Date This publication was produced for review by the United States Agency for International Development. It was prepared by (First author’s First Name, Last Name),

Contents iii

Acronyms vii

Acknowledgments ix

1. Executive Summary xi

1.1 Demographic Situation xii

1.2 Public Commitment and Policy xii

1.3 Public Service Provision and Access xiii

1.4 Product Availability and Supply Chain Management IN THE PUBLIC SECTOR xiii

1.5 The Private Distribution Network xiv

1.6 Private Contraceptive Product Supply xv

1.7 Private Sector Services xvi

1.8 Conclusions and Recommendations xvii

2. Introduction 1

2.1 Chronicle of a Death Foretold 1

2.2 Purpose 2

2.3 Methodology 3

2.3.1 Site Visit Approach 4

2.3.2 Stakeholder Meeting or WORKSHOP 5

3. Demographic Situation and Family Planning Demand 7

3.1 Desired family size and fertility in Azerbaijan 7

3.2 How Azeri familIES achieve their desired fertility levels 7

3.3 Low modern use, high abortion rates, and potential demand 9

4. Public Sector Findings 11

4.1 commitment 11

4.1.2 opportunities/Recommendations 13

4.2 service provision 14

4.2.1 Policies 14

4.2.2 provider bias 14

4.2.3 Access 15

4.2.4 Recommendations/Opportunities 16

4.3 Product Availability 17

4.3.1 Opportunities/recommendations 18

4.4 Supply Chain Management 19

4.4.1 Forecast 19

4.4.2 Finance 20

4.4.3 Procurement 20

4.4.4 Distribution/Storage/waste management 21

4.4.5 LMIS 22

4.4.6 opportunities/recommendations 24

5. Azerbaijan’s Private Pharmaceutical Distribution Network 25

5.1 Manufacturers 26

5.2 Distributors 27

5.3 Pharmacies 28

5.4 Sales in Private Clinics 29

5.5 Contraceptive Products 29

5.5.1 Oral Contraceptives 29

5.5.2 Injectable Contraceptives (IC) 31

5.5.3 Intra-Uterine Devices (IUDs) 31

5.5.4 Spermicides 32

5.5.5 Condoms 32

5.6 Private Sector Services 34

5.6.1 Legal Environment 34

5.6.2 Types of Facilities 35

5.6.3 Opening and Managing a Private Clinic 35

5.6.4 Private Clinic Patients 36

5.6.5 Services and Costs 36

5.6.6 Health Providers 37

5.7 Conclusions 38

6. recommendations 41

6.1 CONTRACEPTIVE SECURITY overview and conclusions 41

6.2 Short term Recommendations 43

6.2.1 Advocacy 43

6.2.1.1 Commitment and PoliciesPolicy Research 43

6.2.1.2 Advocacy Activities 44

6.2.2 Demand Creation and the Private sector 45

6.3 Longer Term 45

6.3.1 Provider training and service improvements 47

6.3.2 Public sector Supply for target populations 47

6.4 Using Demographic Data to Estimate Contraceptive Consumption 50

6.5 Methodology 50

6.6 Limitations 51

6.7 Findings 52

6.8 Costs 53

6.9 Recommendations 54

6.9.1 Product Management in the Rayons 55

6.9.1.1 Sheki 55

6.9.1.2 Ismaili 57

TABLE XX: Existing Market Segmentation in Azerbaijan – Neglected Rural poor xviii

TABLE XX: Proposed Market Segmentation in Azerbaijan – reaching the rural poor xviii

TABLE XX : Existing Market Segmentation in Azerbaijan – Neglected rural poor 41

TABLE XX: Proposed Market Segmentation in Azerbaijan – reaching the rural poor 43

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