Advances and Challenges in Family Planning in Nicaragua Contraceptive Security Committee NicaraguaApril, 2007

NICARAGUA

Surface: 121,428Km210,333Km2 are lakesLargest Central American Country in territorial land extensionTerritorial Administrative Division :15Departments2Autonomous Regions/Caribbean Coast Municipalities

These Autonomous Regions and Municipalities have elected Authorities with descentralised compentences.

Population: 5. 400 000 inhabitants

AdvancesFamily Planning in Nicaragua

Total Fertility Rates and Contraceptive Prevalence RatesFuente: ENDESAS 1993, 1998, 2001 Contraceptive Prevalence by residenceAll methods included.

Percentage of Health Units with adequate Contraceptive SuppliesSource: Annual Evaluation of logistic indicatorsMINSA (Ministry of Health) DELIVER 2005 MINSA 2001-2005

Stakeholders progress (Public sector, NGOs) MINSA (Ministry of Health, MoH)Sexual and Reproductive Health National StrategyHigh prevalence of modern contraceptive methodsBudget support for contraceptive procurementLogistic System: Integrated and operatingINSS (Social Security National Institute)Regulatory Framework for Family Planning (FP) in Private Clinics outsourced by INSSInformation Education Communication (IEC) Campaign to foster demand.NGOsStrengthening of the Community distribution networkLaunching of a Contraceptive Social Marketing StrategyTRANSVERSAL STRATEGYContraceptive Security Plan (DAIA).

CS Committee BackgroundPhasing out of USAID contraceptive funding

Need to maintain the FP accomplishments

Regional Meetings sponsored by Deliver USAID were the starting point of the CS Committee in Nicaragua

NICARAGUA CS COMMITTEE

Goals: Contribute to the reduction in maternal and child mortality and in total fertility rate according to National policies and guaranteeing the sustainable and equitable contraceptive availability in Nicaragua, with the active collaboration between the Government, civil society, private sector and donor community.

NATIONAL CS COMMITTEE:

An interinstitutional and multidisciplinary group that offers counselling and technical support to the public and private sector. This committee facilitates the contraceptive security in Nicaragua.

Committee Members:

GOVERMENTNGOsUSAID PROJECTSAGENCIESMINSA (MoH)PROFAMILIADELIVERUNFPAINSS (Social Security)NicaSaludQAP USAIDPASMO PRONICASS

CS CommitteeChaired by MoHHas a technical secretariatOrganises periodical meetingsCS Committee in Nicaragua has:StatutesBylawsWorking plan

ChallengesFamily Planning in Nicaragua

Prevalence and unmet need by quintilesFuente: ENDESA 2001Population not wanting to use FP

Users by quintile and method sources

Trends of contraceptive funding MoH Nicaragua 2001 - 2008Source: USAID/Deliver ProjectU$ 713,044

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46172610306729000

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USAID

UNFPA

MINSA

MILES DOLARES

TENDENCIA DEL FINANCIAMIENTO DE ANTICONCEPTIVOS MINISTERIO DE SALUD NICARAGUA 1999-2009

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USAID

UNFPA

MINSA

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46172610306729000

42845068012281090

554645405342462218

5778330713044

USAID

UNFPA

MINSA

Hoja1

19992000200120022003200420052006200720082009TOTAL

USAID442,47275,013913,031887,141905,809773,1821,089,894461,726428,450554,645577,8337,109,196

UNFPA510,90861,901146,814455,041405,737394,7831,017,9451,030,672680,122405,34205,109,265

MINSA00000009,00081,090462,218713,0441,265,352

TOTAL953,380136,9141,059,8451,342,1821,311,5461,167,9652,107,8391,501,3981,189,6621,422,2051,290,87713,483,813

200120022003200420052006200720082009

USAID913,031887,141905,809773,1821,089,894461,726428,450554,645577,833

UNFPA146,814455,041405,737394,7831,017,9451,030,672680,122405,3420

MINSA000009,00081,090462,218713,044

Hoja2

Hoja3

Stakeholders ChallengesMoHGradually buying contraceptive supplies since 2007 Improves the demand equity and fundings between contraceptive usersFocus the resources on the most vulnerable populationsFoster cost-effective options of the contraceptive basketKeep the Logistic System operatingINSS (National Social Security Institute)Guarantee 100% contraceptive coverage for female insured and beneficiariesIdentify procurement mechanisms to guarantee sustainable supplies to the clinics NGOsReach the sector with ability to pay that still uses free servicesFacilitate the access to contraceptive methods at affordable pricesAchieve behavioural changes in the use of contraceptive methods

TRANSVERSAL CHALLENGESAchieve the full exercise of reproductive rights for Nicaraguans, reduce the unmet need, improve gender equity and achieve the financial and programme sustainability.

Si comparamos la brecha de necesidad insatisfecha, segn los tipos de mtodos, se observa un porcentaje ms alto en los quintiles ms pobres.

La estrella seala el % de la poblacin que no utiliza ni desea mtodos; poblacin que debe llamar la atencin al Gobierno porque incrementa la TGF. Con mayor educacin en salud, esta poblacin tendr necesidades no satisfechas para espaciar o limitar sus embarazos.