THE ALTERNATIVE DISTRIBUTION STRATEGY –ADS & THE NEXT STEPS FOR FP Dr Mihayo Placid-MoH

Alternative Distribution Model

Why ADS in Uganda The unmet need for contraceptives in Uganda is estimated 28% while the CPR is estimated at 39% (mCPR 35%) , this supposes the total demand of 53%. The HSD-Plan Targets a CPR of 50% by 2020, hence the need for ADS The contraceptive procurement tables projected growth annually by percentage points 2.5, 3, 3.5, 4 and 4.5. by 2015…..are we there

Commodities were procured based on the contraceptive procurement tables , but first quarter of implementation of the national supply plan, there were stock accumulations at service delivery points. JMS the recognized channel of access for the private sector does not handle family planning commodities for religious reasons- that left a gap in access for the private sector. MoH then appraised the distribution system in order to identify the alternative distribution approaches that would increase universal access to RH-Commodities

The RHCS- Strategic plan 2009-2014 recognized the need to engage the private sector as reflected in its objectives below: Promote private sector involvement in RHCS Review and amend the relevant policies to increase access to RH Commodities in the private sector Establish a framework for cooperation between government –districts and social marketing sector for RHCS , & Increase private sector contribution to RH Commodity availability.

Steps in the ADS Development Consultation btn MoH , Private sector family planning service providers & interested development partners Concept note from Family planning working group leading to formation of task force to develop draft ADS strategy A rapid situation analysis through desk reviews, FGDs, & wide stake holder consultations. SWOT analysis based on the above findings Obtaining consensus from key stake holders including family planning working group, maternal and child health technical working group. (MoH, NDA, USAID, UNFPA, DFID, World bank, WHO, NMS, UHMG, PACE, MSI, RHU, UPMA)

Alternative Distribution Strategy Explained Goal of ADS : To increase access to reproductive health commodities across the country. Broad Objectives of ADS To increase uptake of contraceptives and other RH Commodities at the public-private service delivery points by 50% annually To reduce the number of service delivery points experiencing stock outs of contraceptives in both the public and private sector to less than 30% in five years.

Specific Objectives of ADS Improving the relevancy, effectiveness, efficiency, sustainability and potential impact of ADS in contributing to RH commodity security outputs and outcomes. Strengthening Implementation and coordination framework for ADS Streamlining the flow of products and information across the alternative distribution supply chain Promoting a Total Market Approach to Reproductive Health Commodity Security

Benefits of ADS to-date Implementing Partners (IPs) access contraceptives for the private sector which is not served by National Medical Stores (NMS). Promoted equity by reaching clients who go to the private sector Introduced flexibility in source of supplies because the public and private sector can share available commodities Subsidising prices for clients who may not afford but go to the private sector

Strategies for effective ADS Implementation Capacity building for implementation of ADS Strengthen the public sector distribution channel Strengthen the VHTs system through capacity building for provision of family planning services and commodities. Strengthening the private sector distribution system to provide alternative national, regional & district storage- by contracting firms to ware house and distribute FP-RHCs Build capacity for logistics management including strengthening LMIS for ADS-Channels Training in provision of FP Services in public and private sector Demand creation for FP services-SBCC

….Strategies Continued Creation of Partnerships Service charge & pricing of public contraceptives & selected RH commodities distributed through the private sector through the PPPH-FRAMEWORK Engage catholic based institutions to scale up natural family planning methods including cycle beads-A good candidate for social marketing Engage stake holders to raise funds and procure necessary commodities to support the ADS

Innovative Distribution Mechanisms Strengthen the integration of family planning into OPD services , and not just maternity unit service. Integrate family planning information into none health sectors like education, environment and higher institutions. Provide information , services & commodities thru, work place activations, places of worship, Markets & cultural activities Providing information , services & commodities at places including places of entertainment, hotels, & lodges, salons, public transport , universities-tertiary institutions.

…..Innovative Distribution Mechanisms Institutionalizing integrated family planning outreaches to lower health facilities and the community, FP will be included in health education with focus on male involvement. Voucher system & social franchising in poor rural communities to increase access to LTPMs. Conducting family planning days / camps at each facility, each facility shall designate a day for FP EVERY month.

Strengthening Coordination , supervision ,M&E Resources shall be set a side for capacity building for accreditation and monitoring of the private sector Regular meetings of the FP Working groups/ RHCs committee to harmonize guidelines & procedures. Monitoring activities to track progress of implementation & performance using Depo-provera as the tracer drug for contraceptive availability and LMIS tools like bin cards in service delivery points.

Quality Assurance for Contraceptive , FP & RH Services Accreditation of service providers and distributors will be done by Ministry of health, with focus on availability of appropriate storage facilities , human resources, licensing and regulatory compliance.

NEXT STEPS FOR ADS

Social Marketing to improve access and uptake of family planning services MoH Shall Explore branding selected contraceptives so as to increase demand. A cost will be attached to the branded commodities at the service delivery points in the private wings in public sector for willing buyers and private sector. Social marketing in the private sector shall continue as a way to create self reliant clients Social mobilization: creating demand for commodities available through ADS will be done through campaigns, regular community or one on one (IPC) Health talks, use of IEC materials, media, peer education.

Costing & Financing of ADS Costing the ADS: The cost of implementation of ADS is a sub set of the cost of implementation of the road map to accelerate reduction in maternal & neonatal death that has already been costed. The immediate cost involved in the implementation of this strategy both procurement of necessary commodities and payment of handling fees estimated at 12% of the value of commodities ( this cost is already being met by GOVT & Devt partners. ACTIVITIES TO BE COSTED: Institutional & HR resource capacity building, quality Assurance, Monitoring & Evaluation, promotion, coordination, and other innovative approaches proposed-there is a need to cost each activity if ADS is to work.

Implementation & Coordination framework Commodities referred to by this strategy: shall include commodities and selected reproductive health commodities, they will be reviewed and communicated generally by the Director general of health services. Key Assumptions The ADS shall be complimentary to the existing public sector distribution strategy that is implemented by National Medical Stores. There will be continued support for alternative distribution strategy by stakeholders currently involved in the procurement & distribution of RH commodities. MoH shall institutionalize VHTs as a long term strategy for community engagement The strategies proposed are cost effective , sustainable & reach out to all populations.

Key Implementers The assistant commissioner for RH and that of pharmacy division shall coordinate the implementation of ADS. The supporting institutions ; MoH Pharmacy Division, MoH Reproductive health division, AIDS control program, Uganda AIDS commission, National medical stores, National drug authority, District health offices, Family planning working groups- RHCS committee, condom coordination working group, maternal and child health TWG, Medicines procurement & mangt TWG, PRIVATE FIRMS contracted / in MoU with MoH, NGOs, CBOs, FBOs involved in the provision of family planning services and commodities

Acknowledgement UNFPA USAID Global fund MoH pharmacy division Reproductive health technical working group/MCH Cluster Members Uganda family planning consortium (UHMG, PACE, MSU/MSI, RHU, PATH,FHI360,JPIEGO) National Medical Stores National Drug Authority

THANK YOU