Taller regional de coordinación del Fondo de Cooperación del UNFPA/AECID para LAC El Salvador June 2 – 4, 2010

1. Taller regional de coordinacióndel Fondo de Cooperación del UNFPA/AECID para LAC El Salvador June 2 – 4, 2010

2. Contexts 2009 External: • Economic crisis affecting public funding • Repositioning FP in the context of ICPD 15 • Cash flowing away to HIV while facing inequities among specific population (LAC: 49% of total aid to ICPD was for FP in 1997 while in 2007 it was 9%) • Government increased funding but…uncertainties around sustainability • MOH burden of supply and shrinking market segmentation (Social Security) • Ensuring funds in decentralization and third generation of PRS • Setback in Reproductive Health and Rights Policies • volatility and vulnerability of progresses • Swine Flu and humanitarian emergencies crisis driving the attention of GVT/MOH away of SRH priorities.

3. RHCS Concept • Reproductive Health Commodity Security [RHCS] is achieved when all individuals can, obtain and use affordable, quality reproductive health commodities of their choice whenever they need them. • RHC are made up of equipment, pharmaceuticals and supplies for: • obstetric and maternal health care; • the prevention, diagnosis and management of reproductive tract infections and sexually transmitted infections; • contraceptive supplies including male and female condoms • commodities for the prevention of cervical cancer

4. Could you please include the procurement of vitamins to make Mario get taller

5. RHCS Approach • Integrated approaches in-country by promoting better linkages between RHCS and the wider RH and HIV/AIDS prevention programmes and policies, in the context of, for example, the GFATM, PEPFAR, SWAps, Poverty Reduction Strategies, Health Sector Reform, Budget Support. • [a] promoting and retaining pro-RHCS political will; • [b] promoting RHCS in policy dialogues and development framework • [c] stimulating government stewardship to improve health nationally • [d] facilitating public, private and civil society effort to enhance RHCS • [e] eradicating obstacles [physical, legal, cultural, etc.] to RHCS.

6. RHCS Approach • RHCS-related systems [infrastructure] and capacity [practical knowledge] enhanced among national stakeholders at the national level: • [a] Supply side [forecasting, logistics, distribution, procurement, etc.] • [b] Quality of care issues [essential drug list, health policies, protocols, quality control procedures] • [c] Access and Demand • use of contraception: the ability of women and girls to negotiate • tackling unmet need for contraception; • social marketing and insurance, market segmentation and cost recovery strategies, total market approaches.

7. RHCS Approach • RH commodity needs met consistently and reliably: • [a] ensuring an increasing and growing proportion of RH commodity provision in-country is planned; • [b] the development of cost recovery approaches that use household finance to meet a portion of RH commodity needs; • [c] implementation of a national strategy to “mainstream RH commodity provision” by increasing national responsibility by financing RH commodities.

8. RHCS IMPLEMENTATION Planning, M&E Global & Regional Programme Delivery TA Priorities Evidence Mapping Academic Inst. South - South Consultants Inter-agency SRH LACRO CLUSTER Allocation Integration Regional Level Reporting MonitoingExecution Qualityassurance CapacityAssessment NationalLevel Trends & Gaps Country Offices & Regional IPs GVTs NGOs Civil Society Monitoring Execution

9. HEY YOU YES YOU WAKE UP

10. Outcomes and outputs • Outcome 1: Reproductive rights and SRH demand promoted and the essential SRH package, including RH commodities integrated in public policies of development and humanitarian frameworks with strengthened implementation monitoring • OUTPUT 1.1: RLA6R11A Enabling policy environment at regional and sub-regional levels to integrate sexual and reproductive health in public policies. • OUTPUT 1.2: RLA6R12A Regional institutions strengthened to build national capacity for the implementation and monitoring of the essential sexual and reproductive health package, including family planning and reproductive health commodity security. • Outcome 2: Access and Utilization of quality maternal heath services increased in order to reduce maternal mortality and morbidity, including the prevention of unsafe abortion and managements of its complications • OUTPUT 2.1: RLA6R21A Regional and sub-regional partnerships strengthened/established to support the implementation of Regional Inter-Agency Strategic Consensus on Maternal Mortality Reduction. • OUTPUT 2.2: RLA6R22A Regional and sub-regional partnerships established for the promotion of culturally sensitive strategies for the reduction of maternal mortality and morbidity among indigenous & afro-descendents for incorporation and use by health system

11. Outcomes and outputs • Outcome 3: Access to and utilization of quality voluntary family planning services by individuals and couples increased according to reproductive intention • OUTPUT 3.1: RLA6R31A Regional and sub-regional partnerships established to advocate and build sustainable capacity for the provision as part of the essential SRH package of at least 3 FP modern methods – including condoms to enable double protection -- for women, men and adolescent and youth, especially for those living in poverty. • Outcome 4: Demand, access to, and utilization of quality HIV and STI prevention services, especially for women, young people, and other vulnerable groups, including populations of humanitarian concern increased. • OUTPUT 4.1: RLA6R41A Regional entities (such as networks of Ministries of Health, Education and Women’s Affairs, and PLWHA and other civil society groups) strengthened to advocate for and up-scale STI/HIV prevention for women, young people and vulnerable groups, including PMTCT.

12. Outcomes and outputs • Outcome 5: Access of young people to SRH, HIV, and gender-based violence prevention services and gender services life skills-based SRH education improved as part of a holistic, multisectorial approach to young people development. • OUTPUT 5.1: RLA6R51A Enhanced capacity of regional and national institutions (such as the Ibero-American Youth Organization and others) to address the specific sexual and reproductive health needs of adolescents and young adults for information, counseling and differentiated services..

13. Strategies 2010 Health Policy Development Increasing and sustainability of health financing Health Service Management and Health System Development Improving Regulatory frameworks Knowledge sharing Capacity development and Technical Assistance Advocacy Monitoring and evaluation Partnerships & Networking Demand creation

14. these guys are really experts in condom use

15. Ips and Partners 2010 (Regional Level) CLAE = 1) Advocacy with MOH for the incorporation of EC as part of EML 2) With FLASOG/FIGO training national G&O Association on legal aspects for evidence-based advocacy with Supreme Courts 3) Dissemination of materials 4) Research on the impact of EC withdraw PRISMA/CIES = 1) Training under different modalities including DLC 3) Evidence-based research 2) TA plan for COs and GVT on RHCS issues based on countries needs 4) Impact Evaluation of public health course (PAHO/UNFPA/ASDI) JSI/DELIVER = Market Segmentation REPROLATINA/WHO = Monitoring Implementation of FP tools SUPPORT/IPPF = Social Marketing of FC at Central American Countries

16. Ips and Partners 2010 (Regional Level) SUPPORT/REDTRASEX = Comprehensive Condom Programming WHO/PSB = Training on Quality Control Standards COPRECOS = CCP, LMIS and pool procurement mechanism FLASOG = Unsafe abortion, Misoprostol in EML, Strength G&O nat. Assoc. AMDD = Capacity development on EmONC Regional Needs Assessment on EmOC LACRO = Emergency preparedness and Humanitarian Assistance Communication of best practices on RHCS/ HIV/ MH in MIC Rapid Needs Assessment on procurement services CCP training with MOH and UNFPA focal points Regional Task forces on MH and RHCS

17. Ips and Partners 2010 (Regional Level) WHO USAID DELIVER SUPPORT FLASOG REGIONAL IPAS RHCS PASMO COALITION ONUSIDA IPPF CLAE WB PAHO/CLAP Let me in please

18. Country Level 2010 • Health Service Management and Health System Development • Strengthening management model in the implementation of NSRH plans. • Review, update, printing and dissemination of health models and protocols. • Linking SRH services with STI/HIV/AIDS services. • Development of National Strategic Plan on promotion/access to MC&FC • Pilot experience and documentation on the implementation of PEP kits • Elaboration of an Integrated health care protocol for Adolescent. • Capacity development and Technical Assistance • Strengthening technical capacity for provision of quality SRH services • Implementation of intermediate training centers • Incorporate LMIS with emphasis in FP in the curricula • Technical Support to the National Directions of Drugs & Warehouse for maintaining information system, adopting best practices and standards. • Develop the legal and conceptual framework for the operation of the National Coordination Training Center in RHCS • Training on strategic guidelines for integrated SRH on humanitarian crisis

19. Country Level 2010 • Advocacy • Awareness and advocacy workshops with national, departmental and municipal authorities to support SRH&R initiatives. • Advocacy session to secure public funding for contraceptives procurement • Improving Regulatory frameworks • Follow up to the elaboration of laws and legal regulations to implement SRH&R as set by New Political Constitutions • Incorporation of Misoprostol and EC into public services • Elaborate Reproductive Health Administration, Logistical Management and Service Health Delivery Norms • Demand Creation • Develop IEC/BCC on SRH • Operational research on (cultural) barriers to access to SRH services • Design and publish MM edu-comunicational materials to promote the M&N Mortality Accelerated Reduction Plan that includes EmOC and FP.

20. Country Level 2010 • Partnership and networking • Subscribe agreements with partners for RH care services with emphasis on the management of RHCS within the Technical Advisory Committee. • Creation of RHCS Committee and development of National RHCS Plan • Support to Sexual Workers Networks to conduct educational peer activities on STI and HIV prevention, FC&MC use, self-esteem and empowerment. • Alliance with uniformed institution for the inclusion of SRH, HIV prevention and AIDS issues in the curricula. • Monitoring and Evaluation • Develop RHCS evaluation tools for logistical management systems within Health Services. • Monitor progress and/or non-progress of i) Technical Advisory Committee in Sexual and Reproductive Health; ii) National Coordination Training Center and, iii) Demonstrative Models. • Design and publication of the monitoring manual to track the correct use of the WHO FP counseling tool.

21. Country Level 2010 • Health Policy Development • Case study on contraceptive demand for expanding contraceptive diversity • International Colloquia of Male and Masculinity Studies – Montevideo 2010 • Knowledge Sharing • Participation of members of RHCS committee in training and south south cooperation activities. • Document and disseminate regional RHCS updates for knowledge sharing • Increasing and sustainability of health financing • Inclusion of FP services financial needs into the RBM budget. • Promote, develop and establish co-financing/bridge arrangements • Develop a joint UNFPA-PSI Condom Promotion Strategy for Social Marketing of Male and Female Condom. • Conduct research to inform RHCS policy dialogue and sustainability,RH Funding with a focus on Gender dimension

22. ESA – RHCS Opportunities • COPRECOS & Migrants: HIV preventionhealthserviceprovision VBG prevention and masculinity • CLAE & FLASOG: AOE and VBG Prevention of unsafeabortion Misoprostol and prevention of post-partum hemorrhage • MOH: • Maternal MortalitymeasurewithCensus • Adolescent suicide relatedwithunwantedpregnanciesfrom sexual abuse • Adolescentunmetcontraceptionneeds and barrierstoaccess FP services • Inter-cultural sensitivenesshealthcaremodel and impact of structuralchanges • CIES and MesoamericanInitiative: EmONCwithPublichealthAcademies