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

Coalition, seek to ensure that contraceptive security isenjoyed by every person, <strong>in</strong> that s/he is able to choose,obta<strong>in</strong> <strong>and</strong> use high-quality, affordable contraceptives“whenever s/he needs <strong>the</strong>m”. The contraceptive security<strong>in</strong>dex (CSI) was constructed at <strong>the</strong> country level to raiseawareness, advocate, prioritize <strong>and</strong> monitor progress. CSIhas been used <strong>in</strong> 2003, 2006 <strong>and</strong> 2009 for more than60 develop<strong>in</strong>g countries (Aronovich et al., 2010), which<strong>in</strong>cluded a few <strong>Asia</strong>n countries but no <strong>Pacific</strong> ones.The <strong>in</strong>dex has five components: supply cha<strong>in</strong> (logistics),f<strong>in</strong>ance, health <strong>and</strong> social environment, access, <strong>and</strong>utilization; for <strong>the</strong>se <strong>the</strong>re are 17 <strong>in</strong>dicators. Table 4presents 6 of <strong>the</strong> 17 <strong>in</strong>dicators which were selected to show<strong>the</strong> strength of <strong>the</strong> logistics, forecast<strong>in</strong>g <strong>and</strong> procurementsystems, public sector target<strong>in</strong>g <strong>and</strong> contraceptive policy.The total score of <strong>the</strong>se 6 <strong>in</strong>dicators is 72 po<strong>in</strong>ts <strong>and</strong> <strong>the</strong>percentage of maximum is shown for <strong>the</strong> 7 <strong>Asia</strong>n countriesfor which CSI data were available over <strong>the</strong> 3 roundsconducted between 2003 <strong>and</strong> 2009. Figure 4 graphs<strong>the</strong> 2009 partial CSI scores for five of <strong>the</strong>se countries.Bangladesh <strong>and</strong> Indonesia show <strong>the</strong> highest partial CSIscores (75.7% <strong>and</strong> 68.1% respectively), followed by <strong>the</strong>Philipp<strong>in</strong>es (42.5%) <strong>and</strong> India (41.3%), while Pakistanranks last (12.2%). The partial scores do not exhibit al<strong>in</strong>ear trend over <strong>the</strong> years: Bangladesh <strong>and</strong> <strong>the</strong> Philipp<strong>in</strong>eshad a higher score (87.2% <strong>and</strong> 62.8% respectively) <strong>in</strong> 2006than <strong>in</strong> 2009.Although <strong>the</strong> CSI scores have <strong>the</strong>ir imperfections, <strong>the</strong>yprovide a quantitative sense of how well contraceptivecommodity security may be served by exist<strong>in</strong>g logisticsprocurementsystems <strong>and</strong> national commitment <strong>in</strong> <strong>the</strong>form of earmarked budgetary resources for commoditypurchases. The ability to measure <strong>and</strong> assess progress ona regular basis is a critical activity <strong>and</strong> evaluation protocolof family plann<strong>in</strong>g programmes. A data system, such asCSI, available for all <strong>Asia</strong>n <strong>and</strong> <strong>Pacific</strong> countries wouldsignificantly advance contraceptive security for <strong>the</strong> region.Households are a major source of domestic spend<strong>in</strong>g onreproductive health <strong>and</strong> family plann<strong>in</strong>g <strong>and</strong> should not beneglected when assess<strong>in</strong>g <strong>the</strong> national profile of f<strong>in</strong>anc<strong>in</strong>g.Figure 5 displays <strong>the</strong> distribution of estimated domesticexpenditures on population by source of funds <strong>in</strong> 2008.Compiled for <strong>the</strong> UNFPA F<strong>in</strong>ancial Resource Flowsfor Population Activities project, <strong>the</strong> latest such reportof which (UNFPA <strong>and</strong> NIDI, 2010) shows that $15.8billion (current United States dollars) was spent <strong>in</strong> <strong>the</strong><strong>Asia</strong>n <strong>and</strong> <strong>Pacific</strong> region, as compared with $3.01 billion<strong>in</strong> sub-Saharan Africa, $2.55 billion <strong>in</strong> Lat<strong>in</strong> America<strong>and</strong> <strong>the</strong> Caribbean, $1.01 billion <strong>in</strong> West <strong>Asia</strong> <strong>and</strong> NorthAfrica <strong>and</strong> $0.83 billion <strong>in</strong> Eastern <strong>and</strong> Sou<strong>the</strong>rn Europe.The lead<strong>in</strong>g <strong>Asia</strong>n figure is a function of <strong>the</strong> region’spopulation size, but more importantly, <strong>in</strong> this figure, 71per cent of <strong>the</strong> spend<strong>in</strong>g was by consumers, i.e., out-ofpocketexpenditures on health care, <strong>and</strong> 28 per cent wasby governments. NGO spend<strong>in</strong>g accounted for a negligibleamount. Government spend<strong>in</strong>g as a fraction of <strong>the</strong> totalwas nearly half or greater <strong>in</strong> <strong>the</strong> o<strong>the</strong>r develop<strong>in</strong>g regions.The high percentage of total f<strong>in</strong>anc<strong>in</strong>g that was consumerbasedis an <strong>in</strong>dication of susta<strong>in</strong>able contraceptive security,although national spend<strong>in</strong>g will always be a requisite for<strong>in</strong>troduc<strong>in</strong>g advances <strong>in</strong> contraceptive technologies, ref<strong>in</strong><strong>in</strong>gpolicy <strong>and</strong> service protocols, tra<strong>in</strong><strong>in</strong>g <strong>and</strong> supervis<strong>in</strong>ghealth providers’ st<strong>and</strong>ards of care, conduct<strong>in</strong>g monitor<strong>in</strong>g<strong>and</strong> evaluation, <strong>and</strong> subsidiz<strong>in</strong>g <strong>the</strong> services for <strong>the</strong> poorestsegment of persons practis<strong>in</strong>g contraception.The maturation <strong>and</strong> <strong>in</strong>stitutionalization of national familyplann<strong>in</strong>g programmes with<strong>in</strong> <strong>the</strong> health sector mostfrequently has required less <strong>and</strong> less external assistanceover time. In addition, global resources for familyplann<strong>in</strong>g/reproductive health have been decl<strong>in</strong><strong>in</strong>g, from43 per cent ($722.8 million) of <strong>the</strong> total <strong>in</strong> 1998 to 6 percent ($572.4 million) <strong>in</strong> 2008. Resources for HIV/AIDSprevention <strong>and</strong> treatment have been grow<strong>in</strong>g from $336.2million to over $7.7 billion over <strong>the</strong> same period. Thishas shifted <strong>the</strong> geographic dest<strong>in</strong>ation of <strong>in</strong>ternationalfund<strong>in</strong>g for population assistance, as tracked through <strong>the</strong>UNFPA F<strong>in</strong>ancial Resource Flows project, which obta<strong>in</strong>sdata from donor agencies, governments <strong>and</strong> o<strong>the</strong>r sources.Population assistance fund<strong>in</strong>g <strong>in</strong>cludes family plann<strong>in</strong>g<strong>and</strong> reproductive health services, STI/HIV preventionprogrammes, <strong>and</strong> basic research, data <strong>and</strong> population <strong>and</strong>development policy analysis. In 2008, two thirds of <strong>the</strong>total $10.4 billion <strong>in</strong> estimated fund<strong>in</strong>g ($6,983 million<strong>in</strong> 1993 United States dollars) was directed towards sub-Saharan Africa, while 18 per cent ($1,873 million) wasdirected towards <strong>the</strong> <strong>Asia</strong>n <strong>and</strong> <strong>Pacific</strong> region.Although donor support for population activities <strong>in</strong> <strong>the</strong><strong>Asia</strong>n <strong>and</strong> <strong>Pacific</strong> region is a small fraction of <strong>the</strong> totalexpenditures, it would none<strong>the</strong>less be helpful to exam<strong>in</strong>e<strong>the</strong>ir estimated levels <strong>and</strong> channels of distribution. Table 5is drawn from <strong>the</strong> UNFPA report on F<strong>in</strong>ancial ResourceFlows <strong>and</strong> shows, <strong>in</strong> current United States dollars, <strong>the</strong>change <strong>in</strong> donor expenditures over <strong>the</strong> 10-year periodbetween 1998 <strong>and</strong> 2008. Because <strong>the</strong>se expenditure data<strong>in</strong>clude fund<strong>in</strong>g for STI/HIV programmes, sizeable<strong>in</strong>creases are noted <strong>in</strong> some countries where diseasetransmission risk is judged to be significant or where geopoliticalconsiderations have raised <strong>the</strong> status of <strong>the</strong>secountries as deserv<strong>in</strong>g recipients. For <strong>the</strong> populations of<strong>in</strong>terest shown <strong>in</strong> <strong>the</strong> table, <strong>the</strong> <strong>Asia</strong>n <strong>and</strong> <strong>Pacific</strong> regionreceived $1,132 million <strong>in</strong> 2008, $1,050 million <strong>in</strong> <strong>Asia</strong><strong>and</strong> <strong>the</strong> rema<strong>in</strong>der <strong>in</strong> <strong>the</strong> <strong>Pacific</strong>. The overall level of donorexpenditure <strong>in</strong> 2008 was 2.79 times that of <strong>the</strong> 1998 level(<strong>in</strong> current United States dollars). Significant rises <strong>in</strong>donor expenditures are seen for Afghanistan, Kazakhstan,Kyrgyzstan, <strong>the</strong> Democratic People’s Republic of Korea,<strong>the</strong> Philipp<strong>in</strong>es, Tajikistan, Thail<strong>and</strong>, Uzbekistan <strong>and</strong> Viet54