Contraceptive Security The Bangladesh Story

Bangladesh’s Family Planning Program One of the most successful FP programs (CPR -- 7% in 1975 to 55% in 2000) ~ 75 % of contraceptive users require temporary methods Requires VERY regular and reliable contraceptive procurement Thus, our program is a good testing ground for CS strategies

Contraceptive Forecasting Requirements for 2002

An approximate cost of contraceptives needed annually Between $30 and $35 million per year This number will double within the next 15 years

CONTRACEPTIVE INSECURITY The Basic Problem

Before Health Sector Reform (1998) 26 different donors funding over 100 health programs with GOB Nearly all contraceptives for the GOB were procured directly by donor agencies The social marketing company received commodities through direct bilateral support Dominance of temporary methods

After Health Sector Reform Few donors provide any direct procurement of contraceptives Most donor agencies now pool funding under a single umbrella The GOB is expected to use IDA rules and regulations for procurement Continued dominance of temporary methods

Threats to Contraceptive Security CS is not well understood; thus planning to address CS lacking Funding is available for contraceptives, BUT GOB is unprepared to take on the procurement process Alternative means of addressing CS had not been taken into consideration, e.g., private sector involvement, long term methods, etc. Continued dominance of temporary methods

USAID/Dhaka’s Response A Four Pillar Approach Pillar One: Long-term Planning for CS among policymakers and donors (DELIVER) Pillar Two: Supporting Contraceptive Procurement (DELIVER) Pillar Three: Market Segmentation and Social Marketing (SMC) Pillar Four: Revitalizing long-term methods (ENGENDERHEALTH)

Pillar One CS Planning - The Issues CS is a continuing problem in Bangladesh CS is not well understood by key stakeholders Planning is needed NOW in order to address CS needs to avoid future stock-outs

Pillar One CS Planning - Actions “Contraceptive Security” overview paper was developed Workshops/seminars on CS carried out to: –sensitize people to the problem (Minister level) –develop 20 concrete strategies to improve CS Task Force created to implement the 20 strategies Use of media to educate policy makers and public

Pillar Two Procurement Support - The Issues Most donor agencies now pool funding under a single WB umbrella -- GOB procurement The GOB is expected to use IDA rules and regulations for procurement (slow and cumbersome process) GOB was unprepared –MOHFW lacked experience in procurement –Confusion resulted in mis-procurements and major delays No technical assistance to help with the procurement of contraceptives

Pillar Two Procurement Support - Actions Direct TA to the GOB to carry out procurement process (long and short-term) Database to track commodity procurements Creation of an “easy-to-understand manual” and other helpful materials explaining the IDA procurement process Procurement training to build up capacity TA to the GOB to explore future procurement options

Pillar Three Market Segmentation - The Issues Many clients who are willing and able to pay for contraceptives get them free or at highly subsidized prices Price elasticity surveys indicate clients will pay much more for contraceptives SMC is donor dependent for commodities

Pillar Three Market Segmentation - Actions SMC will segment the market to encourage more clients to pay what they are able to afford Based on price elasticity studies, SMC will raise prices to cover more of their overall costs (sustainability) SMC will begin procuring five out of eight of their products directly

Pillar Four Long-Term Methods - The Issues Sharp decline in VSC from 500,000 cases per year (1987) to 50,000 (2001) Limited donor support for VSC High unmet demand for long-term methods

Pillar Four Long-Term Methods - Actions Strengthen VSC services in public and private sectors Improve donor support for VSC Capacity-building for increasing utilization of VSC Undertake studies to understand how to best reach clients who might want long term methods BCC activities for consumers and providers

Guiding Principles CS efforts should be practical CS approach should be holistic CS efforts should be coordinated with the GOB and other partners (shared responsibility)

USAID support has led to… Framework for CS planning Successful procurement of injectables and condoms by the GOB (first time) Increased capacity for future procurements SMC procuring their own products (oral/condom) Increase in VSC cases to meet unmet demand

Lessons learned CS security requires constant attention CS cannot be addressed simply through workshops and seminars -- it has to be tackled in the real world If HSR is to be implemented, it should be phased in over an extended period of time after local capacity has been built up

THANK YOU!