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

Abstract

BackgroundSenegal’s government has pledged to reduce contraceptive stockouts, which have been frequent in public sector health facilities. An innovative distribution system called the Informed Push Model (IPM) addresses supply chain obstacles through direct regional-to-facility delivery of contraceptives and use of private sector logistics operators. Following promising pilot results, Senegal’s Ministry of Health and Social Action committed to a three-year (2013–2016) expansion of IPM to all public health facilities nationwide.MethodsFrom August 2014–July 2016, IPM’s six logisticians made 29,319 visits to restock public sector health facilities. During these regular facility visits, the logisticians conducted a physical inventory to flag contraceptive stockouts (no usable stock of any single method available) and asked facility staff to identify the primary reason for documented stockouts. Our descriptive study examines stockout trends over the course of IPM scale-up. We also describe trends in contraceptive consumption over the three-year period using facility-level data collected by the logisticians.ResultsContraceptive consumption rose by 91% over 35 months in the first three IPM regions, and by 118% in the next five regions (over 26 months). After scale-up to 1,394 health facilities, nationwide consumption rose by 48% over one year. On average, logisticians documented stockouts at fewer than 2% of facility visits. In comparison, two pre-IPM studies in 2011 identified stockouts of selected modern contraceptives at 60–70% of facilities visited, with 84% of clients reporting stockouts in the past year. Six factors (including consumption spikes, IPM-preventable causes, and community outreach) explained most remaining stockouts.ConclusionsIPM has been highly successful in ensuring full availability of contraceptives across regions and health facilities. The model also has facilitated the flow of essential data on consumption and stockouts from facilities up to district, regional, and central-level managers. These achievements highlight the relevance of professionalizing supply chain management while continuing to mitigate stockouts through enhanced stakeholder communication and improved training, coaching, and supervision of third-party logistics operators. Supply reliability is critical in shaping demand for and regular use of contraception. The government is transitioning the IPM to full management by the National Supply Pharmacy.

Evaluation of Senegal supply chain intervention on contraceptive stockouts using routine stock data

“…The odds of having all methods in stock at the health facilities tripled after the IPM intervention, demonstrating its remarkable success in reducing stockouts of contraceptives. Results from our study confirm findings from other sub-national or shorter term evaluations of the positive effect of IPM on improving the availability of contraceptives in public health facilities [3,13]. For example, Daff et al [3] estimated that pre-IPM pilot stockout rates of 14-86% were reduced to 0% post-intervention.…”

“…In contrast to the pre-existing supply chain system which required up-front payment for all products ordered, under IPM the initial stock was provided by the private operators on credit and health facilities paid only for the contraceptive products sold to women. Private operators received extensive training and mentorship from the contracting organisation [3,13,16].…”

“…During the 18 months before the intervention, there were 335 contraceptive stockout events, with a median duration (interquartile range, IQR; not adjusted for sampling weights) of 8 days. Following the intervention, there were 44 contraceptive stockout events, with a median (IQR) duration of 6.5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days. The distribution of stockout event duration is presented by product, in the form of box-plots (Fig 2).…”

“…IUD). However, when a stockout occurred post-intervention (due to unpredicted spikes in consumption or unplanned outreach activities) [13], workers at the health facility were told that they could call private operators for a top-up. However, our results indicate either a lack of flexibility from private operators in responding to unpredicted stockouts or a lack of communication from health facilities to private operators indicating the need for more stock.…”

Improving Supply Chain for Essential Drugs in Low-Income Countries: Results from a Large Scale Randomized Experiment in Zambia

“…24 Since the completion of this randomized trial, a few recent studies have been conducted to analyze the impact of system redesign on health product supply chain performance using simulation models or pilot implementations. [25][26][27] However, the strength of evidence and cost effectiveness of such design changes is still questioned by country-level policy makers. As a result, very few policy changes have been made regarding redesign of the medicine supply chain.…”