Forging Partnerships at Country Level to Achieve Contraceptive Security:

Reproductive Health Supplies in Six Countries

Elizabeth Leahy Madsen and Karen HardeePopulation Action International

Reproductive Health Supplies Coalition MeetingJune 4, 2009

Context for RH Supplies Research and Advocacy

• Donor funding growing but is it enough?

• Awareness high at global level, yet supplies disconnected from other issues

• Advocacy focusing on building capacity and support at country level

• Progress has been made, but we still fall short of universal access

Case Studies Overview

• Produced under Project RMA

• Partnership between DSW, IPPF and PAI

• RHSC definition of RH supplies, with focus on contraceptives and condoms

• Six focus countries

Components of the Case Studies

• The policy environment

• Health system structure

• Financing

• Logistics

• Organizational actors

related to RH supplies

• Potential advocacy strategies

Policies vs. Implementation

• Policies exist but are poorly implemented

• Goals exist for improving access to supplies

• Yet supplies lag behind as a government priority

Supplies available at an UMATI clinic, Tanzania

Fragile Funding

• Increasing country ownership

• Declining share of funding for family planning and reproductive health

• Shrinking quantities of external financing

Truck advertising socially marketed condoms, Nicaragua

Evaluating Budget Line Items

• Each country provides budgetary support at central level

• Line items often drawn from pooled funding

• Allocations are frequently redirected or underspent

Ghana

Coordination and Logistics

• Central level coordination committees fulfill key role

• Governments assuming procurement responsibilities

• Integrated logistics systems include contraceptives

UNFPA supplies at Central Medical Stores, Ghana

Precarious Access at Facilities

• Stockouts remain frequent below the central level

• Many challenges inhibit contraceptive security

• Decentralization can compound shortages in supplies

Family planning counseling at an UMATI clinic, Tanzania

The Role of Civil Society

• Civil society organizations new to RH supplies advocacy

• Expanding role beyond service delivery

• Broadening the scope of potential advocates

MEXFAM youth promoter, Mexico

Building on Advocacy Successes

• Advancing contraceptive security strategies and coordination

• Promoting integration into essential medicines lists

• Securing funding commitments

• Publicizing the importance of supplies

Presentation on adolescent reproductive health in Malangala

village, Uganda

Country Context: Small Group Preview

• Bangladesh: Increasing unmet need, high government turnover, coordination forum revived

• Ghana: Strong policies, financial sustainability plan, insurance scheme neglects contraceptives

• Mexico: Youth-focused policies, decentralization

• Nicaragua: Hostile government, impending donor graduation, universal free health care

• Tanzania: Council health budgets, central line item

• Uganda: New contraceptive security plan

Thank you

www.popact.org