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TYPES OF SUPPLY CHAINS
IN FBO HEALTH FACILITIES IN
AFRICA
Judith E. Brown, PhD
Consultant to CCIH
Acknowledgements
• Hany Abdallah – U3 SystemsWork International (consultant)
• Mona Bormet – Christian Connections for Int’l Health
• Amy Metzger – Christian Connections for Int’l Health
• Ellen Thompsett – Reproductive Health Supplies Coalition
Notes about the survey
• Presents the viewpoint of the FBO facility
(not its clients, patients, or suppliers)
• Asked each FBO facility
-- where and how they get their FP/RH supplies
-- who pays the costs
Where do FBO facilities get FP/RH supplies?
In-country
• MOH depot
• Depot of faith-based supply organization (FBSO)
• Depot of international organization
• Social marketing depot
• For-profit wholesalers, retailers
Out-of-country
• Not-for-profits – US (IMA) & European (IDA, IMRES, Durbin), etc.
• Visiting doctors (occasionally)
Five types of FBO supply systems
Type of Supply Chain
Source of
Contraceptives
Source of other
RH products
No. of
facilities
Five types of FBO supply systems
Type of Supply Chain
Source of
Contraceptives
Source of other
RH products
No. of
facilities
INTEGRATED SUPPLY CHAINS
FBSO reliant
(Vertically Integrated)
FBSO FBSO 7
Five types of FBO supply systems
Type of Supply Chain
Source of
Contraceptives
Source of other
RH products
No. of
facilities
INTEGRATED SUPPLY CHAINS
FBSO reliant
(Vertically Integrated)
FBSO FBSO 7
Public sector reliant MOH MOH 11
Five types of FBO supply systems
Type of Supply Chain
Source of
Contraceptives
Source of other
RH products
No. of
facilities
INTEGRATED SUPPLY CHAINS
FBSO reliant
(Vertically Integrated)
FBSO FBSO 7
Public sector reliant MOH MOH 11
Blended FBSO & MOH FBSO & MOH 16
Five types of FBO supply systems
Type of Supply Chain
Source of
Contraceptives
Source of other
RH products
No. of
facilities
INTEGRATED SUPPLY CHAINS
FBSO reliant
(Vertically Integrated)
FBSO FBSO 7
Public sector reliant MOH MOH 11
Blended FBSO & MOH FBSO & MOH 16
SEPARATE SUPPLY CHAINS
Mixed
MOH
Other sources
in or out of country
(not FBSO)
5
Five types of FBO supply systems
Type of Supply Chain
Source of
Contraceptives
Source of other
RH products
No. of
facilities
INTEGRATED SUPPLY CHAINS
FBSO reliant
(Vertically Integrated)
FBSO FBSO 7
Public sector reliant MOH MOH 11
Blended FBSO & MOH FBSO & MOH 16
SEPARATE SUPPLY CHAINS
Mixed
MOH
Other sources
in or out of country
(not FBSO)
5
Ad hoc
In-country depots of
UNFPA, UNICEF,
NGOs, etc.
FBSO & Other sources
in or out of country
5
Which types of supply systems are
- less likely
- more likely
to have stockouts ?
1. Which types did not have stockouts (past 3 months)?
Type No stockouts of contraceptives No stockouts of other RH
INTEGRATED SUPPLY CHAINS
FBSO reliant 43 % 43 %
Public sector
reliant
73 % 64 %
Blended 19 % 13 %
SEPARATE SUPPLY CHAINS
Mixed 80 % 60 %
Ad hoc 40 % 40 %
2. Which types had fewest / most products stocked out? *
Type Contraceptives Other RH products
INTEGRATED SUPPLY CHAINS
FBSO reliant 17 % 13 %
Public sector reliant 9 % 16 %
Blended 34 % 35 %
SEPARATE SUPPLY CHAINS
Mixed 12 % 11 %
Ad hoc 23 % 23 %
* % of tracer products that were out of stock at some time in the previous 3 months.
3. Which types carry more / fewer RH commodities ?
Type Avg. # of contraceptives Avg. # of RH products
INTEGRATED SUPPLY CHAINS
FBSO reliant 7 13
Public sector reliant 6 12
Blended 8 14
SEPARATE SUPPLY CHAINS
Mixed 4 9
Ad hoc 5 11
4. Which types are more likely to charge fees for FP ?
Type Charge for FP Services
INTEGRATED SUPPLY CHAINS
FBSO reliant 86%
Public sector reliant 30%
Blended 56%
SEPARATE SUPPLY CHAINS
Mixed 25%
Ad hoc 60%
* % of facilities providing FP services that charge for FP services.
60%
37%
SUMMARY OF FINDINGS
• African FBO supply systems differ between and within countries
• 45% of surveyed facilities had stockouts in past 3 months
• Public sector’s inadequate financing leads to FBO stockouts
• FBOs show ingenuity -- filling gaps & accessing diverse sources
• But they cannot consistently offer full choice to their FP clients
• Charging modest fees for contraceptives, materials &/or
services can lead to more consistent & sustainable supplies
FOLLOW-UP TO SURVEY
• Feb 2015 - Field visits to Cameroon and DR Congo
Purpose: to clarify context of FBO supplies & stockouts
Visited: FBO facilities
Depots of FBSOs, MOH, others
Suppliers -- UNFPA, social marketing
• Currently – planning a short intervention in Cameroon
==============================

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CCIH 2015 Judith Brown Breakout 4A

  • 1. TYPES OF SUPPLY CHAINS IN FBO HEALTH FACILITIES IN AFRICA Judith E. Brown, PhD Consultant to CCIH
  • 2. Acknowledgements • Hany Abdallah – U3 SystemsWork International (consultant) • Mona Bormet – Christian Connections for Int’l Health • Amy Metzger – Christian Connections for Int’l Health • Ellen Thompsett – Reproductive Health Supplies Coalition
  • 3. Notes about the survey • Presents the viewpoint of the FBO facility (not its clients, patients, or suppliers) • Asked each FBO facility -- where and how they get their FP/RH supplies -- who pays the costs
  • 4. Where do FBO facilities get FP/RH supplies? In-country • MOH depot • Depot of faith-based supply organization (FBSO) • Depot of international organization • Social marketing depot • For-profit wholesalers, retailers Out-of-country • Not-for-profits – US (IMA) & European (IDA, IMRES, Durbin), etc. • Visiting doctors (occasionally)
  • 5. Five types of FBO supply systems Type of Supply Chain Source of Contraceptives Source of other RH products No. of facilities
  • 6. Five types of FBO supply systems Type of Supply Chain Source of Contraceptives Source of other RH products No. of facilities INTEGRATED SUPPLY CHAINS FBSO reliant (Vertically Integrated) FBSO FBSO 7
  • 7. Five types of FBO supply systems Type of Supply Chain Source of Contraceptives Source of other RH products No. of facilities INTEGRATED SUPPLY CHAINS FBSO reliant (Vertically Integrated) FBSO FBSO 7 Public sector reliant MOH MOH 11
  • 8. Five types of FBO supply systems Type of Supply Chain Source of Contraceptives Source of other RH products No. of facilities INTEGRATED SUPPLY CHAINS FBSO reliant (Vertically Integrated) FBSO FBSO 7 Public sector reliant MOH MOH 11 Blended FBSO & MOH FBSO & MOH 16
  • 9. Five types of FBO supply systems Type of Supply Chain Source of Contraceptives Source of other RH products No. of facilities INTEGRATED SUPPLY CHAINS FBSO reliant (Vertically Integrated) FBSO FBSO 7 Public sector reliant MOH MOH 11 Blended FBSO & MOH FBSO & MOH 16 SEPARATE SUPPLY CHAINS Mixed MOH Other sources in or out of country (not FBSO) 5
  • 10. Five types of FBO supply systems Type of Supply Chain Source of Contraceptives Source of other RH products No. of facilities INTEGRATED SUPPLY CHAINS FBSO reliant (Vertically Integrated) FBSO FBSO 7 Public sector reliant MOH MOH 11 Blended FBSO & MOH FBSO & MOH 16 SEPARATE SUPPLY CHAINS Mixed MOH Other sources in or out of country (not FBSO) 5 Ad hoc In-country depots of UNFPA, UNICEF, NGOs, etc. FBSO & Other sources in or out of country 5
  • 11. Which types of supply systems are - less likely - more likely to have stockouts ?
  • 12. 1. Which types did not have stockouts (past 3 months)? Type No stockouts of contraceptives No stockouts of other RH INTEGRATED SUPPLY CHAINS FBSO reliant 43 % 43 % Public sector reliant 73 % 64 % Blended 19 % 13 % SEPARATE SUPPLY CHAINS Mixed 80 % 60 % Ad hoc 40 % 40 %
  • 13. 2. Which types had fewest / most products stocked out? * Type Contraceptives Other RH products INTEGRATED SUPPLY CHAINS FBSO reliant 17 % 13 % Public sector reliant 9 % 16 % Blended 34 % 35 % SEPARATE SUPPLY CHAINS Mixed 12 % 11 % Ad hoc 23 % 23 % * % of tracer products that were out of stock at some time in the previous 3 months.
  • 14. 3. Which types carry more / fewer RH commodities ? Type Avg. # of contraceptives Avg. # of RH products INTEGRATED SUPPLY CHAINS FBSO reliant 7 13 Public sector reliant 6 12 Blended 8 14 SEPARATE SUPPLY CHAINS Mixed 4 9 Ad hoc 5 11
  • 15. 4. Which types are more likely to charge fees for FP ? Type Charge for FP Services INTEGRATED SUPPLY CHAINS FBSO reliant 86% Public sector reliant 30% Blended 56% SEPARATE SUPPLY CHAINS Mixed 25% Ad hoc 60% * % of facilities providing FP services that charge for FP services. 60% 37%
  • 16. SUMMARY OF FINDINGS • African FBO supply systems differ between and within countries • 45% of surveyed facilities had stockouts in past 3 months • Public sector’s inadequate financing leads to FBO stockouts • FBOs show ingenuity -- filling gaps & accessing diverse sources • But they cannot consistently offer full choice to their FP clients • Charging modest fees for contraceptives, materials &/or services can lead to more consistent & sustainable supplies
  • 17. FOLLOW-UP TO SURVEY • Feb 2015 - Field visits to Cameroon and DR Congo Purpose: to clarify context of FBO supplies & stockouts Visited: FBO facilities Depots of FBSOs, MOH, others Suppliers -- UNFPA, social marketing • Currently – planning a short intervention in Cameroon ==============================