1. Measuring Contraceptive Security Indicators 2013 – Summary Findings

2. Introduction to CS Indicators Why measure contraceptive security (CS)?  Country stakeholders and advocates recognize the importance of monitoring country-level progress toward contraceptive security (CS) for advocacy, program planning, and monitoring purposes. How were the indicators defined?  In 2009, the USAID | DELIVER PROJECT proposed a set of standard CS indicators – some new and some existing – for countries to track changes.  These indicators are collected annually and have been refined over time.

3. Introduction to This Presentation This slide deck presents data from 43 countries, collected through the CS Indicators survey in 2013.  In addition to the information on each slide, clarifying comments and more information can be found in the slide notes. Not all indicators are represented in this presentation  More information can be found in the complete dataset, found here: http://deliver.jsi.com/dlvr_content/resources/allpubs/factsheet s/CSIndiData2013.xlsx http://deliver.jsi.com/dlvr_content/resources/allpubs/factsheet s/CSIndiData2013.xlsx o You can also find a blank survey in the complete dataset that can be adapted for your country needs.

4. Introduction to This Presentation Contraceptive security Definition Framework (SPARHCS) Contraceptive Security Indicators Survey Audience and Uses Limitations 2013 CS Indicators Survey selected findings Finance Policies Commodities Coordination Supply chain Conclusion and additional resources

5. Contraceptive Security (CS) exists when every person is able to choose, obtain, and use quality contraceptives and condoms for family planning and the prevention of sexually transmitted infections. Contraceptive Security

6. Reproductive Health Commodity Security Framework The indicators build on the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS) framework of components considered vital to achieve reproductive health commodity security (RHCS).

7. Contraceptive Security Indicators Survey Key informant survey Conducted annually 40+ countries  USAID | DELIVER PROJECT presence countries  Tier 1 USAID population and reproductive health countries Topics covered Finance Policies Commodities Coordination and Leadership Supply Chain

8. Survey Audience and Uses Intended Audiences Country governments Policymakers CS committees Advocates–local and global Program managers Donors Global partners Uses Monitor progress toward CS Identify advocacy and programmatic entry points

9. Survey Limitations Indicator questions are limited in that they are not intended to require extensive background research Precise data may be difficult for respondents to locate– particularly as relates to financing Official policy may vary from actual practice Data are contingent on the knowledge of respondents

10. 2013 Surveyed Countries

11. Key Findings 2013 Finance 63% of countries used government funds for contraceptive procurement 18 countries indicated insufficient funding for contraceptive procurement Policies On average, countries included 6 out of 9 methods on their National Essential Medicine List 88% of countries include CS in a national strategy Commodities On average, countries offer 8 out of 11 methods in the public sector 86% of countries offer all five of the most commonly offered methods Coordination 91% of countries have a committee that works on CS issues 100% of committees include the Ministry of Health Supply Chain 70% of countries had a central-level stockout at some point during the last year On average, these countries had central-level stockouts of 2 products

12. Finance for Procurement Sufficient financing is key to ensuring a reliable supply of contraceptives. Government financing indicates a government’s commitment to contraceptive security; it also suggests sustainability. A budget line item can help ensure that contraceptives are a priority in annual budgeting.

13. Finance for Procurement Indicators include:  Dollar value of estimated need for contraceptives to be procured for the public sector*  Existence of a government budget line item for contraceptives  Amount of government funds allocated for contraceptives  Government expenditures for contraceptive procurement  Value of in-kind contraceptive donations for the public sector  Value of Global Fund grants used for contraceptives (including condoms)  Information on the existence of a funding gap

14. Financing Sources for Public-Sector Contraceptives Internally generated funds ― these funds are drawn from government revenue sources ― usually from various taxes, duties or fees. Other government funds Basket funds ― the government manages these pooled funds which originate from various sources, including donors and the government. World Bank assistance ― this funding, either credits or loans, can be used for general budget support, sector budget support, or earmarked interventions. Other funds ― include additional funds provided to the government by donors Government Financing Contraceptive supplies that donors provide to a government In-Kind Donations These grants can be used to procure condoms or other contraceptives Global Fund Grants

15. Government Expenditures 63% of respondent countries indicated that their country spent government funds on contraceptive procurement in the most recent complete fiscal year Of these 26 countries using government funds:  73% reported using internally generated funds  54% reported using other government funds The median amount of government funds spent was:  $586,096 from internally generated funds  $1,323,526 from other government funds

16. Government Expenditures Respondent Countries That Did Not Spend Government Funds on Contraceptive Procurement during the Previous Fiscal Year Africa Ghana Guinea Liberia Malawi Mauritania Mozambique Nigeria Sierra Leone South Sudan Togo Zambia Europe & Asia Armenia Azerbaijan Bangladesh Georgia Pakistan Yemen Latin America & the Caribbean Haiti Honduras

17. Government Expenditures ― Africa Country Internally Generated Funds Spent (USD) All Other Government Funds Spent (USD) Total Government Funds Spent (USD) Internally Generated Funds as Percentage of Total Government Spending Benin $ 120,000 $ 216,000$ 336,00036% Burkina Faso $ 720,438$ -$ 720,438100% Burundi $ 59,519 $ 425,180$ 484,69912% Ethiopia $ 400,000$ 16,200,000$ 16,600,0002% Ghana$ -$ 1,347,052 0% Kenya $ 5,967,466$ 5,131,248$ 11,098,71454% Madagascar $ 47,315$ 1,374,680$ 1,421,9953% Mali $ 33,760$ -$ 33,760100% Nigeria$ -$ 17,600,000 0% Rwanda $ 574,367$ - $ 574,367100% Senegal $ 250,000$ - $ 250,000100% Uganda $ 3,300,000$ - $ 3,300,000100% TanzaniaUnknown $ 6,527,892unknown

18. Government Expenditures ― Europe & Asia Country Internally Generated Funds Spent (USD) All Other Government Funds Spent (USD) Total Government Funds Spent (USD) Internally Generated Funds as Percentage of Total Government Spending Bangladesh $ - $ 35,690,361 0% Indonesia $ 50,900,000 $ - $ 50,900,000 100% Nepal $ 2,318,591 $ 579,648 $ 2,898,239 80% Philippines $ 5,712,025 $ - $ 5,712,025 100% Ukraine $ 100,000 $ 76,000 $ 176,000 57% Yemen $ - $ 1,300,000 0%

19. Government Expenditures ― LAC Country Internally Generated Funds Spent (USD) All Other Government Funds Spent (USD) Total Government Funds Spent (USD) Internally Generated Funds as Percentage of Total Government Spending Dominican Republic $ 586,096 $ - $ 586,096100% El Salvador $ 914,500 $ 547,434 $ 1,461,93463% Guatemala $ 374,763 $ - $ 374,763100% Nicaragua $ 1,100,000 $ 400,000 $ 1,500,00073% Paraguay $ 646,700 $ - $ 646,700100%

20. Finance for Procurement

22. 18 countries indicated there was insufficient funding for contraceptive procurement 13 countries covered more than 100% of the quantified need 12 countries did not know if there was a funding gap

23. Finance for Procurement A budget line item alone is not enough to ensure that contraceptives will be funded, but it is usually a good indicator 27 out of 42 respondent countries reported having a government budget line item for contraceptive procurement*  77% of countries with a budget line followed up with funding for contraceptive procurement  33% of countries without a budget line funded contraceptive procurement

24. Policies Policies can reflect the level of government commitment to contraceptive security, as well as significantly impact client access to family planning.

25. Policies Indicators include:  Existence of a national contraceptive security strategy  Policies limiting or promoting access to family planning  Inclusion of contraceptives on the National Essential Medicines List (NEML)  Inclusion of CS concepts and family planning indicators in the Poverty Reduction Strategy Paper (PRSP)  Which method is the lowest level provider allowed to dispense (task shifting)?

26. Policies―National Essential Medicines List On average, countries include 7 out of the 9 surveyed methods on the NEML or equivalent

27. Policies ― Government Strategies A D MAR 15 2013 PPROVE BY: ____________________ 38 out of 43 countries reported having a contraceptive security strategy (or another strategy that includes a CS component) 92% have been formally approved by the Ministry of Health 34 out of 38 of the strategies are reportedly being implemented

28. Policies ― Provision and Access Taxes, duties and fees 26 out of 42 mentioned taxes, import duties, or fees on contraceptives– primarily affecting commercial-sector goods Advertising bans 8 countries report advertising bans that affect the provision of private-sector contraceptives Policies enabling the private sector 30 out of 39 report policies that enable the private sector to provide contraceptive methods Restricting access to sub- populations 6 countries reported that unmarried people or youth have restrictions placed on their access to contraceptives. Charges In 9 countries there are charges to public-sector clients for FP services. In 8 countries there are charges to public-sector clients for FP commodities.

29. Commodities Providing a mix of contraceptive methods is essential to ensure that clients can choose the contraceptive that best fits their needs. Countries were surveyed on 11 methods Male condomsFemale condoms Combined oral contraceptives Progestin only pills IUDInjectablesImplants Emergency contraceptives CycleBeadsTubal ligationVasectomy

30. Commodities Indicators include:  Range of contraceptives offered through: Public sector facilities Nongovernmental organization (NGO) facilities Social marketing Commercial-sector facilities

31. Commodities

32. On average, countries offer 8 out of 11 assessed methods in the public sector 8 surveyed countries offer all 11 methods:  Benin, Burundi, Ghana, Haiti, Kenya, Malawi, Senegal, and Zimbabwe 86% of countries offer all 5 of the most commonly offered methods:  male condoms  combined oral contraceptives  IUDs  tubal ligations  injectables

33. Coordination & Leadership For contraceptive security to be realized, stakeholders from various sectors ― public, NGO, social marketing and commercial ― must work together to promote effective and efficient service delivery and supply chain systems to ensure access to contraceptives for all segments of the population.

34. Coordination & Leadership Indicators include:  Existence of a national committee that works on contraceptive security Organizations represented on the committee Frequency of committee meetings Legal status of the committee Existence of a contraceptive security champion

35. Coordination & Leadership 91% of countries have a committee that works on contraceptive security 59% of the committees have legal status

36. Supply Chain An effective supply chain enables the continuous availability of high-quality contraceptives, which is essential to ensuring contraceptive security.

37. Supply Chain Indicators include:  Central-level stockout data  Whether stockouts are a major problem at the central level  Whether stockouts are a major problem at the service delivery point (SDP) level

38. Supply Chain 70% (26 of 37) of responding countries reported a central-level stockout of at least one contraceptive method during the last year  On average, these countries reported central-level stockouts of approximately 2 products.

39. Supply Chain 58% of countries identified service delivery point stockouts as a large problem 23% of countries identified central-level stockouts as a large problem

40. Supply Chain

41. Conclusions The Good News 91% of countries have a coordination committee working on CS 88% of countries have strategies for working on CS 63% of countries contribute government funds for contraceptives The Good News 91% of countries have a coordination committee working on CS 88% of countries have strategies for working on CS 63% of countries contribute government funds for contraceptives Room for Improvement Diversifying membership of CS coordinating committees Increasing the number of governments contributing funds for contraceptives and the amount of government contributions for contraceptives Expanding the range of contraceptive methods offered in health centers and included in essential medicines lists Room for Improvement Diversifying membership of CS coordinating committees Increasing the number of governments contributing funds for contraceptives and the amount of government contributions for contraceptives Expanding the range of contraceptive methods offered in health centers and included in essential medicines lists

42. For More Information DataMapsDashboards Visit: http://deliver.jsi.com/dhome/whatwedo/commsecurity/csmeasuring/csindicators http://deliver.jsi.com/dhome/whatwedo/commsecurity/csmeasuring/csindicators