Forging Partnerships at Country Level to Achieve Contraceptive Security: Reproductive Health Supplies in Six Countries Elizabeth Leahy Madsen and Karen Hardee Population Action International Reproductive Health Supplies Coalition Meeting June 4, 2009

Context for RH Supplies Research and Advocacy Donor funding growing but is it enough? Awareness high at global level, yet supplies disconnected from other issues Advocacy focusing on building capacity and support at country level Progress has been made, but we still fall short of universal access

Case Studies Overview Produced under Project RMA Partnership between DSW, IPPF and PAI RHSC definition of RH supplies, with focus on contraceptives and condoms Six focus countries

Components of the Case Studies The policy environment Health system structure Financing Logistics Organizational actors related to RH supplies Potential advocacy strategies

Policies vs. Implementation Policies exist but are poorly implemented Goals exist for improving access to supplies Yet supplies lag behind as a government priority Supplies available at an UMATI clinic, Tanzania

Fragile Funding Increasing country ownership Declining share of funding for family planning and reproductive health Shrinking quantities of external financing Truck advertising socially marketed condoms, Nicaragua

Evaluating Budget Line Items Each country provides budgetary support at central level Line items often drawn from pooled funding Allocations are frequently redirected or underspent Ghana

Coordination and Logistics Central level coordination committees fulfill key role Governments assuming procurement responsibilities Integrated logistics systems include contraceptives UNFPA supplies at Central Medical Stores, Ghana

Precarious Access at Facilities Stockouts remain frequent below the central level Many challenges inhibit contraceptive security Decentralization can compound shortages in supplies Family planning counseling at an UMATI clinic, Tanzania

The Role of Civil Society Civil society organizations new to RH supplies advocacy Expanding role beyond service delivery Broadening the scope of potential advocates MEXFAM youth promoter, Mexico

Building on Advocacy Successes Advancing contraceptive security strategies and coordination Promoting integration into essential medicines lists Securing funding commitments Publicizing the importance of supplies Presentation on adolescent reproductive health in Malangala village, Uganda

Country Context: Small Group Preview Bangladesh: Increasing unmet need, high government turnover, coordination forum revived Ghana: Strong policies, financial sustainability plan, insurance scheme neglects contraceptives Mexico: Youth-focused policies, decentralization Nicaragua: Hostile government, impending donor graduation, universal free health care Tanzania: Council health budgets, central line item Uganda: New contraceptive security plan

Thank you