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segment <strong>the</strong> target population by specific characteristics;(h) promote use of longer-act<strong>in</strong>g <strong>and</strong> permanent methods;(ix) streng<strong>the</strong>n behavioural change communications; <strong>and</strong>(i) improve commodity security.Need to adopt a client-segmentedapproach to both behavioural changecommunications <strong>and</strong> family plann<strong>in</strong>gservice deliveryIt is clear that <strong>the</strong> “one-size-fits-all” approach has not beenwork<strong>in</strong>g. Hence, <strong>the</strong>re is need to develop a client-segmentedapproach to both behavioural change communications <strong>and</strong>FP service delivery to be able to motivate non-users to useFP; promote <strong>in</strong>creased contraceptive use among marriedadolescents to delay <strong>the</strong>ir first birth; promote contraceptiveuse <strong>in</strong> underserved areas, <strong>in</strong>clud<strong>in</strong>g urban slums; <strong>in</strong>crease<strong>the</strong> use of longer-act<strong>in</strong>g <strong>and</strong> permanent methods; <strong>and</strong>motivate, <strong>and</strong> provide methods of choice to, those withunmet need <strong>and</strong> those who <strong>in</strong>tend to practise FP <strong>in</strong> <strong>the</strong>future.Over two fifths of eligible couples <strong>in</strong> Bangladesh are notpractis<strong>in</strong>g contraception. The priority target groups<strong>in</strong>clude married adolescents; women aged 35 years <strong>and</strong>older; those <strong>in</strong> Sylhet <strong>and</strong> Chittagong divisions; those <strong>in</strong>urban slums; those with an unmet need for contraception,<strong>in</strong>clud<strong>in</strong>g those us<strong>in</strong>g traditional methods; non-users who<strong>in</strong>tend to practise FP <strong>in</strong> <strong>the</strong> future; <strong>and</strong> those who could bemotivated to adopt longer-act<strong>in</strong>g <strong>and</strong> permanent methods.It is, <strong>the</strong>refore, critical that <strong>the</strong> programme undertakeappropriate measures to motivate <strong>the</strong> priority targetgroups to start us<strong>in</strong>g FP by adopt<strong>in</strong>g a client-segmentedapproach to both behavioural change communications<strong>and</strong> FP service delivery. There should be a differentialor segmented approach to both behavioural changecommunications <strong>and</strong> service delivery. Priority should begiven to ensur<strong>in</strong>g that tra<strong>in</strong>ed providers are available tooffer good-quality FP services. Efforts should be made tomotivate men to practise male methods, as well as support<strong>the</strong>ir wives <strong>in</strong> <strong>the</strong> practice of contraception by develop<strong>in</strong>gappropriate behavioural change communication messages<strong>and</strong> campaigns to remove misconceptions about malemethods; orient<strong>in</strong>g <strong>and</strong> tra<strong>in</strong><strong>in</strong>g staff on male <strong>in</strong>volvement<strong>in</strong> RH <strong>and</strong> FP services; <strong>and</strong> provid<strong>in</strong>g services for malesat health centres, <strong>in</strong>clud<strong>in</strong>g mobile satellite cl<strong>in</strong>ics (forexample, see Ashraf et al., 1999). Major emphasis shouldbe given to implement <strong>the</strong> 2006 Adolescent ReproductiveHealth Strategy <strong>and</strong> <strong>the</strong> 2008 National CommunicationStrategy for <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> <strong>and</strong> Reproductive Health,with due emphasis given to: (a) sensitiz<strong>in</strong>g policymakers<strong>and</strong> <strong>the</strong> population as a whole to <strong>the</strong> dangers of <strong>the</strong>grow<strong>in</strong>g population <strong>and</strong> <strong>the</strong> need for smaller family sizes;(b) address<strong>in</strong>g <strong>and</strong> reduc<strong>in</strong>g high-risk pregnancies; (c)conduct<strong>in</strong>g <strong>in</strong>tensive behavioural change communicationcampaigns <strong>in</strong> low-perform<strong>in</strong>g areas, <strong>in</strong>clud<strong>in</strong>g urban slums;(d) motivat<strong>in</strong>g traditional method users to switch to moreeffective methods of contraception; <strong>and</strong> (e) motivat<strong>in</strong>gusers of temporary methods to use more effective methodsof contraception, especially longer-act<strong>in</strong>g <strong>and</strong> permanentmethods among older clients (see also Alaudd<strong>in</strong> et al.,2010).Need to improve access to, <strong>and</strong> <strong>the</strong>quality of, family plann<strong>in</strong>g servicesIn view of <strong>the</strong> high discont<strong>in</strong>uation rate of contraceptiveuse, it is essential to improve <strong>the</strong> access to, <strong>and</strong> qualityof, FP services. By provid<strong>in</strong>g good-quality services, <strong>the</strong>programme can take advantage of satisfied clients <strong>in</strong>addition to fieldworkers <strong>in</strong> order to advocate for FPmethods among non-users. It is also imperative thatcouples have access to good-quality FP services. Effortsshould be made to: (a) ensure that tra<strong>in</strong>ed providers areavailable to offer good-quality FP services; (b) <strong>in</strong>crease <strong>the</strong>number of follow-up visits to improve <strong>the</strong> cont<strong>in</strong>uation<strong>and</strong> effectiveness rates of commodity-based methods; (c)provide better counsel<strong>in</strong>g on side effects; (d) provide anappropriate mix of methods for spac<strong>in</strong>g <strong>and</strong> limit<strong>in</strong>g births;(e) improve delivery of FP as part of post-abortion care;<strong>and</strong> (vi) ensure that <strong>the</strong>re is no stock-out of FP methods.Public-private partnerships should be streng<strong>the</strong>ned totake advantage of <strong>the</strong> exist<strong>in</strong>g private sector networks <strong>in</strong><strong>the</strong> distribution/sales of contraceptives, successful supplycha<strong>in</strong>systems, <strong>and</strong> well-tra<strong>in</strong>ed providers.Need to streng<strong>the</strong>n service deliveryCurrently, exist<strong>in</strong>g health-care facilities are underutilized,<strong>the</strong>re is a lack of adequately tra<strong>in</strong>ed personnel, <strong>and</strong> prioritysegments of <strong>the</strong> population are neglected. To improve <strong>the</strong>current FP programme <strong>and</strong> achieve <strong>the</strong> desired CPR, it iscritical that service delivery be streng<strong>the</strong>ned adequately.Efforts should be made to: (a) maximize <strong>the</strong> use of exist<strong>in</strong>gtra<strong>in</strong>ed personnel, health-care facilities, equipment<strong>and</strong> services for promotion of FP methods, <strong>in</strong>clud<strong>in</strong>glonger-act<strong>in</strong>g <strong>and</strong> permanent methods; (b) give adequateemphasis to various priority segments of <strong>the</strong> population;(c) remove <strong>in</strong>ternal conflicts between <strong>the</strong> medical <strong>and</strong>non-medical personnel with<strong>in</strong> DGFP; <strong>and</strong> (d) ensurebetter coord<strong>in</strong>ation <strong>and</strong> l<strong>in</strong>kages between DGFP <strong>and</strong>DGHS. The latter two measures are critical for revers<strong>in</strong>g<strong>the</strong> decl<strong>in</strong><strong>in</strong>g trend <strong>in</strong> <strong>the</strong> relative share of longer-act<strong>in</strong>g<strong>and</strong> permanent methods, as well as rais<strong>in</strong>g <strong>the</strong> overallCPR <strong>in</strong> <strong>the</strong> country. Also, MOHFW should work <strong>in</strong> closecollaboration with <strong>the</strong> M<strong>in</strong>istry of Local Government, <strong>the</strong>Urban Primary Health Care Project, <strong>the</strong> Bangladesh RuralAdvancement Committee <strong>and</strong> SMC <strong>in</strong> extend<strong>in</strong>g servicedelivery <strong>in</strong> urban slums.118
Effective public-private partnerships should also bestreng<strong>the</strong>ned to assist <strong>the</strong> government <strong>in</strong> its efforts toimprove <strong>the</strong> current FP programme. The private (forprofit) sector can play an important role <strong>in</strong> provid<strong>in</strong>g goodquality<strong>and</strong> accessible FP services at affordable prices, as isevident from <strong>the</strong> role played by SMC. O<strong>the</strong>r private sectororganizations can also be encouraged to sell contraceptivesat affordable prices, <strong>and</strong> <strong>the</strong>reby contribute to public sectorefforts. If necessary, <strong>the</strong> government <strong>and</strong>/or donors shouldfurnish f<strong>in</strong>ancial <strong>and</strong> commodity support to those privatesector organizations as is <strong>the</strong> case with SMC. Currently,<strong>the</strong> role of <strong>the</strong> commercial sector is largely limited to oralpills <strong>and</strong> condoms; however, it is time to encourage privatesector hospitals <strong>and</strong> cl<strong>in</strong>ics to provide <strong>the</strong> population <strong>in</strong><strong>the</strong> middle- <strong>and</strong> higher-<strong>in</strong>come brackets with temporaryas well as longer-act<strong>in</strong>g <strong>and</strong> permanent methods. If serviceproviders from private health-care facilities are providedwith <strong>the</strong> necessary tra<strong>in</strong><strong>in</strong>g on <strong>the</strong> st<strong>and</strong>ard service deliveryprotocols on longer-act<strong>in</strong>g <strong>and</strong> permanent methods, itwill help <strong>the</strong> public sector efforts <strong>in</strong> <strong>in</strong>creas<strong>in</strong>g <strong>the</strong> useof such methods among <strong>the</strong> upper- <strong>and</strong> middle-<strong>in</strong>comegroups. The role of NGOs, which played a pioneer<strong>in</strong>g <strong>and</strong>laudable role <strong>in</strong> <strong>the</strong> past, needs to be redef<strong>in</strong>ed. With only16 per cent of women be<strong>in</strong>g visited by NGO fieldworkers,<strong>and</strong> NGOs account<strong>in</strong>g for only 4-6 per cent of CPR,NGOs need to be repositioned to serve different functionswhich <strong>the</strong> public sector is not adequately equipped to dealwith, such as serv<strong>in</strong>g underserved areas <strong>and</strong> carry<strong>in</strong>g outspecialized tasks, such as tra<strong>in</strong><strong>in</strong>g <strong>and</strong> behavioural changecommunications.Need to improve commodity securityIt is critical that <strong>the</strong> FP programme ensure a consistent<strong>and</strong> un<strong>in</strong>terrupted supply of a broad range of FP methods,as well as product varieties with<strong>in</strong> methods. As previouslynoted, DGFP’s procurement capacity is not yet up to <strong>the</strong>desired level. Therefore, technical procurement capacity <strong>in</strong>MOHFW/DGFP needs to be fur<strong>the</strong>r enhanced. Also, acha<strong>in</strong> of accountability with<strong>in</strong> DGFP needs to be developedfor timely procurement of FP methods. The HPNSSP preappraisalmission recommended that, among o<strong>the</strong>r th<strong>in</strong>gs,<strong>the</strong> most efficient arrangement for manag<strong>in</strong>g procurementfunctions across <strong>the</strong> seven procur<strong>in</strong>g entities should beidentified, <strong>and</strong> a procurement process<strong>in</strong>g plan developedto ensure timely submission of <strong>the</strong> operational plans <strong>and</strong>procurement plans each year (GOB, 2010f ).Ow<strong>in</strong>g to dependence on <strong>the</strong> support of developmentpartners, coord<strong>in</strong>ation among <strong>the</strong> stakeholders concernedis needed <strong>in</strong> order to achieve contraceptive security<strong>in</strong> Bangladesh. Therefore, a coord<strong>in</strong>ation mechanismamong development partners needs to be developed for<strong>the</strong> purpose of jo<strong>in</strong>tly advocat<strong>in</strong>g government leadership<strong>in</strong> develop<strong>in</strong>g <strong>and</strong> implement<strong>in</strong>g policies, practices <strong>and</strong>procedures relat<strong>in</strong>g to <strong>the</strong> timely procurement <strong>and</strong> supplyof contraceptives. For this purpose, DGFP established<strong>the</strong> Logistics Coord<strong>in</strong>ation Forum, which is supposed tomeet quarterly to review consumption, stock, pipel<strong>in</strong>e <strong>and</strong>procurement status; however, this forum has not met on aregular basis <strong>in</strong> <strong>the</strong> past. Hence, it should be ensured thatthis forum meets regularly to take stock of <strong>the</strong> exist<strong>in</strong>gsituation <strong>and</strong> provide remedial measures as necessary.Based on <strong>the</strong> current consumption trends <strong>and</strong> projectedrequirements for contraceptives <strong>in</strong> <strong>the</strong> period 2011-2015,<strong>the</strong> estimated cost of contraceptives for Bangladesh isabout US$ 55.6 million (Tk. 3,836.4 million) <strong>in</strong> 2011,which is projected to <strong>in</strong>crease to US$ 62.6 million (Tk.4,319.4 million) <strong>in</strong> 2015 (GOB, 2010c). To reduce <strong>the</strong>f<strong>in</strong>ancial burden on <strong>the</strong> public sector <strong>and</strong> on developmentpartners, <strong>the</strong> costs of contraceptives should be sharedby all <strong>the</strong> implement<strong>in</strong>g partners <strong>in</strong> <strong>the</strong> programme,<strong>in</strong>clud<strong>in</strong>g NGOs, SMC, <strong>the</strong> private sector <strong>and</strong> <strong>the</strong> endusers, especially those belong<strong>in</strong>g to <strong>the</strong> middle- <strong>and</strong> upper<strong>in</strong>comegroups.Emphasis should also be given to <strong>the</strong> local productionof contraceptives. Currently, <strong>the</strong>re are two condommanufacturers <strong>in</strong> Bangladesh: one <strong>in</strong> <strong>the</strong> private sector(<strong>the</strong> Bangla-German Latex Company Limited) <strong>and</strong> <strong>the</strong>o<strong>the</strong>r <strong>in</strong> <strong>the</strong> public sector, run <strong>and</strong> managed by EssentialDrugs Company Limited. The pharmaceutical companyOrganon Bangladesh is produc<strong>in</strong>g oral pills <strong>in</strong> limitedquantities; <strong>the</strong>se are sold <strong>in</strong> <strong>the</strong> market at a higher pricecompared with <strong>the</strong> products offered by SMC. Preferencefor local manufacturers dur<strong>in</strong>g <strong>the</strong> process of public sectorprocurement would encourage <strong>the</strong> growth of <strong>the</strong> privatesector <strong>in</strong> manufactur<strong>in</strong>g contraceptives <strong>in</strong> Bangladesh.With <strong>the</strong> requirement for contraceptives <strong>in</strong>creas<strong>in</strong>g,<strong>the</strong> country’s warehous<strong>in</strong>g system is likely to experiencea shortage of space. It is <strong>the</strong>refore imperative that anassessment be made of storage needs for all tiers of <strong>the</strong>supply cha<strong>in</strong>, at least for <strong>the</strong> next decade.The need to improve programmeefficiencyThe current FP programme is <strong>in</strong>efficient because of anumber of factors. These <strong>in</strong>clude low staff morale, absenceof career plann<strong>in</strong>g, staff vacancies, <strong>in</strong>adequate tra<strong>in</strong><strong>in</strong>g,staff be<strong>in</strong>g overburdened with various non-FP activities,poor monitor<strong>in</strong>g <strong>and</strong> supervision, lack of leadership <strong>and</strong>management, limited fund<strong>in</strong>g, weak implementationcapacity, <strong>and</strong> non-<strong>in</strong>volvement of <strong>the</strong> o<strong>the</strong>r m<strong>in</strong>istriesconcerned. All <strong>the</strong>se have resulted <strong>in</strong> considerable systemloss.Efforts are <strong>the</strong>refore needed to: (a) address various humanresources issues by giv<strong>in</strong>g top priority to <strong>the</strong> recruitment119
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Family Pla
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ForewordThe Asia <
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Part 1Part 1Asia <
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Ensuring that <str
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of methods for all, in</str
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and undertake <str
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Report on the Regi
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SESSION 1: Changin
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that improving <st
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at a hospital would be offered post
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Bounkoung Phichit, Deputy M
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medicines
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Thus, while knowledge of modern met
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Hon. Mr. Malakai Tabar, Chairman, P
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curricula. If the
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dialogue as well as regional <stron
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BackgroundGlobal development effort
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TableTable1EventNational policyYear
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A third observation is that reporte
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TableTable2Current Contraceptive Pr
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Figure(-1.2), Cook Island</
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FigureTableTable3Trends in<
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Nam. Nearly all economies i
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2008 2009% Bilateral % Multilateral
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family planning wi
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IntroductionFamily
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The advent of the
Page 77 and 78: FigureFigure1Oceania and</s
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Page 96 and 97: The concept of “unmet need” has
Page 98 and 99: TableTable8Percentage of th
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Page 131 and 132: ConclusionThe Bangladesh Fa
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Page 146 and 147: TableTable5Indicators of contracept
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Page 150 and 151: FigureFigure3Contraceptive prevalen
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Page 154 and 155: the north
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Page 158 and 159: TableTable11 Total fertility rate <
Page 160 and 161: End Note1The first camp was success
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Page 166 and 167: Figure1980s and ex
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__________ (2007). Population <stro
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170
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TableTable2What has the</st
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174
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per cent of women reported us<stron
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is provider bias that such methods
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TableTable7skewed distribution of h
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TableTable8TableTable9182
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that of the nation
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TableTable12 7some policies that ex
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The system guides the</stro
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FigureFigure4Total donor expenditur
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FigureFigureagain
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Impact of family plannin</s
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marketing of contr
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United States Agency for In
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200
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acceptable. From an NGO perspective
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FigureThis trend of limited donor f
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Figureto have the
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FigureFigure5Percentage change <str
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FigureFigure6Desire to limit childb
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coordination betwe
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the 1980s
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Policy Management.__________ (n.d.,
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218
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Population Activities (UNFPA) for a
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where family plannin</stron
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Thus an objective assessment of <st
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226
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Figureeconomic growth durin
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TableTable1TableTable2For spac<stro
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eflect a provider bias (e.g., <stro
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The Indonesian delegation was very
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than in ensur<stro
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in-country <strong
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(Ministry of Healt
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242
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244
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FigureTrends and p
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TableTable3Unmet need for contracep
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TableTable5TableTable6TableTable725
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TableTable8TableTable9Malaysia, abo
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previously mentioned is based on fo
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TableTable16births and</str
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FigureFigure3TRF54.5Scatter plots o
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ReferencesAng, Eng Suan (2007). Stu
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Demographic data sheet: population
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population size, with just 336,000
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NuptialityIn Myanmar nuptiality is
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FigureIn Myanmar, birth-spac<strong
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Scope of coverage and</stro
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FigureIn Myanmar, out of six select
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equirements. The Min</stron
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according to <stro
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Adolescent sexual and</stro
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FigureHIV/AIDS. An HIV-positive wom
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National Population PolicyMyanmar i
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Linkages with o<st
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TableTable4Achievements of Myanmar
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monitoring <strong
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Nay Pyi Taw, 26 October 2010.53 Sit
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292
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294
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TableTableA296
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dispense and adm<s
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(1) I am against a
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FigureFigureFigure3Use of modern co
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FigureFigure7Traditional method use
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Figureprojection, and</stro
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Figure 11 summarizes the</s
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correlating <stron
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Figurethe use of c
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FigureFigure15Sexual behaviour <str
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track the distribu
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Figureservices, which should <stron
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FigureFigureFigure18 Population <st
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National Statistics Office, <strong
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TableTable11326
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TableTable19Laws and</stron
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worker and hours w
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334
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336
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includin</
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TableTable1Contraceptive prevalence
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These results suggest that about 70
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2 The (period) TFR is the</
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346
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FigureThe existence of traditional
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Guinea case by <st
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The establishment of provin
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provide family plannin</str
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Figurelegal requirement nor a condi
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FigureTableTable5TableTable6Figure4
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modern method and
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married or in unio
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Figureolder. Both the</stro
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TableTable15The immediate past Nati
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out that the “ne
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Commodity securitySupply cha<strong
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is able to achieve. In Papua New Gu
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Qualitative assessments by a number
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increasin<
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service delivery poin</stro
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Population: Views from Men
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1545-1730Day 2: December 9Session 2
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Day 3, December 10Session 50830-100
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15Mr. Tong Sithen1
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54Ms. Shadiya IbrahimAssistant Repr
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93Mr. Melkie AntonProject OfficerUn
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131Dr. John P. SkibiakDirectorRepro
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International <str
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