1. E X P A N D I N G F A M I L Y P L A N N I N G O P T I O N S Achieving Security for SDM/CycleBeads in Rwanda and Mali: Untangling Procurement, Distribution & Policy Issues Marie Mukabatsinda, Country Representative, Rwanda Georgetown University’s Institute for Reproductive Health Caucus for New and Underused Method Panel RHSC Annual Membership Meeting Addis Ababa, Ethiopia | June 2011

2. Standard Days Method® & CycleBeads®  Appropriate for women with menstrual cycles between 26 and 32 days long  Identifies days 8-19 of the menstrual cycle as fertile  Helps a couple avoid or plan pregnancy  Is used with CycleBeads ® to :  identify fertile days  communicate with partner  95% effective with correct use  Reaches non-users, traditional method users & reduces unmet need  Accounts for 2 CYPs

3.  Introduced into programs in more than 30 countries  USAID-funded programs can order CycleBeads through USAID | DELIVER, just as they order other contraceptives  Other programs can order directly from manufacturer, Cycle Technologies at www.cyclebeads.com www.cyclebeads.com  Sales data available on RHInterchange (as shown below) SDM/CycleBeads: Available Worldwide Source: RHInterchange

4. Method Concept & Efficacy Trial 1999-2002 Pilot Studies 2000-2004 Operations Research 2003- 2005 Integration Studies 2005 - 2007 Scale-Up Case Studies 2007-2012 SDM: From Research to Scale One factor IRH had to consider during scale-up was how CycleBeads would be integrated into—and sustained by—the health system. This presentation shares four lessons learned from this process.

5. Contraceptive Security for New and Underused Methods (NUMs): 4 Lessons Learned #1: Creative forecasting tools are needed for new methods. #2: Advocacy is needed to ensure that new methods are included in procurement tables and systems. #3: Existing push-pull systems of commodity distribution are not well-suited to ensure new products reach existing health centers. #4: Monitor effects of existing and new finance mechanisms on procurement decisions.

6. LESSON #1: Creative forecasting tools are needed for new methods. ISSUE: SOLUTION: Forecasting for procuring new and underused methods (NUMs) should be based on factors including pilot results, expected increases in awareness, demand and program capacity, and timing issues to avoid stockouts. “Guess work” estimating for initial procurement of CycleBeads in Rwanda & Mali Initial large supply (note: CycleBeads don’t expire) Initial large supply (note: CycleBeads don’t expire) Donors delayed re-ordering CycleBeads even though demand and program capacity increased over time (became a timing issue) IRH developed a CycleBeads forecasting guide with PATH/JSI to include these factors. IRH, with partners JSI and PSI, were awarded an Innovation Fund grant to develop a guide for forecasting NUMs. The guide will be available in early 2012.

7. LESSON #2: Advocacy is needed to ensure that new methods are included in procurement tables & systems. ISSUE: SOLUTION: Currently working with WHO to issue a statement recommending CycleBeads for public sector procurement.

8. LESSON #3: Existing push-pull systems of commodity distribution are not well-suited to ensure that new products reach health centers.

9. ISSUE: In many countries, CycleBeads are not included on reporting or requisition forms. CycleBeads are included on reporting & requisition forms in Rwanda, but this is not enough. GLOBAL SOLUTION: Continue advocacy & TA to ensure proper distribution & reporting mechanisms for new methods. RWANDA SOLUTION: DELIVER Project provided technical assistance to directly address the issue as part of their training & monitoring visits for procurement and supply chain management. GLOBAL SOLUTION: Continue advocacy & TA to ensure proper distribution & reporting mechanisms for new methods. RWANDA SOLUTION: DELIVER Project provided technical assistance to directly address the issue as part of their training & monitoring visits for procurement and supply chain management.

10. LESSON #4: Monitor effects of existing and new finance mechanisms on procurement decisions. ISSUE 1: Performance Based Financing in Rwanda ISSUE 2: Bamako Initiative in Mali ISSUE 2: Bamako Initiative in Mali Does it include CycleBeads? Sometimes Yes Sometimes No Solution: Advocate to include it in 2012 PBF & monitor reforms going forward Community committees with decision-making authority over FP commodity purchases resist purchasing CycleBeads. Solution: Advocacy & training in community social responsibility & RH rights

11. The Questions to Ask: Is the method included in national/local reporting mechanisms? Can donors order it as they order other RH commodities? How will the commodity be distributed in country? Who will be involved? What policies and/or finance mechanisms are in place that will facilitate/inhibit uptake? Are there gaps in the linkages between sub- systems that can inhibit commodity security? What advocacy and/or technical assistance efforts are needed to overcome challenges?

12. For more information about SDM & CycleBeads, visit us at www.irh.orgwww.irh.org Thank you for your attention.