Sustainable supply of reproductive-health commodities (editorial written by Safia Ahsan, Ipas)

Publication date: 2012

Correspondence: Safi a Ahsan, Health Systems Advisor, Ipas, PO Box 5027, Chapel Hill, NC 27514, USA. Tel: � 1 919 883 3711. E-mail: ahsans@ ipas.org I N T R O D U C T I O N Women should not be denied reproductive health-care services because essential commodities are not available. And facilities should not have to stop providing such services because of lack of supply. Yet, these scenarios are commonplace in developing countries. Unfortu- nately, the fact that sustainable supply can be achieved in many low-resource, reproductive-health contexts is frequently not understood. Supply of reproductive- health commodities may be considered sustainable when it is available on a long-term basis, at levels cor- responding to the needs of patients and the community, through secured resource allocations. Reaching Millennium Development Goal (MDG) 5 for maternal health will require sharp acceleration of progress in order to approach the targets. Increasing sustainable supply of reproductive-health commodities can prevent unintended pregnancies and unsafe abor- tions, averting tens of thousands of maternal deaths annually 1,2 . The essential, evidence-based interventions and associated key commodities are also well- documented 3 . Simply put, ‘ No product? No pro- gramme ’ . Additionally, in an uncertain global economic environment, donor constraints will con- tinue to tighten. In order to achieve strong, sustained progress on MDG 5, national governments must take primary responsibility for commodity security, with donors playing a supportive role. A C H I E V I N G S U S T A I N A B L E S U P P L Y Factors infl uencing the attainment of sustainable sup- ply for essential reproductive-health commodities intervene at a variety of levels, globally as well as in each specifi c country (Box 1). They may vary widely for different commodities. For instance, abortion- related commodities are frequently marginalised due to stigma and donor policies. This is true in spite of the fact that deaths from unsafe abortions are largely preventable through the provision of safe abortion services, treatment of abortion complications, contra- ception, and the commodities associated with them. If these factors are to be effectively and permanently addressed, strong leadership and commitment from policy-makers on global and country levels are vital. Realising that this commitment is frequently lacking, many of those active in the fi eld of reproductive health worldwide believe that programme managers must bud- get annually for the donation of essential commodities in order to sustain their service delivery programmes. The European Journal of Contraception and Reproductive Health Care, June 2012; 17: 175–178 EDITORIAL Sustainable supply of reproductive- health commodities Safi a Ahsan Ipas (International Pregnancy Advisory Services), Chapel Hill, North Carolina, USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . K E Y W O R D S Reproductive health ; Sustainable supply ; Availability ; Financing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . © 2012 The European Society of Contraception and Reproductive Health DOI: 10.3109/13625187.2012.677876 Eu r J C on tra ce pt R ep ro d H ea lth C ar e D ow nl oa de d fro m in fo rm ah ea lth ca re .c om b y IP A S Re so ur ce C en te r o n 05 /0 8/ 12 Fo r p er so na l u se o nl y. Sustainable supply of reproductive-health commodities Ahsan 176 The European Journal of Contraception and Reproductive Health Care Yet programme managers often do not implement strat- egies to shift commodity fi nancing from donors to pro- curement by the health-care facilities 4 . Additionally, organisations responding to crisis situ- ations, such as natural disasters, frequently struggle to develop and maintain supply availability of essential reproductive-health commodities in initial crisis response as well as in the aftermath, which may last months or years 5 . Governments, local agencies, and distribution systems are often considerably weakened by the crises, and existing problems are exacerbated. Commercial availability Those active in the fi eld of reproductive health world- wide can still pursue sustainable supply for essential commodities within individual countries while also advocating for greater commitment from policy- makers 6 . This process begins with consideration of the commodity ’ s availability for purchase within the country. Manufacturers must register affordable, high-quality versions of the commodity and/or have approvals from the necessary national regulatory authorities. The product ’ s manufacturer also should engage at least one commercial distributor, possessing experience in marketing and selling reproductive- health commodities, to distribute and actively market the commodity within a country and/or region. Depending upon the distributor ’ s geographic cover- age, more than one distributor or sub-distributor per country may be necessary and desirable. Health system supports The active engagement and support of administrators and professionals within the country ’ s health ministry and health systems greatly infl uence the sustainability of a commodity ’ s supply. In many countries, the deci- sion of the health ministry to add the commodity to national and/or regional essential medicines and sup- plies lists is a critical step toward the commodity ’ s eventual integration into the national public health supply chain infrastructure. Key health-care system policies should sanction use of the reproductive-health commodity. Additionally, statements from professional clinical and health worker organisations supporting commodity use can increase acceptance of the commodity and of the services which it enables. Financing mechanisms As is well-documented and understood by those active in the fi eld of reproductive health worldwide, estab- lishing effective fi nancing mechanisms for essential commodities requires a considerable amount of advo- cacy, technical assistance, and perseverance. Budget line items should be established, as appropriate, within a particular health ministry ’ s or health system ’ s budget- ary process, and should not remain underspent. Governments all too often consider donor funding to be a long-term fi nancial solution for reproductive- health commodity supply, and country fi nancial Box 1 Factors infl uencing sustainability of supply of essential reproductive-health commodities Availability of affordable, high-quality medicines and supplies: • National registration and regulatory approval • National commodity availability through public health supply systems and distributors Structure of national supply systems: • Segmentation and fragmentation of health system structures based on disease-specifi c programmes 4 • Ineffi ciencies in national public health supply infrastructure Institutionalisation of supply: • Funding through short-term donor grants vs. annual health ministry or facility budgets • Use of parallel control systems for donated commodities, rather than inclusion in integrated control systems of health-care systems or facilities Human resource capacity: • Management of staff turnover • Training of staff with supply-related responsibilities Stigma: • Evidenced at global level among major policy-makers and some donors • Potentially present at every level within an individual country ’ s supply system and within health-care facilities Eu r J C on tra ce pt R ep ro d H ea lth C ar e D ow nl oa de d fro m in fo rm ah ea lth ca re .c om b y IP A S Re so ur ce C en te r o n 05 /0 8/ 12 Fo r p er so na l u se o nl y. Sustainable supply of reproductive-health commodities Ahsan The European Journal of Contraception and Reproductive Health Care 177 ownership is avoided. Funding through NGOs, multi- lateral and bi-lateral sources on a short-term basis can be very helpful in establishing commodity supply and service delivery; however, donor funding priorities shift over time, and country ownership of the funding of commodity supply is essential. Many countries have safe motherhood and obstetrics and gynaecology bud- gets which may be relatively reliable, long-term sources of funding. Supply management Finally, well-designed, integrated, and consistently executed forecasting (quantifi cation), procurement, and inventory management practices are necessary ingredients for sustainable commodity supply 7 . Fore- casting methods utilised should consider factors including historical consumption, logistics/distribu- tion data, service statistics, and commodity availa- bility 8 . The forecasts should fl ow into procurement processes to determine order quantities. Consistently executed transactions and well-managed vendor rela- tionships strengthen commodity availability. A strong inventory management system utilises an effective record-keeping system and minimises any losses through theft, expiration, or damage. A coordinated process fl ow between these functional areas is also essential, as it enables information and outputs to be transferred effectively throughout the supply system. Following strong progress for a specifi c commodity in the areas of commercial availability, health system supports, fi nancing mechanisms, and supply manage- ment, health-care systems and facilities achieve a far more sustainable level of commodity supply. However, conditions specifi c to a health-care facility or to a par- ticular country ’ s public-health infrastructure may still negatively affect availability. At health-care facility level, these may include inadequate training of staff with supply-related responsibilities, excessive staff turnover, poor distribution or transportation systems, weak vendor relationships, and stigma. These condi- tions will need to be immediately addressed, as well as subjected to long-term corrective action and monitoring. C O N C L U S I O N Achievement of sustainable supply is not simple, but it results in more women accessing life-saving and preventive care, while receiving the reproductive- health services of their choice. Also, health-care facili- ties which have a high level of supply sustainability can maintain service provision even when donors have shifted their attentions elsewhere. If those active in the fi eld of reproductive health worldwide seek to accelerate progress toward achieve- ment of Millennium Development Goal 5 – reducing the global maternal mortality ratio by three quarters and achieving universal access to reproductive-health care – a strong commitment to sustainable supply of essential reproductive-health commodities, grounded in sound strategies, is imperative. Declaration of interest: Ipas is a non-profi t organisa- tion committed to increasing the availability of reproductive-health supplies in health systems and sites around the world, as well as to strengthening public health supply systems. WomanCare Global, a UK char- ity affi liated with Ipas, is the sole distributor of Ipas manual vacuum instruments and works globally to provide high-quality, affordable reproductive-health products to both public and private health sectors. The author alone is responsible for the content and the writing of the paper. 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