UNFPA Global Programme to Enhance Reproductive Health Commodity Security 2007-2011

Publication date: 2006

[image: image1.png] Global Programme to Enhance Reproductive Health Commodity Security [2007-2011] Acknowledgements: UNFPA would like to thank the large number of people who have contributed to the development of the Global Programme. Within UNFPA particular thanks go to: Benedict Light as principle formulator and coordinator; Jagdish Upadhyay for general oversight; Hedia Belhadj, Stan Bernstein, Elizabeth Calderone, Jo Annah Jensen, Alexei Sitruk and Veikko Kiljunen for technical and substantive support. Outside UNFPA special thanks go to our partners in the Reproductive Health Supplies Coalition and particularly to the Foreign Affairs Ministry of the Netherlands and the Department for International Development of the UK. Table of Contents 61. Executive Summary 92. Background and Justification 112.1 A matter of human rights and social justice 112.2 RHCS in the context of Health Sector Reform and relevant development frameworks 142.3 UNFPA Programming for RHCS 153. Objectives and Guiding Principles 153.1 Hierarchy of Objectives 163.2 The Paris Declaration: implications and relevance for the Global Programme 194. Approach of the Global Programme to Enhance RHCS 194.1 Focus of Global Programme projected results at national level 204.2 Global Programme Funding Mechanisms 204.3 Global Programme Indicative Funding Parameters 224.4 Strategy to Mainstream RHCS 234.5 Global Programme Funding Application Procedures 244.6 Funding Application Assessment Procedures and Consultative Review Board 254.7 Intervention Procedures 265. Role of UNFPA in facilitating implementation of the Global Programme 265.1 UNFPA facilitating the Global Programme at national level 285.2 UNFPA facilitating the Global Programme at regional level 295.3 UNFPA facilitating the Global Programme at global level 325.4 UNFPA using the Global Programme to facilitate other multilateral RH efforts 335.5 Lesson Learning Mechanism 346. Implementation Mechanisms of RHCS Global Programme 346.1 Facilitating an integrated approach to RHCS throughout UNFPA 356.2 Monitoring and Review Mechanisms Annexes 36Annex 1: Indicative Logical Framework to manage for progress 40Annex 2: Orientation Tools and Guidelines 43Annex 3: Institutionalisation and Mainstreaming of RHCS within UNFPA 44Annex 4: Supply and capacity gap in RH Commodity Security Glossary ACT Artemisin-based Combination Therapy ARH Adolescent Reproductive Health ARV Anti-retro viral BS Budget support CS Country Support CCA Common country assessment CCM Country commodity manager CGI Clinton Global Initiative CMB Commodity Management Branch CPAP Country Programme Action Plan CPD Commission on population and development CPR Contraceptive Prevalence Rate CRB Consultative Review Board CST Country Support Technical Team CO Country Office DMS Division of Management Services ECOWAS Economic Community of West African states EECIS Eastern European Commonwealth of Independent States GDP Gross Domestic Product GFATM Global Fund for AIDS, TB and Malaria GP Global Programme GPMT Global Programme Management Team GTT Global Task Team on Improving AIDS Coordination among Multilateral Institutions and International Donors HIV/AIDS Human immunodeficiency virus/acquired immunodeficiency syndrome HRU Humanitarian Response Unit HSR Health Sector Reform ICB International Competitive Bidding ICPD International Conference on Population and Development IERD Information and External Relations Division IPCI International Parliamentarians’ Conference [for the Implementation of ICPD] IPPF International Planned Parenthood Federation LDC Less Developed Country LMIS Logistics Management Information System MDGs Millennium Development Goals MMR Maternal Mortality Ratio MYFF Multi-Year Funding Framework NGOs Non-Governmental Organisation PEPFAR President Bush’s Emergency Plan for AIDS Relief PRSPs Poverty Reduction Strategy Papers RBM Results Based Management RH Reproductive Health RHC Reproductive Health Commodity RTI Reproductive Tract Infection SRH Sexual and Reproductive Health RHCS Reproductive Health Commodity Security STI Sexually Transmitted Infection SWAps Sector Wide Approaches TOR Terms of Reference TSD Technical Support Division UN United Nations UNDAF United Nations Development Assessment Framework UNCT United Nations Country Team UNDGO United Nations Development Group Office UNGASS United Nations General Assembly Special Session UNICEF United Nations Children’s Fund UNFPA United Nations Population Fund WAHO West African Health Organisation WB World Bank WHO World Health Organisation Reproductive Health Commodity Security Global Programme to Enhance RHCS 1. Executive Summary Reproductive Health Commodity Security [RHCS] is achieved when all individuals can, obtain and use affordable, quality reproductive health commodities of their choice whenever they need them. RHCS is essential to meeting the target of universal access to reproductive health by 2015, as called for by the International Conference on Population and Development [ICPD] and reiterated at the 2005 World Summit. It is also critical in the fight against HIV/AIDS. The Global Programme to Enhance Reproductive Health Commodity Security provides a structure for moving beyond ad hoc responses to stockouts towards more predictable, planned and sustainable country-driven approaches for securing essential supplies and ensuring their use. Focused at country level, the Global Programme creates a process that will galvanise, institutionalise and coordinate national efforts. Three separate funding streams offer flexibility to assist countries based on their specific needs and current capacity. Full implementation of the programme will require US$150 million per year for an initial period of five years [2007-2011] extendable on a rolling basis to cover the period up to 2015. Objectives The Global Programme is designed to produce the following results: At national level: Reproductive health commodity needs met consistently and reliably for all who need them; Strong interlinkages between RHCS and national RH and HIV/AIDS programmes and policies; Enhanced capacity of national stakeholders and improved systems [particularly for RH commodity supply, quality of care, demand and access]; Mainstreaming of RHCS through gradual increases in government-controlled funding to finance capacity and system enhancement and planned commodity provision; Increased national ownership and management of all aspects of RHCS. At international level: Regular and dependable funding flows necessary to implement multi-year plans of action; More strategic international support for RHCS; Better collaboration among UN Agencies and better integration of RHCS in the context of joint country level work; Stronger strategic partnerships among global development partners through work with the global Reproductive Health Supplies Coalition and development of stronger links with international funds such as the Global Fund for AIDS, TB and Malaria. In addition, the Global Programme [GP] will forge stronger links with regional institutions in the areas of capacity enhancement and training, research and development, data collection and project monitoring. By encouraging plans of action that emphasise linkages between HIV/AIDS and reproductive health care, it will also seek to harmonise multilateral efforts in the areas of sexual, reproductive and maternal health Features of the Global Programme The Global Programme is aligned with the principles of the Paris Declaration on Aid Effectiveness. Toward this end, it puts national governments at the centre of the decision-making process and encourages strong alliances of stakeholders. It recommends the identification and development of an appropriate body of national stakeholders to oversee the national RHCS strategy . It also calls for countries to present a formal strategy and plan of action that addresses capacity building. Although the specific activities funded through the programme will be decided at the country level, the Global Programme sets clear parameters. This ensures that funded activities further UNFPA’s mandate and international goals while also addressing the specific, self-defined development priorities of each country. The application and review process ensures that supply-side issues are complemented by an integrated, human rights-based approach that will benefit the end user. It will also focus attention on broader health systems issues of quality of care, the policy environment, access and demand. Evolution of RHCS strategy: In recent years, UNFPA funds for RHCS have been used to: [1] build capacity and facilitate development of sustainable procedures and systems that enhance RHCS at national level; and [2] meet countries’ immediate shortfalls in reproductive health commodities. The Global Programme has a more explicit development focus designed to ensure that individuals are able to exercise their human rights in the sphere of reproductive health. The integrated approach that the Global Programme promotes, takes as its foundation the reliable and consistent availability of planned RH commodities complemented by a focus on issues of quality of care, improvements to the national environment [political, cultural, judicial, statutory] as well as questions of access and demand. For further information on the funding streams see the table overleaf. The role of UNFPA and its partners UNFPA will implement the Global Programme in collaboration with national partners, UN sister agencies and international development partners nationally, regionally and globally. The Fund will develop RHCS Orientation Tools and Guidelines to assist UNFPA Country Offices and their national and international RHCS partners to take full advantage of the programme. UNFPA and its partners are well-placed to provide technical assistance where requested by countries in a range of areas including, but not limited to: facilitation of national efforts to define and drive a national RHCS integrated strategy and plan of action; reproductive health costing; commodity management needs projection; procurement; pre-qualification of medicines and reproductive health commodities; information, education and communication, behaviour change and communication, HIV/AIDS prevention strategies and comprehensive condom programming, total market approaches that increase/ensure access for marginalised populations. Funding streams of the Global Programme Countries will apply for funding under three separate funding streams [1, 2 and 3], as described below. Countries receiving GP funds are encouraged to increase financial allocations from government-controlled sources [see p.20] as GP funds gradually decrease over the course of the programme. Stream 1 Eligibility Period Fund Total Thematic focus Funding focus UNFPA Category A and B countries; Individual countries only GP funds for 5 year period $25 million [for 5 year period] Integrated, human rights based approach able to demonstrate significant progress in each of the three results areas [see annex 1: Indicative Logical Framework] Funds for [1] capacity and systems enhancement and [2] planned RH commodity provision. Countries will decide distribution of funds though the funding range is expected to be 40-60% for both capacity and systems enhancement and planned RH commodity provision Stream 2 Eligibility Period Fund Total Thematic focus Funding focus Category A, B, C countries; Countries or groups of countries GP funds for 1, 2 or 3 year period $1m per year for up to 3 years National or sub-regional RHCS initiative focused on reduced number of specific themes [see annex 1: Indicative Logical Framework] Limited funds for some capacity and systems enhancement and planned RH commodity provision. Funding split for capacity and systems enhancement and planned RH commodity provision [expected to be 40-60%] to be decided by country or sub-regional applicant group. Stream 3 Eligibility Period Fund Total Thematic focus Funding focus UNFPA Category A, B, C countries; Individual countries only Ad hoc; based on each specific request No planned minimum or maximum Emergency RH commodity provision Building on national commitment towards RHCS Avert RH commodity stockouts; Facilitate the development of national commitment towards RHCS Estimated annual funding needs Stream Description Country eligibility Est. # countries Est. cost in US$ per country Est. total Costs in US$ Share of total funds 1 High-emphasis countries A, B 15 5 mil. 75 mil. 50% 2 Other countries A, B, C 25 1 mil. 25 mil. 17% 3 Urgent RH commodity shortfalls A, B, C … … 50 mil. 33% Total 150 mil. 100% Distribution of funds among programme components Stream Capacity and systems enhancement RH commodities Total 1 40-60% 60-40% 100% 2 40-60% 60-40% 100% 3 0% 100% 100% 2. Background and Justification At the International Conference on Population and Development [ICPD] in Cairo in 1994, the world agreed on the goal of reproductive health care for all by 2015. A five-year review of the Cairo Programme of Action [ICPD+5] showed that accelerated progress would be needed in order to achieve that goal. Throughout the entire ICPD at 10 process in 2004 and after the ICPD at 10 regional review conferences, the urgent need for RHCS was reiterated. In 2000, world leaders reaffirmed the importance of reproductive health as an international development priority [note the linkages between the fight against HIV/AIDS and RH and Reproductive Rights]. The Millennium Development Goals [MDGs] call for a drastic reduction by the year 2015 in maternal mortality, significant progress in reversing the HIV/AIDS epidemic and marked improvements in the health of the poor. This emphasises once again that timely and coordinated efforts that make reproductive health commodities available to those who need them are fundamental to creating the necessary conditions for the MDGs to be achieved. The UN Secretary General’s report, In Larger Freedom, further stresses that MDG targets cannot be achieved by 2015 if universal access to RH is not secured: and securing such access requires the steady and dependable provision of commodities and services. The Millennium Project’s Task Force on Women’s and Child Health further stresses the need to strengthen health systems to improve maternal health and to achieve maternal mortality reduction targets by 2015. During the International Parliamentarians’ Conference on the Implementation of the ICPD Programme of Action [IPCI/ICPD], in Strasbourg, France, in October 2004, parliamentarians declared they will: Give highest priority in national budgets, sector-wide approaches, and poverty-reduction strategies to expanding access to comprehensive reproductive health services and commodities and ensure that population and reproductive health are prominently reflected in both the preparatory discussions leading up to the five-year review of the Millennium Declaration as well as in the targets and indicators of the MDGs. Give the highest priority to encouraging partnership between the private sector, NGOs and government in providing affordable reproductive health commodities and supplies, especially for family planning and the prevention of sexually transmitted infections, including HIV/AIDS. Mobilise the necessary additional resources to fund the unmet needs in commodities in UNFPA and IPPF-supported programmes to a figure of at least $150 million/year and develop a road map to ensure sustainable financing, recognising the human and economic costs of failing to do so. In April 2005 session of the Commission on Population and Development, UN members emphasised the need to integrate the goal of universal access to reproductive health by 2015 in strategies to attain the world’s development goals. Such access, they resolved, should be part of efforts to eradicate poverty, improve maternal health, reduce infant and child deaths, promote gender equality and combat HIV/AIDS. At the World Summit held at UN HQ in New York in September 2005, the largest-ever gathering of world leaders reaffirmed their resolve to achieve universal access to reproductive health by 2015, to promote gender equality and to end discrimination against women. The leaders undertook to integrate the goal of access to reproductive health into national strategies to attain the MDGs to end poverty, reduce maternal death, promote gender equality and combat HIV/AIDS. Leaders pledged to increase investments in health systems in poor countries with the aim of providing sufficient supplies, health workers and facilities. The Clear Rationale for investing in RHCS Poverty: Falling fertility rates in low income countries correlate with a decline in poverty. Family Planning: Multiple studies demonstrate that family planning programmes produce tangible savings. In Mexico, the equivalent of a dollar invested saved nine dollars in other expenses; in Thailand, a dollar invested saved 16 dollars; in Egypt a dollar invested saved 31 dollars. Maternal Mortality Rate: Life saving obstetric equipment and drugs are essential to ensure safe motherhood. Also, using contraceptives to avoid too early and unwanted pregnancies and to ‘space’ births is crucial to efforts to reduce MMR. Gender Equality and Education: It is estimated that if modern contraceptive services were available to all 201 million women with unmet need for contraceptives in the developing world, the number of unplanned births would be reduced by 72%. HIV/AIDS: Condoms are currently the only product able to prevent sexually transmitted HIV. In addition, the risk of contracting HIV is 2-9 times greater when other STIs are present – good reason to ensure the reliable supply of supplies for testing and drugs for the treatment of STIs. Adolescents and Young People: the largest ever number of young people [> 1.3 billion] are beginning their reproductive and sexual lives. Despite the call from these international conferences and efforts by many governments, UN and the donor community, some 137 million women still have an unmet need for contraception and another 64 million are using traditional family planning methods that are less reliable than modern methods. The highest proportion, several times the level of current use, is in sub-Saharan Africa where 46% of women at risk of unintended pregnancy use no method. Indeed by combining couples using traditional methods to those with unmet need for modern methods, fully 63% of couples in sub-Saharan Africa have unmet needs in terms of desired numbers and spacing of children [2004 State of the world population UNFPA; see also “Adding it Up” – www.unfpa.org/upload/lib_pub_file/240_filename_addingitup.pdf]. Contraceptive prevalence in developing countries has grown dramatically in the past 40 years rising from about 10% to over 60% today. But progress has been uneven, with CPR under 10% in many countries of sub-Saharan Africa. Moreover, demand far outstrips supply and seems set to continue to do so. From 2000-2015 the number of contraceptive users is projected to increase more than 21% [UN Population Division] due to population growth and increased demand for contraception – while donors support remains broadly stable. Increased use of contraceptives and condoms for prevention of STIs and HIV/AIDS is also raising the need for increased national and international resources. Without a reliable supply of sexual and reproductive health commodities [and associated service provision, capacity enhancement and systems development], the promises made at ICPD, the Millennium Summit and reiterated at the CPD [April 2005] and World Summit [September 2005], cannot be kept. New resource estimates demonstrate that the resources required to provide the needs for sexual and reproductive health are much higher than estimated at the ICPD in 1994. The new estimate indicates that the resources needed will reach US$30 billion per year by 2010 and US$36 billion per year by 2015; respectively US$9 billion and US$14 billion higher than originally estimated. [UN Millennium Project. 2006. Public Choices, Private Decisions: Sexual and Reproductive Health and the Millennium Development Goals, New York]. This means that donor contributions will have to increase substantially for the commitments made at ICPD—and reiterated subsequently—to be met. 2.1 A matter of human rights and social justice Emphasis on the rights of individual women and men underpins the ICPD Programme of Action that guides UNFPA’s work. RHCS is designed to provide a foundation for more equitable access to family planning, condoms for HIV prevention, emergency obstetric equipment and other essential RH supplies, as it works towards ensuring that all individuals – regardless of socioeconomic status, gender, ethnicity or age – can credibly exercise their fundamental human right to the highest attainable standard of health. Correlation between socio-economic status and contraceptive prevalence rate: Richer population groups are better able to satisfy their reproductive desires with modern contraception. Where prevalence is low, nearly a third of the couples in the richest income group who wish to delay or avoid a birth use modern contraception. Among the poor, the proportion using modern methods does not reach this level until contraceptive acceptance is more widespread. Differences between poor and rich populations’ access to family planning are huge. In sub-Saharan Africa, for example, women in the richest fifth of the population are five times more likely to have access to and use contraception than women in the poorest fifth. Advancing gender equality and equity: Many women around the world able to access family planning services and HIV prevention methods, such as male and female condoms, are not benefiting from them as they are unable negotiate their use. A woman’s ability to negotiate use of the supplies so integral to her sexual and reproductive health is crucial if she is to effectively exercise her right to decide the number and spacing of her children as well her right to life and survival. Safeguarding young people's rights: In line with its priority of ensuring that young people can exercise their rights, UNFPA recognises: [1] the crucial importance of making sure that young people have access to information and services; [2] that, to be credible, this information and these services must be underpinned by the reliable and consistent supply of the RH commodities that young people need; and [3] that these commodities must be made available in such a way that they are used by young people. 2.2 RHCS in the context of Health Sector Reform and relevant development frameworks In the context of UN Harmonisation and Simplification promoting inter-agency collaboration, current country programming processes [i.e. CCA and UNDAF] building on country population assessments provide the opportunity to: [1] review the political environment; [2] identify opportunities and barriers to fulfilling universal access to RH services; and [3] identify entry points to advocate for and ensure inclusion of RHCS issues. The new aid development frameworks such as Health Sector Reform, PRSPs and SWAps and, more globally, sector programmes and budget support represent good strategic opportunities for RHCS-related issues to be discussed and addressed in a consistent manner. RHCS must be reflected systematically in the relevant national development frameworks to ensure the coherence and completeness of the SRH components of these strategies. It is imperative to take the opportunity to bring these issues to the table when representatives from government, the donor community, UN agencies, the private sector, civil society and the Bretton Woods institutions discuss poverty reduction and development. RHCS and SRH in general often drop off the development agenda when this is not done. Inadequate priority setting mechanisms also contribute to the marginalisation of the issue of Reproductive Health [and, as a consequence, RHCS]. Many countries are making widespread structural changes to their health sectors and there is mounting concern that priority-setting mechanisms used in planning the reforms are not suited to recognising or taking account of the needs and priorities of sexual health services and reproductive health services and rights. Integrating inclusion of RHCS and related issues into systems and priority-setting mechanisms provides a further opportunity to demonstrate that RHCS lies in a crucial policy sphere, underpinning a substantial part of the broader health system. The appropriate inclusion of RHCS and related issues will also lead to more national resources and capacity development efforts focused in support of RHCS. Human Rights, The Millennium Development Goals and the Global Programme The human rights focus of the Global Programme aims to expand choice for individuals by making a broad range of RH commodities consistently available and promoting their use. These efforts underpin efforts to achieve all of the MDGs. MDG1 [Eradicate extreme poverty and hunger]: The ICPD Programme of Action and ICPD+5 benchmark aim for universal access to voluntary RH services, including family planning. Access to these services will give users fundamental choices that can break the cycle of poverty. With access to family planning, women and men can decide if, when and how many children they want; Lower fertility results in slower population growth and opens a “demographic window” of opportunity for economic growth and poverty reduction as the ratio of dependants to working-age people declines; Large families dilute the assets of poorer households and unwanted births deepen household poverty. Smaller families allow more investment in each child’s education and health. MDG2 [Achieve universal primary education]: To achieve universal primary education the gender gap must be closed. The ICPD Programme of Action’s goal of basic education for all boys and girls by 2015 can be supported through the empowerment of women, training of teachers to be gender sensitive, promoting the value of educating girls, postponing early marriage and childbearing, allowing pregnant teens to continue studying, providing scholarships, providing universal access to RH and lowering fertility, morbidity and mortality rates. MDG3 [Promote gender equality and empower women]: Ensuring gender equity and equality and the empowerment of women depends in part on overcoming cultural, social and economic constraints that limit women’s access to education, as well as providing universal access to RH services that allow them to control their fertility; combating violence against women, and removing social and family barriers to women’s wider social participation are essential. MDG4 [Reduce child mortality]: A healthy mother is the first step towards a healthy child. Infant and child mortality are highest for the youngest mothers and after closely spaced births. High fertility reduces the provision of heath care to children; Unwanted children are more likely to die than wanted ones. Providing universal access to RH care will help to prevent unwanted pregnancy. The death of the mother increases the risk that her children will die. MDG5 [Improve maternal health]: The highest proportion of women’s ill health burden is related to their reproductive role. Universal access to RH care—including family planning, inter alia—would reduce unwanted pregnancy, unsafe abortion and maternal death, saving women’s lives and the lives of their children; Women’s empowerment will enable women to address the social conditions that endanger their health and lives. MDG6 [Combat HIV/AIDS and other diseases]: Universal access to RH care is critically important to fight HIV/AIDS; ICPD notes that better information on HIV/AIDS can prevent transmission of HIV and other STIs; Half of new HIV infections are among young people. Preventing infection means enabling young people to protect themselves from STIs, including HIV. This includes teaching abstinence outside marriage, fidelity within it and responsible behaviour at all times, including responsible use of condoms; Poor countries need an adequate supply of RH commodities, including male and female condoms, and strengthened supply and distribution systems. MDG7 [Ensure environmental sustainability]: Balancing resource use and ecological requirements will depend critically on population growth; ICPD acknowledges that rapid growth of poor rural populations puts enormous stress on local environments. Poor people need better education and health services, including universal access to RH care and family planning to improve their health and well-being; Appropriate SRH and health systems policies can reduce urban migration and promote sustainable rural population growth. MDG8 [Develop a Global Partnership for Development]: Population and RH programmes have lagged in the least developed countries, especially those with high levels of mortality and unwanted fertility. These countries benefit most form higher international assistance and the allocation of government-controlled resources for RH and education. They need universal access to RH care coupled with, inter alia, a secure supply of contraceptives and other RH commodities; ICPD called on international donors to provide one third of the support needed for RH programmes in developing countries worldwide: US$5.7 billion in 2000, rising to US$7.2 billion by 2015. Current international support is less then half this level. The country-driven, human rights focused Global Programme constitutes a good programmatic vehicle to contribute tangibly to the pledges made. 2.3 UNFPA Programming for RHCS While the challenges are huge, UNFPA is well-placed to lead international efforts in this crucial policy area. UNFPA, in dialogue with its partners, has developed its Reproductive Health Commodity Security strategy in recognition of its comparative advantages. These include: 30 years of knowledge and technical and programming expertise throughout sexual and reproductive health; Results-based country programming and support for comprehensive RH programmes that address demand and supply issues; Field offices in over 100 developing countries; 9 regional Country Support Teams; Active participation in the CCA/UNDAF process and increasingly in PRSPs, sector-focused work, SWAps and MDG-oriented national development strategies. At UNFPA HQ, the Commodity Management Branch [CMB] of the Technical Support Division is mandated to drive progress on achieving RHCS. This work is currently facilitated by the Inter-Divisional RHCS Task Team, Chaired by the Deputy Executive Director [Management] with broad high-level membership from the technical, geographical and management divisions. The Task Team is tasked with ensuring that RHCS is effectively mainstreamed and institutionalised throughout UNFPA. A good example of this process in action is that the Inter-Divisional RHCS Task Team is to be mainstreamed into the higher level Programme Committee and Management Committee. These two committees, chaired by the relevant Deputy Executive Director and attended by Directors and Deputy Directors, will be responsible for directing and guiding all programme management and related functions. The Global Programme will be a standing item for all meetings of these Committees. Moreover, CMB also coordinates closely with other parts of UNFPA including other TSD Branches, Humanitarian Response Unit [HRU], the Information and External Relations Division [IERD] and the four Geographical Divisions. Further advantages include: UNFPA’s close working relations with programme countries; Collaboration with the members of the Global Coalition for RHCS and with regional initiatives such as ECOWAS and WAHO [an association of 15 African countries] and EAC [Eastern Africa Commission]. Also crucial to UNFPA work on RHCS is the global mandate and leadership role assigned to UNFPA in a number of international fora and mentioned above. UNFPA also has key comparative advantages due to its extensive experience in RH commodity procurement. As the largest, multi-lateral procurer, worldwide of RH commodities and due to its economies of scale, UNFPA is able to do more—with fewer funds—than any other international agency. The UNFPA RH commodity shortfall projection software, Country Commodity Manager [CCM], provides information about the RH commodity stock levels at central warehouse level in country to help avoid stockouts. In addition, the CHANNEL software [currently being tested in-country] captures similar data within the national supply chain. CMB works closely with the Procurement Services Section focusing on supply and delivery as well as on country-level logistics-related capacity and systems enhancement. A secure, reliable source of funding managed by UNFPA and dedicated to driving efforts to enhance RHCS will: [1] Play a crucial role in encouraging country-level partners to take the longer-term action necessary to strengthen national capacity, systems and mechanisms in a sustainable manner; [2] Facilitate the development of national commitment to the procurement of RH commodities [ideally, using government-controlled resources] to ensure reliable access, to meet [and, as necessary, increase] demand and to avoid RH commodity stockouts. 3. Objectives and Guiding Principles By defining RHCS as achieved “when all individuals can obtain and use affordable, quality reproductive health commodities of their choice whenever they need them”, the Global Programme seeks to mainstream RHCS as a key programmatic vehicle by which UNFPA can link concrete country-level interventions to progress in achieving the ICPD, the MDGs and the Beijing Platform for Action. RHCS has to be seen, first and foremost, as a human rights issue, intimately linked to questions of equity, equality and the empowerment of women and girls. The reliable supply of RH commodities underpins RH commodity security but RHCS only makes sense when it promotes an integrated approach—focusing on access and demand—that facilitates delivery of programmatic interventions that actually improve people’s lives. RHCS cannot be achieved by focusing solely on supply side elements. Supply side efforts have to be complimented by all and any UNFPA work that seeks to ensure that every pregnancy is wanted, every birth is safe, every young person is free of HIV/AIDS, and every girl and woman is treated with dignity and respect. In short, within UNFPA, RHCS is—and has to be—everyone’s business. More broadly, UNFPA considers RHCS a prerequisite for the achievement of the many ICPD goals that were incorporated into the MDGs [see box between sections 2.2 and 2.3]. Indeed, as a prerequisite for improvements in sexual and reproductive health, RHCS is a prerequisite for: the eradication of extreme poverty and hunger [MDG 1]; the promotion of gender equality and empowerment of women [MDG 3]; the reduction of child mortality [MDG 4]; the improvement of maternal health [MDG 5]; and combating HIV/AIDS inter alia [MDG 6]. 3.1 Hierarchy of Objectives Super goal: Improved Sexual, Reproductive and Maternal Health for all. Goal: All individuals can obtain and use affordable, quality reproductive health commodities of their choice whenever they need them. Outcome: Improve the sustainability of Reproductive Health Commodity Security at the national level. Outputs: Integrated approaches to RHCS improved at all levels in-country [focus on interlinkages with programmes and policies on RH, including HIV/AIDS prevention]. RHCS-related systems and capacity enhanced among national stakeholders at the national level. RH commodity needs met consistently and reliably. 3.2 The Paris Declaration: implications and relevance for the Global Programme The Paris Declaration on Aid Effectiveness provides the methodological approaches to be adopted by the Global Programme. As per the Paris Declaration, these are: ownership, alignment, harmonisation, managing for results, mutual accountability. Ownership: With regard to ownership, the focus of the Global Programme is to ensure that partner countries exercise effective leadership over their development policies and strategies and co-ordinate development actions. This is to be achieved by stimulating the emergence of an appropriately constituted alliance of national RHCS stakeholders to define, own and drive the national RHCS strategy. The key mechanism promoted by the GP by which this is to be achieved is the constitution and operationalisation of a broad-based RHCS national Coordination Committee. This body, likely to be an extension or refinement of an existing committee or working group, should be government led and include a broad range of national stakeholders involved in RHCS. Part of the process of stimulating broad-based in-country ownership of the national RHCS strategy and plan of action is to facilitate and promote effective government stewardship of RHCS-related issues across the health sector. This will involve promoting cooperation and the exploitation of synergies among national partners from the state sector, civil society and the private sector. Alignment: With regard to alignment, the focus of the Global Programme is to ensure that UNFPA and its development partners base their overall support on partner countries’ national development strategies, institutions and procedures. In procedural terms, there are clear interlinkages between this guiding principle and that of ownership. The challenge once again is to effectively pursue a development mandate while ensuring national counterparts are defining, owning and driving national strategies. Where possible and appropriate, the Global Programme will align with existing national RHCS strategies. However, as part of the Global Programme, it is recommended that existing strategies are revisited and revalidated by as broad an alliance of national stakeholders as possible. The emphasis on national ownership and alignment has significant implications for UNFPA and its development partners with the development practitioner becoming less as a doer and more a facilitator, supporter, advocate, promoter. One key challenge is to reconcile this modified role with the effective pursuit of a development mandate. In an attempt to meet this challenge, the objectives of the Global Programme are outlined above [section 3.1]. The selection of the precise activities and the emphasis of national approaches is a collective decision left to the members of the RHCS national Coordination Committee. This approach allows the Global Programme to reconcile the guiding principles of the Paris Declaration while ensuring that UNFPA is able to effectively facilitate achievement of its development mandate at national level. In the context of the Global Programme UNFPA will seek to build on, and work through, existing national structures and mechanisms [in, for example, the areas of procurement, forecasting, logistics, distribution, etc.]. In order to improve the sustainability of efforts to achieve RHCS, UNFPA is to use, and as necessary enhance, national procurement and distribution systems. While focusing on the steady and reliable supply of RH commodities, the systems used [or enhanced] may currently have additional uses. Where the Global Programme finances RH commodity supply systems, it will be possible for governments and national partners to use such systems to facilitate supply of other health-related commodities [e.g. anti-retrovirals, anti-malarials, etc.]. Indeed, where there are good systems and tools for procurement, distribution, forecasting of other health commodities developed by UNFPA’s partners [e.g. UNICEF, WHO, WB, Clinton Foundation, PEPFAR, etc.], UNFPA will seek synergies for the mutual reinforcement of the national systems. UNFPA will avoid duplication and development of vertical systems. Harmonisation: The Global Programme will seek to enhance coordination: with global partners, at global, regional and national level; with UN sister agencies, at global and national level; and within UNFPA at global and national level. In all cases, the aim is to ensure RHCS is effectively linked to all relevant aspects of reproductive health as well as efforts to prevent STI including HIV/AIDS. Specific efforts will also ensure that RHCS is effectively institutionalised and operationalised within UNFPA. The multi-level coordination will take inspiration from the lessons learned and good practices emanating from the national efforts to enhance RHCS. The Global Programme is designed to ensure there is an appropriate focus on, and prioritisation of, reproductive health at national level. Many donors are phasing out their support to RH or are allocating funds to general budget support [with these funds seldom used for RH]. Care will also be taken to ensure that Global Programme funds are additional to existing government funds. The Global Programme is designed to act as a catalyst to facilitate nationally driven efforts to mainstream RHCS. The centrality of this focus will ensure the additionality—and gradual reduction of—global programme funds as, simultaneously, there is an increase in the use of government controlled funding sources to finance RH commodity provision and capacity and systems enhancement. Where financial ceilings exist, efforts will be made to ensure that Global Programme support does not adversely impact on government funding allocations and implementation within the context of sector wide approaches. This multi-level coordination is also designed to ensure that UNFPA facilitates a process that: [a] contributes to reaffirming the “linkages between HIV/AIDS and sexual and reproductive health” [see the New York Call to Commitment, NYC, June 2004]; [b] progresses, at the national level, towards the achievement of reproductive health goals relating to reducing maternal mortality, increasing the contraceptive prevalence rate, adolescent health and family planning efforts; [c] reduces incidence of and prevents STIs [presence of an STI increases the risk of contracting HIV/AIDS by 2-9 times]. Ensuring effective coordination of the Global Programme will also provide opportunities for UNFPA to develop its comparative advantages in: [i] the procurement and supply of test kits for HIV; [ii] programming of male and female condoms; and [iii] procurement and supply of drugs [antibiotics] for STI treatment. The Programme aims to ensure that genuine and measurable progress at national level informs, inspires and strengthens multi-level coordination globally, regionally and nationally – creating a virtuous circle, to the benefit of the ultimate beneficiaries of the programme. Managing for Results: Meeting the challenges enshrined in the Paris Declaration, in which the development practitioner is a doer and more a facilitator, places increased emphasis on ensuring national stakeholders: [1] are as well informed as possible about choices, approaches, issues, etc.; [2] have appropriate orientation tools and guidelines to pursue objectives; [3] are able to access technical support as required; [4] are provided with appropriate capacity development resources to facilitate the sustainability of this approach. In this context, the Global Programme will establish a Lesson Learning Mechanism [see 5.5] to ensure that the knowledge and experience developed is shared widely to the benefit of all interested parties. All GP funded interventions should be compatible with sound development cooperation methodologies [Results Based Management, Project Cycle Management]. The Lesson Learning Mechanism will finance, inter alia: the development of RHCS Orientation Tools and Guidelines; strong monitoring and evaluations mechanisms and procedures [with strong feedback loops to policy makers nationally and globally]; the GP Advocacy and Dissemination Initiative; and Annual Global Programme Conferences. UNFPA, thus commits to enhancing and/or developing all necessary mechanisms [monitoring and evaluation plans] designed to measure programme impact and country progress towards RHCS. Such mechanisms will permit the identification and synthesis of good practices and lessons learned of the Global Programme. These will be documented and published and—most importantly—replicated for the benefit of others. The Global Programme will also identify and seek to learn from approaches and activities [undertaken by UNFPA COs or global and national partners] which have been successful and innovative in the area of RHCS. Mutual Accountability: The tools and procedures developed to ensure effective management for results will facilitate informed decision-making. Joint evaluation missions [involving national and international partners – and funded by the Lesson Learning Mechanism – see section 5.5] will promote and cement strong collaboration—and encourage mutual accountability—among the national and international stakeholders. To be effective the Global Programme will develop effective coordination and collaboration with a range of partners and initiatives at national, regional and global level on a range of issues [HIV/AIDS, STIs, RH, MH], involving like-minded partners [e.g. GP funders, RH Supplies Coalition partners ] as well as other partners such as UN organisations, the Global Fund for AIDS, TB and Malaria, President Bush's Emergency Plan for AIDS Relief [PEPFAR], Clinton Global Initiative, etc. 4. Approach of the Global Programme to Enhance RHCS The approach of the Global Programme to enhance RHCS is first and foremost to seek to ensure that all elements and interventions either lead to improvements or else prevent, stabilise or reverse problems in the sexual and reproductive health of the ultimate beneficiaries of this programme. In implementing the programme, UNFPA will ensure a sharp beneficiary, country-level focus at all times. 4.1 Focus of Global Programme projected outputs at national level The Global Programme is designed to be a catalyst for governments to mainstream RHCS into core business and build capacity to meet in-country RH commodity needs in a sustainable manner. To this end, three outputs have been identified, which national efforts should seek to achieve. [1] Integrated approaches to RHCS improved at all levels in-country: This output area will focus on promoting better linkages between RHCS and the wider RH and HIV/AIDS prevention programmes and policies, in the context of, for example, the GFATM, PEPFAR, CGI and SWAps, PRSs, HSR, BS, CCA/UNDAF, CF, etc.]. It will focus on emphasising links between the supply side of commodity provision, related questions of quality of care and the need to ensure access and demand. It is likely to include such components as: [a] promoting and retaining pro-RHCS political will; [b] promoting RHCS in policy dialogues and development frameworks [including the development and implementation of strategies to finance an increasing proportion of RH commodity provision through nationally-controlled funding sources]; [c] stimulating government stewardship of all efforts to improve health intra-nationally; [d] promoting and facilitating public, private and civil society effort to enhance RHCS; [e] eradicating obstacles [physical, legal, cultural, etc.] to RHCS. This output area, in particular, is designed to ensure that the key national stakeholders cease to see RHCS as a stand alone vertical issue dealt with by others and make it a national priority that is a prerequisite step towards improving RH and preventing HIV/AIDS [and achieving the MDGs]. [2] RHCS-related systems and capacity enhanced among national stakeholders at the national level: This output area is to focus on systems [infrastructure] and capacity [practical knowledge] enhancement on how to make improvements on: [1] the supply side [forecasting, logistics, distribution, procurement, etc.]; [2] quality of care issues, specifically linked to commodity security and provision; [3] issues of access and demand – encompassing issues such as: use of contraception [particularly the ability of women and girls to negotiate use]; tackling unmet need for contraception; social marketing and insurance, market segmentation and cost recovery strategies; total market approaches that effectively reach the most marginalised populations [such as the poor, indigenous groups, women and youth]. Any cost recovery approaches/strategies developed under the Global Programme will be country-defined and driven taking full account of prevailing conditions, policies, etc. In situations where UNFPA supports market development approaches, it is fully recognised that some population segments require free products and services and that leakage needs to be minimised by increasing transparency. [3] RH commodity needs met consistently and reliably: This output area is to focus on using the skills developed under output 2 to enhance the intra-national mobilisation of resources. This is to include: [a] ensuring an increasing and growing proportion of RH commodity provision in-country is planned [i.e. reduced recourse to emergency funds]; [b] the development of cost recovery approaches that use household finance to meet a portion of RH commodity needs; [c] implementation of a national strategy to “mainstream RH commodity provision” by increasing national responsibility by financing RH commodities not from vertical external sources but from government-controlled integrated sources as in the context of development frameworks such as SWAps, PRSs, HSR, BS, etc. 4.2 Global Programme Funding Mechanisms The Global Programme will support achievement of these outputs by making three streams of funding available for which developing countries will be invited to apply. Stream 1: Will consist of guaranteed finance for five years to support development and implementation of a national plan of action for an integrated approach to RHCS. Stream 2: Will consist of guaranteed finance for 1, 2 or 3 years to support implementation of a transitional national plan of action to enhance the national response to a number of specific RHCS related issues. More than one country will be able for stream 2 finance to fund a regional initiative. It is hoped that stream 2 finance will be used by some countries to prepare for development of a more integrated approach to RHCS to be financed at a later date under stream 1. Stream 3: Will consist of an emergency fund to finance the provision of RH commodities to avert a stockout situation. Countries receiving stream 3 funds will be encouraged to take complementary action to build and demonstrate national commitment to move towards a more strategic approach to RHCS. 4.3 Global Programme Indicative Funding Parameters UNFPA Category A and B countries will be eligible to apply for funding from all streams [1, 2 and 3]. UNFPA Category C countries will be eligible to apply for funding from streams 2 and 3. The Indicative Budget table below explains that streams 1 and 2 will fund capacity and systems enhancement as well as planned RH commodity provision. To ensure the GP builds in-country sustainability in the sphere of RHCS, countries are encouraged to use a substantial percentage [likely to be between 40-60%] GP funding from stream 1 or 2 for capacity and systems enhancement, with the rest for planned commodity provision. Countries will be able to apply for funding from stream 3 to meet emergency commodity needs. Stream 3 funding will be from the Emergency RH Commodity Fund. This Fund will also comprise the Global Contraceptive Commodity Programme [GCCP] mechanism. In making GCCP funds available under stream 3, UNFPA, in compliance with its development mandate, will ensure that countries are encouraged to reimburse the cost of commodities purchased with these funds. In the first year of operation of the Global Programme, the GCCP will be endowed with a budget of US$ 10 million. If less than US$150 million per year is secured, as a guiding principle, funds are to be allocated on a pro rata basis as per the budget table below. The number of countries will fall while the allocation per country will stay the same. That is, if per year funding for five years is US$50m, the figures would be divided by 3. UNFPA would, however, seek flexibility in allocating funds of less than the US$150million/year requested. Indicative Budget Table [in millions of US$] Capacity and Systems enhancement [40-60%] Planned RH Commodity Fund [40-60%] RH Commodity Fund [to avoid stockouts] Total Stream 1 75 million [average 5 million p.a. = 15 countries] Stream 2 25 million [average 1 million p.a. = 25 countries] Stream 3 50 Total 100 50 150 [NB: It should be noted that the figures for funding allocations under Streams 1 and 2 are indicative and will be flexible depending on the country situation and the decisions of the national stakeholders.] Summary of Funding Streams 1, 2 and 3 Stream 1 Eligibility Period Fund Total Thematic focus Funding focus UNFPA Category A and B countries; Individual countries only GP funds for 5 year period $25 million [for 5 year period] Integrated, human rights based approach able to demonstrate significant progress in each of the three results areas [see annex 1: Indicative Logical Framework] Funds for [1] capacity and systems enhancement and [2] planned RH commodity provision. Countries will decide distribution of funds though the funding range is expected to be 40-60% for both capacity and systems enhancement and planned RH commodity provision Stream 2 Eligibility Period Fund Total Thematic focus Funding focus Category A, B, C countries; Countries or groups of countries GP funds for 1, 2 or 3 year period $1m per year for up to 3 years National or sub-regional RHCS initiative focused on reduced number of specific themes [see annex 1: Indicative Logical Framework] Limited funds for some capacity and systems enhancement and planned RH commodity provision. Funding split for capacity and systems enhancement and planned RH commodity provision [expected to be 40-60%] to be decided by country or sub-regional applicant group. Stream 3 Eligibility Period Fund Total Thematic focus Funding focus UNFPA Category A, B, C countries; Individual countries only Ad hoc; based on each specific request No planned minimum or maximum Emergency RH commodity provision Building on national commitment towards RHCS Avert RH commodity stockouts; Facilitate the development of national commitment towards RHCS 4.4 Strategy to Mainstream RHCS The Global Programme is designed to be a catalyst as a result of which recipient governments come to mainstream RHCS in all appropriate policies and programmes. A clear demonstration that this process is underway relates to budgetary allocations. Indeed, in their funding applications for stream 1, countries will receive priority when they propose to use gradually falling amounts of Global Programme finance coupled with a commitment to increase financial allocations from intra-national funding sources [including integrated sources under government control, i.e. SWAps, PRSs, Budget Support, etc.]. Thus, for funding under stream 1, it is recommended that the financial strategy to mainstream RHCS should be reflected by a budget similar to that summarised by the table below. As per the table, GP funds for Capacity and Systems enhancement and Planned RH Commodity Fund will fall to zero over a six-year period, steadily replaced by rising national allocations to cover these needs. It is recognised that national needs will vary in this area. However, national governments receiving stream 1 funding will be expected to prioritise and budget for RHCS-related capacity and systems enhancement and the planned provision of RH commodities. It should be stressed that the table below is a recommendation not a condition or requirement. Stream 1: Recommended Budget in context of national Strategy to Mainstream RHCS Millions of US$ Stream 1 Global Programme Government Sources Total Year 1 5 1 6 Year 2 4 2 6 Year 3 3 3 6 Year 4 2 4 6 Year 5 1 5 6 Year 5 0 6 6 Total 15 21 36 It is recommended that the national Plan of Action [for streams 1 and 2] include the proposed financial strategy [internally monitored and updated annually] to ensure the allocation of national resources for capacity and systems enhancement and for planned RH commodity provision. The strategy must also outline the proposed transition process from GP and other vertical funding sources [e.g. ad hoc funds to cover emergency RH commodity needs] to coverage of projected needs using planned national resources. The annual RHCS Financial and Technical Report, submitted by countries receiving funds from streams 1 and 2, must provide an update of figures as per the mainstreaming strategy. In this way, the GP can serve as an effective catalyst to mainstreaming RHCS within a national context of heightened awareness and understanding—among a broad alliance of committed national stakeholders—of Commodity Security as a fundamental prerequisite for improvements in RH, MH and progress towards the MDGs. The emphasis on integrated approaches will highlight the interlinkages, synergies and symbioses that exist between RHCS, RH, Sexual Health and prevention of HIV/AIDS. 4.5 Global Programme Funding Application Procedures The Global Programme will require countries to apply for Global Programme funds through a simple funding application process, designed to demonstrate national commitment to making progress to enhance RHCS and to provide an outline of how funds would be used. Applications for funding and the resulting national RHCS Plan of Action must adhere to the broad objectives of Global Programme as expressed in the section 3 [Objectives and Guiding Principles]. This is designed to ensure that the Global Programme reconciles the stipulations of the Paris Declaration on Aid Effectiveness and UNFPA's requirement to drive progress on achieving its global development mandate. Application for funding under streams 1 and 2: These will be similar. The application form [prepared by UNFPA] is to be jointly developed and co-signed by - National Government in collaboration with appropriate national stakeholders and possibly the UNFPA CO. The application will be accompanied by a statement explaining who prepared the application and outlining the process followed [<100 words]. Part 1 will show: [a] Commitment to RHCS [achievements, plans] on the part of: government; other national stakeholders; international development partners; UNFPA CO; [b] Evidence of integrated, systematic approaches - with RHCS underpinning improved RH[/MH]; Experience of development frameworks SWAps, HSR, PRS, etc.; Progress on cost recovery; Integration [existing or proposed] with initiatives such as GFATM, PEPFAR, Clinton Global Initiative, etc.; initiatives in RH. Part 2 will explain [in <200 words]: [a] Why you need to be part of Stream 1 or 2; [b] What you intend to focus on; [c] Linkages [existing and/or to develop] to broader goal to improve RH and MH. Part 3 [stream 1 only] will outline how RHCS is to be mainstreamed within core national business over the 5 years of GP funding: [a] strategy and plan to finance RH commodities from any intra-national resources, including government-controlled development framework funds [i.e. from SWAps, PRSs, BS, etc.]; [b] post-funding national RHCS Sustainability Plan. Part 4 [stream 1 only] will focus on dedicated RHCS personnel to facilitate in-country efforts: [a] National Coordinator [government to decide location]: Manager with knowledge and experience of health sector and ability to facilitate and drive national RHCS [3 CVs to be submitted for consideration]; [b] National Facilitator [RHCS coordination Committee to decide location] to support National Coordinator in driving agenda and building collaboration, coordination among present development partners; strong M+E - particular emphasis on monitoring progress and determining needs and facilitating delivery of technical assistance [3 CVs to be submitted for consideration]. Application for funding under stream 3 [Emergency RH Commodity Fund]: will build on system currently used by UNFPA and include development of a more systematic approach to help ensure governments and their national stakeholder partners take complementary action to build and demonstrate national commitment to move towards a more strategic approach to RHCS. 4.6 Funding Application Assessment Procedures and Consultative Review Board In formal terms, the Global Programme does not envisage any new governance arrangements. The UNFPA Executive Board will remain the highest policy decision body for all activities and will receive regular progress reports. UNFPA recognises that it needs to drive global efforts to realise the vision set out by the Global Programme in order to facilitate the country-level nationally-driven efforts outlined. UNFPA feels that the success of the programme will be enhanced by the active collaboration of key global partners in RHCS and related fields in the context of health in developing countries. Thus, to explicitly involve relevant global partners and to facilitate oversight of the Global Programme a Consultative Review Board [CRB] is to be established to play an independent consultative role to facilitate the implementation and operation of the GP. The CRB is to be made up of seven recognised health experts with experience and knowledge in the sphere of RH commodity security. Seven groups are to be asked to nominate one expert each – for a total of seven experts. The groups or bodies invited to nominate the experts are: The international HIV/AIDS community [decision as to exactly who to approach is pending]; The Partnership for Maternal, Newborn and Child Health; International Benevolent Foundations active in the health sector in developing countries; The RH Supplies Coalition; European Union Member States particularly active in the sphere of RHCS; UN Sister agencies [WHO, UNICEF, WB]; UNFPA [The UNFPA selected expert will act as Chairperson]. UNFPA’s Programme Committee and Management Committee, with the approval of the Executive Director, will review and select the representatives who will make up the Consultative Review Board. 4.6.1 Terms of Reference of Consultative Review Board The CRB will act as a quality control and peer review mechanism for the Global Programme. This is to include the following duties: Validation of RHCS Orientation Tools and Guidelines [for example, What is RHCS?; National RHCS Coordination Committee [constitution and TORs]; Developing the National RHCS Strategy and Plan of Action [What and How?] Assessment of funding requests for streams 1 and 2 and recommendation to accept/revise; Assessment of monitoring and reporting tools, processes, mechanisms as well as capacity enhancement [Including 'learning by doing'] for in-country monitoring proposed by the GP; Assessment of mechanisms to capture and disseminate lessons learned, etc.; Assessment of proposals from NGOs, CSOs, Regional Inter-Parliamentarians Fora in the context of the GP Advocacy and Dissemination Initiative [see 5.5] to work globally and regionally to advocate for RHCS and disseminate information resources developed as a result of the GP; Provision of a technical [non-binding] recommendation [accept; revise] of Global Programme reports produced at global level and in countries receiving stream 1 funding. Moreover, it is recommended that: The CRB will be transparent in its operations and seek to reach consensus on all issues. Where consensus is not reached a vote will be conducted and UNFPA will cast the deciding vote. The principle means of communication and interaction of the CRB will be by electronic communication and periodic teleconferences. More rarely, the CRB will be asked to participate in Global Programme meetings and conferences; The Global Programme will pay only the expenses of members of the CRB [e.g. DSA, travel costs, communication costs, etc.]; The nominating body will—at its own discretion—pay any related fee to their nominated expert; The service of the experts will be required for a period of [approximately] 15-20 days for the first six months of the Global Programme and for 15-20 days per 12-month period thereafter. The modified funding application procedure for stream 3 will continue to be managed internally by UNFPA with coordination among the key global partners guaranteed by the Countries At Risk Sub-Group of the Systems Strengthening Working Group of the global Reproductive Health Supplies Coalition. 4.7 Intervention Procedures Countries that are successful in their application for funding under stream 1, will then have six months to prepare their RHCS national Strategy and Plan of Action. This will then be reviewed by the Consultative Review Board and, following approval, funding for the first year of implementation will be disbursed. At the end of each of the four years of programme implementation, the national RHCS Coordination Committee will submit an annual RHCS Financial and Technical Report on the basis of which funds for the following year will be disbursed following due approval from the Consultative Review Board. Under stream 1, funding will be for five years and will consist of three stages [see annex 2 for details]: Preparation phase [6-9 months] to consist of: [a] enhancing the RHCS national Coordination Committee to ensure national ownership of country level RHCS efforts; [b] carrying out an RHCS country situation analysis; [c] defining the RHCS national Strategy and Plan of Action. The Plan of Action will contain comprehensive details on the elements outlined in the Funding Application Procedures [section 4.5], in particular part 3 [b], the national RHCS Sustainability Plan [including details of how the roles of National Coordinator and Facilitator are to be maintained and financed]. Implementation phase [48 months] to consist of implementing the RHCS national Plan of Action with particular focus on: ensuring progress with strong monitoring, reporting and evaluation mechanisms; and identifying lessons learned and good practice to work effectively. Self-sufficiency phase [3-6 months] to begin implementation of the national RHCS Sustainability Plan defined by the RHCS Coordination Committee to ensure the durable mainstreaming of RHCS. During the preparation phase, planned commodity provision and capacity training courses are envisaged. 5. Role of UNFPA in facilitating implementation of the Global Programme UNFPA will facilitate implementation of the Global Programme by working with national partners, UN sister agencies and international development partners at three levels: nationally, regionally and globally. The primary focus of the GP—and the level at which success must be judged—is the country level. All other efforts will be designed to facilitate the enhancement of RH commodity security at national level. 5.1 UNFPA facilitating the Global Programme at national level The Global Programme is designed to be an integrated approach to stimulating the enhancement of RH commodity security in all of UNFPA's partner developing countries. To do this effectively and efficiently in a resource constrained environment, UNFPA has devised an innovative programme faithful to the principles of the Paris Declaration, under which primary responsibility for progress lies with national stakeholders with clear frameworks and parameters for recommended action provided by UNFPA in close collaboration at the national level with its principle international development partners. To facilitate the national level work on RHCS, UNFPA: recommends the development of an appropriate body at national level to drive the national RHCS strategy; will make available a number of RHCS Orientation Tools and Guidelines to facilitate the work of the UNFPA Country Offices and their national and international RHCS partners; will make available an integrated strategy to develop national capacity in the related spheres of RHCS. The integrated, human rights based approach of the Global Programme focuses on the final beneficiary and encompasses consistent commodity provision in combination with capacity and systems enhancement on issues of supply and logistics, quality of care, policy environment, access and demand. The Global Programme can be seen more as a "platform" for collective action rather than a UNFPA programme: with the role UNFPA and its development partners less as doer and more as facilitator and promoter. In implementing the national RHCS Plan of Action countries may request technical support from partners with comparative advantages in a number of areas across the sphere of RHCS. While such technical support may be requested of UNFPA other key partners at national level may well include JSI [on logistics systems], PSI [on social marketing and market development approaches], Crown Agents [on procurement], civil society [particularly on in-country advocacy]. 5.1.1 RHCS national Coordination Committee To be successful at national level, the Global Programme will depend on the emergence of an appropriately constituted and dynamic alliance of national stakeholders involved in RH commodity security and related issues that should come together to define, own and drive the national RHCS strategy and plan of action. In keeping with the principle of alignment, it is often possible to use an existing body [modifications may be recommended – see annex 2] to assume this crucial role and constitute the RHCS national Coordination Committee. While efforts should be made to build on existing structures, the RHCS national Coordination Committee should include, though not necessarily be restricted to: The government [particularly representatives of the Ministries of Health and Finance]; State and private bodies responsible for women’s issues, social services and social insurance; representatives from the police, military, prison service; NGOs [including those focusing on RH, HIV/AIDS, women’s issues and gender sensitive approaches], technical agencies, private companies – particularly those involved in social marketing; Business and trade associations that could contribute to national RHCS efforts – for example, in the area of RH commodity distribution; etc. The Coordination Committee should also include—as invited guests—representatives of key international partners present in the country. "Ownership" of the Coordination Committee should remain with the national stakeholders, with international partners—and the UNFPA Country Office—present to facilitate, recommend and promote – and facilitate provision of technical support as required. 5.1.2 RHCS Orientation Tools and Guidelines To enhance UNFPA’s ability to fulfil its mandate with regard to RHCS, a range of orientation tools and guidelines is to be developed [see annex 2] to facilitate and promote the Global Programme globally and at national level. These will cover the following areas: Ensuring national ownership of country level efforts to achieve RHCS; What is RHCS? What is RHCS and what action needs to be taken for it to be achieved?; What progress has been made towards RHCS? Situation Analysis to determine country progress; Definition of a RHCS national Strategy and Plan of Action; Orientation tools to define the monitoring and reporting plan for RHCS national Plan of Action: Additional tools will be made available on a number of related issues, including, how to advocate for RHCS with different stakeholders. These tools will be complimented by the RH Costing tool recently developed by UNFPA. 5.1.3 RHCS Integrated Capacity Development Strategy [RHCS ICDS] To facilitate the work of country office staff and—more specifically—their national counterparts and as a complement to the development of the orientation tools and guidelines, an integrated capacity development strategy, developed at the global level, is to be available for adaptation in countries receiving GP funding under streams 1 and 2. It is recommended that the RHCS ICDS should be adapted for inclusion in the RHCS national Plan of Action and thus come within the remit of the national RHCS Coordination Committee. 5.1.4 Coordination with in-country partners In stimulating the development and implementation of the interventions financed by the Global Programme at national level, the UNFPA Country Office [with necessary support from other parts of the organisation] will: Provide all necessary support [either by UNFPA staff or external consultants] requested by the RHCS national RHCS Coordination Committee. Engage with all relevant UN sister agencies to ensure that the RHCS-facilitating tools and instruments developed within UNFPA at the global level are effectively operationalised at the national level. Coordinate with partners from the Global RH Supplies Coalition present nationally to ensure that: [i] there is no duplication of efforts and that all synergies are exploited; [ii] GP resources are optimally used. Where the national RHCS Coordination Committee requests it and/or where UNFPA successfully advocates for it, certain technical elements of Global Programme interventions may be undertaken or facilitated by UNFPA in collaboration with: other members of the Global RH Supplies Coalition; other specialist agencies or bodies; and other UN agencies. Such interventions might be in the area of capacity and systems enhancement. For example, in the priority area of condom procurement and logistics management UNFPA is well placed to offer [in collaboration with bodies as necessary] in-country partners comprehensive technical assistance, focusing particularly on sustainable national capacity development in forecasting, planning, procurement, distribution, logistics management and information systems [see also 5.3.3]. 5.2 UNFPA facilitating the Global Programme at regional level UNFPA undertakes to actively engage with regional institutions [including national institutions and ‘south-south’ cooperation institutions with regional or sub-regional reach] that are active in spheres of particular relevance to efforts to promoting and facilitating RHCS. Links are to be forged or, where existing, further developed with institutions involved in: Capacity enhancement and training particularly in issues relating to RH commodity supply issues [forecasting, procurement, logistics, LMIS, etc.] and the development of an increasingly enabled environment [e.g. in seeking to overcome physical, legal and cultural obstacles] propitious to progress on RHCS. Existing links to ECOWAS and WAHO in West Africa will be further developed; links with institutions [regional economic commissions and Africa Union] with similar mandates will be developed. Research and Development related to: production of RH commodities; cost recovery mechanisms to fulfil rights and enhance access to RH commodities; overcoming [e.g.] physical, legal or cultural impediments to achieving RHCS. Data collection and project monitoring: involving in particular, data analysis, documentation, progress and impact monitoring and evaluation. Where the national RHCS Coordination Committee requests it and/or where UNFPA successfully advocates for it, certain technical elements of Global Programme interventions [e.g. capacity building, south-south cooperation] may be undertaken with the collaboration or involvement of one or more of these regional bodies. Regional or sub-regional workshops are to be organised to clarify and prioritise country specific RHCS needs. Representatives from government and members of the RHCS national Coordination Committee as well as UNFPA Country Office staff, representatives from UN organisations, regional organisations and technical agencies are to be invited to facilitate this process, identify synergies and avoid duplications with their own interventions – all with a view to stimulating progress on RHCS. 5.3 UNFPA facilitating the Global Programme at global level UNFPA is to facilitate the Global Programme and related RHCS work at global level: Within UNFPA, by stepping up the on-going process of institutionalising and mainstreaming RHCS throughout the organisation [for details see section 8] With other UN Agencies, as part of regular business, by continuing to step up collaboration within UNDG to develop policies promoting better collaboration among UN Agencies and to promote better integration of RHCS and related issues in the context of joint country level work. With global development partners, by continuing to develop and cultivate strong strategic partnerships, focusing on the different comparative advantages of the various bodies. This will focus on on-going work with the Global RH Supplies Coalition and its members and the development of stronger links with international funding mechanisms such as GFATM, MAP, Clinton Global Initiative and PEPFAR. Working with the above-mentioned partners at global level, it is necessary, in some instances, to harmonise the way some basic common activities are carried out, such as, for example, quantifying needs and agreeing standards for work on logistical aspects related to drugs management. In a number of areas, UNFPA is working with global partners on certain issues that profoundly effect the enhancement of national efforts to enhance RHCS and related issues. 5.3.1 UNFPA facilitating the Global Programme through needs assessment tools UNFPA has developed a series of tools to facilitate work in RHCS and related areas, for example, in the areas of Reproductive Health Costing and Commodity Management. In the area of costing, UNFPA has developed a Reproductive Health Costing tool designed to help countries estimate how much it would cost to provide an essential package of RH interventions, ranging from family planning, antenatal and delivery care to emergency obstetric care and STI treatment. It is the Millennium Project’s official RH costing tool and has been used in several countries. A resource booklet on RH Costing for non-economists is under development and UNFPA/WHO collaboration on the harmonisation of RH costing tools is on-going. In the area of data collection, the UNFPA developed software, Country Commodity Manager [CCM] is used to collect and report public sector RH commodity inventory status and is currently used in 85 countries. CCM provides data on current RH commodity stock levels and average monthly distribution levels in countries’ central warehouses. This information is used to project commodity shortfalls at the highest level of a country’s supply chain, providing the opportunity for the user to seek to avoid such shortfalls. In complement to CCM, UNFPA is developing the CHANNEL software for use in-country to gauge RH commodity stock levels throughout the national distribution pipeline. 5.3.2 UNFPA facilitating the Global Programme through supply-side coordination Globally, with the Global RH Supplies Coalition and its members, UNFPA is working [particularly with the WHO and WB] on the harmonisation of procedures for, inter alia, [i] procurement; [ii] pre-qualification of RH manufacturers in developing countries; [iii] pre-qualification of medicines and RH commodities. In the area of procurement, the Global Programme will promote a strategic approach that encourages and prepares countries to take increasing charge of the procurement process. While the decision lies with the RHCS national Coordination Committee, UNFPA will encourage countries to support procurement reforms and capacity development. UNFPA will also encourage donors to: [a] progressively rely on partner country systems for procurement when the country has implemented mutually agreed standards and processes; and [b] adopt harmonised approaches when national systems do not meet mutually agreed levels of performance or when donors do not use them. It should be clearly understood that UNFPA is not a procurement agent but provides procurement services at the specific request of its partner governments. As a point of principle, UNFPA encourages partner countries to procure RH commodities themselves. UNFPA procures RH commodities on behalf of partner countries when explicitly asked to do so, when: [1] the country in question does not have the capacity itself do carry out an ICB [International Competitive Bidding] process; [2] there are credible fears of a distorted ICB due to corruption and graft; [3] a RH commodity stockout situation is imminent. In cases where UNFPA carries out in-country procurement directly—and in compliance with its development mandate—UNFPA emphasises and is currently stepping up its strategy and capacity to facilitate the development of in-country capacity in this area. The Global Programme will recommend—as part of the national RHCS strategy and plan of action—development of: [1] systematic approaches to procurement and logistics systems and national technical capacity to use them; [2] an integrated and consolidated procurement and logistics system to cover not only RH supplies but other related commodities in the health and related spheres. The goal is for all countries to be able to carry out direct procurement of commodities without external support. As far as possible, the Global Programme is to support and facilitate the development of integrated systems development with these taking primacy over specific RH commodity systems where there is a national commitment to one delivery mechanism. The Global Programme will not support alternative supply arrangements except as a temporary measure, complemented by a clear strategy of how to move towards integration. With regard to a potential conflict of interest where it pools funds, UNFPA does not seek to provide procurement services. However, on occasion when UNFPA has pooled funds, governments have requested UNFPA procurement support for an interim emergency period. Where this request is legitimate, UNFPA has procured on government’s behalf. UNFPA’s development focused procurement strategy involves coming to procure less for countries and to stepping up the provision of quality technical support to help national efforts to meet the challenges of supply, access and demand which underpin improvements in sexual and reproductive health. 5.3.3 UNFPA facilitating the Global Programme through focus on access issues As a guiding principle, UNFPA supports efforts to get rid of user fees in the public health domain but recognises the severe funding constraints that exist in many countries in the sphere of RH commodity security. By making available, advocating for and facilitating the use of market segmentation and cost recovery tools in-country UNFPA will seek to provide national partners with a variety of options that can be tailored to the particular needs of target population groups. Market segmentation approaches will be used to enhance the effective targeting of populations in a bid to ensure that those with a higher purchasing capacity pay as high a share of their RH commodity costs as they can. These approaches will also be used to enhance equity and access to RH commodities for those least able to pay through subsidisation by those better able to pay all or some of their RH commodity costs. In collaboration with members of the Reproductive Health Supplies Coalition working on Market Development Approaches, UNFPA will seek to provide orientation tools and guidelines to facilitate: [a] optimal use of scarce resources for RH commodities; and [b] the development of approaches that increase generation of household funds that can then be used to subsidise RH commodity provision for the poorest populations. In particular, orientation tools will be developed drawing on a number of particular experiences such as: Tamil Naidu initiative: The state government established a corporation to procure and distribute medicines including contraceptives. The corporation has developed an efficient computer model that helps in raising requisitions, placing purchase orders on line and tracking deliveries. The corporation supplies medicines mostly on an actual cost basis. Some medicines are priced above cost and others our subsidised to ensure the scheme breaks even. This approach is designed to enhance access to RH commodities for all, including those least able to pay. Drug revolving funds: A number of countries are experimenting with a new mechanism for the financing of contraceptives and other medical supplies through the “drug revolving fund”. Donors provide initial funds for buying drugs in bulk. These drugs are sold to local hospitals and health centres at full or subsidised prices. Periodically donors provide top-up finance to make up the gap between initial capital and the remaining balance. Insurance schemes: A number of countries have included some contraceptives as part of insurance coverage. Government may or may not subsidise them as several insurance companies started rightly treating contraceptives as prevention methods with huge cost savings. Beyond the financial impediments related to accessing RH commodities, UNFPA will also support efforts that work towards the fostering of an enabled environment, under which legal, physical, and cultural obstacles to access are eradicated. Supporting various actors, such as government, civil society, community organisations, faith-based groups and private sector, UNFPA will work in partnership to ensure that every man and woman have optimal chances of attaining the essential supplies they need. 5.4 UNFPA using the Global Programme to facilitate other multilateral RH efforts In the context of the global fight against HIV/AIDS, as per the UNAIDS division of labour, UNFPA leads on: provision of information and education; condom programming; prevention for young people outside schools; and prevention efforts targeting vulnerable groups [except IDUs, prisoners and refugee populations]. In addition, UNFPA was recently designated as lead agency on sex work and HIV/AIDS. In addition, within the Global Coalition on Women and AIDS, UNFPA co-convenes the areas of: [a] prevention in women and girls with IPPF and Young Positives; and [b] female controlled prevention methods with IPM and Global Campaign for Microbicides. In the context of UNFPA’s HIV/AIDS prevention work with UNAIDS under the 2006-2007 Unified Budget and Workplan, UNFPA focuses on three key areas. [1] Young People - youth-friendly policies and programmes established and/or enhanced that: [a] strengthen national HIV prevention efforts especially for youth in vulnerable situations; and [b] empower young people to effectively participate in halting the epidemic. [2] Comprehensive Condom Programming - Increased implementation of comprehensive condom programming as a means to prevent HIV infection with emphasis on, inter alia: [a] promotion of dual protection; [b] female condom programming scale up; [c] increased access for young people. [3] Women, girls and HIV/AIDS – Intensified country action through policies and programmes to address women, girls and AIDS with emphasis on, inter alia: [a] linking HIV/AIDS and RH; and [b] HIV prevention for young women and girls. The UNFPA policy on Comprehensive Condom Programming [CCP] and within that, the Female Condom Initiative, can be regarded as falling within the parameters of the Global Programme. Where a national RHCS Coordination Committee includes such interventions in its national Plan of Action, UNFPA, with its strong comparative advantage in CCP, will provide all necessary commodity and technical support. UNFPA’s HIV/AIDS prevention work with UNAIDS is facilitated by: [(] the Global Programme focus on ensuring reliable condom provision: a prerequisite of a credible strategy to reinforce HIV/AIDS prevention; [(] the Global Programme approach that encourages integrated country-driven plans of action than emphasis linkages between RHCS and the wider RH and HIV/AIDS programmes and policies. In the context of UNFPA’s work with Partnership for Maternal, Newborn and Child Health [PMNCH], UNFPA will work with its partners to improve access to essential health services at the country level, addressing the continuum of care and with a focus on equity. It will promote greater integration of maternal, newborn and child health in the context of reproductive health, and will urge policy-makers to address the systemic issues that affect the delivery of services, such as financing, human resources, community mobilization and poverty-reduction strategies. In seeking to ensure that a broad range of RH commodities for obstetric and maternal health care [including, as required for the prevention and management of RTIs], the Global Programme is designed to provide an important underpinning to the PMNCH. It is important to emphasise that Global Programme funds can be used, according to the nationally-defined plan of action, to ensure strong linkages between commodity provision and programmatic interventions, such as those financed by the partnership that seek to add value to the base provided by the reliable supply of required commodities. In the context of the Global Fund for AIDS, TB and Malaria, UNFPA is to work with national counterparts in the RHCS Coordination Committee and, more generally, with key national stakeholders in the fight against HIV/AIDS to ensure that GFATM funding applications include financial allocations to finance: [1] consistent supplies of male and female condoms; and [2] the key elements of UNFPA’s HIV/AIDS prevention strategies, including, inter alia: [(] Advocacy to strengthen political commitment; [(] Promotion of IEC and behaviour change efforts designed to encourage young people to delay or abstain from sexual activity; [(] Engagement in comprehensive condom programming to improve access to and use of male and female condoms and training of service providers at various levels; [(] Empowerment of adolescent girls and women to be able to claim their rights to ensure they have the knowledge and means to prevent HIV infection; [(] Fostering male involvement in HIV prevention programmes in order to promote shared responsibility for a more gender equitable approach. 5.5 Lesson Learning Mechanism The Global Programme will establish a Lesson Learning Mechanism to ensure that the knowledge and experience developed is shared widely to the benefit of all interested parties. This Mechanism will fund: Further development of RHCS Orientation Tools and Guidelines [for example, What is RHCS?; National RHCS Coordination Committee [constitution and TORs]; Developing the National RHCS Strategy and Plan of Action [What and How?]; Definition of monitoring and reporting tools, processes, mechanisms as well as capacity enhancement [Including 'learning by doing'] for in-country monitoring; Expenses of the GP Consultative Review Board [see section 4.6] to review funding applications and approve annual working plans; Joint evaluation missions [with the participation of members of, for example, the national RHCS Coordination Committee, Global Programme funding bodies, RH Supplies Coalition]; GP Technical Assistance Initiative to provide support to countries, at their explicit request, where additional work is needed to meet objectives; Advocacy primers on, for example, interlinkages, partners, intersectoral, integrated approaches developed as a result of the Global Programme; GP Advocacy and Dissemination Initiative [contracted out to NGOs, CSOs, Regional Inter-Parliamentarians Fora] to work globally and regionally to advocate for RHCS and disseminate information resources developed as a result of the Global Programme; GP Annual Conferences [at start; then annually; at end]. 6. Implementation Mechanisms of RHCS Global Programme 6.1 Facilitating an integrated approach to RHCS throughout UNFPA Given the importance and scope of the tasks proposed, UNFPA is to create or enhance a number of coordination and validation bodies to ensure the quality of implementation. The structures outlined below will be subject to review as a result of the UNFPA regionalisation process and may be modified slightly. Global Programme Management Team: Management and coordination of the Global Programme will be the responsibility of the Global Programme Management Team [GPMT]. Overall strategic direction will be assured by the Branch Chief of Commodity Management Branch [D1]. Day to day management and coordination will be the responsibility of the Global Programme Coordinator [P5] with support from GPMT members drawn from TSD [Monitoring and Evaluation Specialist – L/P4] and IERD [Resource Mobilisation and Donor Relations Specialist – L4]. The GPMT will also have two junior Programme Officers [to support Global Programme Coordinator – L2/3], one Financial Officer [L/3] and one General Service staff member. In addition, the GPMT will be supported by the RHCS Adviser for Africa [L5] and the RHCS Adviser for Advocacy and Coordination [L5]. The GP will also finance three procurement officers [based in Copenhagen]. Institutionalising and Mainstreaming the Global Programme: Within UNFPA Headquarters, the Global Programme will be discussed quarterly – and more necessary if deemed necessary – in the high level Programme Committee [PC] and Management Committee [MC], chaired by the relevant Deputy Executive Director and attended by Directors and Deputy Directors. The PC/MC meetings will provide senior strategy and policy guidance for the Global Programme. In addition, the Global Programme Management Team [GPMT] [see below] will provide informal monthly progress reports and updates to the Director of TSD, the host division of this initiative. Also, the TSD Director will approve important financial decisions relating to management of the Global Programme. Commodity Working Group: To ensure that UNFPA develops a coordinated, organisation-wide strategy and response to RHCS and the Global Programme which is designed to drive it at national level, an operational level Commodity Working Group [CWG] is to be established. CWG members will be operational level staff drawn from HQ [TSD, IERD, DMS, GDs and OED] and a number of CSTs and COs. The CWG, chaired by the Global Programme Coordinator, will meet every 2 – 4 weeks. Consultative Review Board: The Global Programme will establish a Consultative Review Board [CRB] of seven recognised health experts with experience and knowledge in the sphere of RH commodity security [see section 4.6]. The CRB will act as an advisory quality control and peer review mechanism for the Global Programme. CRB tasks will include: making recommendations on national RHCS Plans of Action and the annual RHCS National Financial and Technical Report for countries receiving stream 1 funding; validating RHCS Orientation Tools and Guidelines. Annual Consultation Meeting: UNFPA is to hold an annual consultation on the Global Programme [the first consultation is to be during the third quarter of year one and then at twelve month intervals thereafter]. Contributors to the Global Programme will be invited as well as members of the UNFPA Executive Board and other interested stakeholders, including a selection of members of the Reproductive Health Supplies Coalition. The purpose of the annual consultation is to: [1] provide an overall review of progress; [2] outline progress made in specific areas/countries; and [3] validate, reconfirm and seek to extend common commitment to the GP. It is also recommended, that at one of the bi-annual meetings of the global RHSC, UNFPA will provide an update of Global Programme progress. 6.2 Monitoring and Review Mechanisms Mainstreaming the Global Programme: As the Global Programme to enhance RHCS is to be an integral part of UNFPA work, Executive Director reports, MYFF and other instruments are also to be used as channels to report on status of progress as deemed pertinent. National Plan of Action, Monitoring and Evaluation: During the preparation phase [first six months] of the programme, a Plan of Action is to be defined for each country receiving funding under stream 1 and for each country or sub-region receiving funding under stream 2. Each national Plan of Action is to include: [1] baseline data; [2] a logical framework [with objectives, indicators of achievement, assumptions, etc.]; [3] a fully budgeted monitoring and reporting plan [detailing frequency of data collection and analysis and stipulating who is to be responsible for each element]; [4] Chronology. Each Plan of Action will be of particular importance in ensuring a strong results focus for the Global Programme. In all cases, efforts [national and sub-regional] must ensure that progress and impact is made and documented. The monitoring and reporting plan must include provisions for taking corrective action where evidence indicates that objectives are not being achieved. The Consultative Review Board will be charged with ensuring that the indicators of success [as defined in the Logical Framework] are set at an appropriate level and are sufficiently rigorous. [See Annex 1: Indicative Logical Framework]. A consolidated but not standardised Global Workplan will be drawn up to facilitate programme oversight and coordination [including lesson learning tasks] at the global level. This will be the responsibility of the Global Programme Management Team [GPMT]. The country-driven nature of each country’s national Plan of Action and the different start dates mean that this will be a flexible, working document focusing on ensuring that the key elements of the national Plan of Action are adhered to and that monitoring and reporting is timely and rigorous. In addition, the GPMT will organise a number of evaluations of GP interventions funded under streams 1 and 2. Joint evaluation teams will be encouraged, comprising UNFPA personnel and members of the CRB, representatives of national partners and GP contributors. National RHCS Financial and Technical Report: For countries receiving funds under streams 1 or 2 a National RHCS Financial and Technical Report will be submitted at the end of the preparation phase [6 months after start up and, subsequently, at the end of each 12-month implementation period. This will contain updated information about progress to date, the annual plan of action for the coming year and any proposed modifications. This will be assessed by the Consultative Review Board who will make a recommendation [accept, revise]. Following modification funds for implementation can be used. Evaluation of the Global Programme: An independent external evaluation is to be conducted at the end of the second and fourth year of the Global Programme to evaluate progress, recommend modifications, assess the continuing pertinence of the initiative, address emerging issues and identify lessons learned. This external evaluation will also make recommendations on the future of the Global Programme in light of broader developments, such as, for example, UN reform. Annex 1: Indicative Logical Framework to manage for progress as per defined results areas of Global Programme UNFPA will seek to facilitate and promote RHCS whereby national efforts focus on some of the objectives outlined below. Working effectively with national counterparts, particularly, the members of the RHCS national Coordination Committee will be central to this effort. [Decisions as to the exact contents of the RHCS national strategy and plan of action will lie with the national RHCS Coordination Committee]. The Indicative Logical Framework is intended to facilitate the development of national Logical Frameworks but is not prescriptive. All or some of the Objectively Verifiable Indicators detailed below may be retained or adapted. Equally, other indicators may be developed. Intervention Logic Objectively Verifiable Indicators Sources of Verification Risks and Assumptions Goal All individuals can obtain and use affordable, quality reproductive health commodities of their choice whenever they need them [1] CPR, MMR, HIV prevalence [2] Reduction in unmet needs: women who would like to space or limit the number of children they are having but who are currently using either highly ineffective traditional methods or no methods at all Demographic Health Survey MoH data National surveys and Population Division data, UNAIDS Financing and political commitment Outcome Objectively Verifiable Indicators Sources of Verification Risks and Assumptions Improve the sustainability of Reproductive Health Commodity Security at the national level [1] Consensual nationally driven strategy and plan of action to achieve RHCS defined and reviewed every six months. Intervention reports Monitoring reports RHCS Coordination Committee – TORs Roles and responsibility documents, DHS Minutes of RHCS Coordination Committee meetings National policy remains committed to implementing the plan of action to achieve RHCS The national socio-economic, political and cultural climate does not impede achievement of the national plan of action for RHCS Outcomes Objectively Verifiable Indicators Sources of Verification Risks and Assumptions [1]: Integrated approaches to RHCS improved at all levels in-country [focus on interlinkages with programmes and policies on RH, including HIV/AIDS prevention] [1] Integration at national level into national development frameworks, including, CPs [as part of regular programming], CPAP and annual workplans, CCA, UNDAF, PRSPs, SWAps and other policy documents of: [a] of budget line for RH commodities; [b] other RHCS related indicators. [2] Incidence of revision/simplification of policy barriers such as tariff and duties, registration mechanisms, etc. that hinder progress on RHCS; Evidence of political will and tangible evidence of action to deal with physical, cultural, traditional barriers to RHCS; Evidence of action to enforce existing pro-RHCS and related legislation more effectively. [3] stimulating government stewardship of all efforts to improve health intra-nationally - # of meetings involving NGOs and state sector health personnel [definition of eligible meetings to be defined as part of monitoring plan]; [4] In-country partners from government, NGOs, industry, business, social insurance mechanisms, etc. make up national RHCS Coordination Committee; partners attend all meetings and execute the tasks set in RHCS plan of action; [5] UNFPA [CO, with appropriate support from CSTs and HQ] and RHCS focused donors have six-monthly meetings with national RHCS Coordination Committee to monitor and discuss progress and facilitate agreement on any necessary follow-up action; # of meetings, attendance rates, # of resulting RHCS-facilitating orientation briefs Intervention reports Monitoring reports Documents of CCA/UNDAFs, PRSPs, SWAps; CPs, MDP target country progress reports National essential drugs/medicines list Minutes of RHCS Coordination Committee meetings Donors remain willing to provide RHCS-related funding to facilitate the continued development of an enabling environment for RHCS Members of National RHCS Coordination Committee understand and value the issues and are committed to working in good faith to achieve RHCS RH commodities are available at final level of supply chain In-country partners: ready, able, willing and, as necessary, mandated and with the necessary financial means to coordinate their respective efforts in this area. Good partnership between the UN system and the host country; Skilled and dedicated human resources available to follow up on RHCS critical steps and to contribute substantively to the RHCS national Coordination Committee meetings Intra UN: Good coordination and cooperation among the UN agencies; Understanding that RHCS is not only UNFPA mandate and property but that other agencies can usefully contribute to the global efforts [UNICEF/WHO/UNDP]; Tools and guidelines provided on time to the UNCT and well understood/implemented by the representatives of the different organisations Intra UNFPA: Commitment and understanding of RHCS by Representative; Cordial working relationship with Government at all levels Outcomes Objectively Verifiable Indicators Sources of Verification Risks and Assumptions [2]: RHCS-related systems and capacity enhanced among national stakeholders [including target populations] at the national level [1] National budget line for RH commodities created and funds allocated from national budget; strategy defined for gradual increase in national allocations to increase proportion of national funds used to meet national RH commodity costs. [2] UNFPA COs with support from CSTs and HQ define and disseminate RHCS-facilitating guidelines [# of guidelines] [3] Contraceptives and other relevant RH commodities placed on the national essential drugs/medicines list [evidence from list]; [4] RHCS-sensitive procurement mechanisms and procedures harmonised in-country [existence of]. [5] Market segmentation strategies in context of Total Market Approach developed and validated that lead to increased cost recovery for RH commodities by those able to pay [#, % and increase of clients paying for all or part of RHC] – such cost recovery among those able to pay will permit sharper focus on poverty alleviation for the poorest; [6] % of young persons with self-identified RH needs using relevant health services – disaggregated as per at least sex, age-group, urban/rural, province]. [7] % of target population [disaggregated as per at least sex, age-group, urban/rural, province]: [a] aware of where to go for RH services; [b] aware of the need to and how to protect themselves against STIs, including HIV/AIDS. Intervention reports Monitoring reports RHCS Coordination Committee meeting minutes Minutes of donor meetings In-country partners: ready, able, willing and, as necessary, mandated and with the necessary financial means to coordinate their respective efforts in this area. Good partnership between the UN system and the host country; Skilled and dedicated human resources available to follow up on RHCS critical steps and to contribute substantively to the RHCS national Coordination Committee meetings Intra UN: Good coordination and cooperation among the UN agencies; Understanding that RHCS is not only UNFPA mandate and property but that other agencies can usefully contribute to the global efforts [UNICEF/WHO/UNDP]; Tools and guidelines provided on time to the UNCT and well understood/implemented by the representatives of the different organisations Intra UNFPA: Commitment and understanding of RHCS by Representative; Cordial working relationship with Government at all levels Outcomes Objectively Verifiable Indicators Sources of Verification Risks and Assumptions [3]: Reproductive Health commodity needs met consistently and reliably [1] Evidence that an increasing and growing proportion of RH commodity provision in-country is planned [reduced recourse to emergency funds]; [2] Total Market Approaches developed generate funds from those able to pay who are contributing to service costs [#, % and increase of clients paying for all or part of RHC]; [3] Evidence of mainstreaming of RHCS; use by government of self-controlled funding sources [e.g. own resources, budget support, health sector reform, PRSPs, SWAps] to finance RHCS; strategy and implementation of strategy to progressively increase use of government-controlled funds for RHCS; [4] Evidence from throughout the supply logistics and distribution system that immediate RH commodity needs consistently and reliably met – no stockouts, stock-level inventory, [disaggregation of data according to at least sex, age-group, urban/rural, province], etc.; [5] In country capacity in forecasting, procurement and distribution enhanced; [a] Contraceptive consumption and needs estimated with accuracy for the next 3 to 5 years; [b] Informed choice of quality and prices of all contraceptives from major suppliers available at the time of procurement decision [e.g. those responsible for procurement]; [c] Procurement actions taken at right time – taking into consideration appropriate lead times; [d] Procurement functions integrated into national procurement system [or at least development and implementation of a national strategy to move towards this objective]; [e] Percentage of warehouses, at regional and district level where RH commodities are spoiled; [f] Standard storage conditions maintained: right temperature "first-to-expire, first-out". [6] LMIS: [a] Information available on monthly consumption and distribution by product and population group; [b] total stock at central, regional, district and peripheral levels available; [ c] information about imminent stock outs and minimum balance level available [8] Quality of Care: Extent of provider bias [evidence of client choice as per their needs], clinical protocol and treatment guidelines available and observed, RH services available to vulnerable groups. Disaggregation of these data according to at least sex, age-group, urban/rural, province. Intervention reports Monitoring reports RHCS Coordination Committee meeting minutes Minutes of donor meetings Multi-partite in-country partners willing to work together in good faith and take necessary individual and collective action to achieve national, sustainable RHCS In-country partners willing to release operational staff for capacity enhancement activities relating to CCM and all supply related issues [such as forecasting, distribution, LMIS, logistics, etc.] In-country partners understand the strategic importance of RHCS in underpinning so much of RH work and act on understanding to promote consideration of RHCS issues Pre-conditions Donor community provides funds to strengthen country capacity to achieve RHCS Annex 2: Orientation Tools and Guidelines To enhance UNFPA’s ability to fulfil its mandate, a range of orientation tools and guidelines is to be developed to facilitate and promote advances in the sphere of Reproductive Health Commodity Security both globally and at the national level. Within UNFPA and among our global, regional and national partners, a great amount of knowledge and experience exists in the sphere of RHCS. A principal aim of this exercise is to bring the existing resources together and present them in a practical, user-friendly way to help UNFPA Country Offices [COs] work with their key national counterparts in this area to facilitate and promote RHCS at the national level. The development and definition process will involve the UNFPA RHCS Operational Working Group. This includes members of TSD’s Inter-Disciplinary Core Team with representatives from the Geographical Divisions as well as a selection of staff from CSTs and COs. The UNFPA RHCS OWG is tasked to pilot, modify and validate the tools developed. 1. Needs analysis and definition of national strategy and plan of action 1.1 Ensuring national ownership of country level efforts to achieve RHCS This basic orientation tool is designed to aid Country Offices in advocating for the establishment [or enhancement] and facilitating the operationalisation of an appropriately constituted RHCS national Coordination Committee. It will contain guidance and recommendations for COs on how to define: [i] the precise roles and responsibilities of the members of the RHCS national Coordination Committee in driving the operational plan forward; [ii] indicators of achievement against which progress of the operational plan is to be assessed; and [iii] monitoring mechanisms. [For the recommended constitution of the RHCS national Coordination Committee please see section 5.1.1.] 1.2 What is RHCS? What is RHCS and what action needs to be taken for it to be achieved? This basic orientation tool is designed to raise understanding of how to effectively operationalise RHCS at national level. It breaks RHCS into the areas in which action needs to be taken at the national level for RHCS to be achieved – and these areas can be regarded in combination as the pillars of an RHCS strategy. Under this approach, RHCS is broken down into four areas: [1] Supply; [2] Enabling environment; [3] Access and Demand. The purpose of this tool is to: [a] help Country Offices understand—and transmit that understanding of—RHCS to their national counterparts; [b] help national counterparts clarify what RHCS consists of in order to permit prioritisation of how they want to achieve it; [c] raise awareness of the different roles of different parts of the organisation; [d] raise awareness of the need for strong inter-linkages between these areas [and others, such as between RHCS, RH and HIV/AIDS] to ensure that the foundation, provided by progress in the areas of supply and enabling environment, is complemented by programmatic interventions that maintain levels of existing demand and increase demand as necessary. 1.3 Situation Analysis to determine country progress on RHCS Having clarified what needs to be done for RHCS to be achieved, this complimentary tool outlines how to conduct a situation analysis comprising: [a] a stakeholder analysis; [b] a programme and policy analysis; and [c] problem analysis. The purpose of this tool is to provide insight into the existing RHCS situation at country level and allow country-level partners, in a process facilitated by UNFPA, to employ a systematic approach to gain in-depth understanding and appreciation of progress made so far towards achieving RHCS – with a view to aiding the process of defining [or enhancing and/or validating] an RHCS national strategy and operational plan. In carrying out this diagnostic analysis, UNFPA intends to help COs make best use of the 2004 joint UNFPA/USAID publication, “SPARHCS – Strategic Pathway to RHCS: A tool for assessment, planning and implementation”. 1.4 Definition of a RHCS national Strategy and Plan of Action This orientation tool is designed to provide guidance directed towards UNFPA COs to help them facilitate the consensual definition by the national RHCS Coordination Committee of: [a] a national RHCS strategy; and [b] a national RHCS Plan of Action – with definition and costing of exactly what action is to be taken in the short- to medium-term in order to enhance RHCS nationally. The orientation tool will include guidelines on how to: facilitate the definition of a national RHCS strategy and plan of action; and develop a complete Logical Framework defining the national RHCS strategy and plan of action. The Logical Framework Matrix is to detail: [a] what is to be achieved [column 1 – the Hierarchy of Objectives]; [b] how progress is to be gauged and monitored [column 2 – indicators of achievement]; [c] where information on the indicators is to be found [column 3 – sources of verification]; and [d] the risks and assumptions entailed in the intervention [column 4 – risks and assumptions]; 1.5 Orientation tools to define the monitoring plan for the RHCS national Plan of Action: These tools will facilitate development of the monitoring and reporting plan to be used to manage and monitor progress by regularly gathering information about the indicators and the assumptions [using the Logical Framework]. The tools will provide guidelines on: Data collection [based on indicators of achievement] identifying the roles and responsibilities of individuals involved, defining frequency, etc.; Comparison of data against objectives; Follow-up action as necessary [[i] if indicators suggest objectives are being achieved, carry on implementing as planned; [ii] if indicators suggest objectives are not being achieved, take corrective action as necessary]. The UNFPA Country Office will be on hand to: [1] facilitate identification of modified activities if required; and [2] to identify and, if possible, provide additional technical support as required. 2. Facilitating the Effective Implementation of national RHCS Plans of action A number of orientation tools are also to be developed, derived from the on-going implementation process, to facilitate: [1] lesson learning; [2] the identification and practical use of good practices; and [3] the definition of operational and policy recommendations [detailing “dos” and “don’ts”]. A number of orientation tools may also be necessary in particular RHCS-related policy areas, such as, for example: Effective Advocacy – definition of advocacy audiences, advocacy techniques, etc.; An advocacy tool directed towards high-level economic decision-makers, explaining “The costs of RHCS versus the costs of failing to achieve RHCS”; Cost recovery and market segmentation strategies: definition, implementation, validation, replication; Achieving effective RH Commodity supply – from forecasting to end user: Enhancing systems, procedures and human capacity; Maximising appropriate use of RH commodities: maintaining and raising demand, ensuring access, negotiating tools for women and girls; Developing an enabling environment for RHCS: tools for identifying and overcoming obstacles [economic, administrative, judicial, traditional, enforcement-related, corruption-related, etc.] The large amount of existing knowledge and experience will be drawn upon in developing and defining these orientation tools. It should be stressed that the focus of these orientation tools and guidelines is to facilitate Country Office work in the sphere of RHCS. Country Offices will be encouraged to use the tools and guidelines for inspiration—adapting them as they see fit—to more effectively achieve Reproductive Health Commodity Security: a key means to progress throughout RH. Annex 3: Institutionalisation and Mainstreaming of RHCS within UNFPA While RHCS is mentioned in the 2004-07 Multi-Year Funding Framework [MYFF], it is being or has been stepped up: in reporting requirements of annual reports of Country Offices and the Geographical Divisions; and in Enterprise Resource Planning [ERP] phase II. It is to be prominently and fully reflected in the 2008-11 MYFF which will have stronger and more explicit RHCS related indicators. Also, RHCS related issues are to be clearly emphasised in revised UNFPA Monitoring and Evaluation guidelines. The mainstreaming of RHCS throughout UNFPA is designed to ensure RHCS is reflected in all relevant development frameworks. These are to include: Intra UNFPA: ensure RHCS appropriately included in: Strategy and Policy documents and relevant programmes produced by other functional teams within UNFPA [TSD or GD] on which RHCS impacts [e.g. UNFPA’s HIV/AIDS Prevention Strategy]; The Office Management Plans of TSD’s CMB, HIV/AIDS Branch, RH Branch and Culture, Gender and Human Rights Branch]; Personal performance appraisal forms for senior management and UNFPA Country Representatives in Fast-Track countries; Country Office performance appraisal Scorecards; Country Programmes; CPAPs; annual workplans [note circulars from ED, CP guidelines, MYFF indicators]; Country Office Annual Reports [COAR]; Intra UN in CCA/UNDAF, key policy documents of UNDGO to [a] UN Country teams and [b] to Bretton Woods institutions [e.g. integration of RHCS into the Health, Nutrition, Population Section of World Bank guidelines on sector reform processes]; Within other national-driven development frameworks, [insofar as the mechanisms mentioned in the previous points may not have ensured the integration of RHCS] – budget support, health sector reform, PRSPs and SWAps. In addition, UNFPA is to implement a number of organisational changes aimed at enhancing effectiveness in addressing the challenges of RHCS. In concrete terms, the Inter-Divisional RHCS Task Team and the UNFPA RHCS Operational Working Group will focus on facilitating and managing the Global Programme and defining how to work effectively in specific areas of RHCS. Efforts to ensure commodity security require attention to two critical shortfalls in current systems: the gap in availability of RH supplies and the gap in capacity development to address all aspects of reproductive health service delivery. Annex 4: Supply and capacity gap in RH Commodity Security Efforts to ensure commodity security require attention to two critical shortfalls in current systems: the gap in availability of reproductive health supplies and the gap in capacity development to address all aspects of reproductive health service delivery. Historically, appeals for investments to address shortfalls in the access to and supply of reproductive health commodities have been justified by estimates of the difference between projected global commodity needs and projections of funding availability. [Assumptions about the proportion of the needs that are to be met from external sources are sometimes applied to projected resource requirements.] This “supplies gap” approach was not tied to a strategy to strengthen country commitment to commodity security and to capacity building. Rather, it often led to stopgap funding for special emergency procurement requests that may have relieved pressure for national action. Under the Global Programme it will be crucial to ensure efforts are country driven and linked into/reconciled with country focus. The Global Programme recognises that funding for family planning overall has been declining both relatively and absolutely [Economic and Social Council 2006] and that safe delivery services are under-funded. Thus, it accordingly takes a broader country-based approach to contributors to reproductive health commodity insecurity [e.g., infrastructure, commodities, health personnel, demand generation and its alignment with supply streams, quality assurance]. The proposal retains a special stream of funding for emergency response, but it is only one component of a revitalised effort. Indeed as governments come to mainstream and fund self-controlled sources, the one key measure of progress will be a gradual reduced recourse to GP emergency funding [Stream 3]. The current approach requires, therefore, not so much an analysis just of commodity needs as it demands a diagnosis of the national processes required to integrate RH broad concerns in functioning health systems and ensure that they receive proper priority and an assessment of ways to invest strategically to catalyse advances towards RHCS by developing testing, modifying and validating, nationally-derived models of action plans. [It is suggested accordingly that UNFPA acts as a partner in a system of support to national action involving government, other multi-lateral and bilateral agencies, civil society actors and the private sector.] Cost requirements for RHCS should emerge from the national level situation analyses envisioned as the first step in the application for consideration under the three streams outlined in the proposal. Though what it costs depends where—in view of our indications—we recommend governments to set the parameters of action with a view to ensure the GP achieves some measurable input. What is known about current and anticipated global funding gaps for commodities alone? Analysing a “gap” requires reliable estimates of the growth of demand, the sources of supply [and changes in financing modalities] and the magnitude of dependable external commitments. The first component, aggregate demand growth is more certain than the other two. Projections have been made of the growth of the number of contraceptive users up to 2015 that reflect both increases in the reproductive age population to be served and in the demand for family planning services. These analyses suggest an increase in users of 15.6 per cent between 2005 and 2015 and in contraceptive commodity costs of 17.1 per cent. [The different pace of increase reflects changes in method mix.] Most dramatically, sub-Saharan Africa is expected to demonstrate a 70 per cent increase in the number of users and a 56 per cent increase in costs. This region further has the highest level of dependence on external funding for meeting this demand. [This analysis is to be a crucial part of the GP’s preparation phase in countries receiving Stream 1 funding.] Sources of supply and finance are less predictable. It is certain thought that the poorest countries will need both technical and financial assistance to encourage direct and effective ownership of their programme development. The poorest of the poor in all countries will require public services even as market segmentation develops a more differentiated supply system for better off population groups. Increases in external funding for commodity security [the third component for gap estimation] are even harder to anticipate. Long-term financial commitments have often been requested but proven difficult to ensure. The current proposal seeks to remedy this situation by encouraging multi-year commitments. In areas other than family planning [including condoms for HIV/AIDS and supplies for safe delivery], predictions are more difficult and contingent but several conclusions can be reached. First, condom supply requirements [male and female methods combined] for the expanded coverage scenario will increase from 2005-2015 by a factor of 2.24 globally and by 2.83 in sub-Saharan Africa. Other regions will also see significant scale-up requirements during the time period [e.g., Latin America and the Caribbean will increase by a factor of 2.53]. Second, scenarios for supply needs for delivery services, obstetric complications and other maternal health services are more complex since the impacts of interventions on incidence are difficult to anticipate and coverage level targets are less well defined. It is nonetheless clear that the higher the level of progress projected towards universal access to reproductive health [i.e., the greater percentage decline in proportions of the populations that are underserved], the greater the required investments and the smaller the resource requirement savings from incidence changes – but the better the health outcomes. Even with these uncertainties about coverage and feedback effects, drugs and medical supply needs are projected to increase globally by 38 per cent between 2005 and 2105 under a reasonable scenario. Partial evidence suggests further that the share of reproductive health commodity needs being met by external assistance has decreased since the early 1990s. The lack of significant progress in reducing maternal mortality, slowing the progression of HIV/AIDS and reducing unmet need for family planning [and the development of plateaus in fertility declines] suggests that needs are not being met by other funding streams and that increased international assistance is required. Analysis of external support needs for behaviour change communications and development of civil society networks supporting reproductive health are even more difficult. However it is clear, even lacking these estimates, that investment is needed to allow national systems to more effectively identify and respond to mismatches between demand and supply. These can develop regionally or in response to changing method preference [see below]. What is known about national gaps for commodities? The 2005 Thematic Trust Fund for RHCS responded to requests from over 51 countries for emergency response activities. This led to disbursements of over $30 million to directly address shortfalls – actual and imminent – and additional obligations for emergency situations [in tsunami affected countries and Pakistan], in support of IPPF total market efforts and for additions to existing pipelines and to backstop future emergencies . Further improvements in the monitoring of supply chains, undertaken with Supply Initiative partners, are urgently needed. Estimates of commodity shortfalls remain imprecise but suggest that [in the 55 countries with data] $90 million would be needed to address shortfall concerns. More detailed analyses are required of these tentative estimates. Such reports are, of course, conditional on the available data and the scope of the analysis. Evidence is available from selected country requests [e.g., in Ethiopia] to indicate that demand for particular methods [especially injectables] has been underestimated and that shifts in method mixes can develop faster than has been previously thought. Different funding sources [including governments, multilateral organizations and NGOs] have responded to these shifts and communicated them to national decision-makers. A closer and more systematic monitoring of these developments could inform further international support needs. Capacity gaps and system needs As indicated above, RHCS issues related to infrastructure, commodities, health personnel, demand generation and its alignment with supply streams and issues of quality assurance and equitable systemic response. As a converse to this, commodity security—if it is to endure—has to involve tackling these issues in combination. Tools and guidelines for a full range of system requirements have not yet been standardised and must, in any event, be adjusted to local situations and population characteristics [demand distribution, population concentration, administrative systems, etc.]. Information is, however, available from the detailed analysis of system needs in a small number of countries. The example of Ethiopia is informative. A detailed analysis of overall health system supply requirements suggests that investment needs are slightly over $12 million dollars per year [LMD team 2006]. This is commensurate with the Stream 1 provision being slightly over 40% of the required investment. [Smaller countries would receive larger proportional initial shares, often in settings with weaker ongoing infrastructure development efforts.] Global analyses undertaken for the UN Millennium Project suggest that approximately 10% of per capita expenditures required for full coverage of health interventions for the attainment of the MDGs are in the area of RH. [These include substantial portions of a wide range of HIV/AIDS prevention interventions.] Supplies constitute about 15% of total direct resource needs [Vlassoff and Bernstein 2006]. UN Millennium Project analyses also suggest significant investments are needed in system improvements [adding 37% to direct supply and personnel costs] in order to attain a systematic scale-up towards universal service coverage [UN Millennium Project 2005]. These analyses confirm that capacity development needs significantly exceed “commodity gaps” and should get higher priority in national programs to ensure reproductive health. For more information about the Global Programme, please contact: Jagdish Upadhyay Chief, Commodity Management Branch Technical Support Division UNFPA +1 212 297 5228 upadhyay@unfpa.org Benedict Light Coordinator of the Global Programme Commodity Management Branch Technical Support Division UNFPA +1 212 297 5255 light@unfpa.org Beatriz de la Mora Resource Mobilisation Specialist for Commodity Security Resource Mobilisation Branch Information, External Relations Division UNFPA +1 212 297 5130 delamora@unfpa.org � Reproductive health commodities, in this discussion, are made up of equipment, pharmaceuticals and supplies for: obstetric and maternal health care; the prevention, diagnosis and management of reproductive tract infections and sexually transmitted infections; and contraceptive supplies including male and female condoms. � Efforts will be made to ensure that, where possible, an existing coordination body is used for this purpose � The Global RH Supplies Coalition is currently [03/2006] made up of: [1] Foundations [Gates; UNF; Wallace Global]; [2] Government Bodies [DfID, UK; KfW, Germany; MoH, Romania; Ministry of Finance, Planning & Economic Development, Uganda; Ministry of Foreign Affairs, Netherlands; USAID]; [3] NGOs [IPPF and its affiliates, PROFAMILIA, Colombia and the Shanghai Institute of Planned Parenthood Research, China; GSMF International; Population Services International; and the Supply Initiative]; and [3] UN [UNFPA; World Bank; and WHO]. � The need to orient field offices to new application procedures and a lack of a multi-year framework led to implementation constraints. Both these challenges are to be amply addressed by the Global Programme. Global Programme to Enhance RHCS [2007-2011] – September 2006 PAGE Page 2 Global Programme to Enhance RHCS [2007-2011] – September 2006

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