• Editors' Summary
• Credits

1. A New Look at Logistics
2. Clients Come First
• Meeting Family Planning Clients' Needs
• Internal Clients
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

Clients Come First

An effective family planning program puts the client first. Policy-makers and managers can ensure that this focus exists throughout the program, including in the supply chain. A focus on the client recognizes that clients’ concerns and preferences are valid and important. It provides a new perspective on delivering contraceptives.

In the commercial sector, meeting customer needs has become the hallmark of successful logistics management (18, 63, 72, 88). Logistics systems that once focused on shipping and warehousing goods now focus on serving customers (129). This change occurred in the 1990s, when businesses recognized that an emphasis on customer service helped improve logistics operations and provided a competitive advantage. In the family planning field customer service translates into a client-centered approach. Programs that offer good-quality services and products meet clients’ needs better (87).

Unlike the commercial sector, most family planning programs do not have a single, easily defined standard of success. In the commercial sector a “bottom line” of profitability provides evidence of the positive effects of better service. In family planning programs success often depends on a combination of factors, including client satisfaction, contraceptive prevalence and continuation, cost-effectiveness, and program sustainability. Thus family planning programs may not recognize the importance of improving logistics to the same extent that private businesses do.

In the past, family planning logistics management has been concerned with ordering, storing, and shipping contraceptives. Today, however, as more family planning programs adopt client-centered approaches that improve the quality of service delivery, more logistics managers see that clients are the purpose of the supply chain, not just the final link.

How can family planning programs focus the supply chain more on the client? Supply chains are client-centered when they provide:

• A dependable supply of contraceptives of clients’ choice,
• Good-quality contraceptives,
• Contraceptives available when and where clients want them, and
• Contraceptives that clients can afford.

In other words, logistics systems meet clients’ needs by following the “six rights”—delivering the right product, in the right quantity, in the right condition, to the right place, at the right time, and for the right cost (5, 25, 48, 49).

Programs can respond best to clients when they offer a continuous supply of a range of family planning methods from which clients can choose. Most people’s contraceptive needs and choices change over the course of their reproductive lives, and some clients become dissatisfied with one contraceptive method and decide to use another. Ideally, family planning clients should be able to depend on ready access to a range of contraceptive methods throughout their reproductive lifetime.

Programs that understand clients’ contraceptive preferences usually can best determine the brands and quantities to offer. Programs can determine client preferences by looking at patterns of contraceptive use and by listening to what clients say. By correctly estimating the number of clients who would use each method, programs are more likely to order the right amount of supplies. Also, offering a range of methods helps ensure that, even if shortages occur, at least some methods will remain available (20).

Although most programs provide at least a few family planning methods, people often do not have easy access to the full range of modern methods (122). A 1999 study of 88 developing countries found that access to contraception is poorest in sub-Saharan Africa. Even in Asia and in Latin America, where access is better, many people do not have easy access to a range of choices (122).

For example, in Africa an estimated 53% of couples have ready access to oral contraceptives compared with 70% in Asia, including India and China, and 74% in Latin America and the Caribbean. In Africa just 13% have ready access to female sterilization compared with 42% in Asia and 52% in Latin America. In no region, however, do more than one-third of couples have easy access to vasectomy, and only 3% do in Africa (122).

Differences in family planning policies, availability of donor funding, and contraceptive delivery systems—rather than people’s actual preferences—often explain variations in method mix among countries (27, 79, 140).

Family planning programs must also consider the needs and expectations of “internal clients”—the people within the logistics system. People at each point in the supply chain receive supplies from the people at the previous point—and thus are their clients. In turn they provide supplies to people at the next point—and so have clients themselves. Just as family planning clients depend on service providers for their supplies, service providers are clients of local or regional stores, while regional managers are clients of central program managers and policy-makers who procure supplies (see Figure 3).

Like family planning clients themselves, internal clients within the supply chain have expectations of their suppliers. Family planning providers at service delivery locations are closest to the family planning client, but, unless they receive the products they need, they cannot adequately serve clients (87). Similarly, warehouses and stores in the distribution chain require logistics systems to operate effectively if they are to meet the needs of service providers.

National policy-makers and senior program managers are important internal clients because they control the allocation of funds and other resources for a country’s supply chain. They are the clients of international donors and others who supply contraceptive products to developing countries. Donors, lenders, and other suppliers, in turn, expect that logistics systems will provide accurate data on stock levels, accountability for products, and cost-effective operations to assure themselves that the contraceptives they are paying for reach clients efficiently.