Changing public/private market shares for family planning in Peru: what about the poor?

Publication date: 2006

Changing public/private market shares for family planning in Peru: What about the poor? Suneeta Sharma and Elaine Menotti May 31, 2006 Indicator 1996 2005 CPR (modern methods) CPR (traditional methods) 15% 15% Unmet need 26% 30% 12% 8% DHS: 1996, 2004 Changes in the FP/RH landscape Issues ‰ Favorable policies, with frequent changes in political commitment ‰ Phaseout of donated commodities ‰ Limited role of social security institutes and NGOs ‰ Failure to target public sector resources to the poor ‰ High cost of private sector contraceptives ‰ State reforms - decentralization Objectives ‰ Share findings of market segmentation analysis covering 1996-2004 ‰ Discuss its use in policy dialogue with key stakeholders ‰ Outline subsequent measures being undertaken by Peru’s MOH to meet contraceptive needs of Peruvians Methodology ‰ 1996, 2000 and 2004 ENDES (Peru DHS) ‰ Wealth quintiles (SES) based on Asset Index and level of poverty ‰ Market Analysis ¾ Family planning use by SES ¾ Provider choice by SES ¾ Trends over time ‰ Assessment of policy environment using SPARHCS Unmet Need among WRA across quintiles in 1996, 2000, and 2004 0 5 10 15 20 25 Poorest Second Middle Fourth Wealthiest Quintiles P e r c e n t 1996 2000 2004 Source mix for Peruvian women ages 15-49 using family planning, 2004 MOH 62% Pharmacy 20% EsSALUD 10% Private Provider 5% NGO 1% Other 2% Policy decisions influence the market ‰ In 1995, MOH mandated the provision of free contraceptives for all ‰ Frequent changes in the level of political commitment ‰ In 1999, MOH began purchasing contraceptives as part of donor phaseout Sources of contraceptive methods among current users of modern methods (1996-2004) 0% 20% 40% 60% 80% 100% 1996 2000 2004 MOH EsSALUD Private prov Pharmacy NGO Other Contraceptive Prevalence Trends among Peruvian Women 0 5 10 15 20 25 30 35 40 45 1996 2000 2004 1996 2000 2004 Year P e r c e n t Modern Traditional Poorest Wealthiest Family planning client profiles in Peru’s Ministry of Health, 1996-2004 53.8 47.2 36.2 20 25 28.9 25.8 28.4 34.9 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1996 2000 2004 Poorest and Lower Middle Middle Upper Middle and Wealthy Summary of findings ‰ Unmet need for FP highest among the poorest ‰ Use of traditional methods increased among poorest ‰ MOH has dominant market share ¾ Two lowest SES groups making up decreasing proportion of clientele ¾ Two highest SES groups making up increasing proportion of clientele Implement a multifaceted strategy that relies on different sectors and diverse financing mechanisms Identify and remove barriers to access (financial, cultural, and/or operational) among the poor Ensure that public sector resources are used primarily to reach the poor Promote alternative financing mechanisms to shift the non-poor away from the public sector Improving access among the poor Implementing Pro-poor Strategies Understand market trends Share findings & conduct policy dialogue Pro-poor monitoring and evaluation Identify & remove operational barriers Design & implement pro-poor strategies Key points ‰ All sectors – government, commercial, NGOs, and social security – have an important and appropriate role to play ‰ Policy decisions and strategies have intended and unintended impacts on the market ‰ Need targeted efforts to improve access among the poor Changing public/private market shares for family planning in Peru: Changes in the FP/RH landscape Issues Objectives Methodology Unmet Need among WRA across quintiles in 1996, 2000, and 2004 Source mix for Peruvian women ages 15-49 using family planning, 2004 Policy decisions influence the market Sources of contraceptive methods among current users of modern methods(1996-2004) Contraceptive Prevalence Trends among Peruvian Women Family planning client profiles in Peru’s Ministry of Health, 1996-2004 Summary of findings Implement a multifaceted strategy that relies on different sectors and diverse financing mechanisms Implementing Pro-poor Strategies Key points

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