This post is part of a monthly blog series profiling viewpoints from leaders in reproductive health who are members of the Bellagio Group on Long-Acting Reversible Contraception. The Bellagio Group is a coalition of experts who convene annually to discuss practices for expanding contraceptive choice and accelerating progress toward the Millennium Development Goal of universal access to reproductive health services. This post represents the views of the authors, and is not a representation of the Population Council or the Bellagio Group. Please direct any questions to the author at firstname.lastname@example.org.
Affordability is often considered one of the biggest barriers to accessing medicines and medical technologies, including contraceptives. But ensuring that a full range of medicines and technologies are universally accessible takes more than just an affordable price; it requires an interconnected web of partners within and outside a national health system who share a commitment to reaching men and women with the supplies they need, when and where they need them.
More than 222 million women in developing countries who don’t want to become pregnant aren’t using modern contraception. They may lack access to contraceptive options, may face family or community opposition to family planning, may be concerned about potential or real side effects, or may be unable to afford an appropriate method. In 2013, Merck and Bayer addressed the affordability barrier by reducing the prices of a key long-acting reversible contraceptive method by 50 percent in the lowest and middle income countries with the greatest unmet need for contraception. Since then, the amount of this contraceptive option distributed in these countries has significantly increased, thereby reducing unmet need among substantial proportions of women.
But increasing access for the hardest-to-reach women is no easy task and goes beyond reducing the price of the product: This requires trust between governments, donors, implementing and service-delivery partners, and the manufacturers working together in true partnership. For Merck, these partners must work as a chain, connecting Merck’s manufacturing site in the Netherlands all the way to the woman at the health clinic, regardless of her location—whether it’s in Malawi, Cambodia, or Honduras.
A strong supply and distribution chain gives women the confidence that their preferred contraceptive option will be available when they take time away from work and their families to travel to their local health clinic. I’ve heard this, for example, from women in rural areas of Ethiopia, a country that has worked hard through its Health Extension Program to ensure clinic and health post shelves are stocked with a range of contraceptive options. Not surprisingly, Ethiopia has achieved remarkable success in increasing the numbers of women able to use a long-acting reversible contraceptive method.
In countries where health products languish in central warehouses or where stock-outs are frequent, confidence is weakened and women may refrain from seeking out family planning services. When a supply chain is weak—and when products are not available at the right time and right place—it affects the critical role of community health workers in reaching out to women who may be unable to access family planning methods and information because of geographical, economic, gender, or other barriers.
Ensuring widespread access requires understanding and managing demand for a range of contraceptive methods. Regular monitoring and tracking of supplies helps to eliminate stock-outs and enables better forecasting, which, in turn, leads to a more reliable product supply. It can identify other issues that may be limiting access as well.
The Clinton Health Access Initiative (CHAI) is doing some of the best work I have seen in this area. It has been working with Ministries of Health in six sub-Saharan African countries to map commodity and human resource capacity to support informed planning and rapid troubleshooting. The project includes an innovative dashboard approach that presents both staffing capacity and product supply availability at health facilities. With this data, program managers are able to identify and troubleshoot weaknesses in their supply and distribution systems.
For example, in Malawi and Nigeria, using the data collected, CHAI helped both governments conduct a rapid assessment at those facilities with trained health care workers and contraceptive products in stock, but where there was limited use. They helped investigate core questions: Did health workers not have time for the work that was needed for this type of contraceptive option? Were they not comfortable with the product? Did they need refresher training?
The dashboard tool can also help identify where workers are trained but there are stock-outs of certain methods. For example, the CHAI team can then investigate whether the facility is newly trained and is not receiving stock because it has never reported consumption in the past, or, if it hasn’t been newly trained, whether monthly distributions for the facility should be raised. Other questions to answer include: Should the facility be restocked in the next distribution? Or is there a nearby facility with abundant stock that could supply the method to the facility in the interim?
CHAI is now moving the dashboard to a more widely accessible web-based tool, and I am confident it will further improve the efficiency of capacity-building and stock-allocation efforts. If pharmaceutical suppliers can also have access and input into the tool, it will enable us, and ultimately countries, to improve our operational effectiveness as partners by helping us better understand demand and meet it with the right supply. In contrast, if pharmaceutical suppliers don’t have insight into future demand, then they won’t have the information needed to plan production accordingly. Without the right information, the pharmaceutical supplier may produce too little or too much inventory. If too little is produced, then the demand won’t be satisfied. If too much is produced, then inventory levels will increase, which may drive up costs.
It can be easy to overlook the private sector’s role as a strong advocate for women’s reproductive choice, and I would encourage our partners to amplify this voice in pursuit of our collective goals of strengthening global reproductive health policy. After all, supply and distribution management isn’t easy. But it’s essential if progress is to be sustained over the long term. And that is in our best interest.
* Merck operates as Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., outside of the United States and Canada.
Other posts in this series:
- Children by Choice, not Chance: Bayer’s Contribution to Sustainable Access to Contraceptives, by Klaus Brill, Bayer HealthCare Pharmaceuticals
- Contraception: Why Access, Choice, and Price Matter, by Victoria Hale, Medicines360 http://www.popcouncil.org/news/world-contraception-day-why-access-choice-and-price-matter
- A Balanced Response to Basic Human Rights Needs in Crisis Settings, Campbell Bright and Vivian Cintron, UNFPA
- Rights-Based Family Planning: Importance of Increased Access, by Chastain Fitzgerald, WomanCare Global