1. Advances and Challenges in Family Planning in Nicaragua Contraceptive Security Committee Nicaragua April, 2007

3. Advances Family Planning in Nicaragua

4. Total Fertility Rates and Contraceptive Prevalence Rates TFRPREVALENCE *1994:4.649% *1998:3.960% *2001:3.269% Fuente: ENDESAS 1993, 1998, 2001 Contraceptive Prevalence by residence All methods included. 30% 10 %

5. Percentage of Health Units with adequate Contraceptive Supplies Source: Annual Evaluation of logistic indicators MINSA (Ministry of Health) – DELIVER 2005 MINSA 2001-2005

6. Stakeholders progress (Public sector, NGOs) MINSA (Ministry of Health, MoH)  Sexual and Reproductive Health National Strategy  High prevalence of modern contraceptive methods  Budget support for contraceptive procurement  Logistic System: Integrated and operating INSS (Social Security National Institute)  Regulatory Framework for Family Planning (FP) in Private Clinics outsourced by INSS  Information – Education – Communication (IEC) Campaign to foster demand. NGOs  Strengthening of the Community distribution network  Launching of a Contraceptive Social Marketing Strategy TRANSVERSAL STRATEGY  Contraceptive Security Plan (DAIA).

7. CS Committee Background  Phasing out of USAID contraceptive funding  Need to maintain the FP accomplishments  Regional Meetings sponsored by Deliver USAID were the starting point of the CS Committee in Nicaragua

8. NICARAGUA CS COMMITTEE Goals: Contribute to the reduction in maternal and child mortality and in total fertility rate according to National policies and guaranteeing the sustainable and equitable contraceptive availability in Nicaragua, with the active collaboration between the Government, civil society, private sector and donor community. NATIONAL CS COMMITTEE:  An interinstitutional and multidisciplinary group that offers counselling and technical support to the public and private sector. This committee facilitates the contraceptive security in Nicaragua. Committee Members: GOVERMENTNGOsUSAID PROJECTSAGENCIES MINSA (MoH)PROFAMILIADELIVERUNFPA INSS (Social Security)NicaSaludQAP USAID PASMO PRONICASS

9. CS Committee  Chaired by MoH  Has a technical secretariat  Organises periodical meetings  CS Committee in Nicaragua has:  Statutes  Bylaws  Working plan

10. Challenges Family Planning in Nicaragua

11. Prevalence and unmet need by quintiles Fuente: ENDESA 2001 Population not wanting to use FP

12. Users by quintile and method sources

13. Trends of contraceptive funding MoH Nicaragua 2001 - 2008 Source: USAID/Deliver Project U$ 713,044

14. Stakeholders Challenges MoH  Gradually buying contraceptive supplies since 2007  Improves the demand equity and fundings between contraceptive users  Focus the resources on the most vulnerable populations  Foster cost-effective options of the contraceptive basket  Keep the Logistic System operating INSS (National Social Security Institute)  Guarantee 100% contraceptive coverage for female insured and beneficiaries  Identify procurement mechanisms to guarantee sustainable supplies to the clinics NGOs  Reach the sector with ability to pay that still uses free services  Facilitate the access to contraceptive methods at affordable prices  Achieve behavioural changes in the use of contraceptive methods TRANSVERSAL CHALLENGES  Achieve the full exercise of reproductive rights for Nicaraguans, reduce the unmet need, improve gender equity and achieve the financial and programme sustainability.