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Contraceptive Security CONTRACEPTIVE SECURITY PRACTICAL EXPERIENCE IN IMPROVING GLOBAL, REGIONAL, NATIONAL, AND LOCAL PRODUCT AVAILABILITY OCTOBER 2006 This publication was produced for review by the United States Agency for International Development. It was prepared by the DELIVER project. CONTRACEPTIVE SECURITY PRACTICAL EXPERIENCE IN IMPROVING GLOBAL, REGIONAL, NATIONAL, AND LOCAL PRODUCT AVAILABILITY The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. DELIVER DELIVER, a six-year worldwide technical assistance support contract, is funded by the U.S. Agency for International Development (USAID). Implemented by John Snow, Inc. (JSI), (contract no. HRN-C-00-00-00010-00) and subcontractors (Manoff Group, Program for Appropriate Technology in Health [PATH], and Crown Agents Consultancy, Inc.), DELIVER strengthens the supply chains of health and family planning programs in developing countries to ensure the availability of critical health products for customers. DELIVER also provides technical management of USAID’s central contraceptive management information system. Recommended Citation Sarley, David, Raja Rao, Carolyn Hart, Leslie Patykewich, Paul Dowling, Wendy Abramson, Chris Wright, Nadia Olson, and Marie Tien. October 2006. Contraceptive Security: Practical Experience in Improving Global, Regional, National, and Local Product Availability. Arlington, Va.: DELIVER, for the U.S. Agency for International Development. Abstract At the Istanbul Conference in 2001, participants identified strategies for increasing contraceptive security to ensure that clients can chose, obtain, and use the methods they need. Particular emphasis was given to increasing donor funding for contraceptives and to ensure the government’s work with the private and nongovernmental (NGO) sectors meets the contraceptive commodity needs of their populations. Since 2001, DELIVER and other cooperating agencies have worked at the global, regional, national and sub-national, and community level to implement the strategies from the Istanbul meeting; and to develop new approaches to improving contraceptive product availability. Five years after Istanbul, this report documents the progress made in improving contraceptive security. It begins by describing the experiences of contraceptive clients in different parts of the world. It describes the experiences countries have had in learning to understand their clients’ needs and improve their contraceptive security. The report documents the lessons learned in increasing and diversifying contraceptive finance; understanding and expanding the total market; and working with the public, private, and NGO sectors to improve service delivery and product availability. It also describes different regional initiatives adopted in Latin America, Africa, and Eastern Europe; and it identifies new challenges countries face around procurement and donor coordination and how these challenges have been addressed. The report describes what has been done and defines what remains to be done to improve contraceptive product availability. DELIVER John Snow, Inc. 1616 North Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: [email protected] Internet: deliver.jsi.com CONTENTS Acronyms . vii 1. Overview . 1 Ten Things You Need for Contraceptive Security. 1 Publication Purpose and Outline . 5 2. Client Perspective. 7 Cynthia in Ghana. 7 Ana in El Salvador . 8 Lorna in the Philippines. 9 Mariana in Romania . 11 Conclusion. 14 3. The Global Challenge . 15 Contraceptive Security, 1998–2006 . 15 Key Funding and Technical Assistance Partners in RHCS . 20 Challenges and Opportunities . 22 Conclusion. 23 4. Regional Approaches . 25 LAC: Confronting Phaseout and Procurement Constraints. 26 Asia:Working with the Media . 28 West Africa: Connecting a Regional Strategy to Existing Challenges. 30 Eastern Europe: Cross Fertilization of Regional Solutions . 34 East Africa: Building on Local Experience . .37 Conclusion. 40 5. Commitment and Coordination . 41 Commitment . 41 Coordination . 42 Conclusion. 46 6. Policy Context . 47 Policy Framework . 47 Product-related Policy Issues . 47 Supply Side Issues . 51 Demand Issues. 53 Issues Related to Health Sector Reform . 55 Conclusion. 58 7. Total Market Approach . 59 What Is a Total Market Approach? . 59 Markets Are Already Segmented . 60 Improving the Targeting of Free and Subsidized Contraceptives . 64 Market Segmentation Case Studies . .67 Practical Strategies for Promoting a Total Market Approach . 76 Conclusion. 77 CONTENTS iii 8. Financial Diversification. 79 The Funding Challenge . 79 Options to Diversify . 80 Classifying Countries by Their Sources of Contraceptive Funding . 81 Strategies to Improve Financial Diversification . 83 Financial Diversifi cation Strategies . 86 Conclusion. 88 9. Procurement. 91 A Growing Need for Procurement Capacity . 91 We Have the Money, but Where Are the Commodities?. 92 What Is an Ideal Public Procurement Model?. 93 Strengthening Procurement Planning and Management . 93 Transparency . 96 Value for Money Strategies . 98 Improving Quality Control . 100 Independence from Political Considerations . 101 Procurement Key Steps. ..
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