Contraceptive Contraceptive Security and Health Security and Health

Sector Reform: Sector Reform: Effects upon the Effects upon the Logistics CycleLogistics Cycle

Contraceptive Contraceptive Security and Health Security and Health

Sector Reform: Sector Reform: Effects upon the Effects upon the Logistics CycleLogistics Cycle

Washington, D.C., October 25, 2007

REPUBLIC OF NICARAGUA

MINISTRY OF HEALTH (MINSA)

Wendy B. AbramsonDirector-General: Planning and Development

MINSA

GOVERNMENT STRATEGY

“The National Unity and Reconciliation Government will give priority to public health, including mass vaccinations, health education, and industrial safety and occupational health for workers.

In Nicaragua, there will be more hospitals and health centers, and they will be better equipped and have more medicines.”

GOVERNMENT STRATEGY

Health To achieve food security and access to an

adequate diet for the population To guarantee access to potable water for

the population To guarantee adequate management of

the environment To promote access to housing with

adequate hygienic conditions To provide access to adequate health

services

BACKGROUND: MINSA LOGISTICS SYSTEM

2003: 9 logistics systems in

parallel Each system had its own

forms and instruments Each system was under

separate program managers

Repetitive information on variety of forms

Lack of communication between programs and program information

Delays in delivery of supplies across programs

Frequent overstock or shortages at health facilities

High cost of maintaining various information and transportation systems

Evaluation of existing logistics systems Preparation of a proposal for a single logistics system for all

medicines

Evaluation of existing logistics systems Preparation of a proposal for a single logistics system for all

medicines

Logistics Cycle and Integration

The process of Integration

DISTRIBUTION, STORAGE:

2004: - Establishment of a unified schedule for the delivery of all medicines, including contraceptives, by national and department-level warehouses

- Reassignment of responsibility for the handling of all supplies to a single person

- Storage of all supplies in the same facility

The process of Integration

Single Information System:

2005: * Development of the Logistics Management Information System (LMIS), which was modified to include all medicines* Pilot program at two of the country’s SILAIS for 17 tracer drugs

2006: * Implementation of integrated information system in 5 Regions. SIGLIM is created, the Information System for the logistics Management of Medical Supplies* Training, monitoring, and supervision

2007: * Evaluation of the integrated information system (SIGLIM)* Comparative analysis of Regions with and without the SIGLIM * Approval from the MINSA senior management for the extension of the SIGLIM to the rest of the country (August)* Coordination among donors (UNFPA, USAID) with technical support from USAID | DELIVER PROJECT

Decentralization and Integration of Essential Drugs and Medical Supplies

Decentralized: At Regional level- storage, distribution,

monitoring, and supervision Centralized: Forecasting (w/input from regional/local

aggregate data), product selection and procurement. Establishment of norms are centralized with input from the local level

Logistics indicators are determined (w/local level input)

Intervenciones para enfrentar la integración del sistema logístico

Key Success Factors Intra-institutional consensus among the Ministry

of Health Programs and divisions (service delivery, planning, norms, administration, etc.);

Logistics assessment included tracer drugs and contraceptives.

Integration conducted gradually – “piloted”

Documentation of the integration process served as an advocacy piece for expansion to national level

MOH commitment to family planning and contraceptive availability

Intervenciones para enfrentar la integración del sistema logístico

Obstacles and Barriers that were overcome Resistance of MOH staff towards “new”

methodology (consumption-based forecasting and resupply)

Awareness within MOH to include contraceptives on the list of essential drugs

Strengthening of internal control of the MOH by putting logistics system in place (resistance to change and controls)

CS Committee advocates for need to identify procurement options (UNFPA, generics…)

Intervenciones para enfrentar la integración del sistema logístico

Future Challenges

Automation of the Logistics Information System

Consolidation of forecasting based on consumption data to secure procurement of adequate supply

Protect MOH funding for contraceptives through a budget line item

Intervenciones para enfrentar la integración del sistema logístico

How Changes Benefit CSThe policies of universal access and free services for all contained in the Government Strategy for Reconciliation and National Unity have as their counterpart:

A guarantee of funds for a line item for procurement of necessary medicines and medical supplies, including gradual procurement of contraceptives as donations decline.

CS is now part of the MOH’s National Strategy for Reproductive Health which promotes sustainability.

A strong commitment of the government to ensure the welfare of the population.