MEASUREMENT

INDICATORS 10-11 : CONTRACEPTIVE STOCK-OUTS AND AVAILABILITY

INDICATOR NO.10
Percentage of facilities stocked out, by method offered, on the day of assessment

Percentage of facilities experiencing stock-outs of specific methods of contraceptive offered, on the day of assessment

INDICATOR NO.11A
Percentage of primary SDPs with at least 3 modern methods of contraception available on day of assessment

The percentage of service delivery points (SDPs) that have at least 3 modern methods of contraception available on the day of the assessment. This indicator considers methods (such as injectables), not products (such as the 3-month or 6-month injectable) or brands (such as Depo-Provera)

INDICATOR NO.11B
Percentage of secondary/tertiary SDPs with at least 5 modern methods of contraception available on day of assessment

The percentage of secondary and tertiary service delivery points (SDPs) that have at least 5 modern methods of contraception available on the day of the assessment. This indicator considers methods (such as injectables), not products (such as the 3 month or 6 month injectable) or brands (such as Depo-Provera). The determination of which health facilities are defined as “secondary” or “tertiary” will be made at the country level, based on existing classifications

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Stock-outs refer to the temporary unavailability of contraceptive commodities (or supplies) at a health facility or store where the method or services are offered, and in the case of sterilization it refers to the temporary unavailability of supplies and/or trained staff at a health facility where the service is supposed to be available according to national health system guidelines. FP2020 indicators reflect the availability of contraceptives at the facility at a point in time (the day of a facility survey), and measure stock-outs by method as well as stock-outs for a range of methods. The availability of comparable data across countries on contraceptive stock-outs continues to improve, and depends largely on facility surveys conducted by UNFPA. This year 27 of the 69 countries had data on Core Indicator 10, stock-outs by method, while 30 countries had data on stock-outs of any method.

The data show that stock-outs vary considerably both by level and by type of method. Figure 14 shows by country the percentage of facilities stocked out by method offered. The levels of of stock-outs range widely, from lows of 0% for condoms in some countries, to the other extreme of 94% of facilities in one country experiencing implant stock-outs. In general, stock-outs are lower for the most commonly used methods in countries (highlighted in Figure 14). In East Africa, for example, where injections are the most common method, stock-out levels are a relatively low 9.8%, with only one country—Sudan—experiencing high double-digit stock-outs in 2017. These data suggest that many countries are successfully monitoring key commodities within supply chains to deliver the most commonly used products to clients.

If we look at the three most commonly dispensed methods at the primary level (condoms, pills, and injectables), nine countries had stock-outs of less than 10%, and five of these had stock-out levels of less than 5%, including Zimbabwe, Sao Tome and Principe, Rwanda, Nepal, and Burkina Faso. If we include long-acting methods (IUDs and implants), six countries had stock-outs of less than 10%. Learning more about these countries’ supply chains can help FP2020 partners working in commodity security identify the common elements in governance, logistics systems, and funding stability that explain the success of these diverse countries.

The Asia region has more limited data, but generally shows lower levels of stock-outs for short term methods such as pills, injectables, and emergency contraception. This region has average stock-out levels that are marginally higher than levels in West Africa, at 33% and 32% respectively.

Stock-out data is currently not available through the routine Logistics Management Information Systems (LMIS) used by the public sector in most countries to manage supply chains for essential medicines and health system supplies. This is expected to change in 2018, when it is anticipated that data from large supply chain partners and projects will be made publicly available. The availability of this data in some countries may begin to change the way that countries are able to monitor supply chains and prevent stock-outs.

Core Indicators 11a and 11b measure method availability at primary and secondary/tertiary facilities respectively. There has been a substantial increase in the number of countries reporting availability of three or five methods in stock on the day of survey. Data are available for 22 countries in 2017—as compared to just 8 in 2016—with the increase due entirely to changes in the questionnaire used by UNFPA in its facility surveys.k In most countries, secondary and tertiary level facilities show greater availability of a wider range of contraceptive methods than primary facilities. There were 9 countries in which fewer than 75% of primary facilities had at least 3 modern methods in stock on the day of the survey. In contrast, there were only 3 countries in which fewer than 75% of secondary or tertiary facilities had 5 or more modern methods in stock on the day of the survey. In several countries the range of methods available was low at both levels, including the Democratic Republic of Congo, in which only 39% of primary facilities and 20% of secondary facilities had 3 or 5 methods available respectively. These data do not indicate stock-outs for specific methods, but do suggest the need for further examination of the limitations that are constraining the range of contraceptive choices at various levels of the health care system.

COUNTRY DATA USE

In most countries data on stock-outs are the responsibility of logistics systems managers, not the family planning program, and the purpose of monitoring stock-outs is principally for inventory management rather than program management.

In Ethiopia, for example, family planning program managers from the Federal Ministry of Health (FMOH) do not have visibility into real-time data on stock-outs. This is the responsibility of the Pharmaceuticals Fund and Supply Agency (PFSA) and is maintained independently of Health Management Information System (HMIS) data. HMIS reports do capture stock-outs of a tracer commodity (Depo-Provera), but with method mix targeted for expansion, the tracer is increasingly insufficient for management. In this year’s data consensus workshop, survey data from UNFPA Supplies pointed to higher than expected levels of method-specific stock-outs, and program managers discussed their lack of access to commodity stock-out data. As a result, the FMOH agreed to begin getting stock-out data routinely from PFSA.

In Zimbabwe, high contraceptive prevalence rates create a disincentive to review facility level stockouts. As in Ethiopia, the logistics management of family planning commodities is not within the purview of the family planning program. Survey data shared at this year’s data consensus meeting showed higher than expected levels of stock-outs for long-acting methods compared with LMIS data. Discussion of the reasons focused on whether facilities that do not yet have trained providers should be counted as “stocked out” of long-acting methods; the consensus was that this is inefficient.

  • k.

    UNFPA facility surveys have now adopted these indicators as part of their alignment with global partners around Universal Stock-out Indicators recommended by the Reproductive Health Supplies Coalition.

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