contraceptive security n.
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Contraceptive Security

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  1. Contraceptive Security The Bangladesh Story

  2. Bangladesh’s Family Planning Program • One of the most successful FP programs (CPR -- 7% in 1975 to 55% in 2000) • ~ 75 % of contraceptive users require temporary methods • Requires VERY regular and reliable contraceptive procurement • Thus, our program is a good testing ground for CS strategies

  3. Contraceptive Forecasting Requirements for 2002

  4. An approximate cost of contraceptives needed annually • Between $30 and $35 million per year • This number will double within the next 15 years

  5. CONTRACEPTIVE INSECURITY The Basic Problem

  6. Before Health Sector Reform (1998) • 26 different donors funding over 100 health programs with GOB • Nearly all contraceptives for the GOB were procured directly by donor agencies • The social marketing company received commodities through direct bilateral support • Dominance of temporary methods

  7. After Health Sector Reform • Few donors provide any direct procurement of contraceptives • Most donor agencies now pool funding under a single umbrella • The GOB is expected to use IDA rules and regulations for procurement • Continued dominance of temporary methods

  8. Threats to Contraceptive Security • CS is not well understood; thus planning to address CS lacking • Funding is available for contraceptives, BUT GOB is unprepared to take on the procurement process • Alternative means of addressing CS had not been taken into consideration, e.g., private sector involvement, long term methods, etc. • Continued dominance of temporary methods

  9. USAID/Dhaka’s Response A Four Pillar Approach • Pillar One: Long-term Planning for CS among policymakers and donors (DELIVER) • Pillar Two: Supporting Contraceptive Procurement (DELIVER) • Pillar Three: Market Segmentation and Social Marketing (SMC) • Pillar Four: Revitalizing long-term methods (ENGENDERHEALTH)

  10. Pillar OneCS Planning - The Issues • CS is a continuing problem in Bangladesh • CS is not well understood by key stakeholders • Planning is needed NOW in order to address CS needs to avoid future stock-outs

  11. Pillar OneCS Planning - Actions • “Contraceptive Security” overview paper was developed • Workshops/seminars on CS carried out to: • sensitize people to the problem (Minister level) • develop 20 concrete strategies to improve CS • Task Force created to implement the 20 strategies • Use of media to educate policy makers and public

  12. Pillar TwoProcurement Support - The Issues • Most donor agencies now pool funding under a single WB umbrella -- GOB procurement • The GOB is expected to use IDA rules and regulations for procurement (slow and cumbersome process) • GOB was unprepared • MOHFW lacked experience in procurement • Confusion resulted in mis-procurements and major delays • No technical assistance to help with the procurement of contraceptives

  13. Pillar Two ProcurementSupport - Actions • Direct TA to the GOB to carry out procurement process (long and short-term) • Database to track commodity procurements • Creation of an “easy-to-understand manual” and other helpful materials explaining the IDA procurement process • Procurement training to build up capacity • TA to the GOB to explore future procurement options

  14. Pillar ThreeMarket Segmentation - The Issues • Many clients who are willing and able to pay for contraceptives get them free or at highly subsidized prices • Price elasticity surveys indicate clients will pay much more for contraceptives • SMC is donor dependent for commodities

  15. Pillar ThreeMarket Segmentation - Actions • SMC will segment the market to encourage more clients to pay what they are able to afford • Based on price elasticity studies, SMC will raise prices to cover more of their overall costs (sustainability) • SMC will begin procuring five out of eight of their products directly

  16. Pillar FourLong-Term Methods - The Issues • Sharp decline in VSC from 500,000 cases per year (1987) to 50,000 (2001) • Limited donor support for VSC • High unmet demand for long-term methods

  17. Pillar FourLong-Term Methods - Actions • Strengthen VSC services in public and private sectors • Improve donor support for VSC • Capacity-building for increasing utilization of VSC • Undertake studies to understand how to best reach clients who might want long term methods • BCC activities for consumers and providers

  18. Guiding Principles • CS efforts should be practical • CS approach should be holistic • CS efforts should be coordinated with the GOB and other partners (shared responsibility)

  19. USAID support has led to… • Framework for CS planning • Successful procurement of injectables and condoms by the GOB (first time) • Increased capacity for future procurements • SMC procuring their own products (oral/condom) • Increase in VSC cases to meet unmet demand

  20. Lessons learned • CS security requires constant attention • CS cannot be addressed simply through workshops and seminars -- it has to be tackled in the real world • If HSR is to be implemented, it should be phased in over an extended period of time after local capacity has been built up

  21. THANK YOU!