To strengthen the availability of and access to contraceptives and other essential medicines, the USAID | DELIVER PROJECT contributes to the design and implementation of contraceptive security (CS) strategies in many developing countries. Of the 14 project countries, six countries—Ghana, Malawi, Nigeria, Uganda, Rwanda, and Nicaragua—have a CS strategy, or another strategy with a strong CS component, currently being implemented. Nepal, Ethiopia, Mozambique, and Bangladesh are developing a CS strategy, or have developed a strategy but it is not yet implemented.
The CS process will differ from one country to another, depending on country goals and objectives, available resources, and needs. For example, in the Latin American and Caribbean (LAC) region, a regional meeting was held in 2003 to examine how to improve CS in countries where USAID contraceptive donations are being phased out. Consequently, several countries in the region determined that they needed to assess their CS status before implementing a plan to address donor phaseout and other program challenges.
After assembling national CS coordinating committees following a regional meeting in Nicaragua, many LAC countries used the Strategic Pathways to Reproductive Health Commodity Security (SPARHCS) tool to conduct CS assessments. In contrast, following a CS assessment in Nepal, stakeholders concluded that the large number of existing committees that were coordinating reproductive health (RH) programs, financing, and supply chains meant that a new CS committee would only have the effect of “over-coordinating” the issue. Instead, Nepal improved coordination between the existing committees and the use of sub-committees to manage issues identified in the assessment.
Below are two country-specific illustrations of strategy development for CS.
Bangladesh In 2002, with support from the DELIVER project, the Government of Bangladesh (GOB) conducted a CS assessment and developed a broad-based CS strategic plan. Bangladesh’s efforts were among the first concrete CS interventions supported by USAID. Since then, DELIVER and the follow-on USAID | DELIVER PROJECT have continued to support the GOB in implementing a number of activities identified in its strategic plan, including procurement capacity building, contraceptive financing, and growing public-private partnerships between the GOB and the Social Marketing Company (SMC) of Bangladesh in providing contraceptives.
In 2003, a behavior change communications (BCC) strategy for CS was developed. As a result of that strategy, the CS Information, Education, and Communications (IEC) Forum was established in 2005 to coordinate all family planning BCC activities and to ensure that CS issues were addressed in all related activities. A market segmentation analysis, completed in 2003, suggested an important role that the private sector could play in reducing the public-sector burden in procuring and distributing contraceptives. Talks with private-sector representatives were held in 2004, followed by a study to identify barriers to private-sector participation in importing and marketing contraceptives. A 2007 analysis showed that the expanded public-private partnership role has improved the efficacy of the national family planning program.
The project has also continued to provide support and technical assistance for increased collaboration among donors and the GOB for CS. Stakeholder meetings and workshops provided feedback on and discussion of the main financial and private sector issues. A Logistics Coordination Forum, chaired by the director general of the Directorate General of Family Planning (DGFP), was created; it includes representatives from development partners (UNFPA, CIDA, KfW, and the World Bank), the USAID | DELIVER PROJECT, and senior GOB officials. This forum has played a significant role in ensuring policy-level commitment to CS. The project has also organized donor coordination meetings to address the challenges of procuring contraceptives in a timely manner. Through this and other resource mobilization efforts, such as pooled funding for procurement, the country has reduced short- and long-term contraceptive funding gaps.
Stakeholders are currently considering a series of concrete actions to foster collaboration and help Bangladesh achieve its targets for increasing the contraceptive prevalence rate and achieving replacement fertility levels by 2010.
View an introductory presentation from the Bangladesh contraceptive security launch event (in Adobe Portable Document Format). Ghana At a stakeholder workshop in 2002, key informants met to develop a priority list of contraceptive security issues based on the Ministry of Health’s (MOH) health sector framework. As a result of this meeting, the Inter-Agency Coordination Committee for Commodity Security was established to further define and prioritize the issues and to begin to develop a national strategy. During the following 18 months, the CS working group met quarterly and addressed a number of issues, including improved coordination, financing, and integration. At a second workshop in 2003, facilitated by the DELIVER project, the working group was reinvigorated with senior MOH leadership. Senior officials at the MOH created a technical planning group within the CS group to develop a draft national strategy.
In 2004, the Ghana MOH published Meeting the Commodity Challenge: The Ghana National Contraceptive Security Strategy, 2004–2010. This publication, the culmination of a two-year process, represents the government’s ownership of and commitment to contraceptive security. A policy conference was held that officially adopted the CS strategy and placed the responsibility for coordination, monitoring, and implementation within the MOH. The CS strategy plan focuses on five main objectives: quality, monitoring and evaluation, efficiency, financing, and partnerships. Strategy activities are to be financed from multiple sources, including donors, nongovernmental organizations, and the government.
Donor and stakeholder coordination has greatly contributed to resource mobilization. Health funds (World Bank loan credits) were used in 2002, 2003, and 2004 for contraceptive procurements; the amounts were significant—over $1 million in each year. The government of Ghana also contributed $230,000 in 2003 and $280,000 in 2004 from its tax revenue for contraceptive procurement, including a line in its budget for contraceptive procurement.
From 2003 to 2006, sufficient funds for contraceptives and condoms were mobilized through donor collaboration, resulting in no funding gaps during that time. A proposal was submitted to UNFPA and approved for European Union trust funds to purchase contraceptives ($1 million in 2006) and support the operation of the integrated supply chain ($1.35 million). The project has assisted in designing a financial sustainability plan for 2007–2010 that adopted a slower donor phaseout and increased role by the MOH.
