Progress to date on Contraceptive Security in Latin America Anabella Sánchez, Manager for LAC CS Regional Initiative Nora Quesada, Manager for LAC country programs Arlington May 20, 2009

What does the LAC CS Initiative do? Designs and implements regional- and country-level interventions to help achieve CS in an efficient and equitable manner, by identifying common and priority CS-related issues in the region

CS Elements supported through the regional initiative

Status of Contraceptive Security Free contraceptive provision by governments High contraceptive prevalence rates (above 70%) Still high unmet need in some populations (17%+ in adolescents, rural areas) Government funds allocated for contraceptive procurement and using UNFPA as procurement agent Most CS Committees supported by (at least) a Ministerial Decree Stock-out rates reduced to minimum Most systems are integrated/working toward integration

Where are we now… FIELD SUPPORT Five countries: Paraguay, Nicaragua, Honduras, El Salvador and Dominican Republic Near graduation from USAID assistance ( ) Strong CS initiatives Integrated systems/moving toward integration with large number of drugs to manage Highly urbanized cities Fairly good infrastructure (roads, communication) LAC CS INITIATIVE Cross-fertilization with input from on-going country work Document and disseminate lessons learned Opportunity to apply new technologies (GIS) for regional impact Supply Chain Guru

Major Accomplishments in CS El Salvador –Maternity law includes contraceptives, elevating their status –Government resources and leadership to develop and launch a national web based LMIS Nicaragua –Highly active CS Committee, with government procuring contraceptive supplies –Case Study on Integration of the Logistics System (2008) –Use of GIS to analyze DHS results and further market segmentation analysis Dominican Republic –Central level using PipeLine (01/09) Training and empowerment –Agreement between Profamilia and SESPAS to secure availability of products

Major Accomplishments in CS Paraguay –Budget line item for contraceptives –GIS used in last LIAT (09/08): geo-coding of representative sample of MOH health facilities for future use Honduras –CS Committee has a work plan, an implementation plan, indicators, and meetings are very structured and focused M&E guide shared with CS Committee –Government procures all contraceptive supplies –Procurement agreement with UNFPA saves GOH $1M per year –TA to revitalize FP services in Social Security applying lessons learned from other countries (Regional SS case studies)

Contraceptive Security: Strenghts and Opportunities Budget for procurement is now part of the budgeting cycle Strong support for CS Use of PipeLine for contraceptive projections, even at regional levels (El Salvador): great tool to negotiate budget allocations Integrated systems enables sustainability of the logistics system in the future: more resources and commitment involved. Common themes allow collaboration between UNFPA and USAID at the regional level (Regional Procurement options paper and workshop)

Contraceptive Security: Challenges Getting a budget line item –Paraguay has it, but still advocates for more funding Coordinating with other partners –ensuring the same focus and approach toward a common goal, and meeting clients’ expectations and needs Identifying procurement options, other than UNFPA Expanding commitment to CS beyond government and USAID-UNFPA supported organizations Consolidating integrated systems: automation, forecasting, etc. Protect contraceptives in an integrated, decentralized environment Sustainability beyond donor support –How to ensure CS committees are empowered to continue advocating for CS Market segmentation: how to convert findings into actions that improve equity and more effective use of resources in FP.

How to address these challenges?  Regional Study: Update of contraceptive procurement options in LAC  Procurement Capacity, UNFPA agreements, New suppliers, generics, Quality, Access RH  Regional procurement workshop in Colombia in September/09  Audience: MOH and Social Security Institutes  Technical assistance to selected CS committees to address challenges facing Social Security Institutes to provide FP services and commodities  Regional Policy Brief for social security institutes  Policy briefs of GLP studies on contraceptive procurement practices and lessons learned from Mexico, Colombia, and Chile  Application of GIS tools to analyze health and logistics indicators  Disseminate monitoring and evaluation guide to institutionalize M&E within CS committees and its stakeholders

Best practices - LAC CS Regional Initiative Evolution of regional meetings –Share best practices, common challenges and lessons learned –From technical to policy and advocacy topics –Engaged other actors outside the health sector to commit to CS –CS champions within and beyond the health sector Key for success: cross fertilization –Regional  country  regional Document best practices, share with country counterparts and incorporate into CS plans and graduation plans Country CS plans include strategies developed during workshops: –protect contraceptive procurement in decentralized settings –Awareness raising to secure funding Five years later…… CS (DAIA) is a symbol, a brand name –Everybody talks about DAIA

THANK YOU!!! Questions?