Reproductive health commodity security: A critical step in enabling the right to choose

Delivering health for all requires a commitment to individual health rights, including the right to choose a service or product that is accessible, culturally acceptable and of high-quality.

This guest blog by Options, an Action for Global Health member, shares four different expert perspectives on how we can achieve this ambition, focusing specifically on examples of driving forward change in sexual and reproductive health (SRH) and family planning (FP) commodity security.

“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, Options Consultancy Services

“Across Options’ Women’s Integrated Sexual Health (WISH) programme, we aim to strengthen government stewardship of healthy markets for SRH/FP commodities. A key component of this involves strengthening government’s capacity to coordinate the financing and management of these commodities and facilitating forums where they can be held accountable for doing so.

Achieving this requires building trust and effective working relationships between actors. In Nigeria, we have supported State Led Accountability Mechanisms, which consist of government, civil society, health providers and other public and private actors to review the data on SRH/FP commodity needs and availability and advocate and hold government accountable for defined actions required to improve challenges within the system

But more action is needed to scale this success across countries and to ensure the supply chain is effective and the availability of SRH/FP commodities sustainable. We need to invest more funding in establishing or strengthening coalitions which bring together civil society and government to identify SRH/FP needs based on evidence, conduct analysis on budget allocation, disbursement and utilisation and advocate for improvements that ensure that people are able to exercise their SRH rights.

“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 Practise Specialist in Commodity Security, Options Consultancy Services

“As Options’ Global Practice Specialist in Commodity Security, 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 overstock of specific commodities.

The Global Family Planning Visibility and Analytics Network (GFPVAN), an initiative of the Reproductive Health Supplies Coalition (RHSC), plays a key role in preventing family planning commodity stockouts. It offers a collaborative digital space where countries, global partners such as USAID and the United Nations Population Fund (UNFPA) and manufacturers can work together to plan how to address commodity supply needs.

Over the past 16 years, 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, we have 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 shows that the GFPVAN has the potential to strengthen supply planning and eliminate frequent stock out in low and low-middle income countries, and we advocate that countries use GFPVAN 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, Options Consultancy Services

“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 in the subnational health systems, changes to the public financial management system and procurement practices.

But centralised processes can still persist many years after the decentralisation agenda has been initiated. For example, in Kenya, where the decentralisation which started in 2013 was among the most rapid and ambitious devolution processes in the world, 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.

We learned that it’s important to ensure that programmes work directly with the government to find sustainable policy and implementation solutions. That’s why our programmes have aimed to strengthen 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, we supported the formation of a taskforce that included representatives from the county health management team, health facility staff and grassroots advocates to draft a Health Service Bill which improved facility financing that would allow facilities to collect and keep revenue raised at source to make any necessary improvements they have identified. 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.

This shows that creating such an enabling environment for health service delivery and ensuring commodity security, which gives people the right to make choices about their own health, requires effective stakeholder engagements between state and non-state actors, including grassroots civil society organisations who can accelerate change by 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, Options Consultancy Services

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

Strengthening SRH/FP commodity security to ensure that individuals or couples need FP services can consistently have easy access to a variety of affordable and quality contraceptives requires collaborative efforts from donors, government and implementing partners and identifying alternative financing sources for SRH commodities. During my time on the WISH programme, we’ve focused on distilling lessons and adapting our technical assistance models to make this a reality.

For example, recently this involved working closely with the State Health Insurance Agency in Jigawa to ensure SRH/FP was included in the benefits package and subsequently working closely with them to ensure all people, including those most vulnerable, are enrolled and able to access these services. These examples show that when the right actors come together with commitment, access to SRH/FP services can be made available even in low resource settings.