Globally, more than 800 women die in pregnancy and childbirth daily, and most of these cases would have been prevented if the women had access to affordable, quality care and modern contraception. Through Merck for Mothers, Merck’s 10-year, $500 million initiative that applies scientific and business expertise—as well as its financial resources and experience in taking on tough global healthcare challenges—we’re focused on reducing preventable maternal deaths worldwide. Merck for Mothers is known as MSD for Mothers outside the United States and Canada.
One of the most cost-effective ways to reduce maternal deaths is to ensure access to modern contraception. A potential one-third of deaths can be averted by lowering the overall number of pregnancies and helping girls and women to space out and plan their pregnancies.
In Senegal, strides have been made in reducing maternal mortality since 1990, but there is still a 1 in 61 chance a woman will die in pregnancy or childbirth. In 2011, public health facilities sampled in two districts in the Dakar region of Senegal exhibited situations where contraceptives were out of stock over 80% of the year. Through interviews, 84% of women reported experiencing stock-outs of their preferred contraceptive method in the previous year. At that time, only 29% of women who wanted to delay or prevent pregnancy were using modern contraceptives.
To tackle the problem of low contraception use in Senegal, Merck for Mothers partnered with the Bill & Melinda Gates Foundation, IntraHealth International, and Senegal’s Ministry of Health and Social Action to introduce an innovative supply chain model to reduce stock-outs at health facilities, broaden contraception options, and, ultimately, empower girls and women.
The Informed Push Model borrows practices from the commercial sector to improve availability of healthcare commodities in public health facilities. Today, third-party logistics providers (3PLs) deliver commodities directly to all 1,400 public health facilities in Senegal, using real-time data to make on-the-spot stocking decisions. The 3PLs use tablets to record health facility inventory, measure recent consumption, and calculate the amount of stock to leave at the facility for future demand, providing unprecedented visibility of contraception use and needs to help inform programmatic and procurement decisions.
The benefits from this shift in responsibility from public sector employees to private logisticians extend in all directions:
· Government: Instead of filling orders, government employees can manage the end-to-end supply chain and analyze supply chain data to improve health outcomes.
· Businesses: By providing opportunities for 3PLs to serve public health facilities, the model has the added bonus of creating jobs and business growth, diversifying the local economy. The private suppliers are incentivized to stock—and maintain—adequate supplies of an array of contraceptives, with oversight provided by the government.
· Health Facilities: When health facilities have reliable, independent provision of health commodities, they can focus on providing services to patients. It also encourages the facilities to carry a wider range of contraception choices.
· Consumers: When given a reliable and broader selection, women are more likely to find the contraception method that meets their needs and be confident in its availability.
· Society: When women survive, the community and nation thrive. Conversely, when a woman dies, her baby is 10 times more likely to die by age 2, and her other children are 10 times more likely to leave school, suffer poor health, or die prematurely.
Over three years, total contraceptive stock-outs have been reduced to less than 2% nationwide across more than 1,400 facilities in all regions, improving contraception access and options for more than 3.2 million women and girls.
The catalyzing action of the Informed Push Model has become a valuable example of private sector engagement in public sector supply chain reform, and a case study of how applying inventive approaches and partnering across sectors—from private to nonprofit and government—can ensure sustainable solutions. Data from the Senegal program is being evaluated so lessons learned and best practices can be shared with other countries seeking to transform their supply chains.
To continue the fight against maternal deaths in Senegal, the informed push model is transitioning to be completely government run—operationally and financially—by the end of 2017. And the impact inspired by this model is expanding much further: Senegal’s government has committed to integrating the private sector into the public health supply chain, beyond contraceptives, to ensure access to other essential commodities for illnesses like AIDS, tuberculosis, and malaria and conditions like post-partum hemorrhage—in all, a total of 118 essential commodities.