It is estimated that 25% of women in developing countries have an unmet need for family planning. The majority of these women live in Sub-Saharan Africa and account for 82% of unintended pregnancies in the developing world.
Modern family planning use in Senegal is one of the lowest in the world. The total fertility rate is 5.3, with an average of four children per woman in urban settings and six children per woman in rural settings. It is estimated that one in three women have an unmet need for contraception.
Family planning programmes have been implemented in Senegal since the early 1980s, when the anti-contraception law of 1920 was repealed. Since then, contraceptive use has only risen moderately. In response, in 2010/2011 the Senegalese Ministry of Health announced a new strategy for reproductive health, a doubling of the budget for contraceptives and a target to increase the Modern Contraceptive Prevalence Rate from 12% to 27% by 2015.
Unmet need is driven by a number of complex and often interrelated factors. The delivery of commodities through inefficient and ineffective supply chains is thought to be key in determining whether women can access the family planning methods they need. As a result, there is increasing interest in the design or modification of supply chain interventions, particularly the distribution components that could address the issue of family planning stock-outs.
Informed Push Model
IntraHealth, with support from MSD for Mothers and the Bill & Melinda Gates Foundation, is implementing a nationwide family planning supply chain strengthening intervention. The Informed Push Model aims to improve the availability of family planning commodities at health facilities throughout the country.
The Senegalese drug distribution system involves four levels: national, regional, district and health facility. Normally, health facilities send their orders to and collect commodities from the district level distributors, who in turn order and collect from regional-level warehouses. This system has resulted in frequent stock-outs.
Under the new distribution model, private operators deliver family planning commodities from regional-level distributors directly to health facilities. The private operators are contracted per region by IntraHealth using performance-based contracts. The operators’ pay depends on reducing stock-outs to specific targets; they are penalised if stock-outs rise above 2%. In addition to making monthly scheduled deliveries, operators are tasked with checking the inventory, topping up stocks and collecting stock availability data. An audit team, contracted by the Bill and Melinda Gates Foundation, assess the performance of the project to measure whether contractual targets are met.