Contraceptive Security Strategic Plan for Egypt 2006-2010

Publication date: 2006

Contraceptive Security Strategic Plan for Egypt 2006–2010 July 2006 National Population Council The USAID | Health Policy Initiative, Task Order 1, is funded by the U.S. Agency for International Development under Contract No. GPO-I-01-05-00040-00, beginning September 30, 2005. Task Order 1 is implemented by Constella Futures, in collaboration with the Centre for Development and Population Activities (CEDPA), White Ribbon Alliance for Safe Motherhood (WRA), and World Conference of Religions for Peace (WCRP). To obtain copies of this report, please contact: Director, Health Policy Initiative; Constella Futures; One Thomas Circle, NW, Suite 200; Washington, DC 20005; USA. Email: policyinfo@healthpolicyinitiative.com. Contraceptive Security Strategic Plan for Egypt 2006–2010 July 2006 ii Table of Contents Abbreviations. iii Executive Summary . iv Introduction. 1 Situation Analysis of Contraceptive Security in Egypt . 2 Development of the Contraceptive Security Strategic Plan. 3 Summary of Contraceptive Security Plan for Egypt: 2006–2010 . 5 Appendix A: Egypt Strategic Plan for Family Planning and Contraceptive Security 2006–2010 . 13 Component 1: Finance . 14 Component 2: Collaboration and Coordination. 23 Component 3: Service Delivery. 31 Component 4: Logistics . 39 Component 5: Advocacy . 47 Appendix B: Budget . 53 iii Abbreviations BBP Basic Benefit Package CDPA Central Department of Pharmaceutical Affairs CFPC Contraceptives Forecasting and Procurement Committee CPI client provider interaction CPR contraceptive prevalence rate CS contraceptive security CSSP Contraceptive Security Strategic Plan for Egypt 2006–2010 CSWG Contraceptive Security Working Group EDHS Egypt Demographic and Health Survey EPTC Egyptian Pharmaceutical Trading Company FP family planning GOE government of Egypt HSR health sector reform LMIS logistics management information system MCH maternal and child health MDG Millennium Development Goal M&E monitoring and evaluation MIS management information systems MOF Ministry of Finance MOHP Ministry of Health and Population MWRA married women of reproductive age NGO nongovernmental organization NPC National Population Council PS population sector RH reproductive health QA quality assurance SDP service delivery point SPARCHS Strategic Pathway for Reproductive Health Commodity Security TOT training-of-trainers TFR total fertility rate USAID United States Agency for International Development WRA Women of reproductive age iv Executive Summary Contraceptive Security exists when all persons are able to choose, obtain, and use high-quality contraceptives whenever they need them. If Egypt is to achieve its national goal of reaching replacement level fertility by the year 2017, it must move toward contraceptive security. The benefits of the family planning (FP) program during the past 25 years have been substantial, resulting in a smaller population with a more favorable age distribution and lower infant, child, and maternal mortality rates. Continuing the progress that has been made to date in the population and FP program will build on these successes and continue to aid in Egypt’s comprehensive development programs. Failure to do so will result in continued population growth and growing pressure on national development, especially social sector spending and limited natural resources. To continue to reap the benefits of a smaller population, the government of Egypt (GOE) must clearly articulate its plans to limit population growth. Although many advances have been made in the population and family planning program, challenges do remain. In addition to the USAID phase out of support for contraceptives, with the last deliveries being made in 2006, there exist other financial, logistical, programmatic, and quality issues that may limit Egypt’s ability to achieve contraceptive security, if they remain unresolved. The Contraceptive Security Strategic Plan for Egypt 2006–2010 (CSSP) was developed in consultation among all concerned stakeholders. These include the Ministry of Health and Population (MOHP), National Population Council (NPC), Ministry of Finance (MOF), Ministry of Planning, Ministry of International Cooperation, NGOs, private sector, public and private sector pharmaceutical companies, donor agencies, technical support agencies, representatives from health and population committees in the Shura and People’s Assembly, heads of the physician and pharmacy syndicates, research institutes, and USAID cooperating agencies and projects like the Population Council, JSI/DELIVER, Frontiers in Reproductive Health Program, and the TASHEEN/POLICY and CATALYST projects. USAID provided technical assistance through the POLICY Project based in Cairo, Egypt. This plan was developed in response to a series of gaps identified by a Contraceptive Security Working Group and stakeholders. Gaps included financial pressures on public resources; insufficient financing for contraceptives; lack of adequate user fees and the absence of an exemption and waiver policy; limited information for decisionmaking; lack of appropriate quality control measures in manufacturing; commodity testing, and service delivery; lack of collaborative between sectors and partners working toward contraceptive security; and an overall lack of awareness of contraceptive security issues. The CSSP was developed to resolve these issues through five components focused on financing, collaboration and coordination, service delivery, logistics, and advocacy. All contribute to the goal of the Contraceptive Security Strategic Plan: to ensure that men and women can choose, obtain, and use, high-quality contraceptive services and commodities, whenever they want them, for planning their families. The estimated cost for the CSSP Year 1 activities is LE 720,199. Activities in Years 2-5 of the CSSP are anticipated to cost LE 799,380; however, costing should be updated annually to account for changes in activities or unit costs. The total costs include v existing direct costs such as salaries and vehicles; required new government investment; required new donor support via projects and/or direct investment; and indirect costs determined as a percentage of the total. Estimates of the commodity costs over the next decade anticipate annual cost growth rates of between 28 and 40 percent. The most likely scenario will result in commodity costs of LE 145 million in 2017.1 However, forecasting of commodity requirements for both budgeting and procurement should take place annually to ensure adequate stocks and to account for changes in the family planning environment, both domestically, and on the international market. The coordination and monitoring and evaluation processes for the CSSP fall within the overall responsibilities of the National Population Council (NPC). Implementation responsibilities will fall to the MOHP, NPC, the MOF, and various partners in the private, commercial, and NGO sectors. The CSSP identifies contraceptive security goals and activities for the years 2006 through 2010, which are intended to ensure that Egypt is achieving contraceptive security for all its citizens, in an environment of growing need for contraceptives and limited donor support. Completion of these activities will aid the GOE to reach its goal of replacement fertility. 1 Futures Group. 2005. Estimating MOHP’s Contraceptive Commodity Costs to 2017. Cairo, Egypt: Futures Group. 1 Contraceptive Security Strategic Plan for Egypt 2006–2010 Introduction The Population and Family Planning Strategy aims to reach replacement level fertility (2.1 children per woman) by the year 2017, as well as reduce child mortality rates by 66 percent and maternal mortality by 75 percent, as specified in the Millennium Development Goals (MDGs). To reach these goals by 2017, the GOE will need to expand reproductive healthcare services and increase utilization of FP among women of reproductive age (WRA) to 74 percent. To this end, it was necessary to integrate and coordinate all efforts related to FP within the context of the Contraceptive Security Strategic Plan for Egypt 2006–2010 (CSSP). The plan, conceived as a series of activities, took into consideration the current demographic situation as well as USAID’s plans for withdrawal from the procurement of contraceptives by 2007 and from the health and population sector by 2011. The total fertility rate (TFR) fell from 5.6 in 1976 to 3.1 in 2005; it is clear that increases in FP use have been a significant factor in this decline. During that same time period, the contraceptive prevalence rate increased from 18.9 percent to 59 percent, and data show this trend was due in large part to an increase in the number of service delivery outlets.2 A recent study elaborated the benefits of the FP program over the past 25 years (1980-2005). These have been substantial, resulting in • A population that is smaller by 12 million (nearly the size of Greater Cairo); • A more favorable age distribution—10 million fewer youth under the age of 15; • A lower infant mortality rate—over 3 million infant deaths averted; • A lower under-5 child mortality rate—approximately 6 million early-childhood deaths averted; and • Fewer maternal deaths—17,000 mothers’ lives saved.3 Although a great deal of progress has been made in the population and FP program, challenges do remain. In addition to USAID’s planned phaseout of support for contraceptives, with the last deliveries being made in 2006, there exist other financial, logistical, programmatic, and quality issues that may limit Egypt’s ability to achieve contraceptive security, if they remain unresolved. The Contraceptive Security Strategic Plan for Egypt 2006–2010 was designed to serve as a platform for the construction and reinforcement of a high-quality, sustainable family planning program that will allow Egypt to achieve contraceptive security. Thus, the CSSP should be viewed as an expression of the GOE’s commitment to a dynamic and proactive response to the nation’s population problems, to meeting the FP/RH needs of its citizens, and to achieving the MDGs. 2 Moreland, Scott. 2006. Egypt’s Population Program: Assessing 25 Years of Family Planning. Cairo, Egypt: POLICY Project/Futures Group. 3 Ibid. 2 Contraceptive Security in the Egyptian Context Contraceptive security exists when all persons are able to choose, obtain, and use high-quality contraceptives whenever they need them.4 Accordingly, in the Egyptian context, the goal of the CSSP is to ensure that men and women are able to choose, obtain, and use high-quality contraceptive services and commodities at a reasonable price, whenever they want them, for planning their families. Priority issues and challenges to be considered within the CSSP were identified by stakeholders during a workshop that was held in October 2004 and were further revisited and assessed through a series of meetings with these same stakeholders. The overall framework of the CSSP was the result of intensive discussion that took place during a second workshop held in March/April 2005. Initial discussions were followed by development of a draft framework articulated by the multisectoral Contraceptive Security Working Group (CSWG)5 later in 2005. This draft was refined through a series of meetings, workshops, retreats, and discussions. These fora focused on gaining consensus on a feasible approach to contraceptive security in Egypt from the CSWG and other key stakeholders. The CSSP is the result of this consultative process. As a partner in this effort, USAID, through its resident POLICY Project, has provided technical assistance throughout the process of developing the CSSP. Situation Analysis of Contraceptive Security in Egypt Current Status of Reproductive Health and Family Planning Egypt’s record on many reproductive health issues is impressive when judged against other nations in the region. This is largely a result of progress made in recent years. The 2005 Egyptian Demographic and Health Survey (EDHS) documented significant progress at various levels. The infant mortality rate during the five years preceding the survey (2001-2005) fell to 33 deaths per 1,000 births compared with 97 during the years 1981–1985. During the same period, under-five mortality declined to 41 per 1,000 births, compared with 139 deaths per 1,000 births in the earlier years. Similar progress was also noticeable with regard to maternal health indicators. The percentages of births whose mothers received regular antenatal care reached 58.5 percent in 2005 (28.3% in 1995), and those who were medically assisted in delivery rose to approximately 74.2 percent compared with 34.6 in 1988. In addition, approximately 89 percent of Egypt’s children are fully immunized by age one,6 and all of Egypt’s citizens have access to basic health services.7 However, the maternal mortality ratio is still 67 deaths per 100,000 live births. In 2005, the average ideal number of children in Egypt was 2.9 children, the same as the ideal number in 2000,8 indicating a preference for a 3-child family. The actual TFR is even higher (3.1 children). Both the actual TFR and the ideal number of children remain above the replacement fertility rate 4 USAID definition of contraceptive security. 5 Current membership in the CSWG is drawn from the Ministry of Health and the Ministry of Finance. 6 2005 EDHS Table 12.1 7 http://www.emro.who.int/emrinfo/index.asp?Ctry=egy#PHC_Concluded 8 2005 EDHS Table 9.6 3 of 2.1 children, the national goal for the year 2017. Ten percent of WRA have an unmet need for family planning and 32 percent of acceptors discontinue use within the first 12 months.9 In 2005, 59.2 percent of married women of reproductive age (MWRA) were using a contraceptive method. However, the number of MWRA is expected to grow by approximately 34 percent in the next 15 years. The demand for contraceptives is increasing annually as a result of both this continuous population growth and the GOE’s efforts to reach replacement level fertility by the year 2017. USAID will phase out their support for contraceptives by the end of 2006. The GOE has assumed gradual responsibility for these costs and is on track to assume full responsibility for contraceptive procurement when USAID ends its support. Contraceptive Security in Egypt: Programmatic Issues To achieve contraceptive security (CS), Egypt needs the following: • A supportive policy environment—commitment from top political and technical leadership and an effective policy • Appropriate contraceptive forecasting, procurement, distribution, and storage mechanisms • Adequate and sustainable financing • The identification and meeting of clients’ needs and demands for contraceptives and services • Effective coordination and collaboration between public and private sector stakeholders A meeting of the CSWG and other stakeholders identified the following issues as hampering the GOE’s ability to achieve CS: • Financial pressures resulting from USAID phaseout and lack of a long-term sustainability/financing plan • Lack of a targeted strategy where free commodities go to the poor while those who can afford to pay do so • Lack of timely and accurate information for decisionmaking • Conditions in which quality standards are not always disseminated and followed; • Lack of clear roles and responsibilities for stakeholders and partners in service delivery and policymaking • Inadequate advocacy capacity at all levels to raise awareness about contraceptive security The CSSP resolves these issues through a series of activities focusing on financing, collaboration and coordination, service delivery, logistics, and advocacy. Development of the Contraceptive Security Strategic Plan To respond to USAID’s phaseout of contraceptive support and achieve the national population goals, the GOE began development of a multi-partner contraceptive security strategy using the 9 2005 EDHS 4 Strategic Pathway for Reproductive Health Commodity Security (SPARHCS) approach in December 2003. Steps taken during 2001–2003 Activities completed during 2001–2003 supplied background for the contraceptive security strategic planning process and assisted with the preparation for phaseout of USAID support for contraceptives. The main activities were: • A Sustainability Strategy Conference was conducted in May 2001 to identify sustainability issues, proposed strategies, and policy dialogue outcomes. • A Contraceptive Commodity Cost Study, completed in 2002, projected costs for the following 15 years under 17 different scenarios. • The MOHP started to expand procurement of contraceptives in 2001 including: condoms (2001), all oral contraceptives and implants (Norplant and Implanon since 2002) as well as foam, and emergency contraceptives. • In July 2002, the USAID/Deliver Project carried out an assessment on the cost of contraceptive distribution systems to governorate-level warehouses. • In preparation for USAID phaseout of IUDs and injectables, the MOHP and USAID negotiated a letter of agreement in 2003. The key points were: o The last delivery of USAID-funded contraceptives will be in 2006. o The MOHP was to initiate IUD procurement in 2004, which it did. o The MOHP was to shoulder the full responsibility for the procurements of IUDs by the end of 2005 and for injectables by the end of 2006, which it is doing. • A number of studies conducted during this period provided useful information: o A Service Provision Assessment Survey was completed in 2002, which covered areas such as (a) storage and stock monitoring systems for contraceptive methods and medicines; and (b) ordering systems and timely receipt of commodities. o CIS Willingness to Pay Study. o Greater Cairo Slum Areas Population/RH Profile based on the 2003 EDHS. This also covered information about the cost of contraceptives and the amount users are willing to pay for IUDs, pills, and injectables. Contraceptive security strategic planning process during 2004–2006 • Awareness raising to develop a common understanding of contraceptive security o Conducted key informant interviews o Organized stakeholder meetings o Formed CS working group o Built capacity of the CS working group • Generating and mobilizing information for decisionmaking o Conducted a detailed situation analysis using the SPARHCS framework in January 2004 o Carried out a market segmentation and trend analysis using 1998, 2000, and 2003 EDHS data o Carried out a rapid assessment of the logistics system 5 o Identified broad and operational policy barriers o Analyzed the cost-benefit of FP program o Completed yearly FP cost studies • Developing the CS strategy and action plan o Held a workshop to identify and prioritize issues to be addressed (October 2004) o Organized small planning and policy dialogue meetings to develop goals and strategies o Conducted strategic planning workshop (March/ April 2005) o Conducted costing exercise for the CSSP with the Contraceptive Security Working Group (November 2005) o Held stakeholder discussions to validate CSSP (May-June 2006) o Advocated for the approval of the CS strategy and GOE funding obligation o Disseminated the CS strategic plan at a workshop in June 2006 Summary of Contraceptive Security Plan for Egypt: 2006–2010 Goal The overarching goal of the Contraceptive Security Strategic Plan for Egypt 2006 – 2010 is to ensure that men and women can choose, obtain, and use high-quality contraceptive services and commodities, whenever they want them, for planning their families. To reach this goal, the CSSP intends to: • Identify long-term and sustainable financing for FP commodities and services; • Improve the collaboration and coordination of the public, private, and NGO sectors; • Ensure that high-quality FP commodities and consistent services are provided by all sectors; • Strengthen the logistics, distribution, storage, and procurement systems; and • Create an environment conducive to achieving contraceptive security and reduce operational and policy barriers to this achievement. Components, Objectives, Activities, Indicators, Key Actors, and Estimated Budget Based on a review of issues affecting the nation’s ability to respond to contraceptive security goals, the population and family planning sectors of the MOHP coordinated a Contraceptive Security Working Group that identified objectives, activities, indicators, and key actors within five priority areas: Finance, Collaboration and Coordination, Service Delivery, Logistics, and Advocacy. The working group costed the activities based on detailed activity descriptions and identification of inputs and unit costs. An estimated budget is presented for the first year (2006) of activities, along with a probable budget for the following four years (2007–2010). The budget for years two through five should be reviewed annually, based on developments during the strategy’s first year of implementation. The estimated budgets are the total cost for conducting these activities. This amount includes existing direct costs such as salaries and vehicles; required new government investment; required new donor support via projects and/or direct investment; and indirect costs determined as a percentage of the total. The monitoring and evaluation process 6 for the CSSP falls within the overall responsibilities of the NPC, and timely periodic reports will allow corrective measures to be taken, if needed. Appendix A of this document presents a detailed presentation of each component of the Contraceptive Security Strategic Plan: 2006–2010. The plan’s components are summarized below. Component 1: Finance Strategic Objective: To provide the funding required for family planning commodities and services based upon actual need. Issues: Major issues confronting financial sustainability of the family planning program include the need for financial support, as well as current and reliable data, and ensuring that the poor and needy get subsidized family planning services and commodities. Activities: In addressing the above issues, the CSSP’s primary objective is to ensure the availability of long-term financial support from both the public and private sectors for contraceptive security in Egypt. As presented in Appendix A, the Finance component’s activities and sub-activities center on developing a financial management system and data flow mechanisms to enable managers to have needed financial information and resources; securing long-term financial support via a ring-fenced budget line item; exploring the feasibility of alternative financing mechanisms, such as including FP services in national social insurance strategies; and paying for commodities. Estimates of the commodity costs over the next decade anticipate annual cost growth rates of between 28 and 40 percent. The most likely scenario will result in commodity costs of LE 145 million in 2017.10 However, forecasting of commodity requirements for both budgeting and procurement should take place annually to ensure adequate stocks and to account for changes in the FP environment, both domestically, and on the international market. Finally, to ensure that the poor and needy can access subsidized family planning services and commodities, activities are included that will assess the feasibility of different forms of resource targeting and develop a resource targeting strategy. These will ensure that scarce resources are directed to the poor and needy, while those who can afford to pay do so. A sample of sub-activities includes: • Submitting a formal request for a ring-fenced budget line item for contraceptive commodities built on accurate forecasting and implementing an advocacy strategy to sustain the flow of funds into this budget line item • Allocating funds • Developing the rules and regulations for both the financial management system and the information system • Training managers and employees on the data flow and financial management systems • Conducting studies on the cost effectiveness of including FP commodities and services in insurance mechanisms and implementing an advocacy campaign based on the results 10 Futures Group. 2005. Estimating MOHP’s Contraceptive Commodity Costs to 2017. Cairo, Egypt: Futures Group. 7 • Conducting a study to explore the feasibility of charging user fees to those who can afford to pay, and holding roundtable discussions with key stakeholders to develop and implement user fees and exemptions • Implementing a user fee pricing structure and exemption mechanisms Indicators: It is expected that implementation of this component’s activities will result in the use of financial data for decisionmaking; funding from the government of Egypt, donors, and other sources for FP commodities and services; and a ring-fenced budget line item for contraceptives approved and operationalized. Success will be measured by: • Whether financial data is used to secure funding from GOE for FP commodities and services • The existence and use of timely data for decisionmaking by managers • Approval and operationalization of a ring-fenced budget line item for contraceptives • The presence of an enabling environment for CS alternative financing, as measured by: o Number of FP-positive statements made in last month by high-level policymakers o Number of CS positive messages in the media in the last month o Percentage of required funding for contraceptives allocated by the GOE • The percent of funding from the Services Improvement Fund allocated for contraceptives and/ or other CS activities • The percent of funding from donors allocated for contraceptives and/or other CS activities • Whether FP services and commodities are included in insurance mechanisms; and • The percent of people in the bottom two income quintiles receiving high-quality FP services Key Actors: Coordination for this component will occur through the NPC and the MOHP, with implementing responsibilities falling to the MOHP, the NPC, the Integrated MCH/FP/RH Project (TAKAMOL), the MOHP Financial and MIS Departments, and governorate authorities. Estimated Budget for Year 1: LE 83,700 Estimated Budget for Years 2–5: LE 246,629 Component 2: Collaboration and Coordination Strategic Objective: To strengthen collaboration and coordination among the public and private sectors, NGOs, and other stakeholders in achieving contraceptive security. Issues: Collaboration and coordination are crucial to the success of the contraceptive security strategic plan. This component is designed to promote partnerships in developing contraceptive security policies and programs among the public, private, and NGO sectors, ensure multisectoral organizational development for improved management of contraceptive security issues, and ensure proper coordination among different stakeholders in contraceptive security. In addition, it is imperative that an environment be created where it is politically and socially feasible for partners to collaborate. 8 Activities: To resolve the issues referenced above, activities include defining a mechanism to maintain cross-sectoral linkages, fostering communication and open dialogue between partners, and involving different partners in decision-making. Other activities under the Collaboration and Coordination component are the creation of a suitable environment to encourage investment in CS, the design and implementation of mechanisms for coordinating CS initiatives, and an effective M&E and policy analysis of the CS strategy. It also includes activities to strengthen organizational management capacity in the private and NGO sectors, mobilize and empower NGOs and the private sector to maximize their roles in CS, and strengthen NGO and private sector capacity in information systems for CS. Examples of specific sub-activities include: • Conducting a situation analysis to assess attitudes toward collaboration, and holding stakeholder meetings to design and approve strategies for collaboration • Establishing a mechanism to exchange information among collaborating partners • Conducting an operational policy barriers study to identify laws and/or regulations that discourage investment in contraceptive security by different sectors and implementing advocacy activities to modify these laws or regulations • Designing and implementing training-of-trainer (TOT) programs for healthcare providers in the NGO and private sectors to build their capacity on CS issues • Identifying all stakeholders related to CS issues in Egypt on the national and international levels and developing tools to coordinate among different stakeholders on the executive level • Identifying CS indicators and suitable tools for data collection and dissemination Indicators: Progress in the area of collaboration and coordination will be measured by the percent of stakeholders involved in CS activities such as finance and service provision; the percent of FP commodities and services provided by the private sector and NGOs; rates of dissemination to and use by managers in all sectors of current and reliable data related to CS; the percent of national and international stakeholders adhering to activities and contributions agreed upon in the strategic plan; and the number of laws, regulations, and policies that affect investment in CS that have been changed during the last year. Key Actors: Coordinating responsibility for the Coordination and Collaboration component lies with the NPC, the MOHP and the Integrated MCH/FP/RH Project (TAKAMOL). It is anticipated that a broad-based coalition of public, private, and NGO sector stakeholders will work with the MOHP and the Integrated Project in addressing this component’s activities. Estimated Budget for Year 1: LE 134,964 Estimated Budget for Years 2–5: LE 126,209 Component 3: Service Delivery Strategic Objective: To ensure secure and permanent access to safe, comprehensive, reliable, and high-quality contraceptive services. 9 Issues: The Service Delivery component will address the need to provide high-quality FP services by the public, private, and NGO sectors; ensure maintenance and sustainability of systems, processes, and provision of services related to the implementation of the contraceptive security strategy; and improve accessibility to family planning services. Activities: Key service delivery activities, as detailed in Appendix A, focus on ensuring sustainable and high-quality FP services within the national health reform strategy; strengthening the supervisory, managerial, and data management capacity of FP departments at the district level; and improving Client Provider Interaction (CPI) skills related to CS in all sectors. Service delivery also includes activities to ensure that the poor and needy get high-quality FP services on a sustainable basis. More specifically, some sub-activities within this component are reviewing, modifying, and disseminating standards and guidelines to service delivery points in the public, private, and NGO sectors; training relevant healthcare providers in the standards and guidelines; and monitoring and evaluating implementation. Others include assessing departmental supervisory capacity, and designing and implementing capacity-building programs to fill gaps, identifying CS data gaps, and designing and implementing programs to help fill them. Attempts to improve the quality of services include identifying gaps in CPI training, developing a training manual to fill them, conducting TOT on these issues, disseminating guidelines for user fees and exemptions, conducting awareness raising on their content among providers and clients, and monitoring client satisfaction with their application. Indicators: Progress in the service delivery arena will be measured by: • The percent of service delivery units in all sectors that provide family planning services in accordance with established quality standards • The percent of providers trained on these standards • Contraceptive discontinuation rate • Rate of improvement in FP indicators after phaseout (contraceptive prevalence rate (CPR), discontinuation rates, and unmet need) • Rate of provision of high-quality FP services as measured by the service standards and guidelines • Percent of discontinuations due to lack of access • The number of national or subnational policies or plans that promote access to high- quality FP services or information • Level of resources available to purchase contraceptives after application of user fee structure and exemptions • The number of instances that data or information are produced and/or used to improve service delivery or provider training • The number of providers trained using new curricula Key Actors: The NPC, MOHP, and private sector representatives will assume coordinating responsibility for this component. Implementing duties will be assumed by the MOHP, NPC, and local FP departments, the commercial sector, and NGOs, along with the Integrated MCH/FP/RH Project (TAKAMOL). 10 Estimated Budget for Year 1: LE 19,084 Estimated Budget for Years 2–5: LE 221,123 Component 4: Logistics Strategic Objective: To provide contraceptives in the proper quantities and types and of acceptable quality, to be delivered in the right place, at the right time and cost. Issues: As a priority component for the CSSP, the Logistics component will address the following issues: the need to ensure the availability of adequate amounts and types of contraceptives, the continuous availability of strategic stocks of contraceptives at all levels, and upgrading storage systems to adequately store contraceptives at all levels. The logistics management and information system (LMIS) and forecasting are weak across levels; there is no long-term strategy to maintain the LMIS, and there is poor communication between the management information system (MIS) of the MOHP and of the Egyptian Pharmaceutical Trading Company (EPTC). In addition, there is incomplete and/or inaccurate service delivery point (SDP) reporting; the supply chain/pipeline is too long and not filled; supervision is weak across levels; and there are poor storage conditions in MOHP warehouses, in part because warehouse staff are not adequately trained. There is no clear strategy for procuring high-quality, low-cost contraceptives from national or international vendors: the MOHP contraceptive procurement capacity is weak; local contraceptive manufactures do not meet international quality standards; and there are considerable policy barriers to CS, including the drug registration process. Activities: As presented in Appendix A in more detail, the Logistics component consists of activities to improve the logistics process from forecasting to storage. These include: • Developing a strategy to forecast contraceptive needs using appropriate data • Expanding method alternatives • Developing a plan for procurement of contraceptives based on forecasting • Strengthening the LMIS to monitor supply levels and provide data for decisionmaking • Monitoring the commodities flow and assessing stocks on a monthly basis • Improving the quality and capacity of storage points Some examples of specific sub-activities are conducting a forecasting exercise to determine contraceptive requirements, conducting a study to assess commodities stores at different storage levels, renovating storehouses, assessing and monitoring commodities flow at different levels, and developing and implementing a training program on commodity storage. Indicators: Progress will be measured by the existence of an adequate and timely commodities supply at all levels, improved method mix, and reduction in stockouts and poor storage at all levels. Indicators for the logistics component’s activities include: the percentage of SDPs that experienced no stockouts in the last 12 months, the number of new contraceptive products introduced into the Egyptian market in the last year, the percent of contraceptives wasted due to 11 expiration and/or damage, and the number of months during the last year when stocks were between the minimum and maximum levels for each contraceptive commodity type at central medical stores. Key Actors: The NPC and the MOHP have coordinating responsibility for this component. Implementing responsibility will fall to the MOHP and its Purchasing Department, along with the MOHP/ Integrated MCH/FP/RH Project (TAKAMOL), and the Contraceptive Forecasting and Procurement Committee (CFPC), the Central Department for Pharmaceutical Affairs (CDPA), and the National Agency for Drug Control and Research. Estimated Budget for Year 1: LE 410,537 Estimated Budget for Years 2–5: LE 198,662 Component 5: Advocacy Strategic Objective: To create an enabling environment and reduce barriers for achieving contraceptive security. Issues: The Advocacy component will address the need for awareness, sensitization, and support on CS issues among strategic stakeholders and decisionmakers. Activities: Activities include establishing a CS advocacy core team, building capacity for policy champions, developing a plan for advocacy on CS issues, and implementing advocacy activities to reduce cultural, legal, institutional, and political barriers to contraceptive security. Some of the more detailed sub-activities include: • Forming of a Contraceptive Security Advocacy Core Group and defining their rules and regulations and scope of work • Training the core group in advocacy skills, and designing and implementing an advocacy campaign designed to increase awareness of and support for CS, including a budget line item and the inclusion of FP in health insurance schemes • Implementing advocacy activities to involve partners in decisionmaking on CS to facilitate the development of laws and regulations that support investment in CS by all sectors Indicators: Ultimately, the success of this component can be measured in the level and sustainability of support for contraceptive security among the public and decisionmakers. The strategy’s design team anticipates that action on this key component will result in increased knowledge and commitment to contraceptive security by policymakers and decisionmakers. Progress on these activities and issues will be measured by the number of advocacy events conducted by members of the CS Advocacy Group in the last six months, the number of FP- positive statements made in last month by high-level policymakers, the number of CS positive messages in the media in the last month, and the percentage of required funding for contraceptives allocated by the GOE and other sectors. Additional indicators include the percent of advocacy activities funded by the private sector; the percent of user fees that cover FP 12 services; and the number of laws, regulations, and policies that have been changed to support CS investment Key Actors: Coordinating responsibility for the strategy’s Advocacy component falls to the NPC and the MOHP. Implementation will be carried out through the MOHP, the MCH/FP/RH Integrated Project (TAKAMOL), and the CS Advocacy Team (once formed). Input from the health, social, media, political, and financial sectors will also be solicited. Estimated Budget for Year 1: LE 71,912 Estimated Budget for Years 2–5: LE 6,757 13 Appendix A: Egypt Strategic Plan for Family Planning and Contraceptive Security 2006–2010 14 Component 1: Finance Goal: To ensure the ability of men and women to choose, obtain, and use high-quality contraceptive services and commodities, whenever they want them, for planning their families Component 1: Finance Component Objective: To provide the funding required for family planning commodities and services based on actual need Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes Strategy 1.1 Ensuring that key decisionmakers and financial managers at the national level are provided with current and reliable data on financial requirements for family planning commodities and services 1.1.1 Develop financial management system for the effective planning, monitoring, and evaluation of CS 1.1.1.1 Set up task force to determine the requirements for financial management mechanisms for contraceptive commodities MOHP NPC MOHP 2006 Task force appointed and functional Financial data used to secure funding from GOE for FP commodities and services (Number of periodic reports) 15 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 1.1.1.2 Develop rules and regulations for the financial management mechanisms MOHP NPC MOHP Integrated MCH/FP/RH Project 2006 - Financial management system developed - Information needed from financial management mechanism identified - Documentation forms developed and printed 1.1.1.3 Develop training program for financial management system MOHP NPC MOHP, Integrated MCH/FP/RH Project 2006 Curriculum developed MOHP/NPC will monitor the financial management system periodically, ensure timely and adequate data flow, and implement required modifications on the system when required. 16 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 1.1.1.4 Train relevant managers on financial management system MOHP NPC MOHP, Integrated MCH/FP/RH Project 2006 Percent of relevant managers trained in financial management mechanism 1.1.1.5 Develop a monitoring system for the financial management mechanism MOHP NPC MOHP, MOHP/ Financial Department, Integrated MCH/FP/RH Project 2006 Monitoring system for financial management designed 1.1.2.1 Identify decisionmakers and financial managers in need of CS data MOHP NPC MOHP 2006 List of decisionmakers concerned with CS 1.1.2 Develop appropriate data flow mechanism to ensure that decisionmakers and financial managers are provided with timely, appropriate data concerning 1.1.2.2 Develop tools and mechanisms for data flow concerning commodity expenditures MOHP NPC MOHP and Integrated MCH/FP/RH Project 2006 Periodic reports developed Existence and use of timely data for decisionmaking by managers 17 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 1.1.2.3 Develop training program on data flow MOHP NPC MOHP Integrated MCH/FP/RH Project 2006 Training curricula developed financial requirements for FP commodities and services 1.1.2.4 Train employees on the data flow system MOHP NPC MOHP, Integrated MCH/FP/RH Project 2006– 2007 Percent of trained employees Strategy 1.2 Securing long-term financial support via a ring-fenced budget line item 1.2.1.1 Develop financial requirements for contraceptives based on sound forecasting MOHP NPC MOHP, Integrated MCH/FP/RH Project 2006– 2010 Timely estimated financial requirements of CS, based on the approved forecasting 1.2.1. Maintain long- term financial support for contraceptive procurement via a ring-fenced budget line item 1.2.1.2 Follow up the submitted formal request for ring-fenced budget line item for contraceptive commodities MOHP NPC MOHP, MOF 2006 Request approved Ring-fenced budget line item for contraceptives approved and operationalized CS financial requirements are identified yearly in October. 18 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 1.2.1.3 Develop and implement an advocacy strategy to sustain flow of funds into budget line for contraceptives MOHP NPC MOHP, Integrated MCH/FP/RH Project 2006– 2008 Advocacy plan developed and implemented 1.2.2.1 Hold awareness-raising workshops on financing for FP commodities and services for Health Undersecretaries, Governorate Financial Officers, other key stakeholders MOHP NPC MOHP, Integrated MCH/FP/RH Project 2007 Workshop reports that define alternatives for CS financing 1.2.2 Explore the feasibility of alternative financing mechanisms for CS fund and commodities line item and where feasible advocate for funding 1.2.2.2 Determine the feasibility of allocating funds to CS and/or commodities from the Services Improvement Fund MOHP NPC MOHP 2007 Policy dialogue with decisionmakers at different levels Percent of funding from the Services Improvement Fund allocated for contraceptives and/or other CS activities 19 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 1.2.2.3 Determine the feasibility of allocating funds from the Governorate Services Development Fund for contraceptives and CS activities MOHP NPC MOHP, governorate authorities 2007 Policy dialogue with Governorate Undersecretary, MOHP, and financial officer Percent of funding from Governorate Services Development Fund allocated for contraceptives and/or other CS activities 1.2.2.4 Explore the feasibility of obtaining additional donor funding via policy dialogue with donors MOHP NPC MOHP, Ministry of International Cooperation 2006– 2007 Policy dialogue with donors completed Amount of funding from other donors allocated for contraceptives and/or other CS activities 1.2.3 Include family planning services within the national social insurance strategies 1.2.3.1 Conduct study to determine cost effectiveness of inclusion of FP commodities and services in insurance mechanisms MOHP NPC MOHP, Integrated MCH/FP/RH Project, Health Insurance Organization 2007 Study completed, results disseminated FP services and commodities included in insurance mechanisms 20 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 1.2.3.2 Define and implement an advocacy campaign to include FP commodities and services in all currently existing health insurance systems MOHP NPC MOHP, Integrated MCH/FP/RH Project 2006– 2008 Advocacy campaign implemented Strategy 1.3 Exploring the feasibility of alternative financing mechanisms 1.3.1.1 Conduct a study to explore the feasibility of charging user fees to those who can afford to pay if indicated MOHP NPC MOHP, Integrated MCH/FP/RH Project 2007 Study completed, policy dialogue about results completed 1.3.1 Assess the feasibility of implementing a resource targeting strategy 1.3.1.2 Hold roundtable discussions with key stakeholders to determine the type of resource targeting most suitable to Egypt MOHP NPC MOHP, Integrated MCH/FP/RH Project 2007 Roundtable conducted Percent of poor and needy people in the last two market segmentation quintiles receiving high- quality FP services and commodities 21 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 1.3.2.1 Identify a mechanism to define those eligible for free services MOHP NPC MOHP, Integrated MCH/FP/RH Project 2007– 2008 Eligibility criteria developed 1.3.2.2 Determine user fee pricing structure and exemption policies MOHP NPC MOHP, Integrated MCH/FP/RH Project 2007 Pricing structure and exemption criteria identified 1.3.2.3 Develop regulations needed to ensure that fees are returned to commodity budget line item MOHP NPC MOHP, Integrated MCH/FP/RH Project, MOF 2007 Regulations developed 1.3.2.4 Develop guidelines for resource targeting strategy including items 1.3.2.1, 1.3.2.2, 1.3.2.3 MOHP NPC MOHP, Integrated MCH/FP/RH Project 2007– 2008 Guidelines developed 1.3.2 Develop a strategy to implement resource targeting 1.3.2.5 Pilot test resource targeting guidelines and modify guidelines according to pilot test results MOHP NPC MOHP, Integrated MCH/FP/RH Project 2008 Pilot test completed and modifications made 22 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 1.3.2.6 Develop and implement scale up strategy MOHP NPC MOHP, Integrated MCH/FP/RH Project 2008– 2010 Scaling up strategy drafted and scale-up implemented 23 Component 2: Collaboration and Coordination Goal: To ensure the ability of men and women to choose, obtain, and use high-quality contraceptive services and commodities, whenever they want them, for planning their families Component 2: Collaboration and Coordination Component Objective: To strengthen collaboration and coordination among the public and private sectors, NGOs, and other stakeholders in achieving contraceptive security Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes Strategy 2.1 Promoting partnership in CS policy and programs among public and private sectors and NGOs 2.1.1.1 Conduct situation analysis to assess private sector and NGOs’ attitudes, position, and practices related to collaboration in CS MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Situation analysis report for each sector produced and disseminated Percent of FP commodities and services provided by the private sector and NGOs 2.1.1 Define a mechanism to maintain public, private, and NGO sector linkages essential to support CS strategy 2.1.1.2 Hold stakeholder meetings to develop concept paper and strategies specifying stakeholder responsibilities/roles MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Strategies and roles of stakeholders identified The MOHP/NPC will ensure implementation of the stakeholder strategies and workplan, and conduct annual workshops to assess progress and modify the workplan. 24 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 2.1.1.3 Approve suitable strategies for collaboration, based on the baseline analysis MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Final strategies approved 2.1.2.1 Establish and maintain data base concerning various aspects and different issues related to CS MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Functioning CS data base 2.1.2 Foster communication and open dialogue among partners (public and private sectors and NGOs) 2.1.2.2 Establish a mechanism to exchange information among collaborating partners MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Specific mechanisms for information exchange established Percent share of stakeholders involved in CS activities such as finance and service provision The database is maintained and updated periodically. Strategy 2.2 Creating a suitable political, cultural, and social environment to implement partner collaboration 25 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 2.2.1.1 Strengthen the CSWG to involve all stakeholders and to participate in policy and decision making (e.g., pricing policies, subsidization policies) MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Expanded list of the CSWG 2.2.1 Involve different partners in decisionmaking for CS issues 2.2.1.2 Implement advocacy activities to involve different partners in decisionmaking MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006– 2010 Advocacy activities implemented Number of stakeholders involved in CS activities such as finance and service provision 2.2.2 Create an environment conducive to investment in CS 2.2.2.1 Conduct operational policy barriers study to identify laws and/or regulations regarding investment in FP MOHP NPC MOHP, Integrated MCH/FP/R H Project 2007 Study conducted and barriers identified 26 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 2.2.2.2 Implement advocacy activities to modify current laws, regulations, and policies to support investment in FP (e.g., tariffs and duties laws, laws for contraceptive advertising, pricing policies) MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006– 2010 - Advocacy plan created to address identified barriers - Advocacy activities implemented Number of laws, regulations. and policies related to CS investment that have been changed last year Strategy 2.3 Ensuring multisectoral organizational development for improved management of CS initiatives 2.3.1 Strengthen CS organizational management capacity in private sector and NGOs 2.3.1.1 Assess private sector and NGO needs for participation in CS activities MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Needs identified Share of FP services and commodities provided by each sector 27 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 2.3.1.2 Design and implement development programs to upgrade capacities of private sector and NGOs based on identified needs MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Development programs designed and implemented The Population Sector helps train NGOs healthcare providers on service delivery and management. 2.3.2 Mobilize and empower NGOs and private sector to maximize their role in CS activities 2.3.2.1 Design and implement TOT program for healthcare providers in NGOs and private sector to build their capacity in CS activities MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Number of trained trainers of health care providers Number of private organizations and NGOs that expanded their CS activities This activity has been costed in training programs in the service delivery component. 28 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 2.3.2.2 NGOs identify and implement mechanisms for fundraising to create their own sources of finance MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Fundraising mechanisms identified and implemented 2.3.3 Strengthen CS organizational capacity in information systems in NGOs and private sector 2.3.3.1 Design and implement TOT program to train relevant personnel in NGOs and private sector about data collection and analysis in areas related to CS MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 The training program designed Rate of dissemination to and use by managers of current and reliable data related to CS Population Sector (PS) continues to disseminate training among different organizations on a scheduled basis. 2.3.3.2 Conduct the training program MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007– 2008 Number of trainers skillful in data collection and management Strategy 2.4 Ensuring proper coordination among different stakeholders in CS 29 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 2.4.1.1 Identify all stakeholders related to CS issues on the national and international levels MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Stakeholders identified Percent of national and international stakeholders implementing activities as agreed in the CS strategy The CSWG meets periodically to monitor multisectoral cooperation on the national and international levels. 2.4.1 Design and implement mechanisms for coordinating all CS initiatives among collaborating partners 2.4.1.2 Develop tools to coordinate between different stakeholders on the executive level MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Coordination tools developed 2.4.2 Ensure effective monitoring, evaluation, and policy analysis of CS strategy by collaborating partners 2.4.2.1 Identify CS indicators and develop consensus between collaborating partners on the indicators MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 M&E plan developed Share of FP services and commodities provided by each sector CS indicators are periodically revised and updated. 30 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 2.4.2.2 Identify tools for data collection and dissemination MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Tools identified 2.4.2.3 Design and implement policy analysis, monitoring and evaluation training for partners MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007– 2008 Number of personnel skillful at policy analysis and M&E 31 Component 3: Service Delivery Goal: To ensure the ability of men and women to choose, obtain, and use high-quality contraceptive services and commodities, whenever they want them, for planning their families Component 3: Service Delivery Component Objective: To ensure secure and permanent access to safe, comprehensive, reliable and high-quality contraceptive services Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes Strategy 3.1 Ensure provision of high-quality FP services by public and private sectors and NGOs 3.1.1.1 Facilitate technical roundtable with stakeholders from all sectors to develop a quality assurance (QA) framework concerning CS service delivery, and define mechanisms for implementation of the program MOHP NPC MOHP, private sector, and NGOs 2006 Joint QA program 3.1.1 Improve quality of provided FP services in all sectors (public/private sectors and NGOs) 3.1.1.2 Review and modify service standards and guidelines related to CS issues MOHP NPC MOHP, NGOs, and Integrated MCH/FP/ RH Project 2006 Service standards and guidelines modified - Percent of service delivery units that provide FP services based on quality standards, in all sectors - Contraceptive discontinuation rate MOHP/NPC will ensure through the overall sector plan that service standards and 32 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 3.1.1.3 Disseminate standards and guidelines to SDPs of the three sectors MOHP NPC MOHP, private sector and NGOs, Integrated MCH/FP/ RH Project 2006 Percent of SDPs that receive the standards and guidelines guidelines are institutionalized by service delivery units in all sectors; and periodically upgrade the standards. 3.1.1.4 Develop TOT program for relevant healthcare providers in all sectors about implementation of the standards MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Training program developed, and TOT implemented Percent of providers trained on implementing the standards, in the different sectors MOHP and NPC will coordinate and implement the training program through a scaling up mechanism starting from 2007, in collaboration with government efforts in HSR. 33 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 3.1.1.5 Develop tools for monitoring implementation of FP service standards in all sectors, and develop monitoring reports MOHP NPC MOHP, NGOs, and Integrated MCH/FP/ RH Project 2007 Monitoring tools developed and disseminated to SDPs FP indicators after phaseout (discontinuation rate, CPR, unmet need) MOHP and NPC will complete monitoring activities related to CS services within the sector M&E plan. 3.1.2.1 Include FP standards and guidelines within the Basic Benefit Package of family medicine MOHP NPC MOHP 2007– 2008 FP standards are included in the BBP Percent of service delivery units in all sectors that provide FP services in accordance with established quality standards PS will work with HSR to train family physicians at the national level. 3.1.2 Ensure sustainable quality of FP services within the national health reform strategy 3.1.2.2 Follow up implementation of standards through family medicine units MOHP NPC MOHP 2007– 2009 Standards applied through family medicine units - Discontinuation rate - Unmet need - CPR Implementation will be done in collaboration with the sector plan. \ 34 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes Strategy 3.2 Ensure maintenance and sustainability of systems, processes, and provision of services related to the implementation of CS strategy 3.2.1.1 Assess department supervisory and managerial needs essential for implementing and monitoring and coordinating CS activities in all sectors MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Study conducted and needs identified Percent of discontinuations due to lack of access 3.2.1 Strengthen supervisory and managerial capacity of FP departments at the district level 3.2.1.2 Design supervisory and managerial organizational capacity development programs to address departmental needs MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Development programs designed Percent of units maintaining providing FP services based on quality standards at the district level MOHP and NPC will integrate supervisory and managerial development of CS- related systems into the overall sector development strategy. 35 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 3.2.2.1 Identify CS data needed to be used at the district level MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Data identified 3.2.2.2 Develop forms for data collection MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Forms developed 3.2.2.3 Develop training manual MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Training manual developed 3.2.2.4 Develop training program including data collection, analysis, interpretation, and use of indicators MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007– 2008 Training program developed 3.2.2 Strengthen FP departmental capacity in data management for CS issues 3.2.2.5 TOT for service providers about data management and use of indicators MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007– 2008 Periodic reports from service providers about indicators and their use - Number of instances that data or information are provided and/or used to improve service delivery or provider training - Number of providers trained using new curricula 36 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes Strategy 3.3 Improve accessibility to FP services 3.3.1.1 Assess CPI training needs of healthcare providers in public/private sectors and NGOs mainly concerning method choice, side effects, and so forth MOHP NPC MOHP, private sector and NGOs, Integrated MCH/FP/ RH Project 2007 Training needs identified 3.3.1.2 Develop training manual concerning priority issues in CPI MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Manual developed and disseminated 3.3.1.3 Develop relevant training program in CPI related to CS MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007– 2008 Training program developed 3.3.1 Improve CPI skills related to CS issues in all sectors 3.3.1.4 Conduct TOT for healthcare providers on CPI skills concerning CS issues in the different governates MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Training conducted - Contraceptive discontinuation rate - Percent of unmet needs - Percent of accessibility to FP services 37 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 3.3.2.1 Role out resource targeting regulations and guidelines to SDPs MOHP NPC MOHP 2008– 2010 Guidelines rolled out 3.3.2 Ensure that the poor and needy get high-quality FP services on a sustainable basis 3.3.2.2 Conduct advocacy and awareness-raising activities at SDPs, for resource targeting to ensure understanding and compliance to targeting strategy MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2008- 2010 Advocacy activities implemented Percent of increased resources available to purchase contraceptives after applying the targeting strategy MOHP institutionalizes the resource targeting mechanisms within the national reform strategy. 38 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 3.3.2.3 Develop mechanisms to assess clients’ satisfaction about FP services MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2009 Mechanisms developed 39 Component 4: Logistics Goal: To ensure the ability of men and women are able to choose, obtain, and use high-quality contraceptive services and commodities, whenever they want them, for planning their families Component 4: Logistics Component Objective: To provide contraceptives in the proper quantities and types, and of acceptable quality, to be delivered in the right place, at the right time, and at the right cost Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes Strategy 4.1 Ensuring availability of adequate amounts and types of contraceptives at all levels 4.1.1.1 Form Contraceptives Forecasting and Procurement Committee (CFPC) MOHP NPC MOHP 2006 Committee established 4.1.1 Develop a strategy to forecast contraceptive needs using appropriate data 4.1.1.2 Develop tools and regulations for the committee activities MOHP NPC MOHP/ Integrated MCH/FP/ RH Project 2006 Tools and regulations developed and approved Percentage of SDPs that experienced no stockouts in the last 12 months The committee performs annual forecasting of contraceptive requirements in September, by developing alternative forecasting scenarios for discussion. A final decision is made and approved on the forecasted requirements, which takes into consideration method mix, multisectoral collaboration and geographical needs 40 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 4.1.1.3 Conduct training needs assessment, update curriculum and train staff, at all levels, on short- and long-term forecasting MOHP, NPC, Integrated MCH/FP/ RH Project MOHP, Integrated MCH/FP/ RH Project 2006 - Training needs assessment completed - Training curriculum developed and approved - Number of staff trained TOT includes MOHP personnel who will conduct training of staff in governorates and districts. 4.1.1.4 Conduct forecasting exercise for contraceptive requirements MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Accurate contraceptive forecasting PS monitors forecast reports regularly and ensures accurate data for decisionmakers. 41 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 4.1.2.1 Review structure and role of the scientific expert committee to strengthen its ability and capacity to assess the feasibility of introducing new products into the FP program MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 - Committee formally restructured - Number of new contraceptive products evaluated 4.1.2 Expand method alternatives through introduction of new products into the national FP program 4.1.2.2 Develop action framework for the committee MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Committee roles, responsibilities and operating guidelines clearly defined Number of new contraceptive products introduced annually to the Egyptian market The committee will hold regular meetings, through the MOHP, to develop/modify regulations on introducing new contraceptive products. MOHP will support and follow-up committee activities and reports. 42 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 4.1.3 Develop an integrated contraceptive procurement plan based on the approved forecasting scenario to the procurement department on time 4.1.3.1 Upgrade comprehensive procurement guidelines to include the procurement cycle time line and procurement requirements and specifications MOHP NPC MOHP 2006 Upgraded comprehensive procurement guidelines 4.1.3.2 Develop an information system to monitor and evaluate procurement procedures and prioritize commodity needs according to available funding to avoid stockouts MOHP NPC MOHP 2007 Procurement data flow chart developed 4.1.3.3 Develop a system for commodities quality control and MOHP NPC MOHP, CDPA, General Agency for 2006 Approved quality control system Number of months during the last year when stocks were between the minimum and maximum levels for each contraceptive commodity at each medical warehouse in the system MOHP modifies product (commodities) specifications for the different commodities in April, assesses available commodities, and makes final decisions on which commodities will be included in the procurement. 43 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes laboratory testing Drug Control and Research Strategy 4.2 Ensuring continuous availability of strategic stocks of contraceptives at all levels 4.2.1 Strengthen the LMIS to monitor the contraceptives supply chain and to provide proper data for decisionmak- ing 4.2.1.1 Develop LMIS to meet the data needs of end users including an adaptable reporting system MOHP NPC MOHP, Integrated MCH/FP RH Project 2006 - Percentage of SDPs that experienced no stockouts in the last 12 months 4.2.1.2 Assess and monitor commodities flow at different levels to increase distribution and storage system MOHP NPC MOHP 2006– 2010 - Approved guidelines for contraceptives distribution - Number of months during the last year when stocks were between the minimum and maximum levels for each contraceptive commodity type at MOHP monitors monthly reports concerning current pipeline, utilization amounts, and monthly stock for every level. 44 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 4.2.1.3 Provide computers and relevant materials and equipment MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Computers, materials and equipment available 4.2.2.1 Develop/ upgrade a training program to train supervisory teams and store keepers at the different levels, about monitoring the minimum and maximum levels and using the reporting system MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007– 2008 Training program developed 4.2.2 Monitor commodities flow at the different levels and assess available stock, utilization, and commodities on a monthly basis at each level to avoid stock shortages 4.2.2.2 Develop/ upgrade a training program to train statisticians in governorates and districts to use commodities flow program MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007– 2008 Percent of statisticians trained each medical store MOHP staff train supervisory teams, store keepers, and statisticians in governorates and districts; monitor their performance; and evaluate their training effectiveness. 45 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 4.2.2.3 Train EPTC workers about the newly developed electronic communication system MOHP NPC MOHP, Integrated MCH/FP/ RH Project, EPTC 2007 Percent of workers trained Strategy 4.3 Upgrading storage systems and ensure adequate stocks at all levels 4.3.1.1 Conduct a study to assess commodities stores at different storage levels MOHP NPC MOHP, Integrated MCH/FP/ RH Project, EPTC 2006 Storage development needs identified 4.3.1.2 Develop a plan to upgrade the stores, based on assessment results, including standards guidelines MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2007 Plan and standards guidelines developed 4.3.1 Enhance capacity to adequately store contraceptive commodities at all levels 4.3.1.3 Implement the renovation process of MOHP NPC MOHP, Integrated 2007– 2008 Percent of stores meeting Percent of contraceptive commodities wasted because of inadequate storing 46 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes the stores MCH/FP/ RH Project adhering to stores guidelines 4.3.1.4 Train personnel at all storage levels MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2008 Percent of trained personnel 47 Component 5: Advocacy Goal: To ensure ability of men and women to choose, obtain, and use high-quality contraceptive services and commodities, whenever they want them, for planning their families Component 5: Advocacy Component Objective: To create an enabling environment and reduce barriers for achieving contraceptive security Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes Strategy 5.1 Strengthening capacity for planning and implementing advocacy activities on all levels 5.1.1.1 Develop scope of work and identify members for the core team MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 5.1.1 Establish a CS advocacy core team that includes all stakeholders 5.1.1.2 Develop rules and regulations for the core team MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Steering core team formulated and rules and regulations developed Number of advocacy activities carried out by CS advocacy group in the last six months The steering committee includes members from different sectors (health, social, media, political, financial, planning). 48 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 5.1.2 Build capacity for champions on advocacy 5.1.2.1 Design and implement advocacy training program for the core team MOHP NPC MOHP, Integrated MCH/FP/ RH Project 2006 Training program designed Number of policy champions involved in advocacy activities 5.2 Increasing awareness and promoting support and sensitization on CS issues among strategic stakeholders and decisionmakers 5.2.1.1 Identify CS advocacy issues and define the target groups of strategic stakeholders and decisionmakers MOHP NPC MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2006– 2007 5.2.1 Develop a plan for advocacy around CS issues 5.2.1.2 Hold a workshop for strategic stakeholders and decisionmakers to identify different barriers to CS MOHP NPC MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2006 CS advocacy plan developed including M&E indicators - Percent of required funding for contraceptives funded by GOE - Percent of advocacy activities funded by the private sector - Percent FP services covered by user fees 49 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 5.2.1.3 Design messages covering identified CS issues, suitable for the target groups MOHP NPC MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2006– 2008 5.2.1.4 Develop advocacy implementation plan MOHP NPC MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2006 MOHP/NPC implements monitoring and evaluation activities, and revises strategies accordingly. 5.2.2 Implement advocacy activities to reduce cultural, legal, institutional, and political barriers to CS 5.2.2.1 Develop and implement advocacy activities to sustain a budget line for contraceptives MOHP NPC MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2006– 2008 Advocacy activities implemented to sustain budget line for contraceptives - Number of CS positive messages made by high-level policymakers in last six months - Number of CS positive messages in the media in last month 50 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 5.2.2.2 Hold awareness-raising workshops on financing for FP commodities and services for Health Undersecretaries, Governorate Financial Officers, other key stakeholders MOHP NPC MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2007 Workshops reports 5.2.2.3 Define and implement an advocacy campaign to include FP commodities and services in all existing health insurance systems MOHP NPC MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2006– 2008 Advocacy campaign implemented 51 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 5.2.2.4 Hold roundtable discussions with key stakeholders to advocate for the approved resource targeting strategy (resource targeting strategy identified in Finance component) MOHP NPC MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2007 Roundtable conducted 5.2.2.5 Implement advocacy activities to involve different partners in decisionmaking MOHP NPC MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2006– 2010 Advocacy activities implemented 52 Activities Sub-activities Coordin- ating Agency Imp. Agency Imp. Date Output Indicators Outcome Indicators Notes 5.2.2.6 Implement advocacy activities to modify current laws, regulations, and policies to support investment in FP (e.g., tariffs and duties laws, laws for contraceptive advertising, pricing policies) MOHP MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2006– 2010 Advocacy activities implemented 5.2.2.7 Facilitate informational roundtable to sensitize media, parliamentarians, and other opinion leaders to CS issues, at the central and governorate levels MOHP MOHP, Integrated MCH/FP/ RH Project, CS Advocacy team 2006– 2008 Roundtable conducted Number of laws, regulations, and policies that have been changed to support CS investment during last year 53 Appendix B: Budget11 Component Year 1 Activities Budget (in LE) Years 2–5 Activities Budget (in LE) Finance 83,700 246,629 Coordination and Collaboration 134,964 126,209 Service Delivery 19,084 221,123 Logistics 410,537 198,662 Advocacy 71,912 6,757 Total 720,199 799,380 11 Includes existing direct costs such as salaries and vehicles; required new government investment; required new donor support via projects and/or direct investment; and indirect costs determined as a percentage of the total.

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