Measuring Contraceptive Security Indicators 2014 – Summary Findings

Introduction to CS Indicators Why measure contraceptive security (CS)?  Country stakeholders and advocates recognize the importance of monitoring country-level progress toward contraceptive security (CS) for advocacy, program planning, and monitoring purposes. How were the indicators defined?  In 2009, the USAID | DELIVER PROJECT proposed a set of standard CS indicators – some new and some existing – for countries to track changes.  These indicators are collected annually and have been refined over time.

Introduction to This Presentation This slide deck presents data from 47 countries, collected through the CS Indicators survey in  In addition to the information on each slide, clarifying comments and more information can be found in the slide notes. Not all indicators are represented in this presentation  More information can be found in the complete dataset, found here: s/CSIndiData2013.xlsx s/CSIndiData2013.xlsx o You can also find a blank survey in the complete dataset that can be adapted for your country needs.

Introduction to This Presentation Contraceptive security Definition Framework (SPARHCS) Contraceptive Security Indicators Survey Audience and Uses Limitations 2014 CS Indicators Survey selected findings Finance Policies Commodities Coordination Supply chain Conclusion and additional resources

Contraceptive Security (CS) exists when every person is able to choose, obtain, and use quality contraceptives and condoms for family planning and the prevention of sexually transmitted infections. Contraceptive Security

Reproductive Health Commodity Security Framework The indicators build on the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS) framework The framework is made up of components considered vital to achieving reproductive health commodity security (RHCS).

Contraceptive Security Indicators Survey Key informant survey Conducted annually 40+ countries  USAID | DELIVER PROJECT presence countries  Tier 1 USAID population and reproductive health countries Topics covered Finance Policies Commodities Coordination and Leadership Supply Chain

Survey Audience and Uses Intended Audiences Country governments Policymakers CS committees Advocates–local and global Program managers Donors Global partners Uses Monitor progress toward CS Identify advocacy and programmatic entry points

Survey Limitations Indicator questions are limited in that they are not intended to require extensive background research Precise data may be difficult for respondents to locate– particularly as relates to financing Official policy may vary from actual practice Data are contingent on the knowledge of respondents

2014 Survey 47 countries were surveyed in 2014

2014 Key Findings Finance 65% of countries used government funds for contraceptive procurement 22 countries indicated insufficient funding for contraceptive procurement Policies On average, countries included 7 out of 9 methods on their National Essential Medicine List 85% of countries include CS in a national strategy Commodities On average, countries offer 8 out of 11 methods in the public sector 91% of countries offer all five of the most commonly offered methods Coordination 89% of countries have a committee that works on CS issues 100% of committees include the Ministry of Health Supply Chain 48% of countries had a central-level stockout at some point during the last year On average, these countries had central-level stockouts of 1- 2 products

Finance for Procurement Sufficient financing (from all sources) is key to ensuring a reliable supply of contraceptives. Government financing indicates a government’s commitment to contraceptive security It also suggests sustainability. A budget line item can help ensure that contraceptives are a priority in annual budgeting.

Finance for Procurement Indicators include:  Dollar value of estimated need for contraceptives to be procured for the public sector*  Existence of a government budget line item for contraceptives  Amount of government funds allocated for contraceptives  Government expenditures for contraceptive procurement  Value of in-kind contraceptive donations for the public sector  Value of Global Fund grants used for contraceptives (including condoms)  Information on the existence of a funding gap

Financing Sources for Public-Sector Contraceptives Internally generated funds ― these funds are drawn from government revenue sources ― usually from various taxes, duties or fees. Other government funds Basket funds ― the government manages these pooled funds which originate from various sources, including donors and the government. World Bank assistance ― this funding, either credits or loans, can be used for general budget support, sector budget support, or earmarked interventions. Other funds ― include additional funds provided to the government by donors Government Financing Contraceptive supplies that donors provide to a government In-Kind Donations These grants can be used to procure condoms or other contraceptives Global Fund Grants

Finance for Procurement 66% 77% 65% Was there a government budget line item for procurement of contraceptives? Were government funds allocated for the procurement of contraceptives? Were government funds spent for the procurement of contraceptives?

Government Expenditures 65% of respondent countries indicated that their country spent government funds on contraceptive procurement in the most recent complete fiscal year Of these 28 countries using government funds:  79% reported using internally generated funds  39% reported using other government funds The average amount of government funds spent was:  $1,182,272 from internally generated funds  $2,270,760 from other government funds

Government Expenditures Respondent Countries That Did Not Spend Government Funds on Contraceptive Procurement during the Previous Fiscal Year Africa Cameroon Guinea Liberia Malawi Mali Mauritania Niger Sierra Leone Togo Europe & Asia Armenia Bangladesh Georgia Pakistan Russia Latin America & the Caribbean Haiti Honduras

Government Expenditures ― Africa Country Internally Generated FundsOther Government Funds Total Government Funds Spent (USD) Internally Generated Funds as Percentage of all Government Funds Benin $ 40, % Burkina Faso $ 2,478, % Burundi $ 59,519 $ 1,326,387 $ 1,385,9064% Cape Verde $ 28, % DR Congo $ - $ 3,000,000 0% Ethiopia $ - $ 21,400,000 0% Ghana $ 1,155,195 0% Kenya $ 6,214,337 $ 3,672,000 $ 9,886,33763% Madagascar $ 45,454 $ - $ 45,454100% Mozambique $ - $ 2,750,000 0% Nigeria $ 3,000,000 $ 8,000,000 $ 11,000,00027% Peru $ 9,616, % Rwanda $ 408,296 $ - $ 408,296100% Senegal $ 250, % South Africa unknown Tanzania $ - $ 2,500,000 0% Uganda $ 3,300, % Zambia $ 1,120, %

Government Expenditures ― Europe & Asia Country Internally Generated Funds Other Government Funds Total Government Funds Spent (USD) Internally Generated Funds as Percentage of all Government Funds Bangladesh $ - $ 34,000,000 0% India unknown Nepal $ 2,048,987 $ 716,919 $ 2,765,90674% Philippines $ 9,343,640 $ - $ 9,343,640100% Ukraine $ 160,625 $ 118,125 $ 278,75058%

Government Expenditures ― LAC Country Internally Generated Funds Other Government Funds Total Government Funds Spent (USD) Internally Generated Funds as Percentage of all Government Funds Dominican Republic $ 1,360,000 $ - $ 1,360,000100% El Salvador $ 1,625,000 $ 125,000 $ 1,750,00093% Guatemala $ 2,713,756 $ - $ 2,713,756100% Nicaragua $ 742,173 $ 712,987 $ 1,455,16051% Paraguay $ 371,000 $ - $ 371,000100%

Finance for Procurement

22 countries indicated there was insufficient funding for contraceptive procurement 16 countries covered more than 100% of the quantified need 4 countries did not know if there was a funding gap 125% 1154% 214%159% 121% 270% AfricaEurope and AsiaLAC

Finance for Procurement A budget line item alone is not enough to ensure that contraceptives will be funded, but it is usually a good indicator 29 out of 44 respondent countries reported having a government budget line item for contraceptive procurement*  79% of countries with a budget line followed up with funding for contraceptive procurement  33% of countries without a budget line funded contraceptive procurement

Policies Policies can reflect the level of government commitment to contraceptive security, as well as significantly impact client access to family planning.

Policies Indicators include:  Existence of a national contraceptive security strategy  Policies limiting or promoting access to family planning  Inclusion of contraceptives on the National Essential Medicines List (NEML)  Inclusion of CS concepts and family planning indicators in the Poverty Reduction Strategy Paper (PRSP)  Which method is the lowest level provider allowed to dispense (task shifting)?

Policies―National Essential Medicines List On average, countries include 7 out of the 9 surveyed methods on the NEML or equivalent

Policies ― Government Strategies A D MAR PPROVE BY: ____________________ 40 out of 47 countries reported having a contraceptive security strategy (or another strategy that includes a CS component) Of those, 92% have been formally approved by the Ministry of Health 92% of the strategies are reportedly being implemented

Policies ― Provision and Access Taxes, duties and fees 30 out of 46 countries mentioned taxes, import duties, or fees on contraceptives– primarily affecting commercial-sector goods Advertising bans 4 countries report advertising bans that affect the provision of private-sector contraceptives Policies enabling the private sector 28 out of 41 countries report policies that enable the private sector to provide contraceptive methods Restricting access to sub- populations 6 countries reported that unmarried people or youth have restrictions placed on their access to contraceptives. Charges In 9 countries there are charges to public-sector clients for FP services. In 10 countries there are charges to public-sector clients for FP commodities.

Policies ― Charges to Clients ServicesCommodities CameroonBenin Democratic Republic of Congo*Burkina Faso GhanaCameroon Guinea*Cape Verde* Haiti*Democratic Republic of Congo* Mali* Senegal*Pakistan* TogoSenegal* Zimbabwe*Togo Zimbabwe* *There are exemptions for those who are unable to pay

Commodities Providing a mix of contraceptive methods is essential to ensure that clients can choose the contraceptive that best fits their needs. 11 methods included in survey Male condomsFemale condoms Combined oral contraceptives Progestin only pills IUDInjectablesImplants Emergency contraceptives CycleBeadsTubal ligationVasectomy

Commodities Indicators include:  Range of contraceptives offered through: Public sector facilities Nongovernmental organization (NGO) facilities Social marketing Commercial-sector facilities

Commodities

On average, countries offer 8 out of 11 assessed methods in the public sector 11 surveyed countries offer all 11 methods: Benin, Burundi, DR Congo, Ghana, Guinea, Haiti, Kenya, Malawi, Senegal, Togo, Zimbabwe 91% of countries offer all 5 of the most commonly offered methods:  male condoms  combined oral contraceptives  IUDs  tubal ligations  injectables

Coordination & Leadership For contraceptive security to be realized, stakeholders from various sectors ― public, NGO, social marketing and commercial ― must work together to promote effective and efficient service delivery and supply chain systems to ensure access to contraceptives for all segments of the population.

Coordination & Leadership Indicators include:  Existence of a national committee that works on contraceptive security Organizations represented on the committee Frequency of committee meetings Legal status of the committee Existence of a contraceptive security champion

Coordination & Leadership 89% of countries have a committee that works on contraceptive security 61% of the committees have legal status

Supply Chain An effective supply chain enables the continuous availability of high-quality contraceptives, which is essential to ensuring contraceptive security.

Supply Chain Indicators include:  Central-level stockout data  Whether stockouts are a major problem at the central level  Whether stockouts are a major problem at the service delivery point (SDP) level

Supply Chain 48% (20 of 42) of responding countries reported a central-level stockout of at least one contraceptive method during the last year  On average, these countries reported central-level stockouts of 1-2 products.

Supply Chain 53% of countries identified service delivery point stockouts as a large problem 14% of countries identified central-level stockouts as a large problem

Supply Chain

Conclusions Finance More than 50% of governments are using their funds for contraceptives Increase number of countries allocating funds and following through to spend them Policies On average, countries included 7 out of 9 methods on their National Essential Medicine List Ensure that policies enable all sectors to offer a range of methods and all clients can access those methods. Commodities On average, countries offer 8 out of 11 methods in the public sector Continue to expand range of commodities offered in all sectors. Coordination 89% of countries have a committee that works on CS issues Diversify committee membership- include Ministry of Finance/ Planning and commercial sector Supply Chain Fewer than 50% of countries experienced a central level stockout Monitor stock at all levels of the system to ensure stockouts at the central level don’t result in stockouts at SDPs Where improvements can be madeWhat’s Working

For More Information DataMapsDashboards Visit: