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

FigureFigure16Public sector share, most recent source of pills <strong>and</strong> condomsIn 2004, a new adm<strong>in</strong>istrative order was issued entitled“Guidel<strong>in</strong>es on <strong>the</strong> Management of Donated Commoditiesunder <strong>the</strong> Contraceptive Self-Reliance Strategy (CSR)”.Most of <strong>the</strong> order's content was on <strong>the</strong> phase-out scheduleof USAID donations <strong>and</strong> mechanisms for divid<strong>in</strong>g up <strong>the</strong>dim<strong>in</strong>ish<strong>in</strong>g supplies: end of condom donations <strong>in</strong> 2004;phase-out of pills from 10.55 million cycles <strong>in</strong> 2004 tozero <strong>in</strong> 2008; phase-out of <strong>in</strong>jectables from 1.17 millionvials <strong>in</strong> 2004 to zero <strong>in</strong> 2009; <strong>and</strong> <strong>the</strong> eventual phase-outof IUDs.*11 CSR was fundamentally different from <strong>the</strong>Initiative <strong>in</strong> that responsibility for fund<strong>in</strong>g contraceptiveswas assigned to LGUs.CSR rapid assessment 49The first attempt to assess CSR revealed that more than half(67 of 122) of LGUs (75 prov<strong>in</strong>ces, 1 region <strong>and</strong> ARMMrepresent<strong>in</strong>g all its component prov<strong>in</strong>ces <strong>and</strong> 46 cities)procured oral contraceptive pills <strong>in</strong> 2007, with 27 LGUsprocur<strong>in</strong>g at a level higher than or equal to <strong>the</strong> estimatedfull requirement of <strong>the</strong>ir constituents. The rema<strong>in</strong><strong>in</strong>g40 LGUs procured at levels below what were required.These figures, augmented by <strong>the</strong> fact that 64 of <strong>the</strong> total67 LGUs that procured used local budgets to f<strong>in</strong>ance <strong>the</strong>irprocurement of pills, <strong>in</strong>dicated encourag<strong>in</strong>g <strong>in</strong>itial CSRresponse <strong>in</strong>itiatives. There is also some <strong>in</strong>dication that<strong>the</strong>se LGUs plan to ma<strong>in</strong>ta<strong>in</strong> or <strong>in</strong>crease <strong>the</strong>ir currentlevel of pill procurement. However, <strong>the</strong> ability to susta<strong>in</strong><strong>the</strong>se promis<strong>in</strong>g trends <strong>in</strong> <strong>the</strong> longer term rema<strong>in</strong>s to beseen, especially with <strong>the</strong> stark reality that often FP is nota priority for some LGUs <strong>and</strong> it is easily <strong>in</strong>fluenced by <strong>the</strong>personal religious convictions of LGU chiefs or a strongChurch lobby. Moreover, more pert<strong>in</strong>ent local barriersto <strong>in</strong>creas<strong>in</strong>g CPR <strong>in</strong>clude geographic isolation, poverty,contraceptive supply shortcom<strong>in</strong>gs, LGUs without a strongcommitment to procur<strong>in</strong>g <strong>and</strong> allocat<strong>in</strong>g FP commodities,<strong>and</strong> lack of male <strong>in</strong>volvement <strong>in</strong> FP.Fall <strong>in</strong> <strong>the</strong> public sector shareThe 2008 NDHS revealed a disturb<strong>in</strong>g trend that beganto be detected <strong>in</strong> 2003: substantial reductions <strong>in</strong> <strong>the</strong> shareof public outlets as <strong>the</strong> source of condoms <strong>and</strong> pills. Fromhigh levels <strong>in</strong> 1993, <strong>the</strong> public sector share <strong>in</strong> condomshas been fall<strong>in</strong>g cont<strong>in</strong>uously s<strong>in</strong>ce 1998, <strong>the</strong> same wayas pills did s<strong>in</strong>ce 2003 (see Figure 16). It is unsafe toignore <strong>the</strong>se trends as a simple redistribution between <strong>the</strong>private <strong>and</strong> public sectors because <strong>the</strong> country's CPR formodern methods is just half <strong>the</strong> targeted level for 2010<strong>and</strong> growth has been very slow <strong>and</strong> has stopped <strong>in</strong> <strong>the</strong> lastfive years. S<strong>in</strong>ce national condom supplies were stoppedfirst, followed by pills, <strong>and</strong> <strong>the</strong>se actions took place priorto <strong>the</strong> 2008 NDHS, <strong>the</strong> decl<strong>in</strong>e exhibited by <strong>the</strong> two maybe repeated with <strong>the</strong> o<strong>the</strong>r methods that were recentlyphased out, namely <strong>in</strong>jectables <strong>and</strong> IUDs. It is possiblethat prov<strong>in</strong>cial <strong>and</strong> city LGUs cannot adequately forecast,fund, coord<strong>in</strong>ate <strong>and</strong> deliver <strong>the</strong> contraceptive needs ofa grow<strong>in</strong>g population. About 1,500 municipalities havedirect responsibility <strong>and</strong> control over all health centres <strong>and</strong>health posts that provide non-surgical supply methods.Thus, it is also possible that <strong>the</strong> impact of <strong>the</strong> CSR policyon municipal family plann<strong>in</strong>g supplies <strong>and</strong> services has notbeen studied enough.In June 2010, Adm<strong>in</strong>istrative Order 2010-0027 was issuedby <strong>the</strong> outgo<strong>in</strong>g Secretary of Health to replace <strong>the</strong> CSRorder of 2004. The goal was made clearer: availability <strong>and</strong>access to all FP methods <strong>and</strong> RH commodities. Objectiveswere focused towards ensur<strong>in</strong>g RH commodity securityto elim<strong>in</strong>ate unmet needs for FP <strong>and</strong> RH services; freecommodities for poor women; a national procurementsystem; <strong>and</strong> a logistics management <strong>in</strong>formation system to315