By Bocar Mamadou Daff, Director of the Reproductive Health and Child Survival Unit for the Senegalese Ministry of Health and Social Action, Senegal
A 2011 public health survey in Senegal revealed a startling discrepancy: 43 percent of married Senegalese women told researchers that they wanted to avoid or postpone pregnancy. Yet only 12 percent of women were actually using contraception.
Why the gap?
The government of Senegal suspected that part of the problem was that contraceptives weren’t consistently available at local health facilities. If pills, injectables, and other commodities are chronically out of stock, it can be difficult for women to find and stick with a method that works.
The principle of Availability—of supplies, services, and information—is one of the key components of rights-based reproductive health care. Family Planning 2020’s Rights & Empowerment Principles for Family Planning defines it this way:
Availability: Health care facilities, trained providers and contraceptive methods are available to ensure that individuals can exercise full choice from a full range of contraceptive methods (barrier, short-acting, long-acting reversible, permanent and emergency contraception). Availability of services includes follow-up and removal services for implants and IUDs.
In Senegal, the government launched a study of the supply chain to understand where and why contraceptive commodities were going out of stock. An audit of health facilities in the Dakar region indicated the magnitude of the problem: on average, local facilities were stocked out of contraceptive pills and injectables on about half of their operating days. The situation with contraceptive implants was even worse, with facilities stocked out more than 80 percent of the time.
Interviews with women confirmed that these stockouts were a major problem. Four out of five contraceptive users reported that they had experienced a stockout of their preferred method in the past year, forcing them to either switch to a less-preferred method, stop using contraception altogether, or try to find supplies in the private market—sometimes at exorbitant cost.
The supply chain study also revealed something crucial: that at least 60% of the local stockouts were happening despite stock availability at the national level. It became clear that an inefficient distribution system was to blame.
Enter the Informed Push Model of distribution for medical supplies. Informed Push is based on the same kind of system that is used in the commercial sector for vending machines. Instead of health facilities having to keep track of their inventory and call in orders, a driver with a truck full of supplies visits each facility on a regular route, topping up the stock as needed. The data collected by the drivers enables health officials to understand the flow of commodities, and allows planners to ensure there is sufficient stock at the warehouse to meet demand.
In partnership with IntraHealth International, the government of Senegal and the Senegal Urban Reproductive Health Initiative (URHI) developed an Informed Push model for contraceptive supplies, and pilot-tested it in the Pikine district between February and July 2012. The results were dramatic. Stockouts of contraceptive pills, injectables, implants and IUDs were completely eliminated in all of Pikine’s 14 public health facilities over the six months of the pilot. The government then expanded the program to the entire Dakar region, and within six months the stockout rate throughout the region had dropped to less than 2 percent.
These effects led directly to an increase in contraceptive use. After one full year of Informed Push in the Pikine district, combined with demand creation interventions and service delivery improvements, the percentage of women using modern contraceptive methods (mCPR) rose by an estimated 11 points—an unprecedented rate of growth. The method mix in Pikine also evolved during this period, with women taking advantage of the newly available choices on offer. Use of contraceptive implants rose by 2,081 percent in one year.
With technical and financial support from key partners, including the Bill & Melinda Gates Foundation and Merck for Mothers, the government of Senegal is now expanding the Informed Push model to all the districts in the country. By delivering supplies at the right place and right time, it will ensure that the contraceptive methods women prefer are available to all who want them.
