2. 1 CAMBODIA RHSC Meeting, Bonn 19-20 October 2006

3. 2 Presentation outline Background Current situation Issues Opportunity for new initiatives

4. 3 BACKGROUND

5. 4 Programme and policies Birth spacing started in Cambodia since 1992, while only 2 clinics provided birth spacing methods In 1994 the National Birth Spacing Programme established and renamed to the National Reproductive Health Programme in 1997 Birth Spacing policy formulated and approved in 1995

6. 5 Goal and strategic plan In Feb 2006, the MoH approved the National Strategy for Reproductive and Sexual Health in Cambodia 2006 – 2010, in which an objective to achieve the CPR set in the CMDG is one of major objectives => RH Commodity security is a key contribution to overall achievement of the Strategy, HSP, CMDG and NSDP.

7. 6 CURRENT SITUATION

8. 7 Essential Drugs and Medical equipment Essential drug and supplies list (being updated) covers key RH products, including contraceptives. Commodities for Safe Motherhood are all purchased from the national budget, through the annual budget allocation from the MEF to the MoH, including male condom Drugs for OIs, STIs, and ARVs are being funded by the WHO, GFATM, WB, ADB and DFID Medical Equipments for Safe Motherhood provided by JICA

9. 8 Contraceptive supply Contraceptives: –funded by government and donors (public sector and NGO) –subsidised by donors (social marketing) and –fully funded by users (private sector) KfW UNFPA USAID DFID

10. 9 Procurement Significant fragmentation of the RH procurement process: –MoH PU, HSSP –KfW –GFATM –NCHADS –Facility level procurement (using user fees) Standard Operating Procedures developed by government with WB/ADB, is implementing from the beginning of this year.

11. 10 LMIS LMIS initiated since 1997, between 1999 and 2002 LMIS was strengthened. Now database program- ODDID/ NATDID is functioning more reliable at operational district and national levels There are ODs in which the LMIS is not functional now It needs strong support to maintain the LMIS functioning at all levels

12. 11 Forecasting and distribution DDF and CMS: for products for Safe Motherhood GFATM and NCHADS: for treatment of STIs, OI and ARVs CSWG: for contraceptive commodities CMS(with external support) stores and delivers all essential drugs to ODs on a "pull" system

13. 12 Key indicators Year199820002005 Population (in million)11.413.1 Annual Growth Rate (%) 2.51.8 (CIPS 2004) CPR (%)24 (CDHS 2000) 40 (CDHS 2005) CPR Modern Contraception (%) 718.5 (CDHS 2000) 27 (CDHS 2005) TFR5.24.0 (CDHS 2000) 3.4 (CDHS 2005)

14. 13 CPR (modern methods)

15. 14 TFR

16. 15 Contraceptives need and supply (thousand of units)

17. 16 Supply of condoms

18. 17 Social marketing (PSI) Contraceptive Social marketing –OK® Pill (COC) – over 9 million cycles sold since 1997 –OK® Injection (Depo) – over 500,000 injections sold since 2002 –Sun Quality Health® Network – started 2002, 117 clinics in 6 provinces –OK® Condom – over 5 million condoms sold since 2004 –IUD – MoH donation, offered in 22 SQH clinics –POP – MoH donation, in 2006 over 4,000 cycles sold

19. 18 ISSUES

20. 19 Demand There is significant demand for RH commodities and services: –Government strongly commits to improve maternal and child health –CDHS 2005 shows 56% of women want no more children –CPR (modern methods) at 27% –Large number of WRA Human resource and capacity building are crucial needs

21. 20 Contraceptive Demand from 2009 onward - But no confirmed supplies

22. 21 Funding Significant funding shortages are likely for contraceptives (pills, Injectables, IUDs) from 2009 onwards Condom funding is under review by DFID with USAID for 2007 onwards; Public sector expenditure on drug and consumables is increasing every year, however an increase in the MoH budget of 1 million US$ per year to cover existing donor funding of contraception to the public sector is not feasible

23. 22 OPPORTUNITY FOR NEW INITIATIVES

24. 23 Improving RH and commodity security Addressing RH needs Implementing the NRSHS 2006-2010 Deepen the roles of CSWG, Appreciate the role of RHSC and the linkage with CSWG Long-term and predictable commitments from donors to RHC/contraceptives supplies, build national capacity for improvement financing, forecasting and procurement Widen the scope of LMIS and HMIS

25. 24 Improving RH and commodity security (cont.) At country level: Gov't commitment from SWIM to SWAP (harmonization and alignment) Need global funding commitment to RH and MNCH

26. 25 System strengthening Minimum Volume Guarantee preferred Government policy on procurement: –National budget- at least GMP required –Donor fund- WHO/UN Prequalification required Globally UNFPA Procurement System recommended

27. 26 Market Development Awareness 2 nd Tier markets to reduce the burden on public and subsidized social marketing programs No barrier for generic products, but WHO pre-qualification required Most clients have a limited ability to pay Involve the sale of different products in the same pharmacy outlets

28. 27 Resource Mobilization Approach Advocate for more resources for RH Donors/ health partners should review the areas of supports from time to time to meet/ respond to country priorities

29. 28 Thank you very much