Contraceptive Security

The Bangladesh Story

Bangladesh’s Family Planning Program

• One of the most successful FP programs (CPR -- 7% in 1975 to 55% in 2000)

• ~ 75 % of contraceptive users require temporary methods

• Requires VERY regular and reliable contraceptive procurement

• Thus, our program is a good testing ground for CS strategies

Contraceptive Forecasting Requirements for 2002

GOB/NGO Social Marketing TOTAL

Condoms 72,000,000 168,000,000 240,000,000

Orals 88,500,000 29,500,000 118,000,000

Injectables 10,380,000 500,000 10,880,000

IUDs 350,000 0 350,000

NORPLANT 62,000 0 62,000

An approximate cost of contraceptives needed annually

• Between $30 and $35 million per year

• This number will double within the next 15 years

CONTRACEPTIVE INSECURITY

The Basic Problem

Before Health Sector Reform (1998)

• 26 different donors funding over 100 health programs with GOB

• Nearly all contraceptives for the GOB were procured directly by donor agencies

• The social marketing company received commodities through direct bilateral support

• Dominance of temporary methods

After Health Sector Reform

• Few donors provide any direct procurement of contraceptives

• Most donor agencies now pool funding under a single umbrella

• The GOB is expected to use IDA rules and regulations for procurement

• Continued dominance of temporary methods

Threats to Contraceptive Security

• CS is not well understood; thus planning to address CS lacking

• Funding is available for contraceptives, BUT GOB is unprepared to take on the procurement process

• Alternative means of addressing CS had not been taken into consideration, e.g., private sector involvement, long term methods, etc.

• Continued dominance of temporary methods

USAID/Dhaka’s Response A Four Pillar Approach

• Pillar One: Long-term Planning for CS among policymakers and donors (DELIVER)

• Pillar Two: Supporting Contraceptive Procurement (DELIVER)

• Pillar Three: Market Segmentation and Social Marketing (SMC)

• Pillar Four: Revitalizing long-term methods (ENGENDERHEALTH)

Pillar OneCS Planning - The Issues

• CS is a continuing problem in Bangladesh

• CS is not well understood by key stakeholders

• Planning is needed NOW in order to address CS needs to avoid future stock-outs

Pillar One CS Planning - Actions

• “Contraceptive Security” overview paper was developed

• Workshops/seminars on CS carried out to: – sensitize people to the problem (Minister level)

– develop 20 concrete strategies to improve CS

• Task Force created to implement the 20 strategies

• Use of media to educate policy makers and public

Pillar Two Procurement Support - The Issues

• Most donor agencies now pool funding under a single WB umbrella -- GOB procurement

• The GOB is expected to use IDA rules and regulations for procurement (slow and cumbersome process)

• GOB was unprepared– MOHFW lacked experience in procurement

– Confusion resulted in mis-procurements and major delays

• No technical assistance to help with the procurement of contraceptives

Pillar Two Procurement Support - Actions

• Direct TA to the GOB to carry out procurement process (long and short-term)

• Database to track commodity procurements

• Creation of an “easy-to-understand manual” and other helpful materials explaining the IDA procurement process

• Procurement training to build up capacity

• TA to the GOB to explore future procurement options

Pillar ThreeMarket Segmentation - The Issues

• Many clients who are willing and able to pay for contraceptives get them free or at highly subsidized prices

• Price elasticity surveys indicate clients will pay much more for contraceptives

• SMC is donor dependent for commodities

Pillar Three Market Segmentation - Actions

• SMC will segment the market to encourage more clients to pay what they are able to afford

• Based on price elasticity studies, SMC will raise prices to cover more of their overall costs (sustainability)

• SMC will begin procuring five out of eight of their products directly

Pillar Four Long-Term Methods - The Issues

• Sharp decline in VSC from 500,000 cases per year (1987) to 50,000 (2001)

• Limited donor support for VSC

• High unmet demand for long-term methods

Pillar FourLong-Term Methods - Actions

• Strengthen VSC services in public and private sectors

• Improve donor support for VSC

• Capacity-building for increasing utilization of VSC

• Undertake studies to understand how to best reach clients who might want long term methods

• BCC activities for consumers and providers

Guiding Principles

• CS efforts should be practical

• CS approach should be holistic

• CS efforts should be coordinated with the GOB and other partners (shared responsibility)

USAID support has led to…

• Framework for CS planning

• Successful procurement of injectables and condoms by the GOB (first time)

• Increased capacity for future procurements

• SMC procuring their own products (oral/condom)

• Increase in VSC cases to meet unmet demand

Lessons learned

• CS security requires constant attention

• CS cannot be addressed simply through workshops and seminars -- it has to be tackled in the real world

• If HSR is to be implemented, it should be phased in over an extended period of time after local capacity has been built up

THANK YOU!