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Planning and Finance

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  • Romania has been undergoing a series of health financing reforms designed to reduce heavy dependence on government financing, central planning, and health services monopolized by the state. These reforms include a national health insurance scheme, contraceptive security initiatives, and revolving drug funds at the subnational level. Contraceptive security is important as Romania is trying to shift from a reliance on abortion to more widespread use of contraception. In August 2000, the government approved policies regarding contraceptive security. This study responds to the aforementioned policy needs by presenting findings from a market segmentation analysis of the Romanian FP market. Specifically, the study identifies and defines market segments for FP and presents policy options for better targeting of public and private sector resources.
    English
    Rom_MarkSeg.pdf

  • There is a growing literature that discusses the impact of HIV/AIDS on prospects for development (Barnett and Whiteside, 2002, provides an excellent overview). Less attention has been paid to the impact of development on the spread of HIV/AIDS. The process of development often leads to rural–urban migration, increased trade and transport, and the attenuation of family relations due to physical separation. These processes pose challenges in the fight against HIV/AIDS. On balance, economic growth and development support the fight against AIDS, yet the process of development must be managed effectively to assure that economic development and the fight against AIDS work together to benefit sub-Saharan Africa. Workplace programs are cost-effective. AGOA factories provide ideal environments for implementation of HIV/AIDS prevention, care, and treatment programs that are mutually beneficial for the companies and societies.
    English
    AGOA2003_1.pdf

  • AGOA representatives met late in 2001, again in 2002, and now for a third time in December 2003. Background papers from previous meetings suggested a number of actions that AGOA member countries could consider to enhance the effectiveness of responses to the threat of HIV/AIDS. This paper summarizes a few issues and actions, linking the actions specifically to (1) finance and planning ministries, (2) trade, labor, and commerce ministries, (3) the business sector, and (4) donors and assistance agencies. The delegates could discuss which key actions they would like to monitor and possibly report on at the next AGOA forum. They are welcome to recommend fresh approaches to maximize the benefits that can derive from a results-oriented, cooperative effort in the fight against HIV/AIDS.
    English
    AGOA2003_2.pdf

  • The accompanying tables provide background data on health spending in AGOA countries; background data on successful applications for grants from the Global Fund to Fights AIDS, Tuberculosis and Malaria and grants received by AGOA countries under the World Bank Multisectoral AIDS Program (MAP) for Africa; and background data on HIV/AIDS prevalence. These data may help orient and clarify discussion of progress and objectives.
    English
    AGOA2003_3.pdf

  • Political commitment and leadership are essential for creating an enabling environment that promotes the development and growth of appropriate, sustainable HIV/AIDS policies and programs. The need for strong leadership is acutely felt in low HIV prevalence countries where there is still an opportunity to contain the spread of the epidemic. However, “political commitment” is a term that is often used without a clear sense of what it means, how it affects programs, when it can be most effective, and how it can be strengthened by advocates and policymakers. Building on experience with monitoring national program efforts in the family planning/reproductive health, maternal health, and HIV/AIDS fields, the POLICY Project developed a questionnaire that assesses various aspects of political commitment. POLICY then worked with local counterparts to pilot test the questionnaire in four low-prevalence countries in Asia. The pilot studies show that the political commitment assessment guide can serve as a useful tool for helping HIV/AIDS advocates and policymakers analyze a country’s national political commitment and leadership for confronting HIV/AIDS. In-country researchers can use the assessment guide to tailor questions to their country’s unique context. Such research can lay the foundation for identifying areas of strength and weakness in the country’s HIV/AIDS program and highlighting areas for future advocacy and policy change efforts.
    English
    ACF1AA.pdf

  • Political commitment and leadership are essential for creating an enabling environment that promotes the development and growth of appropriate, sustainable HIV/AIDS policies and programs. The need for strong leadership is acutely felt in low HIV prevalence countries where there is still an opportunity to contain the spread of the epidemic. However, “political commitment” is a term that is often used without a clear sense of what it means, how it affects programs, when it can be most effective, and how it can be strengthened by advocates and policymakers. Building on experience with monitoring national program efforts in the family planning/reproductive health, maternal health, and HIV/AIDS fields, the POLICY Project developed a questionnaire that assesses various aspects of political commitment. POLICY then worked with local counterparts to pilot test the questionnaire in four low-prevalence countries in Asia. The pilot studies show that the political commitment assessment guide can serve as a useful tool for helping HIV/AIDS advocates and policymakers analyze a country’s national political commitment and leadership for confronting HIV/AIDS. In-country researchers can use the assessment guide to tailor questions to their country’s unique context. Such research can lay the foundation for identifying areas of strength and weakness in the country’s HIV/AIDS program and highlighting areas for future advocacy and policy change efforts.
    English
    ACF1AD.pdf

  • Political commitment and leadership are essential for creating an enabling environment that promotes the development and growth of appropriate, sustainable HIV/AIDS policies and programs. The need for strong leadership is acutely felt in low HIV prevalence countries where there is still an opportunity to contain the spread of the epidemic. However, “political commitment” is a term that is often used without a clear sense of what it means, how it affects programs, when it can be most effective, and how it can be strengthened by advocates and policymakers. Building on experience with monitoring national program efforts in the family planning/reproductive health, maternal health, and HIV/AIDS fields, the POLICY Project developed a questionnaire that assesses various aspects of political commitment. POLICY then worked with local counterparts to pilot test the questionnaire in four low-prevalence countries in Asia. The pilot studies show that the political commitment assessment guide can serve as a useful tool for helping HIV/AIDS advocates and policymakers analyze a country’s national political commitment and leadership for confronting HIV/AIDS. In-country researchers can use the assessment guide to tailor questions to their country’s unique context. Such research can lay the foundation for identifying areas of strength and weakness in the country’s HIV/AIDS program and highlighting areas for future advocacy and policy change efforts.
    English
    ACF1B0.pdf

  • Political commitment and leadership are essential for creating an enabling environment that promotes the development and growth of appropriate, sustainable HIV/AIDS policies and programs. The need for strong leadership is acutely felt in low HIV prevalence countries where there is still an opportunity to contain the spread of the epidemic. However, “political commitment” is a term that is often used without a clear sense of what it means, how it affects programs, when it can be most effective, and how it can be strengthened by advocates and policymakers. Building on experience with monitoring national program efforts in the family planning/reproductive health, maternal health, and HIV/AIDS fields, the POLICY Project developed a questionnaire that assesses various aspects of political commitment. POLICY then worked with local counterparts to pilot test the questionnaire in four low-prevalence countries in Asia. The pilot studies show that the political commitment assessment guide can serve as a useful tool for helping HIV/AIDS advocates and policymakers analyze a country’s national political commitment and leadership for confronting HIV/AIDS. In-country researchers can use the assessment guide to tailor questions to their country’s unique context. Such research can lay the foundation for identifying areas of strength and weakness in the country’s HIV/AIDS program and highlighting areas for future advocacy and policy change efforts.
    English
    ACF1B3.pdf

  • This paper identifies eight interventions for HIV/AIDS prevention, care, and treatment of construction workers. Where prevalence is low, cost of the eight interventions is 0.14 percent of the cost of a major construction project. With high prevalence levels of ten percent of the workforce, costs of the package of interventions would still fall below one percent of total project costs. These percentages are low enough to permit contractors to include the costs of such services among the indirect costs for worker injury protection, insurance and emergency care without substantially increasing total project costs. Economics of AIDS and Access to HIV/AIDS Care in Developing Countries, Issues and Challenges The following series of documents (in PDF) are the chapters of this book, which was assembled by ANRS in June 2003. This paper is part of a book which contributes to the debate on expanding access to HIV/AIDS treatment in developing countries. It presents an important and innovative aspect of the work of the ANRS (Agence Nationale de Recherches sur le Sida), one of the few agencies to have initiated research in this field. Its aim is to increase the engagement of the economic and social science perspective so as to clarify international and national discussions about the best way to overcome the scandalous inequality in access to HIV/AIDS treatment between poor and rich region of the world. For more information on the book follow this link: http://www.iaen.org/papers/anrs.php/
    English
    McGreevey.pdf

  • A primary goal of reproductive health and family planning programs is to ensure that people can choose, obtain, and use a wide range of high-quality, affordable contraceptive methods and condoms for STI/HIV prevention. Referred to as contraceptive security, this goal requires sustainable strategies to ensure and maintain access to and availability of supplies. This wall chart presents a tool developed to measure a country's level of contraceptive security and to monitor it over time. The tool uses a set of indicators covering the primary components of contraceptive security to measure the level of contraceptive security in countries. These indicators can be used separately to monitor progress in each component. They are also aggregated to establish a composite index, which can be used to compare countries at a point in time or to monitor progress over time within a country.
    English
    CS_Wallchart.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    English
    ACF400.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    English
    Honduras_CS_Eng.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    English
    Nicaragua_CS_Eng.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    English
    Paraguay_CS_Eng.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    English
    Peru_CS_Eng.pdf

  • English
    JamRHinteg.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    Spanish
    Bolivia_CS_Sp.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    Spanish
    Honduras_CS_Sp.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    Spanish
    Nicaragua_CS_SP.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    Spanish
    ACF3D1.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    Spanish
    Peru_CS_SP.pdf

  • This study was prepared at the request of the POLICY Project to analyze the existing and potential procurement mechanisms in the Ministry of Health (MOH), Royal Medical Services (RMS), UN Relief and Works Agency (UNRWA), Jordan University Hospital (JUH), and Jordan Association for Family Planning and Protection (JAFPP), which are the main providers of contraceptives obtained through the USAID grant to the MOH in Jordan.
    English
    Jor_procurement.pdf

  • This manual is designed to help manage the Government of Kenya's Facility Improvement Fund successfully in local health centres. Experience in the health centres has shown that implementation of the policies and procedures described in the manual will improve the collection and use of funds, and enhance patient and staff satisfaction with services.
    English
    KEN_FIF_doc.pdf

  • This paper presents a detailed market segmentation analysis of the family planning sector in Jordan. Section 2 provides an overview of the provider market. Section 3 analyzes the consumer market in terms of consumer characteristics, needs, method use, and sources of contraceptives. Section 4 studies profiles of the public-, NGO-, and private-sector clients. Section 5 presents a comparative analysis of the 1997 and 2002 markets. Section 6 assesses the current targeting behavior in the public sector. Section 7 segments the current market to establish a better match between current/potential users and the appropriate source of FP methods and services. Section 8 projects the potential demand across SLI quintiles and the potential market for the public, NGO, and commercial sectors; while Section 9 presents policy options for achieving contraceptive security based on market segmentation results.
    English
    JOR_MS.pdf

  • This report provides a summary analysis of the resources required to achieve the broad objectives outlined in Kenyas National AIDS Strategic Plan (KNASP). The report specifically provides summary information on the key interventions as laid out in the KNASP (2005-2010) and the financial resources required for a credible response to the epidemic. The report also includes the best estimates on the current coverage of those interventions; the current assumptions about HIV/AIDS capacity required to scale up coverage; the best current estimates; and the current and projected HIV/AIDS resources. The data specific to Kenya were obtained using a combination of: 1) key informant interviews with representatives from government, US government agencies, UN institutions, and local universities; 2) a review of six existing HIV/AIDS budgets in Kenya; 3) review of international literature; and 4) various demographic and economic surveys conducted on HIV/AIDS interventions in Kenya.
    English
    KEN_NASP.pdf

  • The volume presents information on the status of RCH financing in Rajasthan. It rests on the multifaceted research endeavor that encompassed: 1) a comprehensive literature review of health financing studies in India; 2) a detailed analysis of cost recovery through Medical Relief Societies; 3) an analysis of public sector health expenditure based on a review of government budget and expenditure reports at both the state and district levels; 4) an RCH expenditure and utilization survey of 1,100 households in the district of Udaipur, Rajasthan; and 5) an inventory of public and private sector health facilities for seven districts in Rajasthan; and provider interviews on time allocation at health facilities in Udaipur, Rajasthan.
    English
    IND_RAJ_FIN.pdf

  • English
    finalbol.pdf

  • English
    Jor_Fpresults.pdf

  • This booklet examines the impact of rapid population growth on development and illustrates how a successful population management program would provide significant economic and social benefits to Ghana, thereby improving the quality of life for all Ghanaians. The booklet is based on analysis conducted using the Resource for Awareness of Population Impacts on Development (RAPID) model.
    English
    RAPID_booklet_final.pdf

  • This manual provides a comlete set of guidelines for operations of the Health Boards and Committees.
    English
    KENGuidelines.pdf

  • Building on a participatory process that began more than a year ago with technical support from POLICY/South Africa, the Anglican Church of the Province of Southern Africa has adopted a provincial HIV/AIDS strategic plan for 2003–2006. Forged diocese-by-diocese, the plan represents the best of the Anglican Church’s collective wisdom and is designed to ensure that local approaches are used to address local concerns. Among the provisions in the document are plans to: ? Expand care and support efforts for people living with HIV/AIDS (PLWHA) through a trainer-of-trainers program involving members of the Mothers Union and the Anglican Women’s Fellowship; ? Conduct a pilot project on voluntary counseling and testing to explore the feasibility of providing these services through faith-based communities; ? Establish “Lay Leadership Training Academies” and clergy schools and training programs to build leadership skills, improve pastoral care, and strengthen commitment to address HIV/AIDS; ? Form of a committee on Sexuality Education and HIV Prevention to develop prevention programs and curricula geared toward youth; and ? Collaborate with multisectoral partners to outline a workplace policy on HIV/AIDS and catastrophic illnesses in order to help reduce stigma and discrimination. In addition, the participatory process used to develop the strategic plan is documented in a training manual so that it can be used as a model for other community- and faith-based organizations.
    English
    CPSA.pdf

  • English
    egypt-co.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    Spanish
    Regional_CS_Sp.pdf

  • This paper is designed to serve as a key background document for the Sustainability Strategy Conference, May 3-4, 2001. It summarized the findings of 12 individual situation analysis papers developed under four different subject areas: financial sustainability, institutional capacity, enabling environment and sustainability of demand.
    English
    EGY_SFP.pdf

  • A major outcome of the International Conference on Population and Development held in Cairo in 1994 is that many countries including Nigeria shifted the focus of their population and development programmes to reproductive health. In this regard, the Reproductive Health Division of the Federal Ministry of Health, with assistance from POLICY Project, developed a 5-year RH strategic plan for the period 2002 – 2006. This strategic framework and plan is fashioned to translate the reproductive health policy into actionable plans. The goal of the strategic framework is to improve the quality of life of all Nigerians, men,, women and children through enhanced reproductive health. Thus the key objectives are to reduce the maternal mortality rate by 90% and perinatal mortality rate by 30% of the 1999 figures. Other objectives to reduce the prevalence of STIs and HIV infections, limit all forms of gender-based violence and other harmful practices, reduce the incidence of reproductive cancers and infertility, and increase contraceptive prevalence rate. In providing a comprehensive right based and gender sensitive reproductive health services, linkages between that make services comprehensive should be established such that health care staff, made polyvalent in their skills offer services in a wide range of RH care needs within each care centre. The strategic framework and plan also promotes community participation and encourages private sector support. Since health is under the concurrent list in Nigeria, the three tiers of government, shall spearhead the funding and implementation of the Plan with support from Developmental Agencies, International organizations and NGOs The following priority areas have been given focused attention: • Safe Motherhood • Family Planning • Adolescent Reproductive Health • STIs, HIV/AIDS • Harmful Practices, Reproductive rights and Gender Issues • Tumours of Reproductive Organs • Infertility and Sexual Dysfunction’ • Menopause and Andropause The contemporary issues under each of these component areas are to be addressed through five strategies of advocacy and social mobilization, promotion of healthy reproductive behaviour, equitable access to quality services, capacity building and research promotion. It is expected that this strategic framework and plan may be reviewed as necessary. With an estimated budget of N21,000,000.000 (Twenty one billion Naira), successful implementation of this strategic framework and plan should substantially contribute to achievement of the goals of the RH policy, the National Health Policy and the National Policy on Population for sustainable Development.
    English
    NIG_RHStrat.pdf

  • Armed forces, police, and other uniformed services around the world face a serious risk of HIV and other sexually transmitted infections (STIs), due to the nature and characteristics of their profession. As a civil force, the Nepal Police work closely with the population in all areas of the country and subsequently are frequently exposed to groups with increased vulnerability to HIV/AIDS. Although the risk of contracting HIV through performing the normal duties of uniformed services employees is so low as to be almost non-existent, there are other factors that can contribute to the vulnerability of uniformed services personnel. The overall objectives of the HIV/AIDS strategy for the Nepal Police are to halt the spread of the HIV/AIDS epidemic within the police force, their partners and families; to sensitize them toward the rights of vulnerable groups and their access to HIV/AIDS services, and to ensure that policing practices do not exacerbate the impact of the epidemic in Nepal through impeding HIV prevention initiatives. In order to meet these objectives, this strategy has been developed. The strategy broadly focuses on prevention as the fundamental basis for an effective response within the Nepal Police. The strategy recognizes the importance of research, accurate surveillance systems, and evaluation and monitoring of interventions. The strategy is guided by underlying principles including a rights-based approach, high-level leadership and commitment, reduction of stigma and discrimination, and greater involvement of people living with HIV/AIDS (GIPA).
    English
    NEP_PoliceStrategy.pdf

  • A key condition of contraceptive security is a policy environment that enables forecasting, financing, procuring, and delivering contraceptives in a fair and equitable way to all women and men who need them. Contraceptive security exists in a country when all women and men who need and want contraceptives can obtain them. Policies can either inhibit or enhance achievement of contractive security. There is a dynamic relationship between the policy environment, the logistics and management functions of delivering contraceptive supplies and services, and contraceptive security. More emphasis is typically given to logistics and management issues than to policy issues in efforts to promote contraceptive security. However, the importance of a favorable policy environment as a lynchpin to contraceptive security is becoming increasingly apparent. This brief focuses on the key policy aspects of contraceptive security, and describes how policy interventions are essential to achieving contraceptive security.
    French
    PI_Frch.pdf

  • A key condition of contraceptive security is a policy environment that enables forecasting, financing, procuring, and delivering contraceptives in a fair and equitable way to all women and men who need them. Contraceptive security exists in a country when all women and men who need and want contraceptives can obtain them. Policies can either inhibit or enhance achievement of contractive security. There is a dynamic relationship between the policy environment, the logistics and management functions of delivering contraceptive supplies and services, and contraceptive security. More emphasis is typically given to logistics and management issues than to policy issues in efforts to promote contraceptive security. However, the importance of a favorable policy environment as a lynchpin to contraceptive security is becoming increasingly apparent. This brief focuses on the key policy aspects of contraceptive security, and describes how policy interventions are essential to achieving contraceptive security.
    Spanish
    PI_Sph.pdf

  • A key condition of contraceptive security is a policy environment that enables forecasting, financing, procuring, and delivering contraceptives in a fair and equitable way to all women and men who need them. Contraceptive security exists in a country when all women and men who need and want contraceptives can obtain them. Policies can either inhibit or enhance achievement of contractive security. There is a dynamic relationship between the policy environment, the logistics and management functions of delivering contraceptive supplies and services, and contraceptive security. More emphasis is typically given to logistics and management issues than to policy issues in efforts to promote contraceptive security. However, the importance of a favorable policy environment as a linchpin to contraceptive security is becoming increasingly apparent. This brief focuses on the key policy aspects of contraceptive security, and describes how policy interventions are essential to achieving contraceptive security.
    English
    PI_Eng.pdf

  • User fees are gaining widespread use in government health programs as a means of alleviating pressure on constrained budgets as demand for services increases. Concerns that fees reduce access to services among the poor have led to the promotion of fee exemption mechanisms in order to protect those unable to pay for services. The exemptions, however, may not effectively ensure access among the poor because (1) informal fees and other costs associated with seeking and receiving services are not alleviated by most exemption mechanisms and (2) exemption mechanisms are poorly implemented. The low proportion of formal fees to total costs to the consumer and the unpredictable nature of informal fees and other costs of access may actually work against formal fee exemption mechanisms. Even though little is known about how well fee and waiver mechanisms function for maternal health services, it is important to understand whether exemption mechanisms alone hold promise for protecting access for the poor or whether the mechanisms need to be supplemented with other strategies. This study was conducted simultaneously in five countries: Egypt, India (Uttaranchal), Kenya, Peru, and Vietnam. The objectives were to survey actual costs to consumers for antenatal and delivery care; survey current fee and waiver mechanisms; assess the degree to which these mechanisms function; assess the degree to which informal costs to consumers constitute a barrier to service; and review current policies and practices regarding the setting of fees and the collection, retention, and use of revenue.
    English
    WPS16.pdf

  • Following the Platform of Action set forth at the 1994 ICPD in Cairo, nearly all countries place at least some policy emphasis on preventing and treating reproductive health problems. However, the necessary resources, both domestic and international, continue to be scarce. Nowhere in the developing world do reproductive health programs reach all the persons who would benefit. This means that policymakers and program managers must set priorities. This policy brief describes how to set priorities, various models and techniques available to set priorities and how priority setting works in practice.
    Spanish
    PI2Spanish.pdf

  • Following the Platform of Action set forth at the 1994 ICPD in Cairo, nearly all countries place at least some policy emphasis on preventing and treating reproductive health problems. However, the necessary resources, both domestic and international, continue to be scarce. Nowhere in the developing world do reproductive health programs reach all the persons who would benefit. This means that policymakers and program managers must set priorities. This policy brief describes how to set priorities, various models and techniques available to set priorities and how priority setting works in practice.
    French
    PI2French.pdf

  • Following the Platform of Action set forth at the 1994 ICPD in Cairo, nearly all countries place at least some policy emphasis on preventing and treating reproductive health problems. However, the necessary resources, both domestic and international, continue to be scarce. Nowhere in the developing world do reproductive health programs reach all the persons who would benefit. This means that policymakers and program managers must set priorities. This policy brief describes various models and techniques available to set priorities and how priority setting works in practice.
    English
    PI2English.pdf

  • In the effort to develop dynamic national family planning service systems, USAID has supported a sustained set of initiatives to strengthen private sector service delivery. Many of these, like the SOMARC, Enterprise, PROFIT, and Initiatives projects, have focused primarily on the operational side of program expansion (e.g., training private providers, helping clinic managers develop business and financial plans, improving management efficiency, and marketing products and services). This paper looks at how activities in the policy domain often determine the success or failure of efforts to develop private sector services. This paper examines lessons learned in USAID's OPTIONS and POLICY projects, both of which have worked extensively in developing countries to foster private sector involvement in family planning and reproductive health care. It presents lessons learned during implementation of these activities and emphasizes ways to strengthen the policy climate and plan for service expansion. Following a general discussion of lessons learned, the paper includes examples from 11 countries that describe efforts to remove impediments to private sector participation and effective health care financing. The issues range from taxation of imported commodities in the Philippines to divestiture of contraceptive brands in Jamaica to market segmentation in Egypt. In sum, the country examples illustrate the steps governments can take to ensure adequate financing of their programs, use their resources efficiently, and tap the extensive resources of the private sector. Summary of Lessons Learned: • Governments should ensure that sufficient resources are available for services from both public and private sector sources. • Government subsidies should be targeted to appropriate clientele. • Efforts to increase private sector participation in family planning service delivery should begin with the public sector. • Many public sector clients can afford to pay for needed services either in part or in full. • Legal and regulatory barriers can impede the involvement/performance of the private sector. • Governments have a fundamental role in regulating the quality of private sector health services; however, many governments lack experience in regulating the private sector. • The private sector is often able and willing to work with the public sector as a partner. • Donors and cooperating agencies need to communicate and collaborate to ensure synergy of efforts in the field.
    English
    wps-02.pdf

  • Global demand for family planning services continues to increase rapidly. By 2015, the number of women using modern contraceptives is expected to nearly double (Ross and Bulatao, 2001). This dramatic growth is due in part to an increase in the number of women of reproductive age. It also stems from the fact that national family planning programs are doing a better job of both reaching out to women in need of family planning products and removing barriers to family planning services. Demand for condoms is rising even faster as a “dual-use” product, protecting against unwanted pregnancies as well as against sexually transmitted infections (STI), including HIV. New challenges for family planning programs have arisen from their success. In many family planning programs operated by the public sector, resources are falling short of growth in demand for services. At the same time, individuals with unmet need for family planning services are increasingly concentrated among hard-to-reach groups. Moreover, as low-cost public services come to dominate the family planning market, they compete with and crowd out the private sector. This brief explores one potential solution—targeting—to meet these challenges, alleviating barriers to the expansion and use of family planning services.
    Spanish
    PF3_Sp.pdf

  • Global demand for family planning services continues to increase rapidly. By 2015, the number of women using modern contraceptives is expected to nearly double (Ross and Bulatao, 2001). This dramatic growth is due in part to an increase in the number of women of reproductive age. It also stems from the fact that national family planning programs are doing a better job of both reaching out to women in need of family planning products and removing barriers to family planning services. Demand for condoms is rising even faster as a “dual-use” product, protecting against unwanted pregnancies as well as against sexually transmitted infections (STI), including HIV. New challenges for family planning programs have arisen from their success. In many family planning programs operated by the public sector, resources are falling short of growth in demand for services. At the same time, individuals with unmet need for family planning services are increasingly concentrated among hard-to-reach groups. Moreover, as low-cost public services come to dominate the family planning market, they compete with and crowd out the private sector. This brief explores one potential solution—targeting—to meet these challenges, alleviating barriers to the expansion and use of family planning services.
    French
    PF3_Fr.pdf

  • Global demand for family planning services continues to increase rapidly. By 2015, the number of women using modern contraceptives is expected to nearly double (Ross and Bulatao, 2001). This dramatic growth is due in part to an increase in the number of women of reproductive age. It also stems from the fact that national family planning programs are doing a better job of both reaching out to women in need of family planning products and removing barriers to family planning services. Demand for condoms is rising even faster as a “dual-use” product, protecting against unwanted pregnancies as well as against sexually transmitted infections (STI), including HIV. New challenges for family planning programs have arisen from their success. In many family planning programs operated by the public sector, resources are falling short of growth in demand for services. At the same time, individuals with unmet need for family planning services are increasingly concentrated among hard-to-reach groups. Moreover, as low-cost public services come to dominate the family planning market, they compete with and crowd out the private sector. This brief explores one potential solution—targeting—to meet these challenges, alleviating barriers to the expansion and use of family planning services.
    English
    PF3_Eng.pdf

  • The 1994 ICPD expanded the population agenda far beyond family planning. Reproductive health, and the preventive and curative services that could assure it in developing countries, became a key objective accepted by the more than 180 signatory governments. Left unclear were the cost of this expansion and the source of funds to finance it. To fill that cost-estimation gap, the authors reviewed 160 publications issued between 1970 and June 1997, most of them about the time of the Cairo conference. The studies highlighted in this paper offer some quantitative data on the costs of reproductive health services identified as part of the Cairo agenda. In this review, cost data are reported for eight categories of reproductive health interventions: family planning, safe motherhood programs, maternal/infant nutrition and immunizations, obstetric care, abortion/postabortion care, STI/HIV/AIDS, reproductive cancers, and miscellaneous gynecology. The review of family planning cost data is treated differently from other reproductive health interventions. For the seven non-family-planning reproductive health elements, there were about 75 examples (29 studies) of unit cost data. We found only 17 instances of cost-effectiveness estimates (i.e., quantitative relations established between costs and health outcomes) in 15 studies. Furthermore, there were only six studies that referred to inter-disease measures of health outcomes, such as disability-adjusted life-years (DALYs), producing 16 cost-effectiveness estimates. This literature review identifies the gaps in cost information regarding potential reproductive health interventions within the individual reproductive health elements; within geographic regions; and by costing methods. First, about one-half of the expected reproductive health (mostly clinical) services have been costed in at least one setting. Second, only four countries—Bolivia, Ecuador, Mexico, and Zimbabwe—have cost information for more than two services. Third, there is considerable variability in the costing methods applied. Some of the reviewed studies do not clearly report the method used and the assumptions made in calculating the cost results. Nor do they provide all the necessary data to make recalculation of the results possible. Even given valid and replicable measurement, the cost-estimates as presented are generally not comparable because of the lack of a common denominator. This review recommends that "filling the gaps" should be based on local information needs, and that issues of quality, access, and integrated service delivery require closer attention. In addition, the ongoing debate about existing measures of health outcomes suggests that alternative methods for comparing health interventions merit attention. Finally, collecting the cost information available in developing countries (i.e., not in the international literature) would be useful both to local decision makers and others involved in setting priorities and allocating resources for health services.
    English
    wps-03.pdf

  • Private sector involvement is crucial not only in helping respond to growing market demand but also in expanding consumer choices and ensuring equity in the contraceptive market. Evidence from many countries shows that the nonpoor benefit disproportionately from free and subsidized public sector services and commodities (Winfrey et al., 2000). A recent analysis of 10 donor-dependent countries reveals that 45 percent of pills and 56 percent of condoms supplied, respectively, by the public sector and social marketing initiatives went to those who could otherwise afford to pay for them (Sine, 2002). Redirecting wealthier/middle-income clients to the private sector will free up scarce donor and public resources for those most vulnerable and in need. A recent market segmentation study in the Philippines shows that shifting middle- and high-income users of government services to the private sector would reduce the burden on the public sector by more than 40 percent (Alano et al., 2002). It is important to recognize that more than one-third of all family planning users in the developing world already obtain contraceptives from the private sector (Rosen and Conly, 1999). In countries such as Cameroon, Colombia, the Dominican Republic, Ghana, and Jordan, more than 60 percent of users obtain their contraceptives from private rather than public sources (Ross et al., 1999). Given that the private sector in many countries is already a major player in the contraceptive market, any feasible contraceptive security plan needs to take into consideration the private sector’s current and potential role. This policy brief provides an overview of processes, strategies, and tools that developing countries can adopt to foster complementary public/private sector roles that enhance the private sector’s contribution to contraceptive security. Specifically, the brief examines the roles of the public and private sectors in the provision of contraceptives and condoms; and describes strategies/mechanisms used at both the policy and operational levels to mobilize the private sector.
    English
    PF4_Eng.pdf

  • Private sector involvement is critical not only in helping respond to growing market demand but also in expanding consumer choices and ensuring equity in the contraceptive market. Evidence from many countries shows that the nonpoor benefit disproportionately from free and subsidized public sector services and commodities (Winfrey et al., 2000). A recent analysis of 10 donor-dependent countries reveals that 45 percent of pills and 56 percent of condoms supplied, respectively, by the public sector and social marketing initiatives went to those who could otherwise afford to pay for them (Sine, 2002). Redirecting wealthier/middle-income clients to the private sector will free up scarce donor and public resources for those most vulnerable and in need. A recent market segmentation study in the Philippines shows that shifting middle- and high-income users of government services to the private sector would reduce the burden on the public sector by more than 40 percent (Alano et al., 2002). It is important to recognize that more than one-third of all family planning users in the developing world already obtain contraceptives from the private sector (Rosen and Conly, 1999). In countries such as Cameroon, Colombia, the Dominican Republic, Ghana, and Jordan, more than 60 percent of users obtain their contraceptives from private rather than public sources (Ross et al., 1999). Given that the private sector in many countries is already a major player in the contraceptive market, any feasible contraceptive security plan needs to take into consideration the private sector’s current and potential role. This policy brief provides an overview of processes, strategies, and tools that developing countries can adopt to foster complementary public/private sector roles that enhance the private sector’s contribution to contraceptive security. Specifically, the brief examines the roles of the public and private sectors in the provision of contraceptives and condoms; and describes strategies/mechanisms used at both the policy and operational levels to mobilize the private sector.
    Spanish
    PF4_Sp.pdf

  • Private sector involvement is critical not only in helping respond to growing market demand but also in expanding consumer choices and ensuring equity in the contraceptive market. Evidence from many countries shows that the nonpoor benefit disproportionately from free and subsidized public sector services and commodities (Winfrey et al., 2000). A recent analysis of 10 donor-dependent countries reveals that 45 percent of pills and 56 percent of condoms supplied, respectively, by the public sector and social marketing initiatives went to those who could otherwise afford to pay for them (Sine, 2002). Redirecting wealthier/middle-income clients to the private sector will free up scarce donor and public resources for those most vulnerable and in need. A recent market segmentation study in the Philippines shows that shifting middle- and high-income users of government services to the private sector would reduce the burden on the public sector by more than 40 percent (Alano et al., 2002). It is important to recognize that more than one-third of all family planning users in the developing world already obtain contraceptives from the private sector (Rosen and Conly, 1999). In countries such as Cameroon, Colombia, the Dominican Republic, Ghana, and Jordan, more than 60 percent of users obtain their contraceptives from private rather than public sources (Ross et al., 1999). Given that the private sector in many countries is already a major player in the contraceptive market, any feasible contraceptive security plan needs to take into consideration the private sector’s current and potential role. This policy brief provides an overview of processes, strategies, and tools that developing countries can adopt to foster complementary public/private sector roles that enhance the private sector’s contribution to contraceptive security. Specifically, the brief examines the roles of the public and private sectors in the provision of contraceptives and condoms; and describes strategies/mechanisms used at both the policy and operational levels to mobilize the private sector.
    French
    PF4_Fr.pdf

  • As countries try to allocate limited public sector funds for family planning effectively and efficiently, there is increasing interest in understanding and measuring clients' ability to pay for services. If public funds are not sufficient to serve the entire population, they should be targeted to users who are less able to pay. Ideally, women with some ability to pay for health care services should use the private sector, at least for less costly contraceptive methods. This paper presents a methodology for describing the extent to which government subsidies are efficiently applied, that is, to users who could not otherwise afford their contraceptive methods. It examines national family planning markets that include both government and commercial providers and in which government resources are not sufficient to provide universal family planning coverage. Using Demographic and Health Surveys (DHS) data from 11 countries, the analysis shows that the commercial sector market share is higher for less expensive contraceptive methods and that women who make use of private sector maternal and child health care services are more likely to use commercial outlets for contraception. Distortions in this general pattern emerge in countries that over-subsidize certain contraceptive methods, particularly oral contraceptives, to the detriment of the commercial sector. Findings from this analysis can provide insights for further exploration of potential problems such as untargeted government subsidies for less expensive methods or lack of access for clinical methods.
    English
    wps-04.pdf

  • The need to meet the family planning needs of men and women, coupled with dwindling donor resources, is forcing family planning programs worldwide to confront increasingly difficult financial challenges. One option for expanding the resource base for family planning and reproductive health services in developing countries is to promote the growth of the commercial family planning sector. Using DHS data for 45 countries, this paper demonstrates that (1) the commercial sector plays an important role in national family planning markets, even in countries where contraceptive prevalence is low; and (2) the commercial family planning sector does not always develop coincidentally as prevalence grows or as programs mature. If the commercial sector does not necessarily gain market share as prevalence grows, what factors account for differences in commercial market shares across countries? This paper examines three sets of factors to explain variations in commercial market share across countries: • Microeconomic or household factors. Characteristics of individuals, such as ability to pay or knowledge of contraception, may make them more likely to use the commercial sector. • Macroeconomic or business climate factors. Characteristics of a country and its economy may lead to a larger commercial market share for contraceptive services and commodities. • Programmatic factors. Characteristics of a family planning program, such as government support and method mix, may lead to a larger commercial market share. The commercial market share for family planning is related to many factors, which can be grouped in two categories: external factors, over which there is no control, such as per capita income and the level of urbanization, but which can be exploited or understood as a program constraint; and programmatic factors, which are under the direct or indirect control of the program, such as public sector pricing or program effort. The cross-national analysis shows that broad-based purchasing power, improved knowledge of reproductive health, critical densities of population, and appropriate public policy are each associated with relatively strong commercial sectors. This paper recommends that public health policymakers take steps to integrate the commercial sector into their programs by developing economic and policy environments supportive of its expansion. In many countries, family planning has been provided as if it were a public good. Large public programs were designed to expand service delivery in public sector facilities, while limited attention was paid to growth of the commercial sector, likely assuming commercial sector share would grow as a consequence of growth in general public interest in family planning. This study identifies factors for which key policy support may be able to generate increased use of the commercial sector for family planning.
    English
    wps-06.pdf

  • El objeto de este breve informe es ayudar a los gobiernos nacionales y subnacionales y directores de programas para que trabajen en forma conjunta para alcanzar sus objetivos de la DAIA. Aún cuando la autoridad y la responsabilidad se transfieran a niveles inferiores de gobierno, una iniciativa de la DAIA efectiva requerirá el liderazgo, compromiso y coordinación del gobierno central. Este breve informe incluye cinco temas que se deberian tratar al intentar de lograr la disponibilidad asegurada de insumos anticonceptivos en niveles inferiores de gobierno: (1) política; (2) planificación estratégica; (3) finanzas; (4) logística, adquisición y administración de recursos humanos; y (5) participación comunitaria. En cada tema, el informe propone estrategias para la capitalización de oportunidades al trabajar en un entorno descentralizado al mismo tiempo que se enfrentan los desafíos relacionados. Asimismo, se incluyen ejemplos de los países que han progresado con respecto a la disponibilidad asegurada de insumos anticonceptivos en entornos descentralizados.
    Spanish
    PF6_Spanish.pdf

  • Ce résumé est un guide ayant pour but d’aider les gouvernements nationaux et sous-nationaux2 et les responsables des programmes à travailler ensemble pour atteindre les buts de la SC de leur pays.Même lorsque les pouvoirs et les responsabilités sont délégués au niveau local, une initiative réussie de SC n’en demande pas moins la direction, l’engagement et la coordination du gouvernement central. Ce communiqué est organisé en cinq domaines d’activités essentielles dans cette quête vers la sécurité contraceptive aux niveaux inférieurs du gouvernement: 1) politiques, 2)planification stratégique, 3) financement, 4) logistique, achat et gestion des ressources humaines, et 5) participation communautaire. Pour chaque domaine, le communiqué propose des stratégies pour tirer profit des possibilités dont s’accompagne la décentralisation tout en cherchant à surmonter les obstacles et relever les défis qui se présentent. Des exemples sont également présentés de pays qui ont réussi à progresser vers la sécurité contraceptive dans un milieu décentralisé.
    French
    PF6_French.pdf

  • This brief is intended to help national and subnational governments and program managers to work together to achieve their countries' CS goals. Even when authority and responsibility are transferred to lower levels of government, a successful CS initiative still requires the central government's leadership, commitment, and coordination. This brief is organized into five areas that focus on issues to be addressed while aiming to achieve contraceptive security at lower levels of government: (1) policy; (2) strategic planning; (3) finance; (4) logistics, procurement, and management of human resources; and (5) community participation. In each area, the brief proposes strategies for capitalizing on the opportunities for working in a decentralized setting while addressing the associated challenges.
    English
    PF6_English.pdf

  • The purpose of this paper is to familiarize policymakers with market segmentation analysis and its role in supporting more efficient and effective resource use. Specifically, the paper summarizes how market segmentation analysis helped initiate public/private dialogue to guide resource allocation decisions in four countries: Turkey, India, Morocco, and Brazil. In Morocco and Turkey, market segmentation analysis results were central to public/private reproductive health finance discussions and guided public sector decisions to concentrate resources more heavily on the most vulnerable and needy population groups. In Brazil and India, market segmentation analysis findings helped guide reproductive health finance discussions between donors and the private sector that led ultimately to private sector expansion.
    English
    wps-07.pdf

  • This brief presents a study of local elected leaders and the planning process for health at the decentralized level. The objectives of the study were to understand socio-demographic characteristics of the local elected leaders and their knowledge and attitudes about reproductive health; what local elected leaders and health technicians know of their own and each others’ roles in the context of decentralization; how health planning is carried out since decentralization; and the role civil society representatives play in the health planning process.
    English
    pm-03.pdf

  • The countries that agreed to the ICPD Programme of Action face a tremendous challenge in its implementation. Additional funds will help; however, in the face of scarce resources, countries also need to find ways to make existing resources go further. As countries strive to implement the reproductive health initiatives to which they agreed at Cairo, many are also undertaking health sector reform, a set of sweeping initiatives that affects all components of health, including decentralizing the management and provision of care, concentrating resources on cost-effective interventions (often through minimum or essential services packages), improving the performance of providers, expanding the role of the private sector, shifting the function of central ministries of health and improving their regulatory capacity, broadening financing, and shifting donor financing to support sector-wide health programs rather than vertical programs, such as family planning. Reproductive health initiatives and health sector reform share the goals of equity and quality. The question of interest to those working in reproductive health is whether the reform measures aimed at increasing efficiency will be sufficient to ensure universal access to high-quality reproductive health services by 2015, as outlined in the ICPD Programme of Action. This paper reviews evidence that addresses the question of the complementarity of reproductive health initiatives and health sector reform. Decentralization: While decentralization is sound in theory, it is not easy to implement in practice and may take as long as 10 to 20 years. Thus, the effect of decentralization on health care, including reproductive health care, is unclear. While some experiences with decentralization have been favorable, central governments have often transferred responsibility to local administrative levels without planning properly for implementation and without allocating adequate resources. In fact, existing human and technical resources are often underdeveloped at the local level. Decentralization may not promote equity, at least not in the short term. Local areas may have variable access to resources; thus, residents of poorer areas may receive less care than residents of wealthier areas. The need is clear for further analysis of health and equity outcomes related to decentralized management and provision of reproductive health. Integration: The ICPD promoted integration of services to ensure greater responsiveness to meeting clients' reproductive health needs. In the context of health sector reform, integration is more broadly defined; to reformers, integration of reproductive health as envisioned at the ICPD is just another vertical program. Integration is best suited for services targeted to a similar clientele, for example, family planning linked with postpartum services. A few examples of successful integration of reproductive health services can be found, most notably in programs of nongovernmental organizations (NGOs). Since ICPD, family planning and STD/HIV/AIDS are the two main reproductive health components that have undergone integration, particularly in Africa. However, many family planning clinics are not equipped to offer services for the detection and treatment of sexually transmitted diseases (STDs), and staff members are not properly trained. Essential Services Packages: Under health sector reform, more and more countries are implementing minimum or essential care packages of cost-effective interventions designed to reduce the burden of disease among the population. Essential services packages developed to date have generally included reproductive health components. Making Better Use of Existing Program Capacity: More efficient, high-quality care could attract additional clients for reproductive health services and thus save money. Without improvements in quality, however, utilization of reproductive health services may suffer, particularly if cost-recovery schemes are introduced. Further evaluation is required to determine whether improvements in quality (as distinct from the availability of drugs) will lead to increased demand for services, which, in turn, can translate into increased revenue. Evaluation of operational policies, including those affecting the provision of reproductive health services, often uncovers procedures that involve unnecessary and burdensome steps. Streamlining operational policies could make services more efficient. In addition, medical and other service barriers often inflate the cost of services. Many countries are updating their service delivery guidelines to reflect the recent international consensus on more streamlined but medically safe protocols for contraceptive and reproductive care. Role of Public and Private Providers: Health sector reform promotes separation of the financing of services from the provision of services. In theory, governments should delegate service provision to organizations closer to communities, including local governments and the private sector, if one exists. Family planning programs have had some success in encouraging wider participation of the private and commercial sectors in service provision. Ministries of health should focus on sector management by developing legal and regulatory frameworks that direct the actions of both local governments and private providers and promote preventive care. Many countries regulate the behavior of private health providers and the distribution of drugs; enforcement of regulations, however, is another matter. If governments remain in the business of service delivery, including reproductive health care, they should ensure a "level playing field" by providing similar subsidies and incentives to the private sector and NGOs as they provide for public sector services. Broadening Health Care Financing: Results of initiatives in cost recovery, particularly the use of user fees, have been mixed, even for family planning. Some studies show that small increases in user fees do not affect health care utilization rates, particularly if quality of care (and drug availability) is improved. Other studies, however, have shown that user fees have adversely affected women and children, forcing them to forgo needed health care. Some countries are seeking to promote equity in health care through prepayment schemes and risk-sharing mechanisms. Sector-Wide Assistance Programs: Donors and international financial institutions are testing various sector-wide assistance programs (SWAPs) to support health sector reform, in order to move from a narrow project focus to a sectoral focus and to help establish joint instead of donor-driven priorities. As with other aspects of health sector reform, SWAPs are not easy to implement and tend to function best in politically and economically stable environments, conditions absent in many developing countries. Discussion: Health sector reform is complex and to be successful, requires time, political commitment, an initial investment of resources, and a favorable policy environment. Without proper planning and implementation, reform is unlikely to be successful and may even waste resources. Within the context of health sector reform, several challenges exist in the design and implementation of reproductive health programs, including setting priorities, costing integrated services, determining new approaches for financing and providing services, and redefining the roles of central maternal and child health (MCH) and family planning divisions. With few current examples of successful reform positively affecting reproductive health programs, it is too soon to say whether health sector reform will promote efficient, effective, and equitable reproductive health care delivery, or whether reforms will result in the neglect of reproductive health in the face of other pressing health care issues. It is imperative that reform processes, including the reform of reproductive health services, be monitored, documented, and evaluated. Equity and access issues often get lost in the details of implementing programs to increase efficiency. Those involved in reproductive health programs, including client advocates at the local, national, and international levels, need to be "at the table" when decisions on reforms are made. In addition to promoting more efficient programs and services for reproductive health, those involved in decision making must ensure that equity and access to high-quality services are primary goals of reform programs if the ICPD Programme of Action is to be achieved.
    English
    op-04.pdf

  • Given the scarcity of resources available to implement the ICPD Programme of Action, this paper assesses effective interventions and their cost for three main components of reproductive health: family planning, safe motherhood, and STD/HIV/AIDS prevention and treatment. The paper also suggests some of the economic criteria governments can use to determine the role of the public sector in providing and/or financing reproductive health services. Family Planning Ensuring that individuals have access to a range of family planning methods and related information can help reduce unwanted pregnancy and thus maternal mortality. Promotion of condoms can help prevent the spread of sexually transmitted diseases (STDs). Family planning is most effectively provided through a range of channels, including clinics, community-based distribution, social marketing programs, and the private sector. Comparing the costs of service delivery approaches is problematic in that each channel tends to serve different clients. Contraceptive methods involve a range of costs; IUDs and sterilization tend to be the least expensive methods per couple-year of protection (CYP), although both have high "up-front" costs. The pill tends to be the least expensive supply method. Family planning, however, is most effective if a range of methods is available so that clients can select a method that matches their needs. One solution to the scarcity of resources may be for governments to subsidize all contraceptive methods for the poor and only lower cost methods for other groups and to require users to pay for the incremental cost of more expensive methods. Safe Motherhood An estimated 40 percent of pregnant women develop complications that require the assistance of a trained provider; 15 percent require medical care to avoid death or disability. Good prenatal care is important; given current screening tools, however, it is not prudent to spend resources on screening as the sole mechanism for predicting women's risk of developing complications. Instead, prenatal care should, among other activities, educate all women about danger signs, possible complications, and where to seek help. Micronutrient supplementation, including vitamin A, iron, folic acid, zinc, and calcium, show promising results in helping to improve pregnancy outcomes and reduce maternal mortality. The most crucial interventions for safe motherhood are to ensure that a health worker with midwifery skills is present at every birth, that transportation is available in case of emergency, and that quality and timely emergency care is available at the referral level. It is not only important that adequate access to emergency care be available but that women, families, and the community have confidence in the referral system and higher levels of care. Communities use emergency obstetric care services that they know to be functioning well. Nearly two-thirds of maternal deaths occur in the postpartum period; therefore, the World Health Organization (WHO) recommends that, if possible, community health workers visit women not attended at birth within 24 hours of delivery and again within three days. In many low-income countries, effective and safe postabortion care can significantly reduce maternal mortality rates by as much as one-fifth. Furthermore, such care can reduce overall health care costs as it is not uncommon for most beds in emergency gynecology wards to be occupied by women suffering from abortion complications, the treatment of which can cost five times the annual per capita health budget. The high cost of postabortion care can be reduced by switching from sharp curettage to manual vacuum aspiration (a safer and less expensive method), establishing referral systems and links with family planning and other reproductive health services, and preventing abortion through family planning. Substantial additional resources may not be required to improve emergency obstetric care. Most of the cost of providing such care is already paid through the maintenance of hospitals, health centers, and health care staff. Instead of creating new medical facilities and hiring new staff, emergency obstetric care can be improved by renovating existing facilities and training staff, including midwives and general practice physicians. STD/HIV/AIDS The best combination of STD/HIV/AIDS activities and services is general information and education, improved health-seeking behavior for STD treatment, wide access to condoms, and STD services with focused attention to core transmitters. WHO advocates the use of the syndromic management approach to managing STDs. This approach has limitations, however. It functions well for men with symptomatic urethral discharge and for women with genital ulcer disease, but not for women with vaginal discharge. The women who receive medical attention are often overtreated with drugs. More work is needed to develop cost-effective approaches to screening and treating reproductive tract infections. There are promising treatments to prevent mother-to-child transmission of HIV. Nevirapine has recently been shown to reduce transmission dramatically from mothers to infants at a fraction of the cost of treatment with Zidovudine (AZT) (US$4 compared with US$100), although universal HIV screening is not part of prenatal care in many developing countries and would raise the cost of prevention. Maternal syphilis diagnosis and treatment is also cost-effective. Blood screening for HIV/AIDS in high-prevalence areas has proven cost-effective. HAART (highly active antiretroviral therapy) for HIV/AIDS-infected individuals presently costs about US$8,000 to US$10,000 per person. Governments and donors will not be able to cover the cost of such treatment. In many developing countries, less than 1 percent of people living with AIDS will ever be treated, even if all reproductive health donor funds were allocated for that purpose. Information, Education, and Communication (IEC) and Behavior Change Communication (BCC) IEC and BCC have the potential to be highly effective in helping promote good reproductive health. Properly executed, IEC and BCC can encourage individuals to take preventive measures to protect their reproductive health as well as seek appropriate reproductive health services. IEC and BCC activities warrant government support if they convey appropriate messages to target audiences and are associated with services already in place. In the absence of these conditions, IEC and BCC activities are not only ineffective but also give rise to unsatisfied demand. Some Economic Criteria for Governments to Use in Deciding Whether They Will Provide and/or Fund Services From an economic standpoint, governments should intervene in reproductive health care if intervention increases efficiency and productivity in the health sector. Governments should redistribute resources to ensure equitable access to reproductive health services by all individuals. Governments should subsidize activities with large external or social benefits that go beyond the individual. Governments must regulate all sectors to ensure high-quality care and equitable access to reproductive health services. Government services are rarely more efficient than private sector services. Governments should encourage development of the private sector and provide subsidies to the poor so that they can afford needed services. To encourage development of the private sector, governments should provide similar subsidies to all providers (rather than only to government providers) either directly or through income transfers to individuals so that consumers can choose their own provider, thereby spurring competition and, it is hoped, better quality services for all. Governments should not provide subsidies to those able to pay for reproductive health services. Growing evidence suggests that some users, particularly in middle-income countries, can pay for family planning, maternal health, and postabortion care services. After reviewing implementation of the ICPD Programme of Action, the international community has reached consensus that certain basic services should be provided at the primary health care level and subsidized for those who cannot afford to pay for them. In low-income countries, where most individuals are too poor to pay for services, evidence suggests that it would be desirable for governments to subsidize family planning services, prenatal care that includes physical examinations, postpartum provision of family planning information and services, and postabortion services. In addition, skilled attendance at delivery and a functioning referral system and emergency care are essential to reduce maternal mortality. As for STD/HIV/AIDS, resources should be focused on prevention activities such as promotion and distribution of condoms to prevent STDs, STD treatment for high-risk groups, improved health-seeking behavior for STD treatment, and maternal syphilis treatment. Where HIV screening is part of prenatal care, provision of Nevirapine or AZT for infants of HIV-positive mothers may be feasible. While governments should strive to ensure that their citizens have access to reproductive health services as agreed at the ICPD and ICPD+5, policymakers will have to begin with a narrower set of interventions consistent with current resource and capacity levels and decide how to phase in additional services as resources become available. It is clear that a substantial amount of work on costing interventions and services and measuring their effectiveness is necessary before we can say, with greater assurance, what combination of services works at the most reasonable cost. Data collected in one country or service delivery setting may not apply in others, and further research is needed. Still, while the data are not comprehensive or perfect, policymakers and others can use the information at hand to help make difficult decisions, especially on what to provide to low-income clients through public sector facilities or financing.
    English
    op-05.pdf

  • The POLICY Project, in collaboration with the Ministry of Social Affairs, Veterans, and Youth Rehabilitation, and CARE Cambodia, facilitated a two-day workshop on August 23 and 24th, 2004, titled 'Orphans and Vulnerable Children Dialogue Workshop'. Participants included a multi-sector group of representatives from government ministries, NGOs, Civil Society groups, donors, Bhuddist pagodas, people living with HIV/AIDS, and children who have been orphaned due to HIV/AIDS. The purpose of the workshop was to disseminate findings of two research studies that have been conducted by the POLICY Project and CARE, Cambodia, in urban and rural areas of Cambodia; to make program and policy recomendations for improving Cambodia's response to the OVC crisis; and to coordinate with stakeholders from all sectors in order to move forward to address OVC issues at the program and policy levels. This report provided a summary of the activities and results of the workshop. (Hard copy available in English and Khmer)
    English
    CAM_OVC_PolicyDialogue.pdf

  • Other
    UKR_PolBrief_(u).pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Benin.
    English
    BEN_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Burkina Faso.
    English
    BUR_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Cameroon.
    English
    CAM_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Cote d'Ivoire.
    English
    CDI_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995ý2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Cýte dýIvoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Benin.
    English
    unmetneed_ghana.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Guinea.
    English
    GUI_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Mali.
    English
    MALI_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Niger.
    English
    NIG_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Senegal.
    English
    SEN_UnmetNeedFP.pdf

  • The countries of West Africa have some of the highest levels of unmet need for family planning in the world. During the six-year period (1995–2000) following the 1994 International Conference on Population and Development, there were an estimated 12 million unintended pregnancies in the 18 West Africa Regional Program (WARP) countries. Yet family planning programs are currently low on most national agendas and there is no concerted effort to address the expressed need for family planning. To reduce the health and development consequences of unintended fertility in West Africa, policymakers and planners need to study the characteristics of women with a demonstrated unmet need for family planning and use that information to improve policies and programs. This series of briefing papers is designed to contribute to that effort by offering some perspectives on the nature and dimensions of unmet need based on the findings of Demographic and Health Surveys (DHS) in 11 West African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Mali, Niger, Nigeria, Senegal, and Togo. This brief focuses on Togo.
    English
    TOG_UnmetNeedFP.pdf

  • This paper summarizes findings from over 130 studies of private services provided to improve child health.
    English
    Final_-_WHO_2.pdf

  • In the summer of 2003, USAID's Bureau for Latin America and the Caribbean launched regional initiative to determine how contraceptive security in the LAC region could be more effectively addressed and strengthened in light of the phase-out of contraceptive donations. The initiative, which is being implemented by the POLICY and DELIVER Projects, commenced in July 2003 with a Regional Meeting in Managua, Nicaragua. Seventy representatives from governments, nongovernmental organizations, UNFPA, and USAID from nine Latin American countries came together to discuss and share their country's experiences with donor phase-out and efforts to achieve contraceptive security. The meeting was followed by two-week country assessments in Bolivia, Honduras, Nicaragua, Paraguay, and Peru, which were conducted between September 2003 and May 2004. Each assessment resulted in a full assessment report and an accompanying summary of country-level findings. Findings in each country were also presented to stakeholders at the end of each assessment. A regional report describes the findings at the regional level and makes recommendations for regional contraceptive security initiatives.
    English
    Regional_CS_Eng.pdf

  • This paper provides a background on the financing of health care and identifies and discusses reproductive health policy issues in the context of the social health insurance system in Romania.
    English
    Romania_Lazarescu_HI_paper.pdf

  • The purpose of this study was to provide the Population Development Group with evidence that operational policy barriers result in inefficient resource use in reproductive health care in Ukraine and to recommend solutions. The analysis will serve as the foundations for recommendations that the MOH will make to the Cabinet of Ministers on ways to remove the existing operational policy barriers. The specific objectives of this study were to understand, analyze, and recommend solutions to the following problems: -Inefficiencies at the facility level in the areas of staff time use, bed capacity and use, and availability and use of supplies and equipment; -Infelxibility in allocating funds for health care from local budget and financial decision making at the facility level; -The shadow economy in health care from the client perspective (and its relationship to inefficiencies in financial resource allocation); and -Poor quality of care from the client perspective (and its relationship to inefficiencies in health care facilities).
    English
    UKR_RH_Efficiency.pdf

  • The success of family planning programs, continued growth in the number of women of reproductive age, and the growing response to curb the HIV/AIDS pandemic are increasing demand for contraceptives, including condoms, worldwide. Countries are faced with the challenge of ensuring that this demand can be sustainably met. Financing is not keeping pace, while the problem is also often one of disruptions and vulnerabilities in the systems that need to work well, and work together, to ensure that supplies are available to people. SPARHCS - The Strategic Pathway to Reproductive Health Commodity Security - is a tool to help countries develop and implement strategies to secure essential supplies for family planning and reproductive health programs. SPARHCS is meant to bring together a wide range of stakeholders to initiate at the country level concerted efforts toward the goal of reproductive health commodity security. It is not a roadmap, or a fixed process. SPARHCS can be customized to a country’s specific needs and resources. It can be used for contraceptives alone, for contraceptives and condoms for HIV/STI prevention, or for a still broader set of reproductive health supplies. (French)
    French
    SPARHCS_fre.pdf

  • The success of family planning programs, continued growth in the number of women of reproductive age, and the growing response to curb the HIV/AIDS pandemic are increasing demand for contraceptives, including condoms, worldwide. Countries are faced with the challenge of ensuring that this demand can be sustainably met. Financing is not keeping pace, while the problem is also often one of disruptions and vulnerabilities in the systems that need to work well, and work together, to ensure that supplies are available to people. SPARHCS - The Strategic Pathway to Reproductive Health Commodity Security - is a tool to help countries develop and implement strategies to secure essential supplies for family planning and reproductive health programs. SPARHCS is meant to bring together a wide range of stakeholders to initiate at the country level concerted efforts toward the goal of reproductive health commodity security. It is not a roadmap, or a fixed process. SPARHCS can be customized to a country’s specific needs and resources. It can be used for contraceptives alone, for contraceptives and condoms for HIV/STI prevention, or for a still broader set of reproductive health supplies.
    English
    SPARHCS.pdf

  • The success of family planning programs, continued growth in the number of women of reproductive age, and the growing response to curb the HIV/AIDS pandemic are increasing demand for contraceptives, including condoms, worldwide. Countries are faced with the challenge of ensuring that this demand can be sustainably met. Financing is not keeping pace, while the problem is also often one of disruptions and vulnerabilities in the systems that need to work well, and work together, to ensure that supplies are available to people. SPARHCS - The Strategic Pathway to Reproductive Health Commodity Security - is a tool to help countries develop and implement strategies to secure essential supplies for family planning and reproductive health programs. SPARHCS is meant to bring together a wide range of stakeholders to initiate at the country level concerted efforts toward the goal of reproductive health commodity security. It is not a roadmap, or a fixed process. SPARHCS can be customized to a country’s specific needs and resources. It can be used for contraceptives alone, for contraceptives and condoms for HIV/STI prevention, or for a still broader set of reproductive health supplies. (Spanish)
    Spanish
    SPARHCS_spa.pdf

  • The following document was written by a team of leading economists and social scientists in response to the question, “What is the state of the art in the field of AIDS and economics”. This question was intentionally designed to provide authors with the ability to focus on the issues that they felt were most critical. As a result, each chapter represents a unique perspective on the question at hand.
    English
    SOTAecon.pdf

  • The purpose of this paper is to summarize POLICY’s assistance in Turkey featuring results and lessons learned to date. In addition to this introduction, the paper is organized in three parts representing technical components of POLICY’s work in Turkey: Contraceptive Self-reliance, National Strategies for Women’s Health and Family Planning, and Nongovernmental Organization (NGO) Strengthening and Advocacy. This paper reflects experiences through December 2001 and will be updated at the close of the project in December 2002.
    English
    TURfinal.pdf

  • USAID and its cooperating agencies are studying procurement issues and options for countries that no longer receive USAID and/or international donor support for contraceptive commodities, including Brazil, Chile, Colombia, Costa Rica, and Mexico. This report summarizes the key findings from Costa Rica. This review of Costa Rica's contraceptive procurement practices suggests that the country program has been successful in maintaining a consistent supply of contraceptives from a variety of sectors. The Costa Rican government received its final contraceptive commodity support from international donors more than 12 years ago. In 1992—just before USAID's withdrawal from Costa Rica—contraceptive prevalence was already high at 75 percent. The latest reproductive health survey conducted (1999) showed another increase in prevalence to 80 percent—almost six years after USAID's withdrawal. This report highlights the key factors that were important in procuring sufficient contraceptive commodities to meet the needs of Costa Rican men and women.
    English
    382_1_Procurement_Options_Costa_Rica.pdf

  • USAID and its cooperating agencies are studying procurement issues and options for countries that no longer receive USAID and/or international donor support for contraceptive commodities, including Brazil, Chile, Colombia, Costa Rica, and Mexico. This report summarizes the key findings from Mexico. The review of Mexico's contraceptive procurement practices suggests that almost seven years after the phaseout of USAID support, public health institutions—particularly the Ministry of Health—are still facing some challenges in ensuring the availability of high-quality, affordable contraceptive supplies.
    English
    383_1_Procurement_Options_Mexico_FINAL.pdf

  • This document was written at the request of the Service Delivery Improvement Division as part of its planning process for the next decade. It focuses primarily upon features that concern the provision of services, not upon all aspects of reproductive health programs. The first five sections present the factual background; the final two sections build on those to suggest future program strategies and options.
    English
    WW_ServiceDelivery.pdf