2. Contraceptive Security and Health Sector Reform: Effects upon the Logistics Cycle Washington, D.C., October 25, 2007 REPUBLIC OF NICARAGUA MINISTRY OF HEALTH (MINSA) Wendy B. Abramson Director-General: Planning and Development MINSA

3. GOVERNMENT STRATEGY “The National Unity and Reconciliation Government will give priority to public health, including mass vaccinations, health education, and industrial safety and occupational health for workers. In Nicaragua, there will be more hospitals and health centers, and they will be better equipped and have more medicines.”

4. GOVERNMENT STRATEGY Health  To achieve food security and access to an adequate diet for the population  To guarantee access to potable water for the population  To guarantee adequate management of the environment  To promote access to housing with adequate hygienic conditions  To provide access to adequate health services

5. BACKGROUND: MINSA LOGISTICS SYSTEM 2003: 9 logistics systems in parallel Each system had its own forms and instruments Each system was under separate program managers Repetitive information on variety of forms Lack of communication between programs and program information Delays in delivery of supplies across programs Frequent overstock or shortages at health facilities High cost of maintaining various information and transportation systems Evaluation of existing logistics systems Preparation of a proposal for a single logistics system for all medicines

6. Logistics Cycle and Integration

7. The process of Integration DISTRIBUTION, STORAGE: 2004: -Establishment of a unified schedule for the delivery of all medicines, including contraceptives, by national and department-level warehouses -Reassignment of responsibility for the handling of all supplies to a single person -Storage of all supplies in the same facility

8. The process of Integration Single Information System: 2005: * Development of the Logistics Management Information System (LMIS), which was modified to include all medicines * Pilot program at two of the country’s SILAIS for 17 tracer drugs 2006: * Implementation of integrated information system in 5 Regions. SIGLIM is created, the Information System for the logistics Management of Medical Supplies * Training, monitoring, and supervision 2007: * Evaluation of the integrated information system (SIGLIM) * Comparative analysis of Regions with and without the SIGLIM * Approval from the MINSA senior management for the extension of the SIGLIM to the rest of the country (August) * Coordination among donors (UNFPA, USAID) with technical support from USAID | DELIVER PROJECT

9. Decentralization and Integration of Essential Drugs and Medical Supplies Decentralized:  At Regional level- storage, distribution, monitoring, and supervision Centralized:  Forecasting (w/input from regional/local aggregate data), product selection and procurement. Establishment of norms are centralized with input from the local level  Logistics indicators are determined (w/local level input)

10. Intervenciones para enfrentar la integración del sistema logístico Key Success Factors  Intra-institutional consensus among the Ministry of Health Programs and divisions (service delivery, planning, norms, administration, etc.);  Logistics assessment included tracer drugs and contraceptives.  Integration conducted gradually – “piloted”  Documentation of the integration process served as an advocacy piece for expansion to national level  MOH commitment to family planning and contraceptive availability

11. Intervenciones para enfrentar la integración del sistema logístico Obstacles and Barriers that were overcome  Resistance of MOH staff towards “new” methodology (consumption-based forecasting and resupply)  Awareness within MOH to include contraceptives on the list of essential drugs  Strengthening of internal control of the MOH by putting logistics system in place (resistance to change and controls)  CS Committee advocates for need to identify procurement options (UNFPA, generics…)

12. Intervenciones para enfrentar la integración del sistema logístico Future Challenges  Automation of the Logistics Information System  Consolidation of forecasting based on consumption data to secure procurement of adequate supply  Protect MOH funding for contraceptives through a budget line item

13. Intervenciones para enfrentar la integración del sistema logístico How Changes Benefit CS The policies of universal access and free services for all contained in the Government Strategy for Reconciliation and National Unity have as their counterpart:  A guarantee of funds for a line item for procurement of necessary medicines and medical supplies, including gradual procurement of contraceptives as donations decline.  CS is now part of the MOH’s National Strategy for Reproductive Health which promotes sustainability.  A strong commitment of the government to ensure the welfare of the population.