Reproductive Health Commodity Security Strategy for the West Africa Subregion

Publication date: 2006

REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY FOR THE WEST AFRICA SUBREGION July 2006 This publication was produced for review by the United States Agency for International Development. It was prepared by the DELIVER project. REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY FOR THE WEST AFRICA SUBREGION The 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. DELIVER John Snow, Inc. 1616 North Fort Myer Drive 11th Floor Arlington, VA 22209 USA Phone: 703-528-7474 Fax: 703-528-7480 Email: deliver_project@jsi.com Internet: deliver.jsi.com 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. This document does not necessarily represent the views or opinions of USAID. It may be reproduced if credit is given to DELIVER. Recommended Citation DELIVER. 2006. Reproductive Health Commodity Security Strategy for the West Africa Subregion. Arlington, Va.: DELIVER, for the United States Agency for International Development. Abstract The vision of this strategy is to achieve reproductive health commodity security (RHCS) in West Africa, which will exist when every West African can reliably choose, obtain, and use quality, affordable, essential reproductive health supplies when he or she needs them. This document demonstrates that the increased use of reproductive health (RH) products can reduce maternal and perinatal mortality and morbidity, which supports the West African Health Organization’s (WAHO) maternal health objectives. The scale, reach, and capacity to advocate for RHCS across the subregion complement and reinforce the implementation of existing efforts at the country level. The approach will serve as a catalyst for policymakers and program managers to share experiences and develop common methods to address the challenges common to countries in the subregion. These include, but are not limited to (1) access to RH commodities, (2) inadequate logistics systems, (3) insufficient commodity financing, (4) a multiplicity of poorly coordinated activities in countries, and (5) substantial national and operational policy barriers to RHCS. Key areas of work are identified where this subregional approach can add value to existing efforts. They include developing systems to enhance the sharing of RH commodity procurement information across countries, building human and institutional capacity, and advocating for harmonized RH commodity policy and regulatory frameworks across ECOWAS member states. CONTENTS iii CONTENTS ACRONYMS . v ACkNOWLEDGMENTS . vii 1.0 SUMMARY . 1 1.1 Context . 1 1.2 Coordination . 2 1.3 Capacity Building . 2 1.4 Country Support Activities . 2 2.0 BACkGROUND . 5 3.0 SUBREGIONAL CHALLENGES . 7 3.1 Link Between Maternal and Infant Health Outcomes and RHCS . 7 3.2 Common Challenges . 9 4.0 THEMATIC AREAS OF THE SUBREGIONAL STRATEGY .13 4.1 Coordinated Informed Buying System for RH Commodities .13 4.2 Institutional Capacity Building .13 4.3 Advocacy for a Harmonized Regulatory and Policy Framework .13 5.0 COMPONENT A: STRATEGIC PLAN .15 5.1 Vision, Mission, and Goal .15 5.2 Objectives .15 5.3 Context .16 5.4 Coordination .19 5.5 Capacity Building .21 5.6 Country Support .23 6.0 ADVOCACY PLAN FOR FINANCING THE IMPLEMENTATION .25 7.0 COMPONENT B: OPERATIONAL PLAN.29 7.1 Budget Summary .29 7.2 Context .30 7.3 Coordination .32 7.4 Capacity Building .34 7.5 Country Support Activities .36 8.0 COORDINATION AND MONITORING AND EVALUATION .37 8.1 Results Indicators .38 9.0 REFERENCES .41 10.0 ANNExES .43 1 – List of Workshop Participants .43 2 – The Interagency List of Essential Medicines for Reproductive Health .51 iv REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION FIGURES 3.1: Contraceptive Prevalence and Maternal Mortality . 7 3.2: Infant Mortality by Birth Interval . 8 3.3: Public Sector SDP Stock Status: Mali (2001 and 2005) on Day of Visit .10 3.4: Public Sector SDP Stock Status: Ghana (2006) on Day of Visit .11 3.5: Donor Financing for Contraceptives (except condoms) Compared with Projected Need in West Africa .12 TABLES 1: Actions to Improve, Increase, and Streamline Common and Specific RHCS Policies at the Country Level .18 2: Actions to Strengthen Planning, Management, and Implementation of RHCS Activities .20 3: Actions to Improve Human, Technical, and Institutional Capacity for the Achievement of RHCS in the West African Subregion. .22 4: Actions to Strengthen Subregional Institutions and Networks to Deliver Targeted RHCS Technical Assistance .24 5: Objectives and How They Will Be Accomplished .26 6: Summary of Budget for Years 1–5 .29 7: Context for the Organizational Plan .30 8: Coordinated Actions for the Operational Plan .32 9: Capacity Building for the Organizational Plan .34 10: Country Support Activities for the Organizational Plan .36 11: Objectives, Actions, Subactions, Estimated Cost, and Timing for M&E Plan .37 12: Results Indicators—Action, Output Indicators, and Expected Outcomes .38 13: List of Participants: Development of a Strategic Plan for Reproductive Health Security Commodity January 24–26, 2006, Bobo-Dioulasso, Burkina Faso .43 14: List of Participants: West Africa Subregion RHCS Strategic Planning, Meeting of the Reproductive Health Commodity Security Task Force, March 8–10, 2006, Accra, Ghana .48 15: Minimum Medicine Needs for a Basic Health Care System (WHO/UNFPA 2006) .53 ACRONYMS v ACRONYMS ACAME Association Africaine des Centrales d’Achats de Médicaments Essentiels ADB Asian Development Bank AIDS acquired immune deficiency syndrome ATP ability to pay AWARE-RH Action for West Africa Region-Reproductive Health (project) BCC behavior change communication BCEAO Banque Centrale des États de l’Afrique de l’Ouest CAMES Conseil Africain et Malgache Enseignement Supérieur CDC Centers for Disease Control and Prevention CERPOD Centre d’Etudes et de Recherche sur la Population pour le Developpement CESAG Centre Africain d’Etudes Supérieures en Gestion CHU Centre Hospitalier Universitaire CIB coordinated informed buying CIDA Canadian International Development Agency CPR contraceptive prevalence rate DANIDA Danish International Development Agency DFID Department for International Development (United Kingdom) DPAT Direction PlanificationDirection Planification DRP drug registration procedure DSSP-CM Division Soins de Santé Primaires-Controle de la Maladie ECOWAS Economic Community of West African States EML essential medicines list EOC emergency obstetric care GTZ Deutsche Gesellschaft für Technische Zusammenarbeit HIV human immunodeficiency virus HMIS health management information system HQ headquarters IEC information, education, and communication IPC International Planning Committee IPPF International Planned Parenthood Federation IPS international partners IRSP Institut Régional de Santé Publique JICA Japan International Cooperation Agency KfW Kreditanstalt für Wiederaufbau LMIS logistics management information system M&E monitoring and evaluation vi REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION MDG Millennium Development Goal MMR maternal mortality ratio MOEd Ministry of Education MOF Ministry of Finance MOH Ministry of Health MSA market segmentation analysis MSP/LCE Ministère de la Santé Publique/Lutte contre les endémies NEPAD New Partnership for Africa’s Development NGO nongovernmental organization OOAS Organisation Ouest Africaine de la Santé OAU Organisation of African Unity PMLO program managers and liaison officers PPP public- and private-sector partnership PRB Population Reference Bureau RH reproductive health RHCS reproductive health commodity security SDP service delivery point SIDA Swedish International Development Cooperation Agency SPARHCS Strategic Pathway to Reproductive Health Commodity Security STG standard treatment guideline STI sexually transmitted infection TA technical assistance TOR terms of reference TOT training of trainers UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations International Children’s Emergency Fund USAID United States Agency for International Development WAHO West African Health Organization WHO World Health Organization WHO-AFRO World Health Organization-Regional Office for Africa WTP willingness to pay ACkNOWLEDGMENTS vii ACkNOWLEDGMENTS The West African Health Organization (WAHO) provided the technical direction and organization necessary to complete the reproductive health commodity security strategy. WAHO, led by Dr. Kabba Joiner, Director General, hosted three strategy development workshops between November 2005 and March 2006. Participants in the workshops included experts from the Economic Community of West African States governments, donors, nongovernmental organizations, and technical partners—grouped together as the reproductive health (RH) task force—and WAHO program managers and liaison officers. Annex 1 lists these individuals. John Snow Inc./DELIVER was the facilitator for the workshops and the editor of this document. The Action for West Africa Region-RH project provided key technical and organizational support. Organizations that provided substantial staff time and financial support for the development of this document include United States Agency for International Development (USAID)/West Africa, USAID/Washington, the United Nations Population Fund, the Kreditanstalt für Wiederaufbau, and the World Bank. The authors especially thank USAID for supporting WAHO and the writing of this document. viii REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION SUMMARY 1 1.0 SUMMARY In November 2005, a concept paper on RHCS in the subregion was presented to the West African Health Orga- nization (WAHO) Ministers of Health at the 6th Ordinary Meeting of Health Experts and Ministers in Dakar, Senegal. At that meeting, Economic Community of West African States (ECOWAS) health ministers approved the development of a subregional reproductive health commodity security (RHCS) strategy and directed WAHO to lead this project. Later in November, the West Africa Reproductive Health Commodity Security Task Force (Task Force), led by WAHO, held an initial workshop to begin developing a subregional strategy for RHCS. After the November workshop, in January 2006, the WAHO program managers and liaison officers (PMLO) met to review and further develop the strategy. In March, the Task Force met again to review the strategy and complete further revisions. These meetings resulted in this final draft. The combined efforts of the Task Force and the PMLO were instrumental in creating this document. The PMLO represented 14 of the 15 countries in ECOWAS; they drew on experiences from country programs to devise feasible RHCS interventions. The RHCS concept paper underscored the importance of framing commodity security within the context of the “7 Cs” of the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS)1 framework (Hare et al. 2004). The Task Force and the PMLO acknowledged that the 7 Cs—client, capacity, capital, commitment, coordination, commodities, and context—are the elements required to achieve RHCS, which exists when every person can reliably choose, obtain, and use quality, affordable, essential reproductive health supplies whenever he or she needs them. Nonetheless, the Task Force agreed that a regional strategy is not feasible if it tries to address the range of all the SPARHCS components. Instead, the focus should be on addressing cross-cutting subregional challenges where, because of scale, reach, and cost-effectiveness, subregional actors can add value by advocating, brokering, and catalyzing efforts that reinforce current and future country-based interventions. National commodity security strategies, both existing and in development in Ghana, Mali, Nigeria, Burkina Faso, Togo, The Gambia, Cameroon, and Sierra Leone already address many of the SPARHCS components, and the regional strategy should not duplicate these efforts. The subregional approach will reflect and complement country efforts and reinforce national-level activities. The framework was modified to reflect subregional strengths—and the thematic areas identified in the concept paper (JSI/DELIVER 2005)—with scope for supporting ongoing country work. (See section 4.0.) The new framework includes four strategic objectives related to context, coordina- tion, capacity building, and country support activities. 1.1 ContExt Improve, increase, and streamline common and specific RHCS policies at the country and regional levels to create a policy environment that will support RHCS in the subregion. To enhance policy support for RHCS and improve the environment for public- and private-sector partnerships, these efforts will focus on advocacy for common and specific RHCS policies at the country and subregional levels, including the establishment of government budget line items for reproductive health (RH) commodities (country level) and the dissemination of materials for information, education, and communication (IEC) (from the subre- gional level). As ECOWAS countries continue to converge around common economic policies, advocating for a � The SPARHCS tool, jointly published by USAID and UNFPA, is available under Publications at www.deliver.jsi.com. 2 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION common external tariff, comparable drug registration procedures (DRPs), and standard treatment guidelines (STGs) for RH supplies can help increase efficiencies and reduce costs. 1.2 CooRDInAtIon The goal of coordination is to— Strengthen planning, management, and implementation of RHCS activities through coordinating mechanisms involv- ing the engagement of a broad range of stakeholders, including donors, governments, the private sector, and civil society organizations. WAHO’s coordination efforts will focus mainly, but not exclusively, on the implementation of the coordinated informed buying (CIB) mechanism, which, as it is designed and implemented, will serve as a practical and ongo- ing coordinating mechanism that allows the routine accessing and sharing of procurement data. Other activities listed in the strategy enhance the coordination within countries and between countries and the subregion. Coun- try support initiatives and capacity building measures will be undertaken throughout the subregion. Further, the development of common DRPs and STGs (noted under Context) will enhance coordination between countries and subregional bodies. 1.3 CApACIty BuILDIng The goal of capacity building is to— Improve human, technical, and organizational capacity for the achievement of RHCS in the West African subregion. The capacity to deliver RH commodities to clients through effective supply chains, monitor and test the quality of commodities, and train personnel in the multitude of functions that include RHCS, varies by country. Yet, it is evident that these and other capacity weaknesses are common to countries in the subregion. A subregional RHCS strategy will address these issues through support for quality control testing laboratories and subregional train- ing programs in supply chain management and procurement. Many countries do not have the resources for such facilities and activities. Subregional and country actors should also document and disseminate best practices and be regularly informed about each other’s activities to avoid duplication of effort and to identify where complemen- tary roles can be played and where south-to-south technical exchanges can be beneficial. 1.4 CountRy SuppoRt ACtIVItIES The goal of the country support activities is to— Increase targeted RHCS country-level technical assistance that produces results that can be replicated and disseminated throughout the subregion. The rationale for this objective is based on the observation that deliberate and strategic technical assistance at the country level can substantially strengthen RHCS. Moreover, because resources are limited, there is a critical need to provide direct RHCS technical assistance to countries where experiences can be translated into best practices for other countries in the subregion. Weak program management systems, notably monitoring and evaluation (M&E) and financial management, characterize many country programs. Subregional country support activities will aim to support the development of a network of technical assistance providers and funding sources to focus on these gaps. The final strategic plan, which follows, is divided into two components: Component A is broadly structured to capture and address many of the issues discussed in the concept paper (JSI/ DELIVER 2005). It includes a description of the objectives, strategies, actions, expected outcomes, assumptions, SUMMARY 3 and risks. Also included is a section on advocacy and financing for the subregional strategy that describes how technical and financial support for implementation of the strategy will be carried out. Component B includes the operational plan, estimated budget, and M&E plan, including output indicators for the expected outcomes. This section includes the specific actions and subactions, timeframe, budget and costs, and detailed indicators. The success of the strategy will depend on the participation and contributions of the many West African institu- tions working in reproductive health, as well as support from international and bilateral partners. WAHO, as the primary subregional health authority for ECOWAS, is positioned to take a leadership role in coordinating a subre- gional RHCS strategy and to advocate for material support directly with donors and member countries. In addi- tion, with WAHO, other subregional actors, notably the World Health Organization’s Regional Office for Africa (WHO-AFRO), the Association Africaine des Centrales d’Achats de Médicaments Essentiels (ACAME), the Centre d’Etudes et de Recherche sur la Population pour le Developpement (CERPOD), and others, will have a substantial role as advocates, brokers, and catalysts for the adoption and implementation of a subregional strategy. The challenge in implementing this plan is determining how to manage efforts at the subregional level while simultaneously supporting country-level interventions. 4 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION BACkGROUND 5 2.0 BACkGROUND Maternal and infant health indicators in the countries of the West African subregion remain weak, although they are comparable to other developing countries. WAHO and its partners recognize the seriousness of the gaps in access and the quality of maternal and perinatal health services in the subregion. To address these challenges, they developed a Strategic Plan for the Reduction of Maternal and Perinatal Mortality in West Africa. This subregional strategy also supports the WHO-AFRO/African Union Road Map and the New Partnership for Africa’s Development (NEPAD)/United Nations Millennium Development Goals (MDGs). Both the road map and the MDGs focus on the reduction of maternal and infant mortality and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) as key factors in poverty reduction. These reductions are dependent upon consistent avail- ability and use of reproductive health (RH) commodities (UNFPA 2004). To address these reproductive health challenges and to advance its Strategic Plan for the Reduction of Maternal and Perinatal Mortality, WAHO has identified and is systematically addressing the interdependence between RHCS and maternal and infant health outcomes. At the Fifth Annual Assembly in Accra in 2004, ECOWAS health ministers recommended that WAHO and its partners develop a subregional strategy for RHCS to support the maternal and perinatal strategic plan. The health ministers subsequently endorsed a road map for that strat- egy and presented it as the RHCS Concept Paper (JSI/DELIVER 2005) at their 2005 annual meeting in Dakar, Senegal. By promoting increased access to and use of RH commodities, the RHCS strategy will also support the attainment of the MDGs and the Road Map goals, which will result in a significant reduction of maternal and infant deaths by 2015 (UNFPA 2004). Many of the challenges to RHCS are common across countries in the ECOWAS region. To take advantage of scale and to promote subregional cooperation, the challenges can be addressed at both the subregional and the country level. This approach has a number of benefits. A subregional approach to RHCS can— function as an excellent vehicle for advocacy and for working across countries to compare, inform, and influ- ence public health policies bring together key decision makers from different stakeholders around a common conceptual framework, terminology, tools, and methods for assessing and addressing challenges facilitate the sharing of experiences between countries attract the attention and support of governments, multilateral organizations, bilateral donors, and other part- ners for RHCS. The partners—WAHO, United Nations Population Fund (UNFPA), USAID, Kreditanstalt für Wiederaufbau (KfW), the World Bank, and other agencies—recognized that there were many common challenges to RHCS that face countries in the subregion; and that a subregional RHCS strategy could be an effective mechanism to address them. The challenges that cut across countries in the subregion include (1) limited access to quality RH commodi- ties and services; (2) weak national logistics systems for managing RH commodities; (3) insufficient financing for RH commodities and services from all sources (household, community, national governments, multilateral and bilateral donors, and lenders); (4) insufficient coordination mechanisms between partners in the subregion; (5) a multiplicity of poorly coordinated activities in countries, leading to unnecessary redundancies and an ineffi- • • • • 6 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION cient use of the limited resources available for RH; and (6) substantial national and operational policy barriers to RHCS. Three key areas have been identified in which a subregional strategy can add maximum value for supporting and advancing RHCS: A CIB system among ECOWAS countries would allow national procurement and supply managers to share supplier price information with their counterparts in the subregion, and in the future, to share quality data and other relevant data. This information could enable informed procurement decisions and, by comparing prices obtained by other countries in the network, help to ensure the procurement of RH commodities that provide the best value. The capacity to deliver RH commodities to clients through effective supply chains, monitor and test the quality of commodities, and train personnel in the multitude of functions involving RHCS, varies by country. Weaknesses in human resource development, institutional capacity building, and technical assistance are common to coun- tries in the subregion. The capacity to deliver commodities needs special attention. The subregional strategy will advocate for a harmonized regulatory and policy framework. Subregional organiza- tions can play a catalytic role in helping to establish a common external tariff, comparable drug registration procedures, and common standard treatment guidelines to support a strengthened policy and regulatory envi- ronment to support RHCS. The proposed subregional strategy will seek to achieve RHCS by focusing on strengthening systems to increase access to RH commodities for current users and those expressing an unmet need for these commodities (that is, they have a desire or a need to use but are not currently using). The SPARHCS tool has been adapted for use as the conceptual framework. SPARHCS takes a strategic, long-term, multidisciplinary, and multi-stakeholder perspective on RHCS by identifying how different elements; including contextual environment, capacity, coordi- nation, and financing, are both interdependent and a prerequisite to achieving RHCS. To assist in designing and implementing RHCS strategies, variations in the SPARHCS assessment tool and framework have already been used in Burkina Faso, Cameroon, The Gambia, Ghana, Nigeria, and Togo. The goal of the subregional approach detailed in this strategy is to build on, not displace, these efforts. Linkages between country and regional RHCS efforts are already under way. USAID’s approach, for example—implement- ed in part by the Action for West Africa Region-Reproductive Health (AWARE-RH) project—has combined support for these country efforts while, at the same time, supported regional systems and institutions, including the Centre Africain d’Etudes Supérieures en Gestion (CESAG) and the Institut Régional de Santé Publique (IRSP)— an acknowledgment that the focus cannot be limited exclusively to one level. The adoption of the RHCS strategy by subregional-level organizations in West Africa should further strengthen these existing approaches and increase the compatibility with country-level RHCS efforts. 1. 2. 3. SUBREGIONAL CHALLENGES 7 3.0 SUBREGIONAL CHALLENGES Subregional challenges include linking the outcomes between maternal and infant health and RHCS; and issues that must be overcome to achieve RHCS. 3.1 LInk BEtwEEn MAtERnAL AnD InfAnt HEALtH outCoMES AnD RHCS For every 100,000 live births in West Africa, there are 880 maternal deaths and more than 100 infant deaths (PRB 2005). The percentage of married women using modern methods of contraception in the subregion stands at 8 percent—making West Africa near the bottom worldwide for contraceptive use. In addition, 4.3 percent of adults in West Africa ages 15–49 have HIV/AIDS, and nearly 60 percent of those with AIDS are women (PRB 2005). These maternal, infant, and reproductive health statistics are unacceptable. The United Nations MDGs include among their indicators the improvement of maternal and infant health outcomes and the reduction of the spread of HIV/AIDS, all of which depend on the consistent availability and use of RH commodities (UNFPA 2004). RHCS, which exists when every person can reliably choose, obtain, and use quality, affordable, essential reproductive health supplies when he or she needs them, is critical for achieving these international goals. Figure 3.1 shows the relationship between high maternal mortality ratios (MMRs) and low contraceptive preva- lence rates (CPRs). By helping women plan and space their children, and eliminate undesired pregnancies, RHCS can play an important role in reducing maternal mortality and improving maternal health. 0 10 20 30 40 50 60 70 80 G u in ea G u in ea -B is sa u N ig er Si er ra L eo n e M au ri ta n ia Li b er ia M al i B en in C ô te d ’Iv o ir e N ig er ia Se n eg al B u rk in a Fa so G am b ia To g o G h an a C ap e V er d e W es te rn A fr ic a Ea st er n A fr ic a Eu ro p e A si a L. A m er ./C ar ib b ea n 500 1,000 1,500 2,000 4 4 4 4 65 5 Sources: CPR and MMR: PRB 2005 Women of Our World Liberia CPR: PRB 1998 World Population Data Sheet CPR Maternal deaths 8 87 7 9 9 9 740 880 540570540 690 1,000 800 690 850 1,200 1,000 760 2,000 1,600 1,100 1,020 150 190 24 330 46 8 17 62 57 54 19 % M W R A u si n g m o d er n c o n tr ac ep ti o n M at er n al d ea th s p er 1 00 ,0 00 li ve b ir th s 0 Figure 3.1: Contraceptive Prevalence and Maternal Mortality 8 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION RHCS also has an impact on infant health. For example, when mothers space their births at least two years apart, infant mortality rates are reduced by as much as 50 percent (see figure 3.2). Although the subregion has made progress in increasing the use of family planning services during the past decade—CPR (for modern methods), for example, has doubled in a number of countries2—the use of family planning is still low and the unmet need is high (approximately 30 percent on average for the subregion).3 If the 30 percent of women who are experiencing unmet need were using contraception, maternal and infant health outcomes would improve. According to the Human Development Report 2003, “If the unmet need for contracep- tion were filled and women had only the number of pregnancies at the intervals they wanted, maternal mortality would drop by 20–35%.” Unsafe abortions resulting from unwanted pregnancies cause about 13 percent of all maternal deaths every year (UNDP 2003). To cover this expressed need and to improve maternal and infant health outcomes, access to reproductive health services and commodities in West Africa must increase substantially. Figures 3.1 and 3.2 indicate a strong relationship between RHCS, specifically for family planning and maternal and child health outcomes. In addition, the effect of the HIV/AIDS pandemic—which has already strained health delivery systems—will exacerbate the situation as the demand for condoms to prevent HIV and other HIV/AIDS products continues to rise. Studies have demonstrated that it is reasonable to expect that a secure supply of condoms for the prevention of sexually transmitted infections (STIs) and HIV/AIDS can help decrease the trend in the HIV/AIDS infection rate (CDC 1993). There are numerous other demonstrated links between RHCS and improved maternal and infant health outcomes. For example, a document published by the POLICY project entitled, What Works: A Policy and Program Guide to the Evidence on Family Planning, Safe Motherhood, and STI/HIV/AIDS Interventions (Gay et al. 2003), cites many examples of this relationship among the proven safe motherhood interventions, including— “Geographic access to and appropriate use of (emergency obstetric care [EOC]), trained responsive personnel, essential equipment, supplies, and drugs are correlated with improved maternal and infant health outcomes…” (page 18) � CPR increased over the last decade in every ECOWAS country where data was available. However, CPR remains lower than in other regions of the world, at 8% compared to �4% overall in sub-Saharan Africa (Demographic and Health Surveys �990–�003). 3 Unmet need is defined as the percentage of all women of reproductive age who wish to delay or prevent their next birth but are not currently using family planning. • Figure 3.2: Infant Mortality by Birth Interval Mali Nigeria Benin Burkina Guinea Togo Ghana Senegal 2001 2003 2001 Faso 1999 1998 2003 1999 2003 less than 2 years at least 2 years 24 In fa n t d ea th s p er 1 ,0 00 li ve b ir th s 0 50 100 150 200 121 120 142142143 177 160 154 53 50 66 105104104 111 87 SUBREGIONAL CHALLENGES 9 A prospective study of 19,545 women in West Africa through pregnancy and for 60 days postpartum found that [in] 69.1 percent of all maternal deaths…[the women] gave birth without access to EOC… Eclampsia is most effectively treated by magnesium sulphate…. (page 29) “Use of prophylactic antibiotics at the time of cesarean sections decreases the incidence of post-operative infec- tious morbidity.” (page 33) For example, the use of antibiotics reduces the incidence of endometriosis by two-thirds to three-quarters and “substantially reduces episodes of fever, wound infection, urinary tract infections, and serious infections.” Immunizing pregnant women against tetanus is one of the simplest and most cost-effective means of reducing the neonatal mortality rate as well as reducing the incidence of maternal tetanus, which is responsible for at least 5 percent of maternal deaths in developing countries. (page 54) Administering drugs locally effective for malaria to pregnant women may reduce the incidence of low birth weight and anemia among low parity women. (page 55) Preventing, detecting, diagnosing, and treating TB can reduce the numbers of maternal deaths among pregnant women, including those with HIV. (page 58) Treating iron-deficiency anemia with iron during pregnancy has been shown to reduce … anemia and mater- nal morbidity …. (page 79) Treating severe iron-deficiency during pregnancy may reduce the risk of maternal mortality. (page 78) These examples underscore the importance of RHCS in improving maternal and infant health outcomes; all of these important interventions require uninterrupted supplies of quality RH commodities. 3.2 CoMMon CHALLEngES As part of WAHO’s RHCS initiative, in-depth RHCS assessments have been completed in Ghana and Burkina Faso. A similar assessment supported by USAID and UNFPA was conducted in Nigeria. Additional assessments designed to measure the feasibility of coordinated informed buying have also been carried out in Burkina Faso, Ghana, Mali, Nigeria, and Senegal. These assessments, combined with the program experience within the RHCS Task Force and PMLO Working Group, have provided critical country-level data that have informed the content of this strategy. Field and desk work completed in previous WAHO RHCS efforts have also identified some of the major obstacles facing the subregion. (See References for additional readings.) On the basis of the desk research, country assessments, and deliberations of the strategy working groups, a number of key issues have been identified; including some of the major, cross-regional RHCS challenges that reinforce the benefits of a subregional RHCS strategy. The issues constitute a set of common challenges that must be overcome to achieve RHCS while, simultaneously, address maternal health outcomes and meet the challenges posed by the MDGs. 3.2.1 ACCESS to QuALIty pRoDuCtS AnD SERVICES Access to RH commodities is limited in many areas of West Africa. Long physical distances to health facilities, frequent stockouts that result in chronic unavailability, lack of reliable transportation, and poor infrastructure characterize the situation in many parts of the subregion. Affordability and inadequate or incorrect information on the use and benefits of RH products are also significant barriers to meeting client demand. In many cases, clients do not have access to a full range of commodities to meet their needs (e.g., there is a limited contraceptive method mix and limited access to new contraceptive technologies), and service providers often do not have the skills or motivation to offer quality services. Furthermore, social, cultural, and religious barriers exacerbate the limits to access in the subregion. • • • • • • 10 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION 3.2.2 LogIStICS MAnAgEMEnt Although most countries in the subregion have public-sector logistics systems in place, the effectiveness of these systems varies. Assessments have revealed weaknesses in human resources, procurement capacity, data manage- ment, warehousing, and transportation (John Snow, Inc./DELIVER n.d.). Moreover, integration of product lines and decentralization are creating new complexities that sometimes hinder effective supply chain management. Systems will be further strained as they respond to the HIV/AIDS pandemic. These weaknesses in the logistics systems lead to expired products, supply imbalances (overstock), and stockouts at service delivery points. To demonstrate the importance of logistics systems interventions in product availability, figure 3.3 shows the availability of contraceptives before and after logistics interventions in Mali. A recent DELIVER project logistics system assessment revealed that product availability at service delivery points (SDPs) and warehouses has increased sharply in Mali and Ghana. Although substantial resources directed at logistics system strengthening (i.e., forecasting, financing, procuring, and distributing) can increase availability and strengthen RHCS, stockouts of essential RH commodities remain a common occurrence, depriving clients of needed supplies. The availability of Protector condoms in Mali increased by more than 40 percent in the four-year period. In Ghana, availability on the day of visits to SDPs has been sustained at nearly 80 percent over several years for a range of contraceptives (see figure 3.4). 3.2.3 fInAnCIng The Abuja Declaration of 2001 stated that at least 15 percent of national budgets should be committed to improvements in the health sector (OAU 2001). No country in the subregion has met this goal. Resulting alloca- tions for the RH sector remain grossly inadequate. The increasing number of women and men of reproductive age and the growing demand of this population for RH products indicates that the existing financing gap for RH commodities will grow unless a sustainable investment from all levels is made to finance commodity costs—from the household, communities, third parties, governments, and international donors and partners. Figure 3.3: Public Sector SDP Stock Status: Mali (2001 and 2005) on Day of Visit Duofem/Pilplan/ Ovrette Condom/Protector Depo-Provera/ Lo-Femenal Confiance 24 86.8 98.1 83.0 45.3 77.479.2 98.1 54.7 LIAT I 2001 LIAT II 2005 0 20 40 60 80 100 SUBREGIONAL CHALLENGES 11 At the household and community level, there is a limit to what the people of West Africa can afford to contribute to financing for RH commodities. “Currently, the true commercial sector, defined as non- subsidized products and services provided for profit through private sector sources, has a limited role in West African reproductive health markets. A benchmark income level of around US$1000 per capita is taken as the level at which low-end commercial contraceptives become affordable. In West Africa, a very small percentage of the population (around 10 percent or less in most countries) has this income level” (Dowling 2004). Most cannot afford to contribute even nominally to financing RH commodities. Also, most governments in West Africa do not contribute adequately to financing the procurement of RH commodities to meet the needs of their populations. Many do not have a budget line item for RH commodities. Whatever funding that does exist is often combined with other health commodities, which often leads to insuf- ficient procurement quantities. This means that RH commodities are competing for scarce resources. As a result, governments are largely dependent on donor contributions, which often fluctuate from year to year. From 1996 to 2002, financing support in the subregion for contraceptives has been erratic at the donor level (see figure 3.5). Donor support for contraceptives in West Africa decreased sharply from $17 million in 2001 to less than $11 million in 2002. The projected costs for contraceptives are expected to reach nearly $25 million annually by 2010. Further, as shown in figure 3.5, if donor financing from 2002 levels remains constant, there will be, at a minimum, a $14 million funding gap for contraceptives every year starting in 2010, excluding condoms. The levels of current and past donor support for contraceptives were obtained from UNFPA. The projected financ- ing needs for contraceptives were obtained from the West African Reproductive Health Commodity Security Study and estimated by factoring projected needs with unit cost. The Spectrum software developed by the Futures Group was used to estimate the projected quantity needed, by applying demographic data from the most recent surveys (i.e., Demographic and Health Surveys conducted by ORC Macro International, the Multi-Indicator Cluster Surveys conducted by UNICEF, or the Reproductive Health Surveys conducted by Centers for Disease Control and Prevention [CDC]) to the United Nations estimated fertility goals for the region. The global average was used for the unit cost of contraceptives. When additional RH commodities for STI prevention, antenatal care, and other conditions are considered, the requirement for the subregion doubles to nearly $60 million. In addition to commodity costs, substantial financ- Figure 3.4: Public Sector SDP Stock Status: Ghana (2006) on Day of Visit 24 77 8081 76 Lofemenal Depo-Provera Male Condom Norplant LIAT 2006 0 20 40 60 80 100 12 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION ing is required for routine operations, service delivery, capacity building, and infrastructure. It is unreasonable to expect a substantial increase in household contributions and significant government expen- diture for RH commodities in the near- and medium-term. The low purchasing power of clients, low prevalence, and uneven and slow economic growth means a continued reliance on donor assistance over the next several years. 3.2.4 CooRDInAtIon: DonoR, goVERnMEnt, AnD pRIVAtE SECtoR The lack of coordination mechanisms among partners in the subregion and the multiplicity of uncoordinated activities at the country level often lead to unnecessary redundancies and an inefficient use of the limited resources available for RH. Because resources are limited, a premium is placed on effective coordination among govern- ments, donors, lenders, and implementing agencies to minimize duplication and mobilize additional resources. WAHO is in a strong position to enable this effective coordination. There are good examples of stakeholder coordination at the country level within the ECOWAS community. Nevertheless, subregional and national efforts could be strengthened by engaging a broader range of stakeholders, including ministries other than health (finance, planning, education, and others), private-sector retailers and manufacturers, physician and nursing asso- ciations, and civil society organizations (religious institutions, nongovernmental organizations, and community- based agricultural and microfinance institutions). 3.2.5 poLICy SuppoRt Many national and operational policy barriers to RHCS remain in place. Increased subregional and national policy support is needed to respond to these challenges, which include the lack of national financing for RH commodities (e.g., budget line item) and uneven, inconsistent, and excessive taxes, tariffs, and duties. Additional cross-cutting challenges include advertising restrictions, restrictive operational policies for service provision, and a lack of quality information, education, and awareness raising. Figure 3.5: Donor Financing for Contraceptives (except condoms) Compared with Projected Need in West Africa 24 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 0 5 10 15 20 25 Past donor financing Constant donor financing (based on financing 1999-2002) 3% annual increase in donor financing Projected cost of contraceptives U .S . $ in m ill io n s THEMATIC AREAS OF THE SUBREGIONAL STRATEGY 13 4.0 THEMATIC AREAS OF THE SUBREGIONAL STRATEGY Three thematic areas have been identified where, because of scale, reach, and cost-effectiveness, subregional actors and activities can add value by advocating, brokering and catalyzing RHCS activities across the subregion. These areas address many of the challenges noted in section 3.0. They include the following: 4.1 CooRDInAtED InfoRMED BuyIng SyStEM foR RH CoMMoDItIES In 2004 and 2005, the WAHO health ministers mandated that work begin on designing and implementing a CIB system that can be shared among ECOWAS countries. The CIB system would enable national procurement and supply managers to share information on supplier price, quality, and other procurement data with their counter- parts in the subregion. This information will help countries make informed procurement decisions. It will also help to ensure that the procurement systems provide better value by, in part, comparing prices obtained by other countries in the network. Other potential benefits could include improved commodity quality and harmonization of standards, improved supply chain management, and reduced wastage and loss. 4.2 InStItutIonAL CApACIty BuILDIng The capacity to deliver RH commodities to clients through effective supply chains, to monitor and test the quality of commodities, and to train personnel in the multitude of functions involving RHCS varies by country. Yet, it is evident that these and other capacity weaknesses are common to countries in the subregion. A subregional RHCS strategy can, therefore, address these issues by supporting, for example, quality control testing laboratories and subregional training programs in supply chain management and procurement. Resources for such facilities and activities are not available in many countries. Subregional and country actors should also document and dissemi- nate best practices; and be regularly informed about each other’s activities to avoid duplication of effort, to identify where complementary roles can be played, and to determine where south-to-south technical exchanges can be beneficial. A subregional reference center could be useful in supporting this type of information sharing. 4.3 ADVoCACy foR A HARMonIzED REguLAtoRy AnD poLICy fRAMEwoRk Subregional organizations can play a role as catalysts in advocating for a strengthened policy and regulatory envi- ronment for RHCS. These groups could, for example, be an informational focal point and advocate for common and specific RHCS policies at the country level. The policies could include government budget line items for RH commodities, support for RHCS coordinating groups, and the dissemination of IEC materials designed to enhance policy support for RHCS. As ECOWAS countries continue to join together around common economic policies, advocating for a common goal could help reduce costs for RH commodities—for example, an external tariff for RH supplies or duty-free status for commodities considered to be of strategic importance for public health and/or an internal free trade zone. 14 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION Further, to achieve greater efficiency in access to RH commodities, subregional bodies such as WAHO could help advocate for standard DRPs across the subregion. Currently, registration is specific to a particular manufacturer and country. Harmonizing registration may help efforts to expand the private sector’s ability to contribute to better access to RH commodities. Respondents to assessment questionnaires in Burkina Faso and Ghana (JSI/ DELIVER 2005) indicated that the lack of coordinated and standardized product selection (e.g., for essential medicines lists [EMLs], STGs, and the like), harmonization of product registration, and standards in product labeling within the subregion were a constraint in promoting access to commodities. Subregional institutions could help coordinate and catalyze efforts between country stakeholders to adopt common DRPs, EMLs, and STGs within the ECOWAS community. COMPONENT A: STRATEGIC PLAN 15 5.0 COMPONENT A: STRATEGIC PLAN 5.1 VISIon, MISSIon, AnD goAL The RHCS strategy is a mechanism for improving maternal and child health in West Africa. The commodities it seeks to make regularly available to clients will include but be broader than those for family planning. The list will include health commodities for maternal health and HIV/AIDS as well as other essential RH products. The full list, in annex 2, provides all the stakeholders who are part of this strategy with a sense of the large number of prod- ucts involved in securing RH supplies (WHO/UNFPA 2006). Country stakeholders will be encouraged to devel- op specific RH product lists from the therapeutic categories described in the essential list of RH commodities.4 The health partners involved in the development of this strategy—including WAHO, USAID, UNFPA, the World Bank, KfW, WHO-AFRO, and other technical agencies—spent a great deal of time talking about the goal. These discussions resulted in the agreement that RHCS will exist when every West African can reliably choose, obtain, and use quality, affordable, essential reproductive health supplies when he or she needs them. The goal is inexorably linked to the broader maternal and perinatal health mission in the subregion. They are as follows: Vision: To achieve reproductive health commodity security in the West Africa subregion Mission: To ultimately reduce maternal and perinatal mortality in conjunction with the WAHO Strategic Plan for the Reduction of Maternal and Perinatal Mortality in the West Africa subregion Goal: To meet the demand of existing users and those expressing unmet need in the subregion. 5.2 oBjECtIVES Each of the four objectives described below support country efforts, whether through capacity building or coor- dination at the subregional level or through direct country technical assistance. The objectives are linked to broad areas of work in advocacy, coordination, and the identification of resources and technical assistance. Regional and country actors should also regularly inform each other about their respective activities to avoid duplication of effort and to identify where complementary roles can be played. ContExt Improve, increase, and streamline common and specific RHCS policies at the country level to create a policy environment that will support RHCS in the subregion. These efforts will focus on advocacy for common and specific RHCS policies at the country level, including the establishment of government budget line items for RH commodities, dissemination of IEC materials designed to enhance policy support for RHCS, and improvement of the environment for public- and private-sector partnerships. As ECOWAS countries continue to converge around common economic policies, advocating for a 4 The UNFPA/WHO list of essential RH medicines is a detailed list of these categories; it is the reference in this document. It provides the current con- sensus among WHO, UNFPA, and other partners on the “rational selection of essential RH medicines” (WHO/UNFPA �006). See annex �. 16 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION common external tariff, comparable DRPs, and common STGs for RH supplies can help increase efficiencies and reduce costs. CooRDInAtIon Strengthen planning, management, and implementation of RHCS activities through coordinating mechanisms, involv- ing a broad range of stakeholders, including donors, governments, the private sector, and civil society organizations. WAHO’s coordination efforts will focus mainly, but not exclusively, on the implementation of the CIB system, which, as the system is designed and implemented, will serve as a practical and ongoing coordinating mechanism that allows the routine accessing and sharing of procurement data. Many of the activities listed in the strategic plan will enhance coordination within countries and between countries and the subregion. Country support initiatives and capacity building measures will be undertaken throughout the subregion. Further, the development of common drug registration procedures, for example (noted above under Context), will enhance coordination between countries and subregional bodies. CApACIty BuILDIng Improve human, technical, and institutional capacity for the achievement of RHCS in the West African subregion. The capacity to deliver RH commodities to clients through effective supply chains, to monitor and test the quality of commodities, and to train personnel in the multitude of functions involving RHCS, varies by country. Yet, it is evident that these and other capacity weaknesses are common to countries in the subregion. A subregional RHCS strategy can, therefore, address these issues through support, for example, for quality control testing laboratories and subregional training programs in supply chain management and procurement. Resources for such facili- ties and activities are not available in many countries. Subregional and country actors should also document and disseminate best practices and be regularly informed about the each other’s activities to avoid duplication of effort and to identify where complementary roles can be played and where south-to-south technical exchanges can be beneficial. CountRy SuppoRt ACtIVItIES Increase targeted RHCS country-level technical assistance where results can be replicated and disseminated throughout the subregion. The broad focus of this strategy is primarily on what can be done to strengthen RHCS from the subregional level. At the same time, the need is critical to provide direct RHCS technical assistance to countries where it can have the greatest impact and where experiences can be translated to best practices that can be shared within and among countries. Weak program management systems—notably, M&E and financial management—characterize many country programs. Subregional country support activities will aim to support the development of a network of technical assistance providers and funding sources to focus on these gaps. 5.3 ContExt oBjECtIVE Improve, increase, and streamline common and specific RHCS policies at the country level to create a policy environment that will support RHCS in the subregion. SuBREgIonAL RHCS ISSuES These issues include— COMPONENT A: STRATEGIC PLAN 17 inadequate integration of RHCS into national health and reproductive health policies in some countries inadequate financing for RH commodity and commodity logistics management at the national level excessive regulatory barriers (e.g., excessive taxes, tariffs, and advertising restrictions) uneven political commitment or prioritization of RHCS on governmental agenda lack of enforcement of regulatory guidelines at national service delivery levels absence of advocacy materials to enhance policy support for financing and promoting RHCS lack of information on unmet need and other data for RH commodity programming poor access and low utilization of RH commodities. StRAtEgIES Advocacy: Advocate for a strengthened and harmonized policy and regulatory framework for RHCS, including DRPs, STGs, and EMLs. Public-Private Sector Partnerships: Create an enabling environment for public-private partnerships. Finance: Encourage countries to establish sustainable financing for RHCS. Unmet Need: Address the issues of unmet need for RH commodities in the subregion. kEy outCoMES Key outcomes may include— increased client access to and use of affordable, quality RH services and commodities through public and private services improved political commitment to RHCS increased funding to purchase RH commodities in the subregion a supportive policy environment to improve RHCS in the subregion. ASSuMptIonS There will be political stability in the subregion. Policymakers are willing to support a coordinated approach to RHCS. Some countries are already engaged in the process of improving the national context for RHCS. Appropriate capacity exists in the subregion and member countries to create the necessary policy environment to support RHCS. The policy environment is adaptable to new RHCS strategies. RISkS The subregion will have political instability, resulting in the inability to implement RHCS activities. Some countries do not perceive RHCS as a priority issue. • • • • • • • • 1. 2. 3. 4. • • • • • • • • • • • 18 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION Ongoing efforts to improve RHCS context have stalled or are not effective. Policymakers prefer not to engage in a subregional effort. It is difficult to identify the appropriate leadership (“national champions”) at the country level to move the RHCS agenda forward. ACtIonS tABLE 1: ACtIonS to IMpRoVE, InCREASE, AnD StREAMLInE CoMMon AnD SpECIfIC RHCS poLICIES At tHE CountRy LEVEL Strategies Actions Subactions 1. Advocacy: Advocate for a strengthened and harmonized policy and regulatory framework for RHCS, including DRPs, STGs, and EMLs. �. Advocate to ensure that RHCS is integrated into RH policy in all countries of the subregion. �.� Identify a pool of consultants to provide technical assistance (TA) to countries, as needed. �.� Collate and provide technical reference materials to countries for the integration of RHCS into the national RH policies. �.3 Carry out advocacy for the integration of RHCS into RH policies (include issues of non-supportive sociocultural norms). �.4 Monitor the integration of RHCS into national RH policies. �. Harmonize country DRPs, STGs, and EMLs (with a focus on RH commodities). � �. Collect and review the drug registration procedures of DRPs, STGs, and EMLs. �.� Convene a meeting of stakeholders to review and establish consensus on the benefits of common approaches. �.3 Implement advocacy efforts to revise and standardize DRPs, STGs, and national EMLs to conform to subregional consensus. �.4 Monitor the implementation of changes in DRPs, STGs, and EMLs. 2. Public- and Private-Sector Partnerships: Create an enabling environment for public-private partnerships. �. Encourage national-level stakeholders to encourage the private sector to participate more actively in the provision of RH commodities. �.� Mobilize national stakeholders to conduct studies on willingness to pay (WTP), ability to pay (ATP), and market segmentation analyses (MSAs). �.� Collate and disseminate existing data on WTP, ATP, and MSAs. �.3 Support national stakeholders to demonstrate the potential benefits of the whole market approach to product availability to the public and private sectors and civil society. �.4 Motivate member states to share this information at the subregional level to disseminate best and promising practices in public-private partnerships. 3. Finance: Encourage countries to establish sustainable financing mechanisms for RHCS. �. Facilitate the creation of sustainable financing mechanisms for RH commodities. �.� Encourage the creation of dedicated budget line items for RH commodities in national health budgets. �.� Mobilize partners (donors, lenders, private sector, and NGOs) to increase funding for RH commodities. 4. Unmet Need: Address unmet need for RH commodities in the subregion. �. Undertake an advocacy campaign to address the unmet need of RH commodities in the subregion. �.� Conduct a desk review on factors contributing to unmet need (e.g., sociocultural, service delivery). �.� Prepare and disseminate evidence-based materials for advocacy campaign. �.3 Monitor actions that have been taken by countries as a result of the advocacy campaign. • • • COMPONENT A: STRATEGIC PLAN 19 5.4 CooRDInAtIon oBjECtIVE Strengthen planning, management, and implementation of RHCS activities through coordinating mechanisms that involve the engagement of a broad range of stakeholders, including donors, governments, the private sector, and civil society organization. SuBREgIonAL RHCS ISSuES Issues include— poor information management insufficient coordination mechanisms and inadequate use of existing ones limited or inefficient use of resources multiplicity or duplication of procedures and activities by stakeholders inadequate inclusion of all stakeholders (public, private, and others) in the coordination process failure on the part of governments to honor political commitments failure by donors to honor pledges of support. StRAtEgIES Strategies include— Coordinated Informed Buying: Establish a coordinating mechanism to facilitate access to and the sharing of procurement information about RH commodities. Interagency Coordination: Improve coordination among partners in the area of RHCS. kEy outCoMES More effective coordination among partners is seen in the subregion. All ECOWAS countries have access to and share information on RH commodity procurement. ASSuMptIonS Stakeholders are willing to participate in coordination activities (with particular reference to CIB). National RHCS plans, strategies, and committees exist. Capacity for coordination exists at the subregional level. Implementation of RHCS activities are documented at the national level. Number of stakeholders to be coordinated is manageable. Stakeholders to be coordinated will be appropriately represented. RISkS Stakeholders prefer to engage in independent planning, management, and implementation of RHCS activities. • • • • • • • 1. 2. • • • • • • • • • 20 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION National RHCS plans, strategies, and committees do not exist. There are barriers to their formation. Stakeholders are unable to be flexible and do not adapt to common coordination mechanisms. Implementation of RHCS activities are not documented at the national level, resulting in the need for unplanned intensive data collection efforts. Stakeholders to be coordinated may be inappropriately represented or not represented in appropriate numbers. ACtIonS tABLE 2: ACtIonS to StREngtHEn pLAnnIng, MAnAgEMEnt, AnD IMpLEMEntAtIon of RHCS ACtIVItIES Strategies Actions Subactions 1. Coordinated Informed Buying: Establish a coordinating mechanism to facilitate access to and the sharing of procurement information on RH commodities. �. Make the CIB network operational. �.� Plan and manage implementation (develop indicators, develop workplan, etc.). �.�. Hire a CIB system manager. �.3 Hold technical design workshop. �.4 Develop terms of reference (TORs) for the network participants. Develop terms of reference (TORs) for the network participants.Develop terms of reference (TORs) for the network participants. �.5 �alidateTORs by countries. �alidateTORs by countries.�alidate TORs by countries. �.6 Designate one contact person from every country, based on the Designate one contact person from every country, based on theDesignate one contact person from every country, based on the content of the TORs. �.7 Identify the other actors in the countries. Identify the other actors in the countries.Identify the other actors in the countries. �.8 Purchase necessary hardware; install initial software. �.9 Design and manage a pilot phase with five countries for one year. Design and manage a pilot phase with five countries for one year. Design and manage a pilot phase with five countries for one year.Design and manage a pilot phase with five countries for one year. �.�0 Design prototype. �.�� Develop training materials; identify and train users, operators, and technical staff. �.�� Install production-ready software. �.�3 Begin network operation. �.�4 Conduct pilot data collection, analyze results, and resolve issues. �.�5 Evaluate pilot phase mid-term review. Evaluate pilot phase mid-term review.Evaluate pilot phase mid-term review. �.�6 Disseminate evaluation report on the pilot phase. Disseminate evaluation report on the pilot phase.Disseminate evaluation report on the pilot phase. �.�7 Extend network to all �5 countries. Extend network to all �5 countries.Extend network to all �5 countries. �.�8 Conduct annual meetings to analyze CIB information and discuss improvements. �.�9 Update workplan and provide periodic updates to stakeholders. 2. Interagency Coordination: Improve coordination among partners in the area of RHCS. �. Create a subregional RHCS partners’ network. �.� Identify all the RHCS partners working at the subregional level. �.� Convene regular meetings of subregional agencies/partners to facilitate coordination and collaboration (e.g., share workplans; identify action items and data gaps). �.3 Establish electronic network (email) to keep partners informed on RHCS activities and issues. �.4 Monitor national-level RHCS interagency coordination and collaboration and share findings in partners’ forum. • • • • COMPONENT A: STRATEGIC PLAN 21 5.5 CApACIty BuILDIng oBjECtIVE Improve human, technical, and institutional capacity for the achievement of RHCS in the West African subregion. SuBREgIonAL RHCS ISSuES Issues include— insufficient number of qualified personnel inadequate training of health workers in RH low staff retention rates absence of effective motivation programs for personnel inefficient logistics management systems inadequate financing mechanisms for RHCS uneven, ineffective follow-through on commitments made by governments low-level use of RH services by the population absence of a mechanism to ensure continuity. StRAtEgIES Human Resource Development: Advocate strengthening of human resources and management of RHCS. Logistics Management Capacity Building: Promote logistics management capacity building, including integration of health management information systems (HMISs), logistics management information systems (LMISs), and vertical programs. Integration of RHCS into the public health curriculum: Advocate for the integration of RHCS into the publicRHCS into the public health curriculum. Promoting IEC and behavior change communication (BCC): Promote the use of IEC and BCC to increase aware- ness of RHCS issues in the community. Program sustainability: Advocate for the importance of maintaining trained staff for program sustainability. kEy outCoMES Outcomes include— number of policies implemented to address program sustainability retention rate in RHCS programs effective and efficient logistic RH management system in place commodity security components of RH teaching introduced into schools and faculties number of countries using IEC and BCC to promote RHCS issues in the community number of skilled personnel providing quality services. • • • • • • • • • 1. 2. 3. 4. 5. • • • • • • 22 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION ASSuMptIonS Assumptions include— high priority accorded to health sector in national development programs continued limited absorption and retention of health care personnel priority given to reproductive health financing by partners. RISkS New priorities (e.g., HIV/AIDS) emerge. Despite retention efforts, brain drain continues. Partners do not provide financial support. ACtIonS tABLE 3: ACtIonS to IMpRoVE HuMAn, tECHnICAL, AnD InStItutIonAL CApACIty foR tHE ACHIEVEMEnt of RHCS In tHE wESt AfRICAn SuBREgIon. Strategies Actions Subactions �. Human Resource Development: Advocate strengthening of human resources and management of RHCS. �. Strengthen regional training centers for human resource management of RHCS. �.� Identify regional training centers. �.� Conduct training of trainers (TOTs) for RHCS. �. Promote retention of trained staff involved in RHCS. �.� Identify and share motivational best practices. 2. Logistics Management Capacity Building: Promote logistics management capacity building, including integration of HMIS/ LMIS and vertical programs. �. Promote training of trainers in— logistics management system integration of HMIS/LMIS into RH service delivery policy formulation quality control implementation of RHCS. • • • • • • �.� Adapt curriculum. �.� Identify training institutions and trainers. �.3 Organize the training. �.4 Monitor trainees to determine training efficacy. �.5 Collect and disseminate data on countries training in RHCS. 3. Integration of RHCS into Public Health Curriculum: Advocate for the integration of RHCSRHCS into public health curriculum. �. Introduce RHCS curriculum into public health programs in universities and public health institutions. �.� Identify universities and public health institutions. �.� Adapt curriculum. �.3 Identify trainers. �.4 Train staff in RHCS curriculum. �.5 Organize the training. �.6 Monitor trainees to determine training efficacy. �.7 Collect and disseminate data on countries training in RHCS. 4. Promoting IEC/BCC: Promote the use of IEC/BCC to increase awareness of RHCS issues in the community. �. Develop subregional capacity for the promotion of training community agents in IEC/BCC. �.� Assess current community-based IEC/ BCC systems. �.� Prepare training documents. �.3 Organize training sessions.Organize training sessions. 5. Program Sustainability: Advocate for the importance of maintaining trained staff for program sustainability. �. Promote program sustainability. �.� Emphasize the importance of staff retention at policymaking fora. �.� Encourage partners to develop exit strategies. �.3 Develop and disseminate advocacy materials including guidelines for staff retention. • • • • • • COMPONENT A: STRATEGIC PLAN 23 5.6 CountRy SuppoRt oBjECtIVE Strengthen subregional institutions and networks to deliver targeted RHCS technical assistance to the country level where results can be replicated and disseminated throughout the subregion. SuBREgIonAL RHCS ISSuES Issues include— ineffective program management practices in— program development financial management monitoring and evaluation low absorptive capacity of allocated funds underutilization and lack of development of coordinating mechanisms. StRAtEgIES Provision of Technical Assistance: Establish mechanism for provision of technical assistance (TA) for RHCS. Advocacy: Advocate for the harmonization of country management tools across the subregion. kEy outCoMES Outcomes include— increased partners’ support for the implementation of harmonized RHCS management tools number of countries that have benefited from TA number of countries applying common management tools number of countries that have applied for and received TA. ASSuMptIonS Assumptions include— political commitment exists regional experts exist national RH programs and RHCS plans in WAHO member countries exist funding identified for technical assistance. RISkS Risks include— absence of commitment by countries to receive technical assistance • – – – • • 1. 2. • • • • • • • • • 24 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION unwillingness to take the necessary steps to harmonize standards insufficient funding to carry out TA. ACtIonS tABLE 4: ACtIonS to StREngtHEn SuBREgIonAL InStItutIonS AnD nEtwoRkS to DELIVER tARgEtED RHCS tECHnICAL ASSIStAnCE Strategies Actions Subactions Provision of Technical Assistance: Establish mechanism for provision of TA for RHCS. �. Identify and provide country support for TA activities. �.� Identify TA needs and process. �.� Prepare and implement a workplan to provideTA to therepare and implement a workplan to provide TA to the countries. �.3 Identify partners to support the implementation of the workplan. �. Establish regional experts network in RHCS. �.� Identify regional experts in RHCS. �.� Prepare theTORs of network of experts.Prepare the TORs of network of experts. �.3 Promote networking of subregional experts. Advocacy: Advocate for the harmonization of country management tools across the subregion. �. Develop common management tools for RHCS components (e.g., procurement planning, LMIS/ pipeline monitoring, strategic planning [SPARHCS], drug registration database). �.� Define the key areas for harmonization. �.� Formulate the common management tools. �.3 Disseminate the harmonized tools in the subregion. �.4 Present the harmonized tools to partners/stakeholders fora. �.5 Follow up on implementation. �. Organize advocacy meetings with partners and stakeholders (round table, fora, conference). �.� Define audience for evidence-based data presentations. �.� Identify the best approaches for each group of partners and stakeholders. �.3 Conduct regular meetings with stakeholders. • • ADVOCACY PLAN FOR FINANCING THE IMPLEMENTATION 25 6.0 ADVOCACY PLAN FOR FINANCING THE IMPLEMENTATION During the January 2006 PMLO strategy development workshop it was agreed that advocacy efforts aimed at securing commitments for the strategy would be crucial to success. The subregional strategy will require the concerted action and commitment of donors, governments, technical agencies, NGOs, and others. Financial commitments will be required from multiple sources. A road map or plan to help ensure that the strategy is disseminated to these groups and their support to imple- ment actions are identified as necessary prerequisites. During the development phase, it is important to engage donors, lending institutions, ECOWAS member govern- ments, community-based organizations, the private sector, international and national nongovernmental organiza- tions (NGOs), and others with a stake in RHCS outcomes in the West Africa subregion. The overall goal of the advocacy plan is to secure adequate and sustainable financing for the implementation of the strategy. The following advocacy plan consists of three objectives. These objectives were included in the Context section. The following section further defines and details how these objectives will be achieved. It proposes a deci- sion-making process, suggested message channels to include in that process, and specific activities. The objectives are as follows: Obtain sufficient funding to support the development and implementation of the RHCS strategy. Establish public- and private-sector partnerships (PPPs) for RHCS in all 15 ECOWAS countries by 2010. Help all 15 ECOWAS countries to include government budget lines for RH commodities by 2010. 1. 2. 3. 26 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION t A B L E 5 : o B jE C t IV E S A n D H o w t H E y w IL L B E A C C o M p L IS H E D o bj ec ti ve # 1: o bt ai n su ffi ci en t fu nd in g to s up po rt t he d ev el o pm en t an d im pl em en ta ti o n o f t he R H C S s tr at eg y. A ud ie nc es D ec is io n- m ak in g p ro ce ss C o al it io n M es sa ge /C ha nn el s k ey A ct iv it ie s/ R es po ns ib ili ti es t im el in e P ri m ar y* Se co nd ar y D on or s: Bi la te ra l: U SA ID D FI D JIC A C ID A KF W M ul til at er al : U N FP A W H O G lo ba l F un d W or ld B an k BC EA O A D B Pr iva te S ec to r: G AT ES F ou nd at io n M TN F ou nd at io n fo r RH M an uf ac tu re rs o f co m m od iti es a nd th ei r di st rib ut or s H ew le tt P ac ka rd Fo un da tio n N G O s: IP PF • • • • • • • • • • • • • • • • • M in ist er s of H ea lth O th er d on or s C ou nt ry go ve rn m en ts W A H O N G O s O th er im pl em en t- in g pa rt ne rs • • • • • • St ep 1 : W A H O a nd pa rt ne rs d et er m in e co st s ne ed ed fo r ea ch co m po ne nt o f t he R H C S st ra te gy . St ep 2 : W A H O a pp ro ac he s do no rs a sk in g th em t o fu nd sp ec ifi c co m po ne nt s of th e pl an . St ep 3 : W A H O a nd pa rt ne rs in vi te k ey d on or s to t he IP C la un ch o f t he RH C S st ra te gy . St ep 4 : D on or s re vi ew as pe ct s of t he p la n an d co m m it to fu nd in g. St ep 5 : D on or s aw ar d fu nd in g. Ta sk F or ce , P LM O , ot he r do no rs , EC O W A S he al th m in ist er s Fo r ev er y �0 0, 00 0 liv e bi rt hs in W es t A fr ic a, 88 0 m ot he rs d ie fr om co m pl ic at io ns o f p re gn an cy a nd c hi ld bi rt h. Fo r ev er y �, 00 0 liv e bi rt hs , m or e th an �0 0 in fa nt s do n ot li ve t o se e th ei r fir st bi rt hd ay ( PR B �0 05 ). T he h ig h ra te s of m at er na l a nd in fa nt d ea th s in W es t A fr ic a ar e un ac ce pt ab le . O ne e ffe ct iv e w ay t o re du ce m at er na l an d in fa nt d ea th s is to e ns ur e fa m ily pl an ni ng m et ho ds a re a va ila bl e to a ll w ho w an t to p la n an d sp ac e th ei r bi rt hs . Fo r ex am pl e, w he n m ot he rs s pa ce t he ir bi rt hs a t le as t tw o ye ar s ap ar t, in fa nt m or ta lit y ra te s ar e re du ce d by a s m uc h as 5 0 pe rc en t. A dd iti on al ly, s tu di es s ho w t ha t if w om en ha d th e nu m be r of p re gn an ci es a t th e in te rv al s th ey w an te d, m at er na l m or ta lit y w ou ld d ro p by � 0– 35 p er ce nt . D es pi te t he p ro ve n lin ks b et w ee n th e us e of fa m ily p la nn in g an d re du ct io ns in m at er na l a nd in fa nt m or ta lit y, im pr ov in g ac ce ss t o fa m ily p la nn in g m et ho ds h as n ot be en a h ig h pr io rit y fo r po lic ym ak er s. W om en in t he s ub re gi on w ho e xp re ss a de sir e to p la n an d sp ac e th ei r bi rt hs s til l la ck a cc es s to fa m ily p la nn in g m et ho ds . W e ne ed t o ac t no w t o m ak e fa m ily pl an ni ng m et ho ds a va ila bl e to a ll w om en w ho w an t to p la n an d sp ac e bi rt hs . Th e re gi on al R H C S st ra te gy w ill he lp in cr ea se a cc es s to R C H S pr od uc ts a nd en su re t he b es t va lu e fo r th e pr od uc ts . �. F in ish R H C S pl an . �. D ev el op m at er ia ls (a o ne - pa ge fa ct s he et /p re se nt at io n) t o ad vo ca te fo r th e RH C S/ C IB p la n. 3. Id en tif y ke y do no rs a nd id en tif y sp ec ifi c ar ea s fo r fu nd in g. Ta rg et IP C m em be rs . 4 . U se t he IP C m ee tin g in Se pt em be r to la un ch th e RH CS st ra te gy , w hi ch w ill be a d on or ’s m ee tin g w he re p ot en tia l do no rs a re in vi te d to h ea r th e pr es en ta tio n of t he s tr at eg y an d th e sp ec ifi c ar ea s of fu nd in g. Th e go al o f t hi s m ee tin g w ou ld be t o ob ta in c om m itm en ts fro m d on or s. Be fo re t he la un ch , sp ec ifi c do no rs w ill ne ed t o be co nt ac te d. W A H O a nd t he t as k fo rc e ne ed t o id en tif y do no rs t o fu nd e ac h as pe ct o f t he p la n. 5. A fte r th e la un ch , in di vi du al m ee tin gs n ee d to b e he ld w ith sp ec ifi c do no rs t o di sc us s RH C S pl an w ith d on or s. 6. E st ab lis h co nt ac t pe rs on a t W A H O t o co or di na te fi na nc es . 7. D isc us s w ith p ar tn er s th e po ss ib ilit y of m an ag in g sp ec ifi c co m po ne nt s of t he R H C S fin an ci ng p la n. Ac tiv ity 1 : J un e �0 06 Ac tiv ity 2 : S ep te m be r �0 06 Ac tiv ity 3 : J un e– Se pt em be r �0 06 Ac tiv ity 4 : S ep te m be r �0 06 Ac tiv ity 5 : S ep te m be r– D ec em be r �0 06 Ac tiv ity 6 : J an ua ry � 00 7 Ac tiv ity 7 : Ju ne –D ec em be r �0 06 * Ea ch d on or h er e re pr es en ts a s ep ar at e de ci sio n m ak er . E ac h sh ou ld b e ta rg et ed s ep ar at el y fo r fu nd in g. ADVOCACY PLAN FOR FINANCING THE IMPLEMENTATION 27 o bj ec ti ve # 2: E st ab lis h pr iv at e- se ct o r in ve st m en t fo r R H C S in a ll 15 E C o w A S c o un tr ie s by 2 01 0. A ud ie nc es D ec is io n- m ak in g p ro ce ss C o al it io n M es sa ge /C ha nn el s k ey A ct iv it ie s/ R es po ns ib ili ti es t im el in e P ri m ar y* Se co nd ar y M TN F ou nd at io n fo r RH M an uf ac tu re rs o f co m m od iti es a nd th ei r di st rib ut or s O th er p riv at e- se ct or c om pa ni es in vo lv ed in co un tr y- le ve l ac tiv iti es • • • M in ist rie s of H ea lth O th er d on or s C ou nt ry go ve rn m en ts W A H O N G O s O th er p ro gr am im pl em en te rs • • • • • • St ep 1 : W A H O a nd pa rt ne rs id en tif y ex am pl es o f p ub lic -p riv at e pa rt ne rs hi ps in t he r eg io n th at a re w or ki ng t o es ta bl ish R H C S. If RH C S ex am pl es a re n ot a va ila bl e, ex am pl es fr om o th er se ct or s su ch a s nu tr iti on , H I� /A ID S, an d fa m ily pl an ni ng , s ho ul d be g iv en . C on ta ct w ith e xi st in g pa rt ne rs w or ki ng in t he fie ld is n ec es sa ry . St ep 2 : W A H O id en tifi es at le as t fiv e pr iv at e- se ct or co m pa ni es t o ta rg et . St ep 3 : W A H O a nd ot he r pa rt ne rs o rg an ize a pr iv at e- s ec to r di al og ue t o so lic it ad di tio na l p ub lic - an d pr iv at e- se ct or p ar tn er s. St ep 4 : W A H O e st ab lis he s pa rt ne rs hi ps w ith r eg io na l m an ag em en t of in di vi du al co m pa ni es . St ep 5 : W A H O t ar ge ts re gi on al p riv at e- se ct or co m pa ni es t o en co ur ag e co un tr y- le ve l o ffi ce s to co lla bo ra te w ith m in ist rie s on R H C S. Ta sk F or ce , P LM O , ot he r do no rs , EC O W A S he al th m in ist rie s Fo r ev er y �0 0, 00 0 liv e bi rt hs in W es t A fr ic a, 88 0 m ot he rs d ie fr om c om pl ic at io ns o f p re gn an cy an d ch ild bi rt h. F or e ve ry � ,0 00 li ve b ir th s, m or e th an � 00 in fa nt s do n ot li ve t o se e th ei r fir st b ir th da y (P RB � 00 5) . T he h ig h ra te s of m at er na l a nd in fa nt d ea th s in W es t A fr ic a ar e un ac ce pt ab le . O ne e ffe ct iv e w ay t o re du ce m at er na l a nd in fa nt de at hs is t o en su re t ha t fa m ily p la nn in g m et ho ds ar e av ai la bl e to a ll w ho w an t to p la n an d sp ac e th ei r bi rt hs . F or e xa m pl e, w he n m ot he rs s pa ce th ei r bi rt hs a t le as t tw o ye ar s ap ar t, in fa nt m or ta lit y ra te s ar e re du ce d by a s m uc h as 5 0 pe rc en t. A dd iti on al ly, s tu di es s ho w t ha t if w om en h ad th e nu m be r of p re gn an ci es a t th e in te rv al s th ey w an te d, m at er na l m or ta lit y w ou ld d ro p by �0 –3 5 pe rc en t. D es pi te t he p ro ve n lin ks b et w ee n th e us e of fa m ily p la nn in g an d re du ct io ns in m at er na l a nd in fa nt m or ta lit y, co nt ra ce pt iv e se cu rit y ha s no t be en a h ig h pr io rit y fo r po lic ym ak er s. W om en in t he s ub re gi on w ho e xp re ss a d es ire to p la n an d sp ac e th ei r bi rt hs s til l l ac k ac ce ss t o fa m ily p la nn in g m et ho ds . W e ne ed t o ac t no w to m ak e fa m ily p la nn in g m et ho ds a va ila bl e to a ll w om en w ho w an t to p la n an d sp ac e bi rt hs . Pu bl ic - an d pr iv at e- se ct or p ar tn er sh ip s ha ve be en in st ru m an ta l t o im pr ov in g th e he al th of in di vi du al s in t he s ub re gi on . E st ab lis hi ng co un tr y- le ve l p ub lic -p riv at e pa rt ne rs hi ps w ill he lp e ns ur e w om en in t he s ub re gi on w ill ha ve ac ce ss t o fa m ily p la ni ng p ro du ct s. Th e re gi on al RH C S st ra te gy w ill he lp in cr ea se a cc es s to RC H S pr od uc ts a nd e ns ur e th e be st v al ue fo r th e pr od uc ts . �. F in ish R H C S pl an . �. H ire a c on su lta nt t o co nd uc t a sit ua tio na l a na ly sis o n su cc es sf ul pu bl ic -p riv at e pa rt ne rs hi ps in RH C S. U se o th er h ea lth s ec to rs (n ut rit io n, H I� /A ID S, an d fa m ily pl an ni ng ) as m od el s or c as e st ud ie s. 3. M ee t w ith t he t as k fo rc e to r ev ie w fi nd in gs o f t he co ns ul ta nt s’ re po rt . 4. D ev el op a dv oc ac y m at er ia ls to p ro m ot e pu bl ic - an d pr iv at e- se ct or p ar tn er sh ip . 5. O rg an ize a “ Pr iv at e Se ct or In ve st m en t in R H C S D ia lo gu e. ” In vi te k ey p riv at e- s ec to r or ga ni za tio ns t o a fo ru m w he re ca se s tu di es a re r ep re se nt ed an d op po rt un iti es fo r PP P ar e id en tifi ed . A dd re ss s pe ci fic co nc er ns a nd c ha lle ng es re ga rd in g T & T an d ot he r iss ue s. 6. Id en tif y co nc re te a re as fo r co lla bo ra tio n. 7. H ol d co un tr y- le ve l m ee tin gs to d ev el op c ou nt ry -s pe ci fic ac tio n pl an s. A ct iv ity 1 : Ju ne � 00 6 A ct iv ity 2 : S ep te m be r– D ec em be r �0 06 A ct iv ity 3 : J an ua ry – Fe br ua ry � 00 7 A ct iv ity 4 : Ja nu ar y– A pr il �0 07 A ct iv ity 5 : A pr il �0 07 A ct iv ity 6 : A pr il �0 07 –A pr il �0 �0 A ct iv ity 7 : A pr il �0 07 –o ng oi ng * Ea ch c om pa ny li st ed h er e re pr es en ts a s ep ar at e de ci sio n m ak er . E ac h sh ou ld b e ta rg et ed s ep ar at el y fo r fu nd in g. 28 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION o bj ec ti ve # 3: H el p al l 1 5 E C o w A S c o un tr ie s to in cl ud e go ve rn m en t bu dg et li ne s fo r R H c o m m o di ti es b y 20 10 . A ud ie nc es D ec is io n- m ak in g p ro ce ss C o al it io n M es sa ge /C ha nn el s k ey A ct iv it ie s/ R es po ns ib ili ti es t im el in e P ri m ar y Se co nd ar y M in ist ry o f H ea lth Pa rli am en ts o f al l � 5 EC O W A S co un tr ie s M in ist ry o f Fi na nc e • • • EC O W A S H ea lth M in ist er s EC O W A S Pa rli a- m en t’s H ea lth C om m itt ee EC O W A S Pa rli am en t M in ist rie s of Fi na nc e O th er D on or s C ou nt ry G ov er nm en ts W A H O • • • • • • • �. R ee ne rg ize c ou ns el o f m in ist er s to p ro m ot e po lic y at c ou nt ry le ve l. �. P re se nt s tr at eg y to t he EC O W A S pa rli am en t. 3. M em be rs o f E C O W A S pa rli am en t fo llo w t he pr oc es s at t he c ou nt ry le ve l. Ta sk F or ce , P LM O , ot he r do no rs , EC O W A S he al th m in ist rie s Fo r ev er y �0 0, 00 0 liv e bi rt hs in W es t A fr ic a, 88 0 m ot he rs d ie fr om c om pl ic at io ns o f p re gn an cy an d ch ild bi rt h. M or eo ve r, fo r ev er y �, 00 0 liv e bi rt hs , m or e th an � 00 in fa nt s do n ot li ve t o se e th ei r fir st b ir th da y (P RB � 00 5) . T he h ig h ra te s of m at er na l a nd in fa nt d ea th s in W es t A fr ic a ar e un ac ce pt ab le . O ne e ffe ct iv e w ay o f r ed uc in g m at er na l a nd in fa nt d ea th s is en su rin g fa m ily p la nn in g m et ho ds ar e av ai la bl e to a ll w ho w an t to p la n an d sp ac e th ei r bi rt hs . F or e xa m pl e, w he n m ot he rs s pa ce th ei r bi rt hs a t le as t tw o ye ar s ap ar t, in fa nt m or ta lit y ra te s ar e re du ce d by a s m uc h as 5 0 pe rc en t. A dd iti on al ly, s tu di es s ho w t ha t if w om en h ad th e nu m be r of p re gn an ci es a t th e in te rv al s th ey w an te d, m at er na l m or ta lit y w ou ld d ro p by � 0– 35 pe rc en t. Th e re gi on al R H C S st ra te gy w ill he lp in cr ea se ac ce ss to R H p ro du ct s an d en su re th e be st va lu e fo r th e pr od uc ts . D es pi te th e pr ov en lin ks b et w ee n th e us e of fa m ily p la nn in g an d im pr ov ed m at er na l a nd in fa nt h ea lth o ut co m es , m os t g ov er nm en ts in W es t A fr ic a do n ot h av e a bu dg et li ne fo r RH c om m od iti es . T he p ur ch as e of RH c om m od iti es is o fte n co m bi ne d w ith o th er he al th c om m od iti es . A s a re su lt, RH c om m od iti es ar e of te n bo ug ht in in su ffi ci en t q ua nt iti es a nd co un tr ie s ar e fo rc ed to r el y on d on or s to in cr ea se th ei r su pp ly. H ow ev er , r el yi ng o n do no r su pp or t is no t s us ta in ab le . F or e xa m pl e, if d on or fi na nc in g re m ai ns a t c on st an t l ev el s, th er e w ill be a t l ea st a $� 4 m illi on g ap fo r co nt ra ce pt iv es in � 0� 0. Th e tim e is no w fo r EC O W A S co un tr ie s to de m on st ra te le ad er sh ip a nd c om m it th em se lv es to s av in g th e liv es o f w om en a nd c hi ld re n. Es ta bl ish a b ud ge t lin e fo r RH c om m od iti es n ow . �. F in ish R H C S pl an . �. R ev ie w d at a to d et er m in e w hi ch E C O W A S co un tr ie s ha ve ad op te d RH c om m od iti es b ud ge t lin es ( N ig er /G am bi a) . 3. H ire a c on su lta nt t o de ve lo p a ca se s tu dy o n a co un tr y th at ha s su cc es sf ul ly a dv oc at ed fo r a bu dg et li ne it em fo r RH co m m od iti es ( N ig er /G am bi a) . In cl ud e co nc re te s te ps a s to h ow th is w as d on e. 4. D ev el op o ne -p ag e fa ct s he et ou tli ni ng im po rt an ce o f b ud ge t lin e ite m s (fo r th e EC O W A S pa rli am en t) . 5. H ol d a su br eg io na l m ee tin g w ith t he h ea lth c om m itt ee of t he E C O W A S pa rli am en t to d isc us s th e im po rt an ce o f ad op tin g bu dg et li ne it em s fo r RH co m m od iti es . 6. E ns ur e th at E C O W A S H ea lth C om m itt ee d ev el op s a pl an o f a ct io n to g ai n po lit ic al co m m itm en t fro m E C O W A S pa rli am en t. 7. H ol d a su br eg io na l m ee tin g w ith t he M O F, th e M O H , a nd pa rli am en t m em be rs fr om a ll �5 co un tr ie s to d ev el op n at io na l-l ev el ac tio n pl an s fo r th e ad op tio n of bu dg et li ne s. Ac tiv ity 1 : J un e �0 06 Ac tiv ity 2 : Ju ne –J ul y �0 06 Ac tiv ity 3 : A ug us t– D ec em be r �0 06 Ac tiv ity 4 : J an ua ry �0 07 –M ay � 00 7 Ac tiv ity 5 : M ay � 00 7 Ac tiv ity 6 : M ay � 00 7 Ac tiv ity 7 : Ju ne –J ul y �0 07 Ac tiv ity 8 : Ju ne /Ju ly � 00 7– Ju ne / Ju ly � 0� 0 COMPONENT B: OPERATIONAL PLAN 29 7.0 COMPONENT B: OPERATIONAL PLAN 7.1 BuDgEt SuMMARy tABLE 6: SuMMARy of BuDgEt foR yEARS 1–5 total Estimated Requirements in u.S.$1 Year 1 2007 Year 2 2008 Year 3 2009 Year 4 2010 Year 5 2011 Total 1. Context $�95,364 $�95,364 $�95,365 $�95,364 $�95,364 $976,821 2. Coordination $�70,045 $�70,045 $�70,045 $�70,045 $�70,045 $1,350,226 3. Capacity $�35,850 $�35,849 $�35,849 $�35,849 $�35,850 $1,179,247 4. Country Support $98,494 $98,495 $98,495 $98,495 $98,494 $492,473 5. Coordination, Monitoring, & Evaluation2 $�30,645 $�30,645 $�30,645 $�30,645 $�30,645 $1,153,225 total $5,151,992 � Total costs over the five-year period were divided equally for the years between �007 and �0��. Annual workplans will show greater activity detail and will provide more accurate year-to-year expenditure projections. � This includes substantial staff time to manage and implement RHCS activities. See section 8.0 for more details. 30 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION 7. 2 C o n t E x t t A B L E 7 : C o n t E x t f o R t H E o R g A n Iz A t Io n A L p L A n S tr at eg ie s A ct io ns S ub ac ti o ns p ro po se d Im pl e- m en ti ng A ge nc ie s C o o rd in at in g A ge nc ie s t im ef ra m e C o st 1. A dv oc ac y: A dv oc at e fo r a st re ng th en ed a nd ha rm on ize d po lic y an d re gu la to ry fr am ew or k fo r RH C S, in cl ud in g dr ug re gi st ra tio n, s ta nd ar d tr ea tm en t gu id el in es , a nd es se nt ia l m ed ic in es li st s. �. A dv oc at e to e ns ur e th e in te gr at io n of R H C S in to RH p ol ic y in a ll co un tr ie s of t he s ub re gi on . �. � Id en tif y a po ol o f c on su lta nt s to p ro vi de T A t o co un tr ie s as n ee de d. �. � C ol la te a nd p ro vi de t ec hn ic al r ef er en ce m at er ia ls to c ou nt rie s fo r th e in te gr at io n of R H C S in to t he na tio na l R H p ol ic ie s. �. 3 C ar ry o ut a dv oc ac y fo r th e in te gr at io n of R H C S in to R H p ol ic ie s (in cl ud e iss ue s of n on -s up po rt iv e so ci oc ul tu ra l n or m s) . �. 4 M on ito r th e in te gr at io n of R H C S in to n at io na l RH p ol ic ie s. W A H O M O H s U SA ID C oo pe ra tin g A ge nc ie s U N FP A IP S W A H O M O H s A pr il �0 07 – O ct ob er � 0� � $� 9, 3� 7 $9 ,6 59 $3 79 ,9 �8 $6 9, 54 � �. H ar m on ize c ou nt ry dr ug r eg ist ra tio n pr ot oc ol s, ST G s, an d EM Ls ( w ith a fo cu s on R H co m m od iti es ). � �. C ol le ct a nd r ev ie w m em be r co un tr ie s dr ug re gi st ra tio n pr oc ed ur es ( D RP s) , S TG s, an d EM Ls . �. � C on ve ne a m ee tin g of s ta ke ho ld er s to r ev ie w , an d es ta bl ish c on se ns us o n, b en efi ts o f c om m on ap pr oa ch es . �. 3 Im pl em en t ad vo ca cy e ffo rt s to r ev ise a nd st an da rd ize ( D RP s) , S TG s, an d na tio na l E M Ls t o co nf or m t o su br eg io na l c on se ns us . �. 4 M on ito r im pl em en ta tio n of c ha ng es in ( D RP s) , ST G s, an d EM Ls . W A H O A C A M E U N FP A M O H s W H O U SA ID c oo pe ra tin g ag en ci es IP S Su pp lie rs a nd m an uf ac tu re rs W A H O A C A M E M O H s (D ru g C on tr ol A ut ho rit y) A pr il– Se pt . � 00 7 $� 9, 3� 7 $4 8, 94 � $3 4, 77 � $3 4, 77 � 2. P ub lic S ec to r an d Pr iva te Se ct or P ar tn er sh ip s: Pa rt ne rs hi ps : C re at e an e na bl in g en vi ro nm en t fo r pu bl ic -p riv at e pa rt ne rs hi ps . �. E nc ou ra ge n at io na l-l ev el st ak eh ol de rs t o en ga ge th e pr iv at e se ct or t o pa rt ic ip at e m or e ac tiv el y in t he p ro vi sio n of R H co m m od iti es . �. � M ob iliz e na tio na l s ta ke ho ld er s to c on du ct s tu di es on w illi ng ne ss t o pa y (W TP ), ab ilit y to p ay ( AT P) , a nd m ar ke t se gm en ta tio n an al ys es ( M SA s) . �. � C ol la te a nd d iss em in at e ex ist in g da ta o n W TP , AT P, an d M SA s. �. 3 Su pp or t na tio na l s ta ke ho ld er s to d em on st ra te th e po te nt ia l b en efi ts o f t he w ho le m ar ke t ap pr oa ch to p ro du ct a va ila bi lit y fo r th e pu bl ic -p riv at e se ct or an d ci vi l s oc ie ty . �. 4 M ot iv at e m em be r st at es t o sh ar e th is in fo rm at io n at t he s ub re gi on al le ve l t o di ss em in at e be st a nd pr om isi ng p ra ct ic es in p ub lic -p riv at e pa rt ne rs hi ps . M O H s U SA ID c oo pe ra tin g ag en ci es U N FP A Pr iv at e se ct or ( C ha m be rs o f C om m er ce ) IP PF M ar ie S to pe s N G O s C iv il so ci et y or ga ni za tio ns W A H O EC O W A S Bu sin es s M en ’s Fo ru m M O H s Li ne g ov er nm en t ag en ci es ( e. g. M in ist rie s of F in an ce , Tr ad e, D ev el op m en t, Ec on om ic P la nn in g) Ja nu ar y �0 08 – D ec em be r �0 �0 $� 9, 3� 7 $9 ,6 59 $5 7, 95 � $5 7, 95 � COMPONENT B: OPERATIONAL PLAN 31 3. F in an ce : E nc ou ra ge co un tr ie s to e st ab lis h a su st ai na bl e fin an ci ng m ec ha ni sm fo r RH C S. �. F ac ilit at e th e cr ea tio n of s us ta in ab le fi na nc in g m ec ha ni sm s fo r RH co m m od iti es . �. � En co ur ag e th e cr ea tio n of d ed ic at ed b ud ge t lin e ite m s fo r RH c om m od iti es in n at io na l h ea lth b ud ge ts . �. � M ob iliz e pa rt ne rs ( do no rs , le nd er s, pr iv at e se ct or , N G O s) t o in cr ea se fu nd in g fo r RH c om m od iti es . W A H O U SA ID c oo pe ra tin g ag en ci es M O H M O F EC O W A S pa rli am en t C ou nt ry p ar lia m en ts U N FP A U SA ID W or ld B an k D FI D JIC A C ID A Kf W IP S W A H O M O H s Ja nu ar y �0 07 – D ec em be r �0 �� $5 7, 95 � $7 0, �0 � 4. U nm et N ee d: A dd re ss un m et n ee d of R H co m m od iti es in t he su br eg io n. �. U nd er ta ke a n ad vo ca cy ca m pa ig n to a dd re ss un m et n ee d of R H co m m od iti es in t he su br eg io n. �. � C on du ct d es k re vi ew o n fa ct or s co nt rib ut in g to un m et n ee d (e .g ., s oc io -c ul tu ra l, s er vi ce d el iv er y) . �. � Pr ep ar e an d di ss em in at e ev id en ce -b as ed m at er ia ls fo r ad vo ca cy c am pa ig n. �. 3 M on ito r ac tio ns t ha t ha ve b ee n ta ke n by co un tr ie s as a r es ul t of t he a dv oc ac y ca m pa ig n. W A H O U N FP A IP S W A H O M O H Fe b. � 00 7– D ec . �0 07 $3 8, 63 5 $� ,6 45 $4 6, 36 � to ta l $9 76 ,8 21 32 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION 7. 3 C o o R D In A t Io n t A B L E 8 : C o o R D In A t E D A C t Io n S f o R t H E o p E R A t Io n A L p L A n S tr at eg ie s A ct io ns S ub ac ti o ns p ro po se d Im pl e- m en ti ng A ge nc ie s C o o rd in at in g A ge nc ie s t im ef ra m e C o st 1. C oo rd in at ed In fo rm ed Bu yin g: E st ab lis h a co or di na tin g m ec ha ni sm to fa ci lit at e ac ce ss t o an d th e sh ar in g of pr oc ur em en t in fo rm at io n on R H c om m od iti es . �. M ak e th e C IB ne tw or k op er at io na l. �. � Pl an a nd m an ag e im pl em en ta tio n (d ev el op in di ca to rs , d ev el op w or kp la n, e tc .). �. �. H ire a C IB s ys te m m an ag er . �. 3 H ol d te ch ni ca l d es ig n w or ks ho p. �. 4 D ev el op t er m s of r ef er en ce ( TO Rs ) fo r th e ne tw or k pa rt ic ip an ts . �. 5 �a lid at io n of T O Rs b y co un tr ie s. �. 6 D es ig na te o ne c on ta ct p er so n fro m e ve ry c ou nt ry , ba se d on t he c on te nt o f t he T O Rs . �. 7 Id en tif y th e ot he r ac to rs in t he c ou nt rie s. �. 8 Pu rc ha se n ec es sa ry h ar dw ar e; in st al l i ni tia l so ftw ar e. �. 9 D es ig n an d m an ag e a pi lo t ph as e w ith fiv e D es ig n an d m an ag e a pi lo t ph as e w ith fi ve co un tr ie s fo r on e ye ar . �. �0 D es ig n pr ot ot yp e. �. �� D ev el op t ra in in g m at er ia ls; id en tif y an d tr ai n us er s, op er at or s, an d te ch ni ca l s ta ff. �. �� In st al l p ro du ct io n- re ad y so ftw ar e. �. �3 B eg in n et w or k op er at io n. �. �4 C on du ct p ilo t da ta c ol le ct io n, a na ly ze r es ul ts , a nd re so lv e iss ue s. �. �5 E va lu at e pi lo t ph as e m id -t er m r ev ie w . �. �6 D iss em in at e ev al ua tio n re po rt o n th e pi lo t ph as e. �. �7 E xt en d ne tw or k to a ll �5 c ou nt rie s. �. �8 C on du ct a nn ua l m ee tin gs t o an al yz e C IB in fo rm at io n an d di sc us s im pr ov em en ts . �. �9 U pd at e w or kp la n an d pr ov id e pe rio di c up da te s to s ta ke ho ld er s. W A H O A C A M E U N FP A U SA ID c oo pe ra tin g ag en ci es W or ld B an k M O H P ro cu re m en t U ni ts W A H O A C A M E M O H Ja nu ar y �0 07 – D ec em be r �0 �� $0 $� ,0 6� ,4 5� $9 3, �3 8 $4 ,8 �9 $0 $0 $0 $6 7, 78 7 $� 3, �� 5 $0 $0 $0 $� ,6 45 $0 $0 $� ,6 45 $0 $3 43 ,� 99 $0 COMPONENT B: OPERATIONAL PLAN 33 2. In te r-A ge nc y Co or di na tio n: Im pr ov e co or di na tio n am on g pa rt ne rs in t he a re a of RH C S. �. C re at e a su br eg io na l RH C S pa rt ne rs ’ ne tw or k. �. � Id en tif y al l t he R H C S pa rt ne rs w or ki ng a t th e su br eg io na l l ev el . �. � C on ve ne r eg ul ar m ee tin gs o f s ub re gi on al a ge nc ie s/ pa rt ne rs t o fa ci lit at e co or di na tio n an d co lla bo ra tio n (e .g ., s ha re w or kp la ns ; id en tif y ac tio n ite m s, da ta g ap s) . �. 3 Es ta bl ish e le ct ro ni c ne tw or k (e m ai l) to k ee p pa rt ne rs in fo rm ed a bo ut R H C S ac tiv iti es a nd is su es . �. 4 M on ito r na tio na l- le ve l R H C S in te ra ge nc y co or di na tio n an d co lla bo ra tio n an d sh ar e fin di ng s in pa rt ne rs ’ f or um . W A H O Eu ro pe an U ni on U N FP A SI D A C ID A D A N ID A D FI D U N IC EF W H O U SA ID c oo pe ra tin g ag en ci es JIC A KF W G TZ D SW IP PF M TN F ou nd at io n W or ld B an k G at es F ou nd at io n W A H O Se pt em be r �0 07 – D ec em be r �0 �� $4 ,8 �9 $� 9� ,9 78 $� 4, �4 7 to ta l $1 ,9 11 ,9 75 34 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION 7. 4 C A pA C It y B u IL D In g t A B L E 9 : C A pA C It y B u IL D In g f o R t H E o R g A n Iz A t Io n A L p L A n S tr at eg ie s A ct io ns S ub ac ti o ns p ro po se d Im pl e- m en ti ng A ge nc ie s C o o rd in at in g A ge nc ie s t im ef ra m e C o st 1. H um an R es ou rc e D ev el op m en t: A dv oc at e st re ng th en in g of h um an re so ur ce s an d m an ag em en t of R H C S. �. S tr en gt he n re gi on al tr ai ni ng c en te rs fo r hu m an re so ur ce m an ag em en t of RH C S. �. � Id en tif y re gi on al t ra in in g ce nt er s. �. � C on du ct t ra in in g of t ra in er s (T O Ts ) fo r RH C S. M O H C A M ES U N FP A U SA ID c oo pe ra tin g ag en ci es W H O Pr of es sio na l b od ie s an d as so ci at io ns W A H O W A H O Ju ne � 00 7– Ju ne � 0� 0 $� 9, �4 3 $� �7 ,� 87 �. P ro m ot e re te nt io n of tr ai ne d st af f i nv ol ve d in RH C S. �. � Id en tif y an d sh ar e m ot iv at io na l b es t pr ac tic es . C ou nt rie s W H O W A H O W A H O W H O Fe br ua ry � 00 8– Ju ne � 0� 0 $� 0, 64 0 2. L og ist ics M an ag em en t Ca pa cit y Bu ild in g: Pr om ot e lo gi st ic s m an ag em en t ca pa ci ty bu ild in g, in cl ud in g in te gr at io n of H M IS / LM IS a nd v er tic al pr og ra m s. �. P ro m ot e tr ai ni ng o f tr ai ne rs in — lo gi st ic s m an ag em en t sy st em in te gr at io n of H M IS /L M IS in to R H se rv ic e de liv er y po lic y fo rm ul at io n qu al ity c on tr ol im pl em en ta tio n of R H C S. • • • • • • �. � A da pt c ur ric ul um . �. � Id en tif y tr ai ni ng in st itu tio ns a nd t ra in er s. �. 3 O rg an ize t he t ra in in g. �. 4 M on ito r tr ai ne es t o de te rm in e tr ai ni ng e ffi ca cy . �. 5 C ol le ct a nd d iss em in at e da ta o n co un tr ie s tr ai ni ng in R H C S. M O H Pr of es sio na l b od ie s an d as so ci at io ns U N FP A U SA ID c oo pe ra tin g ag en ci es C A M ES W A H O W A H O W H O U N FP A Ju ne � 00 8– O ct ob er � 0� � $� 4� ,3 33 (fo r �. �– �. 3) $� 9, 3� 7 $� 5, 8� 0 3. In te gr at io n of R H CS in to Pu bl ic H ea lth C ur ric ul um : A dv oc at e fo r th e in te gr at io n of R H C S in to RH C S in to th e pu bl ic h ea lth cu rr ic ul um . �. In tr od uc e RH C S cu rr ic ul um in to p ub lic h ea lth pr og ra m s in u ni ve rs iti es a nd pu bl ic h ea lth in st itu tio ns . �. � Id en tif y un iv er sit ie s an d pu bl ic h ea lth in st itu tio ns . �. � A da pt c ur ric ul um . �. 3 Id en tif y tr ai ne rs . �. 4 Tr ai n st af f i n RH C S cu rr ic ul um . �. 5 O rg an ize t he t ra in in g. �. 6 M on ito r tr ai ne es t o de te rm in e tr ai ni ng e ffi ca cy . �. 7 C ol le ct a nd d iss em in at e da ta o n co un tr ie s tr ai ni ng in R H C S. M O H M O Ed W A H O U N FP A C A M ES Su br eg io na l t ra in in g in st itu tio ns U SA ID c oo pe ra tin g ag en ci es W A H O U SA ID Ja nu ar y �0 08 – D ec em be r �0 �� $� 4, 48 8 $� 4� ,3 33 (fo r �. �– �. 5) $� 9, 3� 7 $� 5, 8� 0 COMPONENT B: OPERATIONAL PLAN 35 4. P ro m ot in g IE C/ BC C: Pr om ot e th e us e of IE C /B C C t o in cr ea se aw ar en es s of R H C S iss ue s in t he c om m un ity . �. D ev el op s ub re gi on al ca pa ci ty fo r th e pr om ot io n of t ra in in g co m m un ity a ge nt s in IE C /B C C . �. � A ss es s cu rr en t co m m un ity -b as ed IE C /B C C sy st em s. �. � Pr ep ar e tr ai ni ng d oc um en ts . �. 3 O rg an ize tr ai ni ng se ss io ns . O rg an ize t ra in in g se ss io ns . PS I U N FP A M O H U SA ID c oo pe ra tin g ag en ci es IP PF W A H O Ja nu ar y �0 07 – D ec em be r �0 �� $� 4, 48 8 $� 4, 48 8 $5 85 ,9 34 5. P ro gr am S us ta in ab ilit y: A dv oc at e fo r th e im po rt an ce o f m ai nt ai ni ng t ra in ed s ta ff fo r pr og ra m s us ta in ab ilit y. �. P ro m ot e pr og ra m su st ai na bi lit y. �. � Em ph as ize t he im po rt an ce o f s ta ff re te nt io n at po lic ym ak in g fo ra . �. � En co ur ag e pa rt ne rs t o de ve lo p ex it st ra te gi es . �. 3 D ev el op a nd d iss em in at e ad vo ca cy m at er ia ls in cl ud in g gu id el in es fo r st af f r et en tio n. W A H O W H O M O H U N FP A U SA ID c oo pe ra tin g ag en ci es W A H O Ja nu ar y �0 07 – D ec em be r �0 �� $� �, 87 8 $� �, 87 8 $� 4, �0 � to ta l $1 ,1 79 ,2 47 36 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION 7. 5 C o u n t Ry S u p p o R t A C t IV It IE S t A B L E 1 0: C o u n t Ry S u p p o R t A C t IV It IE S f o R t H E o R g A n Iz A t Io n A L p L A n S tr at eg ie s A ct io ns S ub ac ti o ns p ro po se d Im pl e- m en ti ng A ge nc ie s C o o rd in at in g A ge nc ie s t im ef ra m e C o st 1. P ro vis io n of T ec hn ica l As sis ta nc e: E st ab lis h m ec ha ni sm fo r pr ov isi on of T A fo r RH C S. �. Id en tif y an d pr ov id e co un tr y su pp or t te ch ni ca l as sis ta nc e ac tiv iti es . �. � Id en tif y T A n ee ds a nd p ro ce ss . �. � Pr ep ar e an d im pl em en t a w or kp la n fo r th e re pa re a nd im pl em en t a w or kp la n fo r th e pr ov id in g T A t o th e co un tr ie s. �. 3 Id en tif y pa rt ne rs t o su pp or t th e im pl em en ta tio n of t he w or kp la n. W A H O U N FP A U SA ID c oo pe ra tin g ag en ci es M O H s IP S W A H O O ct ob er � 00 7– D ec em be r �0 �0 $� 9, 3� 7 $� 9, 3� 7 $� 9, 3� 7 �. E st ab lis h re gi on al ex pe rt s ne tw or k in RH C S. �. � Id en tif y re gi on al e xp er ts in R H C S. �. � Pr ep ar e th e TO Rs of ne tw or k of ex pe rt s. Pr ep ar e th e TO Rs o f n et w or k of e xp er ts . �. 3 Pr om ot e ne tw or ki ng o f s ub re gi on al e xp er ts . W A H O W H O U SA ID c oo pe ra tin g ag en ci es U N FP A W A H O Ja nu ar y �0 07 – D ec em be r �0 07 $� 6, 09 8 $� 6, 09 8 $� 6, 09 8 2. A dv oc ac y: A dv oc at e fo r th e ha rm on iz at io n of c ou nt ry m an ag em en t to ol s ac ro ss t he su br eg io n. �. D ev el op c om m on m an ag em en t to ol s fo r RH C S. �. � D efi ne t he k ey s ar ea s fo r ha rm on iz at io n. �. � Fo rm ul at e th e co m m on m an ag em en t to ol s. �. 3 D iss em in at e th e ha rm on ize d to ol s in t he su br eg io n. �. 4 Pr es en t th e ha rm on ize d to ol s to p ar tn er s/ st ak eh ol de rs fo ra . fo ra . �. 5 Fo llo w u p on im pl em en ta tio n. W A H O U N FP A U SA ID c oo pe ra tin g ag en ci es W H O M O H W A H O M ar ch � 00 7– N ov em be r �0 09 $� 3, 5� � $� 3, 5� � $� 3, 5� � $6 �, 79 6 $� 3, 5� � �. O rg an ize a dv oc ac y m ee tin gs w ith p ar tn er s an d st ak eh ol de rs (r ou nd ta bl e, fo ra , co nf er en ce ). �. � D efi ne a ud ie nc e fo r ev id en ce -b as ed d at a pr es en ta tio ns . �. � Id en tif y th e be st a pp ro ac he s fo r ea ch g ro up o f pa rt ne rs a nd s ta ke ho ld er s. �. 3 C on du ct r eg ul ar m ee tin gs w ith s ta ke ho ld er s. W A H O IP S W A H O M ay � 00 7– D ec em be r �0 �� $� 6, 09 8 $� 6, 09 8 $� 38 ,� 48 to ta l $4 92 ,4 73 COORDINATION AND MONITORING AND EVALUATION 37 8.0 COORDINATION AND MONITORING AND EVALUATION The success of the subregional RHCS strategy depends in part on the human and institutional capacity to effec- tively manage and coordinate the activities of numerous partners within and across the technical objectives (context, coordination, capacity, and country support). Furthermore, WAHO, as the main subregional coordinat- ing body, with other partners, is tasked with implementing several of the activities, including the identification of TA needs (country support) and the collection and analysis of data on factors affecting unmet need (context). As a result, an RHCS implementation manager will need to be in place as the technical and operational lead to ensure that the range of country, subregional, and technical assistance partners complete these tasks. Additional proposed staff requirements include a full-time monitoring and evaluation manager. Section 8.1 identi- fies the output indicators that correspond to each action and the expected outcomes. Using these indicators as the basis, a detailed M&E plan will need to be developed that includes the routine progress evaluations implementa- tion of the strategy. After the plan is in place, the M&E manager will conduct regular evaluations and compare the findings with the expected outcomes and disseminate the results to all stakeholders. tABLE 11: oBjECtIVES, ACtIonS, SuBACtIonS, EStIMAtED CoSt, AnD tIMIng foR M&E pLAn objective Actions Subactions Estimated Cost timing WAHO coordinates with country partners, donors, and TA providers to effectively implement the activities in the strategy. �. Develop the human and institutional capacity to coordinate with partners and implement action and subactions across the range of objectives. �.� Hire an RHCS implementation manager. $544,505 �007–�0�� A mechanism for monitoring and evaluating results from actions and subactions is developed and implemented. �. Establish an M&E system. �.� Develop, plan, and manage a monitoring and evaluation system (develop indicators, develop workplan, etc.). (included above) �007–�0�� �.� Hire an M&E manager. $500,703 �007–�0�� �.3 Conduct monitoring and evaluation activities. $�08,0�7 �007–�0�� �.4 Analyze and compare data to outputs and outcomes. (included above) �007–�0�� �.5 Disseminate results to stakeholders. (included in above) total $1,153,225 38 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION 8.1 RESuLtS InDICAtoRS tABLE 12: RESuLtS InDICAtoRS—ACtIon, output InDICAtoRS, AnD ExpECtED outCoMES Action output Indicators Expected outcomes Context �. Advocate to ensure the integration of RHCS into RH policy in all countries of the subregion. Number of member countriesmember countriescountries incorporating RHCS into the national RH policy A supportive policy environment to improve RHCS in the subregion. Improved political commitment to RHCS. �. Harmonize subregional DPRs, STGs, and EMLs (with a focus on RH commodities). Harmonized (DRPs), STGs, and EMLs developed for the subregion. A policy environment to improve the quality of RH services in the subregion. Increased access to RH services. 3. Encourage national-level stakeholders to engage the private sector in participating more actively in the provision of RH commodities. Increased number of private- sector providers involved in RHCS coordinating bodies at the national level. Increased access for clients to RH commodities in the public, private, and NGO sectors. 4. Facilitate the creation of sustainable financing mechanisms for RH commodities. Number of member countries that have a dedicated budget line item for the procurement of RH commodities. Increased funding to purchase RH commodities in the subregion. 5. Undertake an advocacy campaign to address unmet need of RH commodities in the subregion. Number of member countries that have developed action plans to address unmet need. Improved access and utilization of RH services. Unmet need decreased. Coordination �. Make the CIB network operational. Number of member countries reporting procurement data into an operational CIB system. Number of member countries receiving procurement data reports back from the CIB system. Access to and sharing of information on RH commodities for all ECOWAS countries. �. Create a subregional RHCS partners’ forum. A functioning partners’ forum at thefunctioning partners’ forum at the subregional level meeting at least annually. More effective coordination among partners in the subregion. Capacity Building �. Strengthen regional training centers for human resource management of RHCS. Number of TOTs carried out on RHCS TOTs carried out on RHCS carried out on RHCS from subregional training centers. centers. Quality of RH services improved in the subregion provided by skilled personnel. �. Promote retention of trained staff involved in RHCS. Number of member countries that have developed a motivational strategy for retention of trained staff. Improved staff retention in RH programs (i.e., decreased staff turnover) due to implementation of national strategies. 3. Promote TOTs in— logistics management system integration of HMIS/LMIS into RH service delivery policy formulation quality control implementation of RHCS. • • • • • • Number of people trained through TOTs in each subject area listed. Effective and efficient logistic RH management system in place. Improved service delivery and quality control systems leading to increased access to and use of RH services in the subregion. COORDINATION AND MONITORING AND EVALUATION 39 Action output Indicators Expected outcomes Capacity Building (continued) 4. Introduce RHCS curriculum into public health programs in universities and public health institutions. Number of schools and faculties implementing the RHCS training curriculum. CS components of RH teaching introduced into schools and faculties, leading to better-trained staff committed to RHCS in the subregion. 5. Develop subregional capacity for the promotion of training community agents in IEC/BCC. Number of trained trainers for community agents in IEC/BCC. Countries use of IEC/BCC to promote RHCS issues in local communities. 6. Promote program sustainability. Number of member countries with national RHCS policies in place for program sustainability. Policies implemented to address program sustainability. Country Support �. Identify and provide country support technical assistance activities. Number of TA visits provided to countries by WAHO/partners. Improved access to and utilization of RH services. �. Establish regional experts network in RHCS. Regional network of RH experts established. Improved access to and utilization of RH services due to inputs from a regional network of RH experts. 3. Develop common management tools for RHCS. Common management tools developed (as defined by subregional stakeholders) Member countries applying common management tools to improve political commitment to RHCS. 4. Organize advocacy meetings with partners and stakeholders (roundtable, fora, conference). Number of advocacy meetings held per year. Increased partners’ support for the implementation of harmonized RHCS management tools. 40 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION REFERENCES 41 9.0 REFERENCES Abdullah, Hany, Dana Aronovich, Aoua Diarra, Paul Dowling, Lisa Hare, Meba Kagone, Ali Karim, Raja Rao, and David Sarley. 2004. The West Africa Reproductive Health Commodity Security Study: Summary of Find- ings from Phase One. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development. Abdallah, Hany, and Mimi Whitehouse. 2005. West Africa Reproductive Health Commodity Security: Development of a Sub-Regional Coordinated Informed Buying (CIB) System. Arlington, Va.: John Snow, Inc./DELIVER, for the United States Agency for International Development. Centers for Disease Control and Prevention. “Update: Barrier Protection Against HIV Infection and Other Sexu- ally Transmitted Diseases.” MMWR 08/06/1993. 42(30); 589–591,597. Diarra, Aoua. 2004. West Africa RHCS: Logistics System Capacity (DRAFT Report). Arlington, Va.:John Snow, Inc./DELIVER, for the U.S. Agency for International Development (USAID). Dowling, Paul. 2004. West Africa RHCS: Local Manufacturing of RH Commodities. Arlington, Va.: John Snow, Inc./DELIV- ER, for the U.S. Agency for International Development (USAID). Gay, Jill, Karen Hardee, Nicole Judice, Kokila Agarwal, Katerine Fleming, Alana Hairston, Brettania Walker, and Martha Wood. 2003. What Works: A Policy and Program Guide to the Evidence on Family Planning, Safe Moth- erhood, and STI/HIV/AIDS Interventions (Module 1 Safe Motherhood). Washington, DC: POLICY Project. Hare, L., C. Hart, S. Scribner, C. Shepherd, T. Pandit, and A. Bornbusch. (ed.). 2004. SPARHCS: Strategic Path- way to Reproductive Health Commodity Security. A Tool for Assessment, Planning and Implementation. Baltimore, Md.: Information and Knowledge for Optimal Health (INFO) Project/Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health. John Snow, Inc./DELIVER. n.d. Logistics System Assessment Survey Results: Mali, Nigeria, Ghana (2001–2002). Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development (USAID). John Snow, Inc./DELIVER. 2003. No Product?, No Program!: RHCS for Improved Maternal and Child Health. 2003. Arling- ton, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development (USAID). John Snow, Inc./DELIVER. 2005. The West Africa Reproductive Health Commodity Security Sub-Regional Strategy: A Concept Paper. Arlington, Va.: John Snow, Inc./DELIVER, for the United States Agency for International Development. Kagone, Meba, Lisa Hare, David O’Brien, Dana Aronovich, and Aoua Diarra. 2003. Reproductive Health Commodity Security for Improved Maternal and Child Health. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development. Organisation of African Unity (OAU). The Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases. Abuja, Nigeria. 26–27 April 2001. Population Reference Bureau (PRB). 2005. Women of Our World: 2005. Washington, DC: Published with the sup- port of the U.S. Agency for International Development (USAID). United Nations Development Programme (UNDP). 2003. Human Development Report 2003, Millennium Devel- opment Goals: A compact among nations to end human poverty. New York: UNDP. 42 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION United Nations Population Fund (UNFPA). 2004. The Millennium Development Goals. New York: UNFPA. West African Health Organization (WAHO), U.S. Agency for International Development (USAID), United Na- tions Population Fund (UNFPA), and the World Bank. 2002. “West Africa Regional Initiative for Reproduc- tive Health Commodity Security.” A concept paper developed based on discussions between WAHO, USAID, UNFPA, and the World Bank. n.p.: n.d. World Health Organization/United Nations Population Fund (WHO/UNFPA). 2006. The Interagency List of Es- sential Medicines for Reproductive Health. Geneva: WHO/UNFPA. ANNExES 43 10.0 ANNExES AnnEx 1 – LISt of woRkSHop pARtICIpAntS Following are the names and information of the individuals who participated in the series of WAHO-sponsored subregional strategy development workshops. Between November 2005 and March, 2006, WAHO technical staff, country program managers, and liaison officers, donors (USAID and UNFPA), and RHCS technical assistance projects (DELIVER and AWARE-RH) participated in and provided substantial technical input to the process. tABLE 13: LISt of pARtICIpAntS: DEVELopMEnt of A StRAtEgIC pLAn foR REpRoDuCtIVE HEALtH SECuRIty CoMMoDIty jAnuARy 24–26, 2006, BoBo-DIouLASSo, BuRkInA fASo no. name function Country/ organization Address � Alh. Omar TAAL DPS/Liaison Officer WAHO The Gambia Department of State for Health and Social Welfare, Banjul, The Gambia Tel. : (+��0) 4� �8 709 Fax : (+��0) 4� �5 873 Email: alhomartaal@yahoo.com � Mrs. Ramou Cole CEESAY Head of RCH Programme DOSH, The Gambia The Gambia RCH Programme Unit, DOSH, Medical HQs Banjul, The Gambia Tel. : (+��0) 4� �8 74� Fax : (+��0) 4� �8 74� Email: onim��@yahoo.com 3 Dr. Laurent A. ASSOGBA Focal Point Directeur National de la Protection Sanitaire Benin Ministère de la Santé Publique 0� BP 88� Cotonou, Benin Tel. : (+��9) �� 33 66 79 / 90 04 55 3� Fax: (+��9) �� 33 04 64 E-mail: laurassog@yahoo.fr 4 Marguerite DA�ID Chief of Division Logistique Contraceptive Benin Direction Santé Familiale Cotonou- Benin Tél.: (+��9) 33 �0 �� Fax: (+��9) 33 00 63 Email: mazolikpo@yahoo.fr 5 Dr. Boubacar Samba DANKOKO Point Focal Conseiller Technique n°� Senegal Ministère de la Santé et de la Prévention Médicale – Rue Aimée Césaire - B.P. 40�4 Fann Résidence Dakar, Senegal Tel.:(+���) 869 4� 47/ 648 34 �4 Fax:(+���) 869 4� 49 E-mail : drdankoko@yahoo.fr 44 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION no. name function Country/ organization Address 6 Dr. Amath MBAYE Chief de la Division de la Santé de la Reproduction (SR) Senegal Ministère de la Santé et de la Prévention Médicale – Rue Aimée Césaire – B.P. 40�4 Fann Résidence Dakar, Senegal Tel.:(+���) 8�� 7� 55 E-mail : mbayepf@yahoo.fr 7 Dr. Benie Bi Joseph �ROH Directeur Coordonnateur du Programme National de la Santé de Reproduction Ivory Coast Ministère de la Santé et de l’Hygiène Publique de la République de Côte d’Ivoire – BP �4 Abidjan Tél. : (+��5) �0 3� �4 �5 Fax : (+��5) �0 3� �4 63 Email : benie4@hotmail.com dcpnsrpf@aviso.ci 8 Dr. Jean-Marc DJOMAN Sous Directeur chargé des Etudes et réflexions au Secrétariat Technique Ivory Coast Ministère de la Santé et de l’Hygiène Publique BP �4 Abidjan Tél. : (+��5) �0 �� �� 97 Fax : (+��5) �0 �� �� �0 Email: djoman_jeanmarc@yahoo.fr 9 Dr. Mamadou Souncalo TRAORE Directeur National Santé, Point Focal OOAS Mali Mali Ministère de la Santé BP : �3� – Koulouba - Bamako République du MALI Tél : (+��3) ��� 64 97 Fax : (+��3) ��� 36 74 Email : mstraore@dnsmali.org �0 Dr. Binta KEITA Chief Division Santé de la Reproduction Mali Ministère de la Santé /Direction Nationale de la Santé BP : �3� – Koulouba - Bamako République du Mali Cell : (+��3) 673 �4 �4 / ��� 64 97 Fax : (+��3) ��� 36 74 Email : bkeita@dnsmali.org �� Dr. Paulo RABNA Responsable du Programme National de Lutte contre le SIDA, Point Focal OOAS Guinée Bissau Guinea Bissau Ministerio da Saude Guinée Bissau – Bissau PO Box 55 Tel. : (+�45) 7�� 56 �5 / 665 73 96 Email : paulo660�@yahoo.co.uk paulorabna@eguitel.com �� Dr. Paulo DJATA Directeur des Soins de Santé Familiale et Coordinateur de Santé de la Reproduction Guinea Bissau MINSAP Av. Unidade Africana BP 50, Bissau, Guinée-Bissau Tél. : (+�45) �� �� 00/ 7� 00 635 �3 Dr. Margarida CARDOSO Directrice Générale des Etudes et de la Planification Point Focal OOAS Cap �ert Cape �erde Ministère de la Santé du Cap-�ert – CP 47 Praia Tél. : (+�38) �6 �0 ��� Fax : (+�38) �6 �0 �63 Email : margarida.cardoso@ms.gov.cv ANNExES 45 no. name function Country/ organization Address �4 Dr. Mohamed Sidatty KEITA Chief de la Division Santé de la Reproduction/ Directeur du Programme National Santé de la Reproduction Guinea Ministère de la Santé Publique de Guinée – Conakry Tél. : Bur : (+��4) 45 �0 �0 / Privé : �9 09 43 Email : sidattymk@yahoo.fr �5 Dr. Nangnouma SANO Chief Section Etablissements Pharmaceutiques, Direction Nationale Pharmacie-Labo Guinea BP 585 Guinée Tél. : (+��4) �7 �6 �� Email : snagnouma@yahoo.fr �6 Dr. Aïssa Bouwayé ADO Directrice de la Santé de la Reproduction au MSP/LCE Niger Ministère de la Santé du Niger – Niamey BP 6�6 Niamey -Niger Cell : (+��7) : �6 3� 3� Email : aissaado@yahoo.com Email Direction Santé de la Reproduction Niger : santereproduction@yahoo.fr �7 Mme Rakiatou DANIA Point Focal OOAS Conseiller Technique du MSP/LCE Niger Ministère de la Santé Publique et de la Lutte contre les Epidémies BP 6�3 Niamey -Niger Tel : (+��7)7� �8 08 / 7� 59 06/ Cell : (+��7) 96 96 �� Fax: (+��7) 73 35 70 / 7� 59 06 Email : rakiadm@yahoo.fr ooasnig@intnet.ne �8 Dr. Ernest OUEDRAOGO Responsable Logistique Contraceptive Burkina Faso Direction Santé de la Famille – Burkina Faso Tél. : (+��6) 50 30 77 78 Fax : (+��6) 50 30 77 68 Email : ernest_ouedraogo@hotmail.com �9 Dr. Kodjo Kitchoou ALEKI Conseiller Technique, Point Focal OOAS Togo Ministère de la Santé du Togo BP 3054� Lomé Tél. : (+��8) ��� 6� 08 Cell : (+��8) 9�� �� 84 Email: draleki@yahoo.fr �0 Mr Aboudou DARE Directeur du Programme Santé de la Reproduction Chief de Division de la Santé Familiale Togo Ministère de la Santé du Togo Division de la Santé Familiale 07 BP �4536 Lomé Togo Tel. : (+��8) ��3 33 70 Fax: (+��8) ��3 33 87 Cell. : (+��8) 904 70 0� Email: darab93@yahoo.fr �� Dr. Adetunji Labiran Assistant Director (HRH) Nigeria Department of Health Planning & Research Federal Ministry of Health, Abuja Nigeria, Tel.: (+�34) 803 439 658� Email: alabiran@yahoo.com 46 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION no. name function Country/ organization Address �� Pauline ARIBISALA Assistant Director (Programme/RHCS) Nigeria Federal Ministry of Health, Department of Community Development & Population Activities Abuja, Nigeria, Tel.: (+�34) 803 3094675/805 9384505 Email: pabari�00�@yahoo.com �3 Dr. Kisito. S. DAOH RH Programme Manager Sierra Leone Ministry of Health and Sanitation 4th Floor Youyi Building, Brookfields Freetown Sierra Leone Tel: (+�3� ) 76 658 976 / 33 3�5 375/ �� �38 83� Fax: c/o DPI (�3�) �� �35 063 Email : ksdaoh@yahoo.com �4 Mr. Tommy T. TENGBEH WAHO Liaison Officer Deputy Secretary (International Div) Sierra Leone Ministry of Health and Sanitation 4th Floor Youyi Building, Brookfields Freetown Sierra Leone Tel: (+�3� ) 33 3�7 474 / 76 634 7�� Fax: c/o Dr. Clifford W. KAMARA (+�3�) �� �35 063 Email : tommytengbeh@yahoo.com �5 Dr. Gloria QUANSAH ASARE Family Planning Programme Manager Ghana Ghana Heath Service Private Mail Bag Ministries Post Office, Accra Tel.: (+��3) �� 68 4� �7/�44 �8� 73� Fax : (+�33) �� 66 38 �0/�� 67 43 66 Email : gloasare�@yahoo.com �6 Mr. Ahmed MOHAMMED Assistant Director Ghana Ministry of Health Ghana PO Box m44 Accra Tel.: (+��3) �� 68 4� 47/ �43 �89 69� Fax : (+�33) �� 67 00 76/�� 66 0� 76/ �� 66 38 �0 Email : ahmedmoh�@yahoo.com �7 Blami DAO Chief du Département de Gynécologie Obstétrique du CHU Souro SANOU Burkina Faso Bobo-Dioulasso Burkina Faso Tél. : (+��6) �0 97 00 44 Ext ��33 Fax : (+��6) �0 97 �6 93 Email : bdao@fasonet.bf �8 Raja RAO Policy Adviser DELI�ER/JSI USA United States �6�6 N. Fort Myer Drive ��th floor, Arlington, �A ���09 USA TEL.: (+�) 703 5�8 7474 Fax: (+�) 703 5�8 7480 Email: raja_rao@jsi.com ANNExES 47 no. name function Country/ organization Address �9 Dr. Kabba JOINER Director General/ WAHO ECOWAS OOAS BP �53 Bobo-Dioulasso Burkina Faso Tél: (+��6) �0 97 57 75/ �0 97 00 97 Fax: (+��6) �0 97 57 7� Email: wahooas@fasonet.bf 30 Dr. Johanna AUSTIN DSSP-CM ECOWAS OOAS BP �53 Bobo-Dioulasso Burkina Faso Tél: (+��6) �0 97 57 75/ �0 97 00 97 Fax: (+��6) �0 97 57 7� Email: austinjohanna@yahoo.fr jaustin@wahooas.org 3� Mr. Salifou ZOUMA DPAT ECOWAS OOAS BP �53 Bobo-Dioulasso Burkina Faso Tél: (+��6) �0 97 57 75/ �0 97 00 97 Fax: (+��6) �0 97 57 7� Email: yzsalifou@yahoo.fr szouma@wahooas.org 3� Dr. Angela OKOLO ECOWAS OOAS BP �53 Bobo-Dioulasso Burkina Faso Tél: (+��6) �0 97 57 75/ �0 97 00 97 Fax: (+��6) �0 97 57 7� Email: aokolo@wahooas.org Angelok4@yahoo.com 48 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION tABLE 14: LISt of pARtICIpAntS:wESt AfRICA SuBREgIon RHCS StRAtEgIC pLAnnIng,LISt of pARtICIpAntS:wESt AfRICA SuBREgIon RHCS StRAtEgIC pLAnnIng, wESt AfRICA SuBREgIon RHCS StRAtEgIC pLAnnIng, MEEtIng of tHE REpRoDuCtIVE HEALtH CoMMoDIty SECuRIty tASk foRCE, MARCH 8–10, 2006, ACCRA, gHAnA n. name function Country/ organization Address � Prof. Dao BLAMI Chief du Département de Gynécologie Obstétrique CHU Souro Sanou, Bobo-Dioulasso Burkina Faso CHU Sourou Sanou Bobo-Dioulasso Tel : (��6)7880�444 Fax : (��6) �097�693 bdao@fasonet.bf daoblami@hotmail.com � Gloria Q. ASARE National Family Planning Programme Manager Ghana Ghana Health Service Private Mail Bag Ministries Post Office Accra Tel : (�33)0�44 �8� 73� Fax : (�33) 0�� 6638�0 gloasare�@yahoo.com 3 Pauline B. ARIBISALA Assistant Director ( Programme / RHCS) Nigeria Federal Ministry of Health Department of Community Dvelopment & Population Activities Federal Ministry of Health, Central Medical Library Compound, Yaba, Lagos, Nigeria Tel : (�34) 803 309 4675 pabari�00�@yahoo.com 4 Raja RAO Policy Adviser DELI�ER/JSI United States �6�6 N. Fort Myer Drive ��th floor Arlington, �A USA ���09 Tel : (703) 5�8 7474 Fax : (703) 588 7480 rajarao@jsi.com 5 Danièle LANDRY –èle LANDRY –le LANDRY – MUGENGANA Technical Adviser RHCS UNFPA UNFPA ��0 East 4�nd St New York, NY �00�7 Tel : ���-�97- 5�43 Fax : ���- �97- 49�7 landry@unfpa.org 6 Penda NDIAYE RHCS.CST UNFPA – DAKAR UNFPA Immeuble FADH, Rue Djily Mbaye Dakar – Senegal Tel : ��-88 03 53 Pndiaye@unfpa.org 7 Carmen COLES Technical Adviser for Advocacy AWARE–RH GHANA � Crescent PMB �4� Demmco House Airport West Accra – Ghana Tel : �33-�4�5�8��5 ccoles@aware-rh.org 8 Antoine NDIAYE Commodity Security Advisor AWARE-RH GHANA PMB CT �4� Tel : �33 – ��786�� Cell : �33- �44 47 6 99 Fax : �33 – ��86�97 andiaye@aware-rh.org antoinendiaye@hotmail.com ANNExES 49 n. name function Country/ organization Address 9 Kabba T. JOINER Director General WAHO ECOWAS BP: �53 Bobo-Dioulasso Tel : (��6)�0975775 / �097�560 Fax: (��6)�097577� wahooas@fasonet.bf kjoiner@wahooas.org kabajoiner@hotmail.com �0 Dr. Johanna L. AUSTIN Directrice de la Division Soins de Santé Primaires et Contrôle des Maladies OOAS - WAHO ECOWAS OOAS /WAHO BP: �53 Bobo-Dioulasso Tel : (��6)�0975775 / 76456483 Fax: (��6)�097577� austinjohanna@yahoo.fr wahooas@fasonet.bf jaustine@wahooas.org �� Prof. Angela OKOLO Professional Officer Maternal & Perinatal Health WAHO (HQ) ECOWAS WAHO : 0� BP �53 Bobo-Dioulasso Tel : (��6) �0970�00 Fax : (��6) �097577� angelok4@yahoo.com akolo@wahooas.org �� Seynabou GAYE Secrétaire de Direction OOAS ECOWAS BP : �53 Bobo-Dioulasso Fax : ��6-�097577� Tel : ��6-�0975775 sgaye@wahooas.org seynabougaye@hotmail.com 50 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION ANNExES 51 AnnEx 2 – tHE IntERAgEnCy LISt of ESSEntIAL MEDICInES foR REpRoDuCtIVE HEALtH The Interagency List of Essential Medicines for Reproductive Health is first presented in the format used in previ- ous RH lists—by clinical groups, with certain medicines repeated in different groups (WHO/UNFPA 2006). Relevant RH STGs developed by WHO’s Department of Reproductive Health Research are included for each clinical group. Information regarding WHO’s Model List therapeutic categories are included for each medicine. The list presents the minimum medicine needs for a basic health care system, listing the most efficacious, safe, and cost-effective medicines for priority conditions. Priority conditions are selected on the basis of current and estimated future public health relevance and the potential for safe and cost-effective treatment. Complementary medicines (indicated with a “c” in the first column of the table) are also listed; these medicines need specialized diagnostic or monitoring facilities and/or specialist medical care and specialist training. If in doubt, medicines can also be listed as complementary on the basis of consistent higher costs or less attractive cost-effectiveness in a variety of settings. When the strength of a medicine is specified in terms of a selected salt or ester, this is mentioned in brackets; when it refers to the active moiety, the name of the salt or ester in brackets is preceded by the word “as.” 52 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION ANNExES 53 tABLE 15: MInIMuM MEDICInE nEEDS foR A BASIC HEALtH CARE SyStEM (wHo/unfpA 2006) Medicine Dosage therapeutic category (14th wHo Model List) Maternal and neonatal Health �. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Geneva: World Health Organization; �000. http://www.who.int/reproductive-health/impac/index.html �. Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice. Geneva: World Health Organization; �003. http://www.who.int/reproductive-health/publications/pcpnc/index.html 3. Managing new born problems: A guide for doctors, nurses, and midwives. Geneva: World Health Organization; �003. http://www. who.int/reproductive-health/publications/mnp/index.html 4. The WHO Reproductive Health Library; http://www.who.int/reproductive-health/rhl/index.html 5. Additional information: http://www.who.int/reproductive-health/ Anaesthetics, general halothane inhalation �.� ketamine injection, 50 mg (as hydrochloride)/ml in �0-ml vial �.� nitrous oxide inhalation �.� oxygen inhalation (medicinal gas) �.� thiopental powder for injection, 0.5 g, �.0 g (sodium salt) in ampoule �.� atropine injection, � mg (sulfate) in �-ml ampoule �.3 suxamethonium chloride injection, 50 mg (chloride)/ml in �-ml ampoule; powder for injection (chloride), in vial �0 Anaesthetics, local lidocaine injection, �%, �% (hydrochloride) in vial, injection for spinal anaesthesia, 5% (hydrochloride) in �-ml ampoule to be mixed with 7.5% glucose solution topical forms, �-4% (hydrochloride) �.� lidocaine + epinephrine (adrenaline) injection, �%, �% (hydrochloride) + epinephrine �:�00 000 in vial; dental cartridge �% (hydrochloride) + epinephrine �:80 000 �.� c epinephrine injection, 30 mg (hydrochloride)/ml in �-ml ampoule (for use in spinal anaesthesia during delivery, to prevent hypotension) �.� Analgesics Opioid morphine injection, �0 mg in �-ml ampoule (sulfate or hydrochloride); oral solution, �0 mg (hydrochloride or sulfate)/5-ml; tablet, �0 mg (sulfate) �.� Non-opioid paracetamol* tablet, �00-500 mg; suppository, �00 mg; syrup, ��5 mg/5 ml *not recommended for anti-inflammatory use due to lack of proven benefit to that effect �.� acetylsalicylic acid tablet, �00-500 mg; suppository, 50-�50 mg �.� Antianaemia ferrous salt tablet, equivalent to 60 mg iron; oral solution equivalent to �5 mg iron (as sulfate)/ml �0.� folic acid tablet �mg, 5 mg �0.� ferrous salt + folic acid tablet equivalent to 60 mg iron + 400 micrograms folic acid (nutritional supplement for use during pregnancy �0.� 54 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION Medicine Dosage therapeutic category (14th wHo Model List) Antibacterials amoxicillin capsule or tablet, �50 mg, 500 mg (anhydrous); powder for oral suspension, ��5 mg (anhydrous)/5 ml 6.�.� ampicillin powder for injection, 500 mg, � g (as sodium salt) in vial 6.�.� benzylpenicillin powder for injection, 600 mg (= � million IU), 3 g (= 5 million IU) (sodium or potassium salt) in vial 6.�.� benzathine benzylpenicillin powder for injection, �.44 g benzylpenicillin (= �.4 million IU) in 5-ml vial 6.�.� c ceftriaxone powder for injection, �50 mg, � g (as sodium salt) in vial 6.�.� cloxacillin capsule, 500 mg, � g (as sodium salt); powder for oral solution, ��5 mg (as sodium salt)/5 ml; powder for injection, 500 mg (as sodium salt) in vial 6.�.� chloramphenicol capsule, �50 mg; oral suspension, �50 mg (as palmitate)/ 5 ml; powder for injection, � g (sodium succinate) in vial; oily suspension for injection 0.5 g (as sodium succinate)/ml in �-ml ampoule 6.�.� ciprofloxacin* tablet �50 mg (as hydrochloride) * final selection depends on indication for use 6.�.� clotrimazole vaginal tablet, �00 mg, 500 mg, vaginal cream �%, �0% 6.3 doxycycline* capsule or tablet, �00 mg (hydrochloride) * final selection depends on indication for use 6.�.� erythromycin capsule or tablet, �50 mg (as stearate or ethyl succinate); powder for oral suspension, ��5 mg (as stearate or ethyl succinate); powder for injection, 500 mg (as lactobionate) in vial 6.�.� gentamicin* injection, �0 mg, 40 mg (as sulfate)/ml in �-ml vial * final selection depends on indication for use 6.�.� metronidazole tablet, �00-500 mg; injection, 500 mg in �00-ml vial; suppository, 500 mg, � g; oral suspension, �00 mg (as benzoate)/5 ml 6.�.� miconazole ointment or cream, �% (nitrate) �3.� nitrofurantoin tablet, �00 mg 6.�.� procaine benzylpenicillin powder for injection, � g (=� million IU), 3 g (= 3 million IU) in vial 6.�.� tetracycline eye ointment, �% (hydrochloride) ��.� sulfamethoxazole + trimethoprim tablet, �00 mg + �0 mg, 400 mg + 80 mg; oral suspension, �00 mg + 40 mg/5 ml; injection, 80 mg + �6 mg/ml in 5-ml and �0-ml ampoules 6.�.� therapeutic category (14th EML) ANNExES 55 Medicine Dosage therapeutic category (14th wHo Model List) Antimalarials It should be noted that the standard treatment guidelines for the treatment and prevention of malaria are currently being updated and should be referred to when available c artemether injection, 80 mg/ml in �-ml ampoule 6.5.3.� c artesunate tablet, 50 mg 6.5.3.� chloroquine tablet, �50 mg (as phosphate or sulfate); syrup, 50 mg (as phosphate or sulfate)/5 ml 6.5.3.� 6.5.3.� c mefloquine tablet, �50 mg (as hydrochloride) 6.5.3.� 6.5.3.� quinine tablet, 300 mg (as bisulfate or sulfate); injection, 300 mg (as dihydrochloride)/ml in �-ml ampoule 6.5.3.� c doxycycline capsule or tablet, �00 mg (hydrochloride) (for use only in combination with quinine) 6.5.3.� 6.5.3.� c sulfadoxine + pyrimethamine tablet, 500 mg + �5 mg 6.5.3.� proguanil tablet, �00 mg (hydrochloride) (for use only in combination with chloroquine) 6.5.3.� Antituberculosis ethambutol tablet, �00 mg-400 mg (hydrochloride) 6.�.4 isoniazid tablet, �00 mg-300 mg 6.�.4 isoniazid + ethambutol tablet, �50 mg + 400 mg 6.�.4 pyrazinamide tablet, 400 mg 6.�.4 rifampicin capsule or tablet, �50 mg, 300 mg 6.�.4 rifampicin + isoniazid tablet, 60 mg + 30 mg; �50 mg + 75 mg; 300 mg + �50 mg; 60 mg + 60 mg (for intermittent use three times weekly); �50 mg + �50 mg (for intermittent use three times weekly) 6.�.4 rifampicin + isoniazid + pyrazinamide tablet, 60 mg + 30 mg + �50 mg; �50 mg + 75 mg + 400 mg; �50 mg + �50 mg + 500 mg (for intermittent use three times weekly) 6.�.4 rifampicin + isoniazid + pyrazinamide + ethambutol tablet, �50 mg + 75 mg + 400 mg + �75 mg 6.�.4 Anthelmintics pyrantel chewable tablet �50 mg (as embonate); oral suspension, 50 mg (as embonate)/ml 6.�.� mebendazole chewable tablet, �00 mg, 500 mg 6.�.� Anticonvulsants diazepam injection, 5 mg/ml in �-ml ampoule (intravenous or rectal) 5 magnesium sulfate* injection, 500 mg/ml in �-ml ampoule; 500 mg/ml in �0-ml ampoule *for use in eclampsia and severe pre-eclampsia and not for other convulsant disorders 5 phenobarbital tablet, �5-�00 mg; elixir, �5 mg/5 ml 5 phenytoin capsule or tablet, �5 mg, 50 mg, �00 mg (sodium salt); injection, 50 mg/ml in 5-ml vial (sodium salt) 5 56 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION Medicine Dosage therapeutic category (14th wHo Model List) Antihypertensives hydralazine* tablet, �5 mg, 50 mg (hydrochloride); powder for injection, �0 mg (hydrochloride) in ampoule *hydralazine is listed for use in the acute management of severe pregnancy-induced hypertension only ��.3 methyldopa* tablet, �50 mg *methyldopa is listed for use in the management of pregnancy-induced hypertension only ��.3 Diuretics furosemide tablet, 40 mg; injection, �0 mg/ml in �-ml ampoule �6 IV Fluids glucose injectable solution, 5%, �0% isotonic; 50% hypertonic �6.� sodium chloride injectable solution, 0.9% isotonic (equivalent to Na+ �54 mmol/L, Cl– �54 mmol/L �6.� Ringer’s lactate injectable solution �6.� glucose with sodium chloride injectable solution, 4% glucose, 0.�8% sodium chloride (equivalent to Na+ 30 mmol/L, Cl– 30 mmol/L) �6.� Plasma substitutes dextran 70* injectable solution, 6% *polygeline, injectable solution, 3.5% is considered as equivalent ��.� Anticoagulants heparin sodium injection, �000 IU/ml, 5000 IU/ml, �0 000 IU/ml in �-ml ampoule �0.� protamine sulfate injection, �0 mg/ml in 5-ml ampoule �0.� phytomenadione (vitamin K) injection, �0 mg/ml in 5-ml ampoule; tablet, �0 mg �0.� Antidiabetics insulin injection, 40 IU/ml in �0-ml vial, �00 IU/ml in �0-ml vial �8.5 intermediate-acting insulin injection, 40 IU/ml in �0-ml vial; �00 IU/ml in �0-ml vial (as compound insulin zinc suspension or isophane insulin) �8.5 Immunologicals and vaccines anti-D immunoglobulin injection, �50 micrograms in single-dose vial �9.� antitetanus immunoglobulin injection, 500 IU in vial �9.� BCG vaccine �9.3.� diphtheria vaccine �9.3.� hepatitis B vaccine �9.3.� poliomyelitis vaccine �9.3.� tetanus vaccine �9.3.� Dermatologicals methylrosanilinium chloride (gentian violet) aqueous solution, 0.5%; tincture, 0.5% �3.� ANNExES 57 Medicine Dosage therapeutic category (14th wHo Model List) Disinfectants and antiseptics polyvidone iodine solution, �0% �5.� chlorhexidine solution, 5% (digluconate) for dilution �5.� calcium hypochlorite (chlorine base compound) powder (0.�% available chlorine) for solution �5.� ethanol solution, 70% (denatured) �5.� Oxytocics c mifepristone* + misoprostol* tablet �00 mg - tablet �00 micrograms, * requires close medical supervision where permitted under national law and where culturally acceptable ��.� c misoprostol vaginal tablet, �5 micrograms ��.� oxytocin injection, �0 IU in �-ml ampoule ��.� ergometrine injection, �00 micrograms (hydrogen maleate) in �-ml ampoule ��.� Tocolytics nifedipine immediate release capsule, �0 mg ��.� Sedatives diazepam injection, 5 mg/ml in �-ml ampoule; tablet, 5 mg �.3 Antiallergics and medicines used in anaphylaxis epinephrine (adrenaline) injection, � mg (as hydrochloride)/ml in ampoule 3 Medicines used in emergencies atropine sulfate injection, � mg (sulfate) in �-ml ampoule 4.� digoxin tablet, 6�.5 micrograms, �50 micrograms; oral solution 50 micrograms/ ml; injection �50 micrograms/ml in �-ml ampoule ��.� ��.4 epinephrine (adrenaline) injection, � mg (hydrochloride)/ml in ampoule ��.� promethazine elixir or syrup, 5 mg (hydrochloride)/5 ml �.3 glyceryl trinitrate tablet (sublingual), 500 micrograms ��.� calcium gluconate injection, �00 mg/ml in �0-ml ampoule 4.� naloxone injection, 400 micrograms (hydrochloride) in �-ml ampoule 4.� furosemide tablet, 40 mg; injection, �0 mg/ml in �-ml ampoule ��.4 prednisolone* tablet, 5 mg, �5 mg * there is no evidence for complete clinical similarity between prednisolone and dexamethasone at high doses 3 chlorphenamine tablet, 4 mg (hydrogen maleate); injection, �0 mg (hydrogen maleate) in �-ml ampoule 3 Steroids dexamethasone injection, 4 mg dexamethasone phosphate (as disodium salt) in �-ml ampoule 3 hydrocortisone powder for injection, �00 mg (as sodium succinate) in vial 3 58 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION Medicine Dosage therapeutic category (14th wHo Model List) Others oral rehydration salts* (for glucose- electrolyte solution) glucose: 75 mEq potassium: �0 mEq or mmol/� sodium: 75 mEq or mmol/� citrate: �0 mmol/� chloride: 65 mEq or mmol/� osmolarity: �45 mOsm/� �7.5.� zinc sulfate* tablet or syrup in �0 mg per unit dosage forms * in acute diarrhoea zinc sulfate should be used as an adjunct to oral rehydration salts �7.5.� retinol sugar-coated tablet, �0 000 IU (as palmitate) (5.5 mg); capsule, �00 000 IU (as palmitate) (��0 mg); oral oily solution �00 000 IU (as palmitate)/ ml in multidose dispenser ; water-miscible injection �00 000 IU (as palmitate) (55 mg) in �-ml ampoule �7 ANNExES 59 Medicine Dosage therapeutic category (14th wHo Model List) family planning �. Medical eligibility criteria for contraceptive use. 3rd ed. Geneva: World Health Organization; �004. http://www.who.int/ reproductive-health/publications/mec/index.htm Oral hormonal contraceptives ethinylestradiol + levonorgestrel tablet, 30 micrograms + �50 micrograms �8.3.� levonorgestrel tablet, 30 micrograms, 750 micrograms (pack of two), �.5 mg �8.3.� ethinylestradiol + norethisterone tablet, 35 micrograms + �.0 mg �8.3.� Injectable hormonal contraceptives medroxyprogesterone acetate depot injection, �50 mg/ml in �-ml vial �8.3.� norethisterone enanthate oily solution, �00 mg/ml in �-ml ampoule �8.3.� IUD copper IUD �8.3.3 Barrier methods condoms �8.3.4 diaphragms �8.3.4 Reproductive tract Infections/Sexually transmitted Diseases �. Pregnancy, childbirth, postpartum and newborn care: A guide for essential practice. Geneva: World Health Organization; �003. http://www.who.int/reproductive-health/publications/pcpnc/index.html �. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Geneva: World Health Organization; �000. http://www.who.int/reproductive-health/impac/index.html 3. Managing new born problems: A guide for doctors, nurses, and midwives. Geneva: World Health Organization; �003. http://www.who.int/reproductive-health/publications/mnp/index.html 4. Guidelines for the management of sexually transmitted infections. Geneva: World Health Organization; �003. http://www.who. int/reproductive-health/publications/rhr_0�_�0_mngt_stis/index.html c ceftriaxone powder for injection, �50 mg, � g (as sodium salt) in vial 6.�.� cefixime* capsule 400 mg * only listed for single-dose treatment of uncomplicated ano-genital gonorrhoea 6.�.� azithromycin* capsule, �50 mg or 500 mg; suspension �00 mg/5 ml * only listed for single-dose treatment of genital C. trachomatis and of trachoma 6.�.� spectinomycin powder for injection, � g (as hydrochloride) in vial 6.�.� amoxicillin capsule or tablet, �50 mg, 500 mg (anhydrous); powder for oral suspension, ��5 mg (anhydrous)/5 ml 6.�.� sulfamethoxazole + trimethoprim tablet, �00 mg + �0 mg, 400 mg + 80 mg; oral suspension, �00 mg + 40 mg/5 ml; injection, 80 mg + �6 mg/ml in 5-ml and �0-ml ampoules 6.�.� doxycycline* capsule or tablet, �00 mg (hydrochloride) * final selection depends on indication for use 6.�.� erythromycin capsule or tablet, �50 mg (as stearate or ethyl succinate); powder for oral suspension, ��5 mg (as stearate or ethyl succinate); powder for injection, 500 mg (as lactobionate) in vial 6.�.� tetracycline eye ointment, �% (hydrochloride) ��.� 60 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION Medicine Dosage therapeutic category (14th wHo Model List) benzathine benzylpenicillin powder for injection, �.44 g benzylpenicillin (= �.4 million IU) in 5-ml vial 6.�.� metronidazole tablet, �00-500 mg; injection, 500 mg in �00-ml vial; suppository, 500 mg, � g; oral suspension, �00 mg (as benzoate)/5 ml 6.�.� c clindamycin capsule, �50 mg; injection, �50 mg (as phosphate)/ml 6.�.� miconazole ointment or cream, �% (nitrate) �3.� clotrimazole vaginal tablet, �00 mg, 500 mg, vaginal cream �%, �0% 6.3 fluconazole capsule 50 mg; injection � mg/ml in vial; oral suspension 50 mg/5 ml 6.3 nystatin tablet, �00 000, 500 000 IU; lozenge �00 000 IU; pessary, �00 000 IU 6.3 gentamicin* injection, �0 mg, 40 mg (as sulfate)/ml in �-ml vial *final selection depends on indication for use 6.�.� chloramphenicol capsule, �50 mg; oral suspension, �50 mg (as palmitate)/5 ml; powder for injection, � g (sodium succinate) in vial; oily suspension for injection 0.5 g (as sodium succinate)/ml in � ml ampoule 6.�.� procaine benzylpenicillin powder for injection, � g (= � million IU), 3 g (= 3 million IU) in vial 6.�.� HIV Medicines (ARt, MtCt and opportunistic Infections) �. Scaling up antiretroviral therapy in resource-limited settings. Treatment guidelines for a public health approach. Geneva: World Health Organization; �004. http://www.who.int/3by5/publications/documents/arv_guidelines/en/index.html zidovudine tablet, 300 mg; capsule �00 mg, �50 mg; oral solution or syrup, 50 mg/5 ml; solution for I� infusion injection, �0 mg/ml in �0-ml vial 6.4.�.� didanosine buffered chewable, dispersible tablet, �5 mg, 50 mg, �00 mg, �50 mg, �00 mg; buffered powder for oral solution, �00 mg, �67 mg, �50 mg packets; unbuffered enteric coated capsule, ��5 mg, �00 mg, �50 mg, 400 mg 6.4.�.� stavudine capsule �5 mg, �0 mg, 30 mg, 40 mg, powder for oral solution, 5 mg/5 ml 6.4.�.� lamivudine tablet, �50 mg, oral solution 50 mg/5 ml 6.4.�.� abacavir tablet, 300 mg (as sulfate), oral solution, �00 mg (as sulfate)/5 ml 6.4.�.� Non-nucleoside reverse transcriptase inhibitors nevirapine tablet �00 mg; oral suspension 50 mg/5 ml 6.4.�.� efavirenz capsule, 50 mg, �00 mg, �00 mg; oral solution, �50 mg/5 ml 6.4.�.� Protease inhibitors saquinavir capsule, �00 mg 6.4.�.3 ritonavir capsule, �00 mg, oral solution 400 mg/5 ml 6.4.�.3 indinavir capsule, �00 mg, 333 mg, 400 mg (as sulfate) 6.4.�.3 nelfinavir tablet, �50 mg (as mesilate), oral powder 50 mg/g 6.4.�.3 lopinavir + ritonavir capsule, �33.3 mg + 33.3 mg, oral solution 400 mg + �00 mg/5 ml 6.4.�.3 therapeutic category (14th EML) ANNExES 61 Medicine Dosage therapeutic category (14th wHo Model List) Medicines used in opportunistic infections c ceftriaxone powder for injection, �50 mg, � g (as sodium salt) in vial 6.�.� c clindamycin capsule, �50 mg; injection, �50 mg (as phosphate)/ml 6.�.� ciprofloxacin* tablet �50 mg (as hydrochloride) *final selection depends on indication for use 6.�.� c sulfadiazine tablet, 500 mg; injection, �50 mg (sodium salt) in 4-ml ampoule 6.�.� fluconazole capsule 50 mg; injection � mg/ml in vial; oral suspension 50 mg/5 ml 6.3 aciclovir tablet, �00 mg; powder for injection �50 mg (as sodium salt) in vial 6.4.� c pentamidine tablet, �00 mg, 300 mg 6.5.4 pyrimethamine tablet, �5 mg 6.5.4 sulfamethoxazole + trimethoprim injection 80 mg + �6 mg/ml in 5-ml ampoule 80 mg + �6 mg/ml in �0-ml ampoule 6.5.4 therapeutic category (14th EML) 62 REPRODUCTIVE HEALTH COMMODITY SECURITY STRATEGY: WEST AFRICA SUBREGION For more information, please visit http://www.deliver.jsi.com DELIVER John Snow, Inc. �6�6 N. Fort Myer Drive ��th Floor Arlington, �A ���09 USA tel: 703-5�8-7474 fax: 703-5�8-7480 deliver.jsi.com

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