Contraceptive Security Index User's Guide

Publication date: 2006

CONTRACEPTIVE SECURITY INDEX USER’S GUIDE December 2006 This publication was produced for review by the United States Agency for International Development. It was prepared by the DELIVER project. DELIVER DELIVER, a six-year worldwide technical assistance support contract, is funded by the U.S. Agency for International Development (USAID). Implemented by John Snow, Inc. (JSI) (contract no. HRN-C-00-00-00010-00) and subcontractors (Manoff Group, Program for Appropriate Technology in Health [PATH], and Crown Agents Consultancy, Inc.), DELIVER strengthens the supply chains of health and family planning programs in developing countries to ensure the availability of critical health products for customers. DELIVER also provides technical management of USAID’s central contraceptive management information system. Recommended Citation DELIVER. 2006. Contraceptive Security Index User’s Guide. Arlington, Va.: DELIVER, for the U.S. Agency for International Development. DELIVER John Snow, Inc. 1616 North Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: Internet: The Contraceptive Security Index ZDV�FDOFXODWHG�DQG�SUHVHQWHG�IRU�WKH�ÀUVW�WLPH�LQ������� WKH������HGLWLRQ�XSGDWHV�WKRVH�ÀQGLQJV��$�WRWDO�RI����FRXQWULHV�DUH�UHSUHVHQWHG�LQ�WKH� 2006 index, including the 57 countries from the 2003 index plus six additional countries. This user’s guide describes and explains how governments, program managers, policymakers, donors, and other stakeholders can use the Contraceptive Security Index to raise awareness, support advocacy, focus priorities, and target resources to achieve contraceptive security. The Contraceptive Security Index uses 17 indicators to measure a country’s level of contraceptive security and to monitor global progress toward reaching that goal, RYHU�WLPH��7KH�LQGLFDWRUV�LQFOXGH�ÀYH�FRPSRQHQWV�WKDW�DUH�HVVHQWLDO�WR�FRQWUDFHS- tive security— N how well the supply chain for contraceptives functions N WKH�SURVSHFWV�IRU�JRYHUQPHQW�DQG�KRXVHKROG�ÀQDQFLQJ�RI�IDPLO\�SODQQLQJ� services and contraceptives N the broader health and social environment as it affects the prospects for contraceptive security N the availability and access to modern methods of contraception N contraceptive use. 7KH�LQGLFDWRUV�DUH�FRPELQHG�LQWR�DJJUHJDWH�VFRUHV�IRU�HDFK�RI�WKH�ÀYH�FRPSRQHQWV�� these scores are then combined to produce an index measure for each country. Methodological Considerations Some care should be taken when using the Contraceptive Security Index: N Although the index represents a country’s contraceptive security situation at a point in time, the actual data were collected over a number of years. Different LQGLFDWRUV�ZHUH�XSGDWHG�DW�GLIIHUHQW�WLPHV��WKH�PRVW�UHFHQWO\�DYDLODEOH�GDWD� are used for each indicator. Ideally, the index will be updated every two to three years. N Since the 2003 index, the data collection methodology for some of the sup- ply chain indicators changed. Consequently, comparing index scores at the country level between 2003 and 2006, or between the 2003 and 2006 scores for the individual supply chain indicators and component, is not recom- mended at this time. Only aggregate level comparisons between the 2003 and 2006 data are recommended. N Indicators in the Contraceptive Security Index should be reviewed within the broader context of a country situation, including aspects that are not captured in the index because of data limitations. To inform program design and implementation, the index can point to areas that require more in-depth analysis. 3 Using the Contraceptive Security Index The information provided in the Contraceptive Security Index can be used to— 1. Advocate for and raise awareness about contraceptive security by demon- strating where investments have already been successful. 2. Identify priority areas for support at the global, regional, and national level by examining different components. 3. Help allocate resources at the global and regional levels by comparing coun- tries and regions and identifying where assistance is most needed. Following are examples of these three uses: USING THE CONTRACEPTIVE SECURITY INDEX AS AN ADVOCACY TOOL By highlighting successes, the Contraceptive Security Index can be used as an advocacy tool to reinforce the commitment of countries, donors, and lenders to contraceptive security. For example, the per capita gross national income (GNI)—one of the indicators used in the index—represents the ability to pay for contraceptives at the household level. Greater ability to pay is associated with better prospects for contraceptive security. Bangladesh ranks second to last in per capita GNI within the Asia and 3DFLÀF�UHJLRQ��%XW��ZKHQ�H[DPLQHG�JOREDOO\�ZLWKLQ�WKH�FRQWH[W�RI�RWKHU�FRXQWULHV� with similar per capita GNI (range +/- $500), Bangladesh has the highest total index score. Even though Bangladesh’s per capita GNI is among the lowest in the region, compared with other countries with similar per capita GNI, investments in FRQWUDFHSWLYH�VHFXULW\�DUH�PDNLQJ�D�GLIIHUHQFH�LQ�%DQJODGHVK��VHH�ÀJXUHV���DQG����� Figure 1. Per Capita GNI in the Asia & Paci!c Region, 2006 4 Figure 2. Contraceptive Security Index Score among Countries with Similar Per Capita GNI, 2006 USING THE CONTRACEPTIVE SECURITY INDEX TO IDENTIFY PRIORITIES The Contraceptive Security Index can be used to give donors and lenders some indica- tion of where regions rank within the spectrum of contraceptive security, and to LGHQWLI\�ZKHUH�LQWHQVLÀHG�HIIRUWV�WRZDUG�FRQWUDFHSWLYH�VHFXULW\�DUH�QHHGHG��)RU� example, by roughly dividing the range of total scores of all ranked countries into top, middle, and bottom thirds, and segregating by regions, it is clear that the total scores of the majority of sub-Saharan African countries fall within the bottom third of all the ranked countries. However, the majority of total scores in the Latin America and Caribbean region fall within the top third of total scores of all countries UDQNHG��ZLWK�QRQH�IDOOLQJ�LQ�WKH�ERWWRP�WKLUG�UDQJH�RI�VFRUHV��VHH�ÀJXUH����� Figure 3. Total Contraceptive Security Index Scores by Region, 2006 5 For another look at sub-Saharan Africa, the Contraceptive Security Index can be used to identify and set priorities among sub-regions and components. For example, by FRPSDULQJ�WKH�LQGH[�VFRUHV�DPRQJ�WKH�IRXU�VXE�UHJLRQV��VHH�ÀJXUH�����LW�LV�FOHDU� that the central African sub-region has the farthest to go toward achieving contra- ceptive security. Figure 4. Comparison of Total Score in Sub-Saharan Africa by Region, 2006 /RRNLQJ�VWLOO�IXUWKHU�E\�FRPSRQHQW��ÀJXUH���VKRZV�WKDW�ÀQDQFH�LV�WKH�ZHDNHVW� FRPSRQHQW�DFURVV�DOO�IRXU�VXE�UHJLRQV�LQ�VXE�6DKDUDQ�$IULFD��DQG�LW�LV�HYHQ�ZHDNHU� in East Africa. Figure 5. Component Score Comparisons in Sub-Saharan Africa, 2006 6 By looking within a sub-region, we see areas of strength and weakness that can help determine the countries most in need of assistance and the kind of assistance they need. In comparing the total scores across seven countries in southern Africa (see ÀJXUH�����=DPELD�VWDQGV�RXW�DV�WKH�FRXQWU\�ZLWK�WKH�ORZHVW�WRWDO�FRQWUDFHSWLYH� security score. Figure 6. Total Scores among Southern African Countries, 2006 Further component score comparisons between top-ranked South Africa and bot- WRP�UDQNHG�=DPELD��VHH�ÀJXUH����UHYHDO�WKH�FRPSRQHQWV�WKDW�DUH�PRVW�DIIHFWLQJ� the total score and where advocacy efforts should be targeted. Figure 7. Component Score Comparison: South Africa and Zambia, 2006 7 USING THE CONTRACEPTIVE SECURITY INDEX TO GUIDE RESOURCE ALLOCATION The Contraceptive Security Index can be used to improve resource allocation by iden- tifying where assistance is most needed. For example, in Guatemala the strongest FRPSRQHQW�LV�WKH�VXSSO\�FKDLQ��WKH�ZHDNHVW�FRPSRQHQW�LV�ÀQDQFH³IROORZHG�E\� XWLOL]DWLRQ��DFFHVV��DQG�KHDOWK�DQG�VRFLDO�HQYLURQPHQW��VHH�ÀJXUH�����,I�DGGLWLRQDO� UHVRXUFHV�DUH�WDUJHWHG�WR�ÀUVW�VWUHQJWKHQ�WKH�ÀQDQFLDO�VLWXDWLRQ��WKLV�SRVLWLYH�FKDQJH� can help improve overall prospects for contraceptive security. Figure 8. Identifying Strengths and Weaknesses in Guatemala, 2006 Comparisons among countries within a region that have similar total scores can also be used to extract lessons for country programming. For example, Paraguay and Peru have similar total scores of 63.1 and 63.6, respectively. However, there are variations in terms of component strengths: the supply chain is the strongest LQ�3HUX�DQG�XWLOL]DWLRQ�LV�WKH�VWURQJHVW�LQ�3DUDJXD\��VHH�ÀJXUH�����:KDW�W\SHV�RI� investments for supply chain improvements might be applicable in Paraguay? Con- versely, why is utilization of modern contraception higher in Paraguay, and what does this say about the allocation of resources for contraceptive security in Peru? 8 Figure 9. Component Comparison between Peru and Paraguay, 2006 Although comparisons should not be made from 2003 to 2006 between scores from individual countries, regional comparisons across time can be used to gauge UHODWLYH�SURJUHVV�RYHU�WLPH�ZLWKLQ�D�UHJLRQ��WKLV�LV�DQRWKHU�ZD\�WR�LGHQWLI\�ZKHUH� progress is lagging and where resources may need to be allocated. For example, in the Latin American and Caribbean region, relative improvements have been PDGH�LQ�VXSSO\�FKDLQ��KHDOWK�DQG�VRFLDO�HQYLURQPHQW��DQG�XWLOL]DWLRQ��ZLWK�ÀQDQFH� UHPDLQLQJ�VWDEOH�DQG�DFFHVV�GHFUHDVLQJ�VOLJKWO\��VHH�ÀJXUH������%\�H[DPLQLQJ�WKHVH� changes within the regional context, policymakers and program managers can focus efforts on certain areas of need. Figure 10. Component and Total Scores for Latin America and the Caribbean, 2003–2006 9 FOCUSING ON THE FUTURE Stakeholders and program managers must continue to focus attention on long-term contraceptive security. Programs cannot meet their clients’ reproductive health and family planning needs without the reliable availability of high-quality contraceptive supplies and services. 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 contraceptive security. The Contraceptive Security Index is a useful tool that can be used to monitor progress toward reaching contraceptive security over time. This user’s guide provides illustrative examples of how stake- holders can use the information provided in the index to raise awareness, identify priority areas, and improve resource allocation. 10 For more information, please visit— The authors’ views expressed in this publication do not necessarily re!ect the views of the United States Agency for International Development or the United States Government. DELIVER John Snow, Inc. 1616 North Fort Myer Drive, 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: Internet:

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