1

Repositioning Family Planning in West Africa

Solutions for Addressing Unmet FP Need

Leadership:

Financing/Contraceptive Security

Presente par

Dr Antoine Ndiaye, Commodity Security Specialist, AWARE-RH

Dana Aronovich, DELIVER PROJECT

Margie Rowan, FUTURES GROUP

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Role of Leadership:The Financing Gap

• Assess and acknowledge the nature and dimensions of the financial gap

• Explore alternatives

• Review strategies

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Contraceptive Prevalence and Unmet Need for FP

05

101520253035404550

Unmet Need for FP 1999

CPR, late 90s-early 00s

Source: Demographic and Health Surveys and Profiles for Family Planning and Reproductive Health ProgramsN.B. Unmet need data not available for Cape Verde, Gambia, Guinea-Bissau, Sierra Leone

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Financial Implications of Growth

Growing population, high unmet need, & demand for services

Growing need forservices & commodities

Increased financing for services & commodities

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Contraceptive Financing Gap:Togo

Funds confirmed and GAP to fill (Millier $ USD)2004 2005 2006 2007 2008

Total contraceptifs prévisions Togo 627.96 414.34 1,068.90 1,212.46 1,375.39

UNFPA - 49.91 33.15 38.17 38.17

IPPF 4.84 7.05 9.01 - -

USAID 623.13 357.58 - - -

Global funds for PSI - - 406.25 412.50 543.95

Total promis confirmé USAID, UNFPA, Global fund

627.96 414.54 448.42 450.67 582.12

Gap to fill - - 620.48 761.79 793.27

GAP en % 0% 0% 58% 63% 58%

Source: TAC aout 2004

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Contraceptive Financing Gap:Burkina Faso

Funds confirmed and GAP to fill (Millier $ USD)2004 2005 2006 2007

Total contraceptifs prévisions Burkina 3,794.58 4,262.43 3,190.75 5,187.05

UNFPA 132,159 660,619 9,252 9,252

IPPF 16,387 - - -

USAID 657,517 - - -

PSI - 62,500 62,500

KFW 2,041,209 2,380,369 1,959,270 2,939,739

WB 756,472

Budget national 190,842 195,972 - - Total promis confirmé par bailleurs 628 415 448 451

Gap to fill - 963 1,160 2,238

GAP en % 0% 23% 36% 43%Source: TAC Fev 2005

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Who Will Fill the Gap?Explore Alternatives

• What are current arrangements for financing reproductive health supplies from each potential source?

• What are the prospects for increasing each?

• What are the most reliable sources for commodity financing during the next five to ten years?

• What role do or could third parties play in financing commodities?

– Employers

– Insurer

– Community-based financing

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Who Will Fill the Gap?Keys actors

• Governments must add/increase budget lines to buy contraceptives with general revenues or loan/credit funds (e.g., WB loans)

• FP program managers should mobilize medicine funds

• Donors may provide financing or donate products

• Households may pay for contraceptives

• Private sector has a social responsibility to provide

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Strategies to Address Financing Gap for Commodity Security

• Government financing

• Donor support

• Alternative financing mechanisms

• Rational segmentation of the market

• Develop funded contraceptive security (CS) strategies

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Government Financing

• Governments must add or increase budget lines especially for contraceptives

• Governments must work to improve resource allocation to eliminate the inefficient use of limited resources

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Donor Support: Forge Partnerships

• Donations of contraceptives, coordinated among donors and country governments

• Mobilize multi-national companies and large enterprises and interest them in Family planning

• Capacity building in budgeting, forecasting contraceptive requirements, procurement, distribution, service delivery, etc.

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Donor Support: Forge Partnerships (cont.)

• Regional strategy: a regional coalition under the leadership of WAHO on RHCS

– Support WAHO to coordinate among donors/partners on RH Commodity Security in the region, including a regional strategy for RHCS.

– Increase and sustain assistance to Member States for contraceptives and other RH Supplies.

– Work with Member States to introduce line for RH Commodity in their budgets.

– Strengthen WAHO leadership for RH Commodity Security, through co-ordination, advocacy, monitoring.

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Alternative Financing Mechanisms

• Social security/national health insurance plans

• Employment-based services

• Community health funds

– E.g., Mutual Health Organization (MHO) managers to include contraceptives on their drug lists

– E.g., Senegal: PF services offered by MHO

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Alternative Financing Mechanisms (cont.)

• Health savings and loan programs

– Highly Indebted Poor Countries (HIPC)

• Vouchers for the poor

• Client fees: revolving drug fund for contraceptives

– E.g., Cameroon under its strategic plan

• Diversification of resources via multi-sectoral efforts

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Rational Segmentation of the Market

• Assess clients’ willingness to pay

• Assess clients’ ability to pay

• Ensure access to highly subsidized or free public sector resources for those who can not afford to pay

• Ensure that wealthier clients have other options in the private/commercial sector

• Provide intermediate options such as subsidized social marketing programs

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Socioeconomic Profile of Public Sector Family Planning Users

34

63

3529 26

3747

63

44

23

24

10

28

25

18

11 25

20

14

25

13

13

40

17

34 17

22

17

8

13

13

23

11

20

119

85 86

19

36 8 12

61611

7 6

0%

20%

40%

60%

80%

100%

Ben

in (44

)

Bur

kina

Fas

o (5

3)

Cam

eroo

n (3

3)

Côt

e d’

Ivoi

re (32

)

Gha

na (41

)

Gui

nea

(50)

Mal

i (47

)

Nig

er (84

)

Nig

eria

(21

)

Tog

o (4

8)

(percent who use public sector in parentheses)

Q1 (lowest)

Q2

Q3

Q4

Q5 (highest)

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National Commodity Security Plans To National Commodity Security Plans To Re-position Financing For ContraceptivesRe-position Financing For Contraceptives

• SPARHCS framework

• Strategic planning examples:

– Ghana, Mali, & Nigeria (completed)

– Cameroon & Togo: ongoing

– Benin, Guinea & Senegal: ongoing

– Burkina (started 2004)

– Gambia and Niger (interested 2005)

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Wrap Up / Conclusions

• Successful FP programs require strong management and contraceptive availability

• Contraceptive availability requires reliable financing and strong logistics management

• Reliable financing and logistics require strong leadership and multi-dimensional strategies to mobilize resources

• When resources are available, they must be used efficiently