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

1. AUTHOR: M G Kibria*1
, Sheena Patel1
, Beth Yeager1
, Shahadat Selim2
1
SIAPS / Management Sciences for Health (MSH), Bangladesh
2
Directorate General of Family Planning, Ministry of Health and Family Welfare, Bangladesh
PRESENTER: Mohammad Golam Kibria, Senior Technical Advisor- Quantification and HIS
SIAPS/ Management Sciences for Health (MSH), Bangladesh
MODE OF PRESENTATION: PowerPoint
THEME: Individual Program/Best Practice abstract- Strategies for contraceptive security
Title: Saving Lives of Women and Children: Pharmaceutical Systems
Strengthening Approaches to Improve Access to Contraceptives in
Bangladesh
Significance/background:
Access to family planning (FP) commodities saves women and children’s lives by allowing
women to delay and limit pregnancies in a healthy manner. The Government of Bangladesh has
made noteworthy progress over the past decade in increasing access to FP methods.
From 2001 to 2011, the total fertility rate decreased by 23% (from 3.0 to 2.3 births per woman),
the maternal mortality ratio decreased by 40% (from 322 to 194 maternal deaths per 100,000 live
births), and the percentage of married women with an unmet need for FP decreased from 17% to
14%.
As part of the Family Planning 2020 global partnership, Bangladesh has further committed to
reduce the total fertility rate to 2.0 by 2016 and 1.7 by 2021 by increasing adolescent-friendly
sexual reproductive health and FP services to one-third of maternal, newborn, and child health
centers. However, ensuring uninterrupted availability of FP commodities at the point of need is
crucial to meet these targets.
Accurate forecasting of essential health commodities, including contraceptives, remains a
challenge. Though recording and reporting on stock levels is a critical component of the supply
chain management cycle, the linkages between facility-level information and national-level
program policies and plans have traditionally been weak.
Program intervention/activity tested:
Ensuring access to life-saving FP methods requires strengthening the national supply chain
system so that quality products are available when and where they are needed. Since 2011, the
USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS)
Program, implemented by Management Sciences for Health, has used a systems approach to:
*
Corresponding author’s email address: mkibria@msh.org

2. • Strengthen governance of supply chain functions within the Directorate General of
Family Planning (DGFP)
• Reform procurement systems and streamline procurement processes
• Build the capacity of supply chain managers and storekeepers
• Increase the availability of reliable and timely data for decision making
Methodology:
Studies indicate that the absence of a national coordination mechanism and limited technical
capacity to forecast for contraceptives have compelled DGFP to rely on past distribution data,
producing stock imbalances, overstocking of contraceptives, and stock-outs with a
preponderance of emergency orders. In 2012, SIAPS worked with DGFP to create a Forecasting
Working Group (FWG), to ensure that resources are forecasted and allocated appropriately.
With SIAPS support, DGFP made a five-year (2012-2016) forecast and a two-year supply plan
by using available data, generating programmatic scenarios for future need.
SIAPS also developed the Supply Chain Management Portal (SCMP), an online procurement
tracking system that allows DGFP to track and monitor the procurement processes of FP
commodities, providing information on procurement delays and notifying managers to take
appropriate actions.
SIAPS also developed an electronic Logistics Management Information System (eLMIS) that
collects data on consumption and availability of FP commodities from all districts and sub-
districts. Data from service delivery points (SDPs) is consolidated and entered into the SCMP,
facilitating national-level forecasting and supply planning and allowing managers to respond
quickly and efficiently to avoid stock-outs and overstock of FP commodities.
Results/key findings:
Key achievements of instituting the FWG and developing the SCMP and eLMIS include:
• Improved coordination in forecasting and supply planning resulted in cost-savings.
As a result of the forecasting exercise, DGFP decided not to procure 65,000 implants in
FY 2012-13 and 410,000 implants for FY 2014-15, leading to USD 1.38 million and
USD 4.1 million in savings, respectively.
• Improved governance led to streamlined procurement processes. The online
procurement system reduced the procurement lead time by 57% for the DGFP in FY
2012-13, facilitating timely procurement and distribution of FP commodities.
• Improved logistics information systems contributed to a responsive supply chain. 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. Finally, among SDPs, stock-out rates for

3. contraceptives reduced from 1.63% in February 2014 to 0.28% in January 2015 in
selected sub-districts.
Program implications/lessons:
A systematic and functional national supply chain ensures availability of affordable, safe,
effective FP commodities, including contraceptives, at the point of need. This begins with
appropriate forecasting exercises using scientific methods and tools with the inputs from the
FWG; sustainable, effective LMISs that make data accessible to decision makers; evidence-
based supply planning of essential commodities; and efficient and timely procurement processes.
It is also crucial to analyze and share available information across systems and stakeholders for
improved decision making. This mechanism ensures good governance and accountability and
creates stronger partnerships among stakeholders. Improved coordination, governance, and
logistics information systems leads to cost-savings, streamlined procurement systems, a
responsive supply chain, and, ultimately, increased availability of FP commodities, saving the
lives of women and children.