measuring contraceptive security indicators 2013 – summary findings
TRANSCRIPT
Measuring Contraceptive Security Indicators 2013 –
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 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/factsheets/CSIndiData2013.xlsxo 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
2013 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.
Contraceptive Security
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).
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
2013 Surveyed Countries
Key Findings 2013Fi
nanc
e • 63% of countries used government funds for contraceptive procurement
• 18 countries indicated insufficient funding for contraceptive procurement
Polic
ies • On average,
countries included 6 out of 9 methods on their National Essential Medicine List
• 88% of countries include CS in a national strategy
Com
mod
ities • 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
Coor
dina
tion •91% of
countries have a committee that works on CS issues
•100% of committees include the Ministry of Health
Supp
ly C
hain • 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
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.
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
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 governmentIn-Kind Donations
• These grants can be used to procure condoms or other contraceptivesGlobal Fund Grants
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
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
Government Expenditures―Africa
CountryInternally 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 $ 336,000 36%
Burkina Faso $ 720,438 $ - $ 720,438 100%
Burundi $ 59,519 $ 425,180 $ 484,699 12%
Ethiopia $ 400,000 $ 16,200,000 $ 16,600,000 2%
Ghana $ - $ 1,347,052 $ 1,347,052 0%
Kenya $ 5,967,466 $ 5,131,248 $ 11,098,714 54%
Madagascar $ 47,315 $ 1,374,680 $ 1,421,995 3%
Mali $ 33,760 $ - $ 33,760 100%
Nigeria $ - $ 17,600,000 $ 17,600,000 0%
Rwanda $ 574,367 $ - $ 574,367 100%
Senegal $ 250,000 $ - $ 250,000 100%
Uganda $ 3,300,000 $ - $ 3,300,000 100%
Tanzania Unknown $ 6,527,892 unknown unknown
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 $ 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 $ 1,300,000 0%
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 $ - $ 586,096 100%
El Salvador $ 914,500 $ 547,434 $ 1,461,934 63%
Guatemala $ 374,763 $ - $ 374,763 100%
Nicaragua $ 1,100,000 $ 400,000 $ 1,500,000 73%
Paraguay $ 646,700 $ - $ 646,700 100%
Finance for ProcurementB
en
in
Bu
rkin
a F
aso
Bu
run
di
Eth
iop
ia
Gh
an
a
Gu
ine
a
Ke
nya
Lib
eri
a
Ma
da
ga
sca
r
Ma
law
i
Ma
li
Ma
uri
tan
ia
Mo
zam
biq
ue
Nig
eri
a
Rw
an
da
Se
ne
ga
l
Sie
rra
Le
on
e
So
uth
Su
da
n
Ta
nza
nia
To
go
Ug
an
da
Za
mb
ia
Zim
ba
bw
e
Afg
ha
nis
tan
Alb
an
ia
Arm
en
ia
Aze
rba
ijan
Ba
ng
lad
esh
Ge
org
ia
Ind
ia
Ind
on
esi
a
Ne
pa
l
Pa
kist
an
Ph
ilip
pin
es
Ukr
ain
e
Ye
me
n
Do
min
ica
n R
ep
ub
lic
El S
alv
ad
or
Gu
ate
ma
la
Ha
iti
Ho
nd
ura
s
Nic
ara
gu
a
Pa
rag
ua
y
Africa Europe & Asia Latin America & the Car-ibbean
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Government Share of Total Spending for Public-Sector Contraceptives, 2013
Finance for ProcurementB
en
in
Bu
rkin
a F
aso
Bu
run
di
Eth
iop
ia
Gh
an
a
Gu
ine
a
Ke
nya
Lib
eri
a
Ma
da
ga
sca
r
Ma
law
i
Ma
li
Ma
uri
tan
ia
Mo
zam
biq
ue
Nig
eri
a
Rw
an
da
Se
ne
ga
l
Sie
rra
Le
on
e
So
uth
Su
da
n
Ta
nza
nia
To
go
Ug
an
da
Za
mb
ia
Zim
ba
bw
e
Afg
ha
nis
tan
Alb
an
ia
Arm
en
ia
Aze
rba
ijan
Ba
ng
lad
esh
Ge
org
ia
Ind
ia
Ind
on
esi
a
Ne
pa
l
Pa
kist
an
Ph
ilip
pin
es
Ukr
ain
e
Ye
me
n
Do
min
ica
n R
ep
ub
lic
El S
alv
ad
or
Gu
ate
ma
la
Ha
iti
Ho
nd
ura
s
Nic
ara
gu
a
Pa
rag
ua
y
Africa Europe & Asia Latin America & the Car-ibbean
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of Total Spending for Public-Sector Contraceptives, by Fund-ing Source, 2013
Global Fund grants In-kind donations Other government funding Internally generated funds
Finance for Procurement
• 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
Beni
n
Burk
ina
Faso
Buru
ndi
Ethi
opia
Ghan
a
Keny
a
Liber
ia
Mad
agas
car
Mal
awi
Mal
i
Moz
ambi
que
Nige
ria
Rwan
da
Sene
gal
Togo
Ugan
da
Zam
bia
Arm
enia
Bang
lade
sh
Nepa
l
Paki
stan
Phili
ppin
es
Ukra
ine
Yem
en
Dom
inica
n Re
publ
ic
El S
alva
dor
Guat
emal
a
Haiti
Hond
uras
Nica
ragu
a
Para
guay
Africa Europe & Asia Latin America & the Caribbean
0%
20%
40%
60%
80%
100%
120%
140%
193% 184% 1169%
Percentage of Quantified Need Covered during the Year, 2013
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
Policies
Policies can reflect the level of government commitment to contraceptive security, as well as significantly impact client access to family planning.
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)?
Policies―National Essential Medicines List
On average, countries
include 7 out of the 9 surveyed methods on the
NEML or equivalent
Male co
ndom
Combined oral IUD
Injectab
le
Proge
stin-only
pill
Implan
t
Emerg
ency
Contracep
tive
Female
condom
CycleB
eads
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Comparison of methods offered in the public sector and included in NEMLs, 2013
Offered in public sector Included in NEML
Policies―Government Strategies
A DMAR 15 2013
PPROVEBY: ____________________
• 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
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.
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 condoms Female condoms Combined oral contraceptives
Progestin only pills
IUD Injectables Implants Emergency contraceptives
CycleBeads Tubal ligation Vasectomy
Commodities
Indicators include: Range of contraceptives offered
through:• Public sector facilities• Nongovernmental organization (NGO)
facilities• Social marketing• Commercial-sector facilities
Commodities
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percentage of Respondent Countries that Offer Con-traceptive Methods, by Method and by Sector, 2013
Public-sector facilities NGO facilities Social marketing Private-sector facilities
Pe
rce
nta
ge
of
co
un
trie
s
Commodities
• 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
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: 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
91% of countries have a committee that works on contraceptive security
• 59% of the committees have legal status
Mini
stry o
f Hea
lth
UN age
ncies
Donor
NGO
Social
mar
ketin
g
Centra
l Med
ical S
tore
/ war
ehou
se
Comm
ercia
l sec
tor
Mini
stry o
f Fina
nce
or P
lannin
g
0%20%40%60%80%
100%
Percentage of Respondent Countries' Contraceptive Security Committees that Include Specific Organizations 2013
Ministries of health are on all
committees
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: 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
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.
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
Supply Chain
Combin
ed O
ral
Male
con
dom
IUD
Injec
table
Proge
stin-
only
pill
Impla
nt
Emer
genc
y Con
trace
ptive
Female
con
dom
CycleB
eads
0
5
10
15
20
25
30
35
40
Number of Respondent Countries and Their Central-level Stockout In-formation by Method 2013
Central-level stock-out(s) Reported dur-ing the Year
No Central-level Stockouts Reported during the yearN
um
ber
of
Co
un
trie
s
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
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
For More Information
Data Maps
Dashboards
Visit: http://deliver.jsi.com/dhome/whatwedo/commsecurity/csmeasuring/csindicators