Costed Implementation Plan for the National Family Planning Programme, Bangladesh, 2016-2020

Bangladesh committed to the overall goal of ‘Ensuring quality and equitable family planning services for all eligible couples by improving access to and utilization of family planning services, particularly by the poor’ at the London Summit on Family Planning (FP2020) in July 2012. Specific targets have been set for reducing total fertility rate, increasing contraceptive prevalence rate (CPR) and method-specific coverage, reducing discontinuation rate and reducing overall unmet need for family planning (FP). To achieve the targets determined at the FP 2020 summit, a Costed Implementation Plan (CIP 2016–2020) is required for Bangladesh to enhance its national FP program (NFPP). Timely mobilization of resources is always a considerable challenge to the implementation of FP program activities; unavailability of financial resources would jeopardize the entire program. Meeting this challenge requires a CIP. The overall objective is to develop a five-year CIP (2016–2020) to strengthen the NFPP to achieve its set goals and objectives by 2021. Preparation of a CIP involved qualitative and quantitative methods of data collection and analysis within a cost analysis approach. These included document reviews, key informant interviews, consultative workshops, future projection analyses based on CPR and LAPM targets, and estimation of costs of family planning program interventions and impacts. The CIP was prepared through a collaborative, participatory and consultative process involving a wide range of stakeholders in September–October 2014. Bangladesh CIP 2016-2020 for NFPP reflects six focus areas required to achieve a CPR of 75% and LAPM 20% in 2021 as well as the resources needed and the intended impact. This CPR goal is based on a projected baseline CPR of 62% in 2014. The six focus areas are: FP services delivery; information, education and communication; high-performing staff; procurement and supply management of FP commodities; planning and management; and policy and advocacy. The focus areas are consistent with national policies and existent operational plans. Twenty-six strategies to achieve the objectives were defined across all six focus areas, and the activities which need to be accomplished were described under each strategy. Expected results, success indicators, stakeholders responsible, time frame and costs were also outlined. Unit costs of the inputs and lump sum allocated amounts (in some cases) were used to estimate the cost for each activity each year. A total of US$1377.36 million will be required to adequately implement all implementation activities for the period 2016 to 2020, rising from US$227.73 million in 2016 to US$327.67 million in 2020. Financial requirements will be high in 2019 (21.67%) and 2020 (23.78%) due to increased demand for services, the need to ensure the quality of services, multi-sectoral engagement and inflation. It should be noted that the CIP includes costs of commodities and services provided by both the public and private sectors. Costs were estimated from an institutional perspective irrespective of the public or private nature of sources. Administrative costs at the national, divisional, district, sub-district and community level were not considered. The FP services delivery focus area accounts for 91.36% (US$1258.34 million) of the total cost. Procurement of commodities and services (time of service providers and medical supplies) constitute 24.51% and 33.19% of total cost respectively. More funding for these activities will be required, mainly due to the expected increase in demand for services, expansion of coverage and inflation. The procurement and supply management focus area has the second-largest costs (5.27% of total). Policy and advocacy focus areas require relatively minimal funding. Broader health indicators were measured to assess the impact of FP services between 2016 and 2020. The NFPP will avert 88.31 million pregnancies and 57.97 million births, and 2.72 million and 0.33 million infant and maternal mortalities respectively. Costs of US$18,832.41 million to individual households and national budgets will be saved as a result of the abortions and infant and maternal deaths averted by the NFPP. 8 DGFP, under the Ministry of Health and Family Welfare (MOHFW), will provide the leadership and political support needed to implement the plan. DGFP will be responsible for developing and updating policies that will be required to accelerate implementation in efficient ways, mobilize resources, and conduct monitoring and evaluation. DGFP will work closely with the FP2020 Bangladesh Country Engagement Working Group (BCEWG) with support from development partners. Effective coordination between national, district and sub-district levels is critical to the successful implementation of the plan. The CIP presents a well-defined monitoring and evaluation framework. DGFP will take the leadership role in monitoring the activities of the CIP. The BCEWG will be responsible for coordinating the activities of the CIP and monitoring progress. The monitoring and evaluation framework will encompass two broad areas: monitoring implementation of activities in the CIP and evaluation. The accomplishment of the CIP will depend on the acquisition of financial resources.  BCEWG should collaborate with national stakeholders and development partners to generate financial resources to fully implement the CIP. They need to work together to prioritize interventions and resource allocation for efficient utilization of available funds.  The MOHFW should allocate funds for FP from its budget.  Involvement of the private sector and NGOs needs to be increased for resource mobilization and allocation.  Private foundations and other innovative financing options for the CIP must be explored. The DGFP should conduct regular periodic reviews of funding status. Reviews should focus on rigorous budgeting, tracking of funds, prioritization, alignment, efficient resource use and accountability. When implemented, this CIP will ensure quality and equitable FP services for all eligible couples by improving access to and utilization of FP services, availability of sufficient FP providers at the community and facility level, and the enabling environment for FP.