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In-Depth Reading Time: 6 minutes

Making Gloves, Forceps, and Other Supplies More Than an Afterthought

Massive improvements in our family planning (FP) supply chains in recent years have generated an expanded and more reliable method choice for women and girls around the world. But while we celebrate such success, one nagging issue that warrants attention is the corresponding equipment and consumable supplies necessary to administer these contraceptives: Are they also getting to where they’re needed, when needed? This piece is based on a larger piece of work funded by the Reproductive Health Supplies Coalition Innovation Fund. The full report is available here.

Current data—both documented and anecdotal—suggest that corresponding equipment and consumable supplies, like gloves and forceps, necessary to administer contraceptives, aren’t reaching their final destinations at optimal times. At the very least, gaps remain in family planning (FP) supply chains. Through a literature review, secondary analysis, and a series of workshops held in Ghana, Nepal, Uganda, and the United States, we sought to understand this situation and put forth solutions to ensure that reliable method choice is accessible to FP users around the world.

Supply Chain Shortcomings

To date, supply chain efforts have largely focused on the contraceptive commodities themselves—IUDs, implants, injectables—but have often failed to consider the corresponding equipment and consumable supplies. Consumables, for this purpose, refer to expendable materials for one-time use, like:

  • Gloves.
  • Gauze.
  • Anesthetic.
  • Iodine.

Equipment includes instruments and reusable materials that are typically used more than once, often for the purpose of infection prevention and control between uses: a towel, forceps, scalpel handle, and kidney dishes, for example. These items are needed for the provision of certain FP methods, like long-acting reversible contraceptives (LARCs), but are not typically packaged with contraceptive commodities. As a result, they need to be planned separately.

The issue of the unavailability of equipment and consumable supplies—and the associated potential outcomes—has been poorly documented to date, both in terms of the extent to which this happens globally as well as the downstream effects that follow. As LARCs continue to gain momentum globally, the necessity to address FP equipment and consumable supplies security will become more urgent, as these methods are more material-intensive (compared to condoms or birth control pills, for example). The COVID-19 pandemic further strained existing supply chains, especially for infection prevention and control supplies (like gloves). As the global family planning community considers how to build resilient health systems and supply chains that provide uninterrupted access to FP services, there is an urgent need to prioritize equipment and consumable supplies security.

Exploring the Issue from Various Perspectives

Through consultations in Uganda, Nepal, and Ghana, as well as with global supply chain experts, we explored potential barriers to equipment and consumable supply availability across different actor groups. Different findings and opportunities for advocacy emerged for each group, though many of the findings transcended groups and were linked across both stakeholders and processes.

Why Does This Matter?

In the ideal scenario, necessary equipment and consumable supplies are present for the method that the client chooses, and the client leaves having received a quality family planning service.
When the equipment and consumable supplies are not available for the client’s method of choice, however, less-than-ideal scenarios can result:

  • The client is turned away (denied the service and/or is referred to a different facility).
  • The client is asked to purchase the supplies for the procedure (cotton, iodine, forceps, etc.).
  • The client receives a lower-quality and potentially unsafe service, which is compromised due to the lack of necessary supplies (e.g., without gloves).
  • The client receives a different family planning method than the one she preferred.

In each of these non-ideal outcomes, the client may face increased health risks (including unintended pregnancy), side effects from a method that she didn’t prefer, or a higher risk of infection due to a compromised procedure. She may also face undue financial burden, as she may be forced to pay for her own supplies or visit additional service delivery sites (to seek her method of choice or obtain care for medical complications stemming from a compromised procedure). As a result, the client’s ability to realize her family planning goals may be restricted.

Click here for an accessible version of the image on page 13 of the PDF.

Salience of Equipment & Consumable Insecurity

Several key conditions enhance the risk for this insecurity:

  • A new method is introduced and requires equipment and consumables. Mechanisms to scale up those materials may not be in place yet.
  • The method mix shifts, particularly towards more material-intensive methods like LARCs. Existing supply chains may face greater strain, and additional materials may not have been procured.
  • Services are newly task-shifted or task-shared. As distribution points expand, minimum volumes of equipment and consumables must also be met.
  • The supply chain management devolves. As the responsibility for supply chain management or procurement shifts, ordering processes may be unclear.
  • Health facilities or subnational health offices grow their financial autonomy over the supply chain. When shifts in autonomy across supply chain actors take place, consumables may receive less-urgent attention, especially if other materials are perceived to have greater urgency.
  • A global pandemic. The past 18 months exposed the challenges of maintaining supply chains and FP services as health facilities struggled to respond to the pandemic. This challenge is highlighted when there may be competing demands on consumable materials and resources are shifted to pandemic response efforts.

What Do the Data Say?

Data collected at service delivery points through Performance Monitoring for Action (PMA) and the Demographic Health Survey (DHS) Program’s Service Provision Assessment (SPA) surveys show equipment and consumable supplies needed for FP service delivery are not always available.

The most recent family planning briefs available through PMA show that of facilities that provide implants, an average of 85% surveyed had the necessary consumables and equipment for insertion and removal on the day of the survey. In some regions, this number was as low as 58%; in others, as high as 92%. The data show a similar snapshot for IUD insertion and removal: An average of 88% of facilities surveyed were stocked with all necessary equipment and consumable supplies (range: 53%–93%). The data collected via the SPA Surveys indicate that just 11%–58% of service delivery points had all of the necessary materials for IUD insertion and removal (including the IUD), and 54%–92% had the materials for implant insertion and removal (including the implant).

Gloves. Credit: Pixabay

In order to better understand the relationship between material shortages and the impact on individual FP users, specifically the extent to which this issue affects a person’s ability to enact their contraceptive choice, significantly more research and data are needed.

Recommendations & Advocacy

Securing a global supply chain that achieves FP commodity security—in all its parts—is complicated. The good news is that significant strides and successes have been celebrated globally. But, the work isn’t done. Equipment and consumable supply chain insecurities threaten to undermine all our progress. Significantly more attention is needed to strengthen the supply chains associated with family planning and deliver more reliable and expanded method choices for women and girls.

By moving the issue of equipment and consumable supplies insecurity into the spotlight and sparking conversation about the potential implications that this issue has on family planning outcomes, it is our hope that the global FP community can come together to advocate for:

  • More research and data, especially data that captures impact. We need to develop a better understanding of the extent to which equipment and consumable supplies insecurity is impacting family planning outcomes, and have the data and evidence to support it.
  • A deeper understanding of what happens within facilities. A thorough investigation at the facility level will yield crucial information about how equipment and consumables are managed within facilities and across departments. This will lead to a greater understanding of different procurement processes, challenges, and potential solutions.
  • Tools to quantify the equipment and consumables needed for FP services. Tools that articulate the volume of materials needed for different FP services will help inform procurement planning and needs, which could strengthen the quality of supply planning.
  • Clarity on funding lines, roles, and accountability. Many settings lack clarity on who should be responsible for paying for equipment and consumable supplies for FP services. Ambiguity exists over whether donors, national governments, or individual facilities should take ownership of these costs. And when that responsibility isn’t clear, we risk passing the costs on to the client.
  • Additional resources. While this project gleaned critical insights into the complexities of FP equipment and consumable supplies security, it’s a complicated issue that will require innovative solutions. Additional resources will be critical to bringing these recommendations to the next level.

While strides are being made to improve FP supply chains, until gaps are closed in how corresponding equipment and consumable supplies are distributed, FP outcomes will continue to be negatively impacted. It is up to donor organizations, multilateral civil society organizations, national and subnational governments, and health care facilities to deploy solutions to rectify these issues and ensure worldwide FP access via equipment and consumable-supply security.

Sarah Webb

Technical Advisor, Jhpiego

Sarah is a Technical Advisor at Jhpiego, where she works across the organization’s RMNCAH and Innovations Portfolios. Sarah provides technical assistance on both family planning and maternal newborn health projects, as well as on approaches for engaging the private sector and utilizing market solutions in reproductive health. She has close to 10 years of experience in global health and international development, with a focus on advocacy and business-oriented solutions to global health challenges. Sarah has experience throughout Africa, South Asia, and Central and South America. She holds a Bachelor’s Degree in Politics & Government from the University of Puget Sound and a Master’s in Public Health and Master’s in Business Administration from Johns Hopkins University.

Megan Christofield

Technical Advisor, Jhpiego, Jhpiego

Megan Christofield is a Project Director & Senior Technical Advisor at Jhpiego, where she supports teams to introduce and scale access to contraceptives by applying evidence-based best practices, strategic advocacy, and design thinking. She is a creative thinker and recognized thought leader, published in the journal of Global Health Science & Practice, BMJ Global Health, and STAT. Megan is trained in reproductive health, design thinking, and leadership & management from the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins Carey Business School, and has an undergraduate degree in Peace Studies.

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