Contraceptive Security Indicators
2015 Summary Findings
USAID | DELIVER PROJECT, Task Order 4
The USAID | DELIVER PROJECT, Task Order 4, is funded by the U.S. Agency for
International Development (USAID) under contract number GPO-I-00-06-00007-00, order
number AID-OAA-TO-10-00064, beginning September 30, 2010. Task Order 4 is
implemented by John Snow, Inc., in collaboration with PATH; Crown Agents Consultancy,
Inc.; Eastern and Southern African Management Institute; FHI360; Avenir
Health; LLamasoft, Inc; The Manoff Group, Inc.; IMPERIAL Health Sciences; PRISMA;
and VillageReach. The project improves essential health commodity supply chains by
strengthening logistics management information systems, streamlining distribution
systems, identifying financial resources for procurement and supply chain operation, and
enhancing forecasting and procurement planning. The project encourages policymakers
and donors to support logistics as a critical factor in the overall success of their healthcare
mandates.
Contents
Defining CS
SPARHCS
3
4
Finance
Policies
Commodities
Coordination
Supply Chain
Conclusions
19
24
27
29
31
9
Overview of CS
Indicators
5
Notes on the
Data
6
Countries
Surveyed
7
Key Findings
8
Contraceptive Security exists
when every person is able to
choose, obtain & use quality
contraceptives whenever
needed.
Reproductive
Health
Commodity
Security
Framework
The Contraceptive Security (CS) Indicators build on the
Strategic Pathway to Reproductive Health Commodity
Security (SPARHCS) framework. The framework is
made up of components considered vital to achieving
reproductive health commodity security (RHCS), often
referred to as the 7 c’s– context, commitment,
coordination, capital, capacity, client demand and
utilization, and commodities.
Overview of
CS Indicators
Who:
What:
Completed by key informants,
survey data is used by country
governments, policymakers, CS
committees, advocates, program
managers, donors and global
partners.
The survey covers 5 areas critical to
CS: finance, policies, commodities,
coordination and supply chain.
When:
Where:
The survey is conducted annually
and data has been collected since
2009.
The 2015 survey collected data from
49 countries, primarily USAID |
DELIVER PROJECT presence
countries and USAID Tier 1
countries for population and
reproductive health.
Note: Finance responses reflect the most
recently completed fiscal year and will vary by
country.
Why measure CS?
Country stakeholders and advocates recognize the importance of monitoring
country-level progress toward contraceptive security (CS) for advocacy,
program planning, and monitoring purposes.
Notes on the
Data
As a key informant survey, the questions have been designed to
not require extensive background research.
As with any key informant survey, the data are contingent on
the knowledge of respondents. In some cases, precise data may
be difficult for respondents to locate- particularly as relates to
financing. Where responses are unknown, they have been
removed from the denominator in calculating the percentages
shown here.
For questions regarding policies, the responses are intended to
reflect official policy, which may vary from actual practice.
See the data sheet for complete survey responses, including any
clarifying comments.
Countries
Surveyed
This slide deck presents data from 49 countries, collected
through the CS Indicators Survey in 2015 during the 7th
annual survey.
Surveyed countries are shown in blue in the map below.
These are primarily USAID | DELIVER PROJECT presence
countries and USAID Tier 1 priority countries for Population
and Reproductive Health.
Key Findings
Finance
• 65% of countries used government funds for contraceptive procurement.
• 15 countries indicated there was insufficient funding for contraceptives.
Policies
• 22 countries indicated insufficient funding for contraceptive procurement
• On average, countries included 7 out of 9 methods on their National Essential Medicine List.
• 45 countries reported having a contraceptive security strategy.
Commodities
• On average, countries offer 9 out of 11 methods in the public sector.
• 92% of
offer
all 5 of the most frequently offered methods.
• 85% of countries include
CScountries
in a national
strategy
Coordination
•86% of countries have a committee that works on CS issues.
•100% of committees have representatives from the Ministry of Health.
• 91% of countries offer all five of the most commonly offered methods
Supply Chain
• 36% of countries had a central-level stockout at some point during the last year.
• On average, these countries had central-level stockouts of 1-2 products .
Finance for
Procurement
Indicators include:





Sufficient financing from all
sources is key to ensuring a
reliable supply of
contraceptives.


Dollar value of estimated need for
contraceptives to be procured for the public
sector
Existence of a government budget line item
for contraceptives
Amount of government funds allocated for
contraceptives
Government expenditures for contraceptive
procurement
Value of in-kind contraceptive donations for
the public sector
Value of Global Fund grants used for
contraceptives (including condoms)
Information on the existence of a funding
gap
Sources of Funding
Government Funds
Internally Generated Funds
• Funds drawn from government revenue sources―usually from various
taxes, duties or fees
Other government funds
• Basket Funds―pooled funds managed by the government which originate from
various sources, including donors and the government
• World Bank assistance―this funding (credits or loans) can be used for general
budget support, sector budget support, or earmarked interventions
• Other funds―include additional funds provided to the government by donors
In-Kind Donations
• Contraceptive supplies that donors provide to a government
Global Fund Grants
• These grants can be used to procure condoms or other contraceptives
Tracking
Financial Flows
Government financing indicates a commitment to CS and
also suggests sustainability. Tracking the financing process
from the creation of a budget line item through funds being
spent for procurement can help stakeholders identify
financing bottlenecks.
60%
Allocation of funds
A budget line item does not always
guarantee a funding commitment. 67%
of countries allocated funds for
contraceptive procurement. The group
of countries allocating funds includes
some countries without a line item. Also
not all countries that included a line in
the budget allocated funds.
67%
Budget line item
A dedicated line item for contraceptive
procurement can help ensure that
contraceptives are prioritized in annual
budgeting. 60% countries surveyed in 2015
included a budget line item.
88%
Funds spent on procurement
Comparing funds spent to those allocated
can help identify causes of funding issues.
The majority of countries that allocated
funds followed through with the
procurement of commodities.
Government
Expenditures
58% of respondent countries indicated that government
funds were spent on contraceptive procurement in the most
recent complete fiscal year. On average, these countries
spent $5.56 million on contraceptive procurement.
Of those 28 countries:
• 68% utilized internally generated funds
• 11% used other government funds
• 21% used some combination of both
21%
Internally Generated
Other government funds
11%
68%
Internally generated &
other government funds
Cameroon
Cote d’Ivoire
Guinea
Kenya
Mali
Mauritania
Mozambique
Niger
Sierra Leone
South Sudan
Togo
Afghanistan
Armenia
Georgia
Pakistan
Russia
Yemen
Haiti
Latin America & the
Caribbean
Burundi
Europe & Asia
Of the 49 countries surveyed, 19 respondent
countries did not spend government funds on
contraceptive procurement during the previous
fiscal year.
Africa
Government
Expenditures
Government
Expenditures
Africa
Country
Benin
Burkina Faso
Cape Verde
DR Congo
Ethiopia
Ghana
Madagascar
Malawi
Nigeria
Rwanda
Senegal
South Africa
Tanzania
Uganda
Zambia
Zimbabwe
Sixteen African countries reported utilizing government funds for
contraceptive procurement. This information is reflected in the table
below. Where known, government spending on contraceptives
totaled $34,845,879. Of the government funds spent, the majority
(75%) came from internally generated sources.
South Africa reported covering 100% of contraceptive procurement
with government funds.
Total government
spending
Internally generated share
of government spending
$
$
$
$
$
$
$
$
$
$
$
40,000
1,000,000
92,364
300,500
11,061,926
2,385,158
14,274
60,000
11,580,170
965,462
96,000
$
$
$
937,576
5,600,000
712,449
Unknown
100%
100%
100%
100%
100%
0%
100%
100%
8%
100%
100%
100%
0%
11%
100%
Unknown
Internally generated funds Other government funds
$
$
$
$
$
$
$
$
$
$
$
$
40,000
1,000,000
92,364
300,500
14,274
60,000
980,170
965,462
96,000
600,000
712,449
Unknown
$
$
11,061,926
2,385,158
$
10,600,000
$
$
Not applicable
937,576
5,000,000
Unknown
Government
Expenditures
Europe & Asia
Country
Six out of twelve European and Asian countries surveyed
utilized government funds for contraceptive
procurement during the most recently completed fiscal
year. This totaled more than one hundred million dollars
($101,000,033). As with the spending in African
countries, the bulk of government funds were internally
generated (83%). Two countries, India and Indonesia,
comprise more than half ($62,620,880) of this spending.
Total government
spending
Internally generated share
of government spending
$
17,040,000
28%
Internally generated funds Other government funds
Bangladesh
$
4,810,000
$
India
$
27,000,000
$
27,000,000
100%
Indonesia
$
35,620,880
$
35,620,880
100%
Nepal
$
583,492
$
686,461
85%
Philippines
$
20,488,372
$
20,488,372
100%
Ukraine
$
135,376
$
164,320
82%
$
$
12,230,000
102,969
28,944
Government
Expenditures
Latin America
& Caribbean
Country
Dominican Republic
El Salvador
Guatemala
Honduras
Nicaragua
Paraguay
Peru
Internally generated funds
With the exception of Haiti, each of the surveyed
countries from the LAC region used government funds
for contraceptive procurement, totaling $14,502,068.
Nearly all (98%) of this funding was internally generated.
Other government funds
Total government spending
Internally generated share
of government spending
$
1,340,000
$
1,340,000
100%
$
1,700,000
$
1,700,000
100%
$
903,535
$
903,535
100%
$
1,279,865
$
1,279,865
100%
$
979,470
$
1,179,470
83%
$
1,923,556
$
1,923,556
100%
$
6,175,642
$
6,175,642
100%
$
200,000
Funding
Sources
In Africa, the majority of countries rely on in-kind donations for the bulk of
their contraceptive financing. Five countries utilized Global Fund grants
for the procurement of condoms, while Malawi use GF grants for both
condoms and other contraceptives. In LAC, contraceptive financing is
primarily done through internally generated funds, as most countries have
graduated from donor assistance.
Percentage of Total Spending for Public Sector Contraceptives, by Funding Source
In-kind donations
Internally Generated Funds
Other government funds
GF grant (condoms)
GF grant (other contraceptive)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
Benin
Burkina Faso
Burundi
Cameroon
Cape Verde
Cote dIvoire
DR Congo
Ethiopia
Ghana
Guinea
Kenya
Liberia
Madagascar
Malawi
Mali
Mauritania
Mozambique
Niger
Nigeria
Rwanda
Senegal
Sierra Leone
South Africa
South Sudan
Tanzania
Togo
Uganda
Zambia
Zimbabwe
Afghanistan
Armenia
Bangladesh
Georgia
India
Indonesia
Nepal
Pakistan
Philippines
Russia
Ukraine
Yemen
Dominican Republic
El Salvador
Guatemala
Haiti
Honduras
Nicaragua
Paraguay
Peru
0%
Africa
Europe & Asia
LAC
Funding Gap
To determine if funding was sufficient to meet the country’s
needs, data on contraceptive financing was compared to the
value of quantified need for the same time period. Where
information was not available, respondents indicated if there
was a funding gap.
Many factors can result in a discrepancy between a quantified
needs and funds spent, resulting in either a gap, or in funds
exceeding the quantification projections.
If a quantification did not accurately reflect the demand for
contraceptive procurement, due to incorrect assumptions or
poor data quality, then this figure does not reflect the true
funding gap.
Other factors that can impact the discrepancy between a
quantification and expenditures, include different time frames,
exchange rates, and changing costs of contraceptives. These
factors can result either in a funding gap, or alternatively in the
funding provided exceeding the projections from the
quantification.
Africa
Europe & Asia
LAC
Peru
Paraguay
Nicaragua
Honduras
Haiti
Guatemala
El Salvador
Dominican Republic
Yemen
Ukraine
Philippines
Pakistan
Nepal
Indonesia
India
Bangladesh
Zimbabwe
Zambia
Uganda
Togo
Tanzania
South Sudan
Sierra Leone
Senegal
Rwanda
Nigeria
Niger
Mozambique
Mauritania
Mali
Malawi
Madagascar
Liberia
Kenya
Guinea
Ghana
Ethiopia
Cote dIvoire
Cape Verde
Cameroon
•
Burundi
505%
74%
98%
100%
100%
91%
95%
160%
126%
79%
96%
100%
115%
105%
99%
97%
100%
80%
100%
43%
149%
119%
299%
123%
101%
72%
100%
95%
100%
97%
68%
80%
131%
10%
87%
100%
100%
38%
100%
150%
100%
100%
100%
•
Burkina Faso
20%
Benin
Funding Gap
15 countries indicated there was a funding gap. On average in countries with a gap, 80% of
quantified need was funded.
12 countries indicated that contraceptive spending exceeded the amount identified through
the quantification.
100%
Percentage of Quantified Need Covered
80%
60%
40%
0%
Policies
Indicators include:




Policies can reflect the level of
government commitment to
contraceptive security, as well
as significantly impact client
access to family planning.

Existence of a national contraceptive
security strategy
Policies limiting or promoting access to
family planning
Inclusion of contraceptives on the National
Essential Medicines List (NEML)
Inclusion of CS concepts and family
planning indicators in the Poverty
Reduction Strategy Paper (PRSP)
Which method is the lowest level provider
allowed to dispense (task shifting)?
Government Strategies
Political support in the form of actionable
government strategies is key to ensuring CS.
These strategies may be standalone, or part of
larger strategic plans. The CS Indicators Survey
captures information on Poverty Reduction
Strategy Papers as well as other strategies
dedicated to or including CS.
37 countries included in the survey have a
Poverty Reduction Strategy Paper (PRSP).
While only 16% explicitly refer to CS, 76%
prioritize reproductive health or family
planning.
45 out of 49 countries reported having a
contraceptive security strategy (or another
strategy that includes a CS component).
Where strategies exist,
• 93% have been formally approved by the
Ministry of Health.
•
98% of countries report that the strategy
is being implemented.
National Essential
Medicines List
(NEML)
Inclusion on the NEML can help prioritize
methods offered and procured for the public
sector. On average, countries include 7 out of 9
surveyed methods on the NEML or equivalent.
Methods Offered in the Public Sector, Included in the NEML
Combined oral
contraceptives
100%
96%
100%
Male condoms
88%
98%
Intrauterine devices
88%
96%
Injectables
90%
81%
Progestin-only pills
86%
83%
Implants
77%
58%
Female condoms
63%
Emergency
contraceptive pills
CycleBeads
Public Sector
56%
65%
46%
21%
National Essential
Medicines List
Provision &
Access
Taxes, duties and fees
33 countries report there are taxes, import duties, or fees on
contraceptives– primarily affecting commercial-sector goods.
Advertising bans
6 countries report advertising bans that affect the provision of
private-sector contraceptives.
Policies enabling the private sector
33 countries report policies that enable the private sector to
provide contraceptive methods.
Restricting access to sub-populations
5 countries report policies that restrict access to contraceptives
for unmarried people.
6 countries report policies that restrict access to contraceptives
for youth.
• In each case, 3 countries are implementing the policy.
Charges to clients
In 15 countries there are charges to public-sector clients for FP
services or commodities.
• In 5 countries there are no exemptions for those clients
who cannot pay.
Charges to Clients
Charges for
Services
Commodities
A key component of family planning
availability is affordability of services
and/or supplies. In the CS Indicators
Survey, countries report on formal policies
regarding charges to clients for services or
commodities.
Cameroon
Benin
Cote d'Ivoire*
Burkina Faso
DR Congo*
Cameroon
Ghana
Cape Verde *
In total, 15 countries charge clients for
family planning services or commodities.
Seven of these countries charge for both
services and commodities.
Guinea*
Cote d'Ivoire*
Haiti*
DR Congo*
Indonesia*
Mali*
Ten countries have exemptions for those
who cannot afford to pay, including five of
the seven countries that charge for both.
Mali*
Pakistan*
Senegal*
Senegal*
Togo
Togo
Zimbabwe*
Zimbabwe*
An asterisk* indicates that there are exemptions for those who
are unable to pay.
Commodities
Providing a mix of contraceptive
methods is essential to ensure that
clients can choose the contraceptive
that best fits their needs.
Indicators include:

Range of contraceptives offered through:
•
Public sector facilities
•
Nongovernmental organization (NGO)
facilities
•
Social marketing
•
Commercial-sector facilities

Methods included in the survey:
•
Male condoms
•
Female condoms
•
Combined oral contraceptives
•
Progestin-only pills
•
Intrauterine Device (IUD)
•
Injectables
•
Implants
•
Emergency Contraceptives
•
CycleBeads
•
Tubal ligation
•
Vasectomy
Methods
Offered by
Sector
Having methods available in a variety of sectors increases client access
and helps promote equity. However, some contraceptive methods are
more likely to be found in certain sectors.
For example: emergency contraceptives and progestin only pills are
more likely to be offered through private-sector facilities than through
any other sector. They may, therefore, be accessible to fewer people
than if they were also widely offered through the public sector or other
sectors. Long-acting, permanent methods (LA/PM) are most commonly
offered through the public sector.
Public Sector
Commercial Sector
100%
90%
Social Marketing
80%
NGO
70%
60%
50%
40%
30%
20%
10%
0%
Combined oral Progestin-only
contraceptives
pills
Injectables
Implants
IUDs
Male condoms
Female
condoms
Emergency LA/PM males LA/PM females CycleBeads
contraceptive
pills
Method
Availability
9
9
92%
On average, countries
offer 9 out of 11 assessed
methods in the public
sector
9 surveyed countries offer
all 11 methods.
92% of countries offer all 5
of the most commonly
offered methods:
 male condoms
 combined oral
contraceptives
 IUDs
 tubal ligations
 injectables
Burundi, DR Congo,
Ghana, Guinea, Haiti,
Kenya, Malawi, Senegal,
and Togo
Coordination &
Leadership
For CS to be realized, stakeholders
from various sectors―
public, NGO, social marketing and
commercial―must work together
to ensure access to contraceptives
for all segments of the population.
Indicators include:

Existence of a national committee that
works on contraceptive security
• Organizations represented on the
committee
• Frequency of committee meetings
• Legal status of the committee
• Existence of a contraceptive security
champion
CS Committee
86% of countries have a committee that works on
contraceptive security. While the membership varies by
country, the Ministry of Health is represented on each
country’s committee. 52% of the committees have legal
status. 64% of committees met 3 or more times in the
past year.
Percentage of Contraceptive Security Committees that Include Specific Organizations
100%
98%
93%
88%
88%
85%
43%
Ministry of
Health units
UN agencies
NGOs
Donors
Central Medical Social marketing Commercial
Store or Central organizations
sector
Warehouse
organizations
40%
Ministry of
Finance or
Ministry of
Planning
Supply Chain
Indicators include:



An effective supply chain enables
the continuous availability of highquality contraceptives, which is
essential to ensuring contraceptive
security.
Central-level stockout data
Whether stockouts are a major
problem at the central level
Whether stockouts are a major
problem at the service delivery
point (SDP) level
Central-level
stockouts
60% of countries identified service delivery point stockouts as a
large problem. 28% of countries identified central-level stockouts
as a large problem. It should be noted that these indicators are
more subjective than others.
Central level stockouts are problematic,
but do not always result in a stockout at
lower levels of the system, and may not
impact product availability for clients.
CycleBeads
36% (16 of 45) of responding countries reported a central-level
stockout of at least one contraceptive method during the last
year--on average of 1-2 products.
5
Emergency
contraceptive pills
Stockouts reported during the year
14
6
Female condoms
No stockouts reported during the year
20
7
Progestin-only pills
22
8
Implants
27
9
Injectables
31
11
Male condoms
32
7
IUDs
36
8
Combined oral
contraceptives
37
9
0
5
36
10
15
20
25
Number of Countries
30
35
40
45
Conclusions
What’s working
More than 50%
of governments
are using their
funds for
contraceptives.
7 out of 9
methods on
average are
included on the
National Essential
Medicine List.
Countries offer
an average of 9
methods in the
public sector.
86% of
countries have
a committee
that works on
CS issues.
Fewer than 50%
of countries
experienced a
central level
stockout.
Continue to
expand range of
commodities
offered in all
sectors.
Diversify
committee
membership and
increase
frequency of
meetings.
Monitor stock at
all levels of the
system to ensure
central level
stockouts do not
result in stockouts
for clients at
SDPs.
What can improve?
Increase number
of countries
allocating funds
and following
through to spend
them
Ensure that
policies enable all
sectors to offer a
range of methods
and all clients can
access those
methods.
For more
information
Data
Maps
Dashboards
USAID | DELIVER PROJECT
Visit:
http://deliver.jsi.com/dhome/whatwedo/commsecu
rity/csmeasuring/csindicators
There you’ll find:
 Data sheets for each year of data collection
(2009 on) with all of the responses for each
surveyed country, blank surveys, and
frequently asked questions/survey tips
 Data dashboards by country (these also have
the country’s responses from all survey
years), region, and a global snapshot
 Briefs and papers
 Presentations
 Interactive maps displaying some indicator
data
the last mile
@deliverproject