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
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