Back to Contraceptive Logistics

Note: Portions of this article excerpted from the Pocket Guide to Managing Contraceptive Supplies.

From 1973 to 2006, CDC/DRH provided technical assistance in contraceptive logistics matters to family planning programs in 65 countries in Asia, Africa, Latin America, and Eastern Europe. In more than 25 years of logistics work, the following maxims emerged.

A well-run contraceptive logistics system is almost invisible, but must not be taken for granted.

Contraceptive logistics sounds simple, but doing it right is complex.

The contraceptive supply chain is only as strong as its weakest link (and that includes the top link).

A good logistics manager is like a good juggler.

A logistics system without good information is like a pen without ink—it can’t do its job.

Never forget who the contraceptives are for—the family planning clients.

When a contraceptive logistics system fails, the consequences can be dire.

These maxims are more than just words; they contain much of what we have learned over the years about the activities, systems, resources, and procedures that are needed to get the right quantity of the right contraceptives to the right place at the right time in the right condition and at the right cost—in other words, to manage a contraceptive logistics system properly and ensure that contraceptives are always available to clients at all service delivery points.

A well-run contraceptive logistics system is almost invisible, but must not be taken for granted.

In a well-run logistics system, contraceptive supplies are always available and in good condition. Clients never complain that contraceptives are damaged, expired, or not in stock. Staff members are not unhappy because they cannot do their jobs properly for lack of contraceptive supplies. There is no hoarding or rationing of contraceptives or submitting inaccurate reports in order to get more supplies. Contraceptives are available for all who need them when they need them.

All appears calm. But an outside observer would hardly be able to guess at all the activity behind the scenes. In a well-run system

A contraceptive logistics system must have enough resources to be run well—and thus to appear invisible to all except those involved in running it.

Just as it takes a lot of work to run a busy home successfully (cleaning, buying food, preparing meals, doing laundry, paying bills, upkeep of the house and property), there is a lot of work involved in running a contraceptive logistics system successfully. If a contraceptive logistics system seems invisible, that means people are doing their jobs well. They are making sure there are no shortages or stock-outs or bottlenecks causing disruptions to the supply or to family planning services.

Although "invisibility" is a hallmark of a well-run system, it can actually cause difficulties for the system if it means that policymakers do not recognize the vital importance of logistics to the family planning program. If these officials—who are often distracted by crises elsewhere—do not view the logistics system as important, it could result in logistics receiving fewer resources, which would be an unfortunate mistake.

Managers, therefore, need to make sure that the contraceptive logistics system’s needs are known and are met. To remind policymakers how essential the logistics system is to the program’s success, managers can regularly send them success stories and problem-solving reports, which show that the policymakers’ support is buying something valuable.

Contraceptive logistics sounds simple, but doing it right is complex.

Logistics sounds so simple—you just have to fulfill the six rights:

And in fact, a logistics system should be as simple and as streamlined as possible. But even in a streamlined system, there is a lot involved in satisfying the six "rights."

First, every supply system has at least a couple of administrative levels, starting with the central level and ending at the service delivery level. Some have a number of levels in between (such as regional, provincial, and district levels). Every level must

• store and issue supplies
• monitor stock levels
• collect data
• produce reports

At every level, there must be well-trained staff members who know the following correct logistics procedures:

• proper storage practices
• first-to-expire, first-out procedures to prevent expiration of contraceptive supplies
• keeping correct levels of supplies to avoid stock-outs and excess supplies
• ordering more supplies when needed and how many to order
• keeping accurate records
• producing reports on time

Every new staff member must be quickly trained in these procedures, and supervisors should be helpful and supportive. These two things—staff training and supportive supervision— are essential at every administrative level if the logistics system is to work properly.

Budgetary expertise is also required, to make sure there is enough money to acquire, manage, and distribute the needed contraceptives and to run the whole logistics system. Some political know-how may also be needed in order to convince policymakers of the need for resources. Busy policymakers may not notice a well-run logistics system—it’s only when the system has problems that it becomes glaringly obvious to them.

A contraceptive logistics system must be supported by an effective information system.

• Staff members must accurately fill out reports on the numbers of contraceptives given to clients and the number still on hand.
• Reports must be sent promptly to managers.
• Managers must be skilled at putting all the data together and analyzing them so the proper actions can be taken, based on what the data show.

To keep the system running smoothly, these steps must be taken at every level. If any information is missing or incorrect, the whole system will be less effective.

Careful advanced planning is needed, especially at the central level of a family planning program that may handle large quantities of contraceptives. These large quantities may have to be ordered many months in advance, although it is difficult to estimate how many of each contraceptive will be needed in the future. Deciding how many to order requires (1) having accurate data on contraceptive use and demand, (2) expertly analyzing these data, and (3) knowing what new activities the program has planned. The logistics manager should be involved in this planning process so that the logistics system is ready to manage the contraceptive supplies when they arrive. The process of procuring supplies, whether requesting them from a donor or buying them from a manufacturer, is complex and requires expertise.

Thus, managing the contraceptive logistics system for an entire family planning program is a complex task. Even managing the supplies for just one clinic requires many skills and frequently checking supplies. A family planning program cannot succeed without a good logistics system—staff, systems, and infrastructure. Therefore, the logistics system must be recognized as an essential part of the program, and it must have adequate resources to sustain it.

The contraceptive supply chain is only as strong as its weakest link (and that includes the top link).

For an entire contraceptive logistics system to run smoothly, every level of the system must function well. This means that the program should have clearly stated and documented policies and procedures, and that staff should follow them.

For the family planning client at the end of the supply chain to receive the contraceptives she or he wants and needs, each of the following "links" must be in place:

The clinic staff must

• monitor the clinic’s supplies of each contraceptive product to make sure there are always enough (but not too many) supplies on hand;
• keep track of how quickly those contraceptives are being given out to clients, and note whether this rate changes over time;
• order the right amount of new contraceptive supplies in time to receive them before the current stock runs out;
• promptly submit accurate reports of how many of each contraceptive have been dispensed to clients.

The regional and district warehouses must 

• keep enough supplies of each contraceptive product on hand;
• keep track of how quickly the contraceptive supplies are being issued to service delivery points and to other warehouses;
• in some systems (where the clinics don’t place orders), monitor the rate of use at the clinics, which means receiving timely and accurate reports of use and analyzing the information in those reports;
• organize timely delivery of contraceptive supplies;
• manage and maintain the vehicles needed to deliver them.

The central warehouse must

• receive and store large quantities of contraceptives;
• check incoming supplies for signs of damage and ensure that they meet specifications;
• quickly and correctly fill the orders of regional and district warehouses;
• in some systems (where the intermediate warehouses don’t place orders), monitor the rate of use at the clinics. This requires the central warehouse staff to analyze the timely and accurate reports from the clinics;
• manage and maintain the vehicles needed to deliver the supplies.

The central administrative level must 

• collect and analyze the data on contraceptive usage throughout the program;
• make projections for contraceptive needs several years into the future, factoring in future program plans;
• include the logistics manager in this planning process;
• make sure there is enough funding to buy, store, and distribute all the contraceptives that are needed;
• select and negotiate with donors or manufacturers to procure the contraceptives;
• monitor the procurement process and quickly resolve any problems that arise;
• make sure the contraceptive shipments arrive in time to prevent supplies from running out at any level of the program.

At every level, staff must

• follow proper storage procedures to protect the contraceptive supplies from damage;
• follow first-to-expire, first-out procedures so that supplies are given to contraceptive users long before their expiration dates;
• record the number of contraceptive supplies that arrive and that leave the facility (whether they are on their way to another facility or given to a contraceptive user);
• check the contraceptives for signs of damage;
• separate and destroy damaged or expired contraceptives.

One of the most important links of all may not seem, at first glance, to be connected to the supply chain. Policymakers may not count, transport, dispense, or ever even see the contraceptive supplies, but their support and involvement is critical. The policymakers decide how much funding the program will receive both for contraceptives and for logistics management in general, and without their support, the program might lack one or more of the following essential ingredients:

• enough contraceptives to meet the demand for them;
• a logistics manager to oversee the whole process and ensure smooth operation of the contraceptive logistics system;
• fuel or maintenance for delivery trucks;
• enough storage space;
• proper upkeep of warehouses;
• training for new staff members in basic logistics or reporting tasks.

If, at any level, a link is broken...    

• If reports are late
  • If a truck breaks down
    • If contraceptives are buried at the back of a shelf and expire before they can be used
      • If the quantity ordered is miscalculated

Then the chances increase that a clinic or service delivery point will "stock out" (run out of supplies) of a contraceptive, a family planning client will not receive the desired and needed contraceptive, and an unwanted pregnancy or disease transmission may occur.

A good logistics manager is like a good juggler.

Things do not always flow smoothly as contraceptives make their way from the manufacturer to the contraceptive users. For example—

• One clinic had a leak in its roof and all their oral contraceptives are now damaged; they need an emergency shipment to replace them. The logistics manager analyzes a routine report from a nearby clinic and finds that demand for oral contraceptives there has declined and they now have too many on hand (they are over their maximum quantity). Excess supplies from that clinic can be sent to the one whose supplies were damaged, which will give them enough until the next regular shipment.
    
• One of the three delivery trucks has broken down and replacement parts will not be available for a week. Can the clinics that are supposed to receive deliveries this week manage for one more week, using their safety stock, or might they experience stock-outs? Can staff members ask the health supplies delivery department if they can borrow a truck or add contraceptive deliveries to their route? Can a truck be rented for the week?
     
• Condom supplies for the entire family planning program must be ordered soon, as the lead time is long between placing an order with the manufacturer and the arrival of the supplies. First, a forecast must be done to estimate the number of condoms that will be needed. But several service delivery points have not sent in all their quarterly reports in the past year. Can the information be obtained through telephone calls? Or must their condom usage be estimated, based on the quantities they reported were dispensed to contraceptive users in the reports they did submit, and from reports on the quantities issued to those service delivery points?
  

Because there are many things that can go wrong, an active, observant logistics manager is needed. This manager must keep a vigilant eye on every stage of the contraceptives’ journey to the user, at every level of the system. The logistics manager must watch out for problems; such as,

• unforeseen delays
• occasional problems due to equipment or illness or weather
• complaints about contraceptive quality
• bottlenecks hidden in routine reports
• unusual surges of demand for one contraceptive or another

The standard, day-to-day responsibilities of a logistics manager are numerous and challenging. They include— 

• monitoring the number of every contraceptive product at every level of the system;
• analyzing these numbers to make sure the quantity of each contraceptive product falls between the prescribed maximum and minimum levels all through the pipeline;
• taking action any time there is a threat to the balance of supplies at any facility in the system.

The logistics manager does this by

• analyzing reports
• keeping track of contraceptive usage for the program as a whole
• forecasting future needs
• monitoring the ordering and delivery of new supplies
• overseeing the storage and transportation of the supplies

In addition, the logistics manager should be a member of any committee that is planning activities for the program. This will ensure that the logistics manager is aware of any new initiatives and can prepare the system to effectively manage the contraceptive supplies that will be required.

Like a good juggler keeping seven balls in the air at once, a logistics manager must have an eye on many things at once—not only on everyday tasks, but also on any new or potential problems. The manager needs to be alert for early signs of trouble, and to think ahead of problems that could arise and prevent them from ever happening. For example—

• Will the upcoming shipments of contraceptives overwhelm the central storage facility; do the shipments need to be staggered?
• A complaint was received from one clinic about discolored pills. How serious and widespread is the problem? Does the entire lot of pills need to be recalled?
• The program is considering switching to a different brand of pills; is that brand registered in this country?

There are many things that can disrupt the smooth and orderly flow of contraceptives to the user; the logistics manager must catch and resolve problems early, before they cause serious trouble.

Every contraceptive user must always find the supplies she or he needs to be available when they are needed; it is the logistics manager’s job to ensure this goal is met.

A contraceptive logistics system without good information is like a pen without ink— it can't do its job.

To get the right quantity of the right goods to the right place at the right time, one needs to know how many of each item are needed at each place and by when. A contraceptive logistics system must have an information system that collects and processes basic logistics data, or it cannot function effectively. Without logistics information, a clinic might receive 200 cycles of pills when it needs 1,000 (or vice versa), or it might receive intrauterine devices (IUDs) when it has a need for condoms.

Accurate, timely logistics data (which consist of the quantity of stock on hand of each contraceptive product; the rate at which it is being dispensed to contraceptive users; and any losses or adjustments to the inventory) are the lifeblood of a smoothly-running logistics system. Any late or missing report reduces the effectiveness of the entire system.

Reports may be missing or late for many reasons 

• The reporting forms are long or complex and time-consuming to fill out or are unavailable; therefore delayed or neglected.
• The mail system is slow or nonexistent and reports must be hand delivered.
• Staff are already overburdened providing services or morale is poor so they don’t "find the time" to complete the reports.
• Staff do not receive feedback or requested supplies as a result of the reports they submit so there is little incentive to complete and submit them.
• There is a high rate of staff turnover so staff are inadequately trained to complete the reports.

Because logistics information is so essential to an effective logistics system, everything possible must be done to ensure full, accurate, and timely reporting. Supervisory visits to service delivery sites are an important part of this process. In addition— 

• Reporting forms must be made as simple as possible, collecting only essential data, not "nice-to-know" information or unnecessary service statistics.
• Reporting forms must be appropriate for the staff that must complete them; the staff members who will use the reporting forms should help design them.
• The staff members responsible for reporting must be trained in completing and submitting the reports.
• Reports are more likely to be sent in when the form is also used for ordering more supplies.
• Providing feedback (letting facilities know their stock status and how well they’re doing maintaining proper stock levels) can increase the incentive for staff members to complete the reports.
• Staff members who have sent in accurate, timely reports should receive recognition from their superiors.

It is essential not only that contraceptive logistics data be collected and reported, but also analyzed and used in decision making at all levels of the program.

Never forget who the contraceptives are for—the family planning clients.

Staff members at all levels of a contraceptive logistics system have many duties and responsibilities. Hard-working staff can be so caught up with their logistics tasks—monitoring stock levels, ordering supplies, filling out reports on time, conducting inventories, delivering boxes—that they lose sight of the real purpose of all their activities—to make sure that every family planning client receives the contraceptives she or he wants and needs, at an affordable price, when and where they are needed.

Staff members often focus on the boxes of contraceptive supplies themselves, which is easy to understand because many logistics workers never see the clients who use the products they manage. But workers might be better motivated to do their jobs well, and might be more inspired to solve logistics problems, if they focused instead on the women and men who need those supplies.

It can be easy for logistics staff members to feel that filling out a report on the number of contraceptives given out to clients is just an administrative burden. But they might think differently if they remember that this task is an essential step in making sure there are enough supplies of the contraceptives that will protect the health and well-being of the women and men who are the program’s clients. Routinely counting and analyzing the number of contraceptive supplies on hand may seem like just tedious calculations. But these calculations could reveal a shortage of supplies and thus prevent a stock-out—and running out of supplies not only disappoints and annoys family planning clients, but may also cause the unfortunate and unnecessary consequences of unintended pregnancies or sexually transmitted infections.

The ultimate purpose of a logistics system is not to have well-stocked storage shelves, on-time deliveries, good feedback reports from the supervisor, and a clean and orderly storage area, even though all these are needed for a logistics system to work well. The real purpose of a logistics system is to meet the contraceptive needs of family planning clients, every time. Staff members at all levels of the logistics system must always be guided by this purpose.

When a contraceptive logistics system fails, the consequences can be dire.

For many women in developing countries, pregnancy is dangerous. More than half a million women die every year from pregnancy-related causes. If a woman is either very young or near the end of her reproductive years, has had many children, is anemic, or has had difficult pregnancies before, she is at risk of developing a number of serious medical problems. Her pregnancy may even prove to be fatal. Many women live far from medical care, especially emergency care that could save their life and their baby's life if something goes wrong. For some women, a pregnancy is so unthinkable they will even risk an illegal abortion, knowing they may be disabled for life or even die.

Therefore, if a woman comes to a family planning clinic—which in itself may be a difficult feat, requiring her to overcome obstacles of distance, financial cost, disapproval of her husband or family, secrecy, embarrassment, fear, or even disrespectful treatment by service providers—she must find that the contraceptives she needs and chooses are there for her.

Children are also greatly affected by family planning. In developing countries, the health and well-being of children whose mother has died are in great jeopardy; 90% of motherless newborns will die within the year, and the risk of death for their older siblings rises considerably. Therefore, saving a mother’s life can save her children’s lives as well. Family planning can also improve the health of children by increasing the time between their births; children born at least two years apart have a much better chance of prospering than those born with less than two years between them.

Men share similar family planning issues. They also may face physical, financial, and cultural obstacles to obtaining contraceptive services; therefore, it is equally important that they always find contraceptive supplies available to them. The lives of men with children become much more difficult if their wives die or are disabled. In addition, HIV threatens the lives and well-being of the entire family—men, women, and children—so it is crucial that condom supplies always be available. Family planning truly benefits the whole family.

To protect the lives, the health, and the well-being of women, men, and their children, contraceptives must always be available to those who need and want them, when they need and want them.

If you would like to learn more about contraceptive logistics, order a free copy of the Pocket Guide to Managing Contraceptive Supplies.

 

Selected Resources

Contraceptive Logistics
Every family planning program must have a good supply of contraceptives on hand at all times. Running out of contraceptives can lead to unwanted, and in some cases life-threatening, pregnancies and can do serious harm to a family planning program’s reputation and effectiveness ...more

Contraceptive Shelf Life and Storage Conditions
A table that describes type of contraceptive, required storage conditions, and their shelf life ...more

Problems with Contraceptive Quality
It is very important to make sure that the contraceptives are in good condition before they are distributed or are dispensed to users ...more

Dealing with Damaged Contraceptives
If you have found warning signs in any contraceptive product, you will need to examine the rest of your supplies of that product for signs of damage ...more

Reproductive Health Epidemiology Workshop

DELIVER project at John Snow, Inc (www.deliver.jsi.com*)

Publication on International Surveys, Reports, and Studies

Page last reviewed: 2/20/08
Page last modified: 2/20/08
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion

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