Getting Contraceptives to the Client

Every family planning program must have safe and effective contraceptives available when they are needed. Without an adequate supply of contraceptives, family planning programs will not be able to provide quality services to their clients. Having an effective commodities management system means that the right quantity of the right quality goods are sent to the right place at the right time for the right cost.

A commodities management system can be used for all types of commodities that a program uses (contraceptives, exam gloves, IEC materials, etc.). This chapter discusses the contraceptive management system specifically, as contraceptives are among the most important commodities in a family planning program. However, the process described in this chapter for managing contraceptives can be applied to almost any type of commodity that a program uses and replaces regularly.

The commodities management system is based on a continuous series of operations that can be divided into four broad areas: product selection, forecasting, distribution, and use of contraceptives. These activities operate in a cyclical process; each activity in the cycle affects the next. For example, if calculations made in the forecasting stage are too low, then even an efficiently-operating distribution process will not provide enough contraceptives to meet program needs. If the service records are not accurately maintained or are not regularly analyzed, then the selection of contraceptives and the forecasting of contraceptive use will not be accurate. The major components of a contraceptive management system and a brief discussion of the activities of each component are described in the following pages.

Contraceptive Supply Cycle*

Selection

• Determining the types of contraceptives the program will provide, based on the clients' needs and preferences.
• Selecting the contraceptive suppliers.

Forecasting

• Determining how much of each type of contraceptive will be needed at each level of the program in a given time period.

Distribution

• Receiving shipments of contraceptives.
• Storing contraceptives.
• Transporting contraceptives from the warehouse to the next distribution point.
• Managing inventory: maintaining adequate supply levels by using established systems and procedures.

Use

• Dispensing the contraceptive of choice to the client.
• Monitoring service records to track contraceptive use for forecasting future needs.

As a manager, even if you don't have direct responsibility for managing day-to-day commodities activities, you will be held accountable for any shortage of contraceptive supplies. To monitor the performance of a contraceptive supply system, all managers need to understand the components of the system and how the system works.

To determine the clients' perceived and real needs, you will need to analyze the contraceptive practices and attitudes of the client population. These may vary by geographic location, age, parity, religious belief, and brand preference. Within each program, an appropriate range of contraceptive methods should be available for different types of clients: women who want to space their births, couples who want no more children, women who are breastfeeding, men, and adolescents.

A woman's contraceptive preference may change during her childbearing years. For example, when a woman is breastfeeding, she should be able to choose a method that is suitable for this stage of her reproductive life. Other reasons for a woman to change her contraceptive method include medical contraindications, general dissatisfaction with her current method, and a change in her reproduction intentions from spacing her children to not having any more children. In addition, some methods may not be acceptable because of the partner's preference or because the method interferes with sexual relations due to side effects or other factors. Thus, a family planning program must be flexible and able to respond to the full range of women's contraceptive needs, desires, and concerns.

Family planning clients often become accustomed to a particular contraceptive method or brand and prefer to stay with that method. If possible, when selecting suppliers, try to ensure that they continue providing the same brands of contraceptives. This may reduce the possibility of clients switching methods or stopping use of contraceptives altogether. Changes in packaging of contraceptives may have a similar effect. If you make sure the most popular methods are always available in each service delivery site or area, new clients will be more likely to become continuing users and to recommend family planning to other potential clients.

There are a variety of modern contraceptive methods available through different manufacturers or suppliers. In some countries, family planning programs obtain these methods within their own country, from a manufacturer, commercial outlet, or the Ministry of Health. Other programs may receive their contraceptives from donor organizations or suppliers outside the country. Whatever potential suppliers you identify, there may be constraints in terms of the diversity of methods, brands available, and supplier reliability. Take the following factors into consideration when selecting your contraceptive supplier.

• Record of past performance: Does the supplier accept orders and then fail to deliver the product requested?
• Response to inquiries and order adjustments: Does the supplier adequately respond to all inquiries from the purchaser within a reasonable period of time? Does the supplier provide information regarding the status of outstanding orders?
• Delivery time: What is the average time between placing an order with the supplier and its delivery? What percentage of the shipments are late? How many days (weeks, months) late are shipments? Does the supplier give advance notice of delivery?
• Adherence to delivery instructions: Do shipments arrive under the proper shipping conditions (such as temperature) to maintain the quality of the contraceptives? Do shipments arrive at the correct port? Are shipments split when requested? Does the supplier ship freight pre-paid?
• Provision of documents: Do shipments arrive with all the required documents correctly and completely filled out and signed? Are any missing documents sent as quickly as possible?
• Packing and labeling: Does the supplier send the correct dosage form, packing size, and quantity? Does the external packaging protect the product during transport from damage caused by heat, humidity, or rough road conditions? Are short shipments frequent? Is labeling complete, accurate, and in the correct language?
• Policy on product expiration: Does the supplier send products that are near their expiration date?
• Cost improvement suggestions: Does the supplier make suggestions concerning ways in which the purchaser can reduce costs, such as altering delivery schedules or splitting orders?
• Quality control: Does the product conform to specified pharmaceutical standards, such as identity, purity, potency, physical appearance, shelf life, etc.? Does the supplier provide reliable quality control analysis results?

Vignette - Preventing Contraceptive Shortages