PARAGUAY Moving Towards Contraceptive Security

1. PARAGUAY Moving Towards Contraceptive Security Semi-Annual Meeting of the Reproductive Health Supplies Coalition Washington, D.C. October, 2007

3. Situation in Paraguay around 2004 • Increase in modern contraceptive use, from 51% in 1998 to 61% in 2004 • Unmet need (18%) – greater in rural areas • 32% of contraceptive use provided by public sector • Donations provided in a non-regular basis: stock outs • Public purchases are not regular, small quantities and one product

4. Challenges to Sustainable Financing of FP Supplies • Institutionalize public sector funding • Create unified plan and commitments • Reach agreement on phase out by donors • Target public service delivery to lower income population and reduce financial barriers

5. Initial Steps Creation of CS Committee (Managua 2003 and after) March 2004 CS Assessment Identified need for budget line for contraceptive procurement

6. Multisectoral Approach • Members of CS Committee (Sexual & Reproductive Health National Council) • Health Program Director and team, MOH • USAID- Health Officer • UNFPA- Reproductive Health Officer, • Executive Director-IPPF Affiliate (CEPEP) • Social Marketing of Contraceptives (PROMESA) • Paraguayan Chamber of Pharmacies (CAFAPAR) • Social Security (IPS) • USAID | DELIVER PROJECT-Advisor

7. Current Achievements • Approval of Law 2907 (Secured budget for MOH Reproductive Health Programs and Birth Kits Provision) • CS Plan approved by National SRH Council • Tripartite Plan of Gradual Phase Out of Contraceptive Donations • Procurement agreement UNFPA-MOH • Free contraceptives and consultation • MOH providedUS$ 261,573forcontraceptive procurement in 2006 and committed US$ 551,000 in 2007

8. Signed by President in May 2006

9. What does Law 2907 say? • Reserves funds for the procurement, storage and distribution of contraceptives based on MOH requirements • Makes decentralized financing of contraceptives possible • Mandates Social Security to procure its own supplies • Establishes permanent budget line item for contraceptives and delivery kits

10. Approval process for Law 2907 • Alliances with key Congresspersons • Draft Bill • Frame FP within constitutional rights • Avoid public confrontation • Link contraceptives with birth kits to reduce resistance • Monitor the Bill through its different steps

11. A Successful Combination • CS members with direct access to the Legislative and Executive Branches of Government • Analysis of similar legal frameworks • Advocacy with key allies and political authorities • Discussions and presentations with MOH stakeholders • Coordinating meetings/CS Committee Planning

12. Impact • Political commitment to support CS • Legal framework for funding • Optimization of financial resources procuring at lower prices • Self-sustainability in the medium term • Guaranteed access for low income users

13. Lessons Learned • Follow critical path for approval of law doing advocacy with stakeholders • Strategic management of the political environment • Advocacy done before process of passing of the law helped sensitize political actors • Empowerment of key Congresspersons • A law must not only guarantee funds but also the procurement mechanism

14. Recent Challenges • Frequent changes in administrative officials at MOH • Legal barriers to non-competitive procurement by MOH • Difficulties at the Social Security Institute to approve non-competitive procurement of contraceptive

15. CHALLENGES AND NEXT STEPS • Create an effective system without barriers for the contraceptive procurement process • Implementation of the Tripartite Plan of Gradual Contraceptive Donations’ Substitution • Institutionalization of FP services at SS (IPS) • Continuous monitoring of the process • Strengthen monitoring and control systems

16. Muchas Gracias