CLICK TO ADD TITLE [DATE][SPEAKERS NAMES] The 5th Global Health Supply Chain Summit November , 2012 Kigali, Rwanda The « Informed Push Model » for Family Planning Commodities in Senegal Dr. Cheikh Seck Director of ISSU Project, IntraHealth International

Family planning commodity stockouts in Senegal Recurring stockouts in family planning commodities Structural causes 1 Average number of stockout days per month (June 2010 – July 2011): 13 days 2 Average number of stockout days per month (June 2010 – July 2011): 25 days Jadelle Depo provera 43% 1 83% 2 Stockout rates in service delivery points High medical staff turnover Work overload Lack of supervision “There’s a high staff turnover. And the transition with new staff is not adequate.” – Midwife “I see so many patients everyday that I can’t keep up with the register.” – Midwife “There’s no supervision at the health post level to assess the quality of the procurement.” – Family Planning Coordinator 60% 40% Local National Testimonies

Objectives The “Informed Push Model” is a distribution model based on the pushing commodities down the supply chain to service delivery points. It revolves around two key objectives: Eliminating stockouts at service delivery points. Transfer of reliable and accurate data on a regular basis to improve the supply chain.

Collaboration with stakeholders Implementing Agency Donor Partners in the Public Health System Partners/ Technical Assistance Senegalese Urban Health Initiative Bill & Melinda Gates Foundation Division of Reproductive Health (Ministry of Health) McKinsey & Company

5 ▪ Collection of products by own means (eg., rental, taxi) ▪ Poor quality of demand forecast ▪ Cash balance issues ▪ Etc. Orders Collection of products Problems encountered Delivery Cost recovery Order-based procurement system Previous Supply Model prior to the “Informed Push Model” PRA District SDP

Collection of products Delivery Cost recovery Mobile Depot PRA District SDP ▪ Regular delivery to complete stock levels ▪ A delivery voucher is signed at the delivery and shared with the district for the cost recovery process ▪ Products are paid after consumption ▪ Margins on sales are preserved “Informed Push model” (No orders) How does the “Informed Push Model” simplifies the procurement of products? Information

Safety threshold Inaccurate Consumption Forecasts Order Delays Maximum stocks Frequent stockouts AprilMarchFebruary Stock levels Units January AprilMarchFebruary Stock levels Units January How are stockouts eliminated through the “Informed Push Model ”?

Results District of Pikine

Lessons learned Strengths Rapid and concrete results (immediate elimination of stockouts) Logistical and financial constraints alleviated for providers Regular collection of updated/accurate data through check-ins at SDPs Documentation/use of consumption-related data

Lessons learned Key aspects Need for a solid engagement from the National Procurement Pharmacy in order to ensure the sustainability of the system Need for increased communication with various stakeholders in order to improve the ownership of the system Importance of providing technical assistance to the logistics operator and other stakeholders in order to facilitate capacity building from the very beginning of the project

Implementation of pilot projects in the districts of Pikine and Kaolack for the procurement of FP products Development of a national program to extend the approach and improve FP integration Scaling up the approach in the regions of Dakar and Saint-Louis Documentation of the model’s achievements and operational parameters Complete system integration within the national health system Extending the system to other commodities and facilitating its progressive integration in the health system Extending the approach at the national level in order to increase the availability of FP products Jan. – Jul Aug – Dec Long tTerm Future opportunities Current focus Under discussion Population Covered ~8%~26%~100%

Conclusions The “Informed Push Model” offers a concrete solution to FP procurement issues in Senegal. It is strongly supported at the national level and has yielded very encouraging results. The main challenge will be to reach full and sustainable integration within, and ownership by, the national supply chain. It is important to note that this approach can be replicated as part of other health programs in other countries.