Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services

Abstract

Dedicated logisticians restocked contraceptives monthly at facilities to maintain defined minimum stock levels, freeing up clinic staff. High stockout rates were virtually eliminated. Also, quality and timely data on contraceptives distributed allowed for better program management. ABSTRACTContraceptive use in Senegal is among the lowest in the world and has barely increased over the past 5 years, from 10% of married women in 2005 to 12% in 2011. Contraceptive stockouts in public facilities, where 85% of women access family planning services, are common. In 2011, we conducted a supply chain study of 33 public-sector facilities in Pikine and Guediawaye districts of the Dakar region to understand the magnitude and root causes of stockouts. The study included stock audits, surveys with 156 consumers, and interviews with facility staff, managers, and other stakeholders. At the facility level, stockouts of injectables and implants occurred, on average, 43% and 83% of the year, respectively. At least 60% of stockouts occurred despite stock availability at the national level. Data from interviews revealed that the current ''pull-based'' distribution system was complex and inefficient. In order to reduce stockout rates to the commercial-sector standard of 2% or less, the Government of Senegal and the Senegal Urban Reproductive Health Initiative developed the informed push distribution model (IPM) and pilot-tested it in Pikine district between February 2012 and July 2012. IPM brings the source of supply (a delivery truck loaded with supplies) closer to the source of demand (clients in health facilities) and streamlines the steps in between. With a professional logistician managing stock and deliveries, the health facilities no longer need to place and pick up orders. Stockouts of contraceptive pills, injectables, implants, and intrauterine devices (IUDs) were completely eliminated at the 14 public health facilities in Pikine over the 6-month pilot phase. The government expanded IPM to all 140 public facilities in the Dakar region, and 6 months later stockout rates throughout the region dropped to less than 2%. National coverage of the IPM is expected by July 2015.

Examining trends in family planning among harder-to-reach women in Senegal 1992–2014

“…Furthermore, only 87% of facilities nationally were found to offer FP services in 2014 (less in the South and West of the country)48. There is also evidence that all contraceptive methods were not always available in all facilities, particularly in Southern regions and in one Central region (Fatick)4849 – although a national intervention aiming to strengthen the contraceptive supply chain had not been rolled out in the South at the time of the survey49 – and that providers place age or marital status restrictions on contraceptive provision61650. Unlike other countries, FP services are not provided for free in Senegal.…”

Understanding and addressing contraceptive stockouts to increase family planning access and uptake in Senegal

“…In fact, as supply chain experts in Senegal and elsewhere have observed, the efficient and reliable distribution of commodities from central warehouses to lower-level health facilities is a frequently challenging and often neglected aspect of effective supply chain management [11–13]. In the past, Senegal used a highly complex order-based “pull” system.…”

Strengthening Government Leadership in Family Planning Programming in Senegal: From Proof of Concept to Proof of Implementation in 2 Districts

“…Collectively these participant observers represent senior Senegalese and external experts with many years of experience in support of family planning and reproductive health project development in Senegal and elsewhere. Their insights were complemented by data gathered from the following sources: Informal interviews conducted over the course of the project by the ISSU team and ExpandNet in Diamniadio and Rufisque with the chief medical officers of the districts, reproductive health coordinators, health educators, community health worker (CHW) supervisors, providers, and religious leadersThe diagnostic assessment undertaken in Diamniadio and Rufisque to determine which supply- and demand-side interventions should be included in the simplified and reduced packageA simple qualitative tool that documented increased leadership by the district health management teams in the areas of planning, monitoring, supervision, coordination among partners, and mobilization of health systems resources, as well as the changing role of ISSU facilitatorsDistrict-level monitoring related to implementation of the simplified package of interventions (based on CHW records of household visits, the number of referrals from communities for family planning services, and outputs from the special service days) as well as other relevant government service statisticsInformation on the provision of contraceptive products at health facilities collected by the Senegal Informed Push Model project, which focused on improving the contraceptive logistics system 14 …”

“…Information on the provision of contraceptive products at health facilities collected by the Senegal Informed Push Model project, which focused on improving the contraceptive logistics system 14 …”

“…Recruitment of additional personnel in Diamniadio and Rufisque was neither feasible nor sustainable, so existing district midwives made a commitment to assume the additional burden of work. Regular availability of contraceptive supplies was ensured through the Informed Push Model, a project designed to improve the contraceptive supply chain 14 . This project had evolved from ISSU, and its interventions were already being expanded more broadly in Senegal, including in Diamniadio and Rufisque.…”