Regional Approach Improves Access to Contraceptives in Latin America: Creating Sustainable Family Planning Programs through Country Collaboration

Publication date: 2011

Regional Approach Improves Access to Contraceptives in Latin America Creating Sustainable Family Planning Programs through Country Collaboration Our goal is to give every woman and man the ability to choose, obtain, and use contraceptives whenever they need them. !is is the de"nition of contraceptive security. JUNE 2011 This publication was produced for review by the U.S.Agency for International Development. It was prepared by the USAID | DELIVER PROJECT,Task Order 4. � � � � � � � � � � � � � � � � � � About the Regional Initiative ,Q�������86$,'·V�%XUHDX�IRU�/DWLQ�$PHULFD�DQG�WKH� &DULEEHDQ��/$&��ODXQFKHG�WKH�/$&�&RQWUDFHSWLYH� 6HFXULW\��&6��5HJLRQDO�,QLWLDWLYH�WR�VWUHQJWKHQ�&6� DQG�EXLOG�D�VRXWK�WR�VRXWK�H[FKDQJH�QHWZRUN�WR�KHOS� VXVWDLQ�FRXQWULHV�ZKHUH�86$,'�GRQDWLRQV�DQG�IDPLO\� SODQQLQJ�WHFKQLFDO�DVVLVWDQFH�DUH�EHLQJ�SKDVHG�RXW�� 7KH�5HJLRQDO�,QLWLDWLYH�EULQJV�FRXQWULHV�WRJHWKHU� WR�VKDUH�OHVVRQV�DQG�VROXWLRQV��ZKLFK�DUH�WKHQ� WUDQVODWHG�LQWR�UHVXOWV�QDWLRQDOO\��:LWK�HLJKW�FRXQWULHV� FRQWLQXRXVO\�FKDOOHQJLQJ�DQG�VXSSRUWLQJ�HDFK� RWKHU�WR�LPSURYH�&6��WKH�LQLWLDWLYH�KDV�EHHQ�D�JUHDW� VXFFHVV��)RU�HYHU\�&6�LPSURYHPHQW�LQ�RQH�FRXQWU\�� SROLF\PDNHUV�DQG�WHFKQLFDO�PDQDJHUV�LQ�RWKHU� The Regional Initiative brings countries together to share lessons and solutions, which are then translated into results nationally. FRXQWULHV�HPXODWH�WKHLU�QHLJKERU·V�DFKLHYHPHQW�� &RXQWULHV�SDUWLFLSDWLQJ�LQ�WKH�/$&�&6�LQLWLDWLYH� LQFOXGH�%ROLYLD��WKH�'RPLQLFDQ�5HSXEOLF��(O�6DOYDGRU�� *XDWHPDOD��+RQGXUDV��1LFDUDJXD��3DUDJXD\��DQG�3HUX�� “!e regional initiative helps us see ourselves re#ected in other countries, share experiences, and strengthen di$erent areas of the family planning program.” Dr. José Delancer, Director of the Maternal, Child, and Adolescent Health Department, Ministry of Health, Dominican Republic USAID Phasing Out Support to Latin America ,Q�WKH�����V��86$,'�EHJDQ�WR�SKDVH�RXW�IDPLO\� SODQQLQJ�VXSSRUW�WR�&KLOH��&RVWD�5LFD��&RORPELD�� 0H[LFR��DQG�%UD]LO��7RGD\��WKHVH�ÀYH�FRXQWULHV� PDLQWDLQ�D�KLJK�OHYHO�RI �IDPLO\�SODQQLQJ�FRYHUDJH�ZLWK� D�PRGHUQ�FRQWUDFHSWLYH�SUHYDOHQFH�UDWH�RI ����SHUFHQW� DQG�DERYH��$FKLHYLQJ�VXFK�VXFFHVV�ZDV�RIWHQ�GLIÀFXOW�� VRPH�LQVWLWXWLRQV�ZHUH�QRW�SUHSDUHG�WR�ÀQDQFH�DQG� PDQDJH�WKHLU�IDPLO\�SODQQLQJ�SURJUDPV��,Q�&KLOH��WKH� ,QWHUQDWLRQDO�3ODQQHG�3DUHQWKRRG�)HGHUDWLRQ��,33)�� DIÀOLDWH�$352)$��ZKRVH�86$,'�IXQGLQJ�ZDV�FXW�� KDG�D�GUDPDWLF�UHGXFWLRQ�LQ�VHUYLFHV³IURP����FOLQLFV� LQ�WKH�����V�WR�RQO\�ÀYH�LQ������� 7HQ�\HDUV�ODWHU��DGGLWLRQDO�FRXQWULHV�EHJDQ�WR� SKDVH�RXW³WKH�'RPLQLFDQ�5HSXEOLF��(O�6DOYDGRU�� +RQGXUDV��-DPDLFD��1LFDUDJXD��3DUDJXD\��DQG�3HUX�� 7KLV�WLPH��86$,'�DQG�UHJLRQDO�IDPLO\�SODQQLQJ� DGYRFDWHV�PDGH�VXUH�WKDW�HYHU\�FRXQWU\�FRXOG�ÀQDQFH�� SURFXUH��DQG�GHOLYHU�IDPLO\�SODQQLQJ�VHUYLFHV�DQG� VXSSOLHV�DV�WKH�SKDVH�RXW�SURJUHVVHG���� :LWK�OHVVRQV�OHDUQHG�IURP�WKH�SKDVH�RXWV��WKH�86$,'� /$&�5HJLRQDO�%XUHDX�UHDOL]HG�PDQ\�FRXQWULHV� VWUXJJOHG�WR�HQVXUH�ORQJ�WHUP�SURGXFW�DYDLODELOLW\�� 1DWLRQDO�IDPLO\�SODQQLQJ�SURJUDPV��QRQJRYHUQPHQWDO� Since 2000, seven of the countries participating in the Regional Initiative have seen an increase in contraceptive use ranging from 3 to 10 percent. RUJDQL]DWLRQV��1*2V���DQG�VRFLDO�PDUNHWLQJ� SURJUDPV�LQ�DOO�WKH�FRXQWULHV�IDFHG�PDMRU�FRQVWUDLQWV� LQ�DFKLHYLQJ�VXVWDLQDELOLW\�LQ�FRQWUDFHSWLYH�ÀQDQFLQJ�� SURFXUHPHQW��DQG�VHUYLFH�SURYLVLRQ��7KH\�DVNHG��LI �WKH� LVVXHV�DUH�VLPLODU�LQ�PRVW�FRXQWULHV��FDQ�DOO�WKH�FRXQWULHV�VKDUH� WKH�VROXWLRQV"�2Q�WKLV�EDVLV��WKH\�HVWDEOLVKHG�WKH�/$&� &6�5HJLRQDO�,QLWLDWLYH�� © 2 00 9 St ep ha ni e V an de nB er g, Co ur te sy o f P ho to sh ar e. Two teenage girls, carrying their sons on their backs, visit a health clinic in Otavalo, Ecuador, a small Andean village. They walked down the mountainside to visit the clinic. 2 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Contraceptive Use Increases in Latin America 0RVW�RI� WKH�/DWLQ�$PHULFDQ�FRXQWULHV�KDYH�PDGH� GUDPDWLF�JDLQV�LQ�FRQWUDFHSWLYH�SUHYDOHQFH�UDWHV� �&35��VLQFH�WKH�PLG� WR�ODWH�����V��'XULQJ�WKLV�WLPH�� JRYHUQPHQWV�DQG�WKHLU�SDUWQHUV�PDGH�PDQ\�FKDQJHV� WR�LQFUHDVH�GHPDQG�IRU�IDPLO\�SODQQLQJ��WKH\�LPSURYHG� VHUYLFH�GHOLYHU\��VWUHQJWKHQHG�WKH�VXSSO\�FKDLQV��DQG� SURPRWHG�IDPLO\�SODQQLQJ��7KH�5HJLRQDO�,QLWLDWLYH� VXSSRUWHG�DOO�RI� WKHVH�HIIRUWV�E\�EULQJLQJ�FRXQWULHV� WRJHWKHU�WR�VKDUH�WKHLU�H[SHULHQFHV��0DQ\�PRUH� ZRPHQ�DQG�PHQ�LQ�/DWLQ�$PHULFD�QRZ�KDYH�DFFHVV�WR� WKH�FRQWUDFHSWLYHV�WKH\�QHHG��DOWKRXJK�WKHUH�DUH�VWLOO� LQHTXLWLHV�DPRQJ�VSHFLÀF�DUHDV�DQG�SRSXODWLRQV�� Supply Chains—a Key to Accessing Contraceptives 7R�UHDFK�WKH�JRDO�RI �JLYLQJ�HYHU\�ZRPDQ�DQG�PDQ� WKH�DELOLW\�WR�FKRRVH��REWDLQ��DQG�XVH�FRQWUDFHSWLYHV�� VXSSO\�FKDLQV�PXVW�EH�LQ�SODFH�WR�EULQJ�SURGXFWV�WR� WKH�FOLHQWV��6LQFH�������WKH�5HJLRQDO�,QLWLDWLYH�KDV� KHOSHG�FRXQWULHV�PDNH�VXSSO\�FKDLQ�DQG�FRQWUDFHSWLYH� VHFXULW\�LPSURYHPHQWV�E\³� „�PRELOL]LQJ�IXQGHG�EXGJHW�OLQHV�IRU�FRQWUDFHSWLYH� SURFXUHPHQW� „�HVWDEOLVKLQJ�VWURQJHU�SURFXUHPHQW�PHFKDQLVPV� IRU�REWDLQLQJ�TXDOLW\�FRQWUDFHSWLYHV�DW�FRPSHWLWLYH� SULFHV� Contraceptive use can only increase if a well- functioning supply chain is in place to bring health commodities to the clients who need them. „�VWUHQJWKHQLQJ�VXSSO\�FKDLQV�IRU�IDPLO\�SODQQLQJ� SURJUDPV�DQG�DOO�HVVHQWLDO�PHGLFLQHV� „�PDLQWDLQLQJ�DQG�VWUHQJWKHQLQJ�VXSSO\�FKDLQV�GXULQJ� KHDOWK�UHIRUP�SURFHVV��LQFOXGLQJ�GHFHQWUDOL]DWLRQ� DQG�LQWHJUDWLRQ� „�HVWDEOLVKLQJ�PXOWLVHFWRULDO�&6�FRPPLWWHHV�WKDW� SURYLGH�FRRUGLQDWLRQ��DGYRFDF\��SODQQLQJ��DQG� DFWLRQ� „�FRPSOHWLQJ�DVVHVVPHQWV�DQG�PDUNHW�DQDO\VHV� OHDGLQJ�WR�QHZ�&6�VWUDWHJLHV�DQG�DQ�LQFUHDVLQJ� UHFRJQLWLRQ�RI �WKH�QHHG�IRU�D�SXEOLF��DQG�SULYDWH� VHFWRU�UHVSRQVH�WR�&6� „�FXOWLYDWLQJ�OHDGHUV�DQG�&6�FKDPSLRQV�ZLWKLQ�SXEOLF�� 1*2��DQG�FLYLO�VRFLHW\�VHFWRUV� „�VWUHQJWKHQLQJ�LQ�FRXQWU\�FDSDFLW\�IRU�GDWD�GULYHQ� GHFLVLRQPDNLQJ�� 7KH�LQFUHDVH�LQ�&35�UDWHV�LQ�/DWLQ�$PHULFD�VKRZV� DQ�LQFUHDVHG�OHYHO�RI �VHUYLFH�SURYLVLRQ�RYHUDOO�� 7KLV�ZDV�RQO\�SRVVLEOH�ZLWK�D�SDUDOOHO�LQFUHDVH�LQ� DYDLODELOLW\�RI �WKH�FRPPRGLWLHV�QHHGHG�WR�SURYLGH� WKHVH�VHUYLFHV��(YHQ�ZLWK�SROLWLFDO�ZLOO�DQG�D�IDYRUDEOH� SROLF\�IUDPHZRUN��RQO\�D�UREXVW�VXSSO\�FKDLQ�FDQ� HQVXUH�FRQWUDFHSWLYHV�IRU�WKRVH�ZKR�QHHG�WKHP�� 7KHVH�LPSURYHPHQWV�KDYH�JHQHUDWHG�LQFUHDVHG�FOLHQW� VDWLVIDFWLRQ�DQG�WUXVW�LQ�IDPLO\�SODQQLQJ�VHUYLFHV�� Modern Contraceptive Use in LAC Countries (women in union) �� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� %ROLYLD� 'RPLQLFDQ� (O�6DOYDGRU� *XDWHPDOD�� +RQGXUDV� 1LFDUDJXD� 3DUDJXD\� 3HUX� 5HSXEOLF� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� �� ��� ��� ��� ��� ��� ��� ��� ��� Notes: Data from the Demographic Health and Reproductive Health Surveys for all countries and years. http://www.measuredhs. com/accesssurveys/ and http://www.cdc.gov/reproductivehealth/surveys/SurveyCountries.htm 3 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Political Will Transforms the Future of Contraceptive Security ,Q�PDQ\�FRXQWULHV��DFFHVV�WR�IDPLO\�SODQQLQJ�LV�D�KLJK� SULRULW\�LQ�FRPEDWLQJ�SRYHUW\�DQG�ZRUNLQJ�WRZDUG� WKHLU�PLOOHQQLXP�GHYHORSPHQW�JRDOV��*XDWHPDOD�DQG� 3DUDJXD\�KDYH�SDVVHG�ODZV�WKDW�SURWHFW�ÀQDQFLQJ�DQG� DFFHVV�WR�IDPLO\�SODQQLQJ�VHUYLFHV�DQG�VXSSOLHV³� DFWLRQV�HQFRXUDJHG�E\�WKH�5HJLRQDO�,QLWLDWLYH�� Sectors Collaborate to Provide Family Planning Services ,Q�VHYHUDO�FRXQWULHV��WKH�5HJLRQDO�,QLWLDWLYH�KDV�SOD\HG� D�NH\�UROH�LQ�IRVWHULQJ�LQFUHDVHG�FRRUGLQDWLRQ�EHWZHHQ� IDPLO\�SODQQLQJ�VHUYLFH�SURYLGHUV��&RXQWU\�OHDGHUV�KDYH� UHFRJQL]HG�WKH�YDOXH�RI�PXOWLVHFWRUDO�&6�FRPPLWWHHV� WKDW�LPSURYH�FRPPRGLW\�DYDLODELOLW\�E\�LQFUHDVLQJ� LQWHUVHFWRUDO�FRRUGLQDWLRQ�DQG�DGYRFDWLQJ�IRU�&6�� ,Q�������&6�FRPPLWWHHV�LQ�+RQGXUDV�DQG�1LFDUDJXD� MRLQHG�QHZ�1*2�RU�SULYDWH�VHFWRU�SDUWQHUV�WR� FRRUGLQDWH�WKHLU�IDPLO\�SODQQLQJ�VHUYLFH�SURYLVLRQ�� ZKLFK�DOORZHG�WKH�02+�UHSUHVHQWDWLYHV�LQ� ERWK�FRXQWULHV�WR�XQGHUVWDQG�WKH�LPSRUWDQFH�RI� FRRUGLQDWLQJ�ZLWK�RWKHU�VHFWRUV�WR�UHDFK�XQGHUVHUYHG� SRSXODWLRQV��7KH�1*2�DQG�SULYDWH�VHFWRU� SDUWLFLSDQWV�OHDUQHG�KRZ�WR�JHW�VXSSRUW�IURP�WKH� 02+�WR�EHWWHU�VHUYH�WKHLU�FXVWRPHUV·�QHHGV�� Supply Chains provide the health products that make family planning programs possible. Here, mothers wait at the health community center in the village of Santabal in Quiche, Guatemala. © 2 00 9 El lie B ur le ig h, Co ur te sy o f J SI Government Coordination Helps Underserved Populations In recent years, after learning more about the family planning market from various regional studies and events, CS committee members in eight countries identi!ed major gaps and duplication of effort in family planning service provision between the MOHs and the social security institutions (SSI). By better coordination of resources and activities, some countries improved access to family planning for underserved populations. For example, the share of FP services provided by social security institutes has increased in Guatemala, Paraguay, and Nicaragua in recent years, which has relieved !nancial pressure on the MOHs and helped them expand their coverage of the poor (Demographic and Reproductive Health Surveys). Paraguay Passes Law to Protect Contraceptive Security In 2006, Paraguay’s congress enacted a law, Funding for Reproductive Health Commodities and Safe Birth Kits, that directly earmarks funds for reproductive health commodities, including contraceptives.This law guarantees funding for commodities and helps sustain contraceptive availability. Guatemalan Congress Sets Family Planning Law in Motion In 2005, an unprecedented initiative was presented to Guatemala’s congress to strengthen the policy framework for family planning. It went further than any previous political action ever taken by requiring the government to ensure and monitor the !nancing and provision of family planning services and supplies. One of the mandates of the Universal and Equitable Access to Family Planning Services Law was to form a monitoring CS committee to address the key challenges to securing stable !nancing of contraceptives. 4 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Sustaining Contraceptive Security by Strengthening Procurement ,Q�������WKH�5HJLRQDO�,QLWLDWLYH�UHFRJQL]HG�WKDW� SURFXUHPHQW�ZDV�D�PDMRU�SUREOHP�LQ�VHFXULQJ�D� VWHDG\�ÁRZ�RI �FRQWUDFHSWLYHV�WR�WKH�/$&�FRXQWULHV�� PDQ\�VWRFNRXWV�ZHUH�FDXVHG�E\�ERWWOHQHFNV�LQ�WKH� SURFXUHPHQW�SURFHVV�� 7R�KHOS�DGGUHVV�WKLV�FKDOOHQJH��WKH�5HJLRQDO�,QLWLDWLYH� FRQYHQHG�D�PXOWLSDUWQHU�WHDP³WKH�86$,'�_� '(/,9(5�352-(&7��86$,'�_�+($/7+�32/,&<� 352-(&7��86$,'�PLVVLRQV��WKH�8�1��3RSXODWLRQ� )XQG��81)3$���DQG�KRVW�FRXQWU\�JRYHUQPHQWV³WR� VWXG\�WKH�FRQWUDFHSWLYH�SURFXUHPHQW�VLWXDWLRQ�DQG� LGHQWLI\�YLDEOH�RSWLRQV�IRU�FRXQWULHV�ZLWK�VLPLODU� UHJXODWRU\�DQG�WHFKQLFDO�FRQVWUDLQWV�� 2QFH�WKH�WHDP�KDG�D�SODQ�DQG�FOHDU� UHFRPPHQGDWLRQV³EDVHG�RQ�H[WHQVLYH�UHVHDUFK��KLJK� OHYHO�GLVFXVVLRQV�ZLWK�81)3$·V�SURFXUHPHQW�VHUYLFHV� EUDQFK��FRQVXOWDWLRQV�ZLWK�H[SHUWV�LQ�SURFXUHPHQW� UHJXODWLRQV��DQG�ORFDO�FRXQWU\�VXUYH\V²²WKH\� GHYHORSHG�DGYRFDF\�PHVVDJHV�DQG�WDUJHWHG�WHFKQLFDO� DVVLVWDQFH�WR�VWUHQJWKHQ�FRQWUDFHSWLYH�SURFXUHPHQW�LQ� FRXQWULHV��RQH�E\�RQH��IURP������WKURXJK������� ,Q�������WKH�5HJLRQDO�,QLWLDWLYH��LQ�FROODERUDWLRQ� ZLWK�81)3$��EURXJKW�WRJHWKHU�NH\�VWDII �IURP�QLQH� FRXQWULHV�WR�OHDUQ�IURP�HDFK�RWKHU·V�VXFFHVVHV�DQG� FKDOOHQJHV��7KH\�XVHG�WKH�UHJLRQDO�UHVHDUFK�ÀQGLQJV� WR�WKLQN�VWUDWHJLFDOO\�DERXW�KRZ�WR�IXUWKHU�LPSURYH� SURFXUHPHQW�LQ�HDFK�RI �WKHLU�FRXQWULHV��7KHQ��WKRVH� A Bolivian technical advisor visits Nicaragua to share her supply chain management expertise and explore ways the two countries can learn from one another to strengthen contraceptive security. U SA ID | D EL IV ER P RO JE CT Results through Collaboration „� In 2005, El Salvador’s Ministry of Health (MOH) saved U.S.$3 million by procuring through UNFPA, rather than bidding on the local national market. „�Nicaragua’s MOH saved U.S.$106,200 and U.S.$320,000 in 2008 and 2009, respectively, by procuring through UNFPA. „�El Salvador halved the time it takes to execute procurements though UNFPA from eight months to just four months. „� In 2006, various Peruvian government agencies pooled their needs and procured 165 essential medicines including contraceptives through reverse auction, saving approximately U.S.$14 million. „� In 2010, prices for injectable contraceptives were reduced from U.S.$1.18 through UNFPA in 2005 to U.S.$0.41 through national procurement in Peru. LQGLYLGXDOV�ZHQW�EDFN�KRPH�DQG�SURYLGHG�VLPLODU� VXSSRUW�DW�WKH�QDWLRQDO�OHYHO�� 7KHVH�VWUDWHJLF�LQWHUYHQWLRQV�SURYLGHG�VXSSRUW� ERWK�DW�WKH�/$&�UHJLRQDO�DQG�DW�WKH�QDWLRQDO�OHYHO� LQ�HDFK�FRXQWU\��WKH\�KDYH�UHVXOWHG�LQ�PRUH�HIÀFLHQW� SURFXUHPHQW�DQG�VXEVWDQWLDO�FRVW�VDYLQJV�LQ�DW�OHDVW� VL[�RI �WKH�HLJKW�FRXQWULHV�� 7KH�5HJLRQDO�,QLWLDWLYH�DOVR�LGHQWLÀHG�FRXQWULHV�DFWLYHO\� H[SORULQJ�PRUH�VXVWDLQDEOH�DQG�FRPSOHPHQWDU\� SURFXUHPHQW�RSWLRQV�IRU�HVVHQWLDO�PHGLFLQHV�DQG� FRQWUDFHSWLYHV��LQFOXGLQJ�UHYHUVH�DXFWLRQ³D�ELGGLQJ� SURFHVV�ZKHUH�WKH�VXSSOLHU�RI� D�JRRG�LV�FKRVHQ�EDVHG� RQ�WKH�EHVW�SULFH�RIIHUHG��WHFKQLFDO�FKDUDFWHULVWLFV�RI� WKH�JRRG�DUH�SUHGHÀQHG�DQG�DSSOLHG�DV�D�PLQLPXP� VWDQGDUG�IRU�SDUWLFLSDWLQJ�LQ�WKH�DXFWLRQ��8VLQJ�UHYHUVH� DXFWLRQ��3HUX�KDV�VXFFHVVIXOO\�SURFXUHG�TXDOLW\�ORZ� SULFHG�FRQWUDFHSWLYHV�DQG�HVVHQWLDO�PHGLFLQHV�� “!e Cartagena workshop was extremely bene"cial for me; I shared our current situation with sexual and reproductive health with other countries in the region and then created a mechanism for reaching out to professionals from other countries.” Edgar SamudioSexual and Reproductive Health Director, Social Security Institute, Paraguay 5 � Mobilizing Country Financing to Meet Demand for Family Planning :LWK�ULVLQJ�GHPDQG�IRU�IDPLO\�SODQQLQJ�VHUYLFHV� DQG�GHFOLQLQJ�DVVLVWDQFH�IURP�86$,'��FRQWUDFHSWLYH� VHFXULW\�DGYRFDWHV�KDYH�HQFRXUDJHG�FRXQWULHV�WR� JUDGXDOO\�LQFUHDVH�WKHLU�IXQGV�WR�HYHQWXDOO\�FRYHU����� SHUFHQW�RI �WKHLU�FRQWUDFHSWLYH�QHHGV�� 8VLQJ�PXOWLSOH�DSSURDFKHV³UHVHDUFK�SDSHUV�� SUHVHQWDWLRQV��WUDLQLQJV��DQG�DGYRFDF\�HYHQWV³� GRQRUV��WHFKQLFDO�DVVLVWDQFH�SURYLGHUV��DQG�ORFDO� FRXQWHUSDUWV�KDYH�KHOSHG�FRXQWULHV�DFFXUDWHO\�IRUHFDVW� GHPDQG��SUHSDUH�EXGJHWV��DQG�JHQHUDWH�VXIÀFLHQW� IXQGV�WR�FRYHU�WKHLU�FRQWUDFHSWLYH�QHHGV��7KH� 5HJLRQDO�,QLWLDWLYH�KDV�PRQLWRUHG�WKHVH�FRPPLWPHQWV�� SURYLGHG�PDQ\�RI �WKH�WRROV��DQG�HQFRXUDJHG� FRXQWULHV�WR�LQFUHDVH�WKHLU�IXQGLQJ�IRU�FRQWUDFHSWLYH� SURFXUHPHQW�� 7R�OHDUQ�PRUH�DERXW�FRQWUDFHSWLYH�ÀQDQFLQJ�DQG� SURFXUHPHQW�LQ�/$&�� „�2SWLRQV�IRU�&RQWUDFHSWLYH�3URFXUHPHQW��/HVVRQV� /HDUQHG�IURP�/DWLQ�$PHULFD�DQG�WKH�&DULEEHDQ�� ������$YDLODEOH�LQ�(QJOLVK�DQG�6SDQLVK�� „�5HJXODWRU\�+DUPRQL]DWLRQ�LQ�&HQWUDO�$PHULFD�� +RZ�+DUPRQL]DWLRQ�&DQ�,PSDFW�5HJLRQDO� &RQWUDFHSWLYH�3URFXUHPHQW��������$YDLODEOH�LQ� (QJOLVK�DQG�6SDQLVK�� „�0HMRUDQGR�ORV�0HFDQLVPRV�GH�&RPSUD�GH� ,QVXPRV�$QWLFRQFHSWLYRV�������� „�/D�$GTXLVLFLyQ�GH�$QWLFRQFHSWLYRV�HQ�$PpULFD� /DWLQD�\�HO�&DULEH�8Q�$QiOLVLV�GH�2SFLRQHV� $FWXDOHV�\�)XWXUDV�HQ�2FKR�3DtVHV�������� Contraceptive Financing from Country Governments 2006–2009 �� ���� ���� ���� ���� ���� ���� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� ��� �� �� �� �� ����� �������� ����� ��� ����� ��� ��� ��� ��� ��� � 'RPLQLFDQ� (O�6DOYDGRU� *XDWHPDOD� +RQGXUDV� 1LFDUDJXD� 3DUDJXD\� 3HUX 5HSXEOLF Source: Olson, Nadia,Anabella Sánchez,Ángel Reynoso, y Nora Quesada. 2010. La Adquisición de Anticonceptivos en América Latina y el Caribe: Un Análisis de Opciones Actuales y Futuras en Ocho Países. Arlington,Va.: USAID | PROYECTO DELIVER, Orden de Trabajo 1. Notes: Donors provide the remaining funds to cover total public sector need in each country. 6 The Road Ahead 'HVSLWH�PXFK�SURJUHVV�RYHU�WKH�SDVW�GHFDGH��PDQ\� /$&�FRXQWULHV�IDFH�FKDOOHQJHV�LQ�SURYLGLQJ�IDPLO\� SODQQLQJ�VHUYLFHV��:RPHQ�OLYLQJ�LQ�UXUDO�DUHDV�� WKH�ORZHVW�VRFLRHFRQRPLF�JURXSV��WKH�\RXQJ��WKH� OHVV�HGXFDWHG��DQG�VSHFLÀF�HWKQLF�JURXSV�VWLOO�KDYH� VLJQLÀFDQWO\�ORZHU�UDWHV�RI �PRGHUQ�FRQWUDFHSWLYH�XVH� FRPSDUHG�WR�RWKHU�JURXSV�� ,Q�%ROLYLD��*XDWHPDOD��3HUX��+RQGXUDV��3DUDJXD\��(O� 6DOYDGRU��1LFDUDJXD��DQG�WKH�'RPLQLFDQ�5HSXEOLF�� &35�LV�DQ�DYHUDJH�RI ���SHUFHQW�ORZHU�LQ�UXUDO�DUHDV� WKDQ�LQ�XUEDQ�DUHDV��LW�LV�XS�WR����DQG����SHUFHQWDJH� SRLQWV�ORZHU�LQ�*XDWHPDOD�DQG�%ROLYLD��UHVSHFWLYHO\�� /$&�FRXQWULHV�KDYH�PDGH�WUHPHQGRXV�SURJUHVV�E\� RIIHULQJ�IUHH�DQG�ORZ�FRVW�FRQWUDFHSWLYHV��EXW�PRVW� &6�DGYRFDWHV�NQRZ�WKH\�ZLOO�QHHG�WR�ZRUN�KDUGHU�WR� PDLQWDLQ�WKH�JDLQV�DFKLHYHG�LQ�UHFHQW�\HDUV��WR�H[WHQG� VHUYLFHV�WR�XQGHUVHUYHG�JURXSV��DQG�WR�VDWLVI\�WKH� UHPDLQLQJ�XQPHW�QHHG�IRU�IDPLO\�SODQQLQJ�WKURXJKRXW� WKH�UHJLRQ��6RPH�DUHDV�IRU�IXWXUH�IRFXV�LQFOXGH³� „�FRQWLQXH�WR�PDLQWDLQ�UREXVW�DQG�HIIHFWLYH�VXSSO\� FKDLQV�GXULQJ�KHDOWK�VHFWRU�UHIRUP� „�GHYHORS�DOWHUQDWLYH�DQG�VXVWDLQDEOH�SURFXUHPHQW� RSWLRQV� „�HQVXUH�DGHTXDWH�DQG�VXVWDLQDEOH�ÀQDQFLQJ�IRU� GLVWULEXWLQJ�FRQWUDFHSWLYHV�DQG�RWKHU�HVVHQWLDO� PHGLFLQHV� „�XVH�SUDFWLFDO�DQG�LQQRYDWLYH�GDWD�GULYHQ�WRROV�WR� DQDO\]H�WKH�IDPLO\�SODQQLQJ�PDUNHW�DQG�UHGXFH� GLVSDULWLHV�DQG�JDSV�LQ�DFFHVV� Woman receiving family planning services in Paraguay. © 2 00 9 El lie B ur le ig h, Co ur te sy o f U SA ID P ar ag ua y The Regional Initiative’s highly interactive and participatory approach has shown that, by sharing challenges, solutions, and successes, country representatives are inspired to return home and develop customized CS strategies that work. „�LPSOHPHQW�FUHDWLYH�VWUDWHJLHV�IRU�UHDFKLQJ�WKH�PRVW� YXOQHUDEOH�DQG�GLIÀFXOW�WR�DFFHVV�SRSXODWLRQV�ZLWK� D�EDVLF�SDFNDJH�RI �KHDOWK�VHUYLFHV��LQFOXGLQJ�IDPLO\� SODQQLQJ� „�FRQWLQXH�WR�XVH�WKH�FROODERUDWLYH�FRQWUDFHSWLYH� VHFXULW\�DSSURDFK�IRU�VWUHQJWKHQLQJ�KHDOWK�V\VWHPV� „�KHOS�ORFDO�VWDNHKROGHUV�DQG�GRQRUV�UHFRJQL]H�WKH� VXSSO\�FKDLQ�DV�D�VWUDWHJLF�SLOODU�IRU�DFKLHYLQJ� SXEOLF�KHDOWK�JRDOV� 7KH�5HJLRQDO�,QLWLDWLYH·V�KLJKO\�LQWHUDFWLYH�DQG� SDUWLFLSDWRU\�DSSURDFK�KDV�VKRZQ�WKDW��E\�VKDULQJ� FKDOOHQJHV��VROXWLRQV��DQG�VXFFHVVHV��FRXQWU\� UHSUHVHQWDWLYHV�DUH�LQVSLUHG�WR�UHWXUQ�KRPH�DQG� GHYHORS�FXVWRPL]HG�&6�VWUDWHJLHV�WKDW�ZRUN�� 2WKHU�SURJUDPV�DQG�LQLWLDWLYHV�LQ�WKH�/$&�KHDOWK�VHFWRU�� DQG�RWKHU�UHJLRQV�RI �WKH�ZRUOG��FDQ�EHQHÀW�IURP�DSSO\LQJ�WKH� SULQFLSOHV�RI �WKH�5HJLRQDO�,QLWLDWLYH�� !rough the regional initiative we have had the opportunity to work on the issue of contraceptive availability and this has helped us improve services at the country level. As for the regional meetings, they provided crucial assistance. We had the opportunity to share experiences with other countries and this helped us to broaden our approach to the topic and allowed us to move forward. Having this support strengthens us. Dr. Esmeralda Ramirez, Director Reproductive Health Department, Ministry of Health, El Salvador 7 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � Bu ild in g O w ne rs hi p fo r C on tr ac ep tiv e Se cu rit y T hr ou gh a R eg io na lA pp ro ac h Pu bl ic -P ub lic A lli an ce s fo r Eq ui ty in F P W or ks ho p M an ag ua , N ic ar ag ua , M ay r� 1V CM JD� JO TU JUV UJP OT �D PN N JU� UP �C FU UF S� co or di na tin g se rv ic es . r� *O DS FB TF E� DP N N JUN FO U�P G� 4P DJB M�4 FD VS JUZ �*O TU JUV UF T UP �TU SF OH UI FO �' 1� QS PH SB N T� r� *O DS FB TF E� DP WF SB HF �JO � TP N F� DP VO US JF T�� R ep ro du ct iv e H ea lth Su pp lie s C oa lit io n G lo ba l C S Ev en t on L A C Lo nd on , E ng la nd , A pr il r� 4I BS FE �- "$ �B QQ SP BD I� gl ob al ly . r� 3F DP HO J[F E� DP VO US JFT �GP S po lic y, s up pl y ch ai n, a nd QS PD VS FN FO U�N PE FM T�� A dv oc at in g fo r C S Ev en t A nt ig ua , G ua te m al a, S ep te m be r r� 4I BS FE �D PV OU SZ �N BS LF U�B OB MZT FT �� r� 4U SF OH UI FO FE �D PV OU SZ �D PN N JUN FO U�U P� JN QS PW JO H� BD DF TT �UP �' 1� � La un ch in g LA C C S *O JUJ BU JWF �' PS VN M an ag ua , N ic ar ag ua , J ul y r� $ PN QM FU FE �D PV OU SZ �S FH JP OB M� BT TF TT N FO UT � r� 'P SN FE �N PT U�P G�- "$ � $ 4� DP N N JUU FF T�� Su cc es se s an d C ha lle ng es to A ch ie ve C S Ev en t P un ta C an a, D om in ic an R ep ub lic , J un e Se ve n co un tr ie s sig n a de cl ar at io n BG àS N JO H UI FJ S�D PN N JUN FO U to C S. Eq ui ty a nd C S Ev en t A nt ig ua , G ua te m al a, Se pt em be r St re ng th en ed co un tr y DP N N JUN FO U�U P� JN QS PW JOH ac ce ss to FP . O pt io ns fo r C on tr ac ep tiv e 1S PD VS FN FO U�8 PS LT IP Q C ar ta ge na , C ol om bi a, S ep te m be r r�1 BS UJD JQ BO UT �P SJF OU FE �UP �C FT U�Q SB DU JDF T GP S� QS PD VS FN FO U� r�1 BS UO FS T�C FU UF S� JO GP SN FE �to su pp or t t he se pr ac tic es . r�1 SP DV SF N FO U�N FD IB OJT N T JN QS PW FE in s ev er al co un tr ie s. LA C C S St at e of t he Pr ac tic e Ev en t W as hi ng to n, D C , U SA , S ep te m be r r� % PO PS T�B OE �Q BS UO FS T�D PN N JUU FE � UP �D PP SE JO BU JO H� $ 4� N PS F� DMP TF MZ� r� -" $ �S FD PH OJ [F E� BT �B �H MP CB M� C S le ad er . 3F HJP OB M�- "$ �$ 4� 'P SV N Li m a, P er u, O ct ob er r� "T TF TT N FO UT �Q SF TF OU FE �� r� $ PV OU SZ �$ 4� BD UJP O pl an s de ve lo pe d. Su pp ly C ha in u nd er H ea lth 3F GP SN �8 PS LT IP Q Sa nt o D om in go , D om in ic an R ep ub lic , S ep te m be r r� 4V QQ MZ� DI BJO �B OE �$ 4� SF DP HO J[F E� as b ui ld in g bl oc ks o f IF BMU I� SF GP SN � r� '1 �C FU UF S�Q SP UF DU FE du ri ng in te gr at io n BO E� EF DF OU SB MJ[ BU JP O� � In th e su m m er o f 2 00 3, U SA ID 's B ur ea u fo r L at in A m er ic a an d th e C ar ib be an (L A C ) l au nc he d a re gi on al in iti at iv e to st re ng th en co nt ra ce pt iv e se cu rit y (C S) in e ig ht c ou nt rie s. Ei gh t y ea rs la te r, th e LA C C S R eg io na l I ni tia tiv e ha s b ui lt a So ut h- to -S ou th e xc ha ng e ne tw or k by m ot iv at in g co un tr y- le ve l C S ch am pi on s t o w or k to ge th er to w ar d ac hi ev in g a co m m on go al i nc re as in g ac ce ss to fa m ily p la nn in g (F P) se rv ic es a nd su pp lie s t hr ou gh ou t t he re gi on . 20 10 20 09 20 08 20 07 20 06 20 05 20 04 20 03 � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � From the Implementers ,Q�������86$,'·V�%XUHDX�IRU�/DWLQ�$PHULFD�DQG�WKH�&DULEEHDQ��/$&��ODXQFKHG�WKH�/$&�&RQWUDFHSWLYH�6HFXULW\��&6�� 5HJLRQDO�,QLWLDWLYH�WR�VWUHQJWKHQ�&6�DQG�EXLOG�D�VRXWK�WR�VRXWK�H[FKDQJH�QHWZRUN�WR�KHOS�VXVWDLQ�FRXQWULHV�ZKHUH�86$,'� GRQDWLRQV�DQG�IDPLO\�SODQQLQJ�WHFKQLFDO�DVVLVWDQFH�DUH�EHLQJ�SKDVHG�RXW�� 7KH�5HJLRQDO�,QLWLDWLYH�EULQJV�FRXQWULHV�WRJHWKHU�WR�VKDUH�OHVVRQV�DQG�VROXWLRQV��ZKLFK�DUH�WKHQ�WUDQVODWHG�LQWR�UHVXOWV� QDWLRQDOO\��:LWK�HLJKW�FRXQWULHV�FRQWLQXRXVO\�FKDOOHQJLQJ�DQG�VXSSRUWLQJ�HDFK�RWKHU�WR�LPSURYH�&6��WKH�LQLWLDWLYH�KDV� EHHQ�D�JUHDW�VXFFHVV��)RU�HYHU\�&6�LPSURYHPHQW�LQ�RQH�FRXQWU\��SROLF\PDNHUV�DQG�WHFKQLFDO�PDQDJHUV�LQ�RWKHU�FRXQWULHV� HPXODWH�WKHLU�QHLJKERU·V�DFKLHYHPHQW�� &RXQWULHV�SDUWLFLSDWLQJ�LQ�WKH�/$&�&6�LQLWLDWLYH�LQFOXGH�%ROLYLD��WKH�'RPLQLFDQ�5HSXEOLF��(O�6DOYDGRU��*XDWHPDOD�� +RQGXUDV��1LFDUDJXD��3DUDJXD\��DQG�3HUX�� Interview with Maria Rosa Gárate Maria Rosa, what is the key to the Regional Initiative's success; what is an example of one success? 7KH�VXFFHVVHV�DUH�QRW�LVRODWHG��7KH\�UHVXOW�IURP�WKH�V\QHUJ\�RI �SDUWQHUV·�HIIRUWV��WKH�OHVVRQV�OHDUQHG��DQG�WKH�RQJRLQJ� FRPPLWPHQW�RI �WKH�&6�FKDPSLRQV��ZKLFK�FDQ�EH�WKH�PRVW�GLIÀFXOW�� 7KH�DQQXDO�PHHWLQJV�KDYH�EHHQ�D�JRRG�YHQXH�IRU�/$&�&6�FRPPLWWHH� PHPEHUV�WR�JLYH�IHHGEDFN��&KDPSLRQV�PXVW�QRW�OHW�SUREOHPV� Ms. Gárate is the Regional Advisor for GLVFRXUDJH�WKHP�RU�WDNH�EUHDNV�ZKHQ�WKH�JRDOV�DSSHDU�WR�EH�PHW�� Latin America and the Caribbean for the 0DMRU�VHWEDFNV�KDSSHQ�ZKHQ�ZH�WKLQN�WKDW�HYHU\WKLQJ�KDV�EHHQ�GRQH� LAC Contraceptive Security Initiative DQG�RU�DFKLHYHG��2XU�FRXQWULHV�KDYH�PDQ\�XSV�DQG�GRZQV��WKH\�QHHG� for the USAID Health Policy Project. She FRQVWDQW�VHQVLWL]LQJ��:H�PXVW�JLYH�WKHP�LQIRUPDWLRQ�WR�NHHS�SROLWLFDO� GHFLVLRQV�WKDW�DUH�IDYRUDEOH�WR�&6��RU�WR�PDNH�WKH�QHFHVVDU\�GHFLVLRQV� has more than 30 years of experience WR�HQVXUH�&6��&KDPSLRQV�VWUHQJWKHQ�VWUDWHJLF�SDUWQHUVKLSV�DQG�NHHS� monitoring and evaluating operational &6�RQ�WKH�SXEOLF��DQG�VRPHWLPHV�SROLWLFDO��DJHQGD�� research for reproductive health programs in both the public and private sectors. Why are CS issues so important for you and your team She has provided technical assistance on working in the region? management information systems and ,�EHOLHYH�WKDW�FRQWUDFHSWLRQ�LV�QRW�RQO\�D�ULJKW��EXW�DOVR�DQ�LQJUHGLHQW� provided FP training on quality healthcare IRU�LPSURYLQJ�WKH�TXDOLW\�RI �RXU�OLYHV��:H�PXVW�UHFRJQL]H�DQG� for many reproductive health programs SURPRWH�WKH�EHQHÀWV�RI �NQRZLQJ�DERXW�DQG�XVLQJ�FRQWUDFHSWLRQ�� in LAC. She has supported human rights, )DPLO\�SODQQLQJ�QRW�RQO\�UHGXFHV�IHUWLOLW\�UDWHV�DQG�VXSSRUWV�WKH�ULJKW� gender, and multiculturalism in Peru’s health WR�GHFLGH�RQ�IDPLO\�VL]H��LW�DOVR�ÀJKWV�SRYHUW\�DQG�VHHNV�HTXLW\�� system and initiated one of the !rst actions :H�PXVW�DOVR�UHPHPEHU�WKH�0LOOHQQLXP�'HYHORSPHQW�*RDOV��&6�FDQ� to eliminate the stigma and discrimination KHOS�XV�DFKLHYH�VHYHUDO�JRDOV³UHGXFH�PDWHUQDO�PRUWDOLW\��PLQLPL]H� against people living with HIV and AIDS. She PDOQXWULWLRQ�DQG�FKLOG�PRUWDOLW\��FRPEDW�+,9�DQG�$,'6��DQG�UHGXFH� JHQGHU�LQHTXDOLW\�DQG�VWUHQJWKHQ�ZRPHQ·V�HPSRZHUPHQW�� was responsible for the !rst training manual for HIV and AIDS service providers in the /DVW�\HDU�LQ�3XQWD�&DQD��'RPLQLFDQ�5HSXEOLF��DQ�DJUHHPHQW��VLJQHG� MOH in her country. E\�VHYHQ�FRXQWULHV��LGHQWLÀHG����NH\�LVVXHV�WR�VXVWDLQ�FRXQWU\� LPSURYHPHQWV�GXULQJ�WKH�86$,'�SKDVHRXW��&6�FRPPLWWHHV�PXVW�EH� LQVWLWXWLRQDOL]HG�DQG�DXWRQRPRXV��WKH�02+V�PXVW�LPSOHPHQW�&6� SROLFLHV��DQG�LQFOXGH�&6�UHVSRQVLELOLWLHV�LQ�WKH�GHFHQWUDOL]DWLRQ�UHIRUP�SURFHVVHV�� :H�PXVW�FRQVWDQWO\�VHHN�HIIHFWLYH�SROLWLFDO�FRPPLWPHQW��HQVXUH�SURWHFWHG�IXQGLQJ��DQG�VWUHQJWKHQ�FLWL]HQ�RYHUVLJKW� � Considerations for Continued Work Toward Contraceptive Security in LAC by Nora Quesada :H�KDYH�PDGH�D�ORW�RI �SURJUHVV�LQ�/$&��3RRU�IDPLOLHV�LQ�P\� FRXQWU\��&RORPELD��DQG�LQ�/DWLQ�$PHULFD�VWUXJJOH�WR�DFFHVV� Based in Colombia, Mrs. Quesada is IDPLO\�SODQQLQJ��:KHQ�WKH\�FDQQRW�JHW�WKH�SURGXFWV�WKH\�QHHG�� the Regional Director for LAC for WKH\�RIWHQ�IDFH�XQZDQWHG�SUHJQDQFLHV�DQG�GHDWKV�� the USAID | DELIVER PROJECT. She has 21 years of experience in 2XU�&6�ZRUN�VDYHV�OLYHV��LW�SUHYHQWV�XQLQWHQGHG�SUHJQDQFLHV�� family planning, reproductive health, DQG�DYHUWV�PDWHUQDO�DQG�FKLOG�GHDWKV��%XW��WKH�ZRUN�LV�QRW�GRQH�� procurement, budgeting, donor :H�VWLOO�KDYH�FRQWUDFHSWLYH�VWRFNRXWV³EXW�IHZHU�WKDQ�WHQ�\HDUV� coordination, commodity security, DJR�� private sector initiatives, HIV and AIDS, &RXQWULHV�DUH�IDFLQJ�86$,'�JUDGXDWLRQ�ZKLOH�DOVR�IDFLQJ� market segmentation, policy advocacy SURIRXQG�LQVWLWXWLRQDO�FKDQJHV��OLNH�KHDOWK�V\VWHP�LQWHJUDWLRQ� and change, and graduation plans and DQG�GHFHQWUDOL]DWLRQ��7KHVH�FKDQJHV�FDQ�VWUHQJWKHQ�RU�ZHDNHQ� strategies for USAID-assisted countries. &6�� Before joining John Snow, Inc., she )RU�H[DPSOH��WKH�02+�LQ�WKH�'RPLQLFDQ�5HSXEOLF�LV� developed the regional logistics and WUDQVIHUULQJ�SURJUDPPDWLF�DQG�VHUYLFH�GHOLYHU\�UHVSRQVLELOLWLHV� family planning training center while IURP�SURYLQFH�GLUHFWRUDWHV�WR�UHJLRQDO�RIÀFHV��7R�PDLQWDLQ�WKHLU� working for PROFAMILIA, Colombia. &6�DFKLHYHPHQWV��UHJLRQDO�DQG�GLVWULFW�KHDOWK��DQG�FRPPRGLW\� PDQDJHUV�PXVW�DGYRFDWH�IRU�IDPLO\�SODQQLQJ�DQG�SUHVHUYH�WKH� LQWHJULW\�RI �VXSSO\�FKDLQV��1DWLRQDO�OHYHO�&6�FKDPSLRQV�PXVW�HQVXUH�WKDW�IDPLO\�SODQQLQJ�DQG�&6�KDYH�SULRULW\� DWWHQWLRQ�ZLWKLQ�WKH�QHZ�KHDOWK�V\VWHP��0RVW�86$,'�VXSSRUWHG�FRXQWULHV�DUH�IDFLQJ�VLPLODU�FKDOOHQJHV�� :H�KDYH�QRW�PHW�DOO�RXU�JRDOV�IRU�SURWHFWLQJ�&6��&RXQWULHV�VWLOO�QHHG�WR�SULRULWL]H�DQG�PDLQWDLQ�WKH�VXSSO\�FKDLQ� GXULQJ�WKH�KHDOWK�UHIRUP�SURFHVV��7KH�JRDO�RI �WKH�KHDOWK�VHFWRU�UHIRUP�LQLWLDWLYHV�LV�WR�LPSURYH�DFFHVV�WR�DQG� HTXLW\�RI �KHDOWK�FDUH�VHUYLFH�SURYLVLRQ��3DUW�RI �WKLV�SURFHVV�LQFOXGHV�JXDUDQWHHLQJ�WKH�DYDLODELOLW\�RI �SUHYHQWDWLYH� VHUYLFHV³VXFK�DV�UHSURGXFWLYH�KHDOWK�DQG�IDPLO\�SODQQLQJ�³DQG�WKHLU�UHODWHG�VXSSOLHV�WR�HYHU\RQH�ZKR�QHHGV� WKHP�� :H�PXVW�NHHS�ZRUNLQJ�WR�LOOXVWUDWH�KRZ�D�VWURQJ�VXSSO\�FKDLQ�LV�WKH�EDFNERQH�RI �WKH�KHDOWK�V\VWHP�DQG�KRZ��E\� LQYHVWLQJ�LQ�DQG�SULRULWL]LQJ�VXSSO\�FKDLQV��ZH�FDQ�FRQWULEXWH�VWUDWHJLFDOO\�WR�EURDGHU�KHDOWK�V\VWHP�VWUHQJWKHQLQJ� LQLWLDWLYHV�� ,�ORRN�IRUZDUG�WR�ZRUNLQJ�ZLWK�FRXQWULHV�WR�WDFNOH�WKHVH�FKDOOHQJHV�LQ�\HDUV�WR�FRPH� 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 For more information, 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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