1. Workshop on Financial Tracking and Advocacy for Contraceptive Security Month Year

2. 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 , order number AID-OAA-TO , beginning September 30, 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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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 accessed April
Data from the DHS Program STATcompiler

10. 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

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

12. 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.

13. 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:

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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)

20. 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

21. 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

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

23. 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.

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

25. 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

26. 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

27. Procurement Requirements

28. 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

29. Commitment as Percentage of Procurement Requirements

30. Spending by Scheme

31. Spending by Commodity
Spending by Scheme

32. Amount of Internally Generated Funds Spent

33. Public and Foreign Share of Spending for the Government Scheme

34. Comparison of Requirements, Commitments, and Spending

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

36. 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?

37. 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?

38. 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

39. 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

40. 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

41. 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

42. 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?

43. 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

44. 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

45. 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

46. 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

47. 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?

48. 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

49. 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.