Measuring Contraceptive Security Indicators 2014 Summary Findings Introduction

Measuring Contraceptive Security Indicators 2014 – Summary Findings

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.

Introduction to This Presentation • This slide deck presents data from 47 countries, collected through the CS Indicators survey in 2014. § 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/CSIndi. Data 2013. xlsx o You can also find a blank survey in the complete dataset that can be adapted for your country needs.

Introduction to This Presentation Contraceptive security • Definition • Framework (SPARHCS) Contraceptive Security Indicators Survey • Audience and Uses • Limitations 2014 CS Indicators Survey selected findings • • • Finance Policies Commodities Coordination Supply chain Conclusion and additional resources

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.

Reproductive Health Commodity Security Framework The indicators build on the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS) framework • The framework is made up of components considered vital to achieving reproductive health commodity security (RHCS).

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

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

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

2014 Survey 47 countries were surveyed in 2014

• 85% of • 22 countries include CS in a • 89% of countries have a committee that works on CS issues • 48% of Supply Chain • On average, countries offer 8 out of 11 methods in the public sector Commodities countries used government funds for contraceptive procurement • On average, countries included 7 out of 9 methods on their National Essential Medicine List Policies Finance • 65% of Coordination 2014 Key Findings countries had a central-level stockout at some point during the last year • On average, these countries had centrallevel stockouts of 1 -2 products

Finance for Procurement • Sufficient financing (from all sources) 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.

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

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 Government originate from various sources, including donors and the government. Financing • 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 In-Kind Donations • Contraceptive supplies that donors provide to a government Global Fund • These grants can be used to procure condoms or other contraceptives Grants

Finance for Procurement 66% Were government funds allocated for the procurement of contraceptives? Was there a government budget line item for procurement of contraceptives? 77% 65% Were government funds spent for the procurement of contraceptives?

Government Expenditures • • 65% of respondent countries indicated that their country spent government funds on contraceptive procurement in the most recent complete fiscal year Of these 28 countries using government funds: § § 79% reported using internally generated funds 39% reported using other government funds • The average amount of government funds spent was: § § $1, 182, 272 from internally generated funds $2, 270, 760 from other government funds

Government Expenditures Respondent Countries That Did Not Spend Government Funds on Contraceptive Procurement during the Previous Fiscal Year • • • Africa Cameroon Guinea Liberia Malawi Mali Mauritania Niger Sierra Leone Togo Europe & Asia • Armenia • Bangladesh • Georgia • Pakistan • Russia Latin America & the Caribbean • Haiti • Honduras

Government Expenditures―Africa Country Internally Generated Funds Other Government Funds Total Government Funds Spent (USD) Internally Generated Funds as Percentage of all Government Funds Benin $ 40, 000 100% Burkina Faso $ 2, 478, 874 100% Burundi $ 59, 519 $ 1, 385, 906 4% Cape Verde $ 28, 398 DR Congo $ - $ 3, 000, 000 0% Ethiopia $ - $ 21, 400, 000 0% $ 1, 155, 195 0% Ghana $ 1, 326, 387 100% Kenya $ 6, 214, 337 $ 3, 672, 000 $ 9, 886, 337 63% Madagascar $ 45, 454 $ - $ 45, 454 100% Mozambique $ - $ 2, 750, 000 0% Nigeria $ 3, 000 $ 8, 000 $ 11, 000 27% Peru $ 9, 616, 296 100% Rwanda $ 408, 296 100% Senegal South Africa Tanzania $ 250, 000 100% $ - Uganda $ Zambia $ $ unknown $ 2, 500, 000 0% 3, 300, 000 $ 3, 300, 000 100% 1, 120, 000 $ 1, 120, 000 100%

Government Expenditures―Europe & Asia Internally Generated Funds Country Bangladesh India Nepal Philippines Ukraine $ $ unknown 2, 048, 987 9, 343, 640 160, 625 Other Government Funds $ $ 34, 000 unknown 716, 919 118, 125 Total Government Funds Internally Generated Funds as Spent (USD) Percentage of all Government Funds $ $ 34, 000 unknown 2, 765, 906 9, 343, 640 278, 750 0% unknown 74% 100% 58%

Government Expenditures―LAC Internally Generated Funds Country Dominican Republic $ Other Government Funds 1, 360, 000 $ El Salvador $ 1, 625, 000 $ Guatemala $ 2, 713, 756 $ Nicaragua $ 742, 173 $ Paraguay $ 371, 000 $ 125, 000 712, 987 - Total Government Funds Spent (USD) Internally Generated Funds as Percentage of all Government Funds $ 1, 360, 000 100% $ 1, 750, 000 93% $ 2, 713, 756 100% $ 1, 455, 160 51% $ 371, 000 100%

0% Benin Burkina Faso Burundi Cameroon Cape Verde DR Congo Ethiopia Ghana Guinea Kenya Liberia Madagascar Malawi Mali Mauritania Mozambique Nigeria Rwanda Senegal Sierra Leone South Africa South Sudan Tanzania Togo Uganda Zambia Zimbabwe Afghanistan Armenia Bangladesh Georgia India Nepal Pakistan Philippines Russia Ukraine Yemen Dominican Republic El Salvador Guatemala Haiti Honduras Nicaragua Paraguay Peru Finance for Procurement Percentage of Total Spending for Public Sector Contraceptives, by Funding Source 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Africa Global Fund grants--contraceptives besides condoms Europe and Asia Internally generated funds Other government funds In-kind donations Global Fund grants--condoms LAC

Benin Burkina Faso Burundi Cameroon Cape Verde DR Congo Ethiopia Ghana Guinea Kenya Liberia Madagascar Malawi Mali Mauritania Mozambique Nigeria Rwanda Senegal Sierra Leone South Africa South Sudan Tanzania Togo Uganda Zambia Zimbabwe Afghanistan Armenia Bangladesh Georgia India Nepal Pakistan Philippines Russia Ukraine Yemen Dominican Republic El Salvador Guatemala Haiti Honduras Nicaragua Paraguay Peru Finance for Procurement • • • 22 countries indicated there was insufficient funding for contraceptive procurement 16 countries covered more than 100% of the quantified need 4 countries did not know if there was a funding gap Percentage of Quantified Need Covered during the Year 125% 1154% 214% 159% 120% 121% Africa 121% 270% 100% 80% 60% 40% 20% 0% Europe and Asia LAC

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 • 29 out of 44 respondent countries reported having a government budget line item for contraceptive procurement* § § 79% of countries with a budget line followed up with funding for contraceptive procurement 33% of countries without a budget line funded contraceptive procurement

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

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

Policies―National Essential Medicines List Methods Offered in the Public Sector, Included in the NEML 100% Male condom On average, countries include 7 out of the 9 surveyed methods on the NEML or equivalent IUD 98% Combined oral contraceptives 98% 96% Injectables Cycle. Beads 89% 50% 83% Implants 74% Progestin-only pills Female condom Emergency contraceptive pills 59% 61% 57% Listed in the NEML Offered in the Public Sector

Policies―Government Strategies • 40 out of 47 countries reported having a contraceptive security strategy (or another strategy that includes a CS component) APPROVE D • Of those, 92% have been formally approved by the Ministry of Health BY: _ MAR 15 2 ____ • 92% of the strategies are reportedly being implemented ____ 013 ____

Policies―Provision and Access Taxes, duties and fees 30 out of 46 countries mentioned taxes, import duties, or fees on contraceptives– primarily affecting commercial-sector goods Advertising bans 4 countries report advertising bans that affect the provision of private-sector contraceptives Policies enabling the private sector 28 out of 41 countries report policies that enable the private sector to provide contraceptive methods Restricting access to subpopulations 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 10 countries there are charges to public-sector clients for FP commodities.

Policies―Charges to Clients Services Commodities Cameroon Benin Democratic Republic of Congo* Burkina Faso Ghana Cameroon Guinea* Cape Verde* Haiti* Democratic Republic of Congo* Mali* Senegal* Pakistan* Togo Senegal* Zimbabwe* Togo Zimbabwe* *There are exemptions for those who are unable to pay

Commodities Providing a mix of contraceptive methods is essential to ensure that clients can choose the contraceptive that best fits their needs. 11 methods included in survey Male condoms Female condoms Combined oral contraceptives Progestin only pills IUD Injectables Implants Emergency contraceptives Cycle. Beads Tubal ligation Vasectomy

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

Commodities Percentage of Respondent Countries that Offer Contraceptive Methods, by Method and by Sector 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Combined oral Progestin-only pills contraceptives Injectable Implant Private Sector Intrauterine Device (IUD) Male condoms Public Sector Female condoms NGO Emergency contraceptive pills Social marketing Vasectomy Tubal Ligation Cycle. Beads

Commodities • On average, countries offer 8 out of 11 assessed methods in the public sector • 11 surveyed countries offer all 11 methods: Benin, Burundi, DR Congo, Ghana, Guinea, Haiti, Kenya, Malawi, Senegal, Togo, Zimbabwe • 91% of countries offer all 5 of the most commonly offered methods: § § § male condoms combined oral contraceptives IUDs tubal ligations injectables

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.

Coordination & Leadership Indicators include: q 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

Coordination & Leadership 89% of countries have a committee that works on contraceptive security • 61% of the committees have legal status Percentage of Respondent Countries' Contraceptive Security Committees that Include Specific Organizations 100% 90% 80% 70% MOH and UN Agency on all committees 60% 50% 40% 30% 20% 10% 0% Ministry of Health UN Agencies Donors Social Marketing Organizations NGOs Central Medical Store or Central Warehouse Commercial sector organizations Ministry of Finance or Ministry of Planning

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

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

Supply Chain • 48% (20 of 42) 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 1 -2 products.

Supply Chain • 53% of countries identified service delivery point stockouts as a large problem • 14% of countries identified central-level stockouts as a large problem

Supply Chain Central Level Stockout Information, by Method 10 Male condom 33 6 Intrauterine Device (IUD) 37 12 Injectables 30 8 Combined oral contraceptives 34 11 Implants 25 4 Progestin-only pills 30 9 Emergency contraceptive pills 17 6 Female condom 20 5 Cycle. Beads 0 5 14 10 15 Stockout(s) reported during the year 20 25 30 Number of Countries 35 40 45 No stockout(s) reported during the year 50

Conclusions Finance Policies Commodities Coordination Supply Chain What’s Working More than 50% of governments are using their funds for contraceptives On average, countries included 7 out of 9 methods on their National Essential Medicine List On average, countries offer 8 out of 11 methods in the public sector 89% of countries have a committee that works on CS issues Fewer than 50% of countries experienced a central level stockout Diversify committee membershipinclude Ministry of Finance/ Planning and commercial sector Monitor stock at all levels of the system to ensure stockouts at the central level don’t result in stockouts at SDPs Where improvements can be made Increase number of countries allocating funds and following through to spend them Ensure that policies enable all sectors to offer a range of methods and all clients can access those methods. Continue to expand range of commodities offered in all sectors.

For More Information Visit: http: //deliver. jsi. com/dhome/whatwedo/commsecurity/csmeasuring/csindicators Data Maps Dashboards