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Monitoring Progress Toward Achieving Contraceptive Security:

CS Index 2003 –2009

Dana Aronovich, Marie Tien, Nadia Olson John Snow, Inc.

APHA Conference, Denver, CO November, 2010

• • • •

Learning Objectives

Describe how the

CS Index

progress towards CS is compiled to help measure Describe the changes/trends that have occurred between the 2003 and 2009

CS Index

at the national, regional, and global levels? Demonstrate how can data from the to identify priority areas for support and to inform program planning

CS Index

can be used Explain how data from the

CS Index

can be used to advocate for improved resource allocation by country governments and global donors.

A critical component of FP programs: Contraceptive security

exists when every person is able to

choose, obtain and use

quality contraceptives and condoms whenever she/he needs them.

Reproductive Health Commodity Security Framework

Contraceptive Security Index

• Tool to raise awareness, support advocacy, focus priorities, monitor progress for CS • Promotes a multisectoral approach to CS at the national, regional, and global levels • Indicators cover a range of inputs and outputs, and programmatic and macro-level areas • Over 60 countries from 5 regions • 3 editions of the Index: 2003, 2006, 2009 – analysis of CS over an extended period of time

Methodology

• Minimize data collection costs and maximize data reliability, validity, and replicability by using only secondary data from regularly updated reliable sources • Updated approximately every 3 years • 5 components, 17 indicators – Supply chain (logistics) – Financing – Health and social environment – Access – Utilization • Aggregate scores for each component and an overall score

Summary of Findings

Range of CS Index Total Scores (2003, 2009)

CS Index Total Scores by Region (2003, 2006, 2009)

50 40 30 20 10 100 90 80 70 60 0 Asia & the Pacific (n=7) Eastern Europe & Central Asia (n=3) Latin America & the Caribbean (n=13) Middle East & North Africa (n=4) sub-Saharan Africa (n=23) N.B. For the 50 countries scored in all 3 indices only.

Overall Average (n=50) 2003 2006 2009

Average Percentage Change by Region

Asia & Pacific E. Europe & C. Asia L. America & Caribbean M. East & N. Africa SS Africa

Average Total Scores 2003 –2006

3.66% 0.31% 4.35% 3.49% 10.50%

5.8% 2006 –2009

0.35% −3.06% 2.67% −1.66% 3.34%

1.6% Entire Period: 2003 –2009 3.87% −2.76% 6.79% 1.73% 13.95% 7.6%

CS Index Total Scores by Component (2003, 2006, 2009)

8 6 4 2 0 14 12 10 20 18 16 Supply Chain Finance Health & Social Environment N.B. For the 50 countries scored in all 3 indices only.

Access Utilization 2003 2006 2009

CS Index – Supply Chain (2003, 2006, 2009) Supply Chain

10 8 6 4 2 0 20 18 16 14 12 Sub-Saharan Africa (n=23) Asia & the Pacific (n=7) Eastern Europe & Central Asia (n=3) Latin America & the Caribbean (n=13) Middle East & North Africa (n=4) All countries (n=50) N.B. For the 50 countries scored in all 3 indices only.

2003 2006 2009

CS Index – Finance (2003, 2006, 2009) Finance

14 12 10 8 20 18 16 6 4 2 0 Sub-Saharan Africa (n=23) Asia & the Pacific (n=7) Eastern Europe & Central Asia (n=3) Latin America & the Caribbean (n=13) Middle East & North Africa (n=4) All countries (n=50) N.B. For the 50 countries scored in all 3 indices only.

2003 2006 2009

CS Index – Health & Social Environment (2003, 2006, 2009) Health & Social Environment

20 18 16 4 2 0 14 12 10 8 6 Sub-Saharan Africa (n=23) Asia & the Pacific (n=7) Eastern Europe & Central Asia (n=3) Latin America & the Caribbean (n=13) Middle East & North Africa (n=4) All countries (n=50) N.B. For the 50 countries scored in all 3 indices only.

2003 2006 2009

CS Index – Access (2003, 2006, 2009) Access

20 18 16 6 4 2 0 14 12 10 8 Sub-Saharan Africa (n=23) Asia & the Pacific (n=7) Eastern Europe & Central Asia (n=3) Latin America & the Caribbean (n=13) Middle East & North Africa (n=4) N.B. For the 50 countries scored in all 3 indices only.

All countries (n=50) 2003 2006 2009

CS Index – Utilization (2003, 2006, 2009) Utilization

20 18 16 6 4 2 0 14 12 10 8 Sub-Saharan Africa (n=23) Asia & the Pacific (n=7) Eastern Europe & Central Asia (n=3) Latin America & the Caribbean (n=13) Middle East & North Africa (n=4) All countries (n=50) N.B. For the 50 countries scored in all 3 indices only.

2003 2006 2009

Total Weighted Scores: 64 Countries

Co ngo , DR Cô te d'Ivo ire Ethio pia Co ngo , Rep. o f Liberia A zerbaijan Gambia Leso tho Chad Swaziland P akistan Uganda Haiti Niger M o zambique Yemen Eritrea B enin M alawi Camero o n Guinea Nigeria A rmenia To go Kenya Zambia M ali M adagascar Ghana Zimbabwe B urkina Faso P hilippines Tanzania Cambo dia Rwanda Namibia Senegal Geo rgia Ukraine Guyana Turkey India B o livia B angladesh M o ro cco Kyrgyzstan Do minican Nepal Egypt Guatemala P eru Co lo mbia A lbania Ho nduras Indo nesia Ecuado r Jo rdan Viet Nam Nicaragua So uth A frica El Salvado r P araguay M o ngo lia M exico 0 10 20 30 40 50 60 70 80 90 100

Trends in Total Scores by 2003 Clusters

100 90 80 70 60 50 40 30 20 10 0 2003 2006 N.B. For the 50 countries scored in all 3 indices only.

2009 Top Middle Bottom

Regions by Clusters: 2003 - 2009 2003

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Asia & the Pacific E. Europe & C.Asia

L. America & Caribbean M. East & N.

Africa Sub Saharan Africa Top Middle Bottom

2009

N.B. For the 50 countries scored in all 3 indices only 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Asia & the Pacific E. Europe & C.Asia

L. America & Caribbean M. East & N.

Africa Sub Saharan Africa Top Middle Bottom

Clusters by Regions: 2003 - 2009 2003

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Sub Saharan Africa M. East & N. Africa L. America & Caribbean E. Europe & C.Asia

Asia & the Pacific Top Middle Bottom N.B. For the 50 countries scored in all 3 indices only.

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Top Middle

2009

Bottom Sub Saharan Africa M. East & N. Africa L. America & Caribbean E. Europe & C.Asia

Asia & the Pacific

Summary of Trends

• Average total scores: statistically significant 2003-09 • Global averages for all components and all but 1 region increased from 2003-09 • Asia & Pacific and LAC had highest scores from 2003-09 • Supply chain: highest or 2 nd  highest average scores Reflects processes and systems put in place to manage contraceptive supplies • Cluster analysis: – Lowest performing countries in 2003 made most progress in total average scores by 2009 – Biggest increases observed in sub-Saharan Africa where significant donor inputs are made.

Using the CS Index Results

• • National and international stakeholders can use results to emphasize importance of CS for better FP program outcomes and to monitor progress toward reaching this goal.

CS Index

can be a powerful tool for raising awareness about CS and interrelationships between different program components. • Results can be used to set priorities and advocate for more rational resource allocation by country governments and global donors to achieve a secure supply of quality contraceptives.

CS Index 2003, 2006, and 2009 CS Index Technical Manual

and

Trends in Contraceptive Security: 2003-2009

are available online at: deliver.jsi.com