Repositioning in Action E-Bulletin
September 2009
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Leveraging Global Fund Financing…
How the Global Fund to Fight AIDS, Tuberculosis and Malaria can support family planning/reproductive health and contraceptive security
A recent analysis carried out on behalf of the Reproductive Health Supplies Coalition showed that in 88 developing countries dependent on donor assistance for contraceptives, the number of users of modern contraceptive methods is projected to increase by 49 percent – from 144 million in 2005 to 214 million by 2020.
To meet this increasing demand, countries face common challenges in securing adequate and sustainable financing to purchase such essential commodities as contraceptives. These challenges include donor phase-outs, decreases in donor funding, declines in host country government budgets, and success itself, i.e., increasing numbers of women and couples demanding family planning/reproductive health (FP/RH) services and supplies.
Identifying new donor sources is one option to help diversify funding sources and increase overall funding for family planning commodities.
The Global Fund Supports Reproductive Health Commodity Security
The Global Fund to Fight AIDS, Tuberculosis and Malaria, an international financing institution, has committed US$ 12 billion in 140 countries as of June 2009 to support large-scale prevention, care and treatment and impact mitigation programs against the three diseases.
The Global Fund encourages countries to strengthen linkages between disease programs (especially for HIV/AIDS) and FP/RH activities. If countries can establish a link to improved disease outcomes (in this case, HIV prevention), the Global Fund will support FP/RH activities, including contraceptive procurement.
Rwanda Uses Global Fund Resources to Finance Contraceptives
In 2008, Rwanda began financing contraceptives with Round 7 funding. The Rwanda Round 7 HIV/AIDS proposal [PDF, 716KB] states the following:
The need to increase family planning services is identified both by political leaders and by the population, which is requesting better access to contraceptive methods for family planning purposes. This is particularly pertinent as a strategy for HIV prevention since access to family planning services, particularly condoms, can prevent vertical transmission of HIV from mother to child by enabling women/couples to choose whether and when to have children and to assess the HIV risk of having children in the future.1
The commitment of US$ 2.4 million in Round 7 funds over three years will be used by the Ministry of Health to supplement funding from USAID and UNFPA as well as supplies procured using direct government funding. Contraceptives procured will be distributed through the public supply chain and made available to all women – not just those infected with HIV. Rwanda has seen a significant increase in the demand for contraceptives over the past few years, with the use of modern contraceptive methods almost tripling from 10 percent in 2005 to 27 percent in 2008, according to the DHS. This funding – the first time Global Fund resources are being used to fund contraceptives other than condoms – will be an important contribution to contraceptive security in Rwanda.
Zambia Follows Rwanda’s Lead
In its recently approved Round 8 proposal [PDF, 3.1MB], Zambia explicitly indicated that it would fund contraceptives, in addition to male and female condoms, to complement existing contraceptive funding sources. Zambia identified provision of FP services as an important gateway for HIV services, including prevention of mother-to-child transmission, and, consequently, recognized the critical need to strengthen those FP services with adequate contraceptive supplies. The Round 8 HIV/AIDS proposal2 states the following:
The health product expenditure is made up of a number of components but the most significant are the procurement of condoms, commodities for family planning interventions and laboratory re-agents.3
Global Funds Can Support Other FP Components
Funding contraceptive procurement is not the only way Global Fund resources can be used to strengthen contraceptive security. To deliver contraceptives, strong supply chains are needed; these often are the same supply chains that deliver drugs, such as antiretrovirals, tuberculosis drugs, antimalarials, and diagnostics such as HIV test kits. As part of the overall health system strengthening effort, Global Fund proposals can target activities that strengthen supply chains, including procurement, warehousing, training, and management information systems. For example, Liberia has used Global Fund Round 6 funding [PDF, 1.0MB] and will use Round 8 funding [PDF, 2.5MB] to construct regional warehouses and provide transport to its central medical stores. These efforts will strengthen supply chains for all essential medicines, including contraceptives.
Of course, contraceptive security depends on more than products. Quality service delivery is also critical, and Global Fund resources can help improve service delivery through improved facilities, systems, and training. For example, in addition to supporting contraceptive financing, Rwanda will also use Global Fund resources to support the recruitment and training of staff for FP services.
Role of FP Champions in Leveraging Global Fund Resources
FP/RH policymakers, program managers, donors, and other advocates can play an important role in ensuring countries can leverage Global Fund resources to strengthen contraceptive security. They can:
- Inform Country Coordinating Mechanism (CCM) members, Principal Recipients, Sub-recipients, and other Global Fund stakeholders of examples of countries using Global Fund resources for contraceptives, advocating for use of these funds to strengthen FP programs, and providing resources and guidelines to help inform stakeholders.
- Advocate, educate, and communicate with CCM members and other stakeholders about how FP/RH interventions can improve HIV outcomes.
- Assist stakeholders in preparing new proposals, helping to build even more evidence and justification for the inclusion of contraceptives and/or other systems strengthening components.
- Evaluate existing grants to see if there is scope to include contraceptives in procurements. For example, if an existing proposal identifies FP as critical to HIV prevention, then countries could propose contraceptive procurement in their Procurement and Supply Management Plan (PSM), even if the proposal does not explicitly include them.
- Ensure accurate and reliable contraceptive forecasts and quantifications are carried out and disseminated. The rationale for Global Fund support is that there is a funding gap or existing funding sources cannot meet demand. Forecasts provide key evidence to highlight gaps and justify Global Fund support for contraceptives.
- Include Global Fund stakeholders in forecast exercises and also in national contraceptive security coordination groups to ensure they are well informed.
- Ensure, if Global Funds are used to procure contraceptives, that these procurements are coordinated with procurements from other funding sources so that the right goods arrive at the right time. Contraceptives should not be targeted for particular groups and should be considered part of the national supply and distributed through normal channels.
FP programs are chronically underfunded, and new funding sources are vital for increasing contraceptive security and eliminating unmet need. The Global Fund can be an important new funding source for FP supplies and services. At the same time, strengthening FP services offers opportunities to reduce the impact of HIV, creating a win-win situation.
Tools and Resources
1 http://www.theglobalfund.org/grantdocuments/7RWNH_1568_0_full.pdf , p. 84
2 Please note, the grant agreement for Zambia's Round 8 HIV/AIDS proposal has not yet been signed.
3 http://www.theglobalfund.org/grantdocuments/8ZAMH_1781_0_full.pdf, p. 106
We Want to Tell Your Repositioning Story
Please contact Carmen Coles at ccoles@usaid.gov with your successes in family planning programming.
For more information on Repositioning Family Planning, please contact Alexandra Todd at atodd@usaid.gov or Carmen Coles at ccoles@usaid.gov.
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