Reaching underserved populations with family planning commodities through strengthening of supply chain and effective data monitoring – The Nigeria Experience 2012 to 2014 Presented by: Olanike Adedeji At: International Family Planning Conference 2016 In Nusa Dua, Indonesia

Olanike Adedeji (UNFPA), Dr Olusegun Afolabi (OAU, Ile Ife), Authors Olanike Adedeji (UNFPA), Dr Olusegun Afolabi (OAU, Ile Ife), Dr Olugbemiga Adelakin (UNFPA), Koffi Kouame (UNFPA) and Dr Kayode Afolabi (FMoH)

Background and Introduction Access to essential supplies is critical to reaching universal health coverage is a key building block of an efficient and effective health system. A consistent and uninterrupted supply of essential medicines to public health facilities in Nigeria, especially in hard to reach areas is necessary to achieve health targets.  The most common challenges in health supply chain is related to stock-outs of essential supplies due to expiry, poor quantification and storage by Health Care Workers, inefficient last mile distribution, and incomplete reporting. This is compounded by poor coordination, financing and poor availability of data to guide procurement systems. The National Contraceptives Logistics Management System (CLMS) is responsible for movement of contraceptives from the port to the service delivery point. Commodities usually gets to the state from where it stalls as mechanisms for getting them to the service delivery points or community based distributors were not too functional. Thus, a bi-monthly review resupply meeting was instituted which focused on ensuring “last mile” distribution of Family Planning (FP) commodities and strengthening the Supply Chain Management System for FP using a cluster model.

The National and Sub national level Supply Chain

Methods Upon removal of user fees for contraceptives in April 2011 by the Federal Government, UNFPA and USAID provided financial and technical support to ensure last mile distribution of family planning commodities in public health facilities by instituting a 2 monthly review resupply meeting SDPs submit their reports and requests to their LGA Coordinators and pick up commodities to stock up to their maximum stock level of four months of stock using a cluster model. At the state meeting, representatives of the FMOH, UNFPA and the other NGOs, the State FP coordinators and LGA FP coordinators who are responsible for collecting, collating and coordinating data from the LGAs and entry of such data into Channels software UNFPA provided financial support through payment of health worker transport reimbursement costs. Reports from the review meetings in each state are written by representative of FMOH and submitted to UNFPA. The data from the annual survey to was used to monitor effectiveness

UNFPA the leading multilateral agency in family planning UNFPA supports over 156 countries to increase access to family planning, especially youth & marginalized, ensuring human rights & gender equality. UNFPA Supplies: the key vehicle through which UNFPA implements its  Family Planning Strategy and contributes to  achieving FP2020 goals Helps countries build stronger health systems & widen access to a reliable supply of contraceptives and live-saving medicines for maternal health. Largest global fund dedicated to family planning Largest contraceptive procurer Key actor to achieve FP2020 goals Convening partner with in-country presence Supports 30% of modern contraceptive users in FP2020 countries 41% of global contraceptive procurement Long standing relationships with governments $900 million + mobilized since inception

Results and Findings - 1 The 2014 survey indicated that 78% all facilities reported no stock out of contraceptives in the last three months prior to the survey compared to 67% in 2012. There was little variation in stock outs across facility levels in urban and rural area. Majority of primary facilities (86%) were able to offer at least three contraceptive methods and significant proportions of secondary and tertiary facilities were able to offer at least five modern contraceptive methods (82% and 93%, respectively). About 78% reported that it took less than two weeks between ordering and receiving family planning supplies. Percentage of primary SDPs offering at least three modern contraceptive methods by states in 2014

Results and Findings - 2 7 fold increase in CYP of commodities issued to lower levels and 5 fold increase in CYP of commodities issued to users at service delivery points. There are regional variations when stock-out of one FP product was assessed on the day of the survey being highest in the South East and South West geo-political zones (28%) but no significant rural-urban variation. The routine data indicated that stock-out of FP commodities reported was consistently lower in the facilities in most states which may suggest under-reporting of stock-out routinely. Figure 3- GPRHCS Survey on Availability Of Essential Medicines at Service Delivery Points in 2014 Result on Stock out by FP commodity

CYP of contraceptives distributed by level

New Users – Routine NHMIS data Establishment of Basket Funds for procurement of contraceptives DfID, DFATD Govt UNFPA 2.9 mil women with unmet need (2013 NDHS)

Delivers results in countries High economic return on investment For every $1 invested in UNFPA Supplies, there is already an estimated $2 savings in health and socioeconomic benefits for a country; benefits that will grow over time (to date, the Programme has potentially saved $2.1 billion in direct health-care costs) Reduced commodity prices Leveraging its role as high-volume procurer to reduce prices for RH commodities - in 2014, UNFPA Supplies reduced prices on 63% of contraceptive items and achieved average price reduction of 2.4% Reduced lead time With AccessRH – UNFPA’s online procurement system - lead time reduced from 12 to 3 weeks for male condoms, and from 10 to 2 weeks for female condoms Expanded method choice for women Ensures a broad range of methods, especially for LARCs, which are difficult to access in many low-income countries Strengthened health systems UNFPA Supplies supports countries in strengthening their national health systems from better forecasting, procurement, and supply chain efficiency to enhanced provider capacity Policy changes Through advocacy and close cooperation, governments have begun several important reforms including committing budget allocation for RH commodities and policy changes to support effective RH programming With AccessRH, reduced lead time from 12 weeks to 3 weeks for male condoms, and from 10 weeks to 2 weeks for female condoms (compared to commodities dispatched from non-AccessRH1 sources)

Conclusions and Recommendations While availability plays a significant role in the provision of contraceptive methods and maternal/RH medicines, it is also dependent upon the correct and regular use of the logistics forms among staff. It is important to continue to strengthen capacity in logistics management through training, supportive supervision, and the availability of guidelines and/or job aids that enable health workers to do their job more accurately and effectively. Efforts should be made to support states to initiate and provide Government led integrated public health supply chains for essential medicines that are feasible and sustainable. It is also critical to continue dedicated advocacy efforts to Federal and State Government to ensure budget lines for FP Programming including distribution are adequately funded and funds released

References Global Fund Nigeria Supply Chain Integration Project document 2014 Reproductive Health Commodity Security (RHCS) Strategic Plan Nigeria 2011-2015 Bock, Ariella, Marie Tien, Elizabeth Igharo. Olanike Adedeji and Juan Agudelo 2011. Nigeria: Contraceptive Logistics Management System Report. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 4. Federal Ministry of Health and UNFPA, Availability of Essential Medicines at Service Delivery Points 2011 United Nations Commission on Life Saving Commodities (UNCoLSC) for Women and Children’s Health Country Implementation Plan Nigeria 2013

MNCH2 Acknowledgement Empowering Communities Strengthening Health Systems Saving Lives