Elements of Family Planning Success

"The most important thing to advancing contraceptive security is commitment...Without commitment to contraceptive security as a public health problem, you will not see the actions and investments to address some of the other obstacles.  For example, the lack of financing for contraceptives, the lack of affordable contraceptives for all the users in the country, [and] lack of policies that support equitable access to contraceptives."
-Dr. Alan Bornbusch [Watch this interview]
 

To succeed, a family planning program needs an uninterrupted supply of contraceptives. Every program needs a logistics system to achieve this goal. The logistics system should make sure that each service delivery point always has enough contraceptives and related supplies to meet clients’ needs.
[The Logistics Handbook: A Practical Guide for Supply Chain Managers in Family Planning and Health Programs]

Q. Why is logistics important?
A. Without a continuous supply, clients have to switch to methods they are less comfortable with using or else go without entirely, and the result is unintended pregnancies. Stockouts are a common and serious problem in many programs. Clinic staff often tell interviewers that they offer certain methods, but when asked if a client could get that method today, the answer is often, “Well, not today. We’re out of supplies.” Stockouts also demoralize staff and limit their ability to provide the best quality care. On the other hand, overstocks result in wastage, damage, and expiry of product, and squander program resources. A good logistics system maintains appropriate stock levels and prevents imbalances that hamper program operations.
 
Q. What does a good family planning logistics system involve?
A. A good logistics system covers planning, procuring, selecting, transporting, storing, and distributing contraceptives and other clinical supplies. In fact, a logistics system comprises both the flow of products themseleves, and the flow of information about them. A logistics management information system is the most critical component of a well functioning supply chain (see image).
 

 
Q. What is the objective of logistics management?
A. The objective of logistics management is the “delivery of the right product, in the right quantity, in the right condition, to the right place, at the right time, for the right cost. In a well-managed logistics system, service delivery points never run out of supplies. Another way to put this is that the purpose of a logistics system is customer service. Good logistics managers focus on making product available for the ultimate user.
 
Q. What is contraceptive security?
A. Contraceptive security is the concept that several intersecting systems must be in place to assure the availability of contraceptives over the longterm. Policy and financial support, service delivery capacity, client demand, and a strong supply chain are all essential to attain contraceptive security. Contraceptive security exists when people are able to choose, obtain, and use high-quality contraceptives and condoms whenever they want them for family planning and STI prevention. A steady supply of contraceptives enables people to use and continue using the method of their choice. If there is an interruption in supply, people will not be able to prevent unwanted pregnancies. A successful program, therefore, will assure contraceptive security. [Contraceptive Security: 5 Ready Lessons]
 
Q. How can programs improve delivery of supplies to clients?
A. Consistent supply depends on both adequate funding (or donation) of supplies and well executed supply chain management activities, including accurate estimates of supply needs, efficient procurement practices, and reliable, timely deliveries. Strengthening logistics may require improvements in four areas:

• Management and staff performance
• Information systems (Logistics Management Information System, or LMIS)
• Forecasting and procurement
• Distribution
  [Strengthening the Supply Chain Population Report]
   
  Q. What is an LMIS, and why is it important to a program’s contraceptive logistics system?
  A. All health service delivery programs are commodity dependent! This is another way of saying “No product? No program.” They all have supply chains, and all top quality supply chains logistics management information systems (LMIS) to support key logistics functions — forecasting, procurement, and distribution of contraceptives. A good LMIS allows programs to collect and report accurate data to make commodity management decisions. It allows programs to manage and monitor the flow of contraceptive supplies, reduce supply imbalances, and improve cost-effectiveness. Data from the LMIS also are useful for evaluating programs and supply chain operations.
   
  Q. Who uses logistics information?
  A. Logistics information is used by logistics managers, of course, so they can move products to the right place at the right time. But accurate and timely logistics information is important for a number of other reasons, as well. Policy makers, donors, and financing staff also need to use logistics information to support their decision making. Funders are more likely to support family planning programs that can provide reliable statistics on contraceptive supplies and their use and can account for the products that the donors have provided. When donors supply commodities, they have a direct reason to need logistics information: they are actually a link in the supply chain.
  [PipeLine Software Tool]
   
  Q. How many contraceptive methods should a program stock?
  A. The methods a program chooses to stock will vary according to clientel, program capacity, budget, and the availability of supplies. Offering a range of effective methods can meet people’s diverse needs and serve individuals over their reproductive lifetimes. Programs should offer as many methods as they can reliably supply. For example, programs shouldn’t offer a monthly injectable if they can’t be sure the supplier will come through when they reorder. No matter how many methods are theoretically available, people will not be able to use them unless supplies of contraceptives are available in the facility they visit when they visit it. Without good logistics, the method is not truly available. On the other hand, a program should not proliferate offerings needlessly; each particular item (method, formulation, and brand) is managed as a separate stock-keeping unit (SKU), and the more SKUs there are, the more important it is to pay attention to logistics.

  An important part of a program’s method mix is long-acting and permanent methods (LAPMs), including female and male sterilization, implants, and IUDs. LAPMs are convenient for users and prevent pregnancy very effectively. They are also cost-effective for programs over time, and can result in substantial cost savings for governments.
  [The Pocket Guide to Managing Contraceptive Supplies]
   
   
  Case Study
  Jordan’s Logistics System Promotes Contraceptive Security
   
  Until the mid-1990s Jordan’s Ministry of Health (MOH) had no formal logistics system for managing contraceptive supplies. Supply chain problems such as stock-outs were common. They threatened to undermine the national family planning service. For example, in some clinics, staff reordered contraceptives only when supplies ran out. Thus clients could not continue their method until new supplies arrived. In other clinics overstocking led to wastage. A needs assessment found that these problems were occurring due to a lack of guidelines, no formal inventory control system, and a lack of logistics training for family planning staff.
   
  To address these problems, the MOH designed a new logistics system for all major public and private family planning providers. The new system included new manuals, guidelines, and training curricula, and a centralized LMIS, which could generate reports about every service delivery site in the country.
   
  By 1999, two years after implementing the new logistics system, the situation had dramatically improved. Health centers experienced fewer stock-outs, eliminated overstocking, and maintained accurate and up-to-date records of their contraceptive inventories. More reliable contraceptive supplies have contributed to rising contraceptive use in Jordan. In just two years, between 1997 and 1999, couple-years of protection from condoms and oral contraceptives doubled.
   
  Logistics hotline. The USAID | DELIVER Project has a new customer service line for technical, procurement, and shipping inquiries. To reach this service, call 001-703-310-5211, Monday through Friday, 08:30 to 17:30 ET, except on U.S. holidays. At other times, you can leave a message. Also, you can send an e-mail message to AskDeliver@jsi.com. A customer relations representative will answer your message within 24 hours.
   

  Each of the 10 elements was chosen based on online survey results and was discussed in an online forum hosted by the Implementing Best Practices (IBP) Knowledge Gateway. Read more about the survey, forum and results in the Forum Synopsis. Learn more about IBP Knowledge Gateway, and join their Initiative here.
   
   

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  Recommended Resources

  Publications

  • Elements of Success in Family Planning Programming
  • Medical eligibility criteria for contraceptive use
  • Elements of Successful Family Planning Programs: Online Survey and Global Forum Discussion

  Job Aids/Tools

  • Family Planning Programming-Elements of Success (online training course)
  • A framework for youth peer education programmes
  • Provision of injectable contraception services through community-based distribution

  Case Studies

  • Looking to the Future: Improving Family Planning Access and Quality in Rwanda
  • Assessment of the USAID/Bangladesh component of DELIVER Project
  • Nepal: Contraceptive security

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