Forging Partnerships at Country Level to Achieve Contraceptive Security:

1. Forging Partnerships at Country Level to Achieve Contraceptive Security: Reproductive Health Supplies in Six Countries Elizabeth Leahy Madsen and Karen Hardee Population Action International Reproductive Health Supplies Coalition Meeting June 4, 2009

2. 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

3. 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

4. Components of the Case Studies • The policy environment • Health system structure • Financing • Logistics • Organizational actors related to RH supplies • Potential advocacy strategies

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Thank you www.popact.org