Informed Push Model

Informed Push Model

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In Senegal, the absence of a well-functioning family planning product supply chain has been a barrier that has contributed to Senegal’s low contraceptive prevalence rate (CPR) (12.3 percent in 2010) and high unmet need for family planning among married women (29 percent). Recurrent family planning product stock-outs at nearly 80 percent of public service delivery points (SDPs) continue to hinder the government’s ability to achieve its goal of more than doubling CPR to 27 percent by 2015.To improve the supply chain and ensure the steady availability of contraceptive products, IntraHealth International is expanding the approach known as the Informed Push Model (IPM) nationally in Senegal. Successful IPM implementation depends on the availability of routine SDP-level product consumption data, but the data have historically been unreliable or unavailable in Senegal. IntraHealth is collaborating with Dimagi to solve this problem by implementing a customized version of CommTrack as the IPM’s logistics management information system (LMIS).

About IPM

The IPM is a distribution model that adapts principles used in commercial distribution to the public health sector. The IPM addresses common supply chain obstacles of transportation, quantification, data availability, and financial flows. The model involves dedicated logistics professionals, who deliver contraceptives from the regional level directly to SDPs on a monthly basis.

A key component of the IPM project’s success has been the use of an LMIS. CommTrack is an open source turnkey product designed to strengthen logistics management through the use of mobile technology. With this support from Dimagi, the IPM project has identified a low-cost and highly scalable mHealth solution that makes it possible to substantially reduce contraceptive stock-outs and broaden Senegalese women’s access to a wide range of family planning products.

IPM’s key features include:

Task shifting. By using specialized and regionally based logistics professionals to carry out logistics tasks such as quantification, data collection, and distribution, logistics performance improves and health workers are free to focus on what they do best—health service provision.

Public-private partnerships. The Senegal IPM uses private operators, or third party logistics providers, to store and distribute the family planning products.

Payment based on consumption. Before the IPM, SDPs were required to pay for family planning products at the time of order, which resulted in cash flow problems and a broken cost-recovery system. With IPM, payments are based on quantities of product delivered and consumed.

Aligning incentives. The IPM aligns the incentives of all parties involved in making sure that family planning products reach SDPs and clients.

Open LMIS. The logistics professionals enter logistics data into CommTrack on tablets at the moment of delivery, and CommTrack automatically calculates delivery quantities based on previous consumption.

Evaluation and Results

Most public health medicine distribution systems involve high numbers of users at each level of the system, with each level required to contribute data to the LMIS. In Senegal, the IPM has decentralized logistics management tasks to the regional level. The result has been a dramatic reduction in the number of individuals interacting with the LMIS, from approximately 1,450 providers, supervisors, or facility workers to 14 logistics operators (one per region).

Among its many benefits, the small number of LMIS users required by the IPM results in simplified training needs and less costly hosting and maintenance. Also key to the IPM approach is the flexibility and mobility of the LMIS. Previously, data were entered via paper registers. Now, users are able to access and enter data directly into the system via portable tablets at each facility or depot anywhere in Senegal.

By customizing open source software, the IPM project has kept development costs to a minimum. Implementing Com- mTrack as the IPM’s LMIS costs less than $140 per SDP and has proved to be a low-cost, highly scalable mHealth solution.

As the IPM and its customized LMIS undergo national scale-up, health workers who are using the model have described it as a “revolution.” Now, providers are able to more accurately plan for and receive contraceptive products. Moreover, clients are benefiting from the regular resupply of family planning products and—because providers’ time is freed up—increased provider-client interactions. Clients are expressing greater satisfaction with family planning services, and providers report greater job satisfaction, improved work flow, and better-quality reporting of data.

Lessons Learned

--The IPM’s distribution of products directly from the regional level to SDPs allows district health teams to maintain their focus on management of SDPs and service provision rather than being sidetracked by physical supply chain operations.

--The IPM’s task-shifting approach leverages the limited supply chain management expertise in Senegal by using a small number of trained professionals to serve a large number of SDPs.

--Shifting nonmedical tasks from health providers to logistics professionals frees up providers’ time, improving service quality and ensuring that women have access to a steady supply of family planning products.

--The IPM strengthens public-private partnerships while incentivizing all parties to ensure that facilities and communities have access to family planning products.

Conclusion

IntraHealth International, in collaboration with Senegal’s Ministry of Health and Social Action, is expanding access to—and use of—family planning by reducing contraceptive stock-outs. Implementation of the IPM reinvests proceeds from clients’ contraceptive purchases back into the public contraceptive supply system to ensure the constant flow and availability of products. By making a wide range of family planning commodities available, the IPM enables women to more freely choose the methods they want at affordable prices. The model also generates data on the consumption of family planning commodities, which can then be used to inform and improve how health services are provided.

With the IPM, the logistics management burden is shifted from health workers to dedicated logistics professionals, leaving more time for providers to focus on service delivery quality. Over time, therefore, improvements in the family planning commodity supply chain have the potential to boost health worker retention, improve client satisfaction, and increase women’s access to contraceptives. The IPM also strengthens the quality of service delivery, reinforces provider roles and responsibilities, and improves workflow at the facility level.

Project Information

Geographic Coverage: National scale in all 14 regions of Senegal to cover 1,400 service delivery points

Implementation Partners: IntraHealth International; Dimagi

Donors: Bill & Melinda Gates Foundation, Merck for Mothers

Contact Information: Carol Cissé, Program Manager; IntraHealth International, cecisse@intrahealth.org