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 BangladeshManagement Sciences for Health (MSH)

Bangladesh Committed Targets (FP 2020)

• Reduce total fertility rate (TFR) from 2.3 in 2014 to 2.0by 2021

• Increase the contraceptive prevalence rate (CPR) from62.4% in 2014 to 75% by 2021

• Increase the percentage of long-acting permanentmethods from 8.1% in 2014 to 20% by 2021

• Reduce unmet need for FP commodities from 12.0% in2014 to 10% by 2021

• Reduce the discontinuation rate to 20% by 2021(currently 30%)

Reduced TFR and Increased CPR

7.7

62.4

726.3

2.32

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 2016Target

TFR

CP

R

CPR TFR

Source: BDHS, CPS, BFS

Reduced Mortality and Increased Life expectancy

472

216 197

143

47 4192

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

Life

Exp

ect

ancy

at

bir

th f

or

fem

ale

Mo

rtal

ity

Rat

e

MMR (Per 100,000 Live Births) U5MR (Per 1000 Live Births)

IMR (Per 1000 Live Births) LEB for female

Source: SVRS

Scenario in Directorate General of Family Planning (DGFP) before SIAPS Intervention

• Lack of clarity among program managers and bottlenecksin 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)

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

Management Support

Organization

Financing

Information management

Human resources

Pharmaceutical Management Framework (Guiding Principle)

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

Improved Coordination in Forecasting and Supply Planning (1)

• Formed a Forecasting Working Group with developmentpartners and other stakeholders led by DGFP

• Bottom-up contraceptive planning and forecasting by frontlinefield workers

• eLMIS data contributes to forecasting and supply planning

• Availability of Costed Implementation Plan 2015-2020 for theNational FP Programme

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.

• Public procurement requirements were reviewed, systematized, and streamlined

• Government procurement planning and approval processmoved to electronic platform

Result:Reduced public procurement lead time by an average of 32.8weeks for any package procured by DGFP, translating into anoverall reduction of 57 percentage points in procurement leadtime 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

Improved eLMIS-www.dgfplmis.org

•Became operational in 2011, now fullyoperated by the Government

•Includes central, regional, & sub-districtwarehouses & 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

eLMIS Stock Monitoring at Different Levels

eLMIS captures individual SDP

(n~30,000) stock data

Result: Improved logistics information systems contributed to a responsive supply chain

Max.

Min.

22

7.3

3.4 3.12

14.8

19

26.9

13.8

24.8

0

5

10

15

20

25

30

Condom Oral Pill IUD Injectables Implant(Implanon &

Jadelle)

Mo

nth

of

Sto

ck

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)

% 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%

Feb

ruar

y

Mar

ch

Ap

ril

May

Jun

e

July

Au

gust

Sep

tem

ber

Oct

ob

er

No

vem

ber

Dec

emb

er

Jan

uar

y

Feb

ruar

y

Mar

ch

Ap

ril

May

Jun

e

July

Au

gust

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

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

Challenges

• Funding mechanism (public sector cost recovery is still anunderutilized approach)

• Government and donor-sustained commitment to ensurecontraceptive security and potential collaboration toaccelerate the progress toward good governance andaccountability in pharmaceutical management

• High visibility of data has profound motivating effectsthrough both recognition of excellence and transparencyof poor performance

Challenges

• Culture of data-driven policy decisions (ForecastingWorking Group Meeting, Logistics Coordination ForumMeeting, etc.)

• Sustainability of the supply chain management tools

• Monitoring and supervision at all tiers

Thanks!!mkibria@msh.org