Greenstar Commodity SecurityReproductive Health Supply Coalition Meeting

June 5 2009

Pakistan FactsDemographics

• Total Population : 167 m

• Per capita income : $1,085

• Population below poverty line : 35%

• Literacy Rate : 54%

Pakistan FactsHealth

• Total Fertility : 4.1

• CPR : 30% (22% modern)

• Population growth rate : 2%

• MMR : 276/100,000

• Govt. Expenditure on Social Sector : 0.75% of GDP

Trends in Fertility Rate 1992-20062007 DHS

5.6

4.54.8

4.5 4.44.1

3.94.1

0

1

2

3

4

5

6

92-94 94-96 97-00 98-00 00-02 01 03 04-06

Year

Fer

tili

ty R

ate

Trends in Fertility Rate 1992-20062007 DHS

5.6

4.54.8

4.5 4.44.1

3.94.1

0

1

2

3

4

5

6

92-94 94-96 97-00 98-00 00-02 01 03 04-06

Year

Fer

tili

ty R

ate

Note TFR stagnation in last 7 years

Note: Modern contraceptive prevalence rate stagnation in last 7 years

13.06

14.94

17.09

19.55

22.36

10.00

12.00

14.00

16.00

18.00

20.00

22.00

24.00

Year2009 Year2010 Year2011 Year2012 Year2013

Value: US $ in Mio5 Year National Commodity Requirement

13.06

14.94

17.09

19.55

22.36

10.00

12.00

14.00

16.00

18.00

20.00

22.00

24.00

Year2009 Year2010 Year2011 Year2012 Year2013

Value: US $ in Mio5 Year National Commodity Requirement

Govt., 48.64

GSMP, 34.54

Others, 3.81

National, 86.99

-

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

1

5 Year National Commodity Requirement Value : US $ in Mio

Govt., 48.64

GSMP, 34.54

Others, 3.81

National, 86.99

-

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

1

5 Year National Commodity Requirement Value : US $ in Mio

National, 0

Govt., 56%

GSMP, 40%

Others, 4%

National Commodities Requirement % Share

National, 0

Govt., 56%

GSMP, 40%

Others, 4%

National Commodities Requirement % Share

Pakistan

Greenstar

Others

Greenstar CYP Contribution

Source: Ministry of Population Welfare / Key Social Marketing / Greenstar reports (2003)

GOP Commodity Security• GOP MOF allocates funding for commodities to MPW and

MOH

• Draft outline of contraceptive security plan prepared but not yet available

• 2006 PDHS shows that women obtain contraceptives from the following sources– Public sector 48%

– Private sector 52% • 82% of condom users report using a social marketing brand

and 74% of pill users

• GOP budgets for provision of minimal supplies to FPAP, but currently not for MSS due to shrinking budget MPW

• No government budgetary support to Greenstar

Greenstar Historical Commodity Support

• Since 1991, the following donors have supported contraceptive

commodities to Greenstar

– KfW (early 90s until 98, and again from 2007)

– DFID (from 2000-2008)

– UNFPA (late 90s – to date)

– Packard Foundation (late 90s until 2003)

– Other private foundation (2007 to date)

Projected Commodity RequirementsJan 2009 – Jun 2012(put in updated figures)• 600m condoms• 15m cycles OCs• 5.7m injections• 1.3m IUDs

Growth projected at 10%-20% annually

Greenstar CYP Projection 2007 - 2012

2,200,000

2,700,000

3,200,000

3,700,000

4,200,000

4,700,000

2007-08 2008-09 2009-10 2010-11 2011-12

GS’s Funding Gap for Upcoming Years

• Greenstar faces a $14.6m commodity shortfall from May 09-Jun 2012– UNFPA continues to donate $1.5m annually– KfW has been contributing $1m annually and might continue

until 2013– Private foundation supports $2m annually through 2010

• In current USAID FP grant there is no commodity support (2007-2012). Assumption was that other donors would continue commodity support

• Based on the principles of the Paris Declaration, in 2008 DFID replaced its commodity support to GreenStar by Budget Support.

Implications from July 2010• Greenstar will face a stock out situation in mid 2010, unless

new funding commitments are made by GOP or a donor

• Due to lead times in procurement funding commitments need to be made in before the end of 2009

• In the absence of new funding Greenstar will have to raise prices to cost recovery, making them unaffordable to lower income people

• Greenstar CYPs may decline by up to 70%

• Government CYPs may decline by 30%

• 2 million couples currently using Greenstar contraceptives will no longer have access to them as the public sector system is not set up to cope with additional demand

0.1

0.6

1.1

1.6

2.1

2.6

3.1

3.6

4.1

4.6

2007-08 2008-09 2009-2010 2010-2011 2011-2012

CYP Projection CYP-Commodity Shotage Impact

Projected Greenstar CYP DeclineCYPs in Million

Projected National Impact

7.8

8.3

8.8

9.3

9.8

10.3

10.8

11.3

11.8

12.3

12.8

2007-08 2008-09 2009-2010 2010-2011 2011-2012

National CYPs National CYPs Less GS - Commodity Shortage

CYPs in Million

National Growth Projected at +8 %

GreenStar’s Dilemma• GreenStar fully supports the process of the Paris Declaration

of Aid Effectiveness • GreenStar is committed support GOPs Reproductive Health

policies• Greenstar is the largest contributor to MDG 5 and

Contraceptive Security outside the public sector• GreenStar’s contribution to achieving the GOP goals are

widely recognized• GreenStar has approached GOP in multiple ways to ensure

continued funding of its commodity needs.• However, GOP has not yet made commitments to funding

GS’s commodity requirements

What can be done?• National contraceptive security plan to incorporate NGO

requirements • Donors to continue the dialogue with GOP to incorporate NGO

commodity requirements into national need• Greenstar to conduct analysis on price increases and sustainability

planning and mitigate impact on poor• Sector-wide Programs to include earmarks for contraceptive

funding for public and NGO sector.• Ministry for Social Welfare to develop long term funding plan for

contraceptives commodities for public and NGO sector and include this is National Strategic Plan

Potential reasons for slow response from GOP

• Reasons for GOP hesitation might be– Funds provided through Budget Support and Sector –

wide programmes are competed by many interests– expectations that additional donor funds can be raised in

the last moment, – Commitment to Contraceptive Security not widely

enough shared outside Ministry of Population and Social Welfare

– Political or religious pressure against Reproductive Health Rights

– Others???

Thank You

Greenstar is funded by The US Government through USAID – the United States Agency for International Development, The German Government through KfW – the German Development Bank , The Global Fund (GFATM), The British Government through DFID – the Department for International Development, UNFPA/UNAIDS, John Snow Research & Training Institute, Packard Foundation,

Procter and Gamble (P&G), The Micronutrient Initiative and PSI