• 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
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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

In family planning programs the term “logistics” refers to activities concerned with selecting, financing, delivering, and distributing contraceptives and other supplies. The term “supply chain” describes the many organizations that are linked in the delivery of supplies from manufacturers to clients and in the flow of information about clients’ contraceptive needs. Similarly, the term “pipeline” refers to the flow of supplies through storage and transportation facilities—including port facilities, central and regional warehouses, district and sub-district stores—to service delivery points and ultimately to family planning clients. In practice, the terms “supply chain management” and “logistics” are often used interchangeably.

Family planning logistics systems are complex. Many local and international manufacturers provide contraceptives to programs, and a variety of donors, policy-makers, and program managers procure, finance, and deliver them. Central and regional warehouses and regional and local facilities store them, and transportation systems distribute them. At each stage of the supply chain, organizations and managers share information and coordinate their activities.

To do the job right, logistics systems require political commitment, leadership and management, and training and support for the people who make the supply chain work. Effec-tive logistics management information systems (LMIS), skillful product selection, accurate forecasting and procurement, and reliable distribution, including storage and transportation, are crucial. Of course, programs need adequate funds to buy the supplies and support the logistics system.

Within the logistics system, each activity depends on all the other activities (see Figure 2). For instance, the mix of contraceptives that the system delivers should reflect clients’ preferences and the capabilities of the service delivery system. The quantities of each contraceptive method procured should reflect accurate forecasts of consumption. Also, each stage of the logistics system should include monitoring and evaluation—of the quality of the products themselves and of the supply chain’s performance (48).

With better logistics, family planning programs can make contraceptives more available, improve the quality of care, and stretch resources further—ultimately helping clients achieve their family planning intentions better. Around the world, better logistics management is linked to more contraceptive use, higher continuation rates, and client satisfaction (28, 59, 61, 81, 83, 116, 126). Improving logistics systems can provide better accountability and thus help assure the trust of policy-makers and donors.

Making contraceptives more available. A good logistics system ensures a reliable supply of contraceptives. For example, when the Jordan Ministry of Health installed a new contraceptive logistics system, only 10% of health centers and 5% of directorates in 1999 experienced contraceptive stockouts in a six-month period, down from 85% of health centers and 72% of directorates in 1997 (116).

In turn, a steady supply of contraceptives enables more people to use and continue using the method of their choice. Increases in contraceptive prevalence, of course, also reflect rising demand for family planning and other service delivery improvements. But these increases cannot occur if contraceptive supplies are not available. In Tanzania, as oral and injectable contraceptives, IUDs, and vaginal foaming tab-lets became more available as the logistics system im-proved, contraceptive prevalence for modern methods more than doubled, from 7% in 1991 to 16% in 1994 (100, 126).

Improving quality of care. The supply chain affects quality of health care in two ways—the quality of the products themselves and their availability to providers and their clients. A good family planning logistics system ensures, at each step of the supply chain, that contraceptive supplies are protected—that they have been stored and handled properly, have not expired, and are not damaged—and that defective or out-of-date supplies do not reach clients (87). It also ensures that the correct methods in the correct quantities reach clinics and other service delivery points and are available to clients.

The sustained availability of a range of contraceptive methods is central to quality of care in family planning programs (19, 74). While there are many components of good-quality services, well-supplied programs make it easier for service providers to offer good-quality reproductive health care to clients (69, 87). Reliable supply also helps build staff morale, since staff do not have to disappoint clients seeking contraceptives that are out of stock.

Getting more for less. Improving logistics systems can cut program costs without sacrificing services. For example, a study in Bangladesh found that streamlining the distribution network by decreasing the number of levels in the supply chain from five to three would reduce logistics operating costs by 66% and would reduce transportation costs by 29% with no reduction in contraceptive supply (45).

A strong supply chain helps reduce program losses by minimizing waste and damage and preventing products from expiring on the shelves. In Kenya, introducing a new tracking and distribution system has helped reduce overestimates of demand and improved forecasts since 1995. Without accurate data on use or a reliable distribution system, for example, a US$600,000 supply of STI kits was projected to serve 143 sites for one year. When the new LMIS was put into effect, program managers were able to use the same supply of kits to serve more than 500 service sites for more than two years (117).

When programs, policy-makers, and donors recognize that logistics systems are important to ensuring that contraceptives are continuously available, they can do more to strengthen the supply chain. Improvements to every part of the supply chain can help. The following steps are crucial:

• Focus on meeting clients’ needs: Family planning programs can improve logistics systems by focusing on clients’ needs at each step of the supply chain.
• Improve management and staff performance: People make the supply chain work. Good leadership, management, training, and support for supply chain staff can improve their skills and motivate them to serve clients better (see Chapter 3).
• Strengthen information systems: An LMIS that collects and reports accurate data on a timely basis helps program managers make accurate forecasts of demand for contraceptives and manage supplies efficiently (see Chapter 4).
• Improve forecasting and procurement: Better forecasting and procurement help to ensure that programs order neither too few nor too many supplies (see Chapter 5).
• Get supplies to clients: Distribution, including storage and transport, works best when it focuses on moving supplies to meet clients’ needs, not just on storing and shipping (see Chapter 6).