Zambia’s Country Experiences QUANTIFICATION

Presentation Outline Background Relevant RMNCH indicators Quantification methodologies Data Challenges Strategies Conclusion

Geographical Location

Some Key Demographic indicators (ZDHS and Census) Baseline Total Population 14.5 Million (2014 projection) Population Growth Rate 2.8% Total Fertility Rate National 5.3 Adolescent Pregnancy Rate (2013-2014) National:29% Unmet Need: 27% Unplanned Births 40% 16% Unwanted Contraceptive Prevalence Rate modern method 45%

Introduction Quantification part of the annual planning process. Include staff with different expertise Exercise conducted in collaboration with stakeholders implementing maternal and Child Health activities in Zambia

Overall objective To determine national commodity needs to facilitate resource mobilization and commodity procurement.

Stakeholders UNFPA SFH USAID DELIVER CHAZ ZHECT PPAZ UNICEF MSL, MSZ, CHAI

Quantification team National quantification teams for different product category formed e.g. ARVs, Contraceptives, Essential medicines Different tools and Methodologies use to undertake the quantification process, 13 lifesaving commodities for maternal health part of the quantification process

Methodology Mainly three different forecast methodologies Demographic, Services statistics and Consumption based Spreadsheet and quantimed used

Methodology Morbidity method: -used for new programmes or for programmes where consumption data is not available.

Methodology Collect and review logistics data from the Central Medical Stores Limited and cooperating partners Develop assumptions Assumptions and draft forecast reviewed with stakeholders.

Methodology Forecast results for all three methodologies reviewed, reconciled and select methodology(s) that yields most realistic, results. Account for recent issues/consumption, programmatic interventions, and ongoing trends in commodity use.

Methodology Limitations in all forecast methods reviewed

Data Challenges Demographic-Based Forecast for commodities Information on private sector activities is typically not readily available Require other statistics not available in the DHS, e.g. brand mix for FP. DHS data does not take into consideration programmatic changes. Data from the private sector not comprehensive

Data Challenges Consumption-Based Forecast for Essential medicines Using central-level MSL demand data and not consumption data. Stock outs experienced at both Central and facility levels.

Services Based Forecast for contraceptive Dispensing protocol for contraceptives not consistently adhered to. HMIS client data is not disaggregated by method. Data on Emergency Contraceptives not captured through HMIS. Limited visibility to stock outs and rationing at facility level by national level

Strategies Instituted Annual National forecasting and quantification is currently led by government with support from partners. F & Q review meetings Central Medical Stores Limited implementing last mile distribution of commodities to health centres National Supply chain strategy launched

Strategies Instituted Draft RHC Strategy developed FP Technical working Group subcommittee on supply chain Focal person for RH commodities National supply chain coordination committee meetings Technical support to health facilities Training more facility-level health workers in supply chain management to improve on data management

Strategic priorities to help meet the objectives Stock outs at service delivery points “To improve the distribution, availability and security of family planning commodities from the central level to service delivery points, including both contraceptives and consumables” Governance structure and program coordination “To strengthen the central, provincial and district-level structures to better coordinate and monitor government and partner activities, in order to deliver services efficiently”

Conclusion To enhance accuracy in quantification and forecasting of medicines and medical supplies within the Ministry through provision of accurate data Improved coordination and communication among stakeholders in the Supply chain

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Commodity Security and Logistics Management Information System

Commodity Security Ensures that patients can choose, obtain, and use medicines and other health commodities as and when they need them.

Commodity Security Challenges and LMIS of UNCoLSC medicines Inadequate funding and delayed disbursement of funds for procurement Misoprstol, MgSo4 not routinely reported Weak links between quantification and procurement planning. Inadequate real time data for decision making at Central Level

Commodity Security Challenges and LMIS of UNCoLSC medicines Capacity at Central and Facility Levels lagging demand for efficient supply network services (e.g. HR, Storage) Use and provider issues in utilizing commodities and provider biases that promote preferential use of a product they are used to.

3 most successful measures ensuring commodity security Establishment of regional hubs by MSL Last mile distribution to health centres by central MSL and Mentorship Holding Quarterly Logistics Management Coordinating Meetings for Districts and Provincial Pharmacist and Managers

Effective LMIS at different levels Electronic LMIS rolled out at district level Monthly report and requisition for essential medicines/contraceptives for facilities

Conclusion Health Management Information System (HMIS) registers adequately captures most aggregate planning data. Strengthened HMIS with two electronic platforms – a web based District Health Information System (DHIS2) and a Health Facility based reporting tool called eLMIS – recently rolled out nationwide