Modernizing the Family Planning Supply Chain in Pakistan. November 19, 2021 Impact Stories Modernizing the Family Planning Supply Chain in Pakistan Since 2016, USAID GHSC-PSM has been working with the national provincial governments in Pakistan to modernize the contraceptive supply chain to improve family planning outcomes. SHARE Noor is a young woman studying to become a nurse in Lahore, Pakistan. She will get married in two months, but she still has a year and a half of school before graduating as a nurse and wants to wait until after that to have a family. Today, she is visiting a health facility to get some guidance on contraceptive methods. What are her options? Although Pakistan was one of the first Asian countries to begin a family planning (FP) program in the 1960s, the decline in fertility rate has remained slow or stagnant when compared to neighboring countries. With a population of 207.7 million in 2017, Pakistan is the fifth-most-populous country in the world. Expected rapid population growth based on high birth and fertility rates means that the country is estimated to surpass 340 million people by 2050. This growth risks straining the already limited natural resources such as water, forests, and arable land and reversing economic gains made in recent years. To mitigate this, the government of Pakistan has set the ambitious goal of increasing the number of couples using birth control from 34% to 50% by 2030; it also signed the Every Woman Every Child pledge — Chemonics is also a signatory — to reduce maternal and infant mortality and ensure universal access to reproductive health services. As Chemonics’ Dr. Muhammad Tariq and Ambreen Khan wrote in a recent WHO journal article, lack of access and availability are among the principal reasons for contraceptive non-use and contraceptive discontinuation. Since 2016, the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project, implemented by Chemonics, has been working with provincial governments to holistically modernize supply chain systems to make contraceptive products and services more accessible. The project provides technical assistance to the government of Pakistan, including advocacy for sustainable public financing, executive dashboard management, contraceptive group purchase/pooled procurement, and contraceptive local production. The first digital contraceptive logistics management information system (cLMIS) was launched in Pakistan in 2011, enabling supply chain data visibility from the federal level to health facilities. The cLMIS reduced paper-based reporting and optimized health systems data reconciliation at the health facility level to ensure that FP commodities are available. With the introduction of the web-based cLMIS, managers, logisticians, and donors have better visibility into the supply chain and can thus improve their management to ensure products reach consumers through Pakistan’s health care delivery system. By improving the timeliness and quality of logistics data and reducing the time needed to access the data, the cLMIS effectively enables evidence-informed decision-making for supply chain management. Related Projects Cutting-edge Technologies in Global Health Supply Chains VIEW ALL PROJECTS PREVIOUS “USAID’s family planning supply chain digitization support has empowered the Government of Pakistan to take informed decisions based on the data reported by more than 12,000 health facilities and district stores. Pakistan improved accountability at the lowest tiers, increased sustainable financing of $138 million from 2014 to 2022 for contraceptive procurement, and improved FP product availability at the last mile from 40% in 2009 to more than 75% today; a great example of leveraging technology for connecting people with products.” Ambreen Khan, GHSC-PSM Pakistan Basic Health and Monitoring, Evaluation & Learning Director “Pakistan and USAID’s partnership on digitization of the family planning supply chain not only improved stock availability, but it also actually encouraged evidence-based domestic provincial and national health financing. In LMICs [low- and middle-income countries], in-country sustainable financing means relative health equity. Imagine more than 12,000 health facilities and district stores reporting multiple online commodity transactions monthly and in real time. Many countries can benefit from Pakistan’s leveraging technology for health.” Dr. Muhammad Tariq, GHSC-PSM Pakistan Country Director NEXT The contraceptive supply chain has seen significant growth over the past decade to meet expanding reproductive health evidence to inform strategic decisions; cLMIS is a prime contributor to improvements registered in FP stock availability at public sector facilities. Based on cLMIS-enabled data visibility, provinces accurately projected their contraceptive requirements and, with GHSC-PSM’s support, included accompanying analysis for their respective chief ministers. GHSC-PSM continues to support the government of Pakistan in improving contraceptive commodity security through joint field monitoring visits at service delivery points in tandem with continuous desk reviews of the cLMIS. Comparison of data use and stock availability for condoms, pills, intrauterine contraceptive devices, and injectables in Pakistan, 2015-2018 (Source: https://bit.ly/3CewY71 ) As a result of these actions, the cLMIS has improved distribution, early warning, and accountability at the lowest tiers in the FP supply chain in the public sector. At the facility level, FP commodity availability increased from 40% in 2009 to 84% in 2018. The reporting rate and data use increased from 71% to 99%, and stock availability increased from 86% to 91% (see figure). The improved data visibility through the cLMIS allowed decision-makers to more efficiently decide where to allocate funds for contraceptive procurement, leading to improved stock availability. This, in turn, has led to an increase in the share of services provided for condoms, intrauterine contraceptive devices, and injectables. The progress made in helping the government of Pakistan meet the contraceptive needs of its population has reduced the 2050 population estimate to 266 million, according to the 2017-2018 Pakistan Demographic and Health Survey. Meeting contraceptive needs also contributes to reduce overall maternal mortality and improves women’s health by preventing unwanted and high-risk pregnancies, reducing the need for unsafe abortions. For Noor, and other women like her, this has a direct correlation with child and family well-being by reducing the economic and emotional burden of parenthood and affording increased opportunities for participation in educational, economic, and social activities. Banner photo: A health worker at the Family Welfare Centre in Lahore, Pakistan counsels a couple on family planning methods. 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