This document summarizes a quantification exercise conducted in Bangladesh to forecast reproductive health commodity needs from 2012-2016. Bangladesh has a very high population growth rate, which the government aims to reduce through family planning programs. The exercise was conducted by the Directorate General of Family Planning in collaboration with SIAPS to develop a 5-year forecast and 2-year supply plan to help guide procurement. Three scenarios were considered based on achieving different contraceptive prevalence and fertility targets. The results will help ensure adequate and sustainable availability of contraceptives to achieve family planning goals.
National Anti-TB Drugs and Laboratory Reagents and Supplies Quantification Ba...Golam Kibria MadhurZa
This document summarizes Bangladesh's 2012-2016 quantification of anti-tuberculosis drugs and laboratory reagents and supplies. It provides background on Bangladesh's TB control program and quantification process. The quantification aims to develop a 5-year forecast and 2-year supply plan to ensure adequate and sustainable availability of TB commodities. The results will guide evidence-based procurement and fill any supply gaps to achieve TB-related health goals.
This document provides an overview of the global and Indian healthcare industry as well as Narayana Health City, where the inventory study was conducted. Globally, healthcare spending reached $7.2 trillion in 2014 and is expected to grow annually by 5.2% through 2018. In India, healthcare spending as a percentage of GDP is among the lowest in the world at about 1.4% of GDP. Narayana Health City is a multi-specialty hospital located in Bangalore, India where the author conducted an inventory classification study to analyze and improve inventory management practices.
Guyana 2016 Health Accounts - Dissemination BriefHFG Project
The 2016 Guyana Health Accounts study found that:
1) Total health expenditure in Guyana was $28.6 billion (Guyanese dollars), with the government contributing 81% of funding.
2) The majority (71%) of health funds were spent on public health facilities like hospitals and clinics.
3) Most funds (64%) were spent on curative care services, while non-communicable diseases received the largest share (34%) of funds.
4) Government funding represents the largest source of financing for HIV/AIDS programs and services in Guyana, providing 62% of funds.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Landscape of Urban Health Financing and Governance in BangladeshHFG Project
The document provides an overview of urban health care delivery in Bangladesh. It finds that while urban local bodies are legally responsible for primary health care, they lack the infrastructure to provide these services. As a result, the urban population relies on a variety of alternative providers, including private clinics and hospitals, government secondary/tertiary hospitals, donor-funded projects like the Urban Primary Health Care Services Delivery Project and NGO Health Service Delivery Project, international NGOs, and local NGOs/CBOs. These institutions are financed through different mechanisms like user fees, government budgets, and donor funding. Governance also varies depending on the type of organization. The analysis concludes there are significant gaps in knowledge around urban health financing, delivery
The Next Frontier to Support Health Resource TrackingHFG Project
The document discusses challenges and opportunities for institutionalizing health resource tracking (HRT) in low- and middle-income countries. It identifies three key elements needed for institutionalization: strong demand for HRT data; sustainable local capacity to produce HRT data; and use of HRT results in policy and decision making. It outlines remaining challenges in each area and suggestions for future investments to address challenges, such as building understanding of HRT's value, maintaining local expertise, improving health information systems, and strengthening communication and use of HRT findings.
National Anti-TB Drugs and Laboratory Reagents and Supplies Quantification Ba...Golam Kibria MadhurZa
This document summarizes Bangladesh's 2012-2016 quantification of anti-tuberculosis drugs and laboratory reagents and supplies. It provides background on Bangladesh's TB control program and quantification process. The quantification aims to develop a 5-year forecast and 2-year supply plan to ensure adequate and sustainable availability of TB commodities. The results will guide evidence-based procurement and fill any supply gaps to achieve TB-related health goals.
This document provides an overview of the global and Indian healthcare industry as well as Narayana Health City, where the inventory study was conducted. Globally, healthcare spending reached $7.2 trillion in 2014 and is expected to grow annually by 5.2% through 2018. In India, healthcare spending as a percentage of GDP is among the lowest in the world at about 1.4% of GDP. Narayana Health City is a multi-specialty hospital located in Bangalore, India where the author conducted an inventory classification study to analyze and improve inventory management practices.
Guyana 2016 Health Accounts - Dissemination BriefHFG Project
The 2016 Guyana Health Accounts study found that:
1) Total health expenditure in Guyana was $28.6 billion (Guyanese dollars), with the government contributing 81% of funding.
2) The majority (71%) of health funds were spent on public health facilities like hospitals and clinics.
3) Most funds (64%) were spent on curative care services, while non-communicable diseases received the largest share (34%) of funds.
4) Government funding represents the largest source of financing for HIV/AIDS programs and services in Guyana, providing 62% of funds.
Guyana 2016 Health Accounts - Statistical ReportHFG Project
The document provides an overview of Guyana's 2016 Health Accounts methodology. It summarizes key aspects of the System of Health Accounts 2011 framework used, including boundaries, classifications, and definitions. Data was collected from government, households, NGOs, employers, insurers, and donors to track financial flows for health for 2016. The results help understand Guyana's health financing and answer questions on spending patterns.
Landscape of Urban Health Financing and Governance in BangladeshHFG Project
The document provides an overview of urban health care delivery in Bangladesh. It finds that while urban local bodies are legally responsible for primary health care, they lack the infrastructure to provide these services. As a result, the urban population relies on a variety of alternative providers, including private clinics and hospitals, government secondary/tertiary hospitals, donor-funded projects like the Urban Primary Health Care Services Delivery Project and NGO Health Service Delivery Project, international NGOs, and local NGOs/CBOs. These institutions are financed through different mechanisms like user fees, government budgets, and donor funding. Governance also varies depending on the type of organization. The analysis concludes there are significant gaps in knowledge around urban health financing, delivery
The Next Frontier to Support Health Resource TrackingHFG Project
The document discusses challenges and opportunities for institutionalizing health resource tracking (HRT) in low- and middle-income countries. It identifies three key elements needed for institutionalization: strong demand for HRT data; sustainable local capacity to produce HRT data; and use of HRT results in policy and decision making. It outlines remaining challenges in each area and suggestions for future investments to address challenges, such as building understanding of HRT's value, maintaining local expertise, improving health information systems, and strengthening communication and use of HRT findings.
Guyana 2016 Health Accounts - Main ReportHFG Project
The document summarizes the key findings of Guyana's first Health Accounts exercise for fiscal year 2016. It found that total health expenditure was G$ 28.6 billion, with the government contributing 81% of funding. Household out-of-pocket spending accounted for 9% of total spending. Non-communicable diseases received the largest share of spending at 34%. The analysis aims to inform strategic health financing decisions and assess domestic resource mobilization as external donor funding declines. Recommendations include increasing prevention spending and strengthening financial commitment to HIV programs.
Strategic Purchasing of Health Care Services in BotswanaHFG Project
The document discusses strategic purchasing of health care services in Botswana, noting that the majority of health funds are currently spent on secondary and tertiary care rather than primary care. It analyzes Botswana's health financing and expenditures, provider payment systems, and lessons that can be learned from international experience to reform primary health care financing through strategic purchasing. The recommendations aim to improve allocative efficiency and incentivize quality primary health care.
Essential Package of Health Services Country Snapshot: PakistanHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
South Africa HIV and TB Expenditure Review 2014/15 - 2016/17. Executive SummaryHFG Project
The South African Government (SAG) and its development partners have mounted a formidable response to the world’s largest HIV epidemic and a persistent burden of tuberculosis (TB), the country’s leading killer. Nearly 4 million South Africans initiated antiretroviral therapy (ART) by the end of financial year 2016/17, helping to curtail new infections and reduce the number of annual HIV-related deaths. Mortality from TB has also declined thanks, in part, to improved treatment success.
Despite progress, challenges remain. Roughly 3 million people living with HIV (PLHIV) lack treatment, and each year more than a quarter million are newly infected. Moreover, nearly a half million South Africans contract TB every year, with an increasing share affected by drug-resistant strains.
To effectively plan and steward the health system, the SAG routinely monitors programmatic and financial performance of the response to HIV and TB, including by tracking expenditure. Analysis of spending, including trends in sources, levels, geographic and programmatic distribution and cost drivers can help policymakers to assess whether resources are reaching priority populations, interventions, and hotspot geographies; to identify potential opportunities to improve allocative and technical efficiency; and to stimulate more productive dialogue at multiple levels of the system.
This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB spending by the three main funders of the disease responses: the SAG, the United States Government (USG), primarily via the President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund). The findings have informed South Africa’s report to the UNAIDS Global AIDS Monitor and the country’s forthcoming funding request to the Global Fund.
Final report mid term review SMART project MadagascarSirill Benton
This document provides a mid-term review report of a poverty alleviation project in Madagascar funded by the European Commission and implemented by ADRA. The review assessed progress towards objectives in the agriculture, crafts, and health components. For agriculture, results showed improved yields, incomes, and farming practices. For crafts, associations gained skills but markets need strengthening. For health, volunteer training was delayed so impact could not be assessed. Overall the project was effective but sustainability and some components require improvements. The review provided recommendations to enhance project results and effectiveness.
Modeling the impact of the health finance and governance projectHFG Project
Over its six-year life (2012-2018), the project worked with more than 40 partner countries to increase their domestic resources for health, manage resources more effectively, and reduce system bottlenecks in order to increase access to and use of priority health services and strengthen health systems overall. HFG provided state-of-the-art and country-specific technical assistance to remove obstacles that impede effective health system functioning and essential reforms. Recognizing the importance of measuring its impact, HFG quantified its return on investment for HFG health systems strengthening efforts.
HFG and its partner Avenir Health conducted a rigorous exercise to estimate the impact of the project’s health systems strengthening activities on its overall goal: increased use of priority health services. We used Spectrum, a suite of modeling tools developed by Avenir Health and partners, to quantify impact on mortality and morbidity based on changes in the coverage of specific priority health services due to the project’s activities aimed at improving access, quality, and use of health care. Given the diverse activities of HFG and the challenge of establishing a measurable causal link between project activities and coverage effects, we adopted a conservative approach and chose for this impact modeling exercise a subset of HFG activities for which a direct link was apparent. Based on these parameters, the exercise was conducted for eight country programs: Bangladesh, Cote d’Ivoire, Cameroon, Ethiopia, Haiti, Nigeria, Senegal, and Vietnam.
Using a methodical approach, we analyzed individual project activities in these countries and the expected effects on service coverage to estimate the impact on morbidity and mortality. We examined how our activities, including implementing strategies for improved human resources for health, operationalizing health insurance schemes, rolling out packages of health services, and using costed plans and packages to advocate for more financial resources, will increase access to health services, which in turn will lead to greater coverage of health services among targeted populations and ultimately to reduced morbidity and mortality. We modeled the impact of HFG’s activities by quantifying the number of deaths that were averted as a result of HFG-supported strategies and reforms.
The modeling results indicate that continued implementation of health systems strengthening strategies like those HFG supported would bring significant expansion of health care coverage and enhanced health outcomes.
This report presents country- and activity-specific results and the methodology for estimating coverage changes and impact. We hope this modeling exercise adds to the global understanding of how the impact of health systems strengthening can be measured. It provides powerful evidence on why investment and effort in strengthening health systems must continue.
Strengthening Primary Care Through Performance - Based Incentive SystemHFG Project
The document summarizes the findings from two cycles of research on Indonesia's primary care incentive system under its national health insurance program. The research found that:
1) Health workers' incomes come from various sources, including government salary, capitation payments, regional allowances, and private practice, but the capitation system does not adequately motivate individual performance.
2) There is wide variation in health workers' incomes between districts and facilities based on local policies and patient volumes.
3) While incentive systems exist, they are often based more on attendance and processes rather than quality metrics or achievement of health targets. Respondents recommended revising incentives and indicators to better promote quality primary care performance.
Integrating the HIV Response at the Systems LevelHFG Project
The global response to combat the acquired immunodeficiency syndrome (AIDS) epidemic scaled up considerably in the early 2000s with the establishment of key institutions, notably the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) (AIDS.gov 2018). In response to high global rates of AIDS-related morbidity and mortality, the internationally supported rapid scale-up of human immunodeficiency virus (HIV) prevention, testing, treatment, and drug development is widely credited with curtailing a global epidemic, thereby limiting the human and financial costs of the virus (Bekker et al. 2018). Still the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 1.8 million people were infected with HIV in 2017, and there are nearly 37 million people living with HIV (PLWHIV) worldwide (UNAIDS 2018a). In many countries, financing and governance of HIV services is transitioning from international donors to national governments.
This funding transition has major implications for the governance, management, and implementation of the HIV response. Governments undergoing funding transitions for the HIV response are integrating aspects of the response into systems and processes for governing, managing, financing, and delivering other essential
health services. But this phenomenon has not been systematically studied, and documentation on how governments achieve this is limited. Understanding how some governments are navigating an HIV funding transition may help other countries and the global health community to better design and plan future or ongoing efforts to transition national HIV responses to domestic resources for health. USAID’s HFG project is helping to fill this gap. In particular, this study helps build an evidence base by exploring whether and how four countries in the process of transitioning to greater domestic financing of their HIV response are integrating HIV programming with local systems and processes for other essential health services.
This study applies the concept of system integration to examine the alignment of rules, policies, and support systems to address HIV and other essential health services in four low and middle-income countries (LMICs). Specifically, the study explores the current extent of integration, the decisions faced by policymakers, and potential barriers/facilitators to integration in four countries. The analysis allows HFG to share lessons learned by each of these countries attempting to optimize rules, policy, and support systems for HIV and other essential health services.
Case Study: Improving Care through Patient-Centered Clinical Pharmacy Service...HFG Project
The Clinical Pharmacy activity in Ethiopia from 2012-2016 aimed to promote patient-centered pharmaceutical services. It trained over 200 pharmacists through a one-month in-service program. As a result, 53 of 65 hospitals implemented clinical pharmacy services. Key factors for its success included a supportive policy environment, stakeholder commitment, and an implementation plan to build staff capacity according to existing guidelines. The activity was part of broader Systems for Improved Access to Pharmaceuticals and Services (SIAPS) project in Ethiopia led by Management Sciences for Health.
The Health Finance and Governance project in Ukraine worked to improve the country's health system through strategic purchasing approaches. It demonstrated the effectiveness of integrating HIV testing into primary care, improving efficiency of the TB hospital system by developing monitoring and simulation tools, and laying the groundwork for strategic purchasing reforms across the broader hospital sector. Key results included increasing HIV testing and detection rates while lowering costs, helping restructure TB hospitals based on data to improve care and achieve savings, and establishing cost accounting methods and a case-based payment system pilot to enhance the performance and efficiency of hospitals nationwide.
Public Financial Management, Health Governance, and Health SystemsHFG Project
While the importance of governance in a health system is well recognized, there is an overall lack of evidence and understanding of the dynamics of how improved governance can influence health system performance and health outcomes. There is still considerable debate on which governance interventions are appropriate for different contexts. This lack of evidence can result in avoidance of health governance efforts or an over-reliance on a limited set of governance interventions. As development partners and governments are increasing their emphasis on improving accountability and transparency of health systems and strengthening country policies and institutions to move towards universal health coverage (UHC), the need of this evidence is ever rising.
To address this evidence gap, the USAID’s Office of Health Systems (USAID/GH/OHS), the World Health Organization (WHO), and the Health Finance and Governance (HFG) Project launched an initiative in September 2016 to ‘Marshall the Evidence’ on how governance contributes to health system performance and improves health outcomes.
The overall objective of the initiative was to increase awareness and understanding of the evidence of what works and why in how governance contributes to health system performance, and how the field of health governance is evolving at the country level. This report provides a synthesis of the findings across the four themes. This report presents the findings of the Public Financial Management.
South Africa HIV and TB Expenditure Review 2014/15 - 2016/17 Full ReportHFG Project
The South African Government (SAG) and its development partners have mounted a formidable response to the world’s largest HIV epidemic and a persistent burden of tuberculosis (TB), the country’s leading killer. Nearly 4 million South Africans initiated antiretroviral therapy (ART) by the end of financial year 2016/17, helping to curtail new infections and reduce the number of annual HIV-related deaths. Mortality from TB has also declined thanks, in part, to improved treatment success.
Despite progress, challenges remain. Roughly 3 million people living with HIV (PLHIV) lack treatment, and each year more than a quarter million are newly infected. Moreover, nearly a half million South Africans contract TB every year, with an increasing share affected by drug-resistant strains.
To effectively plan and steward the health system, the SAG routinely monitors programmatic and financial performance of the response to HIV and TB, including by tracking expenditure. Analysis of spending, including trends in sources, levels, geographic and programmatic distribution and cost drivers can help policymakers to assess whether resources are reaching priority populations, interventions, and hotspot geographies; to identify potential opportunities to improve allocative and technical efficiency; and to stimulate more productive dialogue at multiple levels of the system.
This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB spending by the three main funders of the disease responses: the SAG, the United States Government (USG), primarily via the President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund). The findings have informed South Africa’s report to the UNAIDS Global AIDS Monitor and the country’s forthcoming funding request to the Global Fund.
The Aga Khan Foundation (AKF) has initiated a project in three districts of Bihar, India, which aims to improve the uptake of optimal Infant and Young Child Feeding (IYCF) practices by the mothers and care-givers of children under-two years of age. The project is supported by the Department of International Development (DFID), and AKF is working in collaboration with three other implementing partners. The project will use multiple behaviour change
communication (BCC) tools and techniques which are expected to improve the knowledge of pregnant women and breastfeeding mothers regarding IYCF. This change, along with individualised support to mothers by project functionaries will ultimately result in improved
IYCF practices by the mothers and care-givers.
Budget matters for health: key formulation and classification issuesHFG Project
This policy brief aims to raise awareness on the role of public budgeting – specifically aspects of budget formulation – for non-PFM specialists working in health. As part of an overall WHO programme of work on Budgeting in Health, it will help clarify the characteristics and implications of various budgeting approaches for the health sector.
Essential Package of Health Services Country Snapshot: UgandaHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Each year Bangladesh government distributes the expenditure in different sectors. Health sector is one of them. This is Group presentation made by me. This slide will give you an idea about health sector expenditure, its relative ratio with other economic factors, what kind of problem this sector is facing and how the whole allocation can help the health sector. Enjoy !
What factors explain the fertility transition in India?HFG Project
The purpose of this study is to explain the main causes of fertility change and its implications in India over the time period 1998 to 2016. To accomplish this, we first test the proximate determinants model to see if it is valid in the Indian context and then use it to estimate the contribution of each determinant to changes in India’s total fertility rate. The findings are intended to inform program managers, donors, and researchers about the link between contraceptive prevalence rate (CPR) and fertility decline.
Estimating Bangladesh Urban Healthcare Expenditure Under the System of Health...HFG Project
Bangladesh is a densely populated country with 23 % people residing in urban areas and with a 3.5% annual growth of urban population. Bangladesh Bureau of Statistics divided into seven administrative divisions: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Rangpur, and Sylhet. Each division is divided into zilas, and each zila into upazilas. Each urban area in an upazila is divided into wards, which are further subdivided into mohallas. A rural area in an upazila is divided into union parishads (UPs) and, within UPs, into mouzas. The people who are living in wards were considered as urban population and the Ups’ population was considered as rural. However, the division between urban and rural health care is not so distinct and it is difficult to create an urban and rural demarcation of health expenditure. According to BDHS 2014, the urban population has more access to facility delivery, qualified doctors and less unmet need for contraception. This raises the question whether there is more health expenditure by urban population than the rural.
This study aims to estimate the health expenditures of the urban population in terms of provider, financing agents and functions by analyzing the data of National health accounts, which will eventually give a specific direction to identify the gaps and way of addressing those issues.
Guyana 2016 Health Accounts - Main ReportHFG Project
The document summarizes the key findings of Guyana's first Health Accounts exercise for fiscal year 2016. It found that total health expenditure was G$ 28.6 billion, with the government contributing 81% of funding. Household out-of-pocket spending accounted for 9% of total spending. Non-communicable diseases received the largest share of spending at 34%. The analysis aims to inform strategic health financing decisions and assess domestic resource mobilization as external donor funding declines. Recommendations include increasing prevention spending and strengthening financial commitment to HIV programs.
Strategic Purchasing of Health Care Services in BotswanaHFG Project
The document discusses strategic purchasing of health care services in Botswana, noting that the majority of health funds are currently spent on secondary and tertiary care rather than primary care. It analyzes Botswana's health financing and expenditures, provider payment systems, and lessons that can be learned from international experience to reform primary health care financing through strategic purchasing. The recommendations aim to improve allocative efficiency and incentivize quality primary health care.
Essential Package of Health Services Country Snapshot: PakistanHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
South Africa HIV and TB Expenditure Review 2014/15 - 2016/17. Executive SummaryHFG Project
The South African Government (SAG) and its development partners have mounted a formidable response to the world’s largest HIV epidemic and a persistent burden of tuberculosis (TB), the country’s leading killer. Nearly 4 million South Africans initiated antiretroviral therapy (ART) by the end of financial year 2016/17, helping to curtail new infections and reduce the number of annual HIV-related deaths. Mortality from TB has also declined thanks, in part, to improved treatment success.
Despite progress, challenges remain. Roughly 3 million people living with HIV (PLHIV) lack treatment, and each year more than a quarter million are newly infected. Moreover, nearly a half million South Africans contract TB every year, with an increasing share affected by drug-resistant strains.
To effectively plan and steward the health system, the SAG routinely monitors programmatic and financial performance of the response to HIV and TB, including by tracking expenditure. Analysis of spending, including trends in sources, levels, geographic and programmatic distribution and cost drivers can help policymakers to assess whether resources are reaching priority populations, interventions, and hotspot geographies; to identify potential opportunities to improve allocative and technical efficiency; and to stimulate more productive dialogue at multiple levels of the system.
This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB spending by the three main funders of the disease responses: the SAG, the United States Government (USG), primarily via the President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund). The findings have informed South Africa’s report to the UNAIDS Global AIDS Monitor and the country’s forthcoming funding request to the Global Fund.
Final report mid term review SMART project MadagascarSirill Benton
This document provides a mid-term review report of a poverty alleviation project in Madagascar funded by the European Commission and implemented by ADRA. The review assessed progress towards objectives in the agriculture, crafts, and health components. For agriculture, results showed improved yields, incomes, and farming practices. For crafts, associations gained skills but markets need strengthening. For health, volunteer training was delayed so impact could not be assessed. Overall the project was effective but sustainability and some components require improvements. The review provided recommendations to enhance project results and effectiveness.
Modeling the impact of the health finance and governance projectHFG Project
Over its six-year life (2012-2018), the project worked with more than 40 partner countries to increase their domestic resources for health, manage resources more effectively, and reduce system bottlenecks in order to increase access to and use of priority health services and strengthen health systems overall. HFG provided state-of-the-art and country-specific technical assistance to remove obstacles that impede effective health system functioning and essential reforms. Recognizing the importance of measuring its impact, HFG quantified its return on investment for HFG health systems strengthening efforts.
HFG and its partner Avenir Health conducted a rigorous exercise to estimate the impact of the project’s health systems strengthening activities on its overall goal: increased use of priority health services. We used Spectrum, a suite of modeling tools developed by Avenir Health and partners, to quantify impact on mortality and morbidity based on changes in the coverage of specific priority health services due to the project’s activities aimed at improving access, quality, and use of health care. Given the diverse activities of HFG and the challenge of establishing a measurable causal link between project activities and coverage effects, we adopted a conservative approach and chose for this impact modeling exercise a subset of HFG activities for which a direct link was apparent. Based on these parameters, the exercise was conducted for eight country programs: Bangladesh, Cote d’Ivoire, Cameroon, Ethiopia, Haiti, Nigeria, Senegal, and Vietnam.
Using a methodical approach, we analyzed individual project activities in these countries and the expected effects on service coverage to estimate the impact on morbidity and mortality. We examined how our activities, including implementing strategies for improved human resources for health, operationalizing health insurance schemes, rolling out packages of health services, and using costed plans and packages to advocate for more financial resources, will increase access to health services, which in turn will lead to greater coverage of health services among targeted populations and ultimately to reduced morbidity and mortality. We modeled the impact of HFG’s activities by quantifying the number of deaths that were averted as a result of HFG-supported strategies and reforms.
The modeling results indicate that continued implementation of health systems strengthening strategies like those HFG supported would bring significant expansion of health care coverage and enhanced health outcomes.
This report presents country- and activity-specific results and the methodology for estimating coverage changes and impact. We hope this modeling exercise adds to the global understanding of how the impact of health systems strengthening can be measured. It provides powerful evidence on why investment and effort in strengthening health systems must continue.
Strengthening Primary Care Through Performance - Based Incentive SystemHFG Project
The document summarizes the findings from two cycles of research on Indonesia's primary care incentive system under its national health insurance program. The research found that:
1) Health workers' incomes come from various sources, including government salary, capitation payments, regional allowances, and private practice, but the capitation system does not adequately motivate individual performance.
2) There is wide variation in health workers' incomes between districts and facilities based on local policies and patient volumes.
3) While incentive systems exist, they are often based more on attendance and processes rather than quality metrics or achievement of health targets. Respondents recommended revising incentives and indicators to better promote quality primary care performance.
Integrating the HIV Response at the Systems LevelHFG Project
The global response to combat the acquired immunodeficiency syndrome (AIDS) epidemic scaled up considerably in the early 2000s with the establishment of key institutions, notably the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) (AIDS.gov 2018). In response to high global rates of AIDS-related morbidity and mortality, the internationally supported rapid scale-up of human immunodeficiency virus (HIV) prevention, testing, treatment, and drug development is widely credited with curtailing a global epidemic, thereby limiting the human and financial costs of the virus (Bekker et al. 2018). Still the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 1.8 million people were infected with HIV in 2017, and there are nearly 37 million people living with HIV (PLWHIV) worldwide (UNAIDS 2018a). In many countries, financing and governance of HIV services is transitioning from international donors to national governments.
This funding transition has major implications for the governance, management, and implementation of the HIV response. Governments undergoing funding transitions for the HIV response are integrating aspects of the response into systems and processes for governing, managing, financing, and delivering other essential
health services. But this phenomenon has not been systematically studied, and documentation on how governments achieve this is limited. Understanding how some governments are navigating an HIV funding transition may help other countries and the global health community to better design and plan future or ongoing efforts to transition national HIV responses to domestic resources for health. USAID’s HFG project is helping to fill this gap. In particular, this study helps build an evidence base by exploring whether and how four countries in the process of transitioning to greater domestic financing of their HIV response are integrating HIV programming with local systems and processes for other essential health services.
This study applies the concept of system integration to examine the alignment of rules, policies, and support systems to address HIV and other essential health services in four low and middle-income countries (LMICs). Specifically, the study explores the current extent of integration, the decisions faced by policymakers, and potential barriers/facilitators to integration in four countries. The analysis allows HFG to share lessons learned by each of these countries attempting to optimize rules, policy, and support systems for HIV and other essential health services.
Case Study: Improving Care through Patient-Centered Clinical Pharmacy Service...HFG Project
The Clinical Pharmacy activity in Ethiopia from 2012-2016 aimed to promote patient-centered pharmaceutical services. It trained over 200 pharmacists through a one-month in-service program. As a result, 53 of 65 hospitals implemented clinical pharmacy services. Key factors for its success included a supportive policy environment, stakeholder commitment, and an implementation plan to build staff capacity according to existing guidelines. The activity was part of broader Systems for Improved Access to Pharmaceuticals and Services (SIAPS) project in Ethiopia led by Management Sciences for Health.
The Health Finance and Governance project in Ukraine worked to improve the country's health system through strategic purchasing approaches. It demonstrated the effectiveness of integrating HIV testing into primary care, improving efficiency of the TB hospital system by developing monitoring and simulation tools, and laying the groundwork for strategic purchasing reforms across the broader hospital sector. Key results included increasing HIV testing and detection rates while lowering costs, helping restructure TB hospitals based on data to improve care and achieve savings, and establishing cost accounting methods and a case-based payment system pilot to enhance the performance and efficiency of hospitals nationwide.
Public Financial Management, Health Governance, and Health SystemsHFG Project
While the importance of governance in a health system is well recognized, there is an overall lack of evidence and understanding of the dynamics of how improved governance can influence health system performance and health outcomes. There is still considerable debate on which governance interventions are appropriate for different contexts. This lack of evidence can result in avoidance of health governance efforts or an over-reliance on a limited set of governance interventions. As development partners and governments are increasing their emphasis on improving accountability and transparency of health systems and strengthening country policies and institutions to move towards universal health coverage (UHC), the need of this evidence is ever rising.
To address this evidence gap, the USAID’s Office of Health Systems (USAID/GH/OHS), the World Health Organization (WHO), and the Health Finance and Governance (HFG) Project launched an initiative in September 2016 to ‘Marshall the Evidence’ on how governance contributes to health system performance and improves health outcomes.
The overall objective of the initiative was to increase awareness and understanding of the evidence of what works and why in how governance contributes to health system performance, and how the field of health governance is evolving at the country level. This report provides a synthesis of the findings across the four themes. This report presents the findings of the Public Financial Management.
South Africa HIV and TB Expenditure Review 2014/15 - 2016/17 Full ReportHFG Project
The South African Government (SAG) and its development partners have mounted a formidable response to the world’s largest HIV epidemic and a persistent burden of tuberculosis (TB), the country’s leading killer. Nearly 4 million South Africans initiated antiretroviral therapy (ART) by the end of financial year 2016/17, helping to curtail new infections and reduce the number of annual HIV-related deaths. Mortality from TB has also declined thanks, in part, to improved treatment success.
Despite progress, challenges remain. Roughly 3 million people living with HIV (PLHIV) lack treatment, and each year more than a quarter million are newly infected. Moreover, nearly a half million South Africans contract TB every year, with an increasing share affected by drug-resistant strains.
To effectively plan and steward the health system, the SAG routinely monitors programmatic and financial performance of the response to HIV and TB, including by tracking expenditure. Analysis of spending, including trends in sources, levels, geographic and programmatic distribution and cost drivers can help policymakers to assess whether resources are reaching priority populations, interventions, and hotspot geographies; to identify potential opportunities to improve allocative and technical efficiency; and to stimulate more productive dialogue at multiple levels of the system.
This review of HIV and TB expenditure in South Africa is an input to policy, planning and management processes within and amongst spheres of government and between government and development partners. The data have been especially useful to national and provincial programme managers as they perform their oversight functions, leading to improved spending of available resources. With 52 annexes, it also serves as an authoritative reference document detailing levels and trends in HIV and TB spending by the three main funders of the disease responses: the SAG, the United States Government (USG), primarily via the President’s Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund). The findings have informed South Africa’s report to the UNAIDS Global AIDS Monitor and the country’s forthcoming funding request to the Global Fund.
The Aga Khan Foundation (AKF) has initiated a project in three districts of Bihar, India, which aims to improve the uptake of optimal Infant and Young Child Feeding (IYCF) practices by the mothers and care-givers of children under-two years of age. The project is supported by the Department of International Development (DFID), and AKF is working in collaboration with three other implementing partners. The project will use multiple behaviour change
communication (BCC) tools and techniques which are expected to improve the knowledge of pregnant women and breastfeeding mothers regarding IYCF. This change, along with individualised support to mothers by project functionaries will ultimately result in improved
IYCF practices by the mothers and care-givers.
Budget matters for health: key formulation and classification issuesHFG Project
This policy brief aims to raise awareness on the role of public budgeting – specifically aspects of budget formulation – for non-PFM specialists working in health. As part of an overall WHO programme of work on Budgeting in Health, it will help clarify the characteristics and implications of various budgeting approaches for the health sector.
Essential Package of Health Services Country Snapshot: UgandaHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Each year Bangladesh government distributes the expenditure in different sectors. Health sector is one of them. This is Group presentation made by me. This slide will give you an idea about health sector expenditure, its relative ratio with other economic factors, what kind of problem this sector is facing and how the whole allocation can help the health sector. Enjoy !
What factors explain the fertility transition in India?HFG Project
The purpose of this study is to explain the main causes of fertility change and its implications in India over the time period 1998 to 2016. To accomplish this, we first test the proximate determinants model to see if it is valid in the Indian context and then use it to estimate the contribution of each determinant to changes in India’s total fertility rate. The findings are intended to inform program managers, donors, and researchers about the link between contraceptive prevalence rate (CPR) and fertility decline.
Estimating Bangladesh Urban Healthcare Expenditure Under the System of Health...HFG Project
Bangladesh is a densely populated country with 23 % people residing in urban areas and with a 3.5% annual growth of urban population. Bangladesh Bureau of Statistics divided into seven administrative divisions: Barisal, Chittagong, Dhaka, Khulna, Rajshahi, Rangpur, and Sylhet. Each division is divided into zilas, and each zila into upazilas. Each urban area in an upazila is divided into wards, which are further subdivided into mohallas. A rural area in an upazila is divided into union parishads (UPs) and, within UPs, into mouzas. The people who are living in wards were considered as urban population and the Ups’ population was considered as rural. However, the division between urban and rural health care is not so distinct and it is difficult to create an urban and rural demarcation of health expenditure. According to BDHS 2014, the urban population has more access to facility delivery, qualified doctors and less unmet need for contraception. This raises the question whether there is more health expenditure by urban population than the rural.
This study aims to estimate the health expenditures of the urban population in terms of provider, financing agents and functions by analyzing the data of National health accounts, which will eventually give a specific direction to identify the gaps and way of addressing those issues.
The USAID Health Finance and Governance project in Angola helped the Ministry of Health develop a costed National Health Plan and monitoring and evaluation system to better advocate for health funding. Specifically:
1) HFG assisted MINSA in calculating a 12-year $6.3 billion budget to implement the National Health Plan, which helped gain approval and political support for increased health funding.
2) An M&E plan was developed and led to the creation of an M&E department at MINSA to track health spending and sector progress.
3) Efforts were made to establish a health accounting system to measure how funds are actually spent, but this was not completed due to a change in government leadership.
HFG Indonesia Strategic Health PurchasingHFG Project
The document summarizes the findings of a strategic health purchasing review in Indonesia. Key findings include:
1) JKN coverage has expanded significantly but expenditures are growing faster than revenues, threatening sustainability.
2) Indonesia spends a low amount on health compared to international standards given its commitment to universal coverage.
3) Strategic purchasing, which involves defining benefits and payments to providers, can improve efficiency and quality while maintaining coverage. However, purchasing functions in Indonesia remain split between agencies limiting its effectiveness.
This impact brief outlines the ways in which SIAPS works with USAID Bangladesh & Ministry of Health and Family Welfare to improve access to contraceptives in Bangladesh by strengthening pharmaceutical and supply chain systems.
Essential Package of Health Services Country Snapshot: BangladeshHFG Project
Resource Type: Brief
Authors: Jenna Wright
Published: July 2015
Resource Description:
An Essential Package of Health Services (EPHS) can be defined as the package of services that the government is providing or is aspiring to provide to its citizens in an equitable manner. Essential packages are often expected to achieve multiple goals: improved efficiency, equity, political empowerment, accountability, and altogether more effective care. There is no universal essential package of health services that applies to every country in the world.
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
The government of Bangladesh first defined an “Essential Service Package” in 1998, then updated it in 2003 and renamed it the “Essential Service Delivery” Package. This package is defined at a high level, and includes: child health care, safe motherhood, family planning, menstrual regulation, post-abortion care, and management of sexually transmitted infections; communicable diseases (including tuberculosis, malaria, others); emerging noncommunicable diseases (diabetes, mental health conditions, cardiovascular diseases); limited curative care and behavior change communication; and nutrition.
Reproductive, Maternal, Newborn, and Child Health (RMNCH) Expenditure BangladeshHFG Project
This document analyzes reproductive, maternal, newborn, and child health (RMNCH) expenditures in Bangladesh using data from the Bangladesh National Health Accounts. It estimates expenditures for 2012 by public and private healthcare providers and financing schemes. Key findings include reproductive healthcare expenditures of $134 million, maternal and newborn expenditures of $44 million, and child healthcare expenditures of $83 million. The analysis provides a breakdown of RMNCH spending by provider, function, and financing source to understand where resources are being allocated. It aims to inform policies to improve funding and access to critical maternal and child health services.
KEBBI STATE, NIGERIA PUBLIC EXPENDITURE REVIEW 2013-2016HFG Project
This document provides a public expenditure review of health spending in Kebbi State, Nigeria from 2013 to 2016. It finds that while the state's health budget increased over this period, actual spending on health remained low and did not keep pace with budget allocations. The document makes several recommendations to improve health financing in Kebbi State, including increasing the prioritization of health in the state budget, promoting preventive care at primary health centers, and further evaluating the efficiency of the state health system.
This document provides guidance on developing and using key performance indicators (KPIs) in the health sector. It discusses how KPIs can help health sector decision-makers track progress toward strategic goals, set performance standards and targets, measure improvements over time, and demonstrate results to stakeholders like the Ministry of Finance. The document emphasizes that KPIs should be linked to a sector's strategic framework and developed through strategic planning processes. It introduces the concept of a logic model to illustrate the logical linkages between problems, policies/measures, and goals. Developing the right KPIs involves aligning them with a sector's overarching strategic goals and objectives.
Essential Package of Health Services Country Snapshot: RwandaHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Sustaining the HIV/AIDS Response in Antigua and Barbuda: Investment Case BriefHFG Project
Antigua and Barbuda has made great strides in organizing its response to HIV and AIDS in recent years, and has managed to control the growth of the epidemic. The National AIDS Program (NAP) is now at a critical juncture as the country plans to adapt to the changing donor funding landscape, new clinical guidelines, strategic objectives, and changes in policy including greater program integration into primary care, which are designed to increase access and reduce the cost of service delivery.
This document provides analytic inputs that support a case for investment in the Antigua and Barbuda HIV and AIDS response. This report provides a quantitative analysis of trends in the HIV epidemic and the impact of various prevention and treatment efforts to date, along with a projection of possible future programming scenarios, their costs, and their implications for the epidemic. The report describes estimated funding available and gaps in funding that The Goals and Resource Needs models – part of the Spectrum/OneHealth modeling system that estimates the impact and costs of future prevention and treatment interventions – were used for this analysis.
Case Study: Rwanda’s Twubakane Decentralization and Health ProgramHFG Project
The Twubakane Decentralization and Health Program in Rwanda aimed to strengthen the country's health system through decentralization and capacity building efforts. The project supported six components: family planning and reproductive health, child survival programs, decentralization policy and management, district-level capacity building, health facility management, and community engagement. While the project scope originally focused on health financing and decentralization, after Phase II of Rwanda's decentralization was initiated, the project shifted its top priority to district-level capacity building. Key factors in the project's success included aligning with existing government policies, collaborating across stakeholders, and increasing district ownership over resources and planning. The project contributed to reductions in infant mortality and increases in contra
Health Financing in Botswana: A Landscape AnalysisHFG Project
The government of Botswana is committed to achieving universal health coverage and assuming a higher share of HIV/AIDS and other health spending, even though long-term economic growth prospects are less optimistic than in the past. To guide its path, the government is developing a health financing strategy that will increase efficiency, ensure financial sustainability, and promote an effective mix of public and private mechanisms for health financing and service provision. The government created a multi-stakeholder Health Financing Technical Working Group (HFTWG) to lead the development of the strategy and requested support from the Health Finance and Government Project (HFG), a global initiative funded by the United States Agency for International Development (USAID). HFG conducted this landscape analysis to inform the process by compiling the findings of previous studies, providing information on Botswana’s fiscal space for health, health expenditures, funding gap for health, and health system performance, and outlining policy initiatives for addressing the priorities of the HFTWG.
Summary RHIS Evaluation Report for the Punjab National Health Mission Using t...HFG Project
Resource Type: Evaluation/Report
Authors: Nehal Jain, Vunnava Janardhan Rao and Michael P. Rodriguez
Published: May 31, 2014
Resource Description:
The Health Finance and Governance project has worked with the National Health Mission in Punjab to conduct an assessment of the routine health information systems across three districts in the state. The assessment team utilized the Performance of Routine Information Systems (PRISM) Framework to conduct the exercise, including the Performance Diagnostic Tool, the Overview and Facility/Office Checklist, the Management Assessment Tool and the Organizational and Behavioral Assessment Tool (OBAT). Site visits for data collection and interviews were conducted over a six-week period from mid-June 2014 to late-July 2014. Based on the data collected and analyzed from 24 health facilities across the three districts of Barnala, Mansa and Patiala, this report contains the key findings and recommendations from the PRISM assessment.
Essential Package of Health Services Country Snapshot: NepalHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Essential Package of Health Services Country Snapshot Series: 24 Priority Cou...HFG Project
The document summarizes findings from analyzing essential packages of health services (EPHS) in 24 priority countries. Key findings include:
- 23 of 24 countries defined an EPHS, though specificity of packages varied. Most included the majority of priority reproductive and maternal health interventions.
- Countries delivered EPHS through community health workers and public facilities. Some used EPHS to standardize private sector provision.
- Governments addressed equity through EPHS-related policies on populations and financial protection, though mechanisms varied.
- Priority setting for EPHS appeared limited, with most listing all services rather than prioritizing based on resources. EPHS purposes also varied between guiding service delivery,
Case study: Zambia Integrated Systems Strengthening Program (ZISSP)HFG Project
The Zambia Integrated Systems Strengthening Program (ZISSP) was a USAID-funded health systems strengthening project implemented from 2010-2014 in Zambia. ZISSP worked closely with the Ministry of Health and other partners to improve access and utilization of key health services. It used a whole-systems approach, focusing on strengthening specific program areas like HIV/AIDS, family planning, malaria, and maternal and child health. At the national level, ZISSP worked through technical working groups and with subcontractors to build capacity. It also decentralized training and seconded staff to provincial and district levels. In targeted districts, ZISSP improved community involvement through behavior change communication, small grants, and working
Essential Package of Health Services Country Snapshot: ZambiaHFG Project
This country snapshot is one in a series of 24 snapshots as part of an activity looking at the Governance Dimensions of Essential Packages of Health Services in the Ending Preventable Child and Maternal Death priority countries. The snapshot explores several important dimensions of the EPHS in the country, such as how government policies contribute to the service coverage, population coverage, and financial coverage of the package. Each country snapshot includes annexes that contain further information about the EPHS.
Expanding Coverage to Informal Workers: A Study of EPCMD Countries’ Efforts t...HFG Project
For many low- and middle-income countries (LMICs), expanding health coverage to informal workers is one of the most common, yet complex challenges requiring action. Informal workers are, by definition, not provided with legal or social protections through their employment, and are vulnerable to health and economic shocks. They also account for a large percentage of the population in LMICs. Expanding or deepening health coverage to informal workers is thus an area of interest for stakeholders pursuing universal health coverage (UHC): the goal that the entire population can access needed good-quality care without risk of impoverishment. Pro-poor coverage schemes that rely on prepayment – payment delinked from the time of care seeking – are a key financing strategy for UHC (WHO 2010). However, including informal workers in such schemes is challenging given that informal workers are not typically registered in taxation systems and social protection systems, nor covered by labor laws and regulations, making them less visible to the government and other stakeholders (Rockefeller Foundation 2013).
This report complements existing literature on how health reforms can improve the welfare of informal workers, focusing on the 25 countries prioritized for development assistance by the United States Agency for International Development (USAID) as part of its Ending Preventable Child and Maternal Deaths (EPCMD) initiative. Given the strong interest in these questions among EPCMD countries, USAID commissioned the Health Finance and Governance project (HFG) to conduct this research and provide recommendations relevant to UHC policy discussions in these countries.
Do Better Laws and Regulations Promote Universal Health Coverage? A Review of...HFG Project
The importance of policies, laws, and regulations (referred to collectively below as “policy instances”) as instruments to support progress towards Universal Health Coverage (UHC) in low- and middle-income countries cannot be understated. However, there has been insufficient focus in the literature on the role of these instruments, leading to a lack of evidence as to what constitutes a supportive legal environment that can consistently provide a strong basis for UHC reform processes. In this review, we explore how policies implemented in different country contexts have had an impact on their achievement of UHC goals.
In order to better differentiate the effect of various policy instances on the achievement of UHC goals, we developed a typology for policy instances and then ascribed the different aspects of governance to the instances identified in the literature, based on how they were designed and implemented. Finally, we considered the success of each policy instance identified, in terms of achieving intended UHC-related outcomes.
Governments may have political and process constraints on the number of policy instances they can design and implement in a period leading up to and during health sector reform. In terms of which health system component to focus such change on, we have more evidence for policy instances focused on health financing, given that designing effective financing mechanisms can shape the entire health
sector. Following this, policy instances that address human resources for health and supply chain management should be prioritized as they appear to have key strengthening effects on the provision of healthcare by increasing efficiency, equity, and quality.
This review of the evidence to date of governments’ policy-making experience highlights the importance of effective policy design and implementation with a clear orientation towards better governance, and in particular increased responsiveness and accountability.
Similar to National Reproductive Health Commodities Quantification Bangladesh 2012-2016 (20)
Data-Driven Supply Planning and Decision-making Leads to Cost-Savings and Greater Access to Contraceptives at Service Delivery Points in Bangladesh.
Presentation- International UHC conference, 2015.
Forecasting Exercise of the Reproductive, Maternal, Newborn, and Child Health...Golam Kibria MadhurZa
Forecasting Exercise of the Reproductive, Maternal, Newborn, and Child Health Commodities Prioritized by the UN Commission on Life-Saving Commodities for Women and Children
This document summarizes an exercise to forecast vaccine needs for Bangladesh's Expanded Program on Immunization (EPI) from 2012-2016. It describes the process undertaken so far, which included reviewing population and immunization coverage data, identifying key data points, and analyzing the data using different scenarios. Target populations were estimated for different vaccines using population projections and assumptions about mortality rates, fertility rates, and family planning goals. Vaccine doses needed were calculated based on target populations, coverage goals, and wastage rates. The next steps outlined are getting feedback on inputs and assumptions, finalizing the forecasting methodology, conducting the forecast using tools like Spectrum, and producing a final report.
QuanTB Helps Ensure Medicines Availability, Averts Waste, and Saves Money in ...Golam Kibria MadhurZa
Through improved coordination and use of the QuanTB quantification tool developed by SIAPS, the National Tuberculosis Program in Bangladesh strengthened pharmaceutical management of TB medicines. This averted medicine waste, ensured treatment coverage, and saved nearly $1 million by identifying and addressing potential stock outs and excess stock of both first-line and second-line TB medicines. Regular review of procurement data through the PSM platform now provides early warning of any issues to improve long-term availability of TB treatment.
This document discusses considerations for integrating health management information systems (HMIS) and logistics management information systems (LMIS). It outlines benefits such as improving quantification, disease surveillance, planning, and service delivery. Integrating the systems can also help validate data, reduce duplicate data collection, and enhance monitoring and evaluation of health programs. However, there are also challenges including organizational barriers between the systems, differences in data sources and standards, and technical difficulties in linking the systems. The document provides recommendations for routinely linking HMIS and LMIS data such as encouraging communication, creating data sharing agreements, agreeing on standards, testing the linkage, and resolving data quality issues.
The Supply Chain Management Portal created by USAID programs in collaboration with Bangladesh's Ministry of Health and Family Welfare has led to improved monitoring and management of contraceptive procurement processes. By providing real-time data on procurement, the portal alerts managers to delays and bottlenecks. This has streamlined procurement, reducing lead times by an average of 32.8 weeks. As a result, contraceptive availability has increased at all levels of the health system in Bangladesh.
3. National Reproductive Health Commodities Quantification
Bangladesh 2012-2016
Andualem M. Omer
M. Sheikh Giashuddin
M. Golam Kibria
February 2013
4. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
ii
This report is made possible by the generous support of the American people through the US
Agency for International Development (USAID), under the terms of cooperative agreement
number AID-OAA-A-11-00021. The contents are the responsibility of Management Sciences for
Health and do not necessarily reflect the views of USAID or the United States Government.
About SIAPS
The goal of the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program
is to assure the availability of quality pharmaceutical products and effective pharmaceutical
services to achieve desired health outcomes. Toward this end, the SIAPS result areas include
improving governance, building capacity for pharmaceutical management and services,
addressing information needed for decision-making in the pharmaceutical sector, strengthening
financing strategies and mechanisms to improve access to medicines, and increasing quality
pharmaceutical services.
Recommended Citation
This report may be reproduced if credit is given to SIAPS. Please use the following citation.
Omer, A. M., M. S.Giashuddin, and M. G. Kibria.2013. National Reproductive Health
Commodities Quantification Bangladesh 2012-2016.Submitted to the US Agency for
International Development by the Systems for Improved Access to Pharmaceuticals and Services
(SIAPS) Program. Arlington, VA: Management Sciences for Health.
Systems for Improved Access to Pharmaceuticals and Services
Center for Pharmaceutical Management
Management Sciences for Health
4301 North Fairfax Drive, Suite 400
Arlington, VA22203USA
Telephone: 703.524.6575
Fax: 703.524.7898
E-mail: siaps@msh.org
Web: www.siapsprogram.org
5. iii
CONTENTS
Acronyms and Abbreviations .................................................................................................... iv
Executive Summary .................................................................................................................. vi
Introduction and Background ......................................................................................................1
Introduction.............................................................................................................................1
Background.............................................................................................................................2
Brief Introduction to DGFP Web LMIS (dgfplmis.org) ...........................................................4
Procuring Contraceptives ........................................................................................................4
Scope of FP Quantification Exercise .......................................................................................5
Objectives of the Exercise .......................................................................................................5
Quantification Methodology........................................................................................................6
Methods ..................................................................................................................................6
Input Data and Assumptions....................................................................................................9
Quantification Results...............................................................................................................15
Forecasted Users and Acceptors by Method: Scenario I (Current CPR = 61.1 Percent 2012-
2016).....................................................................................................................................15
Forecasted Contraceptive Commodities Requirements: Scenario I.........................................16
Forecasted Users and Acceptors by Method: Scenario II (Achieve CPR = 72 Percent by 2016)
..............................................................................................................................................16
Forecasted Contraceptive Commodities Requirements: Scenario II .......................................17
Forecasted Users and Acceptors: Scenario III (Achieve TFR = 2.0 by 2016) .........................18
Forecasted Contraceptive Commodities Requirements: Scenario III ......................................19
Estimated Cost of the Commodities.......................................................................................20
Challenges, Recommendations, and Conclusion........................................................................23
Challenges.............................................................................................................................23
Recommendations.................................................................................................................23
Conclusion............................................................................................................................24
References ................................................................................................................................25
Annex A. Other Data ................................................................................................................27
Annex B. List of Books and Reports Consulted and Contributors..............................................33
Annex C. Shipment Summary by Supplier ................................................................................34
6. iv
ACRONYMS AND ABBREVIATIONS
BDHS Bangladesh Demographic and Health Survey
BDT Bangladeshi Taka
CPR contraceptive prevalence rate
CYP couple year protection
DDS drugs and dietary supplements
DGFP Directorate General of Family Planning
FP family planning
FWG forecasting working group
HPNSDP Health, Population, and Nutrition Sector Development Program
IUD intrauterine device
KfW KreditanstaltfürWiederaufbau
LAPM long-acting permanent method
LMIS Logistics Management Information System
MIS management information system
MOHFW Ministry of Health and Family Welfare
MSH Management Sciences for Health
MSR medical surgical requisite
MWRA married women of reproductive age
NIPORT National Institute of Population Research and Training
RH reproductive health
SIAPS Systems for Improved Access to Pharmaceuticals and Services
SOW scope of work
SPS Strengthening Pharmaceutical System
TFR total fertility rate
USD US dollars
WHO World Health Organization
WRA women of reproductive age
7. v
ACKNOWLEDGMENTS
The team would like to extend their appreciation and gratitude to all who participated and helped
accomplish this quantification exercise for reproductive health (RH) commodities. They are
grateful to all the staff of the Directorate General Family Planning (DGFP) for the Ministry of
Health and Family Welfare (MOHFW) of Bangladesh and to the managers and other staff of
SIAPS Bangladesh for their unreserved support throughout this exercise. They are also grateful
to the members of the forecasting and quantification committee for their valuable input,
comments, and recommendations.
The whole exercise and the production of this document were made possible through support
provided by the US Agency for International Development, under the terms of contract
agreement number AID-OAA-A-11-00021. The opinions expressed herein are those of the
author(s) and do not necessarily reflect the views of the US Agency for International
Development or the US government.
8. vi
EXECUTIVE SUMMARY
Bangladesh is one of the world’s most densely populated countries, struggling with the negative
effects of high population growth rates. The government has recognized that the massive
population is an obstacle to economic development and has developed the National Population
Policy to reduce fertility to replacement level by 2016. The Family Planning (FP) Program is
implemented by the leadership of the Directorate General of Family Planning (DGFP). DGFP
has built a nationwide, community-based FP service delivery system. Because of the integrated
efforts of governmental and nongovernmental organizations that work in FP, the total fertility
rate (TFR) has declined steadily from 2.7 in 2007 to 2.3 in 2011, and the use of contraceptive
methods among married women has increased from 56 percent in 2007 to 61.1 percent in 2011;
unmet need for contraceptives has decreased from 17 percent in 2011 to 12 percent in 2011
(BDHS2007, 2011). The Health, Population, and Nutrition Sector Development Program
(HPNSDP) result framework has set the target to reduce unmet need for FP services to 9 percent
by 2016 and to reduce the TFR from 2.3 in 2011 to 2.00 per eligible woman for the same period.
Achieving the targets requires, among other programmatic inputs, commensurate amounts of
contraceptives and related supplies.
To ensure the sustainable availability of FP commodities and achievement of the goals,
commodity demand has to be quantified properly and resources have to be allocated. Thus, this
quantification exercise was organized by DGFP in collaboration with SIAPS to develop a five-
year (2012-2016) forecast of FP commodities with a two-year supply plan; results of the exercise
can be used for evidence-based procurement decisions to guide future procurement actions and
ensure sustainable availability of commodities for the program. The exercise sets the stage for
the establishment of a consistent mechanism for regular updates of the national forecast and
supply plans for FP commodities through DGFP’s forecasting working group (FWG) to ensure
FP commodity security at the national level.
To meet the objectives of the assignment, three scenarios were considered—
Current contraceptive prevalence rate(CPR) of 61.1 percent continues with some changes
in the method mix (scenario I)
Country achieves a CPR of 72 percent by 2016 with some changes in the method mix
(scenario II)
Country achieved TFR of 2.0 by 2016 with some changes in the method mix to ensure
the slight increase in the long-acting permanent method1
(scenario III)
The morbidity method was applied to perform the forecasting exercise. Under these three
scenarios, the estimated cost of the commodities for FP users during the forecasted period will be
$109.2 million, $123.1million, and $124.4 million, respectively.
1
Long-acting permanent method- Female sterilization, Male sterilization, IUD and Implant
9. Executive Summary
vii
For scenario I, the estimated commodities for the public sector are 511.1 million cycles of
pills, 591.5 million condoms, 70.9 million doses of injectables, 1.9 million implants, and
1.77 million intrauterine devices (IUDs) for 2012-2016.
For scenario II, the estimated commodities for the public sector are 566.4 million cycles
of pills, 655.5 million condoms, 78.6 million doses of injectables, 2.2 million implants,
and 2.1 million IUDs for 2012-2016.
For scenario III, the estimated commodities for the public sector are 580.2 million cycles
of pills, 671.5 million condoms, 80.5 million doses of injectables, 2.1 million implants,
and 2.0 million IUDs.
The result viewed as consistent estimate with specified other goals. Scenarios II and III could
come true if some proportion of those using traditional methods shifts to modern methods, or if
short-term users switch to long-acting or permanent methods (LAPMs). For the different
scenarios, scenario III has the smallest variation and is very close to recent trends. So, this
scenario can be used for the forecasted period.
Generally, the total estimated cost for 2012-2106 for contraceptives (oral pills, male condoms,
injectables, implants, and IUDs), permanent methods, and drugs and dietary supplements (DDS)
kits determined using the morbidity forecasting methodology (scenario III) is $211.4 million.
Challenges
Successful forecasting and quantification remains a challenge because of inconsistent data
(consumption data and service data don’t match). Therefore, certain assumptions and
decisions have to be made to cater for this deficiency.
Quantification capacities at the country level and at the program level are limited.
Because the census 2011 data (detailed) was not available, there is some chance that the
estimate of married women of reproductive age (MWRA) is in error.
Obtaining the days out of stock of products at the facility level for use in the consumption
forecasting methodology was not possible.
Recommendations
The FP commodity requirement forecasts should be reviewed and updated bi-annually by the
FWG. This will ensure adequate funding and commodity security for supplies and supply
chain operations, especially by supporting donor coordination efforts. The government,
nongovernmental organizations, and the private and social marketing sectors need to
coordinate among themselves.
10. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
viii
A reliable supply pipeline is required to ensure contraceptive commodity security for clients.
This will only be achieved through close collaboration between the government and other
reproductive health (RH) stakeholders as well as all the partners who support the provision of
commodities for the FP program.
Consideration be made for scheduled deliveries at all levels for bulky commodities due to
space constraints
Comparative analysis of contraceptives usage is required, and the interrelationships between
contraceptives should also be examined. The domino effect of oral pills needs to be assessed
as well.
Quantification and supply planning should be institutionalized by introducing it as a new
module in MOHFW’s procurement training.
Conclusion
The findings of this assessment indicate that the forecasted contraceptive commodities are very
close to the actual figures in the Logistics Management Information System (LMIS)
consumption report. The successful implementation of the quantification will depend on program
achievement and availability of resources. However, if programmatic input is provided to
increase the number of acceptors of FP methods, then the projected requirements can be
modified based on trends in service statistics data obtained in subsequent years.
11. 1
INTRODUCTION AND BACKGROUND
Introduction
Bangladesh is one of the world’s most densely populated countries struggling with the negative
effects of high population growth rates. It is situated in the southern part of Asia, bordered on the
west, north, and east by India, on the southeast by Myanmar, and on the south by the Bay of
Bengal. Bangladesh has a total area of 147,570 square kilometers; it is now the world’s eighth
most populous country with a population of 164.4 million (UN, 2010) people, but it occupies
only 1/3000 of the world’s land space.
The FP Program implemented by the DGFP has built a nationwide community-based service
delivery system that relies primarily on non-clinical methods, such as oral pills and condoms.
The emphasis on short- and long-acting clinical methods, which was relatively high in the 1980s,
faded, but these methods are once again receiving attention. The current pattern of temporary
contraceptive use, with oral pill users close to 45 percent of all married couples, is reaching
saturation, but other individual methods do not even account for 20 percent each. With persistent
early marriage and low fertility, many women complete their childbearing by their mid- to late
twenties, leaving them with two decades of reproductive life in which to avoid unwanted
pregnancies. However, the proportion of couples relying on LAPMs (IUD, implants, male or
female sterilization) remains very low (less than 15 percent). Diversified and mass-scale FP
services will need to be undertaken to bring back the tempo of the 1980s and achieve a TFR of
2.0 by 2016.
Because of the integrated efforts of government and nongovernmental organizations, the TFR
declined steadily from 2.7 in 2007 (BDHS2007) to 2.3 (BDHS2011) in 2011. This result is also
consistent with the increased use of contraception among married women in the past four years
from 56 percent in 2007 to 61 percent in 2011. Unmet need decreased among currently married
women from 17 percent in 2007 to 12 percent in 2011. It is worthwhile to mention that the
HPNSDP result framework has set the target to reduce unmet need for FP services to 9 percent
by 2016 and to reduce TFR from 2.3 in 2011 to 2.00 per eligible woman for the same period.
The government has recognized that a massive population forms an obstacle to economic
prosperity and has developed the National Population Policy to reduce fertility to replacement
level by 2016. This requires a further TFR decline of 0.30 children per couple. But even at
replacement fertility, the country will be adding around two million people annually to the
population, and many in the FP field feel that the decline needs to be greater with a target of 0.6
below present fertility (to TFR 1.7). This decline is projected to have substantial benefits across
many sectors. It will not fall any lower, so all future population growth will be determined
entirely by the fertility level.
The FP services under the HPNSDP will be diversified along with the emphasis on LAPM of
contraception and reducing unmet needs.
12. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
2
Background
Systems for Improved Access to Pharmaceuticals and Services (SIAPS), a USAID-funded global
program, has been providing technical assistance to Bangladesh’s MOHFW and its entities such
as the DGFP, the Directorate General of Health Services, and the National Tuberculosis
Program. The main aim of the program is to strengthen the procurement system and address
supply chain management issues related to FP and other essential health commodities.
Because DGFP is responsible for contraceptive security for the whole country, it must know the
total contraceptive requirement, including private sector needs. However, the DGFP’s minimal
capacities for accurate quantification and forecasting has compelled the national programs to rely
on the use of non-validated Excel spreadsheets for projecting the future needs of RH
commodities in the country. Therefore, it has been difficult to maintain appropriate inventory to
meet the needs of clients. The results have been constant stock imbalances, stock outs of some
important contraceptives, and a preponderance of emergency orders, which, in the end, threatens
the integrity of the FP programs.
Under DGFP, the Logistics and Supply unit is involved in procurement, storage, and supply
management and ensuring that adequate supplies are distributed on time to the service delivery
points so that users and potential clients can have easy access to contraceptives to meet their
needs. To meet this objective, a buffer of critical supplies for a minimum of 18 months will be
built-up for any given point of time at every stage.
DGFP has been procuring contraceptives directly through the Logistics and Supply Unit on the
basis of needs assessed by the line directors in maternal and child health, clinical contraceptive
service delivery, and field service delivery programs. The Logistics and Supply Unit prepares the
procurement plan and processing schedule for contraceptives and medical surgical requisite
(MSR) following International Development Agency (IDA) procurement procedures. After that,
most of the contraceptives (condoms, oral pills, injectables, IUDs, and implants) including DDS
kits are procured by the Logistics and Supply Unit.
The present countrywide distribution system consists of one central warehouse (18,000 square
feet) in Dhaka, 3regional warehouses in Chittagong, Khulna, and Bogra and 17 newly upgraded
regional warehouses (formerly district reserve stores). One out of 20 regional warehouses
(Bhola) is rented. The central warehouse, Chittagong regional warehouse, and Khulna regional
warehouse are offshore consignment recipients. All other warehouses perform as distributors for
their respective catchment areas. Out of 485 upazila FP stores (approximately 297,150 square
feet), 210 were constructed by USAID.
14. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
4
Brief Introduction to DGFP Web LMIS (dgfplmis.org)
To ensure availability of RH commodities at all levels, the DGFP uses web-based LMIS
software, originally developed by the USAID|DELIVER PROJECT and updated by the
Strengthening Pharmaceutical Systems (SPS) Program for the DGFP. The web-based LMIS is a
tool that acts as a central repository of logistics data, stock status of commodities, and
consumption data from all tiers. This system has been extensively used during the exercise.
National, regional, and upazila officials of DGFP enter essential logistics data into the portal and
the dashboard of the web-based LMIS, which prepares charts, maps, and tables for decision
makers. The portal is unique in terms of information management in the public sector.
LMIS Uses and Advantages
Monitors stock position at all levels through interactive dashboard
Monitors consumption trends for RH commodities
Quickly identifies upazila and field-level stock-out situations and takes necessary action
Facilitates stock adjustments, considering requirements of commodities
Monitors monthly logistics report submissions and data accuracy
Improves supply chain monitoring at all levels
Serves as an information source for forecasting future needs based on consumptions trends
Procuring Contraceptives
The major sources of funds for procuring contraceptive are—
Government of Bangladesh
IDA-Pool fund managed by the World Bank
USAID
KfW, the German government-owned development bank
The goal is to develop a data-driven quantification and procurement system, prevent stock outs,
and minimize losses due to over stocks at all levels in the supply chain. This quantification
exercise will provide the Government of Bangladesh policy makers and donors with a
framework for computing contraceptive requirements during the plan period. This will help
DGFP to plan a long-term procurement cycle and to mobilize necessary financing. In addition,
planners will be able to develop a medium-term (five-year) forecast for DGFP with three-year
supply planning that can guide evidence-based procurement decisions and future procurement
actions at the DGFP and MOHFW.
SIAPS has facilitated an in-depth evaluation of procurement management capacity of the DGFP.
The assessment was conducted by an international consultant and as a result, many
recommendations were made for improvement of the supply chain. One important
recommendation was to immediately form an FWG to advocate at the highest levels to secure
15. Introduction and Background
5
guaranteed funding. Membership of the FWG was finalized in a procurement manual workshop
held in October 2010.
Accordingly, DGFP has constituted an FWG to ensure FP commodity security at the national
level with the concurrence of MOHFW. The FWG is chaired by the DGFP and consists of
members from all the stakeholder organizations, both government and nongovernment.
Terms of Reference for the FWG
Prepare estimates based on all available data and projections; SIAPS will provide technical
assistance and facilitate the development of a five-year forecasting and quantification and
three-year supply plan for major contraceptives including DDS kits
Assist the DGFP to secure guaranteed funding and timely release of funds by advocating for
this at the highest levels
Seek additional donor support to bridge any shortfall in funding
The major suppliers of contraceptives for DGFP are the Government of Bangladesh/Essential
Drug Company Limited, KfW, USAID, and UNFPA.
Scope of FP Quantification Exercise
The scope of the forecast was national, covering all FP and all funding sources. The commodities
to be quantified included oral pills, condoms, injectables, IUDs, implants, and DDS kits. The
forecast covers the period January 2012-December 2016.
Objectives of the Exercise
Develop an evidence-based forecast of requirements to support the DGFP for 2012-2016
Develop two-year procurement and supply plans for the FP program, taking forecasts,
service capacity, available funds, and stock on hand, on order, and buffer into consideration
Identify any supply gaps and underfunded categories and forward recommendations
Identify constraints in data management to support regular forecasting and supply planning
Develop recommendations for institutionalization of formal data collection, forecasting,
supply planning, and monitoring systems for FP commodities
Provide technical assistance and technical know-how to DGFP staff in forecasting and
supply planning exercises
16. 6
QUANTIFICATION METHODOLOGY
Methods
Before the international consultant made the trip to conduct this short-term technical assistance,
the following occurred—
Policy documents, fact sheets, previous quantification reports, annual program progress
reports, DHS reports (BDHS 1993-4, BDHS 1996-7, BDHS 1999-00, BDHS 2004,
BDHS 2007), and strategic plans were collected and reviewed
Training materials were developed
Data collection tools were drafted based on the review of the documents and existing data
collection system
Meetings were arranged with shareholders before the trip as a head start to the in-country
activities
A consultants’ meeting was conducted on March 4, 2012, to agree on the scope of work (SOW),
the methodologies that would be used, the list of participants for the trainings and workshops,
and the schedule of the activities, and the SOW was adjusted accordingly. A meeting was held
with Dr. Zubayer Hussain, Country Project Director, SIAPS Bangladesh to come to a consensus
on the SOW for the short-term technical assistance; the program areas to be quantified were
clearly defined and coordination matters were also clarified.
The quantification exercise considered factors such as the estimated current need, national
programmatic strategies, distribution trends, commodities in stock at all levels, commodities to
be delivered, and current costs of the items. This forecast is based on the various assumptions for
RH commodity needs agreed on by various stakeholders at the FWG meeting. The procurement
plan was developed taking into consideration the current stock situation, procedures, and lead
times of the different procuring agencies.
The following processes were undertaken during the exercise—
Determine an appropriate methodology for forecasting national RH commodity needs for
Bangladesh
Develop data collection protocols, assemble programmatic data inputs, collect and collate
product consumption and inventory data, interpret data, select modeling techniques, and
build consensus with stakeholders regarding which assumptions to apply and adjusting
final model estimates with specific reference to program scale-up projections and targets
17. Quantification Methodology
7
Calculate the order requirement for condoms, injectables, IUDs, implants, oral
contraceptive pills, and DDS kits based on the in-country stock status, program capacity,
and funding availability; adjust quantities according to available budget
Develop a two-year rolling supply plan for the above commodities by using PipeLine®
software to cover all sources of funds and commodities, including the private sector
Advise on the current procurement capacities at the DGFP and other relevant bodies for
the successful conduct of future forecasts, continued updates of supply plans, and making
recommendations for strengthening
Subsequently, separate meetings and discussions were held with different government officials,
department heads and non-governmental organization partners (annex B). As a result of the
discussions, more documents, data, and information on the following were obtained—
Collaborating partners in the logistics management of RH commodities
Roles of the partners in the logistics management of RH commodities and the links
among them
Program areas covered, current quantification methodology, and availability of data for
quantification of the commodities
Data and assumptions for the forecasting and supply planning of the RH commodities
Challenges of the existing logistics systems
The major documents collected and reviewed for the exercises are given in annex B.
The data and information collected were then compiled, analyzed, and evaluated. The analyses
and evaluations were then prepared as informative handouts for the consultative quantification
meeting with the stakeholders. The handouts contained—
Data and assumptions tabulated on the basis of the information obtained at the time
A comparison and triangulation of data from different sources
Trends based on historical data to show progress of the programs
Different scenarios to show the impact of using one data source against another and
explanations of how they affect the quantification
Tables to record recommendations and suggestions agreed upon by the workshop
participants
18. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
8
It was decided that the local consultant and the Senior Technical Advisor for Quantification and
Management Information Systems from SIAPS would train government technical staff as soon
as the report was published. The on-the-job training will be conducted using the real data from
the current quantification exercise.
The consultative technical session with FWG members was conducted on March 18, 2012, at the
DGFP/IEM Conference Room, Dhaka. The objectives of the consultative meeting were to—
Review and validate the available data, assumptions, and methodologies presented by the
consultants
Build additional assumptions based on future programmatic goals when there are no
adequate data
Reach consensus and agree on assumptions, data, and methodologies for the current
quantification
Draw up recommendations for future strengthening of supply chain management of
health commodities in Bangladesh in general and RH programs in particular
The consultative meeting was actively attended by 38 representatives from the appropriate
stakeholders—government agencies, logistics partners, implementing partners, and funding
agencies.
Based on the feedback given during the consultative meeting and discussions held afterward, the
following three scenarios were considered for the forecasting. In each scenario, there will be
some changes in the method mix to ensure the slight increase in LAPM—
Scenario I – Current CPR=61.1 percent to continue
Scenario II – Country will achieve CPR=72 percent by 2016
Scenario III – Country will achieve TFR=2.0 percent by 2016
Five-year (2012 -2016) forecasts of the RH commodities were undertaken, supply plans were
developed, and the technical report was written. RH commodities quantified in this exercise were
contraceptives and DDS kits.
Different tools (Spectrum, Reality Check, and basic Excel) were used to forecast the
requirements for the commodities. FamPlan module (FamPlan 2008) was used to forecast the RH
commodities whereas Pipeline was used for the supply planning of the major commodities
(contraceptives and DDS kits). Prices used for valuation of RH commodities were obtained from
DGFP. The specific forecasting methodologies, key assumptions, and forecasting results for each
commodity category are included in the corresponding subsections presented in the
quantification results. Finally, analysis was done on the forecasted results and recommendations
were included.
19. Quantification Methodology
9
Input Data and Assumptions
The following assumptions were adopted based on the discussions at the consultative
quantification workshop and subsequent discussions with specific technical staff from DGFP.
The forecast period was determined to be January 2012 to December 2016.
The morbidity method was adopted for the forecast.
The data from the Bangladesh Population Census 2001 (Bangladesh Bureau of Statistics 2003;
table A-3) was used as a base in DemProj(DemProj 2008) to calculate the population of women
of reproductive age; the following assumptions were used in the calculation—
Life expectancy by sex: based on the trend from the Sample Vital Registration System
report 2009 for the years 2006-2009 (BBS 2009), model life tables with the expected age
pattern of mortality were selected (figure 1). The mortality pattern of the United Nations
General Model life tables was selected for the population projection. Life expectancy at
birth in 2016 for males is assumed to be 67.7 years with an annual increase of 0.23 years
and for females is assumed to be 70.8 years with an annual increase of 0.30 years (table
1).
Migration: because of the lack of valid data, international migration was assumed to be
zero
Sex ratio at birth: estimated at 1.05 male births per 1.0 female birth; this ratio was
assumed to be constant throughout the forecast period
TFR: 2.3 in 2011 (BDHS 2011) and 2.0 target (set in the HPNSDP) for 2016 as stipulated
in MOHFW’s five-year strategy were used as bases to calculate TFR for the forecast
period; to reach the desired level of fertility (TFR = 2.0) in 2016, an annual decrease of
TFR by 0.06 was calculated (figure 2 and table 2)
Table 1. Life Expectancy at Birth by Sex from 2009 to 2016
Year 2009 2010 2011 2012 2013 2014 2015 2016
Male 65.8 66.3 66.6 66.8 67.0 67.3 67.5 67.7
Female 68.7 69 69.3 69.6 69.9 70.2 70.5 70.8
20. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
10
Source: Sample Vital Registration System-2009
Figure 1. Life expectancy at birth by sex from 2001 to 2008
Figure 2. Trends in current fertility rates and TFR in forecasted period
y = 0.5274x-990.823
R2
= 0.8871
y = 0.2321x -400.56
R2
= 0.8145
61
62
63
64
65
66
67
68
69
2001 2002 2003 2004 2005 2006 2007 2008
Male Female Linear (Female) Linear (Male)
3.4 3.3 3.3
3.0
2.7
2.3 2.24 2.18 2.12 2.06 2.00
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
BDHS93 BDHS96 BDHS99 BDHS04 BDHS07 BDHS11 Year
2012
Year
2013
Year
2014
Year
2015
Year
2016
Year
TFRperWoman
21. Quantification Methodology
11
Table 2. Projected TFR per a Woman of Reproductive Age Group
Based on the total population (table 3), the population of women of reproductive age
(WRA) in Bangladesh for the forecast period was projected in tables 4 and 5.
Table 3. Projected Total Population by Sex (Millions)
Year 2001 2011 2012 2013 2014 2015 2016
Total 130.01 153.12 155.16 157.19 159.20 161.20 163.16
Male 67.07 78.43 79.42 80.40 81.37 82.34 83.28
Female 62.94 74.69 75.74 76.79 77.83 78.86 79.88
Table 4. Projected Women of Reproductive Age (Millions)
Age 2001 2011 2012 2013 2014 2015 2016
15-19 5.95 8.27 8.21 8.16 8.10 8.02 7.94
20-24 6.36 7.69 7.92 8.06 8.13 8.18 8.22
25-29 6.16 5.86 6.09 6.45 6.89 7.31 7.64
30-34 4.66 6.23 6.11 5.95 5.80 5.74 5.81
35-39 3.98 6.00 6.15 6.23 6.26 6.23 6.16
40-44 2.91 4.51 4.77 5.08 5.40 5.70 5.92
45-49 2.09 3.82 3.95 4.04 4.13 4.25 4.43
Total 32.11 42.38 43.20 43.97 44.71 45.43 46.12
The forecast of FP commodities was agreed for the MWRA group only. The proportion of the
MWRA group that would need FP commodities was determined to be 80.0 percent of women of
reproductive age group. Table 5 provides the projected number of MWRA for the forecast
period.
Table 5. Projected Total Number of MWRA
2012 2013 2014 2015 2016
MWRA (millions) 34.56 35.18 35.77 36.34 36.90
The use of contraception among married women in Bangladesh has increased gradually from
44.7 percent in 1993-94 to 61 percent in 2011 (table A-3). Most recently, contraceptive use
increased by 5 percentage points in the past four years from 56 percent in 2007 to 61.1 percent in
2011. In this forecast, CPR was calculated based on BDHS 2011 figures and the target set for
2016 by the program. For 2016, it was assumed that the total CPR will grow to 72 percent;
LAPMs (IUD, implants, and female and male sterilization) is assumed to consist of 20 percent of
2011 2012 2013 2014 2015 2016
TFR per woman of reproductive age group 2.30 2.40 2.18 2.12 2.06 2.00
22. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
12
the share and short-acting methods 52 percent. Reality check was used to calculate the projected
trends. Table 6 shows the projected trends of total CPR and CPR by method.
Table 6. CPR Percentage by Method
Method BDHS 2011 2012 2013 2014 2015 2016
Pill 27.2 28.2 29.1 30.1 31.1 32.1
Injections 11.2 11.6 12.0 12.4 12.8 13.2
Male condom 5.5 5.7 5.9 6.1 6.3 6.5
Implant-Norplant 1.1 1.5 1.8 2.2 2.6 3.0
IUD 0.7 1.3 1.9 2.6 3.3 4.0
Female sterilization 5.0 5.2 5.4 5.5 5.7 5.9
Male sterilization 1.2 1.3 1.3 1.4 1.5 1.5
Traditional 9.2 8.9 8.2 7.5 6.7 5.8
Any method 61.1 63.3 65.5 67.6 69.8 72.0
Any modern method 51.9 53.8 55.6 57.5 59.3 61.2
Table 7 shows the assumptions made for couple year protection (CYP), contraceptive
effectiveness, and contraception method discontinuation rates with their respective sources.
Table 7. CYP, Contraceptive Effectiveness, and Contraceptive Method Discontinuation
Rates by Method
Methods CYP (USAID)
Contraceptive
effectiveness (%; WHO)
Discontinuation rates
(%; BDHS 2011)
Oral contraceptives 15 cycles 94.0 39.0
Male condoms 150 condoms 86.0 47.0
IUD 4.6 years 99.2 22.4
Injectables 4 doses 99.7 36.1
Implant single rod 2.5 years 99.9 7.8
Implant double rod 3.2 years 99.9 7.8
Female sterilization 13 years 99.5 0.7
Male sterilization 13 years 99.8 0.7
The source mix (public and private) of each FP contraceptive was projected mainly on the basis
of the average obtained from BDHS reports with some adjustments, especially for the short-
acting methods. Generally, the public sector is the major source of contraceptives. In addition,
the LAPMs are almost exclusively source from the public sector. According to information in
BDHS 2011, the public sector contribution is expected to be higher due to the increased number
of government fieldworkers available for distributing FP supplies.
23. Quantification Methodology
13
Table 8. Source Mix by Method
RH commodity Public source (%) Private source (%)
Oral contraceptives/pills 70 30
Male condoms 40 60
IUD 98 2
Injectables 89 11
Implant single rod 100 0
Implant double rod 100 0
Female sterilization 100 0
Male sterilization 100 0
In addition to the major assumptions listed earlier, the following assumptions given in table 9
were made for2012-2016 based on BDHS1993-BDHS 2007 reports.
Table 9. Post-Partum Menorrhea and Abstinence Insusceptibility, MR Rate, Median Age
of Sterility, Sterility Coefficient
Sex
Post-partum menorrhea and abstinence
insusceptibility MR rate
Median age
of sterility
Sterility coefficient
(BDHS 07)
Female 9.7 months 4.3% 26.8
2.60%
Male - - 36.0
DDS kits were calculated from the DGFP circular and subsequent discussions with experts. The
usage rates per health facility/satellite health clinics for all health facility categories in
Bangladesh were provided by DGFP and were assumed to be constant for the period. In addition,
a total of 35,928 health facilities and satellite clinics were assumed to exist throughout the
forecast period. Table A-2 has the details on the number of facilities and usage rates.
It was assumed for the forecasting period that the following stock levels will be maintained at the
different distribution and storage levels in Bangladesh.
Table 10. Minimum and Maximum Stock Levels for the Program
Min max levels Min MOS Max MOS
Central 2 5
District/region 2 3
Upazila 2 3
SDP 2 3
Total (country/program) 8 14
Shipment intervals (central) 3
Desired stock levels for program 13
24. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
14
Wastage rates for the commodities were assumed to be included in the CYP calculations,
however, the wastage rate for DDS kits was assumed to be 5 percent for the forecast period.
Prices were obtained from DGFP and were assumed to be constant throughout the forecast
period. Prices were converted to USD, and USD was used in the calculations to avoid the
possible price changes due to devaluations.
25. 15
QUANTIFICATION RESULTS
On the basis of the data and assumptions adopted during the national quantification workshops,
expert discussions, review of additional documents, and the tools indicated earlier, the total value
of forecasted pharmaceuticals and supplies required for the FP programs for Bangladesh’s public
sector for the period January 2012 to December 2016 were obtained. Table 12 below provides a
summary of the values of the various classes and categories of pharmaceuticals required for FP.
The forecast is for absolute requirements and wastage only. Buffers, freight and logistics costs,
current inventory position, etc., are not reflected in the figures. These parameters will be used to
develop supply plans and to calculate the final quantities for procurement and cost requirements.
Forecasted Users and Acceptors by Method: Scenario I (Current CPR=61.1
Percent2012-2016)
To estimate the required commodities according to the current CPR trend stipulated for scenario
I, some changes of method mix were required for LAPM. Forecasting accuracy of Scenario I
could be assessed by comparing the gap between required commodities with prevailing
contraceptive uses and commodities for specific programmatic goals. Table 11 shows the
projected users by contraceptive method mix for different methods. Result indicates an increase
in users of pills, injectables, implants, and permanent methods. If the method mix of 2011
continues through 2012-2016, the total method users will increase to 21.1 million in 2012 and
22.6 million in 2016. Among them, 18.2 million and 20.8 million couples will be modern method
users in 2012 and 2016, respectively. The results also indicate that the total cumulative modern
method users during the forecasted period will be 97.5 million. Among them, 48.7 million will
be pill users, 19.9 million injectables users, 9.9 million condom users, 4.1 million IUD users, and
3.5 million implant users; 11.2 million will be permanent method acceptors.
Table 11. Forecasted Number of Users (ScenarioI)
2012 2013 2014 2015 2016 Total
Pill 9,421,176 9,584,731 9,740,568 9,891,787 10,040,489 48,678,751
Condom 1,906,263 1,940,229 1,972,662 2,004,189 2,035,234 9,858,577
Female
sterilization
1,736,818 1,767,764 1,797,315 1,826,039 1,854,324 8,982,260
Injectables 3,825,235 3,906,328 3,984,778 4,061,824 4,138,309 19,916,474
IUD 423,614 625,185 832,902 1,046,632 1,266,368 4,194,701
Male
sterilization
427,850 439,785 451,521 463,190 474,888 2,257,234
Implant 482,920 595,004 710,158 828,398 949,776 3,566,256
Traditional 2,956,826 2,699,074 2,428,567 2,146,710 1,854,324 12,085,501
Total 21,180,702 21,558,100 21,918,471 22,268,769 22,613,712 109,539,754
26. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
16
Forecasted Contraceptive Commodities Requirements: Scenario I
Table 12 shows the projected requirements of contraceptive commodities for scenario I. Under
this scenario, the projected commodities are 1478.7 million condoms, 730.1 million cycles of
pills, and 79.7 million doses of injectableswill be required for 2012-2016. By applying the source
mix, the required commodities for the public sector are 511.1 million cycles of pills, 591.5
million condoms, and 70.9 million doses of injectables will be required. The other commodities
required are one- and two-rod implants and IUDs at 1.52 million, 381.6 thousand, and 1.77
million, respectively. It is worth mentioning that 20 percent of implant users are assumed to be
two-rod users during the forecasted period.
Table 12. Total Commodities Required under Scenario I
Commodi
ty
2012 2013 2014 2015 2016 Total
Pill Public 98,922,360 100,639,672 102,275,960 103,863,768 105,425,136 511,126,896
Private 42,395,296 43,131,288 43,832,556 44,513,040 45,182,200 219,054,380
Total 141,317,656 143,770,960 146,108,516 148,376,808 150,607,336 730,181,276
Condom Public 114,375,800 116,413,744 118,359,744 120,251,352 122,114,040 591,514,680
Private 171,563,696 174,620,608 177,539,600 180,377,024 183,171,072 887,272,000
Total 285,939,496 291,034,352 295,899,344 300,628,376 305,285,112 1,478,786,680
Injectable
s
Public 13,617,836 13,906,528 14,185,810 14,460,092 14,732,381 70,902,647
Private 1,683,103 1,718,784 1,753,302 1,787,202 1,820,856 8,763,247
Total 15,300,939 15,625,312 15,939,112 16,247,294 16,553,237 79,665,894
IUD Public 287,864 336,865 387,045 438,494 288,964 1,739,232
Private 5,875 6,875 7,899 8,949 5,897 35,495
Total 293,739 343,740 394,944 447,443 294,861 1,774,727
Implant
(one rod)
Public 244,272 282,611 321,943 362,302 315,666 1,526,795
Private 0 0 0 0 0 0
Total 244,272 282,611 321,943 362,302 315,666 1,526,795
Implant
(two rod)
Public 61,068 70,653 80,486 90,576 78,917 381,699
Private 0 0 0 0 0 0
Total 61,068 70,653 80,486 90,576 78,917 381,699
Forecasted Users and Acceptors by Method: Scenario II (Achieve CPR=72
Percent by 2016)
Table 13 shows the projected users by contraceptive method mix for different methods. Results
indicate an increase in users of pills, injectables, implants, and permanent methods. If the method
mix of 2011 continues through 2012-2016, the total method users will increase to 21.9 million in
2012 and 26.6 million in 2016. Among them, 18.8 million and 24.5 million couples will be
modern method users in 2012 and 2016, respectively. The results also indicate that the total
cumulative modern method users during the forecasted period will be 101.1 million. Among
them, 53.9 million will be pill users, 22.0 million injectables users, 10.9 million condom users,
4.7 million IUD users, and 3.9 million implant users; 12.5 million will be permanent method
acceptors.
27. Quantification Results
17
Table 13. Forecasted Number of Users (Scenario II)
2012 2013 2014 2015 2016 Total
Pill 9,757,317 10,268,683 10,783,176 11,303,512 11,831,673 53,944,361
Condom 1,974,277 2,078,681 2,183,812 2,290,221 2,398,312 10,925,303
Female
sterilization
1,798,786 1,893,909 1,989,695 2,086,646 2,185,129 9,954,165
Injectables 3,961,716 4,185,078 4,411,300 4,641,515 4,876,568 22,076,177
IUD 438,728 669,797 922,054 1,196,004 1,492,283 4,718,866
Male
sterilization
443,116 471,168 499,850 529,296 559,606 2,503,036
Implant 500,150 637,462 786,172 946,625 1,119,212 3,989,621
Traditional 3,062,324 2,891,676 2,688,515 2,453,081 2,185,129 13,280,725
Total 21,936,414 23,096,454 24,264,574 25,446,900 26,647,912 121,392,254
Forecasted Contraceptive Commodities Requirements: Scenario II
Table 14 shows the projected requirements of contraceptive commodities for scenario II. Under
this scenario, the projected commodities required are 1638.8 million condoms, 809 million
cycles of pills, and 88.3 million doses of injectables during 2012-2016. By applying the source
mix, the required commodities for the public sector are 566.4 million cycles of pills, 655.5
million condoms, and 78.6 million doses of injectables for 2012-2016. The other commodities
required are implants (one- and two-rod) and IUDs at 1.78 million, 446.5 thousand, and 2.1
million, respectively.
Table 14. Total Commodities Required under Scenario II
2012 2013 2014 2015 2016 Total
Pill Public 102,451,832 107,821,168 113,223,344 118,686,880 124,232,568 566,415,792
Private 43,907,924 46,209,076 48,524,292 50,865,804 53,242,528 242,749,624
Total 146,359,756 154,030,244 161,747,636 169,552,684 177,475,096 809,165,416
Condom Public 118,456,632 124,720,848 131,028,696 137,413,264 143,898,720 655,518,160
Private 177,684,960 187,081,280 196,543,024 206,119,888 215,848,080 983,277,232
Total 296,141,592 311,802,128 327,571,720 343,533,152 359,746,800 1,638,795,392
Injectables Public 14,103,710 14,898,876 15,704,226 16,523,792 17,360,580 78,591,184
Private 1,743,155 1,841,434 1,940,972 2,042,266 2,145,690 9,713,517
Total 15,846,865 16,740,310 17,645,198 18,566,058 19,506,270 88,304,701
IUD Public 319,995 390,026 465,069 545,354 340,514 2,060,958
Private 6,531 7,960 9,491 11,130 6,949 42,061
Total 326,526 397,986 474,560 556,484 347,463 2,103,019
Implant
(one rod)
Public 269,971 323,049 380,049 441,119 371,980 1,786,168
Private 0 0 0 0 0 0
Total 269,971 323,049 380,049 441,119 371,980 1,786,168
Implant (two
rod)
Public 67,493 80,762 95,012 110,280 92,995 446,542
Private 0 0 0 0 0 0
Total 67,493 80,762 95,012 110,280 92,995 446,542
28. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
18
Almost 12 million cumulative users would be added during the forecasted period if we could
achieve scenario II. The requirements for contraceptive commodities can be viewed as ambitious
in LAPM because it is assumed that the current mix of modern methods will continue into the
future and users of traditional methods will shift to modern methods and from short-term modern
reversible methods to LAPMs.
Forecasted Users and Acceptors: Scenario III (Achieve TFR = 2.0 by 2016)
To provide consistency, we estimated the required commodities with another programmatic goal
(achieve TFRof 2.0 by 2016). Table 15 shows the projected users by contraceptive method mix
for different methods. Results indicate an increase in users of pills, injectables, implants, and
permanent methods. If the method mix of 2011 continues through 2012-2016, the total method
users will be increased to 23.7 million in 2012 and 25.9 million in 2016. Among them, 20.4
million and 23.8 million WRA will be modern method users, respectively. The result also
indicates that the number of total cumulative modern method users during the forecasted period
will be 110.6 million out of 124.3 million. Among them, 55.3 million use pills, 22.6 million
injectables, 11.2 million condoms, 4.8 million IUDs, 4.0 million implants, and 12.7 million
permanent methods. The number users are somewhat (2.9 million) higher under the TFR goal
than the CPR goal. The reason behind this difference is the relationship between fertility and
CPR. The spectrum model gives an estimate of CPR based on the targeted value TFR and by
using a regression equation; TFR=7.3(1 – 0.88ue). The intercept 7.3 represents the expected
level of natural fertility, u denotes required CPR and e is contraceptive effectiveness (Bongaatrts
1983). Due to the empirical relation of TFR with is its proximate determinant, the estimated CPR
as well as users in higher under TFR goal than CPR goal.
Table 15. Number of Users by Methods 2012-2016, Scenario III
2012 2013 2014 2015 2016 Total
Pill 10,563,214 10,813,280 11,055,785 11,294,264 11,531,010 55,257,553
Condom 2,137,341 2,188,923 2,239,021 2,288,347 2,337,367 11,190,999
Female
sterilization
1,947,355 1,994,352 2,039,996 2,084,939 2,129,601 10,196,243
Injectables 4,288,931 4,407,033 4,522,822 4,637,717 4,752,646 22,609,149
IUD 474,965 705,320 945,364 1,195,026 1,454,362 4,775,037
Male
sterilization
479,714 496,156 512,487 528,862 545,386 2,562,605
Implant 541,460 671,270 806,047 945,850 1,090,771 4,055,398
Traditional 3,315,253 3,045,036 2,756,483 2,451,074 2,129,601 13,697,447
Total 23,748,233 24,321,370 24,878,005 25,426,079 25,970,744 124,344,431
29. Quantification Results
19
Forecasted Contraceptive Commodities Requirements: Scenario III
Table 16 shows the projected requirements of contraceptive commodities for scenario III. Based
on CYP attributes, we estimated that 1,678.6million condoms, 828.9 million cycles of pills, and
90.4 million doses of injectables are required for 2012-2016. By applying the source mix, the
required commodities in the public sector are 580.2 million cycles of pills, 671.5 million
condoms, and 80.5 million doses of injectables for 2012-2016. The other commodities are
implants (one- and two-rod) and IUDs at 1.75 million, 437.8 thousand, and 2.0 million,
respectively, for 2012-2016. These results are consistent with other estimates.
Table 16. Total Commodities Required under Scenario III (TFR Goal 2.0)
2012 2013 2014 2015 2016 Total
Pill Public 110,913,752 113,539,440 116,085,744 118,589,776 121,075,608 580,204,320
Private 47,534,464 48,659,760 49,751,032 50,824,188 51,889,544 248,658,988
Total 158,448,216 162,199,200 165,836,776 169,413,964 172,965,152 828,863,308
Condom Public 128,240,456 131,335,400 134,341,232 137,300,832 140,242,000 671,459,920
Private 192,360,688 197,003,104 201,511,840 205,951,264 210,363,008 1,007,189,904
Total 320,601,144 328,338,504 335,853,072 343,252,096 350,605,008 1,678,649,824
Injectables Public 15,268,593 15,689,034 16,101,245 16,510,273 16,919,418 80,488,563
Private 1,887,129 1,939,094 1,990,042 2,040,596 2,091,164 9,948,025
Total 17,155,722 17,628,128 18,091,287 18,550,869 19,010,582 90,436,588
IUD Public 327,022 385,633 446,236 508,941 332,544 2,000,376
Private 6,674 7,870 9,107 10,387 6,787 40,825
Total 333,696 393,503 455,343 519,328 339,331 2,041,201
Implant
(one-
rod)
Public 277,194 322,726 369,892 418,738 362,946 1,751,495
Private 0 0 0 0 0 0
Total 277,194 322,726 369,892 418,738 362,946 1,751,495
Implant
(two-
rod)
Public 69,299 80,681 92,473 104,684 90,736 437,874
Private 0 0 0 0 0 0
Total 69,299 80,681 92,473 104,684 90,736 437,874
From the scenarios discussed above, we need to select the scenario that provides the most
achievable performance levels. Because the prevailing method mix of contraceptives is likely to
continue during the period of forecasting, the scenario selected should provide the least
deviation from the actual figures for the beginning of the projection period; this scenario may
also provide the least deviation in subsequent years. If we assume that impact of socio-economic
setting on FP outcomes will remain constant during 2012-2016, we may adopt options from
either scenario II or III. These scenarios are based on the program goals with the least deviation.
The share of modern reversible methods will continue as it is now, but there will be a shift from
traditional methods to modern reversible methods such as pills, condoms, and injectables, and
from these methods to LAPMs. There will be a net decline in the share of the method mix of
traditional methods.
30. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
20
Comparison of Reported and Forecasted Requirements of Contraceptive
Commodities
To provide reliable estimates of required commodities, the forecasted result must be compared
with the consumption trend of LMIS data (table 17). The reported number of condoms was
126.76 million in 2011, compared to the projected number of 128.2 million in 2012. Similarly,
the number of cycles of pills actually distributed in 2011 was 109.7 million, and the current
projection is 110.9 million cycles of pills for 2012. The actual number of injectables for 2011
was 13.75 million. However, the forecasted figures appear to be 15.2 million doses for 2012.
The number of doses for 2011 is slightly higher. If we draw the consumption trend with the
previous data, the trend agrees with the forecasted results. The actual number of IUDs and
implant acceptors was 0.274 million and 0.258 in 2011, respectively, compared to 0.327 million
and 0.346 million acceptors in 2012, respectively. Because the use of IUDs and implants are
declining, some changes have been made in the method mix to ensure the slight increase in
LAPM is consistent with the program goal. From this discussion, it would seem that scenario III
might be achievable.
Table 17. Trends in LMIS Consumption Data 2009-2011
Condom (millions) Pill (millions) Injectables (millions) IUD Implant
2009 97.31 104.81 12.44 306,562 31,727
2010 123.93 109.99 12.88 233,750 127,849
2011 126.76 109.69 13.75 274,341 257,993
Estimated Cost of the Commodities
The total cost of commodities is estimated (in Bangladeshi taka, BDT) by taking the current per
unit price of each commodity and multiplying it by the forecasted commodity requirement. The
total estimated cost for 2012-2106 for oral pills, male condoms, injectables, implants, and IUDs
under scenario III is 10,198.3 million BDT equivalent to USD 124.4 million (1 USD=82 BDT).
With the same unit price, the estimated cost under scenario II is BDT 10,090.8 million
(equivalent to USD 123.1 million). The finding indicates that under scenario II, the expected cost
is 1.3 million less (table 18).
31. Quantification Results
21
Table 18. Public Sector: Total Commodity Requirements by Method, Quantity, and Value
in 2012-2016 for each Scenario
Per unit cost
(BDT) Commodity (millions) Total value (BDT, millions)
I II III I II III
Progestin-only pill 5.9 511.13 566.42 580.20 3015.6 3341.85 3423.21
Injectables
a
30 70.90 78.59 80.49 2127.1 2357.74 2414.66
Male condom 1.92 591.51 655.52 671.46 1135.7 1258.59 1289.20
Implant–Jadelle
(2 rods) 1520 0.38 0.45 0.44 580.2 678.74 665.57
Implant –Implanon
(1 rod) 1342 1.53 1.79 1.75 2049.0 2397.86 2351.31
IUD copperT380A 27 1.74 2.06 2.00 47.0 56.00 54.35
Total cost 8954.5 10,090.78 10,198.30
$109.2 $123.06 $124.37
a
Medroxyprogesterone acetate 150 mg/ml in, 1ml
Procedural Cost of Non-Scalpel Vasectomy and Tubectomy
The number of permanent methods users during the period will be 12,758,848, whereas number
of acceptors of the non-scalpel vasectomy (NSV) and tubectomy methods are estimated at
786,271 (annex A). By applying the average procedural cost (3525 BDT per NSV and 3825BDT
per tubectomy), the total estimated cost is BDT 2,903.740 million or USD 35.4 million.
Drugs and Dietary Supplement Kits
Since April 1998, a single kit (known as combined DDS kits) is being used at all service centers
under DGFP for better utilization of drugs in the Maternal Child Reproductive and Adolescent
Health Program. It is essential to ensure an adequate and regular supply of drugs for the
successful operation of health care facilities (table 19). The composition of the DDS, a satellite
kit, and new DDS kits can be found in the annex A.
Table 19. Public Sector Consumption Forecast: Total DDS Kit Requirements by Quantity
and Value
The total estimated cost for 2012-2106 for contraceptives (oral pills, male condoms, injectables,
implants, and IUDs), permanent methods procedures, and DDS kits on the basis of morbidity
forecasting methodology (scenario III) is USD 211.4 million.
Unit
(price)
2011 2012 2013 2014 2015 2016 Total
Quantity each 74,516 77,177 79,839 82,498 85,154 87,811 412,479
Value $125.00 - $9,647,079 $9,979,904 $10,312,234 $10,644,288 $10,976,390 $51,559,895
32. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
22
Three-Year Supply Plan
Effective forecasting and supply planning support programs by ensuring product availability and
by minimizing the need for costly emergency shipments. It also facilitates pooled procurement
(consolidating orders to buy in larger volumes), which further reduces prices. A three-year
supply plan is effective and useful in developing systems for the efficient and timely
procurement of commodities and supplies and the ongoing management of all FP commodities at
the national level (annex C).
33. 23
CHALLENGES, RECOMMENDATIONS, AND CONCLUSION
Challenges
Successful forecasting and quantification remains a challenge because of inconsistent data
(consumption data vs. service data that don’t match). Therefore, certain assumptions and
decisions have to be made to cater to this deficiency.
Quantification capacity at the country level and at the program level is limited.
The current forecast only considered FP commodity requirements. Condom requirements
must be adjusted for the STD and HIV/AIDS prevention program.
DDS kits are distributed at the clinics according to the government supply rule, which does
not consider demand, so unmet needs are high. Therefore, forecasting for DDS kits remains a
challenge.
Since the census 2011 data was not available, there was some chance of error in estimating
MWRA.
Obtaining the number of days out of stock of products at the facility level for use in
consumption forecasting was not possible.
Obtaining the complete document of BDHS 2011 was a challenge for the exercise.
The accuracy of this exercise fully depends on the implementation of successful FP program
(as per target set on HPNSDP).
Recommendations
The FP commodity requirement forecasts should be reviewed and updated bi-annually by the
FWG members. This will ensure adequate funding for supplies and supply chain operations,
especially by supporting donor coordination efforts that will eventually ensure commodity
security. The government, nongovernmental organizations, and the private and social
marketing sectors need to coordinate among themselves.
Timely procurement of commodities is required to fill the pipeline, and information sharing
on lead times and status of procurements/shipments is critical to monitor the pipeline and
make decisions to ensure commodity security.
A secured and reliable supply pipeline is required to ensure contraceptive commodity
availability for clients. This will only be achieved through close collaboration between the
government, other RH stakeholders, and partners who support the provision of commodities
for the FP program.
34. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
24
Delivery of bulky commodities at all levels requires special consideration because of space
constraints.
Improve technical capacity for forecasting and quantification is required at the district level.
Comparative analysis of usage between contraceptives and interrelation changes among
contraceptives are needed. The domino effect of oral pills should be assessed as well.
A situational analysis on the demand of DDS kits at both service and user levels are strongly
recommended.
The output of this exercise should be used for decision making in procurement and resource
mobilization for the next five years.
Quantification and supply planning can be institutionalized by introducing it as a new
module in procurement training run by MOHFW.
Conclusion
The main objective of this assignment was to forecast RH commodity requirements of
contraceptives for 2012-2016. The forecast is accomplished based on three simulations. The first
scenario assumes that the prevailing acceptor method mix will continue to hold during the
projection period, whereas the second and third scenarios assume (with target specific goals) an
increase in the method mix for LAPMs. This assignment shows that the last scenarios provide
estimates of contraceptive commodities that are very close to the actual figures of the LMIS
consumption report. The successful implementation of the quantification will depend on program
achievement and availability of resources. However, if programmatic inputs are provided to
accommodate the increase in the number of acceptors of FP methods, then the projected
requirements can be modified based on trends in service statistics data during subsequent years.
35. 25
REFERENCES
Bangladesh Bureau of Statistics. 2003. Bangladesh Population Census, 2001. Analytical Report.
Dhaka: Bangladesh Bureau of Statistics, Planning Division, Ministry of
Planning.www.bbs.gov.bd
Bangladesh Bureau of Statistics. 2009.Sample Vital Registration System; Planning Division,
Ministry of Planning.www.bbs.gov.bd
BDHS 1993.National Institute of Population Research and Training (NIPORT), Mitra and
Associates, and ORC Macro. 1993-1994. Bangladesh Demographic and Health
Survey,1993-1994.Dhaka, Bangladesh, and Calverton, Maryland, USA.
BDHS 1996.NIPORT, Mitra and Associates, and ORC Macro. 1996-1997. Bangladesh
Demographic and Health Survey,1996-1997. Dhaka, Bangladesh, and Calverton, Maryland,
USA.
BDHS 1999.NIPORT, Mitra and Associates, and ORC Macro. 1999-2000. Bangladesh
Demographic and Health Survey,1999-2000. Dhaka, Bangladesh, and Calverton, Maryland,
USA.
BDHS 2004.NIPORT, Mitra and Associates, and ORC Macro. 2005. Bangladesh Demographic
and Health Survey 2004.Dhaka, Bangladesh, and Calverton, Maryland, USA.
BDHS 2007.NIPORT, Mitra and Associates, and Macro International. 2009. Bangladesh
Demographic and Health Survey 2007. Dhaka, Bangladesh, and Calverton, Maryland, USA.
BDHS 2011.NIPORT, Mitra and Associates, and ICF international. 2011. Bangladesh
Demographic and Health Survey 2011 Preliminary Report. Dhaka, Bangladesh, and
Calverton, Maryland, USA.
Bongaarts, J. and G.R. Potter.1983. Fertility, Biology, and Behavior: An Analysis of the
Proximate Determinants. Academic Press, New York.
DGFP Monthly Logistics and Family Planning, Maternal and Child Health and RH Services
Reports, 2011, MIS unit, Dhaka: DGFP, Ministry of Health and Family Welfare.
www.dgfp.gov.bd
DGFP Procurement Procedure Manual, Dhaka: DGFP, MOHFW and USAID/SPS/SIAPS
Program, January 2012
DGFP Supply Chain Information Portal, www.dgfplmis.org
36. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
26
Family Planning Logistics Management (FPLM). 2000. Contraceptive Forecasting Handbook
for Family Planning and HIV/AIDS Prevention Programs. Arlington, Va.: FPLM/John
Snow, Inc., for the US Agency for International Development
FamPlan.Spectrum System of Policy Models. 2008. A Computer Program for Projecting Family
Planning Requirements. USAID| Health Policy Initiative.
http://www.healthpolicyinitiative.com/index.cfm?id=software&get=Spectrum
http://www.healthpolicyinitiative.com/Publications/Documents/1256_1_FampmanE.pdf
Government of Bangladesh Contraceptive Procurement Bottleneck Study, USAID/JSI, August
2008
Government of Bangladesh. 1998. Statistical Yearbook of Bangladesh 1997,Dhaka: Bangladesh
Bureau of Statistics.
Government of the People’s Republic of Bangladesh, Ministry of Health and Family Welfare,
Planning Wing.Strategic Paper on Health, Population and Nutrition Sector Development
Program (HPNSDP), July 2011-June 2016.www.mohfw.gov.bd
Islam, M. A. and Chakraborty, N. 2001.Projected Contraceptive Requirements 2000-
2005.Dhaka: Ministry of Health and Family Welfare (Bangladesh), Family Planning
Logistics Management, John Snow, Inc., and US Agency for International Development.
http://epc2010.princeton.edu/papers/100498
Mabud, Mohammed A.Bangladesh Population: Prospects and Problems. NorthSouthUniversity,
Dhaka, 2008
Ministry of Health and Family Welfare (Bangladesh). 2011. Strategic Plan for Bangladesh
National Family Planning Programme 2012-2016. www.mohfw.gov.bd
Mridha, M. K., I. Anwar, and M. Koblinsky. 2009. Public-Sector Maternal Health Programmes
and Services for Rural Bangladesh. Journal of Health and Population Nutrition. Apr. 27(2);
124-138.
United Nations 2010.Returning to Bangladesh: A Guide for
Returnees;http://www.unescap.org/esid/psis/meetings/AgingMipaa2007/Bangladesh.pdf .
USAID | DELIVER PROJECT, Task Order 1. 2011. The Logistics Handbook: A Practical Guide
for the Supply Chain Management of Health Commodities. Arlington, Va.: USAID |
DELIVER PROJECT, Task Order 1.
37. 27
ANNEX A. OTHER DATA
Table A-1. FWG Meeting on March 18, 2012; Venue: DGFP/IEM Conference Room
SL # Name Designation
1 Dr. S.A. FidaHasan PM (FSDP), DGFP
2 AmitaDey DPM (FSDP), DGFP
3 Mohammad Shahidul Islam Education Team Leader–USAID
4 Dr.Md.AbdurRaquib AD (QA), CCSDP
5 Md. Abdul Baten AD (L.Proc),L&S Unit DGFP
6 Md. HumayenKabir Asst. PM, DGFP
7 A.K.M. Rokunuzzaman AD(MP), IEM, DGFP
8 SharifMd.ShazedulAlam Assistant Director (L&S),MCH-Service Unit DGFP,
Dhaka
9 Dil Ara Banu Sr. Instructor, NIPORT
10 Dr. Shaif Moh. Ismial Hossain Associate, Population Council
11 Dr. Margub Aref Jhangir NFPP/UNFPA
12 AfsanaTahir Operation Manager, UNFPA
13 Jalal Uddin Ahmed Hossain Director, DGFP
14 Md. Zahiuddin Babar Director (MIS), DGFP
15 Md. Rokon Uddin Asst. Director (Coordinator)
16 Khurshid Islam FPO (CR), L & S Unit
17 Jalal Uddin Ahmed FPO, L&S Unit
18 Md. Momtaz Uddin DD (L&S)
19 Sultana Zakaria Akhter Asst. Director (L&S,) L&S Unit
20 Md. Saiful Islam Additional Director, L&S Unit
21 Sankar LalBarai Proc. Specialist, GFA Consulting Group
22 Md. Lutfur Rahman FPO (LR), L&S Unit, DGFP
23 Md. Shahadat Hossain Procurement Officer, L&S Unit
24 Dr. Rounoq Sultana DPM (FSDP), DGFP
25 Md. Zame Alam Program Manager, CCSDP-DGFP
26 Mohammed Ahsanul Alam Evaluation Specialist NIPORT
27 A.K.M. Zahanur Islam Deputy Director Admin, NIPORT
28 M.M.Neazuddin DG-FP
29 Sabina Parveen Asst. Director (F.Proc.) L&S Unit
30 Md. Shahjahan Ali PA. L&S DGFP
31 Mohammad Badsha Hossain DPM. IEM, DGFP
32 Md. Mortaza Ali DG-FP
33 Abdul DGFP
34 Andualem Oumer Consultant, MSH/SIAPS Program
35 Dr.S.Giashuddin Consultant, MSH/SIAPS Program
36 Dr. Mahbubur Rahman LA-CCSDP
37 GolamKibria Senior Technical Advisor –MSH/SIAPS Program
38 Dr. Zubayer Hussain Country Director- MSH/SIAPS Program
38. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
28
Table A-2.DDS KitUsage Rates per Health Care Category and Number of Facilities
S.no Service center (SDP) name
Updated
number
DDS kits/
month/SDP
1 MCHIT, Azimpur, Dhaka 1 8
2 Fertility Services and TrainingCenter, Mohammadpur, Dhaka 1 2
3
A) High-performing MCWC at district level 23 4
B) Other MCWC at district level 74 3
4 MCWC, Agrabad, Chittagong 1 1
5 FWVTI, Rajshahi 1 1
6
A) EOC operating MCWC at Upazila and Union 10 2
B) Non-EOC operating MCWC at Upazila and Union 28 1
7 MCH Unit at Upazila Health Complex (FP clinic) 485 1
8
A) Improved UHFWC 1,500 1
B) Other UHFWC 2,225 1
9 Rented or Union Parishad Clinic 200 0.5
10 Rural Dispensary (FWV) family welfare visitor posted 1,362 0.5
11 Family Planning Model Clinic (Medical College Hospital attached) 16 1
12 Mohanagar Satellite Clinic, Basabo, Dhaka 1 1
13 For satellite clinic activities 30,000 0.01
Total 35,928 28
Table A-3. Base Year Population by Age and Sex (Census 2001)
Age Male (‘000) Female (‘000) Total (‘000)
0-4 8778.3 8108.8 16887.1
5-9 9261.7 8351.9 17613.6
10-14 8839.2 7802.0 16641.2
15-19 6604.9 5953.4 12558.3
20-24 5100.7 6358.5 11459.2
25-29 5138.3 6157.2 11295.5
30-34 4527.5 4656.6 9184.1
35-39 4412.9 3983.7 8396.6
40-44 3596.4 2912.4 6508.8
45-49 2740.4 2089.7 4830.1
50-54 2283.6 1917.3 4200.9
55-59 1374.5 1099.3 2473.8
60-64 1605.0 1364.4 2969.4
65-69 854.6 660.3 1514.9
70-74 971.8 734.2 1705.9
75-79 375.7 270.5 646.1
80+ 609.1 520.1 1129.1
Total 67076.0 62941.1 130017.1
40. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
30
Table A-6. Proportion of Married Women of Reproductive Age Group
BDHS 93 BDHS 96 BDHS 99 BDHS 04 BDHS 07
15-19 47.8 49.4 48.8 46.6 48.6
20-24 84.3 79.8 78.7 81.7 82.8
25-29 93.8 91.1 89.4 92.1 91.9
30-34 91.0 91.4 90.9 93.2 92.8
35-39 89.9 90.1 87.6 88.1 89.5
40-44 87.6 85.4 82.9 82.7 85.2
45-49 83.7 80.1 83.1 80.9 77.8
Total 81.3 79.8 78.8 79.7 80.4
Table A-7. Abortion/MR Rate by Age Group
Age groups BDHS 96 BDHS 99 BDHS 04 BDHS 07 Period 2012-2016
15-19 3.40 3.20 4.20 3.60 3.60
20-24 3.30 3.40 4.00 3.90 3.65
25-29 4.10 3.90 5.20 3.60 4.20
30-34 4.20 5.50 6.20 4.60 5.13
35-39 5.20 7.30 6.40 6.30 6.30
40-44 3.40 6.80 8.30 8.00 6.63
45-49 5.30 7.40 8.00 12.60 8.33
Total rate 3.80 4.20 5.00 4.20 4.30
Table A-8. Percentage of Sterility Coefficient
BDHS 93-94 BDHS 96 BDHS 99 BDHS 04 BDHS 07 2012-2016
0.7 1.4 1.6 1.4 2.6 2.6
Table A-9. Public Sector: Total Commodity Requirements by Method, Quantity, and Value
Commodities
Total quantities
(2012-2016)
Total values (in BDT)
(2012-2016)
Progestin-only pill 580,204,320 3,423,205,488
Injectable-medroxyprogesterone acetate 150 mg/ml in 1ml 80,488,563 2,414,656,890
Male condom 671,459,920 1,289,203,046
Implant - Jadelle (2 rods) 437,874 665,568,480
Implant - Implanon (1 rod) 1,751,495 2,351,311,978
IUD copperT380A 2,000,376 54,350,216
10,198,296,098
Total USD 124,369,464
Table A-10. Number of New Acceptors During Forecasted Period 2012-2016
41. Annex A
31
2012 2013 2014 2015 2016 Total
Female sterilization 89,916 89,594 89,890 90,586 80,465 440,451
IUD 333,695 393,503 455,343 519,327 339,331 2,041,199
Male sterilization 67,280 68,910 70,683 72,563 66,384 345,820
Implant 346,493 403,407 462,365 523,422 453,682 2,189,369
NSV and Tubectomy 157,196 158,504 160,573 163,149 146,849 786,271
Total 837,385 955,415 1,078,282 1,205,898 939,862 5,016,842
Table A-11. Public Sector: DDS Kit Requirements by Quantity and Value
Commodity Unit Unit price
Total quantity per
month
Total value per
month
Total value
per year
DDS kit each $125.00 5,929 $741,169 $8,894,025
43. 33
ANNEX B. LIST OF BOOKS AND REPORTS CONSULTED AND CONTRIBUTORS
DGFP annual reports
National Strategy on Reproductive Health Commodity Security for Bangladesh DGFP
August 2010
Supply manual, DGFP 2006
Quantification reports 2001
The following experts and institutions were contacted to obtain more data and information on the
FP.
Md.Kafil Uddin, Line Director, L&S unit, DGFP
Dr. Sharif Mohammed Hossain, Associate, Pop Council
Dr. Zane Alam, Program Manager, CCSDP, DGFP
Dr.Fida Hasan, Program Manager, FSDP
Ms. Khursida, Programmer, MIS
Md. Abdullah, Senior Technical Advisor-Logistics
Abdullah Imam Khan, Senior Technical Advisor-Procurement
44. 34
ANNEX C. SHIPMENT SUMMARY BY SUPPLIER
Table C-1. Supply Planning by Products
PipeLine 5.1
Run Date: July 26, 2012
Report Period: January 2012-December 2014
DGFP Bangladesh: NEW-Mor-Demog-basedSP
Status: Planned, ordered, shipped, arrived, received
Supplier: Government of Bangladesh/TBD
Product Funding Receipt date Quantity Status ID Total cost
a
IUD
IDA July 31, 2012 500,000
Ordered
153 180,000
Not selected
Aug 31, 2012 400,000 184 144,000
Oct 31, 2014 208,393 Planned 201 75,021
IUD total 399,021
Male condom IDA
Jan 3, 2012 4,800,000
Received
139 108,480
Jan 5, 2012 4,800,000 140 108,480
Jan 12, 2012 14,400,000 141 325,440
Jan 29, 2012 8,050,000 142 181,930
Feb 29, 2012 4,800,000 146 108,480
Apr 18, 2012 5,202,000 118 117,565
Male condom total 950,375
Oral pills (progestin only) Shukhi
IDA July 31, 2012 150,000,000 Ordered 109 10,500,000
Not selected
Oct 31, 2013 51,364,646
Planned
198 3,595,525
March 31, 2014 50,703,172 199 3,549,222
Sept 30, 2014 58,042,872 200 4,063,001
Oral hormonal contraceptive total 21,707,748
RH/DDS kit
GOB
Apr 30, 2012 3,000
Received
159 375,000
May 20, 2012 11,845 158 1,480,625
IDA Aug 31, 2012 60,000 Ordered 112 7,500,000
Not selected
Jan 31, 2013 28,087
Planned
186 3,510,875
Apr 30, 2013 17,787 187 2,223,375
Aug 31, 2013 23,716 188 2,964,500
Nov 30, 2013 17,787 189 2,223,375
May 31, 2014 35,574 212 4,446,750
RH/injectables KfW Mar 27, 2012 3,600,000 Received 111 3,024,000
45. Annex C
35
Product Funding Receipt date Quantity Status ID Total costa
IDA July 31, 2012 10,000,000 Ordered 110 3,800,000
GOB July 31, 2012 2,000,000 Ordered 163 760,000
Not selected
June 30, 2013 6,833,673
Planned
202 2,596,796
Nov 30, 2013 6,685,924 203 2,540,651
Apr 30, 2014 6,972,220 204 2,649,444
Oct 31, 2014 8,050,633 210 3,059,241
RH total 43,154,631
Subdermal implant/double rod IDA July 30, 2012 130,000 Ordered 157 2,470,000
Not selected
July 31, 2013 38,689
Planned
205 735,091
Dec 31, 2013 42,161 206 801,059
May 31, 2014 42,768 208 812,592
Nov 30, 2014 46,236 209 878,484
Subdermal implant/single rod IDA July 30, 2012 350,000
Ordered
113 5,873,000
GOB July 30, 2012 321,000 115 5,386,380
Not selected Aug 31, 2014 180,799 Planned 211 3,033,807
Subdermal implant total 19,990,413
GOB/TBD total 86,202,189
Grand total 86,202,189
a
Total cost = product cost + freight; in this case, freight = 0, so product cost = total cost
46. National Reproductive Health Commodities Quantification Bangladesh 2012-2016
36
Table C-2.Supply Planning by Products
PipeLine 5.1
Run Date: 26-Jul-12
Report Period: Jan 2012 - Dec 2014
DGFP Bangladesh: NEW- Mor-Demog- basedSP
Category: all
Supplier: GOB
Status: planned
Product Funding Receipt date Quantity Status ID Total costa
IUD Not selected Oct 31, 2014 208,393 Planned 201 75,021
IUD total 75,021
Oral pills (progestin only) Shukhi Not selected
Oct 31, 2013 51,364,646 Planned 198 3,595,525
March 31, 2014 50,703,172 199 3,549,222
Sept 30, 2014 58,042,872 200 4,063,001
Oral hormonal contraceptive total 11,207,748
RH/DDS kit Not selected
Jan 31, 2013 28,087 Planned 186 3,510,875
Apr 30, 2013 17,787 187 2,223,375
Aug 31, 2013 23,716 188 2,964,500
Nov 30, 2013 17,787 189 2,223,375
May 31, 2014 35,574 212 4,446,750
RH/injectables Not selected
June 30, 2013 6,833,673 Planned 202 2,596,796
Nov 30, 2013 6,685,924 203 2,540,651
Apr 30, 2014 6,972,220 204 2,649,444
Oct 31, 2014 8,050,633 210 3,059,241
RH total 26,215,006
Subdermal implant/double rod Not selected
July 31, 2013 38,689 Planned 205 735,091
Dec 31, 2013 42,161 206 801,059
May 31, 2014 42,768 208 812,592
Nov 30, 2014 46,236 209 878,484
Subdermal implant/single rod Not selected Aug 31,2014 180,799 Planned 211 3,033,807
Subdermal implant total 6,261,033
GOB/TBD total 43,758,809
Grand total 43,758,809
a
Total cost = product cost + freight; in this case, freight = 0, so product cost = total cost