Measuring Contraceptive
Security Indicators 2013 –
Summary Findings
Introduction to CS Indicators
• Why measure contraceptive security (CS)?
 Country stakeholders and advocates recognize the
importance of monitoring country-level progress toward
contraceptive security (CS) for advocacy, program planning,
and monitoring purposes.
• How were the indicators defined?
 In 2009, the USAID | DELIVER PROJECT proposed a set of
standard CS indicators – some new and some existing – for
countries to track changes.
 These indicators are collected annually and have been
refined over time.
Introduction to This Presentation
• This slide deck presents data from 43 countries,
collected through the CS Indicators survey in 2013.
 In addition to the information on each slide, clarifying
comments and more information can be found in the slide
notes. Not all indicators are represented in this presentation
 More information can be found in the complete dataset,
found here:
http://deliver.jsi.com/dlvr_content/resources/allpubs/factsheet
s/CSIndiData2013.xlsx
o
You can also find a blank survey in the complete dataset that can be
adapted for your country needs.
Introduction to This Presentation
Contraceptive security
• Definition
• Framework (SPARHCS)
Contraceptive Security Indicators Survey
• Audience and Uses
• Limitations
2013 CS Indicators Survey selected findings
•
•
•
•
•
Finance
Policies
Commodities
Coordination
Supply chain
Conclusion and additional resources
Contraceptive Security
Contraceptive Security
(CS) exists when every
person is able to choose,
obtain, and use quality
contraceptives and condoms
for family planning and the
prevention of sexually
transmitted infections.
Reproductive Health Commodity
Security Framework
The indicators build on
the Strategic Pathway
to Reproductive
Health Commodity
Security (SPARHCS)
framework of
components considered
vital to achieve
reproductive health
commodity security
(RHCS).
Contraceptive Security Indicators
Survey
• Key informant survey
• Conducted annually
• 40+ countries
 USAID | DELIVER
PROJECT presence
countries
 Tier 1 USAID
population and
reproductive health
countries
• Topics covered
Finance
Policies
Commodities
Coordination and
Leadership
Supply Chain
Survey Audience and Uses
Intended Audiences
•
•
•
•
Country governments
Policymakers
CS committees
Advocates–local and
global
• Program managers
• Donors
• Global partners
Uses
• Monitor progress
toward CS
• Identify advocacy
and programmatic
entry points
Survey Limitations
• Indicator questions are limited in that they
are not intended to require extensive
background research
• Precise data may be difficult for respondents
to locate– particularly as relates to financing
• Official policy may vary from actual practice
• Data are contingent on the knowledge of
respondents
2013 Surveyed Countries
• 18 countries
indicated
insufficient
funding for
contraceptive
procurement
• 88% of
countries
include CS in a
national
strategy
8 out of 11
methods in the
public sector
• 86% of
countries offer
all five of the
most
commonly
offered
methods
•91% of
countries have
a committee
that works on
CS issues
•100% of
committees
include the
Ministry of
Health
Supply Chain
• On average,
countries offer
Coordination
countries used
government
funds for
contraceptive
procurement
• On average,
countries
included 6 out
of 9 methods
on their
National
Essential
Medicine List
Commodities
• 63% of
Policies
Finance
Key Findings 2013
• 70% of
countries had
a central-level
stockout at
some point
during the last
year
• On average,
these
countries had
central-level
stockouts of 2
products
Finance for Procurement
• Sufficient financing is key to ensuring a
reliable supply of contraceptives.
• Government financing indicates a
government’s commitment to
contraceptive security; it also suggests
sustainability.
• A budget line item can help ensure that
contraceptives are a priority in annual
budgeting.
Finance for Procurement
Indicators include:
 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
Financing Sources for Public-Sector
Contraceptives
• Internally generated funds―these funds are drawn from government
revenue sources―usually from various taxes, duties or fees.
• Other government funds
• Basket funds―the government manages these pooled funds which
Government
originate from various sources, including donors and the government.
Financing
• World Bank assistance―this funding, either 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 • These grants can be used to procure condoms or other contraceptives
Grants
Government Expenditures
•
•
63% of respondent countries indicated that their
country spent government funds on contraceptive
procurement in the most recent complete fiscal year
Of these 26 countries using government funds:


73% reported using internally generated funds
54% reported using other government funds
• The median amount of government funds spent was:


$586,096 from internally generated funds
$1,323,526 from other government funds
Government Expenditures
Respondent Countries That Did Not Spend Government Funds on
Contraceptive Procurement during the Previous Fiscal Year
Africa
•
•
•
•
•
•
•
•
•
•
•
Ghana
Guinea
Liberia
Malawi
Mauritania
Mozambique
Nigeria
Sierra Leone
South Sudan
Togo
Zambia
Europe & Asia
•
•
•
•
•
•
Armenia
Azerbaijan
Bangladesh
Georgia
Pakistan
Yemen
Latin America &
the Caribbean
• Haiti
• Honduras
Government Expenditures―Africa
Internally Generated
Funds Spent (USD)
Country
All Other Government
Funds Spent (USD)
Benin
$
120,000
Burkina Faso
$
720,438
Burundi
$
59,519
Ethiopia
$
Ghana
Internally Generated Funds as
Percentage of Total Government
Spending
216,000
$
336,000
36%
-
$
720,438
100%
$
425,180
$
484,699
12%
400,000
$
16,200,000
$
16,600,000
2%
$
-
$
1,347,052
$
1,347,052
0%
Kenya
$
5,967,466
$
5,131,248
$
11,098,714
54%
Madagascar
$
47,315
$
1,374,680
$
1,421,995
3%
Mali
$
33,760
$
33,760
Nigeria
$
-
$
17,600,000
$
17,600,000
Rwanda
$
574,367
$
-
$
574,367
100%
Senegal
$
250,000
$
-
$
250,000
100%
Uganda
$
3,300,000
$
-
$
3,300,000
100%
Tanzania
Unknown
$
Total Government
Funds Spent (USD)
$
$
$
-
6,527,892
unknown
100%
0%
unknown
Government Expenditures―Europe & Asia
Internally Generated
Funds Spent (USD)
Country
All Other Government
Funds Spent (USD)
Total Government
Funds Spent (USD)
Internally Generated Funds as
Percentage of Total Government
Spending
Bangladesh
$
-
$
35,690,361
$
35,690,361
0%
Indonesia
$
50,900,000
$
-
$
50,900,000
100%
Nepal
$
2,318,591 $
579,648
$
2,898,239
80%
Philippines
$
5,712,025
$
-
$
5,712,025
100%
Ukraine
$
100,000 $
76,000
$
176,000
57%
Yemen
$
1,300,000
$
1,300,000
0%
-
$
Government Expenditures―LAC
Internally Generated
Funds Spent (USD)
Country
All Other Government
Funds Spent (USD)
Dominican Republic
$
586,096
$
El Salvador
$
914,500 $
Guatemala
$
374,763
Nicaragua
$
Paraguay
$
$
1,100,000 $
646,700
$
Total Government
Funds Spent (USD)
-
Internally Generated
Funds as Percentage of
Total Government
Spending
$
586,096
100%
547,434 $
1,461,934
63%
$
374,763
100%
400,000 $
1,500,000
73%
646,700
100%
-
-
$
Africa
Europe & Asia
Latin America & the
Caribbean
Paraguay
Nicaragua
Honduras
Haiti
Guatemala
El Salvador
Dominican Republic
Yemen
Ukraine
Philippines
Pakistan
Nepal
Indonesia
India
Georgia
Bangladesh
Azerbaijan
Armenia
Albania
Afghanistan
Zimbabwe
Zambia
Uganda
Togo
Tanzania
South Sudan
Sierra Leone
Senegal
Rwanda
Nigeria
Mozambique
Mauritania
Mali
Malawi
Madagascar
Liberia
Kenya
Guinea
Ghana
Ethiopia
Burundi
Burkina Faso
Benin
Finance for Procurement
Government Share of Total Spending for Public-Sector Contraceptives,
2013
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Benin
Global Fund grants
Africa
In-kind donations
Other government funding
Europe & Asia
Internally generated funds
Latin America & the
Caribbean
Paraguay
Nicaragua
Honduras
Haiti
Guatemala
El Salvador
Dominican Republic
Yemen
Ukraine
Philippines
Pakistan
Nepal
Indonesia
India
Georgia
Bangladesh
Azerbaijan
Armenia
Albania
Afghanistan
Zimbabwe
Zambia
Uganda
Togo
Tanzania
South Sudan
Sierra Leone
Senegal
Rwanda
Nigeria
Mozambique
Mauritania
Mali
Malawi
Madagascar
Liberia
Kenya
Guinea
Ghana
Ethiopia
Burundi
Burkina Faso
Finance for Procurement
Percentage of Total Spending for Public-Sector Contraceptives, by
Funding Source, 2013
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Finance for Procurement
•
18 countries indicated there was insufficient funding for
contraceptive procurement
13 countries covered more than 100% of the quantified need
12 countries did not know if there was a funding gap
•
•
Percentage of Quantified Need Covered during the Year, 2013
140%
120%
100%
80%
60%
40%
20%
193%
184%
1169%
Africa
Europe & Asia
Paraguay
Nicaragua
Honduras
Haiti
Guatemala
El Salvador
Dominican Republic
Yemen
Ukraine
Philippines
Pakistan
Nepal
Bangladesh
Armenia
Zambia
Uganda
Togo
Senegal
Rwanda
Nigeria
Mozambique
Mali
Malawi
Madagascar
Liberia
Kenya
Ghana
Ethiopia
Burundi
Burkina Faso
Benin
0%
Latin America & the Caribbean
Finance for Procurement
•
•
A budget line item alone is not enough to ensure that
contraceptives will be funded, but it is usually a good
indicator
27 out of 42 respondent countries reported having a
government budget line item for contraceptive
procurement*


77% of countries with a budget line followed up with
funding for contraceptive procurement
33% of countries without a budget line funded
contraceptive procurement
Policies
Policies can reflect the level of government
commitment to contraceptive security, as
well as significantly impact client access to
family planning.
Policies
Indicators include:
 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)?
Policies―National Essential Medicines List
Comparison of methods offered in the public
sector and included in NEMLs, 2013
100%
90%
On average,
countries
include 7 out of
the 9 surveyed
methods on the
NEML or
equivalent
80%
70%
60%
50%
40%
30%
20%
10%
0%
Offered in public sector
Included in NEML
Policies―Government Strategies
• 38 out of 43 countries reported having a
contraceptive security strategy (or another strategy
that includes a CS component)
• 92% have been formally approved by the
Ministry of Health
• 34 out of 38 of the strategies are reportedly being
implemented
Policies―Provision and Access
Taxes, duties
and fees
26 out of 42 mentioned taxes, import duties, or fees on contraceptives–
primarily affecting commercial-sector goods
Advertising
bans
8 countries report advertising bans that affect the provision of private-sector
contraceptives
Policies
enabling the
private sector
30 out of 39 report policies that enable the private sector to provide
contraceptive methods
Restricting
access to
subpopulations
6 countries reported that unmarried people or youth have restrictions
placed on their access to contraceptives.
Charges
In 9 countries there are charges to public-sector clients for FP services.
In 8 countries there are charges to public-sector clients for FP commodities.
Commodities
Providing a mix of contraceptive
methods is essential to ensure that
clients can choose the contraceptive that
best fits their needs.
Countries were surveyed on 11 methods
Male condoms
Female condoms
Combined oral
contraceptives
Progestin only
pills
IUD
Injectables
Implants
Emergency
contraceptives
CycleBeads
Tubal ligation
Vasectomy
Commodities
Indicators include:
 Range of contraceptives offered
through:
•
•
•
•
Public sector facilities
Nongovernmental organization (NGO)
facilities
Social marketing
Commercial-sector facilities
Commodities
Percentage of Respondent Countries that Offer
Contraceptive Methods, by Method and by Sector, 2013
100%
90%
Percentage of countries
80%
70%
60%
50%
40%
30%
20%
10%
0%
Combined oral Progestin-only
pill
Hormonal
Injection
Implant
Public-sector facilities
IUD
NGO facilities
Male condom
Female
condom
Social marketing
Emergency
contraceptive
Vasectomy
Tubal Ligation
Private-sector facilities
CycleBeads
Commodities
• On average, countries offer 8 out of 11
assessed methods in the public sector
• 8 surveyed countries offer all 11 methods:

Benin, Burundi, Ghana, Haiti, Kenya, Malawi,
Senegal, and Zimbabwe
• 86% of countries offer all 5 of the most
commonly offered methods:





male condoms
combined oral contraceptives
IUDs
tubal ligations
injectables
Coordination & Leadership
For contraceptive security to be realized,
stakeholders from various sectors―
public, NGO, social marketing and
commercial―must work together to promote
effective and efficient service delivery and supply
chain systems to ensure access to contraceptives
for all segments of the population.
Coordination & Leadership
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
Coordination & Leadership
91% of countries have a committee that
works on contraceptive security
• 59% of the committees have legal status
100%
90%
Ministries of
health are
on all
committees
Percentage of Respondent Countries' Contraceptive Security Committees that
Include Specific Organizations 2013
80%
70%
60%
50%
40%
30%
20%
10%
0%
Ministry of
Health
UN agencies
Donor
NGO
Social
marketing
Central
Commercial
Medical Store/
sector
warehouse
Ministry of
Finance or
Planning
Supply Chain
An effective supply chain enables the
continuous availability of high-quality
contraceptives, which is essential to
ensuring contraceptive security.
Supply Chain
Indicators include:
 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
Supply Chain
• 70% (26 of 37) of responding countries
reported a central-level stockout of at
least one contraceptive method during
the last year
 On average, these countries reported
central-level stockouts of approximately 2
products.
Supply Chain
• 58% of countries identified service
delivery point stockouts as a large
problem
• 23% of countries identified central-level
stockouts as a large problem
Supply Chain
Number of Respondent Countries and Their Central-level Stockout
Information by Method 2013
40
Number of Countries
35
30
25
20
15
10
5
0
Central-level
stockout(s) Reported
during the Year
No Central-level
Stockouts Reported
during the year
Conclusions
The Good News
Room for Improvement
• 91% of countries have a
coordination committee working
on CS
• 88% of countries have
strategies for working on CS
• 63% of countries contribute
government funds for
contraceptives
• Diversifying membership of CS
coordinating committees
• Increasing the number of
governments contributing funds
for contraceptives and the
amount of government
contributions for contraceptives
• Expanding the range of
contraceptive methods offered in
health centers and included in
essential medicines lists
For More Information
Visit:
http://deliver.jsi.com/dhome/whatwedo/commsecurity/csmeasuring/csindicators
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