• Editors' Summary
• Credits

1. A New Look at Logistics
• Securing Supply
• What is Logistics
• Benefits of Better Logistics
• What Programs Can Do
2. Clients Come First
3. People and Performance
4. The Role of Information
5. Forecasting and Procurement
6. Distribution
7. Toward Contraceptive Security

• Figures
• Tables
• Side-bars
• Bibliography

• Programs face funding crisis
• Benefits of better logistics
• Improving staff performance
• Tips on building policy support
• Checklist: Assessing the supply chain
• How to make accurate forecasts
• Push or pull distribution
• The commercial sector can help

• POPLINE
• Media/Materials Clearinghouse
• Other issues
• To order copies
• CCP Home Page

This issue of Population Reports was prepared in collaboration with the DELIVER Project of John Snow, Inc.

Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA

Today, many developing countries cannot obtain enough contraceptives to meet demand. Yet demand for family planning is rising, while donor funding for contraceptive supplies is becoming less certain. Improving logistics management has become essential to make better use of existing supplies.

Demand for family planning is rising. In many developing countries the supply of contraceptives is not keeping pace with rising demand for family planning. For one thing, more women are in their childbearing years today than in the past (136). For another, a much higher percentage use contraception (146). Moreover, millions have unmet need for family planning—that is, they want to avoid pregnancy but are not using any contraceptive method—and thus can be considered potential family planning clients (119, 123).

In developing countries and countries of the former Soviet Union, the number of contraceptive users is projected to grow by more than 38% in 15 years—from 552 million in 2000 to 764 million in 2015 according to unpublished UN projections (12)—reflecting both population growth and the rising percentage of people practicing family planning. These numbers include users of both modern and traditional methods; currently an average of 88% of contraceptive users use modern methods in these countries and 86% are projected to be using them in 2015 (121).

Also, addressing the HIV/AIDS pandemic will greatly increase the need for condoms. The cost of supplying enough condoms will rise from US$297 million in 2002 to US$557 million in 2015, the United Nations Population Fund (UNFPA) estimates (38) (see Figure 1).

As demand rises, the volume of contraceptives that a country’s supply system must handle will increase substantially. Distribution networks will need to expand and become stronger to serve the projected 212 million additional cli-ents in 2015. Costs of storage, distribution, data processing, staff training, and other aspects of logistics management will rise. At the same time, programs will need to find secure funding to keep pace with the increasing demand. Only with consistent supply can everyone who wants to use family planning choose, obtain, and use good-quality contracep-tives—a concept known as contraceptive security (see Chapter 7).

The funding crisis. Countries that depend on donor support to help meet the demand for contraceptives face a crisis. Total donor support for contraceptives, after reaching US$172 million in 1996, fell to US$131 million in 1999, according to UNFPA estimates. It rose in 2000 to US$154 million (38, 144).

It is unlikely that spending on contraceptives by governments and by clients through private-sector purchases has increased enough to compensate for declines and irregularities in donor support (144). Estimating government and private-sector spending for contraceptives is difficult, however. Countries itemize their family planning expenditures differently (109), and often spending on contraceptives cannot be separated from other family planning program spending or from other health expenditures (31).

Although inadequate to meet the demand, government spending on family planning is nevertheless substantial, especially considering that many governments are also struggling to provide basic supplies of food and water for their people (57). Many face rising economic and social problems, including the HIV/AIDS epidemic, and some face civil conflict and emergency situations.

Private foundations’ contributions to population and reproductive health activities have increased fivefold since 1995 (71). Several foundations now contribute more to population assistance than many donor nations (32). Typically, however, they do not provide funding for contraceptives, as do donor countries. Some pharmaceutical companies offer large price reductions under specific conditions, but whether they will continue this practice is uncertain (71). Overall, support from foundations and from pharmaceutical companies has not offset the decline of support for contraceptive supplies from traditional donors.

The costs will continue to grow substantially, reaching a projected US$1,249 million in 2015 to meet projected contraceptive requirements for family planning (38). If donors’ share equaled the 1992–1996 level of 41%, donors would need to provide US$269 million in 2002 and increase to US$511 million in 2015. Thus developing countries—primarily national governments and the private sector—would need to provide US$388 million in 2002, rising to US$738 million in 2015 (38). When the costs of meeting the need for condoms for STI/HIV prevention are added, donors would need to provide US$390 million in 2002 and increase to US$739 million in 2015. The amount of money that developing countries would need to provide would be US$564 million in 2002 and US$1,067 million in 2015 (38) (see Figure 1). These amounts reflect only the costs of contraceptives themselves, not the additional costs of providing good-quality services (38).

Declining funding for contraceptives has serious implications for health. Each US$1 million decline in contraceptive assistance would mean 360,000 additional unintended pregnancies, 150,000 more induced abortions, 11,000 more infant deaths, and 800 more maternal deaths, according to an estimate by UNFPA (144).

Without measures to help developing country family planning programs become self-sustaining—principally by increasing government spending for family planning and by expanding private-sector involvement (see Chapter 7.1)—inadequate donor funding for contraceptives threatens contraceptive security (32, 54, 144).

Declining funding is prompting many family planning programs to pay more attention to strengthening the supply chain. The role of logistics management is becoming even more important.