Saving Lives of Women and Children: Pharmaceutical Systems Strengthening to Improve Access to Contraceptives in Bangladesh

1. Saving Lives of Women and
Children: Pharmaceutical Systems
Strengthening to Improve Access to
Contraceptives in Bangladesh
International FP Conference, Nusa Dua, 2016
Mohammad Golam Kibria
Senior Technical Advisor-HIS, SIAPS Bangladesh
Management Sciences for Health (MSH)

2. Bangladesh Committed Targets (FP 2020)
• Reduce total fertility rate (TFR) from 2.3 in 2014 to 2.0
by 2021
• Increase the contraceptive prevalence rate (CPR) from
62.4% in 2014 to 75% by 2021
• Increase the percentage of long-acting permanent
methods from 8.1% in 2014 to 20% by 2021
• Reduce unmet need for FP commodities from 12.0% in
2014 to 10% by 2021
• Reduce the discontinuation rate to 20% by 2021
(currently 30%)

3. Reduced TFR and Increased CPR
7.7
62.4
72
6.3
2.3
2
0
1
2
3
4
5
6
7
0
10
20
30
40
50
60
70
80
1975 1989 1991 1994 1997 2000 2004 2007 2011 2014 2016
Target
TFR
CPR
CPR TFR
Source: BDHS, CPS, BFS

4. Reduced Mortality and Increased Life expectancy
472
216
197
143
47 41
92
36 32
55.7
68.8 71.2
0
10
20
30
40
50
60
70
80
0
100
200
300
400
500
1991 2001 2005 2010 2013
LifeExpectancyatbirthforfemale
MortalityRate
MMR (Per 100,000 Live Births) U5MR (Per 1000 Live Births)
IMR (Per 1000 Live Births) LEB for female
Source: SVRS

5. Scenario in Directorate General of Family
Planning (DGFP) before SIAPS Intervention
•Lack of clarity among program managers and bottlenecks
in procurement processes
•Lack of good governance, accountability, and
transparency
•Lack of evidence-based forecasting of essential health
commodities, including contraceptives
•Absence of recording and reporting on stock levels at the
service delivery points (SDPs)

6. Scenario in DGFP before SIAPS Intervention (2)
•Poor data quality and information use
•Weak linkages between facility-level information and
national-level program policies and plans
•Untapped opportunity to improve logistics management
system and monitoring performance at the last mile
(SDPs)
•Chronic stock-out of commodities at SDP levels

7. Management Support
Organization
Financing
Information management
Human resources
Pharmaceutical Management Framework
(Guiding Principle)

8. Pharmaceutical System Strengthening (PSS) Initiatives
SIAPS Program works with DGFP/MOHFW to improve:
• Procurement and logistics management of FP commodities–
business processes and tools
• Health Information System (HIS)–innovation, system design,
and roll-out
• Evidence-based forecasting and supply planning for product
availability
• Informed decision making on stock situation
• Monitoring progress and performance of supply chain for
improved governance and accountability

9. Improved Coordination in Forecasting and
Supply Planning (1)
• Formed a Forecasting Working Group with development
partners and other stakeholders led by DGFP
• Bottom-up contraceptive planning and forecasting by frontline
field workers
• eLMIS data contributes to forecasting and supply planning
• Availability of Costed Implementation Plan 2015-2020 for the
National FP Programme

10. Improved Coordination in Forecasting
and Supply Planning (2)
Result:
Reduced procurement costs; as a result of a forecasting
exercise, DGFP decided not to procure 65,000 implants in
FY 2012-13 and 410,000 implants in FY 2014-15, saving
USD 1.38 million and USD 4.1 million, respectively.

11. • Public procurement requirements were reviewed,
systematized, and streamlined
• Government procurement planning and approval process
moved to electronic platform
Result:
Reduced public procurement lead time by an average of 32.8
weeks for any package procured by DGFP, translating into an
overall reduction of 57 percentage points in procurement lead
time for the DGFP compared to recorded planned figures (i.e.,
58 weeks) in FY 2012-13
Source: A case study of DGFP (Directorate General of Family
Planning) and Directorate General of Health Services (DGHS)/CMSD
procurement under FY 2012-2013, MOHFW, Bangladesh
Improved Governance in Public Sector
Procurement

12. Improved eLMIS-www.dgfplmis.org
•Became operational in 2011, now fully
operated by the Government
•Includes central, regional, & sub-district
warehouses & contraceptive SDPs
•Presents easy-to-understand charts,
maps, tables, and monthly reports of
contraceptive stock levels and Scheduled
Short Message Service (SMS) alert
Result:
Fosters effective and efficient decision making for supply planning,
prevention of stock-outs, and ensuring contraceptive security

13. eLMIS Stock Monitoring at Different Levels
eLMIS captures individual SDP
(n~30,000) stock data

14. Result: Improved logistics information systems
contributed to a responsive supply chain
Max.
Min.
22
7.3
3.4 3.1
2
14.8
19
26.9
13.8
24.8
0
5
10
15
20
25
30
Condom Oral Pill IUD Injectables Implant
(Implanon &
Jadelle)
MonthofStock
Aug-09 Jan-15
A pre-post analysis showed a significant reduction in contraceptive stock-out rates at sub-
district levels (n=488) from 5.9% in August 2009 to 0.7% in December 2014. At the facility level,
reduction of stock-out rates for Implanon was also observed, from 69% in August 2009 to 1.0%
in December 2014. Source: MOHFW SCMP/eLMIS (www.dgfplmis.org)

15. % of SDPs (Front-Line Field Workers and NGOs)
with Stock-Out of FP-RH Commodities
Source: RHIS- MOHFW SCMP/eLMIS (www.dgfplmis.org)-
SDP dashboard module; implemented in 488 Sub-districts
0.75%
0.94%
0.0%
0.5%
1.0%
1.5%
2.0%
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2014 2015 2015 2015 2015 2015 2015 2015 2015
% of SDPs having stock-out of FP-RH commodities (Adjusted average)
Linear (% of SDPs having stock-out of FP-RH commodities (Adjusted average))
Stock-out rate: <1% at
SDP level

16. In 2013, through the DGFP, the Government of Bangladesh
invested an estimated USD 35.69 million for FP commodities,
leading to more than USD 28.7 million in savings in direct health
care spending through improved access to contraceptives by
preventing:
 4.5m unintended pregnancies
 1.4m unsafe abortions
 7,449 maternal deaths and pregnancy-related deaths
FP: One of the Most Cost-Effective Public
Health Interventions
FP 2020: http://www.familyplanning2020.org/entities/70

17. Challenges
• Funding mechanism (public sector cost recovery is still an
underutilized approach)
• Government and donor-sustained commitment to ensure
contraceptive security and potential collaboration to
accelerate the progress toward good governance and
accountability in pharmaceutical management
• High visibility of data has profound motivating effects
through both recognition of excellence and transparency
of poor performance

18. Challenges
• Culture of data-driven policy decisions (Forecasting
Working Group Meeting, Logistics Coordination Forum
Meeting, etc.)
• Sustainability of the supply chain management tools
• Monitoring and supervision at all tiers

19. Thanks!!
mkibria@msh.org