Contraceptive use has increased during the past two decades as more and more couples in developing countries seek to space, or limit the number of, their children. With an estimated 212 million more women using contraception in 2015 than in 2000, the demand for contraceptives will continue to rise steadily over time. To ensure that couples can chose, obtain, and use a reliable supply of contraceptives when they need them, developing countries will need to strengthen and sustain supply chains.
The family planning supply chain includes many organizations that are linked in the delivery of supplies, from manufacturers to clients, and linked in the flow of information about clients’ contraceptive use and needs. A well-functioning supply chain ensures that all components of the logistics cycle—product selection, forecasting, procurement, distribution (including storage, transportation, and inventory management), logistics management information, quality monitoring, and client service—work effectively and efficiently. A weakness in any system component can cause a major disruption, possibly the collapse of the entire chain.
Since 1986, the USAID | DELIVER PROJECT and its predecessors, the DELIVER project and the Family Planning Logistics Management Project (FPLM), have helped countries improve the availability of contraceptives. Currently, the project is providing technical assistance to approximately 21 countries, with field offices in 14 of those countries. The project’s technical assistance interventions for family planning cover all aspects of the supply chain, including forecasting, financing, procurement, distribution (transportation and storage), inventory management, logistics management information systems, and strengthening policy and advocacy.
Most developing countries are committed to meeting the contraceptive needs of their citizens, but governments cannot do this alone. Faced with limited access to financial and human resources, they welcome a collaborative approach to reach contraceptive security—which is the ability of every person to choose, obtain, and use high-quality contraceptives when they are needed. A multi-sectorial approach that recognizes the contributions of the commercial sector, social marketing, nongovernmental, and public sectors, and includes national, local, and community financing initiatives, can all make contraceptives more available and affordable for the general public. In many countries, governments are assuming increasing responsibility for providing contraceptives to their people. This government support is generally assisted by multilateral and bilateral development partners, and political and policy support from a wide spectrum of partners. Coordination between all these local, national, and international partners is therefore critical to achieve a secure contraceptive supply.
A major focus of the USAID | DELIVER PROJECT is to strengthen contraceptive security at the country level. Key interventions include encouraging the establishment and routine operation of contraceptive security committees; promoting national government and development partner financing of contraceptive procurements; ensuring that contraceptives are included on National Essential Drug Lists; initiating early warning systems to limit or prevent contraceptive stockouts; and developing contraceptive security plans and indicators. At the global and regional level, the project has supported international organizations and forums such as the Reproductive Health Supplies Coalition on contraceptive security issues, and has disseminated best practices and lessons learned to our global, regional, and local partners.
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Family planning supply chains have multiple interconnecting links. Among them are—
Forecasting and Procurement Forecasting contraceptive use helps meet the actual need for family planning products and it can reduce stock imbalances—that is, contraceptive stockouts that could deprive clients of their contraceptives, undersupplies that could increase the possibility of stockouts and require expensive emergency replenishment, or oversupplies that could cause product expiration and wastage. Forecasting entails a prediction about the future and it might incorporate assumptions about many factors: future contraceptive prevalence rates and numbers of couples of reproductive age, changes in contraceptive method mix, publicity campaigns, and the like. Forecasting typically precedes the development of a procurement plan, which includes the type and quantity of products that should be ordered and the order and shipment dates.
Procurement is the process of obtaining products through suppliers or through purchases from manufacturers, procurement agents, or development partners. A good procurement system based on a proper identification of suppliers and tendering process will typically result in lower costs and more reliably available and higher quality products. Procurement actions take time and requires a range of skills and careful management if products are to be procured in a time frame that will avoid stockouts.
Logistics Management Information Systems (LMIS) Family planning logistics systems require a regular flow of information that identifies the quantity of contraceptives in the pipeline and the clients’ consumption of contraceptives. This information is essential to ensure that the service delivery points are regularly resupplied in the right quantities. Information collected can also pinpoint potential stockouts, undersupplies, and oversupplies in the system, and trigger action to avoid stockouts and costly expiries. A well-functioning LMIS channels this information to program managers and logistics system operators in a timely manner, thus allowing continuous monitoring of the pipeline and enabling a rational distribution of family planning products and procurement of new contraceptives. Development partners also use LMIS information to assist governments and social marketing companies for contraceptive procurement and supply management.
THE USAID | DELIVER PROJECT has designed logistics information systems that include the development of form templates and standard operating procedures for managing an LMIS; they have also created computerized databases.
The project has developed computer software programs designed for contraceptive logistics management and the development of supply plans. Such programs are powerful and convenient ways for managers to monitor their pipeline and develop rational procurement plans.
Storage and Distribution Distribution elements (transportation, storage, and inventory management systems) are critical in any supply chain; they are essential to ensuring a continuous supply of usable contraceptives to clients. Sub-optimal storage and transportation conditions will lead to product wastage and higher costs. In some countries, distribution costs have been estimated at 15–20 percent of the value of contraceptives handled and are a significant cost factor. Inventory management systems set the parameters at which supplies should be stocked to avoid stock imbalances.
Transportation systems link points in the contraceptive supply chain from the port of entry through central and sub-national warehouses and stores to service delivery points and clients. Storage systems include central medical stores; intermediate regional and district stores; and service delivery points. Good storage practices protect the quality and integrity of contraceptives against damage from pests, environmental hazards, and extreme climate conditions.
THE USAID | DELIVER PROJECT has undertaken transportation, warehousing, and distribution costing studies and have recommended designs that streamlined distribution systems, reduced expenses, and increased distribution system efficiency. We have adopted a new tool that can model the supply chain for the current or the optimized network, providing different scenarios for supply chain optimization, and simulating the performance of the supply chain over a specific period of time. This tool will help determine the optimal number and location of warehouses, transport equipment and routes, and inventory quantities for supply chain efficiency and effectiveness.
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Human Capacity for Logistics The success of family planning programs hinges on the skill, knowledge, and commitment of the people who manage and implement them. Decision makers and senior program managers help define policies and standards for sound logistics management. Intermediate logistics system operators (procurement agents, distribution agents, store managers, data entry clerks, etc.) ensure the procurement, distribution, information management, and quality monitoring of products; service providers dispense contraceptives to clients and keep essential records and reports. Because the environment in which supply chains function is ever evolving, it is vital to a well-functioning contraceptive supply chain to continuously improve the ability of logistics decision makers and senior managers, intermediate-level operators, and service providers to understand sound logistics management practices and base their decisions on good logistics information.
A major priority for the project has been to build human capacity for logistics by engaging local and regional organizations. It launched the International Association of Public Health Logisticians (IAPHL) and also collaborated with WHO to operate a website that disseminates best practices, suggests solutions for problems, and facilitates communication among IAPHL members. The project is committed to expanding the capacity of local and regional institutions to deliver high-quality logistics performance improvement courses. Working with the Leadership, Management and Sustainability Program (LMS), it awarded a contact to a Peruvian NGO, PRISMA, to conduct supply chain management training courses in the Latin American region. It has also increasingly used local hires in project implementation and subcontractors with specialized supply chain capabilities.
Click here to learn more about the project's organizational strengthening activites.
Click here to learn more about supply chain essentials.
Innovation for Last Mile Delivery
The objective of a well-functioning supply chain system is to deliver or dispense products to the end user. This “last mile delivery” addresses a critical component of the logistics system, which is to serve customers with an uninterrupted availability of high-quality affordable products. Specific ways that the project has encouraged last mile distribution is through outreach efforts to poor and vulnerable populations; rapid program scale-up; and direct delivery of products.
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One of the greatest challenges has been obtaining timely consumption and stock data from the service delivery points. There are many reasons for this, but one important reason is how the data itself is transmitted. Although collected daily, it often is only forwarded to the next level every month; from that level, it is sent to the central level. It could take two to four months to reach some of the decision makers. This time lag makes it difficult to quickly address stock imbalances. One approach the project is implementing is to use cell phones and other handheld devices at the lowest levels to quickly capture and transmit vital data for rapid action; this will ensure product availability where and when it is needed.
Given the rising demand and associated rising costs, national governments and development partners, such as USAID, are constantly looking for ways to improve the effectiveness, efficiency, and sustainability of the family planning supply chain. Approaches for improving the supply chain include integration, decentralization, and public-sector partnership.
The integration of contraceptives with other categories of health products in one harmonized logistics system can lead to improvements in warehousing, storage, and the flow of logistics management information for multiple commodities. This does not imply that all products can be managed in the same way. Products have different requirements—some have short shelf lives and others have longer ones; some require cold or cool chains, others do not.
The project has teamed with the Massachusetts Institute of Technology-Zaragoza International Logistics Program to apply a segmentation approach to international public health products, including contraceptives. The object is to make a complex supply chain more manageable by creating supply chain segments, each with a unique distribution strategy. Decentralized logistics systems can lead to better logistics decision making; management tailored to the needs and resources of local communities and public-private partnerships can lead to greater efficiencies in distribution, storage, and client access.
The project’s innovations and best practices are highlighted in these cutting-edge health sector reform approaches.
