Gates Package — page 545

The leadership of British Prime Minister David Cameron at the London Summit on Family Planning last year was crucial in raising awareness of the need to provide access to contraceptives and family planning (London, England, 2012). women who want to use contraceptives and the number of women who are currently using them. Dozens of partners from many different sectors-- leaders of donor and developing countries, people working for nonprofits on the ground in poor countries, and pharmaceutical companies and other businesses--signed on to a concrete, measurable goal that is ambitious yet achievable: making contraceptives available to an additional 120 million women and girls in the world's poorest countries by 2020. When we started the project, though, I have to admit I was frustrated by how loose the numbers were. Population-based surveys happen infrequently, and since contraceptives have to do with sensitive topics like sex and gender roles, solid service statistics can be hard to come by. I didn't feel I had an accurate picture of how many women currently have or lack access to contraceptives, or what could realistically be done to drive improvement. Itwas hard enough to develop a baseline of how many women were using contraceptives in 2012. Figuring out how many women wanted to use them but didn't have access was even more difficult. I learned, for example, that some health clinics reported having contraceptives "in stock" as long as condoms were on the shelves. However, many women prefer contraceptive injections and implants, in part because they have trouble negotiating the use of condoms with their sex partners. As a result, nobody was counting the many women who had access only to contraceptives they didn't want and couldn't use. For months, the Summit's sponsors studied numbers from many sources to model a rigorous baseline. They also combed through historical data from countries that have invested in family planning services to estimate what could be achieved in the future with adequate investment. That's how we landed on the goal of 120 million women. Now individual countries are in the process of creating plans based on an analysis of the unique challenges they face. As a result, they zero in on the dominant constraints in their particular situation--whether that's funding, supply chain, procurement policies, demand, health education, or any other factor. These plans include clear milestones to help countries stay on track. This is the exciting part, where we can see how measurement leads to sweeping changes in the way health systems serve people. Senegal is one impressive example. An important part of their plan is to improve their contraceptive supply chain, and they're basing changes on a model that was pilot tested last year. The results were astounding: Not only were stockouts eliminated in the pilot clinics, but the amount of contraceptives provided to women shot up [IUDs by 52 percent, contraceptive injections by 61 percent, oral contraceptive pills by 73 percent, and implants by 940 percent}. At the Dominique Health Center in Dakar, Senegal, family planning pilot programs have vastly improved access to contraceptives in the past year (Dakar, Senegal, 2012). The energy created at the London Summit is spreading to the countries where the work is happening. I am certain that we have the tools and the broad-based, long-term commitment to turn that energy into results for millions of women. 2013 Annual Letter from Bill Gates