In Azerbaijan, the SPARHCS framework was used to ensure essential components on contraceptive security were included in the assessment. For example, the team assessed the demographic situation and demand issues (to the best of its ability given the out of date information). Other components included government commitment for family planning, policy factors, public sector service provision and supply chain issues as well as issues affecting pharmaceutical distribution and private sector services. The team interviewed both public and private sector individuals and organizations and visited hospitals, clinics and pharmacies, and conducted a review of key documents, data and systems.
The CS assessment in Azerbaijan reminds us of the difficulty in using an assessment tool to evaluate something that is not functioning. The intention was to modify SPARHCS to develop a formal commodity assessment tool for the assessment. However, the paucity of product availability and the general dysfunction of the logistics management information system (LMIS) made this redundant.
Modified SPARHCS framework with greater focus on private sector and supply chain.
Preasssessement desk review conducted ( (available data limited; focused on demographic FP trends)
Key informant interviews, key informant workshop and field visits to collect data (the latter was necessary because not a lot of data was available).
Low commitment, despite awareness raising and assessement because of pro-fertiltiy policy.
Qs: Were preliminary findings from the assessement presented to stakeholders prior to depature? YES
Has there been any positive action to address FP or CS – process wise or concrete – that resulted from the assessement? NO, LONG TERM STOCK OUT ISSUES AND GENERAL LACK OF COMMITMENT TO FAMILY PLANNING MADE IT DIFFICULT TO APPLY SPARHCS QUESTIONNAIRE - EVEN TO DETERMINE INTENTION IN ABSENCE OF SYSTEMS AND SUPPLY
At the request of USAID/Azerbaijan, the DELIVER and PSP-One projects undertook a joint assessment focusing on respectively the public and private sector’s current and potential contribution to contraceptive security. Key issues addressed in this assessment were the availability and affordability of contraceptive products and services in the public and private sector, legal and regulatory factors affecting product availability, a forecast of potential public sector commodity needs and options for government and private sector collaboration on increasing access to contraceptive methods.
Contraceptive security is said to exist when every woman and man can chose obtain and use the family planning methods they need. As this report will demonstrate, Azeri women and men suffer from “contraceptive insecurity” as products are not available to the majority of the population who would like to use them.
The assessment adapted USAID’s SPARHCS framework and conducted individual meetings with key stakeholders as well as a small workshop with public sector UNFPA and USAID project participants. Site visits to 19 public service delivery points and xx private clincs were also conducted in Baku and seven other rayons. Meetings with the private sector included pharmacy visits, distributors and manufacturers agents.
Couples in Azerbaijan have been successful in actually achieving their desired family size with the total fertility rate (TFR) falling to 2.1 in 2001 from 2.8 in 1994-96. Because of the large proportion of the population in its reproductive years, the total population will continue to grow until it stabilizes at 9.5 million in 2025. Azerbaijan’s fertility reflects trends throughout Europe and Central Asia but is higher than elsewhere in the Caucuses and Eastern Europe.
Azeri couples achieve their desired fertility through use of traditional contraceptive methods (43.5%), which dwarfs modern contraceptive use (11.9%). The high use of withdrawal (41%) is amongst the highest in the world, and demonstrates a commitment of both men and women to regulating the size of their families. Unfortunately, high failure rates from withdrawal contribute significantly to Azerbaijan’s abortion rate, which at 116 per thousand (WRA) of reproductive age, is the second highest in the World. According to the RHS, failure of traditional methods accounts for 58% of abortions, resulting in over 150,000 abortions per year. With 20.6% leading to complications, this contributes to maternal mortality as well as creating unnecessary financial and psychological burdens on Azeri families.
Some 53% of WRA are reported as having an unmet need for contraception, those who do not want to get pregnant and those using ineffective traditional methods. This is amongst the highest levels reported not only in Europe but the world.
There is a lack of interest in investing in reproductive health and family planning among the senior leadership in the Government of Azerbaijan (GOA). This is fueled partly by outdated notions on the fertility aspirations of Azeri couples and ignorance of the true consequences of “contraceptive insecurity”. . There is presently no commitment from the GOA or donors to fund future contraceptive commodities and no sense of urgency amongst the higher echelons of the MOH of the consequences of the imminent expiry of the last remaining donated products in the system. There is a real risk that recent progress in Family Planning (FP) will be lost without some attention and funding.
This lack of commitment contrasts with the innovation and commitment dedication the MOH and new Minster of Health, Dr. Shiraliev, have shown to implementing the World Bank support integrated primary health care based health reforms. These reforms alongside increased GOA funding for health care including maternal health initiatives present opportunities for increasing the attention on RH/FP as part of an integrated package of care.
Champions at the National Reproductive Health Office (NRHO) have been working to promote FP for many years in Azerbaijan. Allied with emerging champions within the MOH itself, and with interested parliamentarians, there is an active nexus to help promote FP in Azerbaijan.