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Contraceptive Contraceptive Security and Health Security and Health
Sector Reform: Sector Reform: Effects upon the Effects upon the Logistics CycleLogistics Cycle
Contraceptive Contraceptive Security and Health Security and Health
Sector Reform: Sector Reform: Effects upon the Effects upon the Logistics CycleLogistics Cycle
Washington, D.C., October 25, 2007
REPUBLIC OF NICARAGUA
MINISTRY OF HEALTH (MINSA)
Wendy B. AbramsonDirector-General: Planning and Development
MINSA
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.”
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
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
Evaluation of existing logistics systems Preparation of a proposal for a single logistics system for all
medicines
Logistics Cycle and Integration
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
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
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)
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
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…)
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
Intervenciones para enfrentar la integración del sistema logístico
How Changes Benefit CSThe 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.