For any health program to be successful, products must be available at the health facilities. This should be obvious, but many developing country public health programs frequently stock out of commodities at their health facilities. The consequences of inefficient last mile distribution are many: if clients do not receive their preventive or curative products, serious complications can follow—unplanned pregnancies, spread of diseases, and even death.
Just as you would not shop at a grocery store that rarely had milk on the shelf, a health facility with frequent stockouts decreases community confidence in the health network, which can ultimately lead to deteriorating health conditions. A reliable supply chain is a key component to ensure that health products, including contraceptives, are available at the service delivery point, whether it is a tertiary hospital, district hospital, clinic in a small town, or rural health post.
The international public health logistics landscape is evolving rapidly. Major initiatives to combat some of the most pressing problems, such as HIV/AIDS, tuberculosis, and malaria, have increased the types of health commodities managed by the public, private, and NGO sectors. The number of drugs and complexities have created a complex distribution and service environment. In addition, health sector reform—decentralization, integration, sector wide approaches, and shifts in donor funding—have placed a heavy burden on in-country distribution systems, including how contraceptives are managed. Many factors can cause a stockout of essential products at the health post, including insufficient funding to procure the needed quantities, inaccurate forecasts, long and complex procurement processes, and supplier shortages.
Another major reason for stockouts could be the performance of the in-country distribution system. Communicating with and delivering to remote areas is often a barrier to ensuring product availability at the last mile. There are many contributing factors.
Inventory reporting processes, often based on lower volumes of fewer products, can be slow and resource-intensive, resulting in low reporting rates.
Administratively-based distribution networks may be too complex, unable to react to quickly changing demand or stock imbalances across the system.
Transportation may be unreliable, resulting in fewer shipments, late shipments, or missed shipments.
Trained personnel may be hard to retain at the end of the supply chain, which can result in inaccurate order quantities.
There are certainly many others. It is only by assessing and analyzing the root cause of the non-availability of health products at the country level that a diagnostic can be made and solutions proposed.
Tools and approaches developed or used by the USAID | DELIVER PROJECT, such as segmenting the supply chain for strategic management or analyzing the distribution network, can offer solutions for improving last mile availability. (Please refer to the Supply Chain Analysis and Design section for more information on these tools and approaches). Other approaches include simplifying the ordering process, implementing technology to improve reporting, or studying transportation solutions that could increase the frequency of deliveries. Finding practical solutions to bottlenecks, gaps, or barriers to effective last mile distribution will help ensure that health products are available where and when they are needed.
