It is recommended that USAID procure commodities for the public sector for 2007 and 2008.
It is also recommended that USAID support the NRHO or other GOA stakeholder in updating this forecast based on the upcoming 2006 DHS data.
While supply chain management costs are not factored into this forecast, they are essential to improving the availability of this investment to public sector clients in the rural areas. UNFPA is considering supporting the management of the logistics system through the following activities:
sponsor GOA and UNFPA representative to DELIVER logistics training
provide ongoing TA to NRHO in the management of the 2007 and 2008 commodities
It is therefore encouraged for USAID to follow up with UNFPA to confirm this commitment. It is also suggested that ACQUIRE use this distribution and logistics management system for its sites.
While visits were made to six different Rayons we highlight the product management situation in the two rayons visited that had the most stock. Information on other facilities visited is provided in Appendix.
The Rayon store in Sheki was formerly a transshipment point for UNFPA commodities. At one point the store distributed contraceptives to ten adjacent districts as well as facilities in Sheki. They have however not received new shipments since 2005 and have not dispensed commodities to other regions since 2004 when they supplied Agsu, Ismyili, Gakh, Oguz, Gabala, Balakan, Agdash and Goychay.
Contraceptives are received by the Chief Midwife who stores them in her room on the third floor of the building adjacent to the RHC. The temperature in the room was 31.5 C on the day of the visit, slightly cooler than the outside temperature. The room is unfortunately in a poor state of repair and the office is cramped and not air conditioned. There is little spare storage space as she still stores products that were expired since 2004.
While records are kept at the store, the information recorded is incomplete and errors were identified. There are no store cards per se but a record of individual stock issued and received is maintained allowing a running commodity balance to be calculated over time by product. There is however, no accounting for adjustment and losses, no attempt to estimate the average monthly consumption, nor months of stock on hand. With products pushed to Sheki from the National RHO this has resulted in an over supply of many commodities that then expired because of the short remaining shelf life. It is not clear whether the National RHO has been informed either about passed over supply or expired product.
There was also no attempt to estimate and monitor what SDPs were actually dispensing to clients. The Chief Midwife said she could not estimate what commodities were being used by various SDPs and had never undertaken a forecasting exercise. She simply accepted whatever products were pushed down the system to her and sent product out when requested when she had available supplies. A quick review of the requisition requests made by various SDPs indicated that a analysis of use was possible and could have helped forecast need.
Data was provided by the Store for three years on the products received and dispensed and is presented in the Table below. When provided to the assessment team the data was said to relate to the three FP centers in Sheki, but it may have also included commodities issued to other Rayons in 2004. This point was not entirely clear and requires further investigation because the amounts dispensed only suggest a barely functioning flow of commodities from Sheki RH/FP to other facilities.
The columns marked Opening balance, received, dispensed and closing balance were the data provided. The assessment team added the calculation of the estimated months of supply and added the comments. Dividing the amount dispensed by 12 gives the average monthly consumption each year. Dividing the closing balance by the average monthly consumption gives the estimated months of supply. While no maximum or minimum stock levels were set by the NRHO, a quick check of the estimated months of supply suggests that at the end of 2003 four out of the six methods were over stocked while one was probably under stocked. In 2004 the situation was even worse with one method expired, one new method stocked out, four over stocked and one under stocked. In 2005 three products were stocked out, two expired, one completely, there is an anomaly in the amount shown for IUDs with 1200 IUDs unaccounted for, Marvelon was overstocked and condoms the only product with a reasonable stock balance. By 2006 only IUDs remained unexpired or stocked out.
This sorry history of poor product management reflects the lack of a working LMIS, no supervision from the NRHO, lack of analytical capacity of the Chief Midwife and lack of concern that so much product was near or at expiry. Expired product is still stored in the Chief Midwife’s office and includes:
3,600 pharmatex, expired April 2004
5,000 cycles Marvelon that expired in February 2006
720 condoms that expired in March 2005
Several hundred cycles of Adepal that expired in October 2004 – this does not tally with the records in the table above.
450 IUDs that expired in 2004
The only product available in the store is 700 IUDs that will expire in 2008.