Ensuring Contraceptive Security at the "Last Mile"

Significant advances have been made at the central and district levels of health systems to ensure contraceptive security (CS). For example, the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS) tool developed by DELIVER guides family planning (FP) programs through a structured process for improving contraceptive security. However, the "last mile" of CS between districts and individual sites requires further attention, especially in countries where authority for FP programs (including procurement) has been devolved to the district level. Gaps in commodity management skills of providers and district managers, distribution challenges and limited supervision all impact the reliability of the contraceptive, equipment and essential drugs supply chains.

Contraceptive security for LA/PMs is particularly challenging due to lack of familiarity with LA/PM service delivery requirements at lower levels of the health system. RESPOND complements existing procurement activities by building the capacity of districts and sites to ensure CS for LA/PMs. In collaboration with the procurement projects, RESPOND is working to improve CS by closing "the last mile" gap in the supply chain between the district and individual health facilities and the community. This includes working in partnership with selected service sites and the communities in their catchment areas, and fostering links to central stakeholders and systems, notably training and supervision. COPE for Contraceptive Security, a tool developed under the ACQUIRE Project will be piloted and evaluated as part of this activity.