CULTIVATING A PUBLIC HEALTH SUPPLY CHAIN TO SUPPORT FAMILY PLANNING PROGRAMMES IN WEST AFRICA


ARC – Africa’s Public Health Supply Chain Institution, in collaboration with technical and financial partners, is assisting ministries of health in West Africa on interventions that strengthen the supply chain of family planning commodities, especially at the last mile.

Date: 
November 17, 2022
Author(s): 
Africa Resource Centre
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Background

As global population growth follows an upward trend, the United Nations estimates that by 2030, Sub-Saharan Africa’s population will rise to 1.7 billion.[1] Given the region’s various demographic and economic challenges, the prioritisation of reproductive health is imperative, especially because universal access to reproductive health is strongly linked to achieving the Sustainable Development Goals.

Family planning programmes, which were introduced to Sub-Saharan Africa in the 1960s, have made steady progress. However, contraceptive prevalence rates remain very low, and unmet demand is unacceptably high. Lack of supply and access continue to be one of the most referenced reasons for non-use, unmet demand and discontinuation of contraceptive use in low- and middle-income countries.[2]

In West Africa, government policies addressing availability and access to modern contraceptives have been key determinants of reproductive behaviour, including maternal and child health. Many governments provide direct support to family planning services through public health facilities. The health supply chain is a core pillar of robust family planning programmes.

The health ministries in West African countries are unwavering in their commitment to strengthening this pillar. Notable initiatives, such as the informed push model in Senegal and Togo[3], have bolstered stock availability of family planning products at the community level. However, myriads of supply chain inefficiencies continue to impact the availability of modern contraception commodities. These inefficiencies are attributed to weak governance and coordination mechanisms; insufficient funding and ineffective financing models; limited visibility due to an un-integrated information technology landscape; and poor planning tools and methods.

ARC’s role

To tackle these issues of access and exercising of choice in family planning options, ARC – Africa’s Public Health Supply Chain Institution, in collaboration with technical and financial partners, is assisting ministries of health on interventions that strengthen the supply chain of family planning commodities, especially at the last mile.

 ARC has supported several regional initiatives, including:

  1. Evaluating and developing an action plan for the Sahel Women Empowerment Demographic Dividend’s (SWEDD) supply chain of maternal and child health products. New methods for planning needs based on statistics and covering the last mile have been introduced in all five SWEDD countries.
  2. Introducing the maturity model as a reference tool for assessing the maturity level of the eight countries in the Ouagadougou Partnership. The tool made it possible to have a baseline from which to measure progress, and to identify areas for improvement in the organisation of the supply chain for family planning products. This database remains the primary tool for managing the supply chain.

Senegal

ARC evaluated Senegal’s health products supply chain, Yeksi Naa, in 2019 and 2021. The findings highlighted demand and supply mismatches in family planning commodities. Consequently, there were frequent out-of-stock incidents at the health facility level. Institutional weaknesses with cross-programmatic impact, primarily attributed to the absence of structured coordination at strategic levels and limited visibility, were found to be the root causes of product unavailability.[4]

ARC then conceptualised a strategic roadmap for the transformation of the public health supply chain. The roadmap integrates a multi-disciplinary health supply chain governance framework and strategic supply chain planning function. The planning function will help bring convergence across the health system, including its material, financial and human resources, and will have a specific, positive impact on the availability of family planning products.

Burkina Faso

The Ministry of Health (MoH) of Burkina Faso developed a community health strategy to improve accessibility of healthcare by establishing community health facilities. Based on this initiative, ARC is working on a complementary intervention focused on improving the availability of family planning commodities and other medicines through alternative channels of delivery.

ARC’s technical assistance facilitated the development of the public health supply chain and last mile distribution strategies, which integrate private sector logistics service models. These strategies outline structural reforms that increase patients’ access to family-planning programme commodities.

Côte d’Ivoire

ARC provides technical assistance to the MoH at the level of the Directorate of Pharmaceutical Activity. This technical assistance has been instrumental in implementing the visibility and analytics network (VAN) concept in Côte d’Ivoire, which has had a notable impact on supply chain planning. This impact includes the facilitation of timely decision-making, more accurate quantification of product needs, structured coordination amongst programmes, central purchasing and central warehousing for more accurate demand projections and supply and distribution planning, including proactive monitoring and action planning.

ARC’s work focuses on advocacy for extending VAN coverage to family planning programmes across all regions and peripheral levels of the health pyramid. To support this ambition, ARC played a crucial role in the engagement of partners for the sustained funding of VAN interventions and the inclusion of an experienced supply chain data analyst at the central and regional levels.

Togo

Based on the MoH’s strategic goals, ARC provides multi-faceted advisory services impacting overall pharmaceutical system strengthening through its positioning at the Directorate of Pharmacy, Medicines and Laboratories. ARC focuses on facilitating supply chain evaluations to assess existing operating models, identify limitations, and design tailored solutions to resolve system challenges. Notable ongoing work includes the distribution network optimisation and Logistics Management Information System (LMIS) assessments that will inform the design of more robust distribution models and urbanised information system landscape.

Outcomes and impact

ARC’s support to ministries of health focuses on strengthening six supply chain elements. Its recent work to support family planning programmes in West Africa strengthened all six areas: strategy, improvement roadmap, governance, policies and research, solutions proposals, and budgets and investment cases.

Redirecting the public health supply chain strategy in Senegal

Key elements: strategy, improvement roadmap and governance

ARC’s work in Senegal to evaluate and redevelop the Yeksi Naa model is a clear example of how strategy, improvement roadmap and governance intersect in supply chain transformation.

IMPACT: The evaluation and roadmap that ARC subsequently developed will help increase the availability of family planning products across the last mile.

Resolving system challenges in Togo’s health supply chain

Key elements: policies and research and solutions proposals

ARC facilitated supply chain evaluations to assess existing operating models, identify limitations, and design tailored solutions to resolve system challenges.

IMPACT: More robust distribution models and urbanised information systems will strengthen product and data availability and ensure equitable access to family planning and other health products.

Supporting the implementation of a VAN in Côte d’Ivoire

Key elements: budgets and investments

The development and expansion of a visibility and analytics network in Côte d’Ivoire engaged partners for sustained funding of VAN interventions.

IMPACT: Experienced supply chain data analysts will be included at the central and regional levels of the supply chain.

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References

[1] https://www.un.org/en/development/desa/population/publications/pdf/trends/Population2030.pdf

[2] Family Planning Commodities Supply Chain Innovation: https://media.path.org/documents/Deck_FP_Innovations-Overview.pdf?_gl=1*1n0pzr2*_ga*MTgwMjg5NTE1OC4xNjY2NDY1MTY1*_ga_YBSE7ZKDQM*MTY2NjQ2NTE2Ni4xLjEuMTY2NjQ2NTI5OC4wLjAuMA

[3] https://www.tandfonline.com/doi/full/10.1080/13625187.2017.1394453

[4] https://www.intechopen.com/chapters/58297