- Increasing access to reproductive health supplies
Catalyzing national action
- Building capacity at the national level
- Going the last mile
- Prioritizing affordable medicines to prevent maternal deaths
- Focusing on underutilized contraceptives
- Preventing HIV and other sexually transmitted infections
- Mobilizing political and financial commitment
Access to reproductive health commodities is essential for achieving universal access to reproductive health and improved maternal health, as called for by Millennium Development Goal 5. These supplies are also crucial to UNFPA’s vision of a world in which every pregnancy is wanted, every childbirth safe and every young person’s potential fulfilled.
The Global Programme to Enhance Reproductive Health Commodity Security works closely with the governments of 46 countries to ensure access to a reliable supply of contraceptives, condoms, medicine and equipment for family planning, prevention of HIV and other sexually transmitted infections and maternal health. Launched in 2007, the Global Programme provides financial and technical support for countries to procure and manage supplies of reproductive health commodities and strengthen their health systems.
Impressive results are reported by countries receiving sustained, multi-year funding through the Global Programme. Higher rates of contraceptive prevalence show that more couples are able to realize their right to plan their families. More health centres are stocked with contraceptives and life-saving maternal health medicines, and fewer stockouts are reported. Family planning is increasingly being prioritized at the highest levels of national policies, plans and programmes. And more governments are allocating domestic resources for contraceptives – a strong sign of commitment to supply security.
The Global Programme is UNFPA’s main channel for providing technical and financial assistance for family planning. The Fund also facilitates third-party procurement of essential reproductive health supplies.
The Global Programme to Enhance Reproductive Health Commodity Security aims to give countries the skills and guidance to plan for their own needs. At the request of governments, UNFPA provides strategic and pivotal support to:
- Integrate reproductive health commodity security in national policies, plans, programmes and budget lines through advocacy with policymakers, parliamentarians and partners in government;
- Strengthen the delivery system to ensure a reliable supply, logistics information and supply management;
- Procure contraceptives and other essential reproductive health supplies and promote their use through various mechanisms such as community-based distribution;
- Provide training to develop capacity at every step, from forecasting needs to providing quality information and services.
Evidence-based advocacy has mobilized high-level support for the national family planning strategy in Ecuador, including a personal commitment by the President of the Republic, along with Government support of $8 million for the strategy plus $7 million to procure modern contraceptives through UNFPA. In Mongolia, pharmacy students at the national university receive training in forecasting and procurement of essential supplies as part of the curriculum. In Sierrra Leone, adoption of a computerized logistic management information system has increased transparency and accountability and reduced stock-outs. The innovative School for Husbands project in Niger has inspired RH education for men in Côte d'Ivoire and Sierra Leone. Community-based distribution has increased access to family planning in Burkina Faso and Lao People's Democratic Republic.
Mobilizing Resources for RHCS
More than 40 per cent of Global Programme support goes toward training, backstopping and other technical assistance designed to strengthen capacity at the national level. UNFPA supports the efforts of governments to mobilize political will and resources for reproductive health commodity security, strengthen integrated health systems and reach underserved communities. At the policy and strategy level, there is evidence-based advocacy. To build capacity, there is training to collect and use data on computerized logistics management information systems. Everything depends on a functioning supply chain, which includes these key elements:
- Product selection, often using a national essential drugs list;
- Forecasting, which is based on past use, warehouse stocks and demographic and programming information to determine the quantity of each product to procure;
- Procurement, with decisions affecting cost and quality of products as well as the timing of their delivery;
- Distribution, where supplies are stored at central and regional warehouses, and then transported to health facilities as needed.
The country-driven activities catalyzed by the Global Programme aim to ensure that everyone who needs them can access appropriate reproductive health commodities. Access is about going the last mile to reach a woman who wants to space or avoid pregnancy but is hard to reach due to poverty, geography, ethnicity, disability, displacement or age. Having access means that national policies are in place, the logistics management systems are functioning and the supply chain ends with a quality method of choice in the hands of the people who need it, when they need it. The ability to exercise human and reproductive rights depend on access. Ultimately, access to reproductive health commodities, including life-saving maternal health medicines, is a requirement for achieving the MDG and ICPD promise of universal access to reproductive health. And to UNFPA’s mission to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.
Underserved Communities and RHCS
Nearly all pregnancy-related deaths could be prevented by these three interventions: Family planning to prevent unintended pregnancies, skilled birth attendance at all births, and emergency obstetric care when needed. All three are dependent on a secure, reliable stream of reproductive health supplies: contraceptives, antibiotics and other medicines and surgical supplies. In order to save mothers’ lives, these basic items must reach the places that they are needed, not just this time, but every time. Often the death of a mother could be prevented by an inexpensive medicine, or a timely Caesaean section.
For countries in the Global Programme to Enhance Reproductive Health Commodity Security, UNFPA monitors the availability of five life-saving medicines at service delivery points. Several affordable medications have been prioritized in the UN Commission on Lifesaving Commodities for Woman and Children.
Family planning, which enables women and couples to determine the timing and spacing of their children, is one of the most cost-effective public health interventions, with far-reaching benefits. Need is growing fast. But voluntary and effective family planning is only possible with a steady supply of contraceptives and condoms people can count on. With support from UNFPA, the largest multilateral supplier of contraceptives and condoms, governments in focus countries are creating the conditions for success. These range from strong national policies to well-stocked warehouses to health workers trained to provide sensitive counselling and services.
Three overlooked contraceptive methods—long-acting implants, emergency contraception and the female condom—are included in the UN Commission on Lifesaving Commodities for Woman and Children. Although these methods are in demand, improve maternal health and support family planning , they have received inadequate attention. The Commission focuses on making them more available, affordable and accessible. A choice of methods increases use of contraceptives over time.
Contraceptive Commodities for Women's Health
Maternal Health Thematic Fund Annual Report
Meeting unmet need: HANDtoHAND Campaign
UNFPA is the largest public-sector procurer of male condoms and the second largest of female condoms in the world. Within the UN system, UNFPA is the lead agency for all aspects of condom programming. Condoms must be universally available -- either free or at low cost -- and marketed widely to motivate people to use them. They are the only method available that offers dual protection from sexually transmitted infections, including HIV, and unintended pregnancy. UNFPA promotes comprehensive condom programming, which seeks to ensure that those at risk of STIs, including HIV, and unintended pregnancy:
- are motivated to use male and/or female condoms
- have access to quality condoms
- have accurate condom information and knowledge
- use condoms correctly and consistently
Comprehensive condom programming is an integrated approach consisting of leadership and coordination of partners, demand, supply and support functions.
UNFPA leadership in reproductive health commodity security is recognized by donors and partners. UNFPA has mobilized more than $450 million from 2007-2013 for strategic and pivotal support to countries in the Global Programme. Major donors include The Netherlands, United Kingdom, Spain, Canada, Luxembourg and Catalonia (Spain).
Budget lines for reproductive health commodities are a strong indicator of government commitment. A budget line was established for the first time in Nigeria and in Sierra Leone in 2011, with lines present in 11 of 12 priority countries in the Global Programme (excepting Haiti). Furthermore, governments are beginning to commit more of their national resources to contraceptives. Allocations increased in 2011 in Burkina Faso, Ethiopia (where the budget for contraceptives nearly doubled), Lao PDR, Mali and Nicaragua.
More broadly, UNFPA tracks trends in support from bi-lateral and multi-lateral donors as well as social marketing organizations and provides information on donor support for essential reproductive health commodities, including contraceptives and condoms. The research is presented in the report Donor Support for Contraceptives and Condoms, published annually by the Commodity Security Branch.