Reproductive Health Supplies Coalition

Since the 1970s, the international community has worked on providing access to the supplies and equipment needed to deliver quality reproductive health services in the developing world. In the early years, that engagement was largely financial and technical, focused in particular on effective supply chain management. By the late 1990s waning interest within the international donor community coupled with weak commitment by countries prompted many to see sustained access to reproductive health supplies as depending as much on effective advocacy as on purely technical support. Alarmed at the prospect of significant funding shortfalls, stakeholders from around the world met in 2001 in Istanbul at a conference entitled "Meeting the Challenge".[1] This conference was the starting point for a coordinated global reproductive health supplies movement. In 2003 the Supply Initiative was established as a coordinating mechanism. In 2004 12 organizations, mostly donors from the public and non-governmental sectors, established the Reproductive Health Supplies Coalition. Their aim was to foster better coordination and collaboration in such areas as global advocacy, resource mobilization, and supply chain strengthening. By the end of 2011 the Reproductive Health Supplies Coalition included 155 member organizations, among them developing country governments, international and national non-governmental organizations, civil society organizations, technical agencies, bilateral donors, multilateral organizations, private foundations, regional bodies, and manufacturers. In 2011, 360 participants from 56 countries gathered in Addis Ababa, Ethiopia[2][3] to mark the 10th anniversary of Meeting the Challenge and raise the international profile of reproductive health commodity security.[4][5]

Reproductive health supplies refer to any material or consumable needed to provide reproductive health (RH) services. This includes contraceptives for family planning, drugs to treat sexually transmitted infections, and equipment such as that used for safe delivery.

More specialized definitions of RH supplies have also been formulated. One of these is WHO's Interagency List of Essential Medicines for Reproductive Health (2006),[6] which reflects the current international consensus on essential medicines for the provision of quality RH services. Because the list prioritizes medicines believed to address the most pressing public health problems, it is by definition, selective. Nonetheless, it does include a broad range of contraceptives, drugs to prevent and treat sexually transmitted diseases and HIV/AIDS, and medicines to ensure healthy pregnancy and delivery. The Interagency List is a subset of the WHO Model List of Essential Medicines,[7] updated every two years since 1977. The 17th edition of the Essentials Medicines List (EML) was last published in 2011. To assist countries who formulate their own lists of essential RH supplies, based on local needs, the Coalition partners WHO, UNFPA and PATH published the Essential Medicines for Reproductive Health: Guiding Principles for their inclusion on National Medicines Lists (2006).[8]

Worldwide, the availability of reproductive health (RH) supplies, including contraceptives, medicines for prevention and treatment of sexually transmitted diseases and HIV/AIDS, and medicines to ensure healthy pregnancy and delivery, falls short of current demands.[9] No single set of factors can fully explain this reality, but the three factors are of particular significance:

• Limited resources: The demand for reproductive health supplies is greater than ever and with the share of development assistance dropping, ensuring adequate donor resources has become critical to meeting the supply challenge.[10]
• Inadequate systems: With more responsibilities brought by a shift towards greater country ownership of the development process, it is more and more difficult to find a way through an environment that is more and more complex.
• Lack of coordination: Coordination and harmonization of tools at the global level are necessary to combat against resource shortfalls and failing to make the most of existing resources. Global political will and advocacy are critical to give priority to reproductive health.

Achieving The Coalition's vision will not occur without certain conditions being met: that supplies actually reach those who need them most; that the supplies are affordable and within the reach of all; that supplies and products are of trusted quality; and that there is a sufficient choice of supplies to meet users' needs. These four broad preconditions—availability, equity, quality, and choice—are the Strategic Pillars.

• Availability: The ability of women and men to obtain safe, affordable supplies that meet their reproductive health needs. Supply availability exists when products feed into the supply chain and successfully make their way to the point-of-distribution, where users can obtain them.
• Quality: The ability of women and men to have supplies they can trust are both safe and effective. Good sexual and reproductive health depends on ensuring the quality of all reproductive health supplies.
• Equity: The ability of all people to have equitable access to reproductive health supplies. Age, economic well-being, gender, and civil status all have profound implications for the kinds of supplies potential users seek and the ability of users to afford them. The barriers impeding universal access to sexual and reproductive health must be overcome.
• Choice: The ability of all who seek family planning services to have a broad range of options from which to choose. An individual's need for contraception evolves throughout his or her life cycle. Accessing the "right" contraceptive increases the likelihood reproductive health needs will be met; a mismatch, research shows, is more likely to lead to dissatisfaction, lower continuation rates, and often method failure.

Three Working Groups are the principal vehicles through which Coalition members collaborate.
The Market Development Approaches (MDA) Working Group contributes to the goal of reproductive health supply security through a greater focus on the "total market", which includes the private and commercial sectors.
The Advocacy and Accountability (A&A WG) Working Group (formerly known as Resource Mobilization and Awareness Working Group RMA WG) contributes to the health and well-being of all individuals by ensuring they have access to RH commodities they want when they need them.
The Systems Strengthening Working Group aims to strengthen the global, regional, and country systems needed to ensure a reliable and predictable supply of RH commodities, primarily in the public sector.

In addition to the Working Groups the Coalition includes fora and caucuses dedicated to youth, maternal health supplies, generic manufacturers, and new and underused reproductive health technologies as well as regional fora for Latin America Foro Latinoamericano y del Caribe para el Aseguramiento de insumos de SR or LAC Forum and Francophone Africa Sécurité Contraceptive en Afrique Francophone SECONAF.

Innovation Fund,[11] made possible by a grant from the Bill & Melinda Gates Foundation makes available over US$2 million to enable member organizations to undertake activities in line with their Working Group's objectives, which would be otherwise unfunded.

AccessRH In 2010, UNFPA's Procurement Services Branch launched AccessrH,[12][13] a procurement mechanism aimed at improving customer access to affordable, high-quality contraceptives with favorable delivery terms. In December 2010, AccessrH placed its first order for 23.8 million condoms.

RHInterchange[14] is a free, web-based tool that provides accurate information on past, present, and future supply orders for over 144 countries.

Supplies Information Database (SID)[15] is an online reference library with over 6,000 records on the status of reproductive health supplies at country-level. The library includes studies, assessments and other publications dating back to 1986, many of which are no longer available even in their country of origin.

Coordinated Assistance for RH Supplies (CARhs) CARhs[16] brings together the world's commodity suppliers to address short-term supply crises. Through electronic data-sharing members identify existing or potential supply shortages and develop solutions. Between October 2009 and September 2010 CARhs addressed 184 separate supply crises and in the instances in which stock levels had dropped below minimal requirements, CARhs averted a stockout, either by issuing new shipments or providing policy advice. In 2010, such remedial efforts drove the procurement of more than $8.7 million in reproductive health commodities.

MarketBookshelf.com[17] is a large and open-access collection of health market literature, offering immediate access to documents and related resources needed to understand, develop and intervene in different global health markets. It covers a broad range of health areas, including malaria, HIV/AIDS, nutrition, contraception, neonatal and child health, maternal health, tuberculosis and other communicable diseases, immunization and non-communicable disease.

The Coalition is funded by the Bill & Melinda Gates Foundation, DFID, UNFPA, USAID[18] and other members' contributions.

Frank van de Looij, Chair, Netherlands Ministry of Foreign Affairs
Susan Clapham, Department for International Development
Nènè Fofana-Cissé, Regional Representative West and Central Africa, EngenderHealth
Manuelle Hurwitz, International Planned Parenthood Federation
Maryjane Lacoste, Bill & Melinda Gates Foundation
Benoit Kalasa, United Nations Population Fund Senegal
Nora Quesada, JSI
John Skibiak, Director, Reproductive Health Supplies Coalition
Ellen Starbird, USAID
Mukul Taparia, Pregna International Ltd
Monique Vledder, Global Financing Facility

More than 215 million women who wish to protect themselves from unintended and potentially unsafe pregnancy do not have access to modern contraception. In 2010, the Reproductive Health Supplies Coalition established the HANDtoHAND Campaign[20] with the goal of reaching 100 million additional users of modern contraception by 2015. Reaching this goal will meet the family planning needs of 80 percent of women in low- and middle-income countries. It will mean 96 million fewer unintended pregnancies, 54 million fewer abortions, 110,000 fewer mothers dying in pregnancy and childbirth, and 1.4 million fewer infant deaths. The Reproductive Health Supplies Coalition is leading the effort by urging stakeholders in both the public and private sectors to commit resources and support to reach this goal. At the September United Nations Summit on the Millennium Development Goals in New York, AusAID, the Bill & Melinda Gates Foundation, Dfid and USAID adopted the 100 million metric as a cornerstone of their International Alliance for Reproductive, Maternal and Newborn Health.[21]

• Birth control
• Condom
• Family planning
• Female condom
• Infant mortality
• International Conference on Population and Development
• Maternal health
• Reproductive rights

• RHSC official website
• Financial Times report on sexual and reproductive health