Original Article | Shakya HS, et al.

Family Planning and Health Commodities Security in Nepal

Family Planning and Health

Commodities Security in Nepal

Shakya HS,1* KC NP2

USAID | DELIVER PROJECT/John Snow Inc.,
1

2
Logistics Management Division, Department of Health Services, Ministry of Health and Population, Nepal

Abstract

Background: Commodity security is essential for effective delivery

of quality health services. Commodity security exists when people are
able to choose, obtain and use products whenever they need them. With
leadership of Government of Nepal’s Logistics Management Division
and with technical assistance from United States Aid for International
Development funded projects have been consistently working toward
this goal with priority to Family Planning (FP), Reproductive Health, and
Maternal Child Health commodities.

Methods: A National Consensus Contraceptive Security Forecast meeting

is held annually at center. The meeting is participated by Regional,
District, Program Divisions, National Planning Commission, Ministry of
Finance, External Donor Partners, Social Marketing agencies, and Non
Governmental Organizations (NGO). The quantity needed, shipment
schedule, funding requirement and funding shortfall, distribution and
storage strategies for the Public, Social Marketing, and NGO sectors are
presented for next five years.

Results: With secured funding, increased availability of family planning

commodities (stock-outs rate is less than 2%) at service delivery sites
have contributed to improve national health indicators like Total Fertility
Rate and Contraceptive Prevalence Rate. Key program interventions
have ensured FP commodity security through effective coordination of
public, private and external donor partners.

Conclusion: Key lessons learned was a spirit of ‘Teamwork’ and good

coordination –active involvement of other stakeholders is essential
for ensuring FP commodity security. Other was an importance of
*Corresponding Author: ‘Advocacy’ for commodity security at district, regional and central levels
Heem Sunder Shakya,
USAID | DELIVER PROJECT, of government and among stakeholders. Challenges are complexity of
Hotel Oasis Complex, 3rd Floor, Patan Dhoka, public procurement procedure and frequent transfer of trained staff, and
PO Box 2901, Kathmandu, Nepal.
Email: [email protected] distribution and transportation of health commodities from district to
health facilities still poses a challenge to supply chain management.
Citation
Shakya HS, KC NP. Family Planning and Health Keywords: Commodities security; pipeline; quantification and
Commodities Security in Nepal. Nepal Journal of Medical
Sciences 2014;3(1):51-6 forecasting; stock-outs

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 Nepal Journal of Medical Sciences | Original Article

Background: of the Family Health Division (FPAN) and LMD in 2000.

The core group consisted of representations from USAID,
Commodity security is essential for effective delivery
United Nations Population Fund (UNFPA), DELIVER,
of quality health services. Commodity security exists
Nepal Family Health Program, and Kreditanstalt für
when people are able to choose, obtain and use products
Wiederaufbau (KfW) which is a German government-
whenever they need them.1 With the leadership of Logistics
owned development bank, based in Frankfurt. Larger group
Management Division (LMD)/MoHP and with technical
consists of representation from the core group plus members
assistance from United States Aid for International
from National Planning Commission, Ministry of Finance,
Development (USAID) funded projects (DELIVER and
FPAN, Social Marketing Agency, and the National Center
Nepal Family Health Program) have been consistently
for AIDS and Standard Control (NCASC).
working toward this goal with priority to Family Planning
(FP) commodities, reproductive health and maternal child Program Intervention
health commodities.
The success of FP commodity security in Nepal can be
attributed to excellent team work of various MoHP Program
Divisions (FHD, LMD, CHD, NCASC), external donor
partners (USAID, UNFPA, KfW, DFID, World Bank,
UNICEF), and stakeholders (social marketing agencies and
FPAN). Some of the key program interventions contributing
to success of the FP commodities securities are – practice
of forecasting and quantification at the national level, scale
up of pull system, strengthening district warehouses, and
capacity building in Government of Nepal’s (GoN’s) staff
on logistics management.

Some of the key program interventions contributing to

success of the FP commodities securities are briefly described
below. These program interventions are nationwide and
targets GoN’s staff working at central, regional, district, and
health facilities level.

(i) LMIS, Forecasting, and National Pipeline Review and

monitoring: Implemented in 1994, the Logistics System
Implementation Plan (LSIP) piloted the LMIS in four
Eastern districts2. A well functioning, integrated, and
robust LMIS is reliable, effective, and used for logistics
decision-making, forecasting, inventory management,
pipeline monitoring, procurement and prevention
of stock-outs at health facility level. Monitoring
and using LMIS data for informed decision-making
ensures availability of health commodities. In 2009/10
LMD implemented web-based LMIS and Inventory
Management System at District and Regional Level.
LMD conducts annual forecast workshop and quarterly
National Logistics Management Information System national pipeline review meetings of FP and other key
(LMIS), a quarterly reporting system from all service program commodities for procurement, shipment, and
delivery point was established in 1995/96 with technical distribution decisions. (For detail reading3, 4)
and financial support from USAID {John Snow Inc. (JSI)}, (ii) Infrastructure (Storage Facilities): Good storage
which is now become a key provider of information for practice helps ensure the quality of drugs and other
logistics decision making for LMD. The Contraceptive commodities and improves their distribution to service
Security Working Group was formed under the leadership delivery sites. And good storage facilities are the key to

NJMS | Volume 03 | Number 01 | January-June 2014 Page: 52

 Original Article | Shakya HS, et al. Family Planning and Health Commodities Security in Nepal

facilitate these processes. Improvement, strengthening has reached to 16,730.

and construction of district warehouses begun with the
Methods:
initiation of USAID/JSI and LMD for need of good
warehouses in the districts in 2001. At present, 54 A National Level Consensus Contraceptive Security
District Warehouses constructed (KfW-43, DFID-5, Forecast workshop is held annually at Center. The workshop
GoN-6). One cold chain warehouse (KfW fund) built in is participated by Regional, District, Program Divisions,
Pathalaiya Transit Warehouse complex. Increased total National Planning Commission, Ministry of Finance,
storage space from 21,223 sq. ft. from 1999 to 86,400 sq. External Donor Partners, Social Marketing agencies, and
ft. in 2011. Safe storage of valuable health commodities Non Governmental Organizations (NGO). The quantity
maintaining storage standards. Decreased wastage and needed, shipment schedule, funding requirement and
expiry of drugs. 18 are under construction from GON’s funding shortfall for the Public, Social Marketing, and NGO
Fund, expected to be completed by 2013/14. (For detail sector (FPAN) sectors are presented for next five years.
reading5) DELIVER project provides technical support in facilitating
the workshop, drafting five years Forecast Report for
(iii) Inventory Control System (Pull System) in all 75
family planning, maternal and child health commodities,
districts: In 1998, an inventory control system was
vaccines, Essential Drugs and ARVs. The Forecast Report
developed and implemented in all districts and health
identifies the long-term costs and requirements for FP and
facilities (HFs). The system not only allowed HFs to
other commodities, allowing better identification of funding
determine the quantity of program commodities that
gaps and procurement and distribution schedules. This
can be ordered from the district store but also set the
exercise also helps program divisions to identify quantity
authorized stock level and emergency order point used
and funding need for their annual work plan activities. And
to trigger re-orders. And demand based Pull System
in each quarter a National Pipeline meeting takes place at
for Essential Drugs was implemented in 2005/06 and
LMD to review, monitor, and evaluate the procurement,
completed in all 75 districts in 2009/10. (For detail
shipment, distribution and transportation status of FP and
reading6, 7)
other health commodities. Intended beneficiaries of this
(iv) Capacity Development in Health Logistics: Health program are population of the entire country.
workers in public health facilities needed updating
of their knowledge and skills in health logistics
management including on Pull System. DELIVER,
NHTC and LMD have worked to institutionalize
logistics and LMIS training. Trainers from NHTC were
trained and Regional Health Training Centers have been
conducting logistics training at HFs. Logistics training
was included in NHTC’s annual work plan and endorsed
by the National Planning Commission. Logistics
practices and LMIS system have been incorporated in
pre- and in-service training curricula of NHTC staff
and the pre-service training of health workers and
public health graduates. Since 2002, number of health
workers trained in basic health logistics management

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 Nepal Journal of Medical Sciences | Original Article

Data Source: LMIS/LMD and Demographic Health Survey (DHS)/Nepal

Data Source: LMIS/Logistics Management Division/MoHP

Results:

- With secured funding, increased availability of family

planning commodities (currently the stock-outs rate of FP
commodities at service delivery sites is less than 2%) at the
service delivery sites have contributed to improve national
health indicators like Total Fertility Rate and Contraceptive
Prevalence Rate

- With years of practice of quantification and forecasting,

quarterly national pipeline review meetings, and other key
program interventions has ensured FP/ Maternal Neonatal
Child Health (MNCH) commodity security through
effective coordination of public, private and external donor
partners

- The GoN’s share in the funding of FP commodities has

significantly increased since 2002 (0% in 2000/01 to 80%
in 2011/12)

- The practice has helped GoN in allocating and finding

needed resources for construction of district medical stores,
procurement of FP commodities, inventory management,
budget for distribution and transportation of commodities
to health facilities

- The working group successfully developed a National

Strategy on Reproductive Health Commodity Security for
Nepal, 2007 - 2011.

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 Original Article | Shakya HS, et al. Family Planning and Health Commodities Security in Nepal

Lessons Learned / Challenges: (fiduciary risk, transparency)

- One of the key lessons learned was a spirit of ‘teamwork’ - Frequent transfer of trained staff (high turn-over and
and good coordination and active involvement of other system loss)
stakeholders is essential for ensuring FP commodity
- Distribution and transportation of health commodities
security
from district to health facilities, and
- Importance of ‘advocacy’ for commodity security at
- Inadequate human resource in the health system and
district, regional and central levels of government and
poor infrastructure at Central, Regional, and Health
among stakeholders is a major factor in achieving FP
Facilities levels
commodities security in the country
References:
- The practice has led to replicate the process
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other program rhem/policy/sparhcs/en/index.html

- Challenges to attain a ‘total’ health commodities 2. Lamichhane JR, Shakya HS, Nepal: Scaling Up an In-
security in Nepal (stock-out rate for selected Essential tegrated Health Logistics System, Boston USA: John
Drugs are still as high as 25% each quarter in health Snow Inc. 2006. Available at; http://www.popline.org/
facilities)7 node/199003

- Complexities of public procurement procedures 3. NFHP Technical Brief 12: Logistics Management In-
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JSIInternet/Resources/publication/display.cfm?txtGeo-
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 Nepal Journal of Medical Sciences | Original Article

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