1. PARAGUAY Moving Towards Contraceptive Security
Semi-Annual Meeting of the Reproductive Health Supplies Coalition
Washington, D.C.
October, 2007

3. Situation in Paraguay around 2004
Increase in modern contraceptive use, from 51% in 1998 to 61% in 2004
Unmet need (18%) – greater in rural areas
32% of contraceptive use provided by public sector
Donations provided in a non-regular basis: stock outs
Public purchases are not regular, small quantities and one product

4. Challenges to Sustainable Financing of FP Supplies
Institutionalize public sector funding
Create unified plan and commitments
Reach agreement on phase out by donors
Target public service delivery to lower income population and reduce financial barriers

5. Initial Steps Creation of CS Committee (Managua 2003 and after)
March 2004 CS Assessment
Identified need for budget line for contraceptive procurement

6. Multisectoral Approach
Members of CS Committee (Sexual & Reproductive Health National Council)
Health Program Director and team, MOH
USAID- Health Officer
UNFPA- Reproductive Health Officer,
Executive Director-IPPF Affiliate (CEPEP)
Social Marketing of Contraceptives (PROMESA)
Paraguayan Chamber of Pharmacies (CAFAPAR)
Social Security (IPS)
USAID | DELIVER PROJECT-Advisor

7. Current Achievements
Approval of Law 2907 (Secured budget for MOH Reproductive Health Programs and Birth Kits Provision)
CS Plan approved by National SRH Council
Tripartite Plan of Gradual Phase Out of Contraceptive Donations
Procurement agreement UNFPA-MOH
Free contraceptives and consultation
MOH provided US$ 261,573 for contraceptive procurement in 2006 and committed US$ 551,000 in 2007

8. Signed by President in May 2006

9. What does Law 2907 say?
Reserves funds for the procurement, storage and distribution of contraceptives based on MOH requirements
Makes decentralized financing of contraceptives possible
Mandates Social Security to procure its own supplies
Establishes permanent budget line item for contraceptives and delivery kits

10. Approval process for Law 2907
Alliances with key Congresspersons
Draft Bill
Frame FP within constitutional rights
Avoid public confrontation
Link contraceptives with birth kits to reduce resistance
Monitor the Bill through its different steps

11. A Successful Combination
CS members with direct access to the Legislative and Executive Branches of Government
Analysis of similar legal frameworks
Advocacy with key allies and political authorities
Discussions and presentations with MOH stakeholders
Coordinating meetings/CS Committee Planning

12. Impact Political commitment to support CS Legal framework for funding
Optimization of financial resources procuring at lower prices
Self-sustainability in the medium term
Guaranteed access for low income users

13. Lessons Learned
Follow critical path for approval of law doing advocacy with stakeholders
Strategic management of the political environment
Advocacy done before process of passing of the law helped sensitize political actors
Empowerment of key Congresspersons
A law must not only guarantee funds but also the procurement mechanism

14. Recent Challenges Frequent changes in administrative officials at MOH
Legal barriers to non-competitive procurement by MOH
Difficulties at the Social Security Institute to approve non-competitive procurement of contraceptive

15. CHALLENGES AND NEXT STEPS
Create an effective system without barriers for the contraceptive procurement process
Implementation of the Tripartite Plan of Gradual Contraceptive Donations’ Substitution
Institutionalization of FP services at SS (IPS)
Continuous monitoring of the process
Strengthen monitoring and control systems

16. Muchas Gracias