1. Dealing with Donor Phase Out of Contraceptives in Ecuador Dealing with Donor Phase Out of Contraceptives in Ecuador How CEMOPLAF Mobilized Resources to Meet Its Needs for Family Planning Supplies Lcda. Teresa de Vargas Executive Director, CEMOPLAF October 2007

2. 1 Situation in Ecuador Great increases in demand for modern contraceptives in past 25 years Great increases in demand for modern contraceptives in past 25 years Unmet need declining (5% in 2004) Unmet need declining (5% in 2004) But, 10% among the rural poor But, 10% among the rural poor USAID and UNFPA began phase out of contraceptive donations in 2001 USAID and UNFPA began phase out of contraceptive donations in 2001 Still provided Duofem in 2003 and 2004, and condoms in 2004 Still provided Duofem in 2003 and 2004, and condoms in 2004

3. 2 The Contraceptive Market by Provider: 2004 Source: ENDEMAIN 2004

4. 3 CEMOPLAF In Brief Founded as an NGO in September 1974 Founded as an NGO in September 1974 Purpose: To provide sexual and reproductive health services Purpose: To provide sexual and reproductive health services National Coverage National Coverage External funding and donated contraceptives until 2001 External funding and donated contraceptives until 2001

5. 4 Challenges resulting from phase out of contraceptive donations How to maintain contraceptive supplies for existing clients How to maintain contraceptive supplies for existing clients How to keep prices in line with people’s ability to pay How to keep prices in line with people’s ability to pay How to become more financially sustainable How to become more financially sustainable

6. 5 CEMOPLAF Strategies Negotiated discounts and rebates with local suppliers Advocated with national and international donors for favorable terms Negotiated contract with CPR Germany to be exclusive provider of condoms – some legal restrictions Received a donation of T Hormonal or Mirena from ICA

7. 6 CEMOPLAF Strategies (cont.) Negotiated with Organon Holland for a 50% discount on subdermal implants Negotiated with Organon Holland for a 50% discount on subdermal implants Collaborated with PPFA-I for the donation and purchase of contraceptives at discount price Collaborated with PPFA-I for the donation and purchase of contraceptives at discount price Created institutional strategic alliances to provide us with other contraceptives Created institutional strategic alliances to provide us with other contraceptives Decentralized CEMOPLAF: individual clinics make purchases and seek discounts Decentralized CEMOPLAF: individual clinics make purchases and seek discounts

8. 7 FP Methods Offered by CEMOPLAF 2001 to 2007 Pills (purchased abroad and locally) Injectables (Quarterly and monthly) Intrauterine Device (Multiload, TCu380A) Hormonal IUD (LNG) Implants (Norplant, Implanon) Condoms (American and German) Voluntary sterilizations (Femenine and Masculine) Vaginal Tablets (2001 and 2002) Cycle Beads (2005 – 2007)

9. 8 CEMOPLAF’s Annual Family Planning Users 2001:119,521 2002:112,570 2003:102,133 2004: 98,908 2005:110,000 2006:122,000 2007 :125,000 (Projected for 3 mos.)

10. 9 FP Methods Provided 2001 – 2007 YearsPillsInj.Implants Emergency Contracept IUDsCondoms Cycle Beads 2001427,90767,14885093997,7371,004,6460 2002220,79467,5739261,15163,3481,141,7400 2003207,21640,46582868479,378879,3170 2004454,14921,4876171,17326,9621,134,7690 2005341,56119,73788685729,0981,314,7694,068 2006435,00020,1821,21892034,1462,226,154564 *2007480,00025,0001,42098035,1002,180,0001,120 * (3 month projection)

11. 10 Prices of Contraceptives Offered by CEMOPLAF 2001 – 2007 MethodAverage IUD (Insertion included)$18 Pills Between $2 and $8 Quarterly injectables$ 6 Monthly injectables$ 2 Emergency contraception$ 2 Implants$ 50 y 100 Voluntary sterilization$ 25 y 100 Condoms$ 0.10 In the last years, prices have not varied due to problems with users’ capacity to pay.

12. 11Sustainability % of costs recovered from all activities conducted by the NGO, including sales of contraceptives

13. 12 Results With much effort, CEMOPLAF kept a steady supply of contraceptives available. With much effort, CEMOPLAF kept a steady supply of contraceptives available. Prices are affordable, but limit sustainability. Prices are affordable, but limit sustainability. CEMOPLAF’s market share has declined since donations ceased. CEMOPLAF’s market share has declined since donations ceased. In 2006 and 2007, number of CEMOPLAF clients has recovered since phase out. In 2006 and 2007, number of CEMOPLAF clients has recovered since phase out. CEMOPLAF success: decentralization, expansion of service offerings, and cross subsidies. CEMOPLAF success: decentralization, expansion of service offerings, and cross subsidies.

14. 13 Future Plans CEMOPLAF wants to be 100% self- sustainable with expanded service provision, increased coverage and optimized resources. Become a member of Ecuador’s Contraceptive Security Committee Assess potential for becoming a FP provider under the government’s free maternal & infant assistance program