Massive improvements in our kuronga mhuri (FP) supply chains in recent years have generated an expanded and more reliable method choice for women and girls around the world. Asi tichipemberera kubudirira kwakadaro, 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, Neparo, Uganda, uye 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.
To date, supply chain efforts have largely focused on the contraceptive commodities themselves—IUDs, kudyara, 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:
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, semuyenzaniso. 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, semuyenzaniso). 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.
Through consultations in Uganda, Neparo, 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.
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, zvisinei, less-than-ideal scenarios can result:
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.
Dzvanya here for an accessible version of the image on page 13 of the PDF.
Several key conditions enhance the risk for this insecurity:
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).
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.
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. Asi, 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:
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.