Measuring Contraceptive Security
Indicators 2014 – 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 47 countries,
collected through the CS Indicators survey in 2014.
 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
2014 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
• The framework is made
up of components
considered vital to
achieving 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
2014 Survey
47 countries were
surveyed in 2014
• 22 countries
indicated
insufficient
funding for
contraceptive
procurement
• 85% of
countries
include CS in a
national
strategy
• 91% of
countries offer
all five of the
most
commonly
offered
methods
•89% of
countries have
a committee
that works on
CS issues
•100% of
committees
include the
Ministry of
Health
Supply Chain
• On average,
countries offer
8 out of 11
methods in the
public sector
Coordination
countries used
government
funds for
contraceptive
procurement
• On average,
countries
included 7 out
of 9 methods
on their
National
Essential
Medicine List
Commodities
• 65% of
Policies
Finance
2014 Key Findings
• 48% of
countries had
a central-level
stockout at
some point
during the last
year
• On average,
these
countries had
central-level
stockouts of 12 products
Finance for Procurement
• Sufficient financing (from all sources) 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
Finance for Procurement
66%
Were government
funds allocated for
the procurement of
contraceptives?
Was there a
government
budget line item
for procurement
of contraceptives?
77%
65%
Were government
funds spent for the
procurement of
contraceptives?
Government Expenditures
•
•
65% of respondent countries indicated that their
country spent government funds on contraceptive
procurement in the most recent complete fiscal year
Of these 28 countries using government funds:


79% reported using internally generated funds
39% reported using other government funds
• The average amount of government funds spent was:


$1,182,272 from internally generated funds
$2,270,760 from other government funds
Government Expenditures
Respondent Countries That Did Not Spend Government Funds on
Contraceptive Procurement during the Previous Fiscal Year
Africa
•
•
•
•
•
•
•
•
•
Cameroon
Guinea
Liberia
Malawi
Mali
Mauritania
Niger
Sierra Leone
Togo
Europe & Asia
•
•
•
•
•
Armenia
Bangladesh
Georgia
Pakistan
Russia
Latin America &
the Caribbean
• Haiti
• Honduras
Government Expenditures―Africa
Country
Internally Generated Funds
Other Government Funds
Total Government Funds Spent
(USD)
Internally Generated Funds
as Percentage of all
Government Funds
Benin
$
40,000
$
40,000
100%
Burkina Faso
$
2,478,874
$
2,478,874
100%
Burundi
$
59,519
$
1,385,906
4%
Cape Verde
$
28,398
$
28,398
DR Congo
$
-
$
3,000,000
$
3,000,000
0%
Ethiopia
$
-
$
21,400,000
$
21,400,000
0%
$
1,155,195
$
1,155,195
0%
Ghana
$
1,326,387
100%
Kenya
$
6,214,337
$
3,672,000
$
9,886,337
63%
Madagascar
$
45,454
$
-
$
45,454
100%
Mozambique
$
-
$
2,750,000
$
2,750,000
0%
Nigeria
$
3,000,000
$
8,000,000
$
11,000,000
27%
Peru
$
9,616,296
$
9,616,296
100%
Rwanda
$
408,296
$
408,296
100%
Senegal
South Africa
Tanzania
$
250,000
$
250,000
100%
$
-
Uganda
$
Zambia
$
$
unknown
-
unknown
unknown
unknown
$
2,500,000
0%
3,300,000
$
3,300,000
100%
1,120,000
$
1,120,000
100%
$
2,500,000
Government Expenditures―Europe & Asia
Internally Generated
Funds
Country
Bangladesh
India
Nepal
Philippines
Ukraine
$
$
$
$
unknown
2,048,987
9,343,640
160,625
Other Government
Funds
$
$
$
$
34,000,000
unknown
716,919
118,125
Total Government Funds
Internally Generated Funds as
Spent (USD)
Percentage of all Government Funds
$
$
$
$
34,000,000
unknown
2,765,906
9,343,640
278,750
0%
unknown
74%
100%
58%
Government Expenditures―LAC
Internally Generated
Funds
Country
Dominican Republic $
Other Government
Funds
1,360,000
$
El Salvador
$
1,625,000
$
Guatemala
$
2,713,756
$
Nicaragua
$
742,173
$
Paraguay
$
371,000
$
125,000
-
712,987
-
Total Government Funds
Spent (USD)
Internally Generated Funds
as Percentage of all
Government Funds
$
1,360,000
100%
$
1,750,000
93%
$
2,713,756
100%
$
1,455,160
51%
$
371,000
100%
Benin
Burkina Faso
Burundi
Cameroon
Cape Verde
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
Nepal
Pakistan
Philippines
Russia
Ukraine
Yemen
Dominican Republic
El Salvador
Guatemala
Haiti
Honduras
Nicaragua
Paraguay
Peru
Finance for Procurement
Percentage of Total Spending for Public Sector Contraceptives, by Funding Source
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Africa
Global Fund grants--contraceptives besides condoms
Europe and Asia
Internally generated funds
Other government funds
In-kind donations
Global Fund grants--condoms
LAC
Benin
Burkina Faso
Burundi
Cameroon
Cape Verde
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
Nepal
Pakistan
Philippines
Russia
Ukraine
Yemen
Dominican Republic
El Salvador
Guatemala
Haiti
Honduras
Nicaragua
Paraguay
Peru
Finance for Procurement
•
•
•
22 countries indicated there was insufficient funding for
contraceptive procurement
16 countries covered more than 100% of the quantified need
4 countries did not know if there was a funding gap
Percentage of Quantified Need Covered during the Year
125%
1154%
214%
159%
120%
121%
Africa
121%
270%
100%
80%
60%
40%
20%
0%
Europe and Asia
LAC
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
• 29 out of 44 respondent countries reported having a
government budget line item for contraceptive
procurement*


79% 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
Methods Offered in the Public Sector, Included in the NEML
100%
100%
Male condom
On average,
countries
include 7 out of
the 9 surveyed
methods on the
NEML or
equivalent
IUD
98%
98%
Combined oral
contraceptives
98%
98%
96%
96%
Injectables
CycleBeads
89%
50%
83%
83%
Implants
74%
74%
Progestin-only
pills
Female condom
Emergency
contraceptive pills
59%
61%
57%
57%
Listed in the NEML
Offered in the
Public Sector
Policies―Government Strategies
• 40 out of 47 countries reported having a
contraceptive security strategy (or another
strategy that includes a CS component)
• Of those, 92% have been formally
approved by the Ministry of Health
• 92% of the strategies are reportedly being
implemented
Policies―Provision and Access
Taxes,
duties and
fees
30 out of 46 countries mentioned taxes, import duties, or fees on
contraceptives– primarily affecting commercial-sector goods
Advertising
bans
4 countries report advertising bans that affect the provision of private-sector
contraceptives
Policies
enabling
the private
sector
28 out of 41 countries 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 10 countries there are charges to public-sector clients for FP
commodities.
Policies―Charges to Clients
Services
Commodities
Cameroon
Benin
Democratic Republic of Congo*
Burkina Faso
Ghana
Cameroon
Guinea*
Cape Verde*
Haiti*
Democratic Republic of Congo*
Mali*
Mali*
Senegal*
Pakistan*
Togo
Senegal*
Zimbabwe*
Togo
Zimbabwe*
*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.
11 methods included in survey
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
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Combined oral Progestin-only pills
contraceptives
Injectable
Implant
Private Sector
Intrauterine
Device (IUD)
Male condoms
Public Sector
Female condoms
NGO
Emergency
contraceptive pills
Social marketing
Vasectomy
Tubal Ligation
CycleBeads
Commodities
• On average, countries offer 8 out of 11
assessed methods in the public sector
• 11 surveyed countries offer all 11 methods:
Benin, Burundi, DR Congo, Ghana, Guinea, Haiti, Kenya,
Malawi, Senegal, Togo, Zimbabwe
• 91% 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
89% of countries have a committee that
works on contraceptive security
• 61% of the committees have legal status
Percentage of Respondent Countries' Contraceptive Security Committees
that Include Specific Organizations
100%
90%
80%
70%
MOH and UN Agency on all
committees
60%
50%
40%
30%
20%
10%
0%
Ministry of Health
UN Agencies
Donors
Social Marketing
Organizations
NGOs
Central Medical Store
or Central Warehouse
Commercial sector
organizations
Ministry of Finance or
Ministry of 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
• 48% (20 of 42) 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 1-2 products.
Supply Chain
• 53% of countries identified service
delivery point stockouts as a large
problem
• 14% of countries identified central-level
stockouts as a large problem
Supply Chain
Central Level Stockout Information, by Method
10
Male condom
33
6
Intrauterine Device (IUD)
37
12
Injectables
30
8
Combined oral contraceptives
34
11
Implants
25
4
Progestin-only pills
30
9
Emergency contraceptive pills
17
6
Female condom
20
5
CycleBeads
0
14
5
10
15
20
25
30
35
40
45
Number of Countries
Stockout(s) reported during the year
No stockout(s) reported during the year
50
Conclusions
Finance
Policies
Commodities
Coordination
Supply Chain
What’s Working
More than 50%
of governments
are using their
funds for
contraceptives
On average,
countries
included 7 out
of 9 methods on
their National
Essential
Medicine List
On average,
countries offer 8
out of 11
methods in the
public sector
89% of
countries have
a committee
that works on
CS issues
Fewer than 50%
of countries
experienced a
central level
stockout
Diversify
committee
membershipinclude Ministry
of Finance/
Planning and
commercial
sector
Monitor stock at
all levels of the
system to ensure
stockouts at the
central level
don’t result in
stockouts at SDPs
Where improvements can be made
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.
Continue to
expand range of
commodities
offered in all
sectors.
For More Information
Visit:
http://deliver.jsi.com/dhome/whatwedo/commsecurity/csmeasuring/csindicators
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