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SPARHCS    |    Rapid Assessment Tool of Sexual and Reproductive
Health and HIV Linkages

 

THE STRATEGIC PATHWAY TO REPRODUCTIVE HEALTH COMMODITY SECURITY (SPARHCS)
Kabir Ahmed and Kris Valaydon

Description

The strategic pathway to reproductive health commodity security (SPARHCS) is a tool to help countries develop and implement strategies to secure essential supplies for family planning and reproductive health programmes. It helps develop in-country capacity to increase reproductive health commodity security in a country-driven and sustainable manner. RHCS is achieved when all individuals can obtain and use affordable, quality reproductive health commodities of their choice whenever they need them. RHCS is more than a supply issue – its elements include quality of care, access and demand. RHCS involves making sure everyone, especially women, newborns and young people, face no obstacles to accessing and using life-saving, health promoting supplies.

 

The SPARHCS process uses the country-specific national programme cycle
(planning, implementation, monitoring and evaluation) to improve RHCS planning
and implementation.

 

The SPARHCS tool is a framework for identifying and prioritizing key RHCS issues and for governments to carry out a process to plan and implement RHCS strategic plans. There is a companion guide to the SPARHCS tool intended for use by programme managers, consultants, and technical assistance providers. The guide provides examples and options on how to use the programme planning cycle to steer the process (a set of activities from awareness raising and diagnosis, to monitoring the effectiveness of a funded and implemented strategic plan).

 

An examination of the tool together with a review of this guide will help users understand the complex, overlapping systems and programmes that are key components of RHCS and how to set in motion a process to improve it. The major stakeholder in the implementation phase is the government, along with other key players.

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Key Elements

Strengths of the tool SPARHCS takes a strategic, long-term perspective to help a broad range of stakeholders understand their requirements on product availability and their role in ensuring it.


SPARHCS embeds the traditional focus on “logistics” within the context of the elements needed to ensure that supplies are available to clients, such as policies; quality assurance; financing mechanisms; service delivery channels, and advocacy. It approaches reproductive health commodity security as a goal to strive for, requiring ongoing commitment and continuous progress. It defines RHCS from the client’s perspective. Unless individuals can choose, obtain, and use the reproductive health supplies they want, there can be no reproductive health commodity security.


SPARHCS takes a multidisciplinary, multistakeholder approach to demonstrate the complex set of relationships inherent in reproductive health commodity security. This
includes, but is not limited to facilitation of national efforts to define and drive a national RHCS integrated strategy and plan of action; RH costing; commodity management needs
and projection; procurement; pre-qualification of essential medicines and other RH commodities; IEC/BCC; HIV/AIDS prevention strategies and comprehensive
condom programming; and a total market approach that ensures access for
marginalized populations.


The SPARHCS framework is a comprehensive, multipartner strategy and action plan for RHCS that is evidence-based, fundable and feasible; facilitates strategy implementation, and guides ongoing monitoring and evaluation of results.


The SPARHCS process is a well-tested and successful approach that allows stakeholders to take a strategic view of RHCS challenges.

 

Limitations of the tool SPARHCS is a tool to help countries develop and implement strategies to secure essential supplies for family planning and reproductive health programmes. SPARHCS is meant to bring together a wide range of stakeholders to initiate concerted efforts at the country level toward the goal of RHCS. One limitation may be the challenge of bringing all stakeholders together from the initial planning stage up to the completion of the exercise applying this tool. It requires a participatory process – even during the data and information collection and analysis phase – with key in-country partners, under government direction. It is sometimes difficult to ensure full and active participation and involvement of all, especially government counterparts.


In countries with no experience in using SPARCHS external technical
assistance is needed.

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Principles and Steps for Using the Tool

Partners Before the process is started, stakeholders are advised to achieve consensus and resolve questions on specific subjects such as defining the rationale for improving RHCS (e.g., is the country or region facing donor phase-out, unusually high unmet need, or system weaknesses?); the priority categories of RH products, short and long-term expected results, and the current and anticipated amount of available funding to plan and implement activities.

 

Target Data is collected from a variety of sources, using different questionnaires, and interview and observation guidelines:

Ministry of Health

Planning and Finance Ministries

Other relevant ministries and government bodies

Drug regulatory administration

Central medical stores, central pharmacy department

Regional, provincial, district stores

Service delivery points (SDPs, all levels)

Key Stakeholders:

– UN agencies

– Donors

– Civil society organizations

– Ob/gyn, midwifery, nursing professional associations

– Other private bodies.

Private sector

– Pharmacies

– Pharmaceutical distributors

– Manufacturers

– Private donors

 

Methodology Information is obtained through document reviews, key informant interviews, and selected site visits by a team drawn from key players led by government. Adaptation of the SPARHCS tool is possible and in most cases the tool is customized by addressing the country context and needs.

 

Time required In case there is need for out-of-the country technical assistance, the time required is 3-4 weeks in-country mission by an external expert team, and prior to that at least 2 weeks for the preparatory phase by the country team working closely and in consultation with the relevant government counterparts.

 

Human resources Ministry of Health takes a guiding role and decides on technical assistance, such as the need for a national consultant, and need for inviting a team from UNFPA Regional Office or Headquarters. If a decision for technical assistance is made both the national consultant(s) and external consultants, experts from UNFPA Regional Office or Headquarters should be involved as early as possible in the process.

 

At least one (and in some cases two) external consultants experienced in situation analysis should take part.

 

Budget line items

In-country consultant for 4-5 weeks;

Travel and per-diem for regional RHCS advisor;

One or two external consultants for 3-4 weeks: fees, travel and per diem, incidentals;

Local and in-country costs: meetings, local travel costs for the team, fees
   or honoraria for the other non-UNFPA team members (if applicable and needed),
   other related local costs;

Cost for reporting and dissemination.

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Adaptation and Technical Assistance

Experience with the tool The SPARHCS tool has addressed country-specific needs and comprehensive assessments on RHCS over the last few years in different regions. Regional and country-level 3-5 day capacity-building workshops with country stakeholders have helped to:

1. Familiarize the stakeholders with SPARHCS.

2. Adapt the SPARHCS tool to the country context and address in brief
    all questions in SPARHCS.

3. Prepare an action plan to develop a draft national RHCS strategy
    including situation analysis.

 

For example a workshop in Thailand in 2006 on SPARHCS included MOH officials from Mongolia, Nepal, Timor Leste and Viet Nam along with their UNFPA country office counterparts. Each country developed work plans to conduct an RHCS assessment followed by RHCS strategy development.

 

There are case studies on the SPARHCS tool from different regions, including Afghanistan, Benin, Burkina Faso, CAR, Ethiopia, Fiji, Haiti, Madagascar, Nepal, Papua New Guinea, Somalia, Timor Leste and Tonga.

 

Recommendations for adaptation The SPARHCS process can begin with different elements of the programme cycle. In Jordan and Bangladesh, national stakeholders used workshops, discussions, and existing data to develop a consensus on the priority RHCS issues, rather than first undertaking a comprehensive awareness-raising effort or formal joint diagnosis.

 

This approach has been more the exception than the rule. Experience from other countries suggests that a deliberate effort to raise awareness and methodically diagnose the issues leads to a more comprehensive strategy that is likely to attract and sustain support.

 

Samples of questionnaires used by this tool can be found at:
the Bank of Sample Questionnaires

 

Possibilities for technical assistance and contact information
Jagdish Upadhyay, Chief, Commodity Security Branch, Technical Division, UNFPA NY (upadhyay@unfpa.org) Dr.Kabir Ahmed, Technical Adviser, Commodity Security Branch, Technical Division, UNFPA, NY (kahmed@unfpa.org).

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SPARHCS Photo

© Micah Albert Chad/UNFPA

Shortcuts within this document:

Description

Key Elements

Principle and Steps for Using the Tool

Adaption and Technical Assistance

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