GUATEMALA S FAMILY PLANNING TRANSITION Successes, Challenges, and Lessons Learned for Transitioning Countries ATTAINING SUSTAINABLE FINANCING FOR FAMILY PLANNING IN SUB-SAHARAN AFRICA ACCRA, JANUARY 2018 JAY GRIBBLE 1
Guatemala: Country Profile USAID Guatemala Area: 109,000 square km similar to Malawi, Eritrea, Benin, and Liberia Population: 16 million similar to Malawi, Zambia, Senegal, and Zimbabwe 40% indigenous population 60% Catholic + 30% other Christian Guatemala s demographics have produced a number of barriers to access Cultural appropriateness of services and religious acceptability of contraception 2
Guatemala: Family Planning Progress 70% 60% Contraceptive prevalence rate (CPR), modern and traditional, 1999 vs. 2015 6 5 Total fertility rate, 1999 vs. 2015 50% 40% 30% 20% 10% 4 3 2 1 0% 1999 2015 0 1999 2015 CPR, traditional methods CPR, modern methods 3
Making Family Planning a National Priority in Guatemala 2001: Social Development Law Individual s rights about sexual activity and reproductive health Reproductive Health Program Access to and information about both natural and artificial family planning methods 2005: Law of Universal Access to Family Planning Sustainable access to contraceptive methods Creates National Commission for Contraceptive Security (NCCS) 4
Guaranteeing Access to Family Planning Commodities 2004: Alcohol Tax Law Establishes a tax of 6 8.5% on alcoholic beverages Minimum of 15% of revenue for family planning/reproductive health 2006: Reproductive health line item established 2010: Safe Motherhood Law 30% alcohol tax earmark for purchasing contraceptives Increased accountability in the use of resources for family planning 5
Guatemala Legislation Related to Family Planning Since 2001 NCCS established 6
Public Domestic Resource Mobilization for Family Planning Revenue and Allocations from Alcohol Tax Source: HP+, 2017 7
Achieving Sustainable, Domestic Financing Share of Ministry of Health contraceptive purchases covered by domestic resources Source: HP+, 2017 8
Advocacy for Family Planning as a National Priority Lighting the Spark July 2003 USAID launched a series of regional exchanges on contraceptive security Motivated country-level contraceptive security champions Developed common vision family planning sustainability USAID DELIVER PROJECT, 2013, http://jsi.com/jsiinternet/inc/common/_download_pub.cfm?id=16387&lid=3 9
Advocacy for Family Planning as a National Priority Championing Family Planning USAID-trained advocates led the way in advocating for family planning and contraceptive security laws Engaged journalists and undertook public education campaigns Coalesced broad support for family planning/reproductive health Understanding of various political actors, their positions, and power is important for effective advocacy Political economy analysis Budget advocacy as a critical tool in ensuring sufficient sustainable family planning financing to be discussed in later session 10
Putting the Law into Practice National Commission for Contraceptive Security Established by law in 2009 Comprised of nine organizations: six public, three private Advocates for the availability of contraceptive commodities to guarantee access to family planning methods Member organizations: Ministry of Health and Social Assistance; Guatemala Social Security Institute; Ministry of Public Finance; Association for Family Well-being; Presidential Secretariat for Women; Guatemala Women s Association; Guatemalan Association of Women Doctors; Agency for Health Policy Action and Women s Development; Department of Protection of Ingenious Women Conducts strategic planning and forecasting of commodity needs Market Segmentation Strategy (2013) Projects contraceptive demand and resource requirements from public and private sources to ensure the availability of sufficient commodities National Strategy for Family Planning, 2014 2020 Establishes targets for contraceptive prevalence and unmet need, as well as intermediate objectives for financing and availability of contraceptive commodities, service delivery, and quality 11
Ensuring Transparency in Implementation Network of Reproductive Health Watchdogs USAID Guatemala Formed in 2008 Comprised of 12 organizations: one public, 11 private Political arm of NCCS Network of departmental-level watchdogs through member organizations Closer to population Greater transparency, responsiveness Member organizations: Faculty of Medical Sciences, University of San Carlos; Faculty of Medical Sciences, University of Mariano Gálvez; USAC University Women s Institute; Agency for Women s Health and Development; College of Doctors and Surgeons; Guatemalan Gynecology and Obstetrics Association; Guatemalan Association of Women Doctors; Association for Family Well-being; Foundation of Eco-Development and Conservation; World Vision; Plan International; GOJoven International 12
Applying Guatemala s Experience Lessons for Transitioning Countries Transition planning must begin well before graduation Legal framework is necessary, but not sufficient Implementation and compliance requires accountability mechanisms, monitoring, and transparency African countries may be further along than Guatemala was in 2000 Existence of family planning laws Still work to be done Need for designated funding streams Need appropriate accountability mechanisms to ensure fulfillment of legal and financial commitments 13
Health Policy Plus (HP+) is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-15-00051, beginning August 28, 2015. HP+ is implemented by Palladium, in collaboration with Avenir Health, Futures Group Global Outreach, Plan International USA, Population Reference Bureau, RTI International, ThinkWell, and the White Ribbon Alliance for Safe Motherhood. This presentation was produced for review by the U.S. Agency for International Development. It was prepared by HP+. The information provided in this presentation is not official U.S. Government information and does not necessarily reflect the views or positions of the U.S. Agency for International Development or the U.S. Government. 14
This is an accessible version of the time line presented on page 9. In the summer of 2003, USAID's Bureau for Latin America and the Caribbean (LAC) launched a regional initiative to strengthen contraceptive security (CS) in eight countries. Nine years later, the LAC CS Regional Initiative has built a South-to-South exchange network by motivating country-level CS champions to work together toward achieving a common goal increasing access to family planning (FP) services and supplies throughout the region. Launching LAC CS Initiative Forum Managua, Nicaragua, July Completed country/regional assessments. Formed most of LAC CS committees. Advocating for CS Event Antigua, Guatemala, September Shared country market analyses. Strengthened country commitment to improving access to FP. Reproductive Health Supplies Coalition Global CS Event on LAC London, England, April Shared LAC approach globally. Recognized countries for policy, supply chain, and procurement models. Equity and CS Event Antigua, Guatemala, September Strengthened country commitment to improving access to FP. Public-Public Alliances for Equity in FP Workshop Managua, Nicaragua, May Public institutions committed to better coordinating services. Increased commitment of Social Security Institutes t o strengthen FP programs. Increased coverage in some countries. South to South Exchange Workshop: Learning about Alternatives for Efficient and Sustainable Contraceptive Procurement in the Public Sector Lima, Peru, May Country delegations committed to exploring the diversification of procurement options in their countries. A Call to Action: Advancing Contraceptive Security by Improving Access for Adolescents and Youth Guatamala City, Guatamala, June Two-country teams (including adolescents) formed to implement and monitor their work plans. 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Regional LAC CS Forum Lima, Peru, October Assessments presented. Country CS action plans developed. LAC CS State of the Practice Event Washington, DC, USA, September Donors and partners committed to coordinating CS more closely. LAC recognized as a global CS leader. Supply Chain under Health Reform Workshop Santo Domingo, Dominican Republic, September Supply chain and CS recognized as building blocks of health reform. FP better protected during integration and decentralization. Options for Contraceptive Procurement Workshop Cartagena, Colombia, September Participants oriented to best practices for procurement. Partners better informed to support these practices. Procurement mechanisms improved in several countries. Successes and Challenges to Achieve CS Event Punta Cana, Dominican Republic, June Seven countries signed a declaration affirming their commitment to CS. Joint USAID Health Policy Project and USAID DELIVER PROJECT Regional Meeting: Commodity Security Committees in LAC Asuncion, Paraguay, December Country delegations agreed to apply CS Committee lessons learned to help achieve more sustainable programs.