and the amount of financing mobilized could be due to the uncertainty when a quantification is conducted. If a quantification did not accurately reflect the demand for contraceptive procurement (inclusive of client and supply chain needs), then figure 4 does not reflect the true funding gap. When doing their quantifications, countries and programs make different assumptions about the future demand; also, the quality of a quantification may be compromised by poor quality data on current demand. In addition, other factors can impact the discrepancy between a quantification and expenditures, including different time frames, exchange rates, and changing costs of contraceptives. These factors can result either in a funding gap, or alternatively in the funding provided exceeding the projections from the quantification. Africa

Importance of Public and Private Sectors UPDATE FOR COUNTRIES OF INTEREST – Most Recent Source of Supply or Information Data from ICF International. The DHS Program STATcompiler - http://www.statcompiler.com, accessed April 16 2014. Data from the DHS Program STATcompiler

Global Need for Tracking FP2020 is mobilizing commitments to add 120 million FP users by the year 2020 There is a need to track these and other commitments Given the global context, it is crucial to track contraceptive financing in each country to work toward contraceptive security

Challenges What do you think the main challenges to achieving contraceptive security are?

What Can You Do? List on a flip chart… 3 things government can do 3 things advocates and advocacy groups can do 3 things technical experts can do 3 things government, advocates and technical experts can do together …to address the financial, policy, and implementation challenges to contraceptive security.

Status and Plans for Financial Tracking Efforts Tracking Area Current Status Recommendations for Improving Tracking Objectives of financial tracking   Composition of tracking team Which commodities are tracked Mapping of the financing players and decision makers Mapping of financing and procurement processes Data collection Analyses Dissemination & use of information Overall challenges with financial tracking:   Overall successes with financial tracking:

Status and Plans for Financial Advocacy Efforts   Advocacy Effort #1: Advocacy Effort #2: Advocacy Effort #3: Future Advocacy Efforts (planned or desired):  Time frame  Responsibility (who leads effort)  Decision-makers targeted  Principal activities undertaken (up to 5)  Messages developed (up to 3)  Obstacles encountered (up to 5)  Advocacy outcome achieved

Mechanism by which people get financial access to health care Financing Schemes Mechanism by which people get financial access to health care Three general categories: Government schemes and compulsory contributory healthcare financing schemes MOH family planning program Social health insurance Voluntary healthcare payment schemes Voluntary health insurance Household out-of-pocket payment Individual or household direct payment for contraceptives

Financing Schemes in Uganda Government Central government (MOH) Voluntary NGOs Reproductive Health Uganda (RHU) PACE MSU (NGO and social marketing) Social Marketing Uganda Health Marketing Group (UHMG) Corporate health insurance Out-of-pocket

Funding Sources by Scheme in Uganda Government   Central government (MOH) Internally generated funds (via Vote 116) DFID non-earmarked foreign revenues (to health sector budget support) World Bank loans In-kind donations from external donors—UNFPA (including from DFID funding), Global Fund, USAID, Chinese donations Voluntary   NGOs Reproductive Health Uganda (RHU) IPPF PACE PSI and potentially others MSU (NGO and social marketing) USAID, DFID, UNFPA, Global Fund in-kind donations Social Marketing Uganda Health Marketing Group (UHMG) In-kind donations from USAID, DFID Corporate health insurance Employer and employee contributions

Institutions that manage and operate financing schemes Financing Agents Institutions that manage and operate financing schemes Collect revenues Purchase contraceptives May provide other services May have one agent for collecting revenues and another for purchasing contraceptives Ex: Ministry of Finance may collect revenue; government Procurement Unit may purchase contraceptives

Funding Sources and Financing Agents by Scheme in Uganda   For revenue collection For purchasing commodities Government Central government (MOH) Internally generated funds (via Vote 116) DFID non-earmarked foreign revenues (to health sector budget support) World Bank loans In-kind donations from external donors—UNFPA (including from DFID funding), Global Fund, USAID, Chinese donations Ministry of Finance NMS USAID | DELIVER PROJECT and StarEC (in-kind USAID donations) UNFPA (with its own funds and with DFID funds) Global Fund Baylor (for Mama kits, through in-kind CDC donations)

Funding Sources and Financing Agents by Scheme in Uganda (cont.)   For revenue collection For purchasing commodities Voluntary NGOs Reproductive Health Uganda (RHU) IPPF RHU/IPPF PACE PSI and potentially others MSU (NGO and social marketing) USAID, DFID, UNFPA, Global Fund in-kind donations International Procurement Agency: IPA (from DFID funds), USAID | DELIVER PROJECT, UNFPA, Global Fund Social Marketing Uganda Health Marketing Group (UHMG) In-kind donations from USAID, DFID For public sector channel storage and distribution: NMS, UNFPA, USAID (through USAID | DELIVER PROJECT) For private sector channel: International Procurement Agency (for DFID), USAID Corporate health insurance Employer and employee contributions

Financing Framework Diagram Funding Sources Scheme Agents Central government contraceptive financing scheme Internally-generated funds MOH, CMS 3rd party procurement agents Foreign, in-kind procurement agents Foreign, non-earmarked Foreign, earmarked Foreign, in-kind

Day 1 Homework Assignment Review the Financial Tracking Guide. Write 3 questions on the content. Be able to answer the questions.

End of Day 1 Homework Assignment Complete the Scavenger Hunt handout, by consulting your guide Write down the page number where the answer can be found in the guide Feel free to work with another participant if you would like The Table of Contents is your friend! But then check within the guide to make sure you’re in the right place.

Categories of Financial Analyses Procurement Requirements Commitments Spending Comparisons Comparison of commitment vs. need Comparison of spending vs. commitment Comparison of spending vs. need

Common Analyses for Financial Data Procurement Requirements Funding Commitments by Source Commitment as Percentage of Procurement Requirements Contraceptive Spending by Source and Financing Scheme Amount of Internally Generated Funds Spent Public and Foreign Share of Spending for the Government Scheme

Common Analyses for Financial Data (cont.) Spending by Scheme Spending by Commodity Comparison of Requirements, Commitments, and Spending Spending as a Percentage of Procurement Requirements Spending as a Percentage of Commitments Spending as a Percentage of Commitments, by Source

Procurement Requirements

Amount Committed for Contraceptives by Funding Source (from table 7) Committed for Analysis Year 1 (e.g., FY2011) Committed for Analysis Year 2 (e.g., FY2012) Committed for Analysis Year 3 (e.g., FY2013) Public funds   Private funds Direct foreign transfers Total committed

Commitment as Percentage of Procurement Requirements

Spending by Scheme

Spending by Commodity Spending by Scheme

Amount of Internally Generated Funds Spent

Public and Foreign Share of Spending for the Government Scheme

Comparison of Requirements, Commitments, and Spending

Spending as a Percentage of Procurement Requirements Spending as a Percentage of Commitments

Results from Financing Analyses—Exercise What general statements can you make about the status of commitments and spending on contraceptives? How well is this country meeting its procurement requirements? What are some possible areas that may require action to better ensure contraceptive security? What are potential causes of the increase in public spending and other positive trends reflected in the graphs? What are some of the potential causes of disparities between needs, commitments, and spending? What are advocacy actions that can be used to address these issues?

Which Analyses Best Meet My Objectives In your small group, discuss the following questions: Which objective(s) most closely matches what you need to achieve to address contraceptive security challenges in your country? Which analysis (or analyses) will provide the best information to help you take action to improve contraceptive security?

Three Categories of Financial Data Funds Needed (for Procurement Requirements) The amount of funds needed for the quantity of contraceptives needed to be procured Funds Committed The amount of funds that various sources of revenue say they will spend on contraceptives Funds Spent The amount the program actually spent on contraceptives

Sources of Data – Small Group Activity Information on Commitment Information on Spending by Public Sources Secondary Sources of Information on Public Spending Information on Spending by Private Sources Information on Spending by Foreign Sources As a small group… Review the part of section 2.5 in Guide assigned to your group; be prepared to summarize your section Discuss any experiences you have had obtaining data from these sources

What was spent in fiscal year 2013?   Calendar year 2012 Calendar year 2013 Estimate spent in fiscal year 2013 (July 2012-June 2013) Donor spending $1 million $2 million $1.5 million

What was spent in fiscal year 2013?   Calendar year 2012 Calendar year 2013 Estimate spent in fiscal year 2013 (April 2012-March 2013) Donor spending $1 million $2 million $1.25 million

Considerations for Data Collection What range of data to collect? Subsidized contraceptives usually What time period to use for funding needs, commitments, and expenditures? What is the appropriate commodity price to use in spending calculations? (see page 26 in the guide) What adjustment to make for exchange rates and inflation? What do you do when data available is incomplete or inaccurate?

Example of Commodity Requirements from a Quantification Exercise 2011 2012 Item Description Pack Size Indicative Unit Price (US$) Quantity Total Cost (US$) Injectables vial 1.13 5,400,000 6,102,000 6,300,000 7,119,000 Combined oral contraceptives cycle 0.25 5,280,000 1,320,000 5,750,000 1,437,500 Progestin-only pills 0.28 460,000 128,800 499,000 139,720 Condom unit 0.03 5,000,000 150,000 10,000,000 300,000 IUDs 0.49 76,000 37,240 101,000 49,490 Implants set 21.18 115,000 2,435,700 160,000 3,335,800 Sub-total   10,173,740 12,381,510

Funding Needs for Subsidized Contraceptives, Historical and Projected   Analysis Year Financing Scheme Needs for 2010 Needs for 2011 Needs for 2012 Needs for 2013 Needs for 2014 Needs for 2015 Needs for 2016 Government Voluntary Out-of-pocket Total

Worksheet for Collecting Information on Commitments Source of contraceptive financing commitment_______________________________   Commitment Method Amount (US$) Date Committed Commit-ment Start Date Commit-ment End Date Destination of Funds (financing scheme) Amount Committed for This Analysis Year Source of Info Comment Total Committed

Worksheet for Collecting Information on Spending Source of contraceptive spending _________________________ Date of Transaction Product Description Quantity Value Funding Scheme Destination (recipient) Source of Information Comment  

Country Specific Data Collection – Small Group Activity In your country team, spend 20 minutes discussing the following. Be as specific as possible. What sources of data do we have for contraceptive funds needed, committed, and spent? What additional data sources can we tap? Who should collect this data? How? What challenges might we have in collecting the data we need for financial analyses?

Typical Financing Process Steps Procure contraceptives Disburse funds for procurement of contraceptives Release funds for use Officially allocate or obligate funds Finalize budget Negotiate request Develop budget request Identify contraceptive financing needs

Day 2 Homework Assignment Review the Status of Financial Tracking Efforts and the Status of Financial Advocacy Efforts templates for your country Review any country specific work you have done in the workshop (notes from discussions, etc.) Think about some of the next steps you will take after returning to your country.