Senegal has practically eliminated contraceptive shortages. Here’s how

Antoinette Tine of Senegal recalls a time not so long ago when she would go to her local health clinic for contraception, only to leave empty handed because the product she wanted wasn’t available. “They’d tell me to return within a week, and I’d feel stressed, because it put me at risk of getting pregnant again,” the 41-year-old mother of six said during a recent interview. “Unplanned pregnancy stops all your activities. You can’t work or take care of yourself.”

Tine wasn’t alone. Contraceptive shortages – a telltale sign of a failing health commodity supply chain – were common as recently as 2011, affecting an estimated 60% to 70% of facilities in some regions in Senegal. There was plenty of inventory housed in central warehouses; last-mile distribution was the problem. And it was threatening to undermine Senegal’s commitment to reducing maternal mortality. According to researchers, satisfying the unmet need for contraception is a low-cost, highly effective way of preventing maternal deaths from complications related to having babies too young or too close together. One leading study concluded that improving access could reduce maternal mortality by as much as 29%. In 2015, 1,800 women died in childbirth in Senegal.

So the government decided to take action to strengthen the supply chain within Senegal. A public-private partnership (PPP) was formed to support the endeavor. Through that PPP, Senegal integrated private-sector approaches into last-mile distribution to make the full range of modern methods of contraception accessible to all.

The overhaul was a collaborative process driven by Senegal’s Ministry of Health and Social Action and the National Pharmacy (PNA), with support from MSD for Mothers, The Bill & Melinda Gates Foundation, IntraHealth International and other partners. The donor-partners provided funding and business and technical expertise to help devise, test and scale a solution tailored to Senegal’s needs and priorities.

That solution required switching from the traditional “pull” model, to an “informed push” model, or IPM, a concept borrowed from the commercial sector. This included hiring private, third-party logisticians, or 3PLs, for last-mile product deliveries from district warehouses to individual health facilities. This new IPM-3PL system reconfigured the flow of goods, money and information, boosting performance while reducing costs. Important changes include:

Public health care workers no longer have to travel from their health facilities to central depots to collect stock; 3PLs make stocking decisions on the spot, at time of delivery.

Products are sold on a consignment basis, so those same stocking decisions are not limited by the amount of cash the clinics have on hand.

3PLs use tablet computers to collect and share data on consumption, which allows for more accurate forecasting and a more responsive procurement process – while also helping to identify communities where additional family planning outreach and education may be needed. Improved data is expected to yield additional benefits related to strengthening the overall health system.

As a result of the IPM-3PL, shortages have been practically eliminated. Today, a woman in Senegal seeking contraception has more than a 98% chance of finding the method of her choice, wherever and whenever she wants it. After the IPM-3PL was extended to serve all 1,400 health facilities across the country, consumption jumped 48% over one year nationwide.

The hiring of 3PLs has proven to be an important differentiator when compared to other public supply chain systems, where government employees perform all functions. For one thing, it frees up healthcare workers to focus on patient care. For another, contracting 3PLs also encourages local entrepreneurs to invest in their businesses, which helps create jobs.

Senegal has already begun to capitalize on the success achieved with contraceptives, expanding to 90 essential medicines in all – including those for primary care, malaria, maternal health, tuberculosis and HIV – and integrating IPM-3PL into the national supply chain, overseen by Senegal’s central purchasing department, and renaming it Yeksi Naa (Wolof for “I have arrived”). It is, in effect, a consolidation of several different supply chains into one.

What remains to be seen, of course, is whether the new system proves sustainable. We believe it will – that Yeksi Naa will not only succeed as a fully-integrated public-private system, but also serve as an example for other low- and middle-income countries that are keen to fix their own struggling public health supply chains.

We’re optimistic for two reasons. First, the political will is there. The President of Senegal listed the success of Yeksi Naa among Senegal’s top priorities for health in 2017. Top officials have been vocal champions of the effort, embracing private sector as part of the solution, while remaining at the helm throughout the process, including the transition from a donor-managed system to a fully government-owned and managed one.

Second, the government has found a way to pay for Yeksi Naa, through a revenue-sharing arrangement with the health facilities and districts that was developed in consultation with private sector partners, and adopted with support from community health committees. The approach will go a long way toward ensuring financial sustainability and supply reliability over the long term.

As Bill and Melinda Gates wrote in their recent “Goalkeepers” report, which recognizes the great progress made in Senegal, “achieving the family planning goal makes it more likely that we will achieve every other Sustainable Development Goal”.

Antoinette Tine, for one, says she appreciates being able to get the method of contraception she wants, when she wants it. Better birth spacing, she points out, allows a woman more time to recover from each birth, more time to pursue employment opportunities, more time to care for the young children she already has. “I advise my fellow women: use family planning,” Tine says. “It can improve your health – and your life.”