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GUATEMALA’S FAMILY

PLANNING TRANSITION

Successes, Challenges, and Lessons

Learned for Transitioning Countries

ATTAINING SUSTAINABLE FINANCING FOR

FAMILY PLANNING IN SUB-SAHARAN AFRICA

ACCRA, JANUARY 2018

JAY GRIBBLE

Guatemala:

Country Profile

• Area: 109,000 square km –similar to Malawi, Eritrea, Benin, and Liberia

• Population: 16 million – similar to Malawi, Zambia, Senegal, and Zimbabwe

– 40% indigenous population

– 60% Catholic + 30% other Christian

• Guatemala’s demographics have produced a number of barriers to access

– Cultural appropriateness of services and religious acceptability of contraception

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Guatemala:

Family Planning Progress

Contraceptive prevalence

rate (CPR), modern and

traditional, 1999 vs. 2015

0%

10%

20%

30%

40%

50%

60%

70%

1999 2015

CPR, traditional methods

CPR, modern methods

Total fertility rate,

1999 vs. 2015

0

1

2

3

4

5

6

1999 2015

Making Family Planning a National Priority in

Guatemala

• 2001: Social Development Law

– Individual’s rights about sexual activity and reproductive health

– Reproductive Health Program

– Access to and information about both natural and artificial family

planning methods

• 2005: Law of Universal Access to Family Planning

– Sustainable access to contraceptive methods

– Creates National Commission for Contraceptive Security (NCCS)

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Guaranteeing Access to Family Planning

Commodities

• 2004: Alcohol Tax Law

– Establishes a tax of 6–8.5% on alcoholic beverages

– Minimum of 15% of revenue for family planning/reproductive health

• 2006: Reproductive health line item established

• 2010: Safe Motherhood Law

– 30% alcohol tax earmark for purchasing contraceptives

– Increased accountability in the use of resources for family planning

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Guatemala Legislation Related to Family Planning

Since 2001

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NCCS

established

Public Domestic Resource Mobilization for Family

Planning

Revenue and Allocations from Alcohol Tax

Source: HP+, 2017 7

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Achieving Sustainable, Domestic Financing

Share of Ministry of Health contraceptive purchases covered by domestic

resources

Source: HP+, 2017

Advocacy for Family Planning as a National Priority

Lighting the Spark

• July 2003 – USAID launched a series of regional exchanges

on contraceptive security

– Motivated country-level contraceptive security champions

– Developed common vision family planning sustainability

9USAID DELIVER PROJECT, 2013, http://jsi.com/JSIInternet/Inc/Common/_download_pub.cfm?id=16387&lid=3

Advocacy for Family Planning as a National Priority

Championing Family Planning

• USAID-trained advocates led the way in advocating for family planning

and contraceptive security laws

– Engaged journalists and undertook public education campaigns

– Coalesced broad support for family planning/reproductive health

• Understanding of various political actors, their positions, and power is

important for effective advocacy

– Political economy analysis

• Budget advocacy as a critical tool in ensuring sufficient sustainable

family planning financing

– to be discussed in later session

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Putting the Law into Practice

National Commission for Contraceptive Security

• Established by law in 2009

• Comprised of nine organizations: six public,

three private

• Advocates for the availability of

contraceptive commodities to guarantee

access to family planning methods

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Member organizations: Ministry of Health

and Social Assistance; Guatemala Social

Security Institute; Ministry of Public Finance;

Association for Family Well-being; Presidential

Secretariat for Women; Guatemala Women’s

Association; Guatemalan Association of

Women Doctors; Agency for Health Policy

Action and Women’s Development;

Department of Protection of Ingenious Women

• Conducts strategic planning and forecasting of commodity needs

– Market Segmentation Strategy (2013)

– Projects contraceptive demand and resource requirements from public and private sources to ensure the availability of sufficient commodities

– National Strategy for Family Planning, 2014–2020

– Establishes targets for contraceptive prevalence and unmet need, as well as intermediate objectives for financing and availability of contraceptive commodities, service delivery, and quality

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• Formed in 2008

• Comprised of 12 organizations: one public, 11 private

• Political arm of NCCS

• Network of departmental-level watchdogs through member organizations

– Closer to population

– Greater transparency, responsiveness

Ensuring Transparency in

Implementation Network of Reproductive

Health Watchdogs

Member organizations: Faculty of Medical Sciences, University of San

Carlos; Faculty of Medical Sciences, University of Mariano Gálvez; USAC

University Women’s Institute; Agency for Women’s Health and

Development; College of Doctors and Surgeons; Guatemalan Gynecology

and Obstetrics Association; Guatemalan Association of Women Doctors;

Association for Family Well-being; Foundation of Eco-Development and

Conservation; World Vision; Plan International; GOJoven International

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Applying Guatemala’s Experience

Lessons for Transitioning Countries

• Transition planning must begin well before “graduation”

– Legal framework is necessary, but not sufficient

– Implementation and compliance requires accountability

mechanisms, monitoring, and transparency

• African countries may be further along than Guatemala was in 2000

– Existence of family planning laws

• Still work to be done…

– Need for designated funding streams

– Need appropriate accountability mechanisms to ensure fulfillment

of legal and financial commitments

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Health Policy Plus (HP+) is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-15-00051, beginning August 28, 2015. HP+ is implemented by Palladium, in collaboration with Avenir Health, Futures Group Global Outreach, Plan International USA, Population Reference Bureau, RTI International, ThinkWell, and the White Ribbon Alliance for Safe Motherhood.

This presentation was produced for review by the U.S. Agency for International Development. It was prepared by HP+. The information provided in this presentation is not official U.S. Government information and does not necessarily reflect the views or positions of the U.S. Agency for International Development or the U.S. Government.

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In the summer of 2003, USAID's Bureau for Latin America and the Caribbean (LAC) launched a regional initiative to strengthencontraceptive security (CS) in eight countries. Nine years later, the LAC CS Regional Initiative has built a South-to-South exchangenetwork by motivating country-level CS champions to work together toward achieving a common goalincreasing access to familyplanning (FP) services and supplies throughout the region.

This is an accessible version of the time line presented on page 9.

2003

Launching LAC CSInitiative ForumManagua, Nicaragua, July

• Completed country/regionalassessments.

• Formed most of LAC CS committees.

2004

Regional LAC CS ForumLima, Peru, October• Assessments presented.Assessments presented.• Country CS actionCountry CS action

plans developed.plans developed.

2005LAC CS State of the PracticeEventWashington, DC, USA,September• Donors and partners committed

to coordinating CS more closely.• g gLAC recognized as a global CS

.leader leader.

Advocating for CS EventAntigua, Guatemala,SeptemberSeptember• Shared country market analyses.Shared country market analyses.• Strengthened country commitment toStrengthened country commitment to

improving access to FP. improving access to FP.

2006 2007

Reproductive HealthSupplies Coalition GlobalCS Event on LACLondon, England, April• Shared LAC approach

globally. • Recognized countries for

policy, supply chain, andprocurement models.

Supply Chain under HealthReform WorkshopSanto Domingo, DominicanRepublic, September• Supply chain and CS recognized

as building blocks ofhealth reform.

• FP better protectedduring integrationand decentralization.

2008

Equity and CS EventAntigua, Guatemala,SeptemberStrengthened countrycommitment to improvingaccess to FP.

2009

Options for ContraceptiveProcurement WorkshopCartagena, Colombia,SeptembeSeptember

• • ParticipanParticipants oriented to bestpracticespractices for procurement.

• • PaPartners better informedtooo oto support these practices.

• Procurement mechanismsimproved in several countries.

Public-Public Alliances for Equityin FP WorkshopManagua, Nicaragua, May

• Public institutions committed to bettercoordinating services.

• ocialIncreased commitment of Social Security Institutes t o hen strengthen FP programs.

• Increased coveragein some countries.

2010

Successes and Challenges to Achieve CS EventPunta Cana, Dominican

eRepublic, JunegggggSeven countries signedned

a declaration affirmingming their commitmentto CS.

Joint USAID | Health Policy Projectand USAID | DELIVER PROJECTRegional Meeting: Commodity SecurityCommittees in LAC Asuncion, Paraguay, DecemberCountry delegations agreed to apply CSCommittee lessons learned to help achievemore sustainable programs.

2011

South to South ExchangeWorkshop: Learning aboutAlternatives for Efficient andSustainable ContraceptiveProcurement in the Public SectorLima, Peru, May

Country delegations committed toexploring the diversification ofprocurementoptions in theircountries.

2012

A Call to Action: AdvancingContraceptive Security byImproving Access forAdolescents and Youth Guatamala City,Guatamala, June

Two-country teams (includingadolescents) formed toimplement and monitor theirwork plans.