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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