Commodity security: a critical step in achieving universal health coverage

Ensuring people have access to comprehensive family planning services is a vital step towards achieving universal health coverage, and health for all. A critical component of this is commodity security. By ensuring women have access to, and a choice of, contraceptives, countries can significantly improve overall health outcomes, leading to economic growth.

A group of our experts recently attended the Reproductive Health Supplies Coalition (RHSC) general member meeting in Ghana. Here are some of their key learnings on how we can strategically drive forward inclusive change and strengthen commodity security in family planning.

“Collaboration between government, health providers and civil society plays a key role in ensuring commodity security.”

JEREMIAH MAKULA, DEPUTY TEAM LEAD, WOMEN’S INTEGRATED SEXUAL HEALTH (WISH) PROGRAMME

“Across the Women’s Integrated Sexual Health (WISH) programme, we aim to strengthen government stewardship and coordination of health commodity markets and supply chains, as well as government accountability for delivery and improved funding for commodities.

I was delighted to be able to present on some of our key lessons and learnings from across the WISH programme, and specifically on how to strengthen national ownership and improve domestic resource mobilisation for commodities. In Nigeria we have supported State Led Accountability Mechanisms, comprised of government and civil society, to advocate and hold government accountable for their sexual and reproductive health (SRH)/FP commitments, which includes FP commodity security.

But more action is needed to scale this success across countries. We need to invest more in establishing or strengthening coalitions which bring together civil society and government to identify needs based on evidence, conduct budget analysis on allocation, disbursement and utilisation and advocate for improvements. Only with multi-stakeholder and multi-sectoral coordination and collaboration can we ensure effectiveness of the supply chain and sustainable availability of FP commodities. ”

“The Global Family Planning Visibility Analytics Network can be a gamechanger, connecting information from multiple sources to enhance visibility of the supply chain.”

GEOFFREY OKUMU, GLOBAL PRACTICE SPECIALIST IN COMMODITY SECURITY

“As the Global Practice Specialist in Commodity Security at Options, a key challenge I’m often trying to address with governments, civil society and the private sector is how to support different partners in the health system to better monitor the supply chain to avert the understock or overstocking of specific commodities.

As such, one of my personal highlights from the meeting was the presentation on the Global Family Planning Visibility and Analytics Network (GFPVAN). The GFPVAN, an initiative of the RHSC, offers a collaborative digital space where countries are linked to global partners such as USAID and UNFPA as well as manufacturers to plan for their commodity supply needs. Over the past 16years, the GFPVAN has enabled governments, global procurers, and manufacturers to access timely information required for forecasting needs, planning procurement and averting delays. Unlike other platforms, the GFPVAN captures data from multiple sources, providing supply chain visibility from the supplier to the country of destination. The 37 countries that have enrolled now have a platform to assess supply needs, prioritise them, and act when supply imbalances loom.

In Kenya, Options, through the Delivering Equitable and Sustainable Increases in Family Planning (DESIP) programme has been a key partner participating in the annual national forecasting and quantification exercise which relies on the GFPVAN network for real time information on the supply chain pipeline which then informs estimated commodity needs for the country. In addition, it provides accurate data on orders made, production timelines and estimated arrival dates for shipment.

This demonstrates that the GFPVAN has the potential to strengthen the supply planning and eliminating frequent stock out in low and low-middle income countries. Options will be advocating for use of the GFPVAN to countries as key to forecasting and supply planning.”

“In decentralised settings, it’s important to support effective policy reform to ensure true autonomy lies with facilities and lower levels of government.”

STEPHEN YAMBI, SENIOR ADVISOR FOR THE EVIDENCE FOR ACTION (E4A)-MAMAYE PROGRAMME IN KENYA 

“Over the past five decades, many countries have adopted decentralised governance systems, creating sub-national government units which assume varying degrees of decision-making authority. As this happens, changes and reforms within and across different sectors are required. This may involve newly created roles and functions, changes to the public financial management system and procurement practices.

However, decentralisation is not a magic bullet and centralised processes can continue to exist many years after the decentralisation agenda was initiated. For example, in Kenya, many counties have attributed commodity insecurity in part to the confusion surrounding how products are now procured and the continued centralised processes. Coupled with a lack of skills in supply chain management within “newly” created health departments, this has frequently led to delays in getting needed commodities to the point of service delivery.

Programmes like Evidence for Action (E4A)-MamaYe, WISH and DESIP are important as they work directly with government to find sustainable policy and implementation solutions. In all programmes, we have strengthened the role of civil society, building skills in commodity tracking, health budget advocacy and, critically, ensuring government and civil society work together as allies in identifying and implementing improvements.

In Bungoma County, Kenya, E4A-MamaYe supported the formation of a taskforce including representatives from the county health management team, health facility staff and grassroots advocates to draft a Health Service Bill which provided for Facility Improvement Financing that would allow facilities to collect and keep revenue raised at source on improvements identified by the facility. Now passed into law, this has provided facilities with a level of financial autonomy, which in turn has incentivised facilities to improve their planning, forecasting and budget management including on how they determine the types and quantities of SRH/FP commodities needed to deliver effective services.

Creating this enabling environment for health service delivery and assuring commodity security requires effective stakeholder engagements between state and non-state actors, including grassroots civil society organisations who would accelerate change using evidence-based advocacy with government.”

“I’ve seen the impact poor commodity security can have. Looking creatively at different financing sources and pooling expertise will be important to strengthening systems going forward.”

JOY UZOHO, OPTIONS’ SENIOR CONSULTANT IN HEALTH SYSTEMS AND FINANCING

“As a Health Financing and Systems Expert, I have witnessed the many challenges Nigeria faces in ensuring FP commodity security and the profound impact these have on service availability and uptake over the last ten years.

Participation in the RHSC conference highlighted the importance of collaborative efforts from donors, government and implementing partners in strengthening FP commodity security to ensure that individuals or couples who need FP services can consistently have easy access to a variety of affordable and quality contraceptives. Of particular interest to me was discussion on the importance of identifying alternative financing sources for SRH commodities and the role of the private sector in ensuring continued financing during system shocks, such as COVID-19.

Through the WISH programme we have implemented several interventions in Jigawa and Kano states, Nigeria, to address these challenges and strengthen commodity security.

One example of this is where we worked closely with the government agencies to ensure that access to FP commodities, as well as comprehensive FP services, were included in the benefits package of the Jigawa State Health Insurance Scheme. This enabled vulnerable people to access FP services. As of October 2023, 350,000 people where enrolled on the scheme, marking a significant milestone on the path to UHC in Jigawa State.”

You can find out more about how we achieved this and lessons learned here.