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1. CLICK TO ADD TITLE The 5th Global Health Supply Chain Summit November 14 -16, 2012Kigali, Rwanda The « Informed Push Model »  for Family Planning Commodities in Senegal Dr. Cheikh Seck Director of ISSU Project, IntraHealth International [SPEAKERS NAMES] [DATE]

2. Family planning commodity stockouts in Senegal Recurring stockouts in family planning commodities Structural causes Stockout rates in service delivery points Testimonies High medical staff turnover “There’s a high staff turnover. And the transition with new staff is not adequate.” – Midwife 83%2 National 40% Work overload “I see so many patients everyday that I can’t keep up with the register.” – Midwife 43%1 Local 60% Lack of supervision “There’s no supervision at the health post level to assess the quality of the procurement.” – Family Planning Coordinator Depo provera Jadelle 1 Average number of stockout days per month (June 2010 – July 2011): 13 days 2 Average number of stockout days per month (June 2010 – July 2011): 25 days

3. Objectives The “Informed Push Model” is a distribution model based on the pushing commodities down the supply chain to service delivery points. It revolves around two key objectives: Eliminating stockouts at service delivery points. Transfer of reliable and accurate data on a regular basis to improve the supply chain.

4. Collaboration with stakeholders Implementing Agency Senegalese Urban Health Initiative Donor Bill & Melinda Gates Foundation Division of Reproductive Health (Ministry of Health) Partners in the Public Health System Partners/ Technical Assistance McKinsey & Company

5. Orders Previous Supply Model prior to the “Informed Push Model” Cost recovery Collection of products Delivery Problems encountered Order-based procurement system PRA • Poor quality of demand forecast • Cash balance issues • Etc. • Collection of products by own means (eg., rental, taxi) District SDP 5

6. How does the “Informed Push Model” simplifies the procurement of products? Cost recovery Collection of products Delivery Information “Informed Push model” (No orders) PRA Mobile Depot • Products are paid after consumption • Margins on sales are preserved District • Regular delivery to complete stock levels • A delivery voucher is signed at the delivery and shared with the district for the cost recovery process SDP

7. How are stockouts eliminated through the “Informed Push Model ”? Frequent stockouts Stock levels Units Inaccurate Consumption Forecasts Order Delays January February March April Stock levels Units • Maximum stocks • Safety threshold January February March April

8. Results District of Pikine

9. Lessons learned • Rapid and concrete results (immediate elimination of stockouts) • Logistical and financial constraints alleviated for providers • Regular collection of updated/accurate data through check-ins at SDPs • Documentation/use of consumption-related data Strengths

10. Lessons learned • Need for a solid engagement from the National Procurement Pharmacy in order to ensure the sustainability of the system • Need for increased communication with various stakeholders in order to improve the ownership of the system • Importance of providing technical assistance to the logistics operator and other stakeholders in order to facilitate capacity building from the very beginning of the project Key aspects

11. Conclusions The “Informed Push Model” offers a concrete solution to FP procurement issues in Senegal. It is strongly supported at the national level and has yielded very encouraging results. The main challenge will be to reach full and sustainable integration within, and ownership by, the national supply chain. It is important to note that this approach can be replicated as part of other health programs in other countries.