Building the Evidence: Unique Stockout Challenges of

FBO Health Facilities: Email Survey &

Phone Interview Findings

Amy Metzger, MPH Consultant to CCIH

Study Goals 1. To identify distinct typologies of FBO supply chains 2. To identify associated challenges resulting in

stockouts (when products are out of stock) 3. To recommend solutions

Objectives

• Identify and describe the basic characteristics and challenges of FBO supply chains at the service delivery level.

• Deepen understanding of the types of supply chains used by FBOs to access vital reproductive health commodities, including contraceptives.

• Identify potential FBO partners and design strategic interventions to improve RH supply chain at the service delivery level.

Methodology • Email survey - baseline data on products carried,

stockouts rates, etc 46 completed in 13 countries • In-depth follow-up to 6 countries yielded 16

completed phone interviews Topic covered: 1. Ordering 2. Transport 3. Storage and Product Quality Assurance 4. Cost Recovery and Financing

Email Survey Responses by Country (% of FBO facilities who responded)

Daily Average of FP Clients by Size and Location

Characteristics of Facilities Responding to Email Survey

Products Managed By FBO Facilities

Sources of Products Managed By Facility

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Cycle beads

Combined Pills

Progestin-only Pills

Male Condoms

Implants

Injectables

Magnesium Sulfate

Oxytocin

% of Facilities that Reported Being Stocked Out/Not Stocked Out of the Product in Last 3 Mos (preceding survey):

Stocked Out Not Stocked Out No Response or DK

Stockout of Products

Phone interviews - FBO Facilities’ Logistics Practices,

Strengths & Challenges

Ordering Facilities generally make ordering decisions for FP/RH products When dependent on Ministry of Health (occasionally other donors), MOH decides on quantity and sometimes the product Most consider safety stocks when determining quantities Challenges 69% experienced stockouts of contraceptives in prior 3 months Ordering practices inconsistent – in large part related to irregular supply and delivery MOH orders were not always complete

FBO Facilities’ Logistics Practices, Strengths & Challenges

Transport: Wide spectrum of answers on how products delivered and if on time and complete Most common scenario – Facility collects products with own vehicle (or rents a vehicle, truck, motorcycle) Faith Based Supply Organizations typically deliver to facility on a regular schedule Challenges: Rural facilities are many hours from MOH and FBSO

depots

FBO Facilities’ Logistics Practices, Strengths & Challenges

Storage and Product Quality Assurance: Some use general stores & some keep supplies close to point of use 87% reported at least 1 person designated to deal with QA issues An equally high percentage had procedure for incidents Strengths: Almost all facilities: storage capacity did not affect quantities ordered Low evidence of expiry or quality issues Challenges: A few reported issues regulating temps & maintaining cold chain Less often mentioned – insufficient space, poor security & lack of steady electricity A few had compromised quality of Misoprostol, Oxytocin & Magnesium Sulfate

FBO Facilities’ Logistics Practices, Strengths & Challenges

Cost Recovery and Financing: Fees charged varied widely If contraceptives free from MOH, typically can’t charge the patient In most facilities with single faith-based source – patients pay for all products including contraceptives The facility’s main source of financing is through: Patient fees External funds or donations Subsidies from government –salary payments or direct subsidies

Challenges: A few facilities noted contraceptives from FBSOs are too expensive

Thank you for attending!