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RHSC Meeting, Bonn 19-20 October 2006   1
       Presentation outline
• Background
• Current situation
• Issues
• Opportunity for new initiatives




                                    2
BACKGROUND



             3
    Programme and policies
• Birth spacing started in Cambodia
  since 1992, while only 2 clinics
  provided birth spacing methods
• In 1994 the National Birth Spacing
  Programme established and renamed
  to the National Reproductive Health
  Programme in 1997
• Birth Spacing policy formulated and
  approved in 1995
                                    4
    Goal and strategic plan
• In Feb 2006, the MoH approved the
  National Strategy for Reproductive
  and Sexual Health in Cambodia 2006
  – 2010, in which an objective to
  achieve the CPR set in the CMDG is
  one of major objectives => RH
  Commodity security is a key
  contribution to overall achievement
  of the Strategy, HSP, CMDG and
  NSDP.
                                    5
CURRENT SITUATION




                    6
    Essential Drugs and Medical
             equipment
• Essential drug and supplies list (being
  updated) covers key RH products, including
  contraceptives.
• Commodities for Safe Motherhood are all
  purchased from the national budget,
  through the annual budget allocation from
  the MEF to the MoH, including male condom
• Drugs for OIs, STIs, and ARVs are being
  funded by the WHO, GFATM, WB, ADB and
  DFID
• Medical Equipments for Safe Motherhood
  provided by JICA
                                          7
      Contraceptive supply
• Contraceptives:
  – funded by government and donors (public
    sector and NGO)
  – subsidised by donors (social marketing) and
  – fully funded by users (private sector)
• KfW
• UNFPA
• USAID
• DFID
                                                  8
                   Procurement
• Significant fragmentation of the RH
  procurement process:
  –   MoH PU, HSSP
  –   KfW
  –   GFATM
  –   NCHADS
  –   Facility level procurement (using user fees)
• Standard Operating Procedures developed
  by government with WB/ADB, is
  implementing from the beginning of this
  year.

                                                     9
                 LMIS
• LMIS initiated since 1997, between 1999
  and 2002 LMIS was strengthened. Now
  database program- ODDID/ NATDID is
  functioning more reliable at operational
  district and national levels
• There are ODs in which the LMIS is not
  functional now
• It needs strong support to maintain the
  LMIS functioning at all levels

                                             10
Forecasting and distribution
• DDF and CMS: for products for Safe
  Motherhood
• GFATM and NCHADS: for treatment of
  STIs, OI and ARVs
• CSWG: for contraceptive commodities

• CMS(with external support) stores and
  delivers all essential drugs to ODs on a
  "pull" system

                                             11
             Key indicators
         Year             1998 2000 2005
Population (in million)   11.4            13.1
Annual Growth Rate        2.5              1.8
(%)                                      (CIPS 2004)


CPR (%)                          24         40
                                 (CDHS     (CDHS
                                 2000)     2005)

CPR Modern                 7     18.5       27
Contraception (%)                (CDHS
                                 2000)
                                           (CDHS
                                           2005)

TFR                       5.2    4.0       3.4
                                 (CDHS     (CDHS
                                 2000)     2005)12
       CPR (modern methods)

70
60
50
                                 Target
40
                                 Achievement
30
                                 Linear (Achievement)
20
10
0
     2000   2005   2010   2015
                                                   13
                    TFR
4.5
 4
3.5                               Target
 3
                                  Achievement
2.5
 2                                Linear (Target)
1.5
                                  Linear
 1                                (Achievement)
0.5
 0
      2000   2005   2010   2015
                                                14
Contraceptives need and supply
      (thousand of units)
10,000




 1,000
                                     COC supplies
                                     PoP supplies
                                     Injectables supplies
                                     IUD supplies
  100
                                     CoC needs
                                     PoP needs
                                     Injectables needs
                                     IUD needs
   10




    1
         2006   2007   2008   2009
                                                         15
              Supply of condoms
6,000,000

5,000,000

4,000,000
3,000,000

2,000,000

1,000,000
       0
            1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

                     Nat. budget   UNFPA   KfW
                                                                16
      Social marketing (PSI)
• Contraceptive Social marketing
  – OK® Pill (COC) – over 9 million cycles sold
    since 1997
  – OK® Injection (Depo) – over 500,000
    injections sold since 2002
  – Sun Quality Health® Network – started 2002,
    117 clinics in 6 provinces
  – OK® Condom – over 5 million condoms sold
    since 2004
  – IUD – MoH donation, offered in 22 SQH clinics
  – POP – MoH donation, in 2006 over 4,000
    cycles sold
                                                17
ISSUES




         18
                   Demand
• There is significant demand for RH
  commodities and services:
  – Government strongly commits to improve maternal and
    child health
  – CDHS 2005 shows 56% of women want no more
    children
  – CPR (modern methods) at 27%
  – Large number of WRA


• Human resource and capacity building are
  crucial needs
                                                      19
Contraceptive Demand from 2009
   onward - But no confirmed
            supplies
   4000000

   3000000

   2000000

   1000000

         0
             COC    POP    DMPA     IUD     Condom

      2009 2036582 119799 2268194   17890   2875175
      2010 2137388 125729 2380464   18775   3017489
                                                      20
               Funding
• Significant funding shortages are
  likely for contraceptives (pills,
  Injectables, IUDs) from 2009 onwards
• Condom funding is under review by
  DFID with USAID for 2007 onwards;
• Public sector expenditure on drug and
  consumables is increasing every year,
  however an increase in the MoH
  budget of 1 million US$ per year to
  cover existing donor funding of
  contraception to the public sector is
  not feasible                          21
OPPORTUNITY FOR NEW
    INITIATIVES




                      22
    Improving RH and commodity
              security
• Addressing RH needs
• Implementing the NRSHS 2006-2010
• Deepen the roles of CSWG,
• Appreciate the role of RHSC and the
  linkage with CSWG
• Long-term and predictable commitments
  from donors to RHC/contraceptives
  supplies, build national capacity for
  improvement financing, forecasting and
  procurement
• Widen the scope of LMIS and HMIS
                                           23
 Improving RH and commodity
        security (cont.)
• At country level: Gov't commitment
  from SWIM to SWAP (harmonization
  and alignment)
• Need global funding commitment to
  RH and MNCH




                                       24
       System strengthening
• Minimum Volume Guarantee
  preferred
• Government policy on procurement:
  – National budget- at least GMP required
  – Donor fund- WHO/UN Prequalification required
• Globally UNFPA Procurement System
  recommended


                                               25
Market Development Awareness
• 2nd Tier markets to reduce the
  burden on public and subsidized
  social marketing programs
• No barrier for generic products, but
  WHO pre-qualification required
• Most clients have a limited ability to
  pay
• Involve the sale of different products
  in the same pharmacy outlets
                                       26
     Resource Mobilization
          Approach
• Advocate for more resources for RH
• Donors/ health partners should
  review the areas of supports from
  time to time to meet/ respond to
  country priorities




                                       27
Thank you very much




                      28

				
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