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

FigureFigure4Total donor expenditures for population assistance, by channel, Nepal, 1998-20086000050000Total $US (<strong>in</strong> thous<strong>and</strong>s)40000300002000010000NGOMultilateralBilateral01998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008YearSource: UNFPA F<strong>in</strong>ancial Resource Flows for Population Activities, 2010.been carried out by lead<strong>in</strong>g private organizations<strong>and</strong> some NGOs: Nepal Contraceptive Retails SalesCompany, Population Services <strong>International</strong>, MarieStopes <strong>International</strong> <strong>and</strong> Academy for EducationalDevelopment. In addition, Lomus Pharmaceuticals hasbeen manufactur<strong>in</strong>g three br<strong>and</strong>s of oral contraceptivepills s<strong>in</strong>ce 2009. Lomus provided <strong>the</strong> funds for productdevelopment <strong>and</strong> manufactur<strong>in</strong>g, <strong>and</strong> USAID providedfunds for market<strong>in</strong>g <strong>and</strong> distribution.The cost of contraceptives is a major factor <strong>in</strong> <strong>the</strong> promotionof methods by <strong>the</strong> government <strong>and</strong> private sector. Forexample, <strong>in</strong> comparison with o<strong>the</strong>r methods, implantsare very expensive (<strong>in</strong> <strong>the</strong> public sector: $29 per implantcompared with US$ 0.63 for <strong>in</strong>jectables <strong>and</strong> US$ 0.24for IUDs). Although <strong>the</strong>re is a dem<strong>and</strong> for <strong>the</strong> implant <strong>in</strong>Nepal, <strong>the</strong> supplies of implants are be<strong>in</strong>g reduced due to<strong>the</strong>ir high cost (key stakeholders <strong>in</strong>terviews).Payment for contraceptionIn Nepal, <strong>the</strong> public sector now provides free familyplann<strong>in</strong>g services to anyone, whereas NGOs such as FPAN<strong>and</strong> Marie Stopes <strong>International</strong> charge nom<strong>in</strong>al fees forservices, <strong>and</strong> pharmacies <strong>and</strong> private providers charge <strong>the</strong>sell<strong>in</strong>g price of <strong>the</strong> commodities.Table 16 shows <strong>the</strong> percentage of couples who paid forcontraceptive commodities <strong>in</strong> Nepal, draw<strong>in</strong>g on data from<strong>the</strong> 2006 NDHS. Overall, among <strong>the</strong> contraceptive users,one fifth paid a fee for a contraceptive method. Paymentswere only for female sterilization, male sterilization, pills,<strong>in</strong>jectables <strong>and</strong> condoms. Almost half of <strong>the</strong> users from<strong>the</strong> NGO/private medical sector paid some fee, while 12per cent of those who used <strong>the</strong> public sector paid a fee.Accord<strong>in</strong>g to <strong>the</strong> 2006 NDHS, <strong>in</strong> many cases <strong>the</strong> onlycost for public sector users was a registration fee, whereasprivate sector users had to bear <strong>the</strong> cost of <strong>the</strong> consultancy<strong>and</strong> payment for <strong>the</strong> method, as well as <strong>the</strong> registrationfee. In terms of <strong>in</strong>dividual methods, pills are <strong>the</strong> mostmarketed method (52%), followed by <strong>in</strong>jectables (43%)<strong>and</strong> condoms (23%). For sterilization (both male <strong>and</strong>female), only a small proportion (less than 5%) paid somefee for us<strong>in</strong>g <strong>the</strong> method.ProcurementIn <strong>the</strong> public sector, <strong>the</strong> Logistic Management Divisionis responsible for <strong>the</strong> procurement of contraceptives <strong>and</strong>o<strong>the</strong>r reproductive health <strong>and</strong> essential drug commodities.District-level tra<strong>in</strong><strong>in</strong>g has started <strong>in</strong> some selected districtsus<strong>in</strong>g <strong>the</strong> st<strong>and</strong>ard procurement tra<strong>in</strong><strong>in</strong>g manual.The government follows <strong>the</strong> Procurement Act 2007 whichfurnishes a st<strong>and</strong>ard procedure to issue tenders, evaluatebids <strong>and</strong> monitor supplier performance. Although <strong>the</strong>process is transparent, <strong>the</strong> actual procurement gets delayed,very often due to long bureaucratic processes. Accord<strong>in</strong>g toa key stakeholder, corruption also plays a role <strong>in</strong> delay<strong>in</strong>gprocurement. For example, last year <strong>the</strong>re was a delay <strong>in</strong>procurement, so USAID gave an advance to CRS. The190