E X P A N D I N G F A M I L Y P L A N N I N G O P T I O N S

Achieving Security for SDM/CycleBeads in Rwanda and Mali: Untangling Procurement, Distribution & Policy Issues

Marie Mukabatsinda, Country Representative, Rwanda

Georgetown University’s Institute for Reproductive Health

Caucus for New and Underused Method PanelRHSC Annual Membership MeetingAddis Ababa, Ethiopia | June 2011

Standard Days Method® & CycleBeads® Appropriate for women

with menstrual cycles between 26 and 32 days long

Identifies days 8-19 of the menstrual cycle as fertile

Helps a couple avoid or plan pregnancy

Is used with CycleBeads® to : identify fertile days communicate with

partner 95% effective with correct

use Reaches non-users,

traditional method users & reduces unmet need

Accounts for 2 CYPs

Introduced into programs in more than 30 countries USAID-funded programs can order CycleBeads through

USAID | DELIVER, just as they order other contraceptives Other programs can order directly from manufacturer, Cycle

Technologies at www.cyclebeads.com Sales data available on RHInterchange (as shown below)

SDM/CycleBeads: Available Worldwide

Source: RHInterchange

Method Concept & Efficacy Trial

1999-2002

Pilot Studies2000-2004

Operations Research

2003- 2005

Integration Studies

2005 - 2007

Scale-Up Case Studies 2007-2012

SDM: From Research to Scale

One factor IRH had to consider during scale-up was how CycleBeads would be integrated into—and sustained by—the health system. This presentation shares four lessons learned from this process.

Contraceptive Security for New and Underused Methods (NUMs): 4 Lessons Learned

#1: Creative forecasting tools are needed for new methods.

#2: Advocacy is needed to ensure that new methods are included in procurement tables and systems.

#3: Existing push-pull systems of commodity distribution are not well-suited to ensure new products reach existing health centers.

#4: Monitor effects of existing and new finance mechanisms on procurement decisions.

LESSON #1: Creative forecasting tools are needed for new methods.ISSUE: SOLUTION:

Forecasting for procuring new and underused methods (NUMs) should be based on factors including pilot results, expected increases in awareness, demand and program capacity, and timing issues to avoid stockouts.

“Guess work” estimating for initial

procurement of CycleBeads in Rwanda

& MaliInitial large supply

(note: CycleBeads don’t expire)

Donors delayed re-ordering CycleBeads even though demand and program capacity increased over time

(became a timing issue)

• IRH developed a CycleBeads forecasting guide with PATH/JSI to include these factors.

• IRH, with partners JSI and PSI, were awarded an Innovation Fund grant to develop a guide for forecasting NUMs. The guide will be available in early 2012.

LESSON #2: Advocacy is needed to ensure that new methods are included in procurement tables & systems.ISSUE:

SOLUTION:

Currently working with WHO to issue a statement recommending CycleBeads for public sector procurement.

LESSON #3: Existing push-pull systems of commodity distribution are not well-suited to ensure that new products reach health centers.

ISSUE: In many countries, CycleBeads are not included on reporting or requisition forms. CycleBeads are included on

reporting & requisition forms in Rwanda, but this is not enough.

GLOBAL SOLUTION: Continue advocacy & TA to ensure proper distribution & reporting mechanisms for new methods. RWANDA SOLUTION: DELIVER Project provided technical assistance to directly address the issue as part of their training & monitoring visits for procurement and supply chain management.

LESSON #4: Monitor effects of existing and new finance mechanisms on procurement decisions.

ISSUE 1: Performance

Based Financing in Rwanda

ISSUE 2: Bamako

Initiative in Mali

Does it include CycleBeads?

Sometimes Yes

Sometimes No

Solution: Advocate to include it in 2012 PBF & monitor reforms going forward

Community committees with decision-making authority over FP

commodity purchases resist purchasing

CycleBeads.Solution: Advocacy & training in community social responsibility & RH rights

The Questions to Ask: Is the method included in

national/local reporting mechanisms? Can donors order it as they order

other RH commodities? How will the commodity be

distributed in country? Who will be involved?

What policies and/or finance mechanisms are in place that will facilitate/inhibit uptake?

Are there gaps in the linkages between sub-systems that can inhibit commodity security?

What advocacy and/or technical assistance efforts are needed to overcome challenges?

For more information about SDM & CycleBeads, visit us at www.irh.org

Thank you for your attention.