Global Reproductive Health:
Lessons Learned from Contraceptive Logistics |
|
Back to
Contraceptive Logistics
Note: Portions of this
article excerpted from the
Pocket
Guide to Managing Contraceptive Supplies.
From 1973 to 2006, CDC/DRH provided
technical assistance in contraceptive logistics matters to family
planning programs in 65 countries in Asia, Africa, Latin America,
and Eastern Europe. In more than 25 years of logistics work, the
following maxims emerged.
A
well-run contraceptive logistics system is almost invisible, but must
not be taken for granted.
Contraceptive
logistics sounds simple, but doing it right is complex.
The
contraceptive supply chain is only as strong as its weakest link (and
that includes the top link).
A
good logistics manager is like a good juggler.
A
logistics system without good information is like a pen without ink—it
can’t do its job.
Never
forget who the contraceptives are for—the
family planning clients.
When
a contraceptive logistics system fails, the consequences can be dire.
These
maxims are more than just words; they contain much of what we have learned
over the years about the activities, systems, resources, and procedures
that are needed to get the right quantity of the right contraceptives to
the right place at the right time in the right condition and at the right
cost—in other words, to manage a contraceptive logistics system properly
and ensure that contraceptives are always available to clients at all
service delivery points.
A
well-run contraceptive
logistics system is almost invisible, but must not be taken for
granted.
In
a well-run logistics system, contraceptive supplies are always available
and in good condition. Clients never complain that contraceptives are
damaged, expired, or not in stock. Staff members are not unhappy because
they cannot do their jobs properly for lack of contraceptive supplies.
There is no hoarding or rationing of contraceptives or submitting
inaccurate reports in order to get more supplies. Contraceptives are
available for all who need them when they need them.
All
appears calm. But an outside observer would hardly be able to guess at all
the activity behind the scenes. In a well-run system
|
- stocks of
every contraceptive product are frequently checked to make sure they
never fall below the minimum quantity needed or exceed the maximum
desired quantity;
|
|
- accurate
reports of the numbers of contraceptives given to family planning
users are turned in on time;
|
|
- appropriate
quantities of contraceptive supplies are ordered at the right times;
|
|
- supplies
are delivered on schedule;
– and, most importantly–
|
|
- family
planning clients always find all the contraceptives they need when
they need them.
|
A contraceptive logistics system must have
enough resources to be run well—and thus to appear invisible to all
except those involved in running it.
Just
as it takes a lot of work to run a busy home successfully (cleaning,
buying food, preparing meals, doing laundry, paying bills, upkeep of the
house and property), there is a lot of work involved in running a
contraceptive logistics system successfully. If a contraceptive logistics
system seems invisible, that means people are doing their jobs well. They
are making sure there are no shortages or stock-outs or bottlenecks
causing disruptions to the supply or to family planning services.
Although
"invisibility" is a hallmark of a well-run system, it can
actually cause difficulties for the system if it means that policymakers
do not recognize the vital importance of logistics to the family planning
program. If these officials—who are often distracted by crises elsewhere—do
not view the logistics system as important, it could result in logistics
receiving fewer resources, which would be an unfortunate mistake.
Managers, therefore, need to make sure that
the contraceptive logistics system’s needs are known and are met. To
remind policymakers how essential the logistics system is to the program’s
success, managers can regularly send them success stories and
problem-solving reports, which show that the policymakers’ support is
buying something valuable.
Contraceptive
logistics sounds simple, but
doing it right is complex.
Logistics sounds so
simple—you just have to fulfill the six rights:
1. Get the right quantities of the
2. right contraceptives to the
3. right places at the
4. right time in the
5. right condition at the
6. right cost |
And
in fact, a logistics system should be as simple and as streamlined as
possible. But even in a streamlined system, there is a lot involved in
satisfying the six "rights."
First,
every supply system has at least a couple of administrative levels,
starting with the central level and ending at the service delivery level.
Some have a number of levels in between (such as regional, provincial,
and district levels). Every
level must
- store and issue supplies
- monitor stock levels
- collect data
- produce reports
At every level, there must be well-trained staff members who know the
following correct logistics procedures:
- proper storage practices
- first-to-expire, first-out procedures to prevent expiration of
contraceptive supplies
- keeping correct levels of supplies to avoid stock-outs and excess
supplies
- ordering more supplies when needed and how many to order
- keeping accurate records
- producing reports on time
Every new staff member must be quickly trained in these procedures, and
supervisors should be helpful and supportive. These two things—staff
training and supportive supervision— are essential at every
administrative level if the logistics system is to work properly.
Budgetary expertise is also
required, to make sure there is enough money to acquire, manage, and
distribute the needed contraceptives and to run the whole logistics
system. Some political know-how may also be needed in order to convince
policymakers of the need for resources. Busy policymakers may not notice a
well-run logistics system—it’s only when the system has problems that
it becomes glaringly obvious to them.
A contraceptive logistics system must be supported by an effective
information system.
- Staff members must accurately fill out reports on the numbers of
contraceptives given to clients and the number still on hand.
- Reports must be sent promptly to managers.
- Managers must be skilled at putting all the data together and
analyzing them so the proper actions can be taken, based on what the
data show.
To keep the system running smoothly, these steps must be taken at every
level. If any information is missing or incorrect, the whole system will
be less effective.
Careful advanced planning is needed,
especially at the central level of a family planning program that may
handle large quantities of contraceptives. These large quantities may have
to be ordered many months in advance, although it is difficult to estimate
how many of each contraceptive will be needed in the future. Deciding how
many to order requires (1) having accurate data on contraceptive use and
demand, (2) expertly analyzing these data, and (3) knowing what new
activities the program has planned. The logistics manager should be
involved in this planning process so that the logistics system is ready to
manage the contraceptive supplies when they arrive. The process of
procuring supplies, whether requesting them from a donor or buying them
from a manufacturer, is complex and requires expertise.
Thus,
managing the contraceptive logistics system for an entire family planning
program is a complex task. Even managing the supplies for just one clinic
requires many skills and frequently checking supplies. A family planning
program cannot succeed without a good logistics system—staff, systems,
and infrastructure. Therefore, the logistics system must be
recognized as an essential part of the program, and it must have adequate
resources to sustain it.
The
contraceptive supply chain is only as strong as its weakest link
(and that includes the top link).
For an entire
contraceptive logistics system to run smoothly, every level of the system
must function well. This means that the program should have clearly stated
and documented policies and procedures, and that staff should follow them.
For the family planning client at the end
of the supply chain to receive the contraceptives she or he wants and
needs, each of the following "links" must be in place:
The clinic staff
must
- monitor the clinic’s supplies of each contraceptive
product to make sure there are always enough (but not too many)
supplies on hand;
- keep track of how quickly those contraceptives are
being given out to clients, and note whether this rate changes over
time;
- order the right amount of new contraceptive supplies
in time to receive them before the current stock runs out;
- promptly submit accurate reports of how many of each
contraceptive have been dispensed to clients.
The regional and
district warehouses must
- keep enough supplies of each contraceptive product on
hand;
- keep track of how quickly the contraceptive supplies
are being issued to service delivery points and to other warehouses;
- in some systems (where the clinics don’t place
orders), monitor the rate of use at the clinics, which means receiving
timely and accurate reports of use and analyzing the information in
those reports;
- organize timely delivery of contraceptive supplies;
- manage and maintain the vehicles needed to deliver
them.
The central
warehouse must
- receive and store large quantities of contraceptives;
- check incoming supplies for signs of damage and
ensure that they meet specifications;
- quickly and correctly fill the orders of regional and
district warehouses;
- in some systems (where the intermediate warehouses
don’t place orders), monitor the rate of use at the clinics. This
requires the central warehouse staff to analyze the timely and
accurate reports from the clinics;
- manage and maintain the vehicles needed to deliver
the supplies.
The central
administrative level must
- collect and analyze the data on contraceptive usage
throughout the program;
- make projections for contraceptive needs several
years into the future, factoring in future program plans;
- include the logistics manager in this planning
process;
- make sure there is enough funding to buy, store, and
distribute all the contraceptives that are needed;
- select and negotiate with donors or manufacturers to
procure the contraceptives;
- monitor the procurement process and quickly resolve
any problems that arise;
- make sure the contraceptive shipments arrive in time
to prevent supplies from running out at any level of the program.
At every level,
staff must
- follow proper storage procedures to protect the
contraceptive supplies from damage;
- follow first-to-expire, first-out procedures so that
supplies are given to contraceptive users long before their expiration
dates;
- record the number of contraceptive supplies that
arrive and that leave the facility (whether they are on their way to
another facility or given to a contraceptive user);
- check the contraceptives for signs of damage;
- separate and destroy damaged or expired
contraceptives.
One of the most important links of all may
not seem, at first glance, to be connected to the supply chain. Policymakers
may not count, transport, dispense, or ever even see the contraceptive
supplies, but their support and involvement is critical. The policymakers
decide how much funding the program will receive both for contraceptives
and for logistics management in general, and without their support, the
program might lack one or more of the following essential ingredients:
- enough contraceptives to meet the demand for them;
- a logistics manager to oversee the whole process and
ensure smooth operation of the contraceptive logistics system;
- fuel or maintenance for delivery trucks;
- enough storage space;
- proper upkeep of warehouses;
- training for new staff members in basic logistics or
reporting tasks.
If, at any level, a link is
broken...
- If reports are late
- If a truck breaks down
- If contraceptives are buried at the back of a
shelf and expire before they can be used
- If the quantity ordered is miscalculated
Then the chances increase that a clinic or service
delivery point will "stock out" (run out of supplies) of a
contraceptive, a family planning client will not receive the desired and
needed contraceptive, and an unwanted pregnancy or disease transmission
may occur.
A
good logistics manager is like a good juggler.
Things do not always flow smoothly as
contraceptives make their way from the manufacturer to the contraceptive
users. For example—
- One clinic had a leak in its roof and
all their oral contraceptives are now damaged; they need an
emergency shipment to replace them. The logistics manager analyzes a
routine report from a nearby clinic and finds that demand for oral
contraceptives there has declined and they now have too many on hand
(they are over their maximum quantity). Excess supplies from that
clinic can be sent to the one whose supplies were damaged, which
will give them enough until the next regular shipment.
- One of the three delivery trucks has
broken down and replacement parts will not be available for a week.
Can the clinics that are supposed to receive deliveries this week
manage for one more week, using their safety stock, or might they
experience stock-outs? Can staff members ask the health supplies
delivery department if they can borrow a truck or add contraceptive
deliveries to their route? Can a truck be rented for the week?
- Condom supplies for the entire family
planning program must be ordered soon, as the lead time is long
between placing an order with the manufacturer and the arrival of
the supplies. First, a forecast must be done to estimate the number
of condoms that will be needed. But several service delivery points
have not sent in all their quarterly reports in the past year. Can
the information be obtained through telephone calls? Or must their
condom usage be estimated, based on the quantities they reported
were dispensed to contraceptive users in the reports they did
submit, and from reports on the quantities issued to those service
delivery points?
Because there are many
things that can go wrong, an active, observant logistics manager is
needed. This manager must keep a vigilant eye on every stage of the
contraceptives’ journey to the user, at every level of the system. The
logistics manager must watch out for problems;
such as,
- unforeseen delays
- occasional problems due to equipment or illness or
weather
- complaints about contraceptive quality
- bottlenecks hidden in routine reports
- unusual surges of demand for one contraceptive or
another
The standard, day-to-day responsibilities
of a logistics manager are numerous and challenging. They include—
- monitoring the number of every
contraceptive product at every level of the system;
- analyzing these numbers to make sure the quantity
of each contraceptive product falls between the prescribed maximum
and minimum levels all through the pipeline;
- taking action any time there is a threat to the
balance of supplies at any facility in the system.
The logistics manager does this by
- analyzing reports
- keeping track of contraceptive usage for the
program as a whole
- forecasting future needs
- monitoring the ordering and delivery of new
supplies
- overseeing the storage and transportation of the
supplies
In addition, the logistics manager should
be a member of any committee that is planning activities for the program.
This will ensure that the logistics manager is aware of any new
initiatives and can prepare the system to effectively manage the
contraceptive supplies that will be required.
Like a good juggler
keeping seven balls in the air at once, a logistics manager must have an
eye on many things at once—not
only on everyday tasks, but also on any new or potential problems. The
manager needs to be alert for early signs of trouble, and to think ahead
of problems that could arise and prevent them from ever happening. For
example—
- Will the upcoming shipments of contraceptives
overwhelm the central storage facility; do the shipments need to be
staggered?
- A complaint was received from one clinic about
discolored pills. How serious and widespread is the problem? Does the
entire lot of pills need to be recalled?
- The program is considering switching to a different
brand of pills; is that brand registered in this country?
There are many things that can disrupt the smooth and
orderly flow of contraceptives to the user; the logistics manager must
catch and resolve problems early, before they cause serious trouble.
Every contraceptive user must always find the supplies
she or he needs to be available when they are needed; it is the logistics
manager’s job to ensure this goal is met.
A
contraceptive logistics system without good information is like a pen
without ink— it can't do its job.
To get the right quantity of the right
goods to the right place at the right time, one needs to know how many of
each item are needed at each place and by when. A contraceptive logistics
system must have an information system that collects and processes basic
logistics data, or it cannot function effectively. Without logistics
information, a clinic might receive 200 cycles of pills when it needs
1,000 (or vice versa), or it might receive intrauterine devices (IUDs)
when it has a need for condoms.
Accurate, timely logistics data (which
consist of the quantity of stock on hand of each contraceptive product;
the rate at which it is being dispensed to contraceptive users; and any
losses or adjustments to the inventory) are the lifeblood of a
smoothly-running logistics system. Any late or missing report reduces the
effectiveness of the entire system.
Reports may be missing
or late for many reasons
- The reporting forms are long or complex and time-consuming to fill
out or are unavailable; therefore delayed or neglected.
- The mail system is slow or nonexistent and reports must be hand
delivered.
- Staff are already overburdened providing services or morale is poor
so they don’t "find the time" to complete the reports.
- Staff do not receive feedback or requested supplies as a result of
the reports they submit so there is little incentive to complete and
submit them.
- There is a high rate of staff turnover so staff are inadequately
trained to complete the reports.
Because logistics information is so
essential to an effective logistics system, everything possible must be
done to ensure full, accurate, and timely reporting. Supervisory visits to
service delivery sites are an important part of this process. In addition—
- Reporting forms must be made as simple as possible, collecting only
essential data, not "nice-to-know" information or
unnecessary service statistics.
- Reporting forms must be appropriate for the staff that must complete
them; the staff members who will use the reporting forms should help
design them.
- The staff members responsible for reporting must be trained in
completing and submitting the reports.
- Reports are more likely to be sent in when the form is also used for
ordering more supplies.
- Providing feedback (letting facilities know their stock status and
how well they’re doing maintaining proper stock levels) can increase
the incentive for staff members to complete the reports.
- Staff members who have sent in accurate, timely reports should
receive recognition from their superiors.
It is essential not only that
contraceptive logistics data be collected and reported, but also analyzed
and used in decision making at all levels of the program.
Never
forget who the contraceptives are for—the family planning clients.
Staff
members at all levels of a contraceptive logistics system have many duties
and responsibilities. Hard-working staff can be so caught up with their
logistics tasks—monitoring
stock levels, ordering supplies, filling out reports on time, conducting
inventories, delivering boxes—that
they lose sight of the real purpose of all their activities—to
make sure that every family planning client receives the contraceptives
she or he wants and needs, at an affordable price, when and where they are
needed.
Staff members
often focus on the boxes of contraceptive supplies themselves, which is
easy to understand because many logistics workers never see the clients
who use the products they manage. But workers might be better motivated to
do their jobs well, and might be more inspired to solve logistics
problems, if they focused instead on the women and men who need those
supplies.
It can be easy for logistics staff members
to feel that filling out a report on the number of contraceptives given
out to clients is just an administrative burden. But they might think
differently if they remember that this task is an essential step in making
sure there are enough supplies of the contraceptives that will protect the
health and well-being of the women and men who are the program’s
clients. Routinely counting and analyzing the number of contraceptive
supplies on hand may seem like just tedious calculations. But these
calculations could reveal a shortage of supplies and thus prevent a
stock-out—and running out of supplies not only disappoints and annoys
family planning clients, but may also cause the unfortunate and
unnecessary consequences of unintended pregnancies or sexually transmitted
infections.
The ultimate purpose of a logistics system
is not to have well-stocked storage shelves, on-time deliveries, good
feedback reports from the supervisor, and a clean and orderly storage
area, even though all these are needed for a logistics system to work
well. The real purpose of a logistics system is to meet the contraceptive
needs of family planning clients, every time. Staff members at all levels
of the logistics system must always be guided by this purpose.
When
a contraceptive logistics system fails, the consequences can be dire.
For
many women in developing countries, pregnancy is dangerous. More than half
a million women die every year from pregnancy-related causes. If a woman
is either very young or near the end of her reproductive years, has had
many children, is anemic, or has had difficult pregnancies before, she is
at risk of developing a number of serious medical problems. Her pregnancy
may even prove to be fatal. Many
women live far from medical care, especially emergency care that could
save their life
and their
baby's
life
if something goes wrong. For some women, a pregnancy is so unthinkable
they will even risk an illegal abortion, knowing they may be disabled for
life or even die.
Therefore, if
a woman comes to a family planning clinic—which in itself may be a
difficult feat, requiring her to overcome obstacles of distance, financial
cost, disapproval of her husband or family, secrecy, embarrassment, fear,
or even disrespectful treatment by service providers—she must find that
the contraceptives she needs and chooses are there for her.
Children are also greatly affected by family planning.
In developing countries, the health and well-being of children whose
mother has died are in great jeopardy; 90% of motherless newborns will die
within the year, and the risk of death for their older siblings rises
considerably. Therefore, saving a mother’s life can save her children’s
lives as well. Family planning can also improve the health of children by
increasing the time between their births; children born at least two years
apart have a much better chance of prospering than those born with less
than two years between them.
Men
share similar family planning issues. They also may face physical,
financial, and cultural obstacles to obtaining contraceptive services;
therefore, it is equally important that they always find contraceptive
supplies available to them. The lives of men with children become much
more difficult if their wives die or are disabled. In addition, HIV
threatens the lives and well-being of the entire family—men, women, and
children—so it is crucial that condom supplies always be available.
Family planning truly benefits the whole family.
To protect the lives, the health, and the
well-being of women, men, and their children, contraceptives must always
be available to those who need and want them, when they need and want
them.
If you would like to learn more about contraceptive logistics, order a free copy of the
Pocket Guide to Managing
Contraceptive Supplies.
Contraceptive Logistics
Every family planning program must have a good supply of contraceptives on
hand at all times. Running out of contraceptives can lead to unwanted, and in
some cases life-threatening, pregnancies and can do serious harm to a family
planning program’s reputation and effectiveness
...more
Contraceptive Shelf Life and
Storage Conditions
A table that describes type of contraceptive, required
storage conditions, and their shelf life
...more
Problems
with Contraceptive Quality
It is very important to make sure that the contraceptives are in good
condition before they are distributed or are dispensed to users
...more
Dealing with
Damaged Contraceptives
If you have found warning signs in any contraceptive product, you will need
to examine the rest of your supplies of that product for signs of damage
...more
Reproductive Health Epidemiology Workshop
DELIVER project at John Snow, Inc (www.deliver.jsi.com*)
|