June 23, 2015
Family planning can help reduce unintended pregnancies and allow women to better space their pregnancies. Providing access to family planning supplies is one of the most cost-effective ways to reduce maternal mortality and economically empower women. In Senegal, a critical lack of contraceptives hindered the country’s progress toward Millennium Development Goal 5 – Improve Maternal Health. In 2012, the Government of Senegal committed to address this issue and the results have been impressive thanks in part to public-private partnerships. One partnership in particular, involving Merck for Mothers and the Bill & Melinda Gates Foundation, has had remarkable success in ensuring that women across the country have consistent access to a mix of contraceptive options.
In May at the World Health Assembly in Geneva, Switzerland, the Global Leaders Council for Reproductive Health and the Aspen Institute honored Senegal, along with the Philippines and Uruguay, as winners of the 2015 Resolve Award, which recognizes countries that are making landmark progress toward the goal of universal access to reproductive health services.
The Facts about the Issue
In 2011, nearly 80% of health facilities in Senegal were affected by recurrent stock outs of family planning products despite these products’ availability at the national level.i,ii Only 30% of women seeking contraceptives had the ability to obtain themiii – clearly revealing a major problem with the country’s supply chain. The lack of reliably available contraceptives was contributing to the country’s high likelihood (1:60) that a woman could die during pregnancy and childbirth.iv
In 2011-2012, the Government of Senegal, IntraHealth International (a global NGO) and the Bill & Melinda Gates Foundation piloted a direct delivery system called the “Informed Push Model” (IPM). IPM is a last-mile distribution system that adapts principles used in the commercial sector, such as vendor-managed inventory, to the public health sector. IPM’s methods incorporate local private sector infrastructure, task shifting, and performance-based contracts to ensure that women have access to a full range of contraceptives. The pilot showed that IPM effectively reduced stock out rates of contraceptives at 140 health facilities across the Dakar region to less than 2% after only 12 months.ii
Recognizing the importance of family planning and its impact on maternal mortality, the Senegalese government set an ambitious goal to increase the percent of married women using a modern form of contraception from 12% to 27% between 2012 and the end of 2015. To help reach this goal, the government committed to national expansion of the IPM.
A Path to Empowerment
Merck & Co., Inc, through its Merck for Mothers initiative, and the Bill & Melinda Gates Foundation are providing financial and technical support for the national expansion, including guidance on performance-based frameworks and cost-effectiveness. Under the Senegalese Ministry of Health and Social Action’s leadership and guidance, IntraHealth International is the local implementing partner.
Through the collaborative efforts of all stakeholders, the full range of contraceptives is now available in all public health facilities across the entire country (14 regions). Data from at least nine regions show that the IPM has reduced the percentage of health facilities experiencing contraceptive stockouts to below 2%. This sharp reduction coupled with Senegal’s demand creation and service delivery efforts have had a major impact. The country has increased the proportion of married women using a modern form of contraception to 20% in just 2 ½ years (2011-2014).v, vi
IPM keeps the needs and preferences of women central to its goals and this focus has been critical to its success. IPM’s national scale enables Senegal to provide over 3.2 million women of reproductive age with the ability to choose and stay on family planning methods that work for them. Improving women’s access to family planning has tremendous economic implications: it allows girls to delay motherhood so they can stay in school longer and develop the knowledge and skills to earn income later in life.
In recognition of the landmark progress in reducing family planning stock outs and improving women’s access to modern contraception, the Global Leaders Council for Reproductive Health and the Aspen Institute recently announced Senegal as the winner of the 2015 Resolve Award for Service Delivery. The council presented the award to Senegal at the Aspen Institute’s ceremony in Geneva during this year’s World Health Assembly.
Ultimately, the foundational key to success has been the Ministry of Health’s commitment to family planning and reproductive health. This political will has translated IPM’s national expansion from a plan to a reality, demonstrating the power of country-led, public-private partnerships with clear, measurable goals. As the global health community continues its effort to reach the 225 million women who want but lack access to contraceptionvii, there is an opportunity to learn from the IPM’s cost-effective, scalable approach to expanding access to family planning supplies. By engaging technically skilled implementing partners and committed donors, governments can establish strategies for improving their contraceptive prevalence rate, reducing maternal mortality, and empowering women and their economic well-being.
i Hasselback, L., Gueye, B., Ndao, O., Ndour, S. K., & Cissé, C. (2014). Incentivizing access to family planning in Senegal via the informed push model. Journal of Pharmaceutical Policy and Practice, 7(Suppl 1), O12. doi:10.1186/2052-3211-7-S1-O12
ii Daff, B.M., Seck, C., Belkhayat, H., & Sutton, P. (2014). Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services. Global Health Science and Practice, 2(2):245-252.
iii Urban Reproductive Health Initiative. (2012). “2011 Baseline Survey for the Senegal Urban Health Initiative (ISSU) Service Delivery Site Survey: Final Report.” Accessed at: http://www.urbanreproductivehealth.org/sites/mle/files/issu_service_delivery_site_baseline_survey_english.pdf
iv WHO, UNICEF, UNFPA, World Bank. (2013). “Trends in Maternal Mortality 1990-2013.” Accessed at: http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1
v Agence Nationale de la Statistique et de la Démographie (ANSD). (2013). Enquête Démographique et de Santé Continue au Sénégal (EDS-Continue) 2012-2013. Calverton (MD):ICF International.
vi Agence Nationale de la Statistique et de la Démographie (ANSD). (2015). Enquête Démographique et de Santé Continue au Sénégal (EDS-Continue) 2014. Calverton (MD):ICF International.
vii Singh S, Darroch J, Ashford L. (2014). Adding It up: The Costs and Benefits of Investing in Sexual and Reproductive Health 2014. Guttmacher Institute. Accessed at: http://www.guttmacher.org/pubs/AddingItUp2014.pdf