international fp conference pss-2016.final
TRANSCRIPT
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