Empowering Her, Health for All
In partnership with The Challenge Initiative (TCI), we are proud to share stories that illustrate the positive impact that family planning has on women and low-income communities around the world. Published monthly, these stories aim to capture the perspectives of women and their communities that benefit from TCI’s efforts and the dedicated individuals working to empower women with access to family planning.
Taking Stock: Nigeria's Supply Chain Race to Fulfill Family Planning Demands
Many African governments and societal leaders have been working hard over the past few years to promote the benefits of family planning to young women and girls. The results look promising. According to the UN's 2020 Family Planning Report, 66 million females currently use contraceptives – up 66 percent from 2012.
Even the societal leaders and governments pushing these family planning initiatives were surprised at the sharp uptake. However, this development has cast a bright light on supply chain issues. The mix of rising demand for contraceptives and supply chain bottlenecks in the wake of the COVID-19 pandemic are increasing the pressure on health facilities to maintain adequate stock.
The dangers of prolonged stock outages are becoming increasingly clear among community and health leaders in Nigeria. While the nation maintains a contraceptive prevalence rate of nearly 22 percent, Rahila Telfim, State Family Planning Coordinator for Nigeria's Plateau State, is concerned that interruptions to supply may reduce that rate significantly.
So, what is the path forward to counter these challenges? TCI recently spoke with Nigerian health leaders and uncovered four potential strategies to resolve commodity disruption and capitalize on the nation's support for family planning.
Move Past the Pandemic
Mirroring much of the rest of the world, Nigeria’s economy and supply chains are still recovering from COVID-related roadblocks. More specifically, globally activated lockdowns closed borders, restricted shipping and distribution, and brought contraceptive supply chains to a halt. Nigeria continues to work to get its supply chain back on track.
"When commodities from abroad go out of circulation, the country has limited supply to deliver to the states," said Umar Gumau, Director of Pharmaceutical Services, State Ministry of Health, Bauchi state of Nigeria. "I'm concerned that this lack of movement already has started a backlog that eventually could lead to acute shortages. We have some alternative [commodities] to cushion the effect, but we may reach a point where we will not be able to give people what they want."
Clarify Responsibility Delegation
Within the last decade, Nigerian states have assumed responsibility for contraceptive distribution. The transition has generated mixed results at best, with an underlying perception among health officials and the population that government institutions have not taken responsibility for ensuring commodity availability.
More specifically, funding and resource allocations continue to blur the situation. As part of the transfer, the Nigerian State Primary Health Care Board assumed control of last mile distribution. However, it only proceeds with transporting contraceptives to service delivery points when it receives federal or donor funding. Without a clear path for purchase and distribution, health facilities face delays in receiving the valuable contraceptives that eager patients seek.
"We'd like to see government leaders collaborate more frequently with their counterparts, and donor partners as needed, to ensure consistent availability of contraceptives," said Rahila. "Even with the current supply chain challenges, government leaders can take measures to support and strengthen the accountability of our nation's distribution and delivery framework."
Remove Costs Where Possible
Funding and support barriers often redirect the costs of contraceptives to the population. While Nigerian states recognize the benefits of family planning and have seen an uptick in the use of contraceptives when they are made freely available, doing so can require a heavy financial burden that government and health officials are not always willing to assume.
"When contraceptives aren't readily available, costs can become an obstacle," adds Rahila. "In these cases, some individuals will go beyond the system and purchase family planning materials independently. These costs become problematic in low- and middle-income areas, and in some cases, individuals won't be able to afford these valuable items." The consequences can be dire, with the frequency of unwanted pregnancies increasing.
Amplify Visibility
Umar also believes that more in-depth monitoring and reporting are key components to work through the logistical and financial cost challenges of contraceptive access.
"(Nigeria) could benefit greatly from a system that ensures rational utilization and leverages quantity data reporting to enable facilities to pull the commodities they need," adds Umar. "For example, when men can freely take condoms from public restrooms, there is no documentation on who is using them and how frequently. This lack of visibility makes it difficult to determine when and what to restock."
Despite the challenges, Umar and Rahila are optimistic that the nation can continue to serve patients in need. In Nigeria's Plateau State, the Primary Board already has announced plans to implement high-impact interventions to streamline the purchase and delivery of contraceptives. TCI also is working with Nigerian health leaders to implement rigorous and effective logistics management information systems that have been introduced successfully in other regions.
