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

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

TableTable16TableTable17biddong>inong>g procedures comply with ong>inong>ternational biddong>inong>gprocedures of fundong>inong>g agencies.Although ong>theong>re are delays ong>inong> procurement, ong>theong> qualityassurance ong>inong> procurement is maong>inong>taong>inong>ed by followong>inong>gstong>andong>ards of ong>theong> World Health Organization, pre- ong>andong>post-shipment ong>inong>spections, ong>inong>cludong>inong>g followong>inong>g laboratorytest results.A hybrid “push-pull” system for contraceptive commoditiesbegan ong>inong> Nepal ong>inong> 2004/2005 ong>inong> order to reduce waste ong>andong>contraceptive expiry, ong>andong> to ensure ong>theong> availability of FPcommodities at all service poong>inong>ts of ong>theong> health system. Inthis system, half ong>theong> annual estimated consumption of ahealth facility is dispatched directly to ong>theong> facility ong>andong> ong>theong>remaong>inong>ong>inong>g half is stored at ong>theong> district level for demong>andong>basedsupply. Health facilities use LMIS to forwardong>theong>ir demong>andong>s quarterly to ong>theong> appropriate district store.Meanwhile, regional medical stores maong>inong>taong>inong> “bufferstocks” of 20 key essential drugs to supply district stores asneeded. All health facilities maong>inong>taong>inong> six-month maximumstock levels, with regular quarterly resupply. As of 2008this system was operatong>inong>g ong>inong> 23 of 75 districts ong>andong> seemedto be successful (2008 NFHP).Evaluation of ong>theong> familyplannong>inong>g programme:The ong>Familyong> ong>Plannong>inong>gong> Effort IndexThe ong>Familyong> ong>Plannong>inong>gong> Effort (FPE) Index was developed tomeasure ong>theong> strengths of ong>inong>puts of national family plannong>inong>gefforts. The scores have also been used by major donors ong>andong>agencies to set country priorities, to gauge progress ong>andong> todiagnose programme weaknesses at ong>theong> national level. Theong>inong>dex is based on 120 items which are coded ong>inong> 30 scoresong>inong> four components: (a) policy (8 items); (b) services (13items); (c) evaluation (3 items); ong>andong> (d) method access (6items). Scores are converted to a percentage value, whichranges from 0 to 100. The higher is ong>theong> score, ong>theong> strongerare ong>theong> efforts of ong>theong> family plannong>inong>g programme ong>inong> terms ofpolicy development, providong>inong>g services, regular monitorong>inong>gong>andong> evaluation ong>andong> access to contraceptive methods ong>inong> ong>theong>country ong>inong> question.Drawong>inong>g on ong>theong> FPE Index calculated by ong>theong> FuturesGroup (Ross ong>andong> Smith, 2010), it appears that Nepalmade considerable progress ong>inong> family plannong>inong>g ong>inong> ong>theong> 1980s(see Table 17). The score reached 59 ong>inong> 1989 but declong>inong>edto 51 ong>inong> 1994. Thus, ong>theong> lowest effort was recorded ong>inong> ong>theong>early 1990s. The score agaong>inong> ong>inong>creased to 57 ong>inong> 1999 ong>andong>191

TableTable16TableTable17bidd<str<strong>on</strong>g>in</str<strong>on</strong>g>g procedures comply with <str<strong>on</strong>g>in</str<strong>on</strong>g>ternati<strong>on</strong>al bidd<str<strong>on</strong>g>in</str<strong>on</strong>g>gprocedures of fund<str<strong>on</strong>g>in</str<strong>on</strong>g>g agencies.Although <str<strong>on</strong>g>the</str<strong>on</strong>g>re are delays <str<strong>on</strong>g>in</str<strong>on</strong>g> procurement, <str<strong>on</strong>g>the</str<strong>on</strong>g> qualityassurance <str<strong>on</strong>g>in</str<strong>on</strong>g> procurement is ma<str<strong>on</strong>g>in</str<strong>on</strong>g>ta<str<strong>on</strong>g>in</str<strong>on</strong>g>ed by follow<str<strong>on</strong>g>in</str<strong>on</strong>g>gst<str<strong>on</strong>g>and</str<strong>on</strong>g>ards of <str<strong>on</strong>g>the</str<strong>on</strong>g> World Health Organizati<strong>on</strong>, pre- <str<strong>on</strong>g>and</str<strong>on</strong>g>post-shipment <str<strong>on</strong>g>in</str<strong>on</strong>g>specti<strong>on</strong>s, <str<strong>on</strong>g>in</str<strong>on</strong>g>clud<str<strong>on</strong>g>in</str<strong>on</strong>g>g follow<str<strong>on</strong>g>in</str<strong>on</strong>g>g laboratorytest results.A hybrid “push-pull” system for c<strong>on</strong>traceptive commoditiesbegan <str<strong>on</strong>g>in</str<strong>on</strong>g> Nepal <str<strong>on</strong>g>in</str<strong>on</strong>g> 2004/2005 <str<strong>on</strong>g>in</str<strong>on</strong>g> order to reduce waste <str<strong>on</strong>g>and</str<strong>on</strong>g>c<strong>on</strong>traceptive expiry, <str<strong>on</strong>g>and</str<strong>on</strong>g> to ensure <str<strong>on</strong>g>the</str<strong>on</strong>g> availability of FPcommodities at all service po<str<strong>on</strong>g>in</str<strong>on</strong>g>ts of <str<strong>on</strong>g>the</str<strong>on</strong>g> health system. Inthis system, half <str<strong>on</strong>g>the</str<strong>on</strong>g> annual estimated c<strong>on</strong>sumpti<strong>on</strong> of ahealth facility is dispatched directly to <str<strong>on</strong>g>the</str<strong>on</strong>g> facility <str<strong>on</strong>g>and</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g>rema<str<strong>on</strong>g>in</str<strong>on</strong>g><str<strong>on</strong>g>in</str<strong>on</strong>g>g half is stored at <str<strong>on</strong>g>the</str<strong>on</strong>g> district level for dem<str<strong>on</strong>g>and</str<strong>on</strong>g>basedsupply. Health facilities use LMIS to forward<str<strong>on</strong>g>the</str<strong>on</strong>g>ir dem<str<strong>on</strong>g>and</str<strong>on</strong>g>s quarterly to <str<strong>on</strong>g>the</str<strong>on</strong>g> appropriate district store.Meanwhile, regi<strong>on</strong>al medical stores ma<str<strong>on</strong>g>in</str<strong>on</strong>g>ta<str<strong>on</strong>g>in</str<strong>on</strong>g> “bufferstocks” of 20 key essential drugs to supply district stores asneeded. All health facilities ma<str<strong>on</strong>g>in</str<strong>on</strong>g>ta<str<strong>on</strong>g>in</str<strong>on</strong>g> six-m<strong>on</strong>th maximumstock levels, with regular quarterly resupply. As of 2008this system was operat<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> 23 of 75 districts <str<strong>on</strong>g>and</str<strong>on</strong>g> seemedto be successful (2008 NFHP).Evaluati<strong>on</strong> of <str<strong>on</strong>g>the</str<strong>on</strong>g> familyplann<str<strong>on</strong>g>in</str<strong>on</strong>g>g programme:The <str<strong>on</strong>g>Family</str<strong>on</strong>g> <str<strong>on</strong>g>Plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g</str<strong>on</strong>g> Effort IndexThe <str<strong>on</strong>g>Family</str<strong>on</strong>g> <str<strong>on</strong>g>Plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g</str<strong>on</strong>g> Effort (FPE) Index was developed tomeasure <str<strong>on</strong>g>the</str<strong>on</strong>g> strengths of <str<strong>on</strong>g>in</str<strong>on</strong>g>puts of nati<strong>on</strong>al family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>gefforts. The scores have also been used by major d<strong>on</strong>ors <str<strong>on</strong>g>and</str<strong>on</strong>g>agencies to set country priorities, to gauge progress <str<strong>on</strong>g>and</str<strong>on</strong>g> todiagnose programme weaknesses at <str<strong>on</strong>g>the</str<strong>on</strong>g> nati<strong>on</strong>al level. The<str<strong>on</strong>g>in</str<strong>on</strong>g>dex is based <strong>on</strong> 120 items which are coded <str<strong>on</strong>g>in</str<strong>on</strong>g> 30 scores<str<strong>on</strong>g>in</str<strong>on</strong>g> four comp<strong>on</strong>ents: (a) policy (8 items); (b) services (13items); (c) evaluati<strong>on</strong> (3 items); <str<strong>on</strong>g>and</str<strong>on</strong>g> (d) method access (6items). Scores are c<strong>on</strong>verted to a percentage value, whichranges from 0 to 100. The higher is <str<strong>on</strong>g>the</str<strong>on</strong>g> score, <str<strong>on</strong>g>the</str<strong>on</strong>g> str<strong>on</strong>gerare <str<strong>on</strong>g>the</str<strong>on</strong>g> efforts of <str<strong>on</strong>g>the</str<strong>on</strong>g> family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g programme <str<strong>on</strong>g>in</str<strong>on</strong>g> terms ofpolicy development, provid<str<strong>on</strong>g>in</str<strong>on</strong>g>g services, regular m<strong>on</strong>itor<str<strong>on</strong>g>in</str<strong>on</strong>g>g<str<strong>on</strong>g>and</str<strong>on</strong>g> evaluati<strong>on</strong> <str<strong>on</strong>g>and</str<strong>on</strong>g> access to c<strong>on</strong>traceptive methods <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g>country <str<strong>on</strong>g>in</str<strong>on</strong>g> questi<strong>on</strong>.Draw<str<strong>on</strong>g>in</str<strong>on</strong>g>g <strong>on</strong> <str<strong>on</strong>g>the</str<strong>on</strong>g> FPE Index calculated by <str<strong>on</strong>g>the</str<strong>on</strong>g> FuturesGroup (Ross <str<strong>on</strong>g>and</str<strong>on</strong>g> Smith, 2010), it appears that Nepalmade c<strong>on</strong>siderable progress <str<strong>on</strong>g>in</str<strong>on</strong>g> family plann<str<strong>on</strong>g>in</str<strong>on</strong>g>g <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g> 1980s(see Table 17). The score reached 59 <str<strong>on</strong>g>in</str<strong>on</strong>g> 1989 but decl<str<strong>on</strong>g>in</str<strong>on</strong>g>edto 51 <str<strong>on</strong>g>in</str<strong>on</strong>g> 1994. Thus, <str<strong>on</strong>g>the</str<strong>on</strong>g> lowest effort was recorded <str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>the</str<strong>on</strong>g>early 1990s. The score aga<str<strong>on</strong>g>in</str<strong>on</strong>g> <str<strong>on</strong>g>in</str<strong>on</strong>g>creased to 57 <str<strong>on</strong>g>in</str<strong>on</strong>g> 1999 <str<strong>on</strong>g>and</str<strong>on</strong>g>191

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