Family Planning in Asia and the Pacific - International Council on ...

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