• Editors' Summary
• Credits

1. A New Look at Logistics
2. Clients Come First
3. People and Performance
4. The Role of Information
5. Forecasting and Procurement
6. Distribution
• Streamlining Distribution
• Improving Storage
• Managing Inventory Better
• Managing Transportation
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
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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

Distribution

Distribution—that is, the storage and transportation of supplies—functions best in a family planning program when it focuses on getting contraceptives to clients, not just moving them from one point to another and keeping them on shelves. A distribution network that demonstrates its value to the program and its clients finds it easier to attract funds and policy support.

In some developing countries the distribution function of the health care logistics system performs extremely well. In Kenya, for example, the Division of Family Health within the Ministry of Health distributes contraceptives to 60 district stores and 530 service delivery points through its Logistics Management Unit (LMU) (see Profile, right).. Software developed by the LMU helps staff manage vehicle capacity and delivery routes (81).

In developed countries the commercial sector’s distribution costs have been estimated at 15% to 20% of the value of goods being handled (95). Such general estimates can be misleading because costs depend on many factors specific to programs (30). The annual investment in the distribution system of a developing-country reproductive health program, however, should be at least this level. If the percentage is much lower, more resources probably are needed.

A single, central warehouse cannot effectively supply thousands or even hundreds of service delivery points. Thus most family planning programs use a tiered distribution network, with several storage and distribution levels. A typical contraceptive distribution network might have three to five levels. A five-level network might include, for example, central, regional, district, clinic, and community distribution points.

Today, as transportation infrastructures improve in developing countries and as programs focus more attention on cost-effectiveness, the trend is for contraceptive distribution networks to have the minimum feasible number of levels (49). Streamlining the distribution network can save money and, with fewer levels, contraceptives can reach clients faster (45). To determine the appropriate number of levels, managers should consider the total length of the pipeline, the desired frequency and speed of delivery of contraceptives, the cost of their transport, storage, and handling, and operational constraints.

Push versus pull. Supply chains use one of two distribution models: “push” (allocation) or “pull” (requisition). In a push system the highest level decides what contraceptives to move through the supply chain, how many, and when and where to allocate them. In a pull system each lower-level facility controls the flow of products through the supply chain by ordering the quantity needed. Some systems use a combination of these two approaches. For example, regional warehouses may pull from the central store and then push to health centers (48).

Either type of system can work effectively if logistics managers have the needed data. The appropriate distribution model depends on the needs of the program, the management skills of staff at each level, the logistics data available at each level, and the number of different contraceptive methods that the program offers (48).

A push system is usually best where data processing and analysis capabilities are strong at the central and intermediate levels. A push system is required where demand for contraceptives exceeds supply, because higher levels must ration supplies among competing service delivery facilities and their clients. Conversely, a pull system is best where the responsibility for program operations is decentralized or where staff at lower levels are well-trained in commodities management (152).