• Editors' Summary
• Credits

1. A New Look at Logistics
2. Clients Come First
3. People and Performance
• Leadership
• Improving Staff Performance
• Sustaining Good 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

Managers can improve the performance of the supply chain by analyzing and improving staff performance. Often, managers do not clearly define standards for performance, and staff are not aware of expectations—or they may lack the skills to keep daily records and to track movement of supplies (50, 84, 96, 115). Also, tracking forms and other tools used in supply management often are poorly designed and difficult to use (13).

A number of systematic approaches can assess performance and help devise solutions to problems in family planning programs, including Performance Improvement (23, 92), Situation Analysis (98), and Operations Research (152). Program managers can use results of performance assessments to hold discussions with staff, make improvements, or present training and other performance-improvement needs to policy-makers and donors (49, 96, 116).

Contraceptive logistics training. Assessments often find that the solution to weak contraceptive logistics management is staff training (24, 39, 41, 49, 60, 96, 98, 108, 116, 125). A variety of training approaches have helped improve performance, including competency-based training, classroom training, on-the-job training, internships and apprenticeships, study tours, distance education, and whole-site training (17, 51, 91, 132, 133). Also, job aids such as procedures manuals and quick reference guides can support training, ensure the consistency of the information provided, and contribute to the long-term continuity of the supply chain (52).

Most supply chain workers need to know how to keep daily records, monitor stock levels, and correctly record supplies received, distributed, and on hand. The quality of record keeping varies among programs and among different levels of the same supply chain. In Jordan, for instance, a 1997 Situation Analysis found that only 30% of health centers and 25% of directorates kept accurate records of contraceptive inventories. In 1999, after widespread logistics training in clinics, 63% of health centers and 52% of directorates kept accurate records of their inventories (116).

In Chile in 1990 the family planning program had 4.5 years’ worth of condoms on hand, far in excess of demand and thus in danger of deteriorating, since the standard shelf life of condoms is 5 years. By 1993, after training improved forecasting skills, the program could reduce condom stock levels to an appropriate 10 months’ worth. This reduction not only helped minimize overstocks of contraceptives but also reduced the need for warehouse space (26).

Some programs have established a cadre of trainers to meet the continuous need for skilled employees (52). In Jordan in 1999 the Ministry of Health developed a cadre of logistics trainers because few staff had any logistics skills. This cadre of trainers now provides refresher training as well as training for new logistics workers (116).

Training can improve staff performance when the causes of performance problems are deficient skills, lack of knowledge, or poor attitudes. Training, however, cannot correct problems related to inadequate infrastructure, inappropriate regulations or policies, or other aspects of the organizational environment, such as insufficient information flow (49).

Like all workers, supply chain staff need continuing support and reinforcement from managers and supervisors in order to keep skills fresh and sustain good performance. Often, organizations devote substantial resources to training without recognizing the importance of other aspects of job performance, such as good compensation systems, motivated workers, and skillful supervision.

Motivated staff sustain good performance (11, 68). Some studies have shown that pay is a powerful determinant of family planning job performance (29, 53, 75), while others have not (4, 78). Studies also have linked good performance to noneconomic factors such as accreditation, recognition, status, and employee commitment (16, 105).

Skillful supervision and effective monitoring can contribute to good-quality health care (15, 104). Supervisors can ensure that family planning logistics staff are doing their jobs correctly, are motivated, and focus on serving clients. In most logistics systems, however, supervisors work in central or regional offices and visit clinics and other service delivery points only once or twice a year.

A 1999 assessment in Nepal, for example, found that supervision took place sporadically, and in some places not at all. The average number of Ministry of Health super-visory visits to service delivery locations in the preceding six months was 1.5. The number of logistics supervisory visits averaged less than one (84).

Since supervisors have many different activities to monitor during site visits, they tend to have little time for discussion with staff and cannot help with on-the-job training or problem solving. In many cases the supervisor leaves the site without developing and discussing specific recommendations for improvement and with no written recommendations or plan for follow-up. Without guidance, staff often find it difficult to improve their own performance or the performance of the facility as a whole (9).

Even frequent supervisory visits may not help if supervisors are not trained to provide on-site support and guidance to staff. For example, an analysis in Botswana of maternal and child health and family planning facilities in 1995–1996 found that, although supervisors had visited over 90% of facilities at least once in the six months before the study, in only 65% of visits did supervisors ask the workers about problems. Moreover, in only 50% of visits did supervisors examine clinic records, in 43% observe service delivery, and in 38% make suggestions (3).