Innovative Approaches to Improve Contraceptive Security in Romania GHC 32nd Annual Conference, May 31 - June 3, 2005 Health Systems: Putting Pieces Together

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Innovative Approaches to Improve Contraceptive
Security in RomaniaGHC 32nd Annual Conference,
May 31 - June 3, 2005Health Systems Putting
Pieces Together
Laurentiu Stan, M.D., MPH Program Coordinator,
JSI/Romania Romanian Family Health Initiative
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Romanias RH Situation in 1999

• Contraception banned before the revolution
• 1999 RHS CPR for modern methods of 29.5
• Low TFR of 1.3
• High abortion rate 2.2 per woman
• One of the highest maternal mortality rates in
  Europe half is due to abortion
• Only Ob/Gyn and FP clinics were providing FP
  services

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Abortion and Unmet Need for Modern Contraceptives
Among Women in Romania
Data source 1999 Romanian Reproductive Health
Survey
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Romanian Family Health Initiative, 2001-2006 FP
Strategy

• Increase access to FP services, by integrating
  them into PHC
• Strategic approach training, increase awareness
  and contraceptive supplies
• LMIS at national, district, and provider levels
• Strong, active partnership - MOH/District
  Public Health Authorities - Romanian NGO
  Society for Education on Contraception
  and Sexuality - Donors USAID and UNFPA
  (national, regional)

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A Successful First Year! 2002
Data source MOH/SECS LMIS database
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Contraceptive Security for Romania

• Coordinated contraceptive procurement
  (government-donors)
• Annual MOH procurement
• Targeting of free contraceptives
• Eligibility criteria for free contraceptives
• Payment of FP services for uninsured
• A functional logistics system (LMIS) for free
  supplies
• Expanded participation of private sector
• Collaborate with social marketing programs
• Limited contraceptives in the list of subsidized
  commodities for the Insurance House (NHIH)

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Government Procurement

• Based on annual forecasting, using LMIS data
• Ensure the national method-mix, but procure only
  one brand of contraceptive per method
• Product selectionknowledge of international FOB
  prices
• Follow WHO recommendations and list of EU
  approved drugs for bidding documents

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Targeting Free Contraceptives- Women of
Reproductive Age -
Data sources 1993, 1999, 2004 Romanian
Reproductive Health Survey
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A Functioning Logistics System

• Use the existing infrastructure build on
  already existing systems (e.g. vaccination)
• Respect the financial accountability regulations
• Use vertical distribution and reporting
  procedures, regardless of source
• Tailored with health reform efforts, particularly
  decentralization
• Easy to use

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Logistics System for Free Contraceptives
Ministry of Health
Donors (UNFPAUSAID)
MIS consultativegroup

National Procurement
JSI/Romania
Procurement Unit, Institute of Public Health
Bucharest
District Public Health Authorities
FP clinics
NGO clinics public abortion departments
PHC clinics (Family Doctors)
Legend
Funds
Free of charge contraceptives
MIS reports for 24 districts
MIS reports for 18 districts
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Coverage with FP Providers
September 2001
Produced with ArcMAP 8.3 Courtesy of ESRI Romania
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Coverage with FP Providers
December 2004
Produced with ArcMAP 8.3 Courtesy of ESRI Romania
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Active Users of Pills from FP Program and Private
Sector (including SM)
Data sources MOH LMIS database and private
sector sales in Romania database
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Trends of Contraceptive Prevalence (CPR) and
Abortion Rate for Rural Women
Data sources 1993, 1999, 2004 Romanian
Reproductive Health Survey
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MOH Financing of National Family Planning
Program
Data sources Romania MOH budget for National
Programs
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Conclusions

• LMIS is a key component for improving
  contraceptive security in Romania
• Tailored with existing service provision
  infrastructure
• Forecasting for government procurement
• Timely and effective distribution
• Market segmentation is important
• Target free supplies to the most vulnerable
  populations (low income, low access)
• Collaboration government-NGOs-private sector

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Future Priorities

• Sustainable contraceptive security plan
• Integration of other RH services into PHC,
  following the model of FP program prenatal care
• Inclusion of contraceptives in the Health
  Insurance list
• Full coverage with FP/RH services in rural areas
• Functional integration of all PHC providers
  community nurses, Roma health mediators
• Improve the referral system between PHC level and
  specialists