SPARHCS - Strategic Pathway to Reproductive Health Commodity Security
1. SPARHCS and the Goal of Reproductive Health Commodity Security
Reproductive health commodity security (RHCS) exists when people are able to choose, obtain, and use the reproductive health supplies they want.
Many countries face the challenge of meeting people's rising demand for contraceptives, including condoms 1, and other essential reproductive health supplies. Attention was first drawn to the challenge by projections of shortfalls in the financing required to pay for these supplies. The problem, though, is often not only one of financing, but also of disruptions and vulnerabilities in the many systems that need to work well, work together, and have the resiliency to adapt to changes to ensure that reproductive health supplies are available to people.
RHCS is not only a problem of increasing financing for supplies, but also of improving the systems needed to make them available to people.
SPARHCS (pronounced "sparks") - Strategic Pathway to Reproductive Health Commodity Security - is an approach to help countries address these concerns and develop and implement strategies for reproductive health commodity security (RHCS) 2. During the 2001 conference Meeting the Reproductive Health Challenge: Securing Contraceptives and Condoms for HIV/AIDS Prevention, held in Istanbul, donors and countries called for a common approach and framework to operationalize RHCS. In response, under the leadership of the U.S. Agency for International Development (USAID) and United Nations Population Fund (UNFPA), a wide range of collaborating agencies provided technical inputs, participated in workshops, and assisted with field tests to develop SPARHCS.
RHCS is a long-term goal requiring a multisectoral approach and continuous commitment.
The goal of RHCS and its translation into operational terms through SPARHCS focuses on supplies and is informed by decades of experience in supply chain management. From this basis, SPARHCS takes a strategic, long-term perspective to help a broad range of stakeholders understand their dependence on product availability and their role in ensuring it. SPARHCS embeds and links the traditional focus on "logistics" within a larger picture of what is needed to ensure supplies are available to clients: policies, financing, service delivery, advocacy, etc. 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 RH supplies they want, there can be no reproductive health commodity security 3.
SPARHCS provides a framework and diagnostic guide to support assessment, planning and implementation for RHCS.
SPARHCS takes a multidisciplinary, multistakeholder perspective to demonstrate the complex set of relationships inherent in reproductive health commodity security. It is built of three parts:
- A goal statement. Reproductive health commodity security exists when people are able to reliably choose, obtain, and use the contraceptives, condoms, and other essential reproductive health supplies they want.
- A conceptual framework. The framework identifies key elements that are involved in securing client access to reproductive health supplies and related services and that should be considered during country-level assessment, planning, and implementation for RHCS.
- And, a diagnostic guide. The guide follows from the goal statement and framework, and supports stakeholders to assess their present RHCS situation, define future expectations, and take into account trends from the past.
SPARHCS is meant to initiate concerted action toward the goal of people being able to choose, obtain, and use the reproductive health supplies they want. It is not a roadmap, nor a fixed process, but rather a guide that brings together the various factors that play a role in RHCS. As a "convener," SPARHCS can bring together a wide range of stakeholders to:
- establish and maintain multisectoral commitment to RHCS by raising awareness of and support for it as a public health objective;
- conduct a multisectoral, joint diagnosis of a country's RHCS status;
- identify factors that limit or enhance the prospects for RHCS;
- process those findings to reach consensus on priorities for improving RHCS;
- develop a comprehensive, multipartner strategy and action plan for RHCS that is evidence-based, fundable and feasible; and
- facilitate strategy implementation and guide ongoing monitoring and evaluation of results.
While the SPARHCS approach may appear linear, it is a continuous cycle (see figure, below), akin to the typical program cycle (planning - implementation - monitoring and evaluation). Entry into the cycle can occur at a variety of points, from awareness raising to evaluation, depending on the country situation. At any of these stages, the application of SPARHCS is designed to develop a new or strengthen an existing reproductive health commodity security strategy and funded implementation plan.
SPARHCS and the Program Cycle
SPARHCS can be adapted to a wide range of country contexts and stakeholder interests.
As country examples 4 demonstrate, the SPARHCS approach is flexible and the level of effort it requires is variable, permitting countries to customize the approach to their own needs and resources. SPARHCS can be used for contraceptives alone, for contraceptives and condoms for HIV/STI prevention, or for a still broader set of reproductive health supplies. 5 It can be used at national or subnational levels; in countries more or less experienced in working on reproductive health commodity security; in countries not yet ready to phase out donor support or in countries planning for self-reliance; and in countries at different stages of health sector reform.
- Condoms are singled out here for their dual role in family planning and HIV/STI prevention, but are henceforth included under "contraceptives."
- Because contraceptives and condoms are the sine qua non of family planning, are among the essential supplies for HIV/STI prevention, and have long been of special interest to the donor community, some agencies use "contraceptive security" (a term first coined by the Family Planning Logistics Management Project/John Snow, Inc. in 1998) to describe their work with reproductive health supplies. Others use "reproductive health commodity security." Regardless, all are dedicated to securing an adequate supply and appropriate range of RH supplies for developing countries.
- Henceforth, "reproductive health supplies" or "RH supplies" are used to refer to contraceptives and other essential supplies eproductive health supplies. Other essential supplies can include, for example, supplies for maternal and neonatal health care and for prevention and treatment of reproductive tract infections (UNFPA and WHO, 2003).
- See Section 4. SPARHCS Applied: Country Examples.
- So far, SPARHCS has been applied mostly to contraceptives and condoms for HIV/STI prevention.
