Bill & Melinda Gates Foundation

Senegal Pushes Bold Action on Contraception

August 08, 2012

Imagine you are a working mother of two, and though you would like to have a third child, you have decided for health, professional and financial reasons that you want to wait two or three years before your next pregnancy. You have tried different contraceptive methods in the past, and have found the vaginal ring to be the only one that works well with your body chemistry and lifestyle. You obtained a prescription and went to the pharmacy to pick up a three month supply. Relatively simple, right? Now imagine that every pharmacy in your state is stocked-out of vaginal rings. Furthermore, there is a nation-wide shortage and it could be several months before they become available. You reluctantly return to your health provider for a prescription for the pill, and go back to your local pharmacy to pick it up. Lo and behold they are also stocked-out of contraceptive pills, and it turns out there’s a nation-wide stock-out! The pharmacist shrugs, points you toward their condom selection and offers to unlock the case for you.

While this scenario may sound outrageous to a woman living in the United States, it is a reality that women in poor countries face time and time again. The most effective and woman-preferred methods of contraception are persistently stocked-out at clinics, hospitals and pharmacies.

Let’s take Senegal for example.

Last year we learned that on average among urban public health centers and hospitals (where the vast majority of women go for family planning), contraceptive implants were stocked out 83 percent of the year, and injectable contraceptives were stocked out 42 percent of the year. These are the two methods of contraception that women there request the most. Would you find it unacceptable if your first two preferences for contraceptive methods were unavailable? I would.

Fortunately, the Minister of Health, Dr. Awa Marie Coll-Seck, is making it a priority to fix the problems that result in stock-outs and ensure that women have access to the full range of contraceptive options. Dr. Coll-Seck stood before a global audience on July 11th at the London Summit on Family Planning and announced that she will increase the national budget for contraceptives by 200 percent and double the budget for family planning services. Furthermore, she is working with local leadership on a refined national action plan for family planning, and one of the pillars of her plan is the reform of Senegal’s contraceptive supply chain to eliminate stock-outs.

Sounds ambitious, but how will it be done? The Minister has a well-defined strategy based on early success.

Pilot tests of a model for contraceptive distribution, known locally as “pousse pousse” or informed push, have provided the Minister with all the evidence she needs to eliminate stock-outs. The model is inspired by the commercial sector, and looks much like a typical system used to stock candy and chips in vending machines.

Basically, a driver with a truck full of supplies visits each point of sale on a regular schedule, topping up the stock and recording quantities of products sold. The data collected by the driver is used to ensure sufficient stock at the warehouse and at each site, figure out which products and sites are the most popular, and prepare the manufacturers to keep pace with demand.

In Senegal, through a collaborative effort led by the Reproductive Health Department of the Ministry of Health, this model was tested in select sites over the past six months. The results are impressive.

Not only have stock-outs been eliminated across the clinics involved, but the average weekly dispensing of a variety of contraceptives has increased dramatically. IUDs have increased by 100 percent, contraceptive injectables are up 74 percent, oral contraceptive pill dispensing has increased by 63 percent, and implants are up an astonishing 1,250 percent.

Another powerful aspect of the informed push distribution model is that, for the first time in Senegal, district, regional and national decision-makers have information on the quantity and types of contraceptives requested and dispensed.  

This is incredibly useful to optimize the performance of the health system to provide women with high quality family planning services. For example, at the outset of the pilot program it was apparent that women were not receiving implants at one health center despite the fact that implants were a popular method at neighboring health centers. The district coordinator paid a visit to that health center and quickly learned that the midwife responsible for family planning services was uncomfortable with the implant insertion procedure. The coordinator was able to respond by providing that midwife with mentoring on implant insertion. Soon thereafter, that clinic was providing implants at a rate comparable to high performing sites.

Ultimately, this model offers accurate and timely information which fosters an understanding of true demand: when a woman’s selection of contraceptive method is not dependent upon or influenced by the availability of her preferred method.

As this system is rolled out across the country, Senegal will have confidence in national estimates of future demand for each product. As a result, the Ministry of Health will be able to: (1) place orders that bring sufficient quantities into the country; (2) ensure that enough contraceptives move through warehouses and delivery trucks; (3) keep the full range of products on shelves at health centers; and (4) enable women to access the contraceptive method she wants, when she wants it.

Every woman deserves the ability to decide whether, when and how many children she has. Senegal’s Minister of Health is taking bold action to provide the women of her nation with this life-saving opportunity.

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