Contraceptive Security Index 2009: A Tool for Priority Setting and Planning

Publication date: 2009

CONTRACEPTIVE SECURITY INDEX 2009 A Tool for Priority Setting and Planning OCTOBER 2009 This publication was produced for review by the United States Agency for International Development. It was prepared by the USAID | DELIVER PROJECT, Task Order 1. CONTRACEPTIVE SECURITY INDEX 2009 A Tool for Priority Setting and Planning !e authors’ views expressed in this publication do not necessarily reflect the views of the U.S. Agency for International Development or the United States Government. USAID | DELIVER PROJECT, Task Order 1 !e USAID | DELIVER PROJECT, Task Order 1, is funded by the U.S. Agency for International Development under contract no. GPO-I-01-06-00007-00, beginning September 29, 2006. Task Order 1 is implemented by John Snow, Inc., in collaboration with PATH, Crown Agents Consultancy, Inc., Abt Associates, Fuel Logistics Group (Pty) Ltd., UPS Supply Chain Solutions, !e Manoff Group, and 3i Infotech. !e project improves essential health commodity supply chains by strengthening logistics management information systems, streamlining distribution systems, identifying financial resources for procurement and supply chain operation, and enhancing forecasting and procurement planning. !e project also encourages policymakers and donors to support logistics as a critical factor in the overall success of their health care mandates. Recommended Citation USAID | DELIVER PROJECT, Task Order 1. 2009. Contraceptive Security Index 2009: A Tool for Priority Setting and Planning. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 1. Abstract !is wall chart presents a set of indicators that can be used to measure a country’s level of CS and to monitor global progress toward reaching this goal over time. !e indicators are aggregated to establish a composite index. !e Contraceptive Security Index was first calculated and presented in 2003 and again in 2006; the Contraceptive Security Index 2009 presents the latest update of these data. USAID | DELIVER PROJECT John Snow, Inc. 1616 Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 E-mail: askdeliver@jsi.com Internet: deliver.jsi.com A primary goal of reproductive health and family planning programs is to ensure that people can choose, obtain, and use a wide range of high-quality, affordable contraceptive methods and condoms for STI/HIV prevention. Referred to as contraceptive security, this goal requires sustainable strategies that will ensure and maintain access to and availability of supplies. As global demand for family planning continues to rise, contraceptive security (CS) will become more challeng- ing to achieve. Adequate financing for reproductive health (RH) and family planning programs is not keeping pace with demand; donor and national resources are more constrained than ever. Despite investments in service delivery and logistics systems, these systems remain inadequate in many countries. At the same time, increased demand—coupled with the impact of the HIV and AIDS pandemic, health sector reforms, limited national and international funding, and the brain drain—leaves countries unable to meet all their populations’ RH needs. It remains critical that stakeholders and program managers focus attention on long-term CS. Programs cannot meet their clients’ RH and family planning needs without the reliable availability of high-quality contracep- tive supplies and services. Attaining the poverty reduction and health goals adopted by many countries will be slowed unless improvements are made in CS. Ensuring contraceptive supply and service availability to clients requires a multi-sectoral approach. !e public and private sectors must work together to ensure an enabling policy environment, appropriate forecasting and procurement of commodities, efficient supply chains, well- trained providers, effective service delivery systems, an accepting social environment, and adequate financing. To plan effective interventions to reach this goal, policymakers, program managers, and international donor agencies need to know if and how their programs are progressing toward CS. !is wall chart presents a set of indicators that can be used to measure a country’s level of CS and to monitor global progress toward reaching this goal over time. !e indicators are aggregated to establish a composite index. !e Contraceptive Security Index was first calculated and presented in 2003 and again in 2006; the Contraceptive Security Index 2009 presents the latest update of these data. USES !e Contraceptive Security Index is a powerful tool for raising awareness about CS and the interrelationships between program components, different sectors, and program outcomes. At the national and international levels, the index can be used to set priorities; and to plan and advocate for supportive policies and other interventions that promote progress toward CS. At the country level, it can help identify areas of relative strength and weakness to help stakeholders target their resources more effectively and appropriately. However, because the CS Index presents a broad picture of CS in a country, in-depth assessments of specific components are required to identify issues that need to be addressed in national CS strategic plans. !e CS Index is also a useful guide for helping global donors and lenders determine the countries most in need of assistance and to determine what kind of assistance they need. !e index can help country governments, donors, and lenders improve resource allocation by giving them a way to track where countries are on a continuum of CS. With repeated measures taken over time, the index can provide a measure of progress toward the goal of CS. By drawing attention to the importance of CS, this tool can help donors and governments focus on meeting the growing contraceptive needs into the future. Methodological Considerations !is index represents a country’s CS situation at a point in time, although the actual data was collected over a period of years. It is unavoidable that indicators will be updated for different countries at different intervals. Ideally, to use the results to monitor progress toward the goal of CS over time, the index will be updated periodically (e.g., every two to three years). Comparisons can be drawn, over time, between the 2003 and 2006 findings at the aggregate level (i.e., by region, component, and total score), as presented in the Results section. However, because of a change in the data collection methodology for some of the sup- 1 ply chain indicators (see the Methodology, Definitions, Component I: Supply Chain section), comparisons across time from 2003 to 2006 at the country level and at the individual supply chain indicator level are not advisable. Nonetheless, the index’s applicability for the other purposes mentioned above remains valid. From 2006 to 2009, no further changes were made in the data collection methodology; therefore, comparisons of data from 2006 to 2009 at the country level can be considered. RESULTS A total of 64 countries are represented in the 2009 index, with 50 countries that have scores for all three indices to date. Table 1 shows the raw data for the 17 indicators, grouped into the five components that were used to construct the CS Index: supply chain, finance, health and social envi- ronment, access, and utilization. !is represents the most current data available. However, where new values were not available in 2009, raw scores from the 2006 index are included in this index as the most current data available. Data from 2003 were not carried forward to this version. Table 2 shows the weighted scores by component and total. Figure 1 shows the total weighted scores for the 64 countries presented in the index. !e range of possible scores on the weighted CS Index is 0 to 100, al- though actual scores in 2009 range from 37.4 to 74.1. In 2003, the range was 28.1 to 68.1; in 2006, the range of scores was 35.5 to 73.2. Using a paired t-test, the 2009 total scores represent a statistically significant increase from 2003 for the 50 countries scored in both indices, which indicates overall improvement. Figure 2 com- pares total index scores averaged by region. !e observed increases in total index score for countries overlapping in the 2003 and 2009 indices are significant only in Latin America and the Caribbean and in sub-Saharan Africa. !e global averages for the components show a signifi- cant improvement in finance, health and social environ- ment, and access from 2003 to 2009 for the overlapping countries (see figure 3). In many cases, the component scores by region also showed improvement (excluding Eastern Europe and Central Asia, as there were too few overlapping countries for comparison between 2003 and 2009), although these improvements were only significant in the following cases: Supply Chain: Middle East and North Africa and sub-Saharan Africa Finance: Asia and the Pacific and sub-Saharan Africa Health and Social Environment: Asia and the Pacific, Latin America and the Caribbean, and sub- Saharan Africa Access: sub-Saharan Africa Utilization: Latin America and the Caribbean Component scores for an individual country can be compared within a year (maximum weighted score of 20 for each component), enabling users to identify components that need attention and further assessment. Countries can score similarly overall but have strengths or weaknesses in different components. !is highlights the need for the indicators to be reviewed within the broader context of a country, including aspects not captured in the CS Index because of data limitations. Finally, it is important to note that movement in rank up or down by a few places at the country level may not represent significant differences or changes in the level of contraceptive security. 2 T ab le 1 . C on tr ac ep ti ve S ec ur it y In de x In di ca to rs , R aw D at a 3 Table 2. Weighted Component Scores 4 Figure 1. Total Weighted Scores: 64 Countries 5 Figure 2.Total Scores Averaged by Region Figure 3. Global Average Scores by Component N.B. !ese figures present results for the 50 countries scored in all 3 indices only. 6 C O N T E X T C lie nt D em an d an d U ti liz at io n G ov er nm en t D on or Th ird Pa rt y H ou se ho ld Fo re ca st in g Po lic y Pr oc ur em en t D is tr ib ut io n Se rv ic e D el iv er y M on ito ri ng & E va lu at io n et c. . G ov er nm en t Pr iv at e Se ct or D on or s C O O R D I N A T I O N CA P I T A L C O M M I T M E N T C A P A C I T Y P u b li c S ec to r NGOs Commercial So ci al M ar ke ti ng Fi gu re 4 . S P A R H C S Fr am ew or k fo r R ep ro du ct iv e H ea lt h C om m od it y Se cu ri ty 7 BACKGROUND !e CS Index 2009 presents an update of the findings from the 2003 and 2006 versions of the CS Index. !e framework at the core of the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS) was used as a conceptual guide in developing the CS Index. It defines the program and program environment components that are required to achieve RH commodity security, whether for contraceptives or for other RH commodities (see figure 4). !e CS Index and other efforts that promote and advance contraceptive security have drawn much needed attention to these issues and have led to a global movement around contraceptive security. METHODOLOGY !e original CS Index was developed in 2003 by a team of CS experts from USAID, the John Snow, Inc./DELIVER project, the POLICY Project of Futures Group, and Commercial Market Strategies (CMS). Using the same methodology as the 2003 index, the CS Index was updated in 2006 and, again with this version, in 2009, with input from many of the same partners. !e same indicators and data sources were maintained for the 2009 index using the latest version of all the reference documents. (Refer to notes by indicator below.) If new indicator values were not available since the publication of the 2006 index, the 2006 data are preserved as the most current data available. Data from 2003 were not carried forward to this version. !e process of constructing the CS Index was planned to minimize data collection costs (using only secondary data), and to maximize data reliability, validity, and replicability. !e selected indicators are a mix of inputs and outputs, and programmatic and macro-level issues. Together, they paint a picture of CS and promote a cross-sectoral approach to addressing CS. Although some indicators are highly correlated, each represents an important aspect of CS. !e 17 indicators are arrayed across the five CS components described below; the components are aggregated to create the index. For detailed information about how missing data were filled in to calculate the index, how indicators were weighted, and other technical issues, please refer to the Contraceptive Security Index Technical Manual (USAID | DELIVER PROJECT 2009). Definitions Component I: Supply Chain—Each of the five indicators of logistics management represents a key function in the supply chain for contraceptive supplies. An effective supply chain ensures the continuous supply of sufficient quantities of high-quality contraceptives needed to achieve security. More effective management of supplies is associated with better prospects for contraceptive security. When the CS Index 2003 was calculated, the largest database available with the first four indicators listed below was from the application of the Family Planning Logistics Management (FPLM) project’s Composite Indicators for Contraceptive Logistics Management (JSI/ FPLM and EVALUATION Project 1999).1 !is tool was updated and improved under the John Snow, Inc./ DELIVER project and it became the Logistics System Assessment Tool (JSI/DELIVER 2004),2 which is the source of the updated data for the first four indicators for the CS Index 2006 and the CS Index 2009. !e two tools are comparable because the LSAT was directly derived from the Composite Indicators; however, the maximum possible score for each indicator changed in the new tool. Due to the change in the data collection tool and methodology, comparisons over time between the 2003 and 2006 CS Index at the country level are discouraged. From 2006 to 2009, country-level comparisons are possible. • Storage and distribution—Assesses storage capacity and conditions, standards for maintaining product quality, inventory control, stockouts, how system losses are tracked, and distribution and transportation systems. • Logistics Management Information Systems (LMIS)—Assesses reporting systems, validation of data, information management, and use in decision making. • Forecasting—Assesses how forecasts of consumption are prepared, updated, validated, and incorporated into cost analysis and budgetary planning. 8 • Procurement—Assesses how forecasts are used to determine short-term procurement plans and the degree to which the correct amounts of contraceptives are obtained in an appropriate time frame. !e fifth supply-related indicator is drawn from the results of the Family Planning Effort (FPE) Survey (Ross and Smith 2009).3 • Contraceptive policy—Under some circum- stances, locally manufactured contraceptives can provide an affordable and sustainable option for clients. In many countries, it will be more effective to have policies and regulations that facilitate open markets and the importation of competitively priced, high-quality products. !is indicator measures the extent to which import laws and legal regulations facilitate the importation of contraceptive supplies that are not manufactured locally, or the extent to which contraceptives are manufactured within the country. Component II: Finance—Sustainable and adequate financing for the procurement of contraceptives, service delivery, and other program components from international donors and lenders, national or local governments, households, and third parties is critical for ensuring contraceptive security. Without a commitment of financing, program quality and access will suffer and CS will not be sustainable. Data are not widely or readily available to obtain an adequate country-level picture of contraceptive financing by donors/lenders, third parties (e.g., insurers, employers), or the private sector. !ree indicators are used to capture the prospects for government and household financing of family planning services and contraceptives in a country. !e World Bank’s 2009 World Development Indicators (WDI) are the source for these indicators. • Government health expenditures as a percentage of total government spending— A national government’s commitment to public health, specifically to reproductive health and family planning, is critical for CS. !e poorest segments of a population depend on free or subsidized health services, often provided by the government for essential preventive and curative health services. !is indicator is a measure of spending means more potential resources for family planning programs as part of overall government health programs. !is indicator is derived from two indicators in the WDI: public expenditures on health as a percentage of the gross domestic product (GDP), divided by total government expenditures as a percentage of GDP: (Gov Exp on Health/GDP) ÷ (Total Gov Exp/GDP) = (Gov Exp on Health/Total Gov Exp) • Per capita gross national income (GNI)— A greater ability to pay for contraceptives at the household level is associated with better prospects for CS. To allow for a better comparison across countries, this indicator represents the average consumer’s potential ability to pay for family planning services and contraceptives expressed in purchasing power parity (PPP), which corrects for the differences in the market price of goods in each country. • Poverty level—While per capita income measures the average consumer’s ability to pay, there are always inequalities in the distribution of income. High poverty rates can threaten CS if provisions are not made to ensure access to services and com- modities for the poor. Higher poverty rates can indicate a greater reliance of the population on the public sector, adding stress to already overburdened systems. Because higher poverty rates are associated with lower household incomes and poorer access to health care, higher poverty rates are also associated with poorer prospects for contraceptive security. !is indicator is expressed as the percentage of the national population living below the nationally defined poverty line. Component III: Health and Social Environment— !e health and social environment component comprises three indicators; this component is included because it is widely recognized that other factors in the broader health and social environment can affect prospects for contraceptive security at both the country and individual levels, as described below. • Governance—A healthier political environment improves prospects for contraceptive security. An accountable, stable, effective, and transparentpolitical commitment to public health spending government is more likely to be committed toas a proxy for government commitment to family the health and well-being of its population andplanning programs. Greater commitment to health 9 to use its resources appropriately for the public good. International donors are also more likely to provide financial and material support to such a government. !e private sector is more likely to invest in creating new or expanding existing markets for contraceptives. !is indicator is a composite measure that includes six dimensions of governance: voice and accountability, political stability, government effectiveness, regulatory quality, rule of law, and control of corruption. It is derived from the World Bank’s Governance Matters (Kaufmann, Kraay, and Mastruzzi 2009). • Women’s education—Women’s educational attainment is one of the best predictors of contraceptive use. Women who are educated beyond primary school are more likely to use a contraceptive method. In addition, in countries where women’s status is good, educated women are more likely to advocate for the protection of family planning programs. !is indicator is expressed as the percentage of females enrolled in secondary school, which is defined as the ratio of the number of students enrolled in secondary school to the population in the applicable age group (gross enrollment ratio). Secondary school enrollment rates were obtained from the UNESCO Institute for Statistics, which is the source for the Population Reference Bureau’s online DataFinder database 2009. • Adult HIV prevalence—It is increasingly recognized that a higher burden of HIV in a population can erode prospects for contraceptive security. HIV and AIDS contribute to higher levels of poverty and the pandemic has put new, competing demands on health financing. !is indicator is expressed as the percentage of adults aged 15–494 who were infected with the HIV virus at the end of 2007. Adult HIV prevalence rates were obtained from the UNAIDS Report on the Global HIV/AIDS Epidemic 2008. Component IV: Access—!e three access indicators measure aspects of availability and access to modern methods of contraception—the degree to which clients can choose and obtain their method of choice. Family planning and reproductive health programs should strive to offer a variety of methods to meet the needs of all clients. • Access to modern family planning methods—Ready and easy access by clients to a wide range of contraceptive methods is associated with better prospects for contraceptive security. When family planning services are widely available, it is very difficult to reverse progress in access and availability of these services and supplies. !is indicator from the FPE Survey measures the per- centage of a country’s population that has ready and easy access to male and female sterilization, pills, injectables, condoms, spermicides, and IUDs (Ross and Smith 2009).5 • Public sector targeting—Public sector family planning programs that offer heavily subsidized (and sometimes free) services and commodities are designed to meet the needs of the poor and near-poor segments of a population. !is public sector funding is limited in virtually every country. !e degree to which the poorest people benefit from these subsidized services, while wealthier clients who can afford to pay for ser- vices and commodities have and use other options, reflects on the long-term CS in a country. !is indicator measures the proportion of a country’s contraceptives distributed through public sector channels that go to poor and near-poor family planning clients. Poor and near-poor are clients who are in the lowest 40 percent of the population as defined by a standard of living index (SLI). Data from the Demographic and Health Surveys (DHS) and Reproductive Health Surveys (RHS) are used both to compute the SLI and the distribution of public sector family planning users across SLI categories.6 • Spread of access to modern family planning methods—Access to a wide range of family planning methods represents a choice for clients. Access to a range of methods can also mean that if one method becomes unavailable, other methods are available to clients in the interim. !is concept of choice is key to contraceptive security, regardless of what methods clients choose (reflected in Component V: Utilization). !is indicator is related to the access indicator above and it uses the same data from the FPE Survey. It measures whether clients have ready and easy access to a broad range of at least three contraceptive methods by selecting the highest-scored method, minus the third-highest 10 scored method, divided by the sum of access scores for all methods (Ross and Smith 2009). Component V: Utilization—!is component comprises three indicators that measure clients’ behavior in terms of contraceptive use within the country program context. • Method mix—While the access indicators (see Component IV: Access) measure the extent to which consumers have ready and easy access to methods, this indicator measures the degree to which consumers use a range of methods. !e broader the range of methods used, the better the prospects for contraceptive security, because it demonstrates that women have a choice and are choosing from a range of methods. !is indicator was measured as the difference in prevalence rates between the most prevalent modern method in a country and the third-most prevalent method, divided by the total modern method prevalence. A higher value indicates a higher concentration of use on a limited number of methods, which is interpreted as being not conducive to contraceptive security. !is indicator was derived from the most recently available DHS or RHS data set for each country. • Unmet need for family planning—Unmet need is indicative of barriers to accessing and using family planning. !e higher the percentage of women with unmet need for contraception, the poorer the prospects for contraceptive security, because unmet need represents clients who express a need to use family planning but cannot or do not. !is indicator measures the percentage of women who express a desire to space or limit their next pregnancy, or who would have preferred to avoid or delay their current pregnancy, but are not using a contraceptive method. !is indicator was derived from the most recently available DHS or RHS data set for each country. • Contraceptive prevalence rate (CPR)— !is indicator is the most obvious outcome of contraceptive security—women actually using contraception. Higher contraceptive use is indicative of better access and availability of contraceptives for the population. Increased contraceptive use will also encourage the improved availability in both the public and private sectors through political pressures and market forces. !is indicator measures the percentage of married women of reproductive age currently using a modern method of family planning. !is data is from the Population Reference Bureau’s 2009 World Population Data Sheet. 1 Staff from the Family Planning Logistics Management (FPLM) project (the predecessor project to DELIVER) and Ministry of Health counterparts scored the Composite Indicators for Contraceptive Logistics Management through a participatory focus group discussion held in each country in 1999–2000. 2 Staff from the John Snow Inc./DELIVER (2006) or the USAID | DELIVER PROJECT (2009) and Ministry of Health counterparts scored these indicators in 2006 and 2009 for public sector contraceptive logistics systems based on expert opinion in each country. 3 The FPE survey is conducted periodically around the world by administering a questionnaire to expert respondents from each country. 4 HIV prevalence among adults of reproductive age (15–49) is used as the indicator for the CS Index because this population is most likely to use contraceptives and avail themselves of services from family planning programs, making it the most relevant population for contraceptive security. It is also the most widely available data. 5 This indicator uses the mean access score for these contra- ceptive methods. 6 DHSs are generally conducted with oversight from a USAID centrally funded project. In some countries, RHSs, similar to a DHS but overseen by the Centers for Disease Control and Prevention, have been used where a recent DHS data set was not available. 11 REFERENCES DELIVER and Task Order 1 of the USAID | Health Policy Initiative. 2006. Contraceptive Security Index 2006: A Tool for Priority Setting and Planning. Arlington, Va.: DELIVER for the U.S. Agency for International Development. Demographic and Health Surveys (DHS), various countries and various years. Calverton, Md.: MEASURE DHS. www.measuredhs.com Hare, L., Hart, C., Scribner, S., Shepherd, C., Pandit, T. (ed.), and Bornbusch, A. (ed.). 2004. SPARHCS: Strategic Pathway to Reproductive Health Commodity Security. A Tool for Assessment, Planning, and Implementation. Baltimore, Md.: Information and Knowledge for Optimal Health (INFO) Project/Center for Communications Programs, Johns Hopkins Bloomberg School of Public Health. International Bank for Reconstruction and Development (IBRD)/World Bank. 2009. World Development Indicators 2008. http://publications.worldbank.org/WDI/ John Snow, Inc./DELIVER. 2004. Logistics System Assessment Tool (LSAT). Arlington, Va.: John Snow, Inc./ DELIVER, for the U.S. Agency for International Development. John Snow, Inc./Family Planning Logistics Management (JSI/FPLM) and the EVALUATION Project. April 1999. Composite Indicators for Contraceptive Logistics Management. Arlington, Va.: JSI/FPLM, for the U.S. Agency for International Development. Kaufmann, Daniel, Aart Kraay, and Massimo Mastruzzi. June 2009. Governance Matters VIII: Governance Indicators for 1996–2008. http://info.worldbank.org/governance/wgi/ Population Reference Bureau. August 2009. 2009 World Population Data Sheet. Washington, DC: Population Reference Bureau. www.prb.org Reproductive Health Surveys (RHS), various countries and various years. U.S. Centers for Disease Control and Prevention. www.cdc.gov/reproductivehealth/Surveys/SurveyList.htm Ross, John, and Ellen Smith. 2009. Effort Ratings for National Family Planning Programs. Forthcoming. Washington, DC: Futures Group International prepared for International Conference on Family Planning, Kampala, Uganda, November 2009. UNAIDS. 2008. Report on the Global HIV/AIDS Epidemic 2008. Geneva: UNAIDS. UNESCO Institute for Statistics. Women’s education data downloaded April 2009 from: http://www.uis. unesco.org/ev_en.php?URL_ID=3753&URL_DO=DO_TOPIC&URL_SECTION=201 USAID | DELIVER PROJECT, Task Order 1. 2009. Contraceptive Security Index Technical Manual. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 1. 12 ADDITIONAL RESOURCES Additional contraceptive security resources are available at the following web sites: Department for International Development (DFID): www.dfid.gov.uk DKT International: www.dktinternational.org Extending Service Delivery (ESD) Project: www.esdproj.org Health Systems 20/20: www.healthsystems2020.org Implementing Best Practices (IBP) Knowledge Gateway: www.ibpinitiative.org/ International Planned Parenthood Federation: www.ippf.org Knowledge for Health Project (K4Health): www.k4health.org/node/2 Marie Stopes International: www.mariestopes.org Maximizing Access and Quality (MAQ) Initiative: www.maqweb.org PATH: www.path.org POLICY Project: www.policyproject.com Population Action International: www.populationaction.org Population Reference Bureau: www.prb.org Population Services International (PSI): www.psi.org PSP-One Project (formerly Commercial Market Strategies Project): www.psp-one.com Reproductive Health Interchange: rhi.rhsupplies.org/ Reproductive Health Supplies Coalition: www.rhsupplies.org RESPOND Project (formerly the ACQUIRE Project): www.respond-project.org UNFPA: www.unfpa.org USAID: www.usaid.gov USAID | DELIVER PROJECT: www.deliver.jsi.com USAID | Health Policy Initiative (HPI): www.healthpolicyinitiative.com 13 !e USAID Contraceptive Security Team works to advance and support planning and implementation for contraceptive security in countries. !e team provides technical assistance to USAID missions, country partners, donors, and international partners. !e team can be contacted c/o Mark Rilling or Alan Bornbusch, Commodities Security and Logistics Division, Office of Population and Reproductive Health, Bureau for Global Health, mrilling@usaid.gov or abornbusch@usaid.gov. !e Reproductive Health Supplies Coalition is a coalition of donors, multilateral organizations, private foundations, nongovernmental organizations, low- and middle-income country governments, and others dedicated to improving global health and the quality of life by ensuring access to high-quality reproductive health (RH) supplies. !e coalition works to synthesize and share information, knowledge, and experience; improve coordination and harmonization of programs; and develop new tools and approaches to address the challenges of inadequate and unreliable financing for RH supplies, inefficiencies in supply systems; and inequities in access to RH supplies. More information can be found at (www.rhsupplies.org.) ACKNOWLEDGMENTS Development of the CS Index 2009 was led by Dana Aronovich of the USAID | DELIVER PROJECT, Task Order 1, of John Snow, Inc. (JSI) with support from Disha Ali, Elizabeth Bunde, Nadia Olson, and Marie Tien. We thank Alan Bornbusch (USAID) and Leslie Patykewich (USAID | DELIVER PROJECT) for their leadership and guidance, as well as John Ross (Futures Group), Bill Winfrey (Futures Institute), Gus Osorio, and Pat Shawkey (USAID | DELIVER PROJECT) for their input during the development of the index and wall chart. Funding for the development and publication of the CS Index 2009 was provided by the U.S. Agency for International Development (USAID) under the USAID | DELIVER PROJECT, Task Order 1 (GPO-I-01-06-00007-00) implemented by John Snow, Inc. !e authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government. Cover photographs courtesy of DELIVER and the USAID | DELIVER PROJECT. RECOMMENDED CITATION USAID | DELIVER PROJECT, Task Order 1. 2009. Contraceptive Security Index 2009: A Tool for Priority Setting and Planning. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 1. 14 For more information, please visit deliver.jsi.com. USAID | DELIVER PROJECT John Snow, Inc. 1616 Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: askdeliver@jsi.com Internet: deliver.jsi.com

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