MINISTRY OF PUBLIC HEALTH AND SOCIAL WELFARE

EL SALVADOR, CENTRAL AMERICA

EXPERIENCE WITH CONTRACEPTIVE PROCUREMENT

Ministry of Health, El Salvador

OCTOBER 2007

Dr. Esmeralda de Ramírez, MSPASNational Coordinator, FP Program

▓ Increase in the use of contraceptives*▓ 1993 – 53.3%, 1998 – 59.7%, 2002/03 - 67.3%

▓ Reduction in total fertility rate*▓ 1993 – 3.83 1998 – 3.54 2002/03 – 2.97

▓ Main providers of contraceptives (FESAL 2002/03):MSPAS (55%); ISSS (19.3%), ADS-Profamilia (10.1), Pharmacies (4.3%)

▓ Donations covered up to 100% of demand through year 2001 (USAID and UNFPA)

* Fuente: Encuestas FESAL

CONTEXT

▓ In 2002, MOH procured 3 contraceptive products in the local market (20% of needs), at very high prices

▓ Due to high local prices, other procurement options were analyzed within the framework of national laws and regulations.

▓Procurement from local suppliers resulted in high costs, and the procurement mechanism through UNFPA is explored. (2003)

▓ Once legal and technical barriers were resolved, a procurement agreement between UNFPA and MOH is signed (Feb. 2004)

▓ Agreement is endorsed through Ministerial Resolution (Dec. 2004)

▓ Duration of the process: 2 years (Nov. 2002 – Dec. 2004)

BACKGROUND: CONTRACEPTIVE PROCUREMENT

▓ Intra-institutional coordination, which enabled the implementation of the UNFPA –MOH agreement, ratified by Ministerial Resolution in 2004.

▓ Technical knowledge gained by MOH staff as they learned how to prepare financial scenarios and negotiate procurement plans.

▓ Training of key personnel to manage the system and reduce under-reporting of key data for forecasting, which has been essential for preparing financial and procurement scenarios.

▓ Participation in CS regional meetings: Nicaragua, Dominican Republic, Peru, Guatemala.

▓ Meetings with key MOH officials to gain support for the CS Initiative.

▓ Official recognition of the CS Committee, by Ministerial Resolution

▓ Approval and implementation of the donor Phase-Out Plan for Contraceptives in 2006.

KEY FACTORS THAT FACILITATED THE PROCUREMENT PROCESS, USING GOVERNMENT FUNDS

Financial Justification, promoted and defended at the Legal, Administrative and Financial Units of the Ministry of Health, which compared local and UNFPA prices (in dollars)

Local Price UNFPA Price

Product Unit Total Unit Total

Lofemenal 0.45 171,720 0.35 133,560

Depoprovera 5.80 2,784,000 0.87 417,600

Mycrogynon 0.45 39,060 0.22 19,096

Neogynon 0.60 13,800 0.60 13,800

Noristerat 3.48 783,000 1.07 240,750

3,791,580 824,806

Source: Women’s Health Program, MSPAS (MOH)

KEY FACTORS THAT FACILITATED THE PROCUREMENT PROCESS, USING GOVERNMENT FUNDS

PERCENTAGE OF NEEDS VS. FUNDS ALLOCATED FOR THE PROCUREMENT OF CONTRACEPTIVES,

MOH (MSPAS) 2002-2007

0%

20%

40%

60%

80%

100%

120%

2002 2003 2004 2005 2006 2007

CONDOMS DEPOPROVERA NORISTERAT LOFEMENAL MICROGYNON

$943,557

$2,093,945$1,830,059

$899,320

$373,053

$571,380

▓ Low-priced, high-quality products procured since 2005

▓ Quantities procured cover demand of contraceptive supplies at health facilities

▓ Significant $ savings for government, by procuring through UNFPA (i.e. savings in 2005 were US$ 2,748,521, and investment covered 94% of total need)

▓ Official approval of Technical Committee to follow-up on the CS Initiative, through Ministerial Resolution No. 2215

▓ Strengthening of technical and strategic planning skills of MOH personnel

▓ Compliance with the gradual procurement of contraceptives agreed upon in the donor Phase-Out Plan (signed in 2006)

ACHIEVEMENTS IN THE PROCUREMENT PROCESS, TO DATE…

MSPAS (MOH)▓ Administration Unit ▓ Women’s Health Unit▓ Division of Planning; UACI; UFI; UTMIN ▓ Legal Department

USAID▓ Local mission and technical assistance through its USAID | DELIVER PROJECT

UNFPA▓ Local Office and Headquarters

Other players:▓ Ministry of Finance▓ Ministry of Foreign Affairs

KEY PLAYERS IN THE PROCUREMENT PROCESS

▓Lack of awareness regarding the need to procure contraceptives with government funds ▓ Legal acceptance of agreement with UNFPA, based on interpretation of National Laws and Regulations

▓ Main obstacle: Advance payment ▓ Fear as to who is liable for making purchases with advance

payment▓ Budgets are not always approved at the beginning of the year

▓ Budget reduction in 2006

OVERCOME CHALLENGES

▓ Lobby from local suppliers with MOH authorities to resume local purchases, without offering better prices in exchange

▓ Change of key top level government officials (need to explain legal validity of the agreement with UNFPA in order to implement it, and be able to procure contraceptives using this mechanism)

▓ UACI, UFI, URMIN endorse the procurement process through UNFPA, and recognize it as a new institutional mechanism

OVERCOME CHALLENGES

▓ Ensure sustainable funding for the annual procurement of contraceptives

▓ Create a specific budget line item for contraceptives

▓ Honor the procurement schedule agreed upon in Phase-Out plan for contraceptives between USAID and MOH, which requires:

▓ Year 2010 and beyond, MOH purchases 100% of needs (~$1.4 million, assuming current method mix and market share remain the same)

▓ Create the political and legal framework for CS in country

▓ Create the conditions to implement MSPAS- ISSS joint procurement agreement (UNFPA)

▓ Expand method mix and ensure the allocation of funds to procure them

FUTURE CHALLENGES