THE INFORMED PUSH MODEL
In Senegal, as in many poor countries, one reason women do not use contraceptives is because the products are simply not available. Gaps in the supply chain mean that stock-outs are a frequent occurrence at pharmacies and clinics. That spells serious problems for contraceptive users. When a woman is unable to refill her pills or get her next three-month injectable, her contraceptive protection is gone. Supply limitations also mean that many locations offer only one or two types of products— making it difficult for women to find and stick with a method that works for them. A 2011 study in Senegal found that 84% of women had experienced a stock-out of their preferred contraceptive in the past year.
The Informed Push Model of distribution promises to change all that. Instead of relying on pharmacies and clinics to keep track of their inventory and call in orders, the push model employs the same kind of system that is used in the commercial sector for vending machines. A driver with a truckful of supplies visits each point of sale on a regular schedule, topping up the stock and recording quantities of products sold. The data collected by the driver is used to ensure that there is sufficient stock at the warehouse and at each site, and to prime the manufacturers to keep pace with demand. On the systemic level, the information can be used by regional and national decision makers to figure out which contraceptives are most popular and where.
The government of Senegal and IntraHealth pilot-tested the Informed Push Model in Pikine between February and July 2012. Stock-outs of contraceptive pills, injectables, implants and IUDs were completely eliminated at the 14 public health facilities in Pikine over the six months of the pilot project. The government then expanded the model to all 140 public facilities in the Dakar region and six months later the stock-out rates in the region dropped below 2%. Now the Informed Push Model is being rolled out nationwide and is expected to be in place across the country by the end of 2015. Funding for the rapid national rollout is being supplied by the Bill & Melinda Gates Foundation and Merck for Mothers.