Monitoring Progress Toward Achieving Contraceptive Security:
APHA Conference, Denver, CONovember, 2010
CS Index 2003–2009
Dana Aronovich, Marie Tien, Nadia OlsonJohn Snow, Inc.
Learning Objectives
• Describe how the CS Index is compiled to help measure progress towards CS
• Describe the changes/trends that have occurred between the 2003 and 2009 CS Index at the national, regional, and global levels?
• Demonstrate how can data from the CS Index can be used to identify priority areas for support and to inform program planning
• Explain how data from the CS Index can be used to advocate for improved resource allocation by country governments and global donors.
A critical component of FP programs:
Contraceptive security exists
when every person is able to
choose, obtain and use
quality contraceptives and condomswhenever she/he needs them.
Contraceptive Security Index
• Tool to raise awareness, support advocacy, focus priorities, monitor progress for CS
• Promotes a multisectoral approach to CS at the national, regional, and global levels
• Indicators cover a range of inputs and outputs, and programmatic and macro-level areas
• Over 60 countries from 5 regions
• 3 editions of the Index: 2003, 2006, 2009 – analysis of CS over an extended period of time
Methodology
• Minimize data collection costs and maximize data reliability, validity, and replicability by using only secondary data from regularly updated reliable sources
• Updated approximately every 3 years
• 5 components, 17 indicators– Supply chain (logistics)
– Financing
– Health and social environment
– Access
– Utilization
• Aggregate scores for each component and an overall score
Range of CS Index Total Scores (2003, 2009)
0
10
20
30
40
50
60
70
80
90
100
2003 2009
Highest Score
Average Score
Lowest Score
CS Index Total Scores by Region (2003, 2006, 2009)
0
10
20
30
40
50
60
70
80
90
100
Asia & the Pacific(n=7)
Eastern Europe &Central Asia (n=3)
Latin America & theCaribbean (n=13)
Middle East & NorthAfrica (n=4)
sub-Saharan Africa(n=23)
Overall Average (n=50)
2003
2006
2009
N.B. For the 50 countries scored in all 3 indices only.
Average Percentage Change by Region
2003–2006 2006–2009
Entire Period:
2003–2009
Asia & Pacific 3.66% 0.35% 3.87%
E. Europe & C. Asia 0.31% −3.06% −2.76%
L. America & Caribbean 4.35% 2.67% 6.79%
M. East & N. Africa 3.49% −1.66% 1.73%
SS Africa 10.50% 3.34% 13.95%
Average Total Scores 5.8% 1.6% 7.6%
CS Index Total Scores by Component (2003, 2006, 2009)
N.B. For the 50 countries scored in all 3 indices only.
0
2
4
6
8
10
12
14
16
18
20
Supply Chain Finance Health & SocialEnvironment
Access Utilization
2003
2006
2009
CS Index – Supply Chain (2003, 2006, 2009)
Supply Chain
0
2
4
6
8
10
12
14
16
18
20
Sub-Saharan Africa(n=23)
Asia & the Pacific(n=7)
Eastern Europe &Central Asia (n=3)
Latin America &the Caribbean
(n=13)
Middle East &North Africa (n=4)
All countries (n=50)
2003
2006
2009
N.B. For the 50 countries scored in all 3 indices only.
CS Index – Finance (2003, 2006, 2009)
Finance
0
2
4
6
8
10
12
14
16
18
20
Sub-Saharan Africa(n=23)
Asia & the Pacific(n=7)
Eastern Europe &Central Asia (n=3)
Latin America & theCaribbean (n=13)
Middle East &North Africa (n=4)
All countries (n=50)
2003
2006
2009
N.B. For the 50 countries scored in all 3 indices only.
CS Index – Health & Social Environment (2003, 2006, 2009)
Health & Social Environment
0
2
4
6
8
10
12
14
16
18
20
Sub-Saharan Africa(n=23)
Asia & the Pacific(n=7)
Eastern Europe &Central Asia (n=3)
Latin America & theCaribbean (n=13)
Middle East &North Africa (n=4)
All countries (n=50)
2003
2006
2009
N.B. For the 50 countries scored in all 3 indices only.
CS Index – Access (2003, 2006, 2009)
Access
0
2
4
6
8
10
12
14
16
18
20
Sub-Saharan Africa(n=23)
Asia & the Pacific(n=7)
Eastern Europe &Central Asia (n=3)
Latin America & theCaribbean (n=13)
Middle East &North Africa (n=4)
All countries (n=50)
2003
2006
2009
N.B. For the 50 countries scored in all 3 indices only.
CS Index – Utilization (2003, 2006, 2009)
Utilization
0
2
4
6
8
10
12
14
16
18
20
Sub-Saharan Africa(n=23)
Asia & the Pacific(n=7)
Eastern Europe &Central Asia (n=3)
Latin America & theCaribbean (n=13)
Middle East &North Africa (n=4)
All countries (n=50)
2003
2006
2009
N.B. For the 50 countries scored in all 3 indices only.
Total Weighted Scores: 64 Countries
0 10 20 30 40 50 60 70 80 90 100
MexicoMongoliaP araguay
El SalvadorSouth Africa
NicaraguaViet Nam
J ordanEcuador
IndonesiaHonduras
AlbaniaColombia
P eruGuatemala
EgyptNepal
DominicanKyrgyzstanMorocco
BangladeshBolivia
IndiaTurkey
GuyanaUkraineGeorgiaSenegalNamibiaRwanda
CambodiaTanzania
P hilippinesBurkina Faso
ZimbabweGhana
MadagascarMali
ZambiaKenyaTogo
ArmeniaNigeriaGuinea
CameroonMalawiBenin
EritreaYemen
MozambiqueNigerHaiti
UgandaP akistan
SwazilandChad
LesothoGambia
AzerbaijanLiberia
Congo, Rep. ofEthiopia
Côte d'IvoireCongo, DR
Trends in Total Scores by 2003 Clusters
0
10
20
30
40
50
60
70
80
90
100
2003 2006 2009
CS
Inde
x T
otal
Sco
res,
max
=100
poi
nts
Top
Middle
Bottom
N.B. For the 50 countries scored in all 3 indices only.
Regions by Clusters: 2003 - 2009
2003
0%10%20%30%40%50%60%70%80%90%
100%
Asia & thePacific
E. Europe &C.Asia
L. America &Caribbean
M. East & N.Africa
Sub SaharanAfrica
Top
Middle
Bottom
2009
0%10%20%30%40%50%60%70%80%90%
100%
Asia & thePacific
E. Europe &C.Asia
L. America &Caribbean
M. East & N.Africa
Sub SaharanAfrica
Top
Middle
Bottom
N.B. For the 50 countries scored in all 3 indices only
Clusters by Regions: 2003 - 20092003
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Top Middle Bottom
Sub Saharan Africa
M. East & N. Africa
L. America & Caribbean
E. Europe & C.Asia
Asia & the Pacific
2009
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Top Middle Bottom
Sub Saharan Africa
M. East & N. Africa
L. America & Caribbean
E. Europe & C.Asia
Asia & the Pacific
N.B. For the 50 countries scored in all 3 indices only.
Summary of Trends
• Average total scores: statistically significant 2003-09
• Global averages for all components and all but 1 region increased from 2003-09
• Asia & Pacific and LAC had highest scores from 2003-09
• Supply chain: highest or 2nd highest average scores Reflects processes and systems put in place to manage contraceptive
supplies
• Cluster analysis: – Lowest performing countries in 2003 made most progress in total
average scores by 2009– Biggest increases observed in sub-Saharan Africa where significant
donor inputs are made.
Using the CS Index Results
• National and international stakeholders can use results to emphasize importance of CS for better FP program outcomes and to monitor progress toward reaching this goal.
• CS Index can be a powerful tool for raising awareness about CS and interrelationships between different program components.
• Results can be used to set priorities and advocate for more rational resource allocation by country governments and global donors to achieve a secure supply of quality contraceptives.