• 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
7. Toward Contraceptive Security
• Expanding the Commercial Sector's Role
• Health Care Delivery Is Changing

• 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

Many countries are integrating family planning with other health services, particularly other reproductive and maternal and child health services (7, 65, 73, 89, 97, 134). Well-integrated service delivery can reduce duplication, waste, and lack of coordination among programs.

Lauren Goodsmith This shopkeeper in Guinea, West Africa, sells condoms along with pharmaceutical drugs. The commercial sector could do more to supply contraceptives to clients who can afford to pay.

When health care is integrated, often the supply chains are integrated too. Integrated supply chains can make service delivery more efficient through joint purchasing of commodities and other cost-sharing activities, such as integrated storage and transport.

Integration often complicates other aspects of logistics, however. The logistics systems of integrated programs must manage a larger array of products than just contraceptives (7, 64, 102). Forecasting and procurement become more complex, and broader information systems become essential. Integrated supply chains could be less reliable than supply chains that focus only on contraceptives (7, 49).

Little research has been done on the impact of integrated supply chains. Integrated supply chains could offer an advantage to family planning programs in attracting government commitment and support. Policy-makers often are more concerned with pharmaceuticals than contraceptives, and in some places family planning is still more controversial than other types of health care. Family planning program managers, however, may fear that contraceptives will be neglected or forgotten in an integrated supply chain in favor of other health products.

Decentralization. An accompanying trend is decentralization—shifting the responsibility for managing health care services from the central level to intermediate and community levels. Decentralization aims to improve access to health care services, as well as to build quality and efficiency, by putting more responsibility and authority in the hands of local managers close to delivery points.

Local managers, because they are closer to clients, should be able to make better resource allocation decisions than central-level officials. Also, decentralization may spark more local interest in and commitment to family planning programs (66). For effective decentralization of logistics systems, staff at local levels need to be well trained, and all parts of the system have a greater need to share information (64). Retraining is required throughout the supply chain (86).

Decentralization may not improve all aspects of service delivery, however. In particular, the logistics system is most efficient when information systems, product selection, forecasting, and procurement are centralized. In a centralized system the supply chain can be better controlled and kept focused on its core purpose of ensuring that supplies are available to meet clients’ demand (1, 99). As program decision-making is decentralized, the size of the central logistics management staff is often reduced, and supply chain performance can suffer as a result (7).

Lauren Goodsmith In Morocco a health worker explains the various contraceptive methods to a family planning client. Strengthening the supply chain helps provide widespread access to a range of methods.

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Health care delivery is changing. Donor funding for contraceptives has become less certain. More and more people need and want contraception and protection against HIV/AIDS and other STIs. Few developing countries will be able to pay the costs by themselves in the near future. If programs strengthen family planning supply chains, they can make better use of existing supplies and serve more clients. Ultimately, both an effective supply chain and secure sources of financial support for contraceptive supplies are crucial to meeting clients’ needs and ensuring reproductive health for all.