Innovations in Global Health: Strengthening public health supply chains through private sector integration: Lessons from Senegal

By Dr. Mary-Ann Etiebet, Executive Director, Merck for Mothers

Fatou Binetou Badji, a midwife and head nurse at a Senegalese medical center, recalls a time when she had to have tough conversations with patients who would come in to her facility, only to find out their preferred contraceptive method was not available.  “It was very difficult when a patient already used to taking one method came in and we told her that method was out of stock. We may have referred them to a pharmacy, but it’s more expensive.” She added, “We would ask if her husband would accept using condoms until the product was available again. That’s how we used to handle those situations. “

In 2011, more than 80% of sampled health facilities in Senegal experienced stock-outs of at least one type of contraceptive. Due to bottlenecks in the supply chain, women in need of contraception would find their local public clinic’s shelves empty. Contraceptive use is one of the most cost-effective ways to reduce maternal mortality which is why Merck for Mothers[1] is focused so intently on access to these lifesaving products. Despite Senegal’s ambitious goals to improve reproductive health and reduce maternal mortality,[2] nearly one-third of married women in the country who wanted to prevent pregnancy had no access to contraception.

In response, Merck for Mothers partnered with Senegal’s Ministry of Health and Social Action, the National Supply Pharmacy, IntraHealth International, and the Bill & Melinda Gates Foundation on an innovative supply chain model adapted from the commercial sector. A cornerstone of the model is integrating private, third-party logistics providers. These local, private operators deliver contraceptives directly to “last mile” public health facilities, using digital technology to collect actual consumption data that informs sales and inventory decisions. Having real-time data allows products to be in the right place at the right time and enables authorities at the district, regional and national levels to monitor progress and make prompt programmatic and commodity procurement decisions.

Today in Senegal, significantly fewer women leave without the product they came for because stock outs have declined dramatically to 2% of facilities nationwide. In only three years, the partnership has helped provide an estimated 3.2 million women with more reliable access to a full range of contraceptive methods.

This initiative – known as the Informed Push Model with third-party logistics providers (IPM-3PL) – is considered a best practice in the field and has been highlighted by top-level supply chain experts through numerous commentaries, peer-reviewed articles, case studies, and other publications.

The success of the program convinced the government of Senegal to take on full financial and managerial ownership and install an innovative cost recovery system, helping ensure long term sustainability. Furthermore, given the model’s success in transforming the supply chain for contraceptives, the government is expanding it to include approximately 90 essential medicines to treat patients with malaria, HIV, and other diseases – trimming the number of parallel supply chains at the same time. Underscoring the importance of Senegal’s commitment to increasing access to medicines, President Macky Sall highlighted the partnership in his 2017 New Year Address to the Nation and in October 2017, the model was fully transitioned to the government.

The collaboration demonstrates that the private sector, in partnership with government, can play a critical role in strengthening health systems to provide broad, reliable access to contraceptives and other lifesaving products. We urge African country governments and global health donors to consider leveraging the expertise, efficiency and invention of local private businesses in transforming health care delivery to help ensure that families have access to the products they need, 100% of the time.

Lessons learned:

  • Performance-based contracts incentivize private suppliers to ensure that logistics, forecasting and transportation systems are all working smoothly so that shelves are stocked
  • Leadership from the national government committed to “doing business differently” can be transformative
  • Inclusive planning for scale up and securing local input and ownership at the beginning of a project is critical to success
  • Demonstrating the affordability of making systems-level change is an effective way to build consensus among partners

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[1] Merck for Mothers, known as MSD for Mothers outside the United States and Canada, is a 10-year, $500 million initiative focused on improving the health and well-being of mothers during pregnancy and childbirth.

[2] Some researchers have projected that in satisfying the unmet need for contraceptives, worldwide maternal mortality could be reduced by as much as 29%. (Ahmed S et al, Maternal deaths averted by contraceptive use: an analysis of 172 countries, The Lancet, Vol. 380, Issue 9837, pp. 111 – 125, 10 July 2012)

Alyssa GovindanInnovations in Global Health: Strengthening public health supply chains through private sector integration: Lessons from Senegal