How COVID-19 has challenged us to think about the sexual and reproductive health supply chain
To achieve Universal Health Coverage people need access to medicines, and hospitals need medical supplies and drugs to provide quality care to patients. This is fundamental to the 2030 Agenda for Sustainable Development. It means health systems require secure and sustained access to quality and affordable commodity supplies. This includes contraceptives which are a critical component of sexual and reproductive health (SRH).
The rapid spread of COVID-19 in the past year has exposed the fragility of many health systems worldwide. Particularly under threat is countries’ ability to access health commodities, an area that has seen considerable progress over the past decades. We’ve worked with governments that have experienced disruptions to the delivery of menstrual health products, for example, and felt the impact of lockdowns on the manufacturing of active pharmaceutical ingredients in China and India, two of the largest global drugs producers. We’ve also witnessed an interruption of routine health services due to national movement restrictions and safety priority issues (for example, social distancing in workplaces or closing clinics). This has meant that fewer women have been able to access contraceptive services.
The pandemic has exacerbated some of the structural and policy barriers and bottlenecks for the supply of commodities. According to estimates, a drop of just 10% in available contraceptives in low and middle-income countries could result in an additional 49 million women facing an unmet need for modern contraception, a further 15 million unintended pregnancies, and 3.3 million unsafe abortions.
The crisis' socio-economic and health impact will be felt strongly in 2021, and SRH commodity security is likely to remain a hot topic. COVID-19 is challenging us to think more broadly about how we understand and address the challenges of accessing SRH commodities in three main ways:
1. Complex systems thinking: If we had any doubts until now, COVID-19 has shown us the complexity and the interconnectedness between global and local health systems, and sub-systems (for example, health financing or human resources). It has also highlighted the constant and dynamic relationship between health systems and other sectors (intersectorality) such as transport, education, technology and food systems. It is now essential to invest more in strengthening integrated health systems, by shifting towards a holistic view of health and focusing on systemic and preventive policies and interventions that can prepare us to face global health crises.
At Options, we have adopted a system-wide lens that has resulted in the implementation of adaptive programmes that recognise the complexities and dynamic nature of health systems. These programmes are informed by extensive political economy analysis, stakeholder and process mapping, and integrate participatory and multi-sectoral approaches.
This has achieved positive results in improving access to SRH commodities and services.
2. Support national ownership: As obvious as this seems, recent international development debates have highlighted the unresolved issue of power imbalances in the way organisations based in the global North work with local partners in the South, in global health policy or the global supply chain. There is a need to build partnerships based on mutual trust and a shared agenda, with decisions informed by country needs and priorities. Options’ experience leading the new total market approach strategy for Kenya has proven effective in fostering collaborations among different stakeholders, strengthening national stewardship, and increasing access to contraceptive products in countries phasing out from donor support. We’ve also worked closely with key partners in Kenya to advocate for the government to take responsibility for funding family planning commodities which had previously been heavily donor-financed. As a result, the government committed KES 785million towards commodity procurement in the FY 2019/2020 budget. It also committed to a specific budget line for family planning in the national health budget.
The risks and disruptions caused by COVID-19 call for a new supply chain and logistics model, that is more flexible, less reliant on single-sources and more human centered. Governments, the private sector and development partners need to work together to explore long-term solutions that support local manufacturing of SRH products, investment in building a professionalised workforce across all the supply chain and more lean and resilient procurement systems.
3. Data integrity and visibility: Many health systems rely on faulty logistics management information systems. But the effectiveness of SRH programmes depends on the uninterrupted availability of contraceptives and other SRH supplies. This requires access to good quality data for planning and managing supplies, estimating and making effective decisions on supply needs and allocation of resources, providing evidence on product efficacy, advocating for funding allocation to SRH and monitoring how funding is spent. To do this we need investment is needed in capacity at all levels, from forecasting and quantification to logistic management.
Over the last year, the world has learned the importance of real-time data to develop an effective emergency response, and to inform decisions on how to build more resilient and inclusive health systems in the future. Increasing data visibility and use is a precondition for governments, development partners, manufacturers, distributors, providers and service users to build resilient health systems.
Interesting initiatives have started to emerge in the SRH space. Such as the Global Family Planning Visibility and Analytics Network (Global FP VAN), which connects key supply chain actors like governments and manufacturers, and integrates information globally helping to manage supply chain disruptions. But bridging the digital divide, especially in Africa, remains a priority and requires strengthening data collection and use at all levels of the supply chain (from the manufacturer to the final user), ensuring the right regulatory frameworks and infrastructure are in place.
Looking ahead, addressing commodity security in the SRH sector requires balancing the challenges at the global level (for example, logistic disruptions) and the realities at the country level (for example, operational and commercial challenges). It also requires recognising that the most sustainable and innovative solutions are likely to be generated locally. But this is probably a topic for another blog.
Written by Sebastiana Etzo, Technical Advisor