By John Skibiak
John Skibiak is the Director of the Reproductive Health Supplies Coalition, the world’s largest voluntary network of reproductive health organizations, working with health systems, manufacturers, distributors, providers and educators to increase access to a range of quality and affordable contraceptive methods.
Women must have access to the contraception they need, when they need it, and where they need it. To that end, partners from across the reproductive health (RH) community – health care workers, curators, development specialists, donors and manufacturers – have spent decades building the supply chains and service delivery systems now in place to realize this vision.
Today, COVID-19 threatens these systems. prompting our community to come together to ensure its survival. We recently saw his associates Global Family Planning Visibility and Analysis Network (Global FP VAN) calls on countries to maintain progress on greater data sharing.[1] VAN is a common platform for increasing supply chain data visibility for collaborative decision making. In April, FP2020 – a global family planning partnership – called on national governments to maintain support for family planning programmes.[2] Also, to ensure sufficient space for planned supply shipments, national ministries of health are being advised by international donors to push their stocks to the last mile. All of these efforts to maintain the systems we’ve worked so hard to build are absolutely critical. However, while COVID-19 may indeed be global, every country is different. Each approaches the virus from different positions of strength or weakness, each striking a delicate balance between, on the one hand, the supplies it has in stock and, on the other, the services now in place to deliver those supplies. As this pandemic unfolds, we must recognize that efforts to sustain systems over the long term cannot substitute for new strategies that enable women and girls to prevent unwanted pregnancies today. As a community, and as a procurement community in particular, we need to come to terms with the fact that the world we buy for is not necessarily the world we see in front of us today.
We need to encourage alternative supply options where contraceptive choice is limited. explore new ways of providing supplies and services in the face of social distancing; and advance regulatory approval of new products with quality assurance. Fortunately, in our community, we’re seeing growing evidence of all of these efforts: self-care, telemedicine, and more are coming into their own in these unprecedented times.
Through the work of professional organizations such as the Royal College of Obstetricians and Gynaecologists, new clinical guidelines have been developed to help health professionals offer self-care alternatives, including emergency contraception, in settings where face-to-face contact prevents the provision of long-acting contraception.[3][4] Global FP VAN partners offer supply planners consumption and supply data that can help them make critical supply plan decisions, based not only on past supplies, but also how those supplies are likely to be used in the coming months. Leverage data already available within it Commodity Gap Analysis[5] will allow countries to explore and quantify the impact of women’s decisions to maintain access to contraception. We see members of our regional network in Latin America, ForoLAC, working together to shorten supply chains by bringing quality contraceptives and other products closer to home. In East Africa and elsewhere, we are seeing improved performance in applications for regulatory approval of new RH supplies. The East African Community (EAC) regional harmonization initiative, for example, now accepts registration files via email, file sharing or even regular mail. EAC constituent country regulatory authorities respond within reasonable time frames and allow online payment of registration invoices and other fees. We are also seeing the advent of innovative approaches to get supplies into the hands of those who need them. For example, we are seeing widespread use of virtual care platforms such as telemedicine, clinic locators, pharmacy care, and direct-to-consumer delivery of essential RH supplies. Finally, to help users better navigate new private sector opportunities and to increasingly de-medicalize points of supply, we see calls for putting development finance directly into the hands of those most at risk.[6]
In some cases, these efforts can be seen as going against the tide of past procurement achievements – a trajectory that reflects, for example, greater investment in long-term reversible contraception, increased globalization of supply chains, volume procurement to lower prices for quality products. or in the development of fundamental principles governing the broad choice of method. To be sure, dealing with new crises as they happen can be potentially more dangerous than supporting systems that have benefited from decades of refinement. Today, we face a new world and time is not on our side. The Guttmacher Institute estimates that just a 10% reduction in the use of short-term and long-term reversible contraceptives would result in 15 million unintended pregnancies[7]―in turn leading to unsafe abortions, increased maternal morbidity and mortality, and other negative health outcomes.
If we are to successfully mitigate the threat of COVID-19, we must recognize today’s different realities and work with partners at all levels to address them. We must avoid allowing our concern about the resilience of established supply chains and service delivery systems to hinder the development of new responses to social distancing, uncertain supply chains, increased commercial risk and rapid service delivery needs. We must share the successes of new adaptation strategies, we must support local efforts to implement them, and we must act now.
[1] Coalition for Reproductive Health Supplies. Joint statement on the importance of continued sharing and collaboration for family planning. 2020.
[2] FP2020. Access to contraception is critical to combating COVID-19. FP2020 Statement. 2020.
[3] Royal College of Obstetricians & Gynaecologists. FSRH CEU clinical advice to support the provision of effective contraception during the COVID-19 outbreak. March 20, 2020.
[4] Royal College of Obstetricians & Gynaecologists. FSRH CEU recommendation for extended use of etonogestrel implant and levonorgestrel 52 mg intrauterine delivery system during COVID restrictions. March 20, 2020.
[5] Coalition for Reproductive Health Supplies. 2019 Commodity Gap Analysis. 2019.
[6] Access to SRH care: new delivery models & radically new funding. Health Implications. 2020.
[7] Riely T, Sully E, Ahmed Z, Biddlecom A. Estimates of the potential impact of the COVID-19 pandemic on sexual and reproductive health in low- and middle-income countries. International Perspectives on Sexual and Reproductive Health. 2020 (46): 73-76.
Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of SRHM as an organization.
