Pdack 082

DELIVER: FINAL PROJECT REPORT
JULY 2007
This publication was produced for review by the United States Agency
for International Development. It was prepared by the DELIVER project.
DELIVER: FINAL PROJECT
REPORT
The authors' views expressed in this publication do not necessarily reflect the views of the United States
Agency for International Development or the United States Government.
DELIVER
DELIVER, a six-year worldwide technical assistance support contract, is funded by the U.S. Agency for International
Development (USAID).
Implemented by John Snow, Inc. (JSI) (contract no. HRN-C-00-00-00010-00) and subcontractors (Manoff Group,
Program for Appropriate Technology in Health [PATH], and Crown Agents Consultancy, Inc.), DELIVER strengthens
the supply chains of health and family planning programs in developing countries to ensure the availability of critical
health products for customers. DELIVER also provides technical management of USAID’s central contraceptive
management information system.
Recommended Citation
DELIVER. 2007. DELIVER: Final Project Report. Arlington, Va.: DELIVER, for the U.S. Agency for International
Development.
Abstract
USAID funded the DELIVER project from 2000 through 2006. Implemented by John Snow Inc., the overarching aim of
the project was to improve commodity security for health products in the public sector in developing countries. The
project worked more with contraceptives than other product categories, but essential drugs, and drugs and diagnostic
supplies also received significant attention. Based on needs that USAID had identified, the project carried out work
under the following headings: logistics improvement; human capacity development; resource mobilization for
commodity security; adopting advances in logistics technology; estimation of USAID’s contraceptive needs; and
operating USAID’s contraceptive procurement database.
DELIVER
John Snow, Inc.
1616 Fort Myer Drive, 11th Floor
Arlington, VA 22209 USA
Phone: 703-528-7474
Fax: 703-528-7480
Email: deliver_project@jsi.com
Internet: deliver.jsi.com
CONTENTS
Acronyms .........................................................................................................v
Acknowledgments.........................................................................................vii
Project Overview .............................................................................................1
Purpose .............................................................................................................1
Project Elements ...............................................................................................1
Structure and Operations ..................................................................................1
Organization of this Report................................................................................3
Resource Mobilization for Contraceptive Security ......................................5
Requirements for Contraceptive Security..........................................................5
Global Initiatives ................................................................................................6
Regional Approaches ......................................................................................10
Country Contraceptive Security Programs ......................................................12
Human Capacity Development and Logistics System Improvement .......19
Relationship between Capacity Building and System Improvement ...............19
Performance Monitoring ..................................................................................20
Examples of Country Work in Supply Chain Improvement..............................20
New Challenges ..............................................................................................25
Results.............................................................................................................30
Adoption of Advances in Logistics .............................................................37
Supporting Forecasting and Procurement.......................................................37
Supporting Warehousing and Inventory Management Systems .....................38
Supporting Supply Chain Management...........................................................39
Working with Enterprise Resource Planning Systems ....................................40
Working with Two Other “Cutting Edge” Solutions ..........................................41
Make or Buy? ..................................................................................................42
Estimation of USAID's Contraceptive Needs ..............................................43
Operation of USAID's CCMIS .......................................................................45
Leadership: DELIVER was More than the Sum of the Parts......................49
Appendices
1. Countries Where DELIVER Worked and Country Fact Sheets
2. Final Publications List
3. Contraceptive Security Index
4. Case Study
5. Trends in Consumption Data from Contraceptive Procurement Tables
6. Correlations of LSAT, LIAT and CPR
7. Country Performance/Achievement Notes, DELIVER
DELIVER: Final Project Report iii

8. Summary of HIV/AIDS Supply Chain Interventions in Nine
Sub-Saharan African Countries
Figures
1. DELIVER Model for Commodity Security and Supply Chain Improvement.......2
2. Projected Gap in Donor-Provided Contraceptive Funding ................................5
3. Contraceptive Prevalence and Maternal Mortality in West Africa, 2002..........12
4. Correlation between Product Availability and LSAT Score..............................33
5. Correlation between Contraceptive Prevalence Rate and
Product Availability..........................................................................................34
6. Correlation between LSAT Score and Contraceptive Prevalence Rate ..........34
Tables
1. Total CSI Scores for 10 Active DELIVER Countries, 2003 and 2006...............9
2. Classification of 24 Countries by Diversification of Contraceptive Funding....16
3. Specific DELIVER Interventions, 2002–2006 .................................................28
4. DELIVER Achievements ................................................................................29
5. Trend in the Annual Consumption of Public Sector Contraceptives
(in 1,000s of CYP) in Selected Countries, 2000 to 2006..............................31
6. Total Value ($U.S.) of HIV Tests, Laboratory .................................................36
7. CPTs by Year .................................................................................................43
8. Number of Production Memos and Amendments Issued by Fiscal Year .......46
iv DELIVER: Final Project Report

ACRONYMS
ACAME Association Africaine des Centrales d’Achats de Médicaments Essentiels
ACS Authorization for Contraceptive Shipment
AIDS acquired immunodeficiency syndrome
AL artemether-lumefantrine
ART antiretroviral therapy
ARV antiretrovirals
ATLAS Assessment Tool for Laboratory Services [created by the DELIVER project]
ATM automated teller machine
AutoCAD Automated Computer Aided Design (software)
CA cooperating agency
CC Country Coordinators
CCMIS Contraceptive Commodities Management Information System
CCP Central Contraceptive Procurement (USAID)
CERPOD Centre d’Etude et de Recherche sur la Population pour le Development
CIB coordinated informed buying
CIDA Canadian International Development Agency
COTS commercial off-the-shelf software
CPR contraceptive prevalence rate
CPT Contraceptive Procurement Table
CS contraceptive security
CSI Contraceptive Security Index
CSL Commodities Security and Logistics Division (USAID)
CTL Country Team Leader
DFID Department for International Development (UK)
DGFP Directorate of Family Planning
DHS Demographic Health Surveys
DR Democratic Republic of Congo
DRP Distribution Resource Planning
DTTU Delivery Truck Topping Up
ECOWAS Economic Community of West African States
EML essential medicines list
ERP enterprise resource planning
FPLM Family Planning Logistics Management (project)
FY fiscal year
GFATM Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria
GTZ Deutsche Gesellschaft für Technische Zusammenarbeit [German international
development agency]
HIV human immunodeficiency virus
HR human resources
HSR health sector reform
ICC/CS inter-agency coordinating committee for contraceptive security
IPPF International Planned Parenthood Federation
IWG Interim Working Group on Reproductive Health Commodity Security
JCRC Joint Clinical Research Centre
JSI John Snow Inc.
DELIVER: Final Project Report v

KfW Kreditanstalt für Wiederaufbau (German funding agency for international development)
LAC Latin American countries
LIAT Logistics Indicator Assessment Tool
LMIS logistics management information system
LSAT Logistics System Assessment Tool
MCH maternal and child health
MDG Millennium Development Goal
MOH Ministry of Health
NAVISION [software used by the Ugandan National Medical Stores]
NEWVERN [USAID automated ordering, processing, and financial tracking system]
NGO nongovernmental organization
NMS National Medical Store
ODDID [Reproductive and Child Health Alliance of Cambodia implemented this system]
OI opportunistic infection
PAI Population Action International
PATH [organization uses acronym only
PEPFAR President’s Emergency Plan for AIDS Relief
PMI President’s Malaria Initiative
PMTCT preventing mother-to-child transmission (of HIV)
ProQ [software developed by the DELIVER project]
PSI Population Services International
RACHA Reproductive and Child Health Alliance of Cambodia
RHCS reproductive health commodity security
RHeXchange [web-based contraceptive procurement mechanism that was the precursor to the
RHInterchange]
RHI Reproductive Health Interchange (RHI),
RHSC Reproductive Health Supplies Coalition
SCM Supply Chain Manager
SCMS Supply Chain Management System
SDP service delivery point
SI Supply Initiative
SIGM Sistema Integrado De Gestao De Medicamentos
SOPS standard operating procedures
SPARHCS Strategic Pathway for Reproductive Health Commodity Security
STGs standard treatment guidelines
STI sexually transmitted illness
SWAp sector wide approach
TB tuberculosis
UN United Nations
UNFPA United Nations Population Fund
USAID U.S. Agency for International Development
VCT voluntary counseling and testing
WAHO West Africa Health Organization
WHO World Health Organization
WHO-AFRO World Health Organization African Regional Office
vi DELIVER: Final Project Report

ACKNOWLEDGMENTS
The real authors of this report are the many JSI and USAID staff members, plus their country counterparts
who carried the work of the DELIVER project. When it came time to write the final report, the work was
greatly simplified by the abundance of good documentation that they produced. DELIVER staff who
shared the work of producing the document include Jennifer Antilla, Dana Aronovich, Jim Bates,
Elizabeth Bunde, Yasmin Chandani, Abdourahmane Diallo, John Durgavich, Jim Eberle, Barbara Felling,
Ali Karim, Sun Lee, David O'Brien, Youssouf Ouedraogo, Erika Ronnow, Raja Rao, David Sarley,
Lesley Slevin, Sharon Soper, and Marie Tien.
DELIVER: Final Project Report vii

viii DELIVER: Final Project Report
EXECUTIVE SUMMARY
The U.S. Agency for International Development (USAID) funded the DELIVER project from October
2000 through September 2006. The contract requires a final report. The DELIVER project takes pleasure
in providing this presentation to fulfill that obligation. The overarching goal of DELIVER was to assist
developing country health programs in securing the availability of a broad range of contraceptives,
HIV/AIDS condoms, and other essential health commodities to clients at service delivery points (SDPs).
Using examples from the project’s ample documentation, the report describes how DELIVER fulfilled
both the letter and spirit of the contract.
The contract specified six elements through which the project worked to achieve the overarching goal.
These elements are—
• logistics system improvement, or upgrading the physical and procedural components necessary to
ensure the availability of contraceptives and other essential health commodities at SDPs
• human capacity improvement, or the fostering of the knowledge, skills, attitudes, and practices
necessary to operate logistics systems
• resource mobilization for contraceptive security, an inclusive approach that works broadly with all
stakeholders, including the private sector, to develop long-term strategies for effective forecasting,
procurement, distribution, and financing of contraceptives
• adoption of advances in logistics, that is, the introduction into country systems of new technologies
that will improve the efficiency with which contraceptives and other commodities are managed.
The final two project elements were focused in Washington, and these elements enhanced USAID’s
capacity as a major supplier of contraceptives:
• estimation of USAID's contraceptive needs, an activity designed to support USAID’s requirement to
know how many contraceptives to purchase and ship
• operation of USAID's Contraceptive Commodities Management Information System (CCMIS), to
manage and enhance, on the agency’s behalf, the commodity management information system that
supports the central contraceptive procurement process.
DELIVER inherited from the Family Planning Logistics Management (FPLM) III project a large and
experienced staff who were working in Washington and at the country level. Numbers of staff varied over
the life of the project; in June 2005, there were approximately 160 experts worldwide, working in such
specialties as contraceptive logistics, information technology, drug management, performance
improvement, policy, financing, and evaluation. Of this total, about 100, or 60 percent, were based in
Washington.
Over the life of the project, DELIVER worked in 48 countries, and in late 2006, had an active portfolio of
29 countries. At that time, field offices with one or more resident advisors were in 19 of the 29 countries.
In addition to the country programs, there were two active regional programs, one for West Africa and
one for Latin America.
When a project with six contractual elements runs for six years, operates in as many as 48 countries, and
has ample documentation, it is a challenge to present brief summaries of the results. Listed below are a
DELIVER: Final Project Report ix

few highlights from the project’s different elements. They are ordered them to minimize the redundant
writing that their interrelated nature would encourage.
Resource Mobilization for Contraceptive Security

Contraceptive security (CS) was a particularly strong activity area. Of the 29 countries in the end-of-
project portfolio, 18 had active CS plans. Four countries had plans on paper that were not active, and
seven had no plans. Twelve countries, or 40 percent of the active portfolio, were clearly engaged in
funding diversification activities, which is a significant fact as insufficient funding is arguably the most
important CS issue.
At the global level, DELIVER made progress on a number of activities that promote interagency
collaboration. These included supporting the organization of contraceptive working groups, such as the
Interim Working Group on Reproductive Health and Commodity Security and the Supply Initiative (SI).
In partnership with the POLICY Project, DELIVER made substantial contributions to the development of
the Contraceptive Security Index, a planning tool that aggregates the results of 17 indicators for 57
countries. For 47 countries, the index measures for both 2003 and 2006 are available.
Bringing the country and global work together, DELIVER developed a list of ten countries where
practical work experience suggested that the ministries of health were genuinely interested in CS. This
group showed an average 11.7 percent improvement in the CS Index, while the other 37 countries
averaged 2.7 percent. Although not conclusive for showing causality, this analysis does suggest that
countries that want to move toward CS are able to do so.
Human Capacity Building and Logistics System Improvement

This report combines human capacity building and logistics system improvement in one discussion,
because, at the country level, the work for improving human capacity is not distinguishable from the work
for logistics system improvement. It could be said that the first term describes the discipline and the
second term describes the setting. Country by country, there were many specific achievements, and the
list below illustrates the different ways in which DELIVER participated.
• In Rwanda, a country recovering from civil war, a vertical contraceptive distribution system brought
measurable reductions in stockouts at the facility level. This simple program, characteristic of an
earlier time, is the one most appropriate for Rwanda today and, for now, continues to serve the
country well.
• Ghana is far advanced in its health sector reform (HSR) efforts, including the integration of its
contraceptive, essential drugs, vaccines, and medical supplies distribution systems. DELIVER played
a central role in this complex activity, which represented a major change from its predecessor, the
FPLM III project, when access was limited and work in HSR situations was primarily to defend
logistics systems from poorly planned reforms. In six countries—Ghana, Uganda, Ethiopia, Malawi,
Indonesia and Bolivia—DELIVER was at the reform planning table and played an important role in
inducing rational logistics reform.
• In Uganda, there were enormous escalations in funding and commodity inputs for contraceptives,
essential drugs, vaccines, as well as drugs and other supplies for malaria and HIV/AIDS. DELIVER
assisted the Uganda Ministry of Health (MOH) with the integration of some supply systems, as well
as maintaining vertical ones where it made the most sense. Because of product or program
requirements, this meant one overall system for contraceptives, essential drugs, sexually transmitted
infection (STI) program drugs, HIV/AIDS, opportunistic infection (OI) drugs, HIV and malaria test
kits, and general laboratory supplies. It also meant separate vertical systems for tuberculosis (TB)
drugs, antiretrovirals (ARVs), and antimalarials. This configuration represented DELIVER’s attempt
x DELIVER: Final Project Report

to help the Ministry cope with scale-up by seeking the efficiencies through integration where possible
and making pragmatic choices where separate systems served the situation best.
• Apart from a recently completed CS assessment, DELIVER did not work in the Central Asian
Republics, but the region still merits a brief note here because JSI Logistics Services carried out
supply chain–related work there using DELIVER’s lessons learned, thus reducing costs to the client,
a USAID-funded regional project. In Uzbekistan, Tajikistan, Turkmenistan, and Kyrgyzstan, JSI
Logistics Services collaborated with Project HOPE to implement a TB drug distribution system. In a
situation where the quantity of work to do greatly exceeded the funds available, it was possible to
design and implement a simple and locally appropriate logistics management information system
(LMIS), based on models developed elsewhere. In carrying out this work the JSI logistics staff
consulted the DELIVER LMIS and performance improvement staff to ensure that the work met
DELIVER’s quality standards.
Adopting Logistics Advances

Public-sector logistics systems are becoming more sophisticated as population increases and new health
programs place increasing burdens on them. While this is happening, financial constraints are limiting the
options for providing effective service. The overall logic of this situation calls for improved logistics
system efficiency. Use of appropriate techknowledgy programs, such as PipeLine for supply planning and
ProQ for quantifying HIV/AIDS test requirements, seemed to work well in most countries, but they did
not solve all the problems.
Throughout the life of the project, DELIVER experimented with adapting private-sector methods and
products. The results were mixed. Commercial-off-the-shelf software and cutting edge innovations, such
as bar coding, have not worked as well as hoped; the principal problems were the cost of making required
modifications and the scarcity of local software companies that could help maintain extremely
sophisticated software. It is possible, however, as we learn more about the setup and support requirements
of these products, companies will be identified that can improve efficiency and be economically
replicated. Certainly efforts should continue. One technology that worked well was the use of electronic
smart cards to track the dispensing of antiretroviral therapy (ART) to HIV/AIDS patients.
Estimating USAID’s Contraceptive Needs

Under DELIVER, as under FPLM III, the Contraceptive Procurement Table (CPT) was the key tool for
estimating contraceptive requirements and the connected global procurement activities with work at the
country level. Between fiscal year (FY) 2001 and FY 2006, 1,548 CPTs were received, reviewed for
quality assurance, analyzed, and entered into NEWVERN (the automated order processing and financial
tracking system, also known as CCMIS). These CPTs represented 37 countries, 66 recipients, and 53
products. As will be shown, the data in the CPTs are useful not only for estimating contraceptive needs,
but also for monitoring trends when the project is evaluated.
DELIVER annually produced the USAID Contraceptive Procurement Guide and Product Catalog as a
guide to missions, programs, cooperating agencies (CAs), Commodities Security and Logistics Division
(CSL), and DELIVER staff on CPT preparation and USAID ordering procedures. In FY 2002, DELIVER
successfully implemented the CPT skills assessment training course, which was another opportunity to
improve the quality and reliability of CPTs. Over the course of the DELIVER project, seven training
sessions were held for 99 participants.
To measure the reliability of CPTs, DELIVER conducted statistical analyses of forecasting accuracy.
Most recently, the Accurately Forecasting Contraceptive Needs: Levels, Trends and Determinants (Karim
forthcoming) assessed the accuracy of annual contraceptive forecasts in CPTs prepared between 1994 and
2002 compared to the actual demand contained in CPTs prepared between 1996 and 2004. The
comparison consisted of 1,050 CPTs covering 50 programs in 19 countries.
DELIVER: Final Project Report xi

Ali Karim’s study reviewed the factors that influence forecast accuracy; his paper defined forecast
accuracy as “the absolute percentage difference between projected and actual quantities of a contraceptive
distributed in a specific year for a given program.” The study revealed the following:
• Forecast accuracy improved between 1995 and 2004.
• Expected forecast error was about 25 percent (considered good in commercial circles).
• Forecasts were more likely to overestimate rather than underestimate actual consumption.
• Improvements in forecast accuracy were associated with improvements in the LMIS and with the
use of PipeLine software.
Operating CCMIS
DELIVER maintained and managed NEWVERN; the project used NEWVERN to assist CSL with the
purchase, storage, and shipment of family planning and reproductive health commodities to USAID-
supported recipients throughout the world. NEWVERN was the primary repository of information
relating to CSL’s contraceptive production, warehousing, and shipping activities. It also contained
information on CPTs; production contracts; and warehouse stocks by lot, field orders, and shipments in
process; and funds received and expended.
NEWVERN was available through the Internet to USAID staff, recipient programs, and other partners
involved in the procurement and shipping process. In FY 2005, DELIVER introduced a redesigned
NEWVERN website with many new user-friendly features and greater security options. Improvements
included the ability for users to view shipment information, account statements and publications, as well
as updating pertinent shipping information for customers and recipients.
During the course of the DELIVER contract, the system had five major version updates with 12 minor
upgrades, including 47 functionality additions/modifications, 23 report additions/modifications, 14
interface modifications, and four website updates.
Leadership for Logistics Solutions

DELIVER was more than the sum of its parts and the work described in greater detail in the body of the
report demonstrates that the project provided innovative leadership in a number of areas, including—
• In 2001, following the Istanbul conference on contraceptive security, emphasis was placed on the
need to increase donor financing. Since then, advocacy for funding increases have not achieved the
hoped-for results. DELIVER found, however, that work at the country level, especially work with
diversification of financing, offered considerable hope for improvement, independent of donor
funding. This was a concrete and direct contribution to long-term sustainability goals.
• Research carried out under the FPLM III project documented persistent problems where HSR efforts
insufficiently planned for logistics and, in a number of cases, caused serious disruptions to logistics
systems. DELIVER put considerable effort into reversing this tendency by working with reform
planners in a number of countries to ensure that their work constructively embraced logistics.
DELIVER’s presence at the table in a number of countries meant that reforms were supported and
strengthened by improvements to the logistics systems, rather than undermined by their disruption.
• DELIVER’s start-up coincided with the worldwide movement to bring ARTs to developing countries
and the concomitant rise of the President’s Emergency Plan for AIDS Relief (PEPFAR) and Global
Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM) funds. These developments, plus
targeted funding from bilateral donors, soon induced massive increases in the procurement of drugs,
test kits, and other supplies for HIV/AIDS, TB, and malaria. Some of these products brought special
xii DELIVER: Final Project Report

problems, such as short shelf lives or unusual bulk. Countries anxious to deliver these life-saving
supplies to the people were usually not equipped to cope with these surges. DELIVER led the way in
developing specific methods for coping with the needs of specific products, as well as exponential
increases in volumes of supplies.
• Although some countries continue to operate rudimentary public health logistics systems, others have
grown considerably in their sophistication and efficiency. Where once it was sufficient to use stock
record cards, forward motion began to require the introduction of advances technologies, such as bar
coding, radio frequency identification devices, and smart cards. The introduction of these technologies
was not easy and some efforts failed. Looking to the future, however, the efficiencies promised by
these technologies will be required to cope with the simultaneous rollouts of the new initiatives
described in the preceding paragraph. DELIVER invested considerable effort in identifying, testing,
and installing advanced commercial sector technologies; this leaves the USAID | DELIVER
PROJECT with a strong foundation for introducing advanced systems into resource poor settings.
DELIVER: Final Project Report xiii

xiv DELIVER: Final Project Report
PROJECT OVERVIEW
PURPOSE
USAID funded the DELIVER project from October 2000 through September 2006. The overarching goal
of DELIVER was to assist developing country health programs in securing the availability of a broad
range of contraceptives, HIV/AIDS condoms, and other essential health commodities to clients at SDPs.
Using examples from the project's ample documentation, this report describes how the DELIVER project
fulfilled both the letter and spirit of the contract.
PROJECT ELEMENTS
The contract specified six elements that the project used to achieve the overarching goal. The first four
elements focused on work at the country level:
• logistics system improvement, or upgrading of the physical and procedural components necessary to
ensure the availability of contraceptives and other essential health commodities at SDPs
• human capacity improvement, or the fostering of the knowledge, skills, attitudes, and practices
necessary for operating logistics systems
• resource mobilization for contraceptive security, an inclusive approach that works broadly with all
stakeholders, including the private sector, to develop long-term strategies for effective forecasting,
procurement, distribution, and financing of contraceptives
• Adoption of advances in logistics, that is, the introduction of new technologies into country systems,
to improve the efficiency with which contraceptives and other commodities are managed.
The final two project elements were Washington-focused and enhanced USAID’s capacity as a major
supplier of contraceptives:
• estimation of USAID’s contraceptive needs, an activity designed to support USAID’s requirement to
know how many contraceptives to purchase and ship
• operation of USAID’s CCMIS, that is to manage and enhance, on the agency’s behalf, the commodity
management information system that supports the procurement process.
STRUCTURE AND OPERATIONS

From the FPLM III project, DELIVER inherited a large and experienced staff working in Washington and
at the country level. Numbers have varied over the life of the project; in June 2005, there were
approximately 160 experts worldwide, working in such specialties as contraceptive logistics, information
technology, drug management, performance improvement, policy, financing, and evaluation. Of this total,
approximately 100, or 60 percent, were based in Washington.
Over the life of the project, DELIVER worked in 48 countries and toward the end of 2006 had an active
portfolio of 29 countries. There were field offices in 19 of the 29 countries. In addition to the country
programs, there were two active regional programs—one for West Africa and one for Latin America. See
appendix 1 for a list of the countries where DELIVER worked, including fact sheets about our work in
each of the countries.
DELIVER: Final Project Report 1

Figure 1 displays a flow chart of DELIVER’s approach to commodity security and logistics improvement.
Although individual country plans may have varied, the following sequence was usually observed:
• assessment
• analysis
• selection and planning for interventions
• design
• implementation
• monitoring.
It was through this process that DELIVER designed and implemented typical project activities that
included diversifying funding options, improving storage conditions, installing inventory controls,
rationalizing transport, or strengthening the LMIS.
Figure 1. DELIVER Model for Commodity Security and Supply Chain Improvement
The flow chart stresses quality monitoring at every step. DELIVER ensures the quality of its work in a
number of ways, including—
• Written quality standards were required for products and activities that included curricula and
training materials, automated LMIS designs, application of evaluation tools, preparation of
contraceptive procurement tables, and quantifications and forecasts for essential medicines and
laboratory supplies.
• Internal review was done for the design and implementation work carried out by DELIVER advisors
at the country level. In any given country, one or several advisors were asked to contribute,
2 DELIVER: Final Project Report

depending on the specialties required. Each country had an assigned Country Team Leader (CTL),
who coordinated the work of the advisors; the team leaders, in turn, were supervised by Country
Coordinators (CC). The CTLs and CCs were responsible for monitoring the quality of all the work
and for ensuring that quality standards were met. Advisors, CTLs, and CCs routinely submitted
proposals and draft products to specialists in the home office for review; this process frequently
resulted in revisions and improvements.
In addition to country-level work, which was DELIVER’s main focus, the project also developed and
disseminated a variety of tools, hosted a series of events, and participated at many conferences. These
efforts improved logistics management, allowed the sharing of results and best practices, and raised
awareness of the importance of logistics. These were USAID’s contribution to supply chain management,
lessons learned, and accomplishments.
Concrete examples of tools that the project has put to extensive use at the country level include the
Strategic Pathway for Reproductive Health Commodity Security (SPARHCS) assessment tool; PipeLine
computer software for managing procurements; and ProQ software for forecasting HIV/AIDS test kit
needs. (See appendix 2 for a complete list of these publications.)
Major studies include analyses of CPT-based forecasting activities, investigation of decentralized logistics
systems, and evaluation of contraceptive prices in West Africa.
Part of DELIVER’s communications strategy included sharing knowledge through the project website
and other electronic means, including listservs and newsletters, as well as by mail. Over the life of the
project, DELIVER publications and software were disseminated to more than 65 countries. See the
references page for a complete list of the DELIVER publications.
DELIVER hosted and participated at many conferences and events in Washington, D.C., and abroad. A
few specific examples include—
• In October 2006, DELIVER hosted the State of the Practice: Contraceptive Security in Latin America
and the Caribbean. To ensure future contraceptive security, the event focused on common findings
across countries and recommendations that merited investment at the regional and country level.
• Held in May 2006, DELIVER’s Critical Issues Series event, Delivering HIV/AIDS Commodities to
Customers: Insights and Partnerships for Seamless Supply Chains, brought together stakeholders that
influence, implement, or integrate HIV/AIDS supply chains to discuss gaps in and solutions for
achieving seamless supply chains.
• USAID, DELIVER, and KfW hosted the East Africa Reproductive Health Contraceptive Security
Workshop: Ensuring Access to Family Planning in November 2005 in Dar es Salaam, Tanzania. The
workshop addressed the critical need to improve access for the family planning supplies and services
for women and men in the region.
DELIVER also adhered to USAID’s branding and marking requirements and complied with Section 508
for website accessibility. See appendix 2 for a list of all publications (including tools) produced during the
project.
DELIVER will provide the volume of funds expended and the level of effort provided over the life of the
project in a separate document.
ORGANIZATION OF THIS REPORT

In the summary above, the project elements have been listed in the order in which they appear in the
contract. Given, however, the overlap and interrelationships among these elements, the original order

would result in a great deal of repetitive writing if it were used as the sequence of discussion in a report.
The following presents a more unified and efficient presentation:
• The technical discussion opens with Resource Mobilization for Contraceptive Security, which is an
inclusive concept that requires the mention of the other elements of the project and the activities that
they cover.
• In the next section, Human Capacity Development and Logistics System Improvement are one
presentation. Capacity development is carried out to improve systems; during country-level
implementation, the two elements are not distinguishable in practice.
The other elements of the project are then presented in the original order:
• Adopting Logistics Advances
• Estimating USAID’s Contraceptive Needs
• Operating CCMIS.
The report concludes with a brief discussion of how the project has provided leadership in commodity
management that has benefited clients and other stakeholders, and how the project has enhanced
USAID’s reputation and capacity in commodity management.

RESOURCE MOBILIZATION FOR
CONTRACEPTIVE SECURITY
Projections prepared for the Interim Working Group on reproductive health commodity security
(RHCS) in 2001 showed that donor funding would need to increase initially by $24 million; then by 5.3
percent annually if donor-funded contraceptive supplies were to meet projected demand in 2015 (see
figure 2). Available information shows that over the last four years, donors have not sustained the
required increase in funding. DELIVER’s practical experience showed, however, that in other ways the
situation is much more positive than these disappointing results suggest. It is clear that recent initiatives at
country, regional, and global levels have improved the outlook for RHCS.
Figure 2. Projected Gap in Donor-Provided Contraceptive Funding
REQUIREMENTS FOR CONTRACEPTIVE SECURITY

As the DELIVER project began, it worked with a consensus definition of contraceptive security. At that
point, this important concept was defined as a state in commodity management that is characterized by
the availability of contraceptive supplies for all who wanted them, which could be achieved when
countries could carry out the following four activities:

• forecast their needs
• efficiently procure the required product
• distribute it to customers
• achieve a financial situation in which funds from all sources were sufficient to support required
purchases.
Six years later, DELIVER's work suggests that a more complete definition would take into account the
following factors:
• Commitment of key stakeholders to CS is required if improvements are to be sustained.
• Favorable policies, often included in HSR, are needed to encourage the public and private provision
of contraceptives.
• Coordination among all stakeholders is required for the true partnerships and information flow
required to avoid duplication and address gaps.
Reaching all segments of the market requires a total market approach in which the roles of the public,
private, and nongovernmental organization (NGO) sectors are understood and even coordinated, if
possible.
• Realistically, in most countries, securing enough funding will require financial contributions from all
market segments.
• Accurate forecasting based on consumption data and efficient procurement capacity are required to
ensure that the best prices and quality are obtained through transparent contracting and timely
ordering and delivery.
• Well functioning in-country distribution systems (storage and transport) need to be in place to ensure
that contraceptives are always available where they are needed.
• Equity in and access to service delivery must be in place to ensure that clients, including underserved
populations, are reached.
• A monitoring and evaluation capacity is needed to make necessary adjustments as new constraints
emerge or outputs do not meet targets.
• A focus on the client and an understanding of the context in which clients seek service is essential for
determining the reasons for unmet need.
The balance of this section provides examples of these variables in play as we consider DELIVER’s role
in global, regional, and country CS activities.
GLOBAL INITIATIVES
NEW WORKING GROUPS

JSI had worked with partners that included the Wallace Global Fund, Population Action International
(PAI), and PATH. With these partners, they set up the Interim Working Group on Reproductive Health
Commodity Security (IWG/RHCS). Within IWG/RHCS, DELIVER played a leadership role in preparing
for the highly influential Istanbul conference, Meeting the Reproductive Health Challenge: Securing
Contraceptives and Condoms for HIV/AIDS Prevention. This meeting was an important moment for the

global community; it created the space and commitment to raise awareness in the issues surrounding
supplies, and more importantly, to seek solutions for those issues. IWG partners prepared nine papers,
including the highly influential paper, Contraceptive Projections and Donor Gap, which predicted a $140
to $210 million shortfall in donor funding by 2015 (all nine papers are on the RHSC website. 1 DELIVER
prepared a business plan, functional requirements, and a prototype website for the RHeXchange, a web-
based contraceptive procurement mechanism that was the precursor to the RHInterchange. The Istanbul
conference ended with a call to action. In 1999, prior to the meeting, the funding level of contraceptives
had dropped to $154 million; after Istanbul, by 2004, bilateral and multilateral donor support for
contraceptives had increased to $203 million.
The original IWG partners worked with a broad array of stakeholders to move the agreed-upon actions
that emerged from the Istanbul meeting forward. In January 2003, the SI was formed, based in Europe in
response to stakeholder input, and managed and staffed by the German Foundation for World Population
(DSW), JSI, PAI, and PATH. The organization carried out a number of advocacy activities, some of them
are ongoing. One contribution was the creation and operation of the Reproductive Health Interchange
(RHI), which is a consolidated contraceptive procurement database, currently including data from
USAID, United Nations Population Fund (UNFPA), and International Planned Parenthood Federation
(IPPF). Information from the Supply Chain Management System RHI is intended to facilitate and
improve discussions about the coordination of inbound supplies. For additional information on this
activity, go to the RHI website. 2
The efforts that DELIVER and other organizations made through the IWG and SI eventually led to a very
important development in which DELIVER has not been directly involved—the Reproductive Health
Supplies Coalition, which has met five times since it was organized in 2004 and has a permanent
secretariat in Brussels. Among its 20 members are such influential agencies working for reproductive
health as the World Bank, UNFPA, the World Health Organization (WHO), European Union, USAID,
DFID, GTZ/KfW, and the Bill & Melinda Gates foundation. 3 Three well-established working groups,
each of which is grounded in priorities established at the Istanbul conference, include (1) resource
mobilization and awareness raising, (2) systems strengthening, and (3) market development approaches.
It is significant that a number of the RHSC members are important funders of contraceptives and
providers of technical assistance for systems strengthening—USAID, UNFPA, DFID, and KfW.
Concomitant to the founding and evolution of RHSC, a consensus for a worldwide contraceptive security
movement has emerged, with UNFPA having assumed a visible coordinating role. As a result, there are a
growing number of individual country commodity security programs in every region of the world.
It is fair to say that USAID through DELIVER played a key role, first with its support for the Istanbul
conference and, subsequently, with JSI and DELIVER’s ongoing collaborations with UNFPA and other
partners in country-level contraceptive security programs. It is here that we see the critical link between
global advocacy and improved coordination in country arenas. DELIVER has played concrete roles at
both ends of the continuum.
1
http://www.populationaction.org/Publications/Reports/Meeting_the_Challenge/asset_upload_file852_5487.pdf
2
www.rhi.rhsupplies.org.
3
The complete membership list includes Bill & Melinda Gates foundation, Department of International Development (DFID), German
Development Cooperation (GTZ)/German Development Bank (KfW), GSMF International (Ghanaian social marketing company) , International
Planned Parenthood Foundation (IPPF), Ministry of Finance, Planning and Economic Development of Uganda, Ministry of Health of Romania,
Ministry of Health and Family Welfare of India, Netherlands Ministry of Foreign Affairs, Partners in Population and Development (PPD),
Population Services International (PSI), Profamilia of Columbia, Shanghai Institute of Planned Parenthood Research, Supply Initiative, United
National Foundation, United Nations Population Fund (UNFPA), United States Agency for International Development (USAID), World Bank
and World Health Organization (WHO).

CONTRACEPTIVE SECURITY INDEX
Another global initiative, undertaken in collaboration with the POLICY Project, is the aggregation and
dissemination of the 2003 and 2006 Contraceptive Security Index (CSI.) The purpose of the CSI, which is
disseminated by means of technical papers and wall charts, is to raise awareness about CS and the
interrelationships between program components, different sectors, and program outcomes. At the
international level, the index can be used for priority setting, planning and advocacy to support policies,
and other interventions that promote progress towards CS. At the country level, it can be used to identify
areas of relative strength and weakness to help stakeholders apply their resources more effectively.
The CSI has 17 indicators, grouped into five components:
1. supply chain
2. finance
3. health and social environment
4. access
5. utilization.
The indicator results are weighted and aggregated to establish a composite index that distills the results
for all five components. DELIVER and POLICY have compiled the index two times, once in 2003 for 57
countries and again in 2006 for 63 countries. See appendix 3 for copies of the wall charts for 2003 and
2006.
The range of possible index sores is 0 to 100. For 2006, they ranged from 35.5 to 73.2. In 2003, the range
was 28.1 to 68.1. Using a paired t-test, indicating aggregate improvement, the 2006 total scores, averaged
across the 57 countries included in both aggregations, represent a statistically significant increase from
2003. The global averages for the five components also show significant improvement in every
component from 2003 to 2006. In most cases, averages for the component scores by region also showed
improvement but the results for regions are not always significant.
Table 1 lists the 10 countries where DELIVER staff felt the ministries of health had taken CS seriously;
these are the total CSI scores for 2003 and 2006. Except for Kenya and Ethiopia, they show moderate to
large increases. The average point increase for this set is 11.7. The average increase for the other 47
countries on the 2003 list is 2.7. This comparison does not establish a causal relationship between
DELIVER inputs and the above average scores. It is safe to say, however, that these 10 countries’
collaboration with DELIVER demonstrates their interest in CS, and that countries with a high interest are
able to make progress.

Table 1. Total CSI Scores for 10 Active DELIVER Countries, 2003 and 2006
Country 2003 Total Score 2006 Total Score Percentage

Difference
Ghana 48.6 54.6 +12
Malawi 45.3 49.6 +9
Kenya 50.7 51.2 +1
Nigeria 42.3 48.6 +15
Bangladesh 56.4 62.7 +11
Tanzania 47.5 52.4 +10
Uganda 39.1 48.5 +24
Ethiopia 38.0 38.9 +2
Nicaragua 57.1 66.3 +16
Bolivia 51.1 59.8 +17
Although time trends derived using this methodology must be viewed with caution, these comparisons
help substantiate the observation at the beginning of this section, that despite disappointing results for
donor funding increases six years after Istanbul, other initiatives have improved the outlook for CS.
As noted, within countries, the CSI displays a broad indication of the state of affairs for variables that
affect CS. To do useful planning for improvement at the country level, however, much more information
is needed. DELIVER has devoted significant attention to the problem of how to collect and present such
information, and it is to this subject that we turn next.
STRATEGIC PATHWAY TO REPRODUCTIVE HEALTH COMMODITY SECURITY

The Strategic Pathway to Reproductive Health Commodity Security (SPARHCS) is a framework for
collecting and organizing information on the multiple components of reproductive health commodity
systems. SPARHCS can be used for at least three different purposes in developing RHCS strategies:
• As a framework that helps stakeholders understand the full range of elements that make up an
effective approach to RHCS.
• As a diagnostic guide that highlights a system’s problem areas by using a series of targeted questions
that assess a country’s RHCS situation.
• As a process that facilitates cooperation among stakeholders who convene to use SPARHCS, because
strengthening RHCS requires coordinated efforts.
The SPARHCS framework echoes the variables that affect CS and with which we began this section,
including context, commitment, capital, coordination, capacity, and clients. Its data collection instruments
are easily adaptable to individual country situations, and it is designed to make maximum use of pre-
existing bodies of information.
What makes SPARHCS a truly global initiative is the fact that it results from a collaboration between
DELIVER and other prominent participants in the field of RHCS—USAID, UNFPA, DELIVER, and the
POLICY Project. Many other important organizations have also participated: Abt Associates, PATH, and
PSI from USAID CAs; Schering-Plough and Wyeth from the manufacturing sector; the Wallace Global
Fund and the Packard Foundation from philanthropic organizations; and the World Bank and WHO from

among multilateral agencies. This demonstrates that SPARHCS is accepted worldwide as providing the
common language for assessment and planning.
DELIVER and other partners pilot tested SPARHCS in Bangladesh (2000), Nigeria (2001), and
Madagascar (2002). Since then, SPARHCS has been implemented in 11 other countries, including Peru,
Indonesia, Bolivia, Nepal, Nicaragua, Paraguay, Honduras, Ghana, Burkina Faso, Cameroon, and Togo.
In addition, elements of SPARHCS have been used in regional assessments carried out in West Africa
and Central Asia.
REGIONAL APPROACHES
A regional approach can provide many benefits to country teams working on CS. Regional workshops
and conferences provide settings for the exchange of ideas and lessons learned with neighbors who
typically face similar problems.
• As countries compare experiences, solutions for problems that are apparently intractable in one
country may be found in another.
• Historical similarities between countries in a region may lend themselves to the adoption of common
solutions.
• Bringing neighboring countries together can also engender some positive competition as countries see
how they are performing compared to their neighbors. There are several examples of previously
recalcitrant countries becoming energized after seeing what their neighbors had accomplished.
Although there has been some regional work in Eastern Europe, Eastern Africa, and Central Asia,
DELIVER has implemented its most definable regional approaches in Latin America and West Africa.
In recent years, USAID has begun a gradual phaseout of contraceptive donations to all programs in the
Latin America and Caribbean region. As countries have started preparing for this development they have
struggled with similar challenges. During the early 2000’s, certain key constraints to contraceptive
security throughout the region were noted:
• little financial planning and limited political commitment toward sustaining the long-term supply of
contraceptives
• varied capacity for the logistics functions of selection, forecasting, and procurement of contraceptives
• lack of information on options for improvement, including successful experiences within the region
• laws that favored the use of relatively expensive local distributors over the use of international
suppliers known to supply good quality contraceptives at competitive prices
• despite relatively high contraceptive prevalence rates (CPRs), low use of modern methods and high
unmet need in rural areas, among the lowest socioeconomic groups, the uneducated, and certain
ethnic groups.
Countries facing phaseout include Bolivia, Dominican Republic, Ecuador, El Salvador, Guatemala,
Honduras, Nicaragua, Paraguay, and Peru. DELIVER supported USAID’s LAC Bureau in convening a
meeting in July 2003 in Managua that focused on the development of CS committees and strategies for
each country. Despite the commonalities, it was clear that the strategies must be country-specific, taking
into account local needs, resources, and constraints.
Five countries (Bolivia, Peru, Nicaragua, Paraguay, and Honduras) agreed to undertake SPARHCS
assessments. DELIVER and the POLICY Project assisted in carrying these out. USAID sponsored a

second regional contraceptive security meeting in Lima in October 2004. Results of this workshop
included two additional countries (Ecuador and Dominican Republic) that decided to carry out the
SPARHCS assessments and three countries (Bolivia, Nicaragua, and Paraguay) that decided to further
engage the private sector, starting with a market segmentation analyses. These specialized assessments
are the basis for specific countries’ CS plans. As work in all countries has progressed, a regional strategy
has emerged that includes the following elements:
• Establishment of multi-sector CS committees (DAIA in Spanish) at the country level that have
continued to meet since the regional workshops; they have also carried out coordination, planning,
and action.
• SPARHCS assessments and market segmentation analyses that have led to the development of CS
strategies that make increased use of the private sector.
• Increased public sector funding for contraceptives. Paraguay and Guatemala have established line
items for contraceptive procurement, while Ecuador, Peru, Honduras, Dominican Republic, and El
Salvador have all begun to fund part of their supply. All of these developments post-date the start of
the regional initiative. Although the Ecuador and Peru examples pre-date the regional activity, the
other four items have occurred in response to this process.
• Increasing use of UNFPA as a procurement agent, as well as other options, to gain access to the
competitive international contraceptive market.
DELIVER followed approximately the same process in West Africa as in Latin America. Starting in 2003,
DELIVER worked with West Africa Health Organization (WAHO), which is the health secretariat for the
16-member Economic Community of West African States (ECOWAS). This work has had two major
objectives:
• development of a regional RHCS strategy
• design and implementation of a coordinated informed buying (CIB) procurement information system.
These efforts were actively supported by such important regional partners as WHO/AFRO, the
Association Africaine des Centrales d’Achats de Médicaments Essentiels (ACAME), and the Centre
d’Etude et de Recherche sur la Population pour le Development (CERPOD). Major international partners
such as UNFPA, the World Bank, and KfW have also lent their support.
DELIVER used the results of the country-level SPARHCS assessments to develop a regionwide
assessment. The specific findings were not strikingly different than the findings in Latin America and
they do not need be listed in detail. There was, however, one major difference: in Latin America, the
stimulus for regional work was the commonly shared problem of phaseout of donor contraceptive grants;
while in West Africa, it was the urgent need to address a bad and still declining situation for maternal and
child health. In West Africa, on average, 880 women die for every 100,000 births and 100 infant deaths
occur for every 1,000 live births. The gravity of the situation is recognized by the UN’s Millennium
Development Goals (MDG), whose indicators include improving MCH outcomes and reducing the spread
of HIV/AIDS. As figure 3 shows, there is a demonstrable correlation between CPR and maternal
mortality, meaning that the availability of contraceptives and other reproductive health commodities is a
necessary condition for achieving the MDG goals.

Figure 3. Contraceptive Prevalence and Maternal Mortality in West Africa, 2002
70 2,500
Maternal Deaths per 100,000 Live Births

% MWRA Using Modern Contraception
60
2,000 2,000
50
1,600
1,500
40
1,200
30 1,100
1,000 1,000 1,020 1,000
850 880
760 740 800
20 690 690
570 540 540 500
10 330
150 190
0 24 0
Côte d’Ivoire
Senegal
Sierra Leone
Europe
Asia
Ghana
Guinea-Bissau
Mauritania
Guinea
Mali
Liberia
Benin
Cape Verde
Nigeria
Niger
Burkina Faso
Togo
Eastern Africa
Gambia
L.Amer./Caribbean
Western Africa
CPR Maternal deaths
West African leaders have recognized DELIVER’s assessment for its direct strategic relevance. At its
fifth annual assembly in Accra in 2004, ECOWAS health ministers recommended that WAHO and its
partners develop a regional strategy for RHCS. In Dakar, in 2005, ministers endorsed a road map for that
strategy that was directly based on the recommendations in DELIVER’s regional assessment.
Using a CIB model that incorporates commercial sales agents’ price quotations for a defined set of
reproductive health drugs, DELIVER’s assessment estimated that a savings of up to 14 percent below
international indicator prices are possible. Unit prices for contraceptives could be lowered by as much as
28 percent. It is not surprising then that the ministers in Dakar also called for the implementation of the
CIB mechanism. DELIVER worked with WAHO to place a CIB manager in Dakar who will chair a
system design workshop that will be attended by procurement managers from countries across the region.
The aim of the workshop is to specify the procedures and routines required to allow the flow of price and
other procurement information between country programs and the central database at WAHO.
As noted, DELIVER also pursued regional approaches for RHCS in Eastern Europe, Eastern Africa, and
Central Asia. Details for these promising activities are in the report Contraceptive Security: Practical
Experience in Improving Global, Regional, National, and Local Product Availability (Sarley et al. 2006).
COUNTRY CONTRACEPTIVE SECURITY PROGRAMS

Beginning in 1986, USAID invested in three successive family planning logistics management projects—
FPLM I, FPLM II, and FPLM III. Although the work of these projects expanded and diversified over
time, they still maintained a relatively narrow focus on vertical public sector contraceptive supply chains.
DELIVER’s mandate for contraceptive security was one of two major distinctions between this project

and its predecessors. (The other was the mandate to expand beyond contraceptives and to significantly
engage work for other products.)
During DELIVER, USAID recognized that work on supply chains alone will not resolve the complex of
dilemmas posed by the quest for secure supplies of contraceptives. This point was anticipated at the
beginning of this section with the listing of 10 factors that influence contraceptive security. It has already
been noted that worldwide UNFPA, USAID, and other donors are sponsoring country contraceptive
security plans.
DELIVER was providing services in 29 countries in the last year of the project. Resource mobilization
staff consider that 18 of them had CS plans that were active, and receiving attention from stakeholders.
Four countries had plans on paper that were not active. Seven countries did not have plans. Inevitably,
these distinctions are not always clear. In the case of Guatemala, there was no formalized CS strategy, yet
the government had within the past two years enacted a law that earmarks 15 percent of alcoholic
beverage tax revenues for reproductive health, and the country was working on a plan to set aside
matching funds for replacing donated contraceptives.
The substance of the country CS plans varied greatly. For Bangladesh, a charter family planning country
with a well-established and effective distribution system, the CS plan had focused on activities that would
make the available financing go further, such as making procurement more efficient or making greater use
of the private sector. For Rwanda, a fragile state emerging from a devastating civil war, the CS plan
placed priority on establishing a public sector contraceptive distribution system; meaning that the Rwanda
program closely resembled those that characterized FPLM.
The most distinctive new departures that the country-level CS planning brought along included—
• investment in building commitments for CS, creating favorable policies, and improving coordination
among stakeholders
• adopting a total market approach
• diversification of funding
• emphasis increased on improving public sector procurement practices than in the past.
Prominent within CS plans but not a new departure was—
• general supply chain improvement.
DELIVER attempted a tabulation of these new departures to give a sense of which CS activities were in
the greatest demand. This effort immediately ran into problems because of the difficulty of counting
intangibles, such as commitment, coordination, and policies. Nor could the logistics system improvement
activities that took place in almost all DELIVER countries be counted as a new trend. However,
diversification of funding and procurement emerged more clearly as countable new activities. Twelve
countries or 40 percent of all DELIVER countries and 66 percent of active CS plan countries were clearly
engaged in funding diversification activities. They included Bangladesh, Benin, Cameroon, Ethiopia,
Ghana, Dominican Republic, Ecuador, El Salvador, Paraguay, Peru, Madagascar, and Guatemala. Four
countries, or 14 percent of the overall portfolio and 22 percent of the active CS plan–listed countries had
procurement improvement-related activities. To this may be added regional work on this topic through the
ECOWAS.
Following are discussions of each of these CS activity areas, with specific country examples.
Commitment, coordination, and policy. Commitment is needed from the highest levels of country
leadership, but also from other levels of the public sector and from civil society. In this respect,

commitment must be understood in a broad socio-cultural context. Indicators that demonstrate
commitment to CS include policies that support the right to family planning; budget lines for commodity
procurement; and explicit inclusion of CS in national social policy initiatives, such as poverty reduction
strategy papers.
To be effective, contraceptive supply chains must include many partners working together to ensure the
availabilities of products to all who need them. Coordination between partners promotes efficient and
optimal utilization of limited resources, which reduces the likelihood of waste, duplication, or
contradictory decisions. Specific examples of coordination requirements include the national level
between commodity suppliers, such as ministries of health, UNFPA, USAID, and IPPF; and between
sectors providing services, such as the public sector, NGOs, faith-based organizations, and commercial.
A supportive policy and regulatory environment is required for contraceptives to be both available and
accessible. The areas to be covered are diverse. Among the most important are product registration and
quality control; essential medicines lists (EMLs) and standard treatment guidelines (STGs); patents,
tariffs, duties, and other import-related items; distribution strategies, including both public- and private-
sector options; and HSR initiatives, such as integration and decentralization. Two examples of progress
for commitment, policy, and coordination took place in Ghana and Georgia.
• Ghana in 2002 created an inter-agency coordinating committee for contraceptive security (ICC/CS).
In 2003, the ICC/CS set up a technical working group that remains active, working on such activities
as monitoring progress of CS activities, consolidating forecasts and quantifications, and developing
financial sustainability plans. The Government of Ghana contributed a combination of health funds
(World Bank credits) and internal revenue to the procurement of contraceptives, starting with
$230,000 in 2003 and adding $1 million in 2006.
• Georgia—not a DELIVER country—made a significant commitment to CS following the country’s
participation in a DELIVER-sponsored conference in Bucharest in March 2005. Until that time, the
country had a policy in place that restricted family planning services provision to a relatively small
number of care providers called reproductologists. After reviewing Romania’s experience with
general practice (GP)-based reproductive health services in rural areas, Georgia decided to adopt a
similar model. In so doing, it used a change in human resources policy to significantly expand the
number of health facilities where contraceptives could be dispensed. Subsequently, a Romanian
expert identified by DELIVER helped design Georgia’s contraceptive distribution system.
Concomitant to this development, USAID began supplying contraceptives for rural and urban
facilities; the result was that both the service and product supply in Georgia were greatly
strengthened.
Total market approach: The most concrete manifestation of the total market approach is market
segmentation analysis. This marketing tool divides a country’s current and potential contraceptive users
into sub-groups with specific characteristics and family planning needs. These characteristics can include
age, education, geographic location, and wealth. The primary purpose of market segmentation analysis is
to help public-sector policymakers become more aware of the roles and advantages of different sources of
contraceptives. Not all contraceptive users can or will use public sources of supply. Private pharmacies,
social marketing outlets, NGO providers, and commercial distributors all play important roles in reaching
market segments underserved by the public sector. For example, pharmacies are the most important
source of contraceptives for newlyweds in Bangladesh, a segment of the population not well served by
public facilities.
The recognition that the public sector is not the only provider of family planning methods is a prerequisite
for expanding supply options for contraceptive users. Market segmentation analysis is most effective
when this awareness is translated into concrete actions to improve market efficiency and expand family

planning product availability through coordination and partnership between the public- and private-sector
providers.
• While market segmentation analysis was completed in a number of countries, practical results were
mixed. The key constraint appeared to be the willingness of policymakers to accept and use the
findings of market segmentation analysis. In Romania, for example, policymakers used an analysis of
urban and rural contraceptive users to target public subsidies to rural health facilities. This allowed
the private sector to expand its supply in urban areas without competition from subsidized public-
sector products. In Nicaragua, the Social Security Institute recognized from market segmentation data
that its beneficiaries, instead of receiving contraceptives as part of their insurance-covered benefits
package, were going to MOH facilities instead. Social Security has now made efforts to expand
contraceptive supplies at its facilities.
• Market segmentation facilitates making adjustments to optimize responses to demand. Total market
approaches can also be the focus on supply side issues. In 2004, Peru’s MOH, in collaboration with
UNFPA, conducted a study to identify the best available prices for the four contraceptive products
that the family planning program procures. Condoms were not procured that year because sufficient
stocks remained from previous years. For IUDs, the UNFPA price was far lower than prices available
on the local market. The local and UNFPA prices for the three Depo-Provera options were identical.
The MOH bought both products from the UNFPA. However, the price of the oral contraceptives used
by the public sector was significantly lower in the local market, even after including costs of
distribution to SDPs, a service not offered by UNFPA. Therefore, for 2004, the MOH procured oral
contraceptives locally, thereby achieving significant savings. The supplier was ESKE, the local
representative of the Indian company FamilyCare. The entry of companies like ESKE into local
markets has great potential to increase competition among suppliers, and thereby yield better prices.
Diversification of funding: For many years, public sector programs relied on one or more donors to
provide their contraceptives. As noted previously, a future funding gap as large as $140 to $210 million
was projected. Preliminary analysis suggested that since this projection was announced in 2001, donor
funding increased at less than half the annual rate that would have been required to resolve the problem.
Because of this, the diversification of funding sources, that is, the securing of financial alternatives to
traditional donor grants, was probably the most urgent of many CS challenges. DELIVER worked to
define this challenge as concretely as possible; this was a first step toward working for solutions
systematically across countries.
One output of this work was a simple classification of actual and potential funding alternatives that
included global funds, sector wide approach (SWAp) funds (development bank loans and direct budgetary
support), earmarked national budget lines, third party private providers, and households. A second output
was a scheme for classifying countries according to the degree of diversification they had achieved. There
are five classes ranging from high donor dependency to private sector and household funding, the largest
source. DELIVER has also gathered information for classifying 24 countries. See table 2 for the results of
this work. This approach has the advantage of providing a global summary for the state of affairs while
also characterizing individual country situations. The examples below show how two countries responded
to this particular challenge.

Table 2. Classification of 24 Countries by Diversification of Contraceptive Funding
Country/Classification Sources
Donated SWAp Budget Line Household Private
Groups Commodities Funds Income CPR
A: High donor dependency Public sector Not used yet None or Small
• Benin dependent on limited contribution/ 4.0
commodity market
• Burkina Faso 2.3
donations (over
• Cameroon 90%) 4.8
• Ethiopia 1.4
• Mali 3.7
• Nigeria 6.5
• Rwanda 2.0
B: Still donor dependent Less dependency Being Limited but Larger

but greater household in relative terms increasingly increasing proportion of
funding and more on donations than used household
government input the first group but contribution
• Bangladesh still receiving 20.8
important
• Ghana commodity
11.1
• Nepal donations (over 4.6
• Tanzania 80%) 5.4
• Uganda 12.5
C: Less donor and Some donations Being Some funding Significant

government funding with but phasing out increasingly household
more private-sector (between 30– used contribution
contribution 80%)
• Bolivia 14.8
• Guatemala 19.2
• Honduras 30.2
• Paraguay 41.6
• Nicaragua 23.9
D: More balanced public None or limited No Yes Varied

and private contribution (5–30%) contribution
• Chile n/a
• Peru 10.9
• Egypt 27.7
• Jordan 25.8
E: Private-sector and Phased-out or no No Limited local Very high

household funding the commodity relative to the
largest source support (less than previous
• Georgia 5%) groups 15.8
• Kazakhstan 14.0
• Ukraine na

• Ghana, in 2002, established an Inter-agency Working Group on Contraceptive Security (ICC/CS).
ICC/CS quickly evolved into an effective mechanism for advocating, planning, and implementing
contraceptive security strategies. One of its early accomplishments was quantifying a $2.4 million gap
between the financing actually available for contraceptives and the projected needs. Led by the MOH
and the Ghana Health Service, the ICC/CS has taken on the work of forecasting and coordinating
financial inputs. Among the specific initiatives are the use of World Bank SWAp funds, with
procurements by contracted agents; establishment of a line item for contraceptives in the regular
government budget; and reaffirming bilateral funding from USAID and DFID and multilateral
funding from UNFPA. The funding gap has been eliminated for 2005; plans are in place for a mid-
term strategy to expand contributions from the commercial and social marketing sectors.
• Guatemala, similar to other LAC countries, is in an advanced stage of donor phaseout; in 2001,
USAID ended all contraceptive donations except IUDs. In March 2002, the MOH signed an
agreement with UNFPA under which the UN agency—using funds from Holland and Canada—
would donate 100 percent of the public sector contraceptive needs. In turn, the MOH would deposit in
a joint bank account an amount equivalent to a specified percentage of the total donation for each year
(5 percent of the total donation in 2002, 20 percent in 2003, 30 percent in 2004, 40 percent in 2005,
and 45 percent in 2006). This money will go toward creating a fund that will be used to purchase
contraceptives when donations end in 2008, as well as to improve the public sector supply chain. It is
expected that by 2008 the government of Guatemala will have enough funds to cover 100 percent of
their contraceptive needs. However, in 2008, the government will also need to allocate enough funds
to cover 2009.
Emphasis on procurement. Another activity that became prominent in country CS plans was improving
the efficiency of public sector procurement. Certainly, procurement is a basic logistics function, but there
was less demand during the FPLM years than there was during DELIVER. No doubt this is related to the
shifting of mandates from helping ministries take good care of their donated contraceptives to helping
ministries develop options for replacing the declining donor contribution.
Areas that typically need attention include strengthening planning through improved product selection
and forecasting, guaranteeing transparency, and working with qualified procurement agents. The
following two examples show how DELIVER assisted with procurement.
• Nepal: As donors grappled with the continuing funding gap for contraceptives, national leadership
and coordination efforts supported by DELIVER helped identify strategies to reduce the commodity
gap. Through its own procurement unit, with technical support and partial commodity financing from
KfW, Nepal was able to obtain prices on the international market for contraceptives below the unit
cost obtained from donor-supported procurement agencies. A procurement and pricing analysis,
conducted by Nepal’s Logistics Management Division (LMD), demonstrated the benefits of central
government procurement, which has been able to obtain quality, low-priced contraceptives from the
growing South and South-East Asian manufacturing market. The MOH has also established a budget
line item for contraceptive procurement that it is increasing at an annual rate of 8 percent. The net
result of the shift toward MOH procurement has been an increase in local capacity and increased
funds for further procurements. Nepal has also recently moved toward a sector wide basket funding
mechanism for health, enabling it to draw on World Bank credit for contraceptive procurements.
• Jordan: Through the FPLM project, USAID made a significant investment to improve Jordan’s
contraceptive distribution system. This work took place from January 1997 to December 1999.
DELIVER assisted in the design, testing, and roll-out of a new system. Overall, the intervention was
so successful that technical assistance was terminated. All indications are that the MOH continues to
competently operate the system. However, a new problem arose when USAID announced in March
2004 that it would terminate commodity donations. At this point, DELIVER was invited to provide

narrowly targeted technical assistance for upgrading the ministry’s capacity for procuring
contraceptives. The work consisted of developing a three-year phaseout plan for USAID donations,
revised procurement guidelines, on-the-job training in quantifications skills, and preparing the
specifications for the impending condom procurement. As with the distribution system, the transfer of
technology was successful. In 2006, the ministry began successfully executing contraceptive
procurements without outside assistance.
General supply chain improvement. As it was under the FPLM projects, work on general supply chain
improvement was a central focus under DELIVER. This included providing assistance for physically
improving warehouses, creating and maintaining distribution systems, forecasting, procurement (as noted
above), management information systems, and evaluation. Most important, it also included work to adapt
supply chains to important HSRs, such as integration and decentralization. The following section of the
report provides details and examples for work in this area.

HUMAN CAPACITY
DEVELOPMENT AND LOGISTICS
SYSTEM IMPROVEMENT
RELATIONSHIP BETWEEN CAPACITY BUILDING AND
SYSTEM IMPROVEMENT
Human capacity building is another inclusive concept which, if defined broadly, could include advocacy,
behavior change communications, system design, curriculum development, training, supervision,
monitoring, and evaluation. DELIVER did significant work in all these areas; however, for this
discussion, priority is given to those aspects of human capacity building that contribute directly to
country-level logistics system improvement, as this was the contract’s emphasis.
As with the FPLM projects, DELIVER always had a group of staff whose work focused not only on
specific methods for transferring logistics technologies, such as training and supervision, but also on
ensuring that logistics improvement activities were designed and implemented in ways that continually
4
enabled and reinforced good logistics performance. As a result, almost any country work plan that
included system improvement activities had a high human capacity building content.
Many of the products called for in the work plans were directly related to human capacity building,
including—
• process maps, which are detailed assessments of how logistics activities are carried out before
changes for improvement are proposed. The process maps provide important insight into obstacles to
good system operations and into problems that should be avoided in the future.
• system designs for forecasting, procurement, inventory control, storage, transport, and an LMIS that
incorporate either manual or automated features and are as simple as possible to document, train,
operate, and evaluate
• standard operating procedures (SOPs) (formerly manuals) that document the correct steps for
systems operations
• job descriptions that clearly present the minimum list of essential tasks that must be carried out by
staff members to ensure that the systems will operate as intended
• job aids or well-designed summaries that remind workers at a glance of the correct steps to take for
important tasks; they are often desk top or wall-posted checklists
• training materials of various types including curricula, trainers’ guides, participant guides, role play
summaries, and simulations
• supervisory materials, including special training for good supervision practices and checklists for
monitoring performance
4
Historically, we have called this performance improvement, but can also be called human capacity building, the term used in the contract and in
this report.

• evaluation methods to measure the effectiveness of training and the correct or incorrect operations of
systems that have been implemented; in some cases evaluations may trigger additional work on every
one of the points listed here.
PERFORMANCE MONITORING
Performance monitoring is related to, but distinct from, quality monitoring. Quality monitoring focuses
on technical content and adherence to practices of proven efficacy. Performance monitoring, on the other
hand, focuses on how well logistics systems actually perform before, during, and after implementation of
changes intended to produce improvement. For performance monitoring, building on experience from
FPLM, DELIVER developed two tools—one qualitative and one quantitative. The qualitative tool is the
Logistics System Assessment tool (LSAT), and the quantitative tool is the Logistics Indicator Assessment
Tool (LIAT).
• The LSAT is an instrument used to gather the opinions of key informants on the performance of nine
logistics functions. The results provide qualitative descriptions of the status of the nine functions,
including the LMIS, product selection, forecasting, procurement, inventory control, warehousing,
product use, financing, and organization and staffing. By assigning numerical scores for how well
these functions are carried out at given points of time overall system performance can be determined.
• The qualitative assessment provided by the LSAT requires supplementation with empirical measures
of logistics systems performance. The LIAT is used to gather these measures in warehouses and SDPs
using sample surveys, with data collected through shelf-checks and retrospective document review.
The indicators measured include product availability, frequency of stockout, storage conditions, data
quality for inventory control, training, and supervision for logistics system operators.
DELIVER used the tools extensively across the country portfolio, performing 37 LSAT measures in 22
countries and 36 LIAT measures in 19 countries.
EXAMPLES OF COUNTRY WORK IN SUPPLY CHAIN IMPROVEMENT

The scope and ambition of DELIVER country programs varied greatly. Some countries, such as Rwanda
and Jordan, focused narrowly on vertical contraceptive distribution systems. Others, such as Bangladesh,
retained their primary focus on family planning, but worked extensively with sustainability related supply
chain functions, including procurement or funding diversification. Still other countries, such as Ghana,
Uganda, and Kenya, retained a focus on family planning but also worked with other health programs—
HIV/AIDS, TB, or malaria. A few countries, for example, Zambia with its HIV/AIDS focused work, were
entirely outside family planning. In some cases, for example, in Uganda, Tanzania, Malawi, and Ghana,
DELIVER assisted with adapting logistics systems to important HSRs, such as integration or
decentralization.
The main determinants of program focus and scale were the scopes of work provided by USAID missions
and the size of the investments they chose to make. In Uganda, which covered all but one of the
possibilities summarized above, the mission allocated $9.3 million over a six-year period. In Rwanda,
where the narrow focus was appropriate for a fragile government recovering from a civil war, the
allocation totaled $1.7 million over a five-year period. In some situations, such as the Central Asian
Republics, the regional mission opted for assessments only, with no design or implementation
component, and a correspondingly modest budget of $200,000 for a one-time assignment carried out over
a six-month period.
Following are several examples of country interventions and the types of human capacity development
and supply chain improvement activities, including—

• Tanzania, in 2002, launched an ambitious plan to improve efficiency by integrating the LMIS and
storage and distribution of a number of vertical systems, including essential drugs, contraceptives,
STI supplies, malaria control supplies, and laboratory supplies. Intentionally excluded were the
Expanded Programme on Immunizations (EPI) and TB programs. DELIVER helped the MOH off to
a rational start with a process mapping exercise that specifically identified factors that would
complicate the integration. As a result, before the integration took place, the MOH developed a new
system design that included improvements and simplifications for ordering, receiving, and issuing;
disbursing funds at the central level; managing funds at local levels; aligning transport schedules;
reporting; and special products handling. One special feature of the new design is a mechanism for
prioritizing products into essential products that must always be in stock, and additional products that,
while important, may be ordered and stocked on a discretionary basis. The new system was pilot
tested, evaluated, and revised. The test results were good, and the transparent design and evaluation
process gave confidence to other donors, such as DANIDA, which provided significant funding for
the national rollout.
• In Rwanda DELIVER’s work reflected the USAID Mission’s desire to directly support one important
program—family planning—with the design and implementation of a vertical distribution system.
Prior to 2002, contraceptive distribution was plagued by problems that included bad storage
conditions and a limited choice of products at SDPs—often only one or none. At higher levels of the
system, unfilled logistics positions were associated with stockouts at district levels. A design
workshop held in 2002 produced consensus on how to upgrade storage, stock control,
minimum/maximum inventory control mechanisms, and the LMIS. Following the workshop,
DELIVER assisted with preparing SOPs for district and SDP levels, as well as job aids for staff with
logistics responsibilities. DELIVER assisted the MOH in training or orienting 546 staff members at
SDP, district, and national levels.
Such important negative indicators, such as stockouts and product expirations, improved
dramatically. As often happens, concrete and visible progress in improving logistics for family
planning stimulated interest in upgrading logistics in general. Subjectively, it appears that better
storage and inventory control for contraceptives resulted in limited improvements for other
programs—such as essential medicines—without an additional investment. The MOH filled all
central-level logistics positions and created a logistics committee to coordinate work for all programs
that required improved service.
• Bangladesh, with years of assistance from USAID and other donors, long ago addressed its public-
sector contraceptive distribution problems. Extensive training and retraining at the strategic district
store level resulted in good storage, inventory control, and an LMIS. During DELIVER, a total of
2,635 staff members at all levels received training on these systems. Training in monitoring and
supervision reached 105 supervisory staff members. Although DELIVER continued to provide inputs
into contraceptive distribution, the project also made important contributions elsewhere.
An activity with considerable measurable impact was assisting the MOH with upgrading its
procurement practices. This came about because, as the MOH attempted to pursue a funding
diversification strategy, it found that it had neither the staff nor the procedures in place to carry out
transparent international competitive procurement practices. With key input from DELIVER’s
partner, PATH, newly developed SOPS and training materials were used to train 489 desk officers
from the directorate generals of both health and family planning in internationally accepted
procurement practices. One concrete result, as noted above, was a reduction in unit costs, in some
cases for good quality Indian contraceptives, a savings of $17.2 million for one 2004 procurement.
Another new departure in Bangladesh was DELIVER’s support in improving NGO contraceptive
distribution systems, training 621 staff in logistics management systems.

One important misadventure taught the project a valuable lesson. The MOH’s loan agreement with
the World Bank called for integration of the health and family planning logistics systems. Although it
was evident that the program’s logistics component had been poorly planned, after a request from the
MOH, DELIVER agreed to help out—or at least try. From 2000 to 2003, DELIVER carried out an
assessment, developed an SOP for integration at the district level, and helped train staff and merge
storage and inventory control systems in more than 483 districts.
DELIVER’s first contribution was to advise the MOH that, optimistic Bank reports not withstanding,
integration was extremely unpopular with the rank and file of health and family planning workers,
and there was considerable resistance to this reform at district and SDP levels. At least one law suit
and one national election later, the MOH cancelled the integration plan. The lesson to be learned was
to recognize the risks of investing in reforms that look good on paper, but which are not, in fact,
politically feasible. As will be seen below, however, when planned carefully and implemented
incrementally, integration of logistics functions can be made to work and can bring benefits to all
stakeholders.
• Ghana’s MOH in 2001, asked DELIVER to assist with a broad assessment of four vertical logistics
systems: contraceptives, essential drugs, expendable medical supplies, and vaccines. Process mapping
revealed that many procedures were either duplicative, unnecessarily time consuming, or both. Based
on this analysis, the MOH decided to integrate the management of contraceptives, essential drugs, and
expendable medical supplies. For contraceptives, this resulted in a reduction of tiers in the
distribution system from four to three. One of the key challenges for the integration was forecasting,
the specialized requirements of which vary by product category. DELIVER worked with the
procurement unit to create schedules and routines for coordinating the work of different health
program specialists to ensure that the preparation of comprehensive forecasts could be synchronized
to support procurement schedules.
DELIVER supported these efforts by creating SOPs and training 1,055 staff at all levels to operate the
integrated distribution system. To promote sustainability, DELIVER also developed a comprehensive
commodity security training program for central-level staff that focused on forecasting, procurement,
and overall logistics systems management. In addition to on-the-job training, six key staff attended
DELIVER’s international course. The overall result of this particular performance improvement
activity was to create at the MOH a cadre of logistics resource staff to support operations at district,
regional, and central levels.
In addition to supporting the major thrust towards integration, DELIVER also assisted with design
and implementation of systems for HIV/AIDS products management. This included training staff
from 21 ARV sites in LMIS, and ARV and HIV test kit quantification. Due to the special nature of its
products, the HIV/AIDS distribution system was set up as a vertical one, with the intention of
merging it with the larger system later. The MOH also requested assistance with logistics support for
laboratories, and DELIVER completed a needs assessment for work in this area.
With so much going on, it would be easy to overlook the fact that DELIVER continued to support
contraceptive logistics, preparing the MOH to use World Bank funds to manage its own
procurements.
• In Uganda, DELIVER’s work covers all of the items described for Ghana and much more. DELIVER
assisted with almost every public health logistics activity imaginable, beginning by integrating
contraceptives, general essential drugs, STI drugs, malaria drugs, OI drugs, HIV and malaria test kits,
and general laboratory supplies into one system. In addition, DELIVER assisted in setting up
specialized partially vertical systems for TB drugs, ARVs, and malaria bed nets. These efforts
covered the four functions of the logistics cycle—selection, procurement, distribution, and use—and

all the human capacity building and logistics improvement activities described above for other
countries.
It is difficult to summarize any country program in a small space, but this is especially true for
Uganda because of the size of USAID’s investment and the multiplicity of programs receiving
simultaneous support. Accordingly, we have developed a case study for Uganda (see appendix 4).
What is discussed here is a relatively recent development that is dramatically affecting work in
Uganda, as well as other countries in Africa. We refer to the enormous increase in commodity inputs
for donors’ highest priority projects, which recently have been immunizable diseases, HIV/AIDS, and
malaria.
Uganda received commodity inputs from bilateral donations, World Bank procurements, and GFATM
grant procurements, plus, very recently, PEPFAR and the President’s Malaria Initiative (PMI).
Furthermore, service targets were growing significantly. To give a sense of the scale and velocity of
increase, note the following:
• Between 2001 and 2006 the value of essential drugs that the MOH distributed grew from $18.7 to $84
million. Over the same period, the value of TB drugs increased from $1.46 to $3.22 million. Vaccines
increased from $2.36 million to $17.7. With the introduction of polyvalent vaccines, ARVs increased
from zero to $16 million. During the same period, the increase in contraceptive funding was more
modest, but still significant at 20 percent.
• The MOH served no ARV patients in 2001, 2,225 in 2004, about 35,000 in June 2006, and a target
for 2007 of 56,000. From 2004 to 2006, the number of sites providing ARVs grew from 26 to 220.
• The number of condoms distributed rose from 35 million in 2001 to 80 million in 2006.
• During the same period, DELIVER assisted with quantifications and other procurement-related
activities for the GFATM, the World Bank, and PEPFAR, with a total value in excess of $250
million.
These examples represent orders of magnitude increases in the MOH’s logistics requirements. It is not so
much that they include problems that have not been seen before, but rather they bring along every
problem anyone has ever seen and all at the same time. Examples of interventions that DELIVER
supported to manage the scale-up included—
• As programs expanded, the National Medical Store (NMS) was working to capacity and struggling to
respond to emergency orders from the field. An interim solution to this problem was to establish an
emergency order team to respond to life-threatening situations that included ARVs, TB drugs, or AL.
• The long-term solution to the problem lies in continuing to upgrade the LMIS and distribution
capacities of the integrated and vertical systems that now serve the MOH. Some concrete
interventions were to design a logistics system for HIV tests and ARV drugs, and to develop clearly
documented SOPs for both systems that assisted supply chain managers and officers at all levels to
understand and execute their logistics responsibilities. Another significant contribution was the
implementation of a computerized LMIS at the central level to manage logistics information for HIV
test kits and ARV drugs. The computerized LMIS, which was a version of Supply Chain Manager
software customized for the Uganda systems, is housed in the MOH’s Resource Center. It facilitated
rapid aggregation and analysis of logistics data (consumption, stock on hand, and adjustments),
which, in turn, enabled the MOH to make on-time decisions and inform the NMS on resupply
quantities.
• Surges in volume can be managed better when system operations become more efficient. Introducing
bar coding and shrink-wrapping should improve the security and tracking of stock—especially high-

value items, such as ARVs—as they move through the system. Though bar coding failed in a
previous attempt, the potential benefits may warrant another try. A related but distinct effort is the
harmonization of the forms and LMIS procedures for all the different public-sector and NGO logistics
systems. This was particularly important for ARV drug management. All LMIS records and reports
were harmonized for the MOH sector and for the Joint Clinical Research Centre (JCRC), the largest
non-government provider of ART services. Some facilities received ARV drugs from both the MOH
and JCRC, and given that the same pharmacist manages the same supplies separately, harmonizing
the forms and procedures greatly facilitated their ability to perform this duty.
• Customs clearance—always a headache—becomes a bigger headache when funding increases and
procurements increase the volume of imports. In human resource terms, NMS was not well staffed or
organized to handle the surge in work. Focused support to create a cadre that understands customs
clearance requirements can improve the situation; DELIVER helped the NMS begin the process of
creating such a staff.
Beginning in the mid-1990s, with help from the Family Planning Logistics Management project and later
the DELIVER project, Bolivia implemented a number of governmental reforms that decentralized health
sector financial and managerial responsibility to the 311 municipalities:
• In 1999, the Maternal and Infant Health Insurance program was expanded to cover ninety different
services, and LPP revenues doubled, from 3.2 to 6.4 percent.
• In 2002, with DELIVER’s assistance, the now Universal Maternal Infant Health Insurance (SUMI)—
was established by law. Supplies provided by national health programs (including contraceptives)
were included in service benefits to be reimbursed with SUMI funds.
• In January 2006, in accordance with Resolution 0032, Article 2, SUMI, again with help from
DELIVER staff, was expanded to include all girls and women between five and sixty years of age. It
also covered annual pap smears for the prevention of uterine cancer, treatment of precancerous
lesions, and mutually agreed-to voluntary contraception. Contraception will be offered to all women
of reproductive age.
These reforms resulted in the transfer of responsibility, authority, and funding for most pharmaceutical
purchases to health establishments and/or municipal governments.
• Apart from a recently completed CS assessment, DELIVER did not work in the Central Asian
Republics, but the region still merits a brief mention because JSI Logistics Services carried out supply
chain–related work in the region using DELIVER’s lessons learned, thus reducing costs to the client.
In Uzbekistan, Tajikistan, Turkmenistan, and Kyrgyzstan, JSI collaborated with Project HOPE to
implement a TB drug distribution system. In a situation where the quantity of work to do greatly
exceeded the funds available, JSI designed and implemented a simple, locally appropriate LMIS that
was based on models developed elsewhere. In completing this work, the JSI logistics staff consulted
the DELIVER LMIS and performance improvement staff to ensure that the work met DELIVER’s
quality standards.
Project HOPE and the National TB Center staff greatly appreciated the support for training, in
particular, and they took the transfer of technology very seriously, which enabled them to work with
increasing independence. As a result, USAID’s Central Asia TB Control project made significant
progress in a key area of logistics and were able to contain costs by using DELIVER-developed
methods and products.
This completes a review of DELIVER’s work in a sample of countries to illustrate the spectrum of
DELIVER interventions in Rwanda, Bangladesh, Ghana, and Uganda, plus DELIVER’s influence in
Central Asia. Country reports for all countries in the DELIVER portfolio that received substantial

assistance will be available on the DELIVER website. However, this sample clearly demonstrates the
interplay between the human capacity development and logistics system improvement elements at the
country level, which, when taken together, were the heart of the project.
NEW CHALLENGES
The country summaries mentioned above note some of DELIVER’s work to improve logistics for the
closely related areas of HIV/AIDS and laboratory services and the work in the fragile state of Rwanda.
However, these passing mentions do not do justice to the volume and complexity of work carried out in
these critical and growing program areas.
• Logistics support for HIV/AIDS and laboratories were both new challenges—neither was a focus
under the FPLM projects. DELIVER’s progress in both areas reflects well on the project’s ability to
start from zero and increase work substantially in response to demand.
• When DELIVER began, USAID had yet to develop its Fragile State Strategy, but the project knows
now that some of the countries in the DELIVER portfolio fall within this category. In addition to
Rwanda, the countries include the Democratic Republic of Congo (DRC), Nigeria, and Zimbabwe.
HIV/AIDS
At the start of the DELIVER project, the landscape of HIV/AIDS programs was vastly different than it is
now. Few national HIV/AIDS programs existed in many of the countries where DELIVER worked, and,
if they did exist, they were under-resourced. The majority of HIV/AIDS interventions in countries were
pilot projects—none had been taken to scale and few had dedicated logistics components. As a result, the
project’s experience working with HIV/AIDS supply chains was extremely limited. DELIVER’s first
forays into HIV/AIDS-related technical assistance was in Tanzania in 2001, where, due to our long-
standing and successful logistics support for contraceptives, the mission requested support for HIV test
kits and STI drug quantification. Many of the project’s initial HIV-related supply chain work was limited
to HIV tests, given that treatment was still considered unaffordable and impossible for developing
countries to consider. However, in 2003, with the launch of several global initiatives—the Global Fund
for AIDS, Tuberculosis, and Malaria; WHO’s 3 by 5 strategy; and the President’s Emergency Plan for
AIDS Relief—resource-poor countries, for the first time, began to have access to the financial and
technical resources needed to provide ARTs to thousands of people living with HIV/AIDS.
Implementation of large-scale treatment programs, however, was fraught with technical challenges,
especially in countries that were hardest hit by the epidemic.
Because of DELIVER’s experience in helping to strengthen supply chains and improve product
availability for contraceptives, essential medicines, and HIV tests; and its model of collaborative and
consultative system design and implementation; DELIVER increasingly became a partner of choice for a
number of USAID Missions and MOHs. The project provided technical assistance and support in supply
chain management for emerging national HIV/AIDS programs, all of which were under extreme political
pressure to scale-up rapidly. Between 2002 and the end of September 2006, DELIVER provided support
in the supply chain management of HIV/AIDS commodities to 18 countries, including Côte d’Ivoire, El
Salvador, Ghana, Guyana, Haiti, Honduras, Kenya, Malawi, Mozambique, Nepal, Nigeria, Rwanda,
South Africa, Tanzania, Uganda, Ukraine, Zambia, and Zimbabwe. A number of these countries only
requested short-term, isolated interventions for one or more logistics functions, or for just one category of
commodities. In eight of the countries, however, DELIVER designed logistics systems for HIV tests
and/or ARV drugs and provided support in all aspects of implementation.
Given the complex commodity funding and partner environment in many of these countries, DELIVER’s
approach was to build on and leverage existing supply chain approaches that had previously worked well,
and then to continually adapt them to meet the challenges posed by the changing environment. DELIVER

tapped into another strength—its ability as a centrally funded project to (1) provide standard approaches
that countries could use as a template to adapt, simultaneously test, and learn new approaches across a
variety of countries and settings; (2) identify emerging promising approaches; and (3) rapidly share those
lessons with other countries further behind in the process of system design and implementation.
For example, DELIVER developed two versions of Guidelines for Managing the HIV/AIDS Supply Chain
(DELIVER 2006), the equivalent of The Logistics Handbook: A Practical Guide for Supply Chain
Managers in Family Planning and Health Programs (John Snow Inc./DELIVER 2004), but for
HIV/AIDS commodities. Published on CD-ROM, the guidelines were easily accessible by country
counterparts, and could be updated quickly and affordably. The guidelines comprised eight documents,
each addressing different components of the logistics management cycle. The inventory management
document included sample templates for LMIS records and reports for managing HIV tests and ARV
drugs that could be downloaded by program or supply chain managers and adapted to the country
requirements. More than 3,000 CDs have been distributed to MOH and NGO partners in over 17
countries; the LMIS forms have been used as models for developing a national LMIS in Nepal, Nigeria,
Zambia, and Zimbabwe.
LABORATORY SUPPORT
The scale-up of ARV treatment programs highlighted overwhelming deficiencies in laboratory services,
and the process was a catalyst to the start of DELIVER’s laboratory logistics support programs.
Laboratory services to support HIV programs are required to diagnose HIV, opportunistic infections, and
related conditions, as well as for baseline testing and monitoring of patients beginning ARV treatment.
Consequently, WHO developed a minimum menu of laboratory test categories for individual countries to
determine the specific number and type of tests required to support HIV/AIDS prevention and treatment
programs. Although the resulting recommended test menu represented a finite number of laboratory tests,
the laboratory supplies (e.g., reagents and other consumables) required to complete each test can increase
very rapidly as there are a number of different testing methods that can be used for each test, each
requiring its own combination of reagents and consumables. The management of potentially thousands of
laboratory supplies introduced a level of complexity that had far-reaching implications for supply chain
logistics.
DELIVER’s work to support laboratory services began with assessments of laboratory systems. Initially,
survey instruments to determine ART readiness, including a dedicated laboratory section, were used to
assess laboratory system readiness in Zimbabwe, Ghana, Tanzania, and Burkina Faso. By mid 2004, the
process evolved into a comprehensive assessment tool designed specifically for laboratories: the
Assessment Tool for Laboratory Services (ATLAS). The ATLAS was fully implemented in Ghana and
Uganda, for a total of 560 laboratory sites, and it was adapted in Kenya and used to assess 16 laboratories.
As is true of most logistics activities, assessments provide the foundation from which additional technical
initiatives are identified and built. The same is true of laboratory assessments. Each of the assessments
executed by DELIVER resulted in deliberate and targeted logistics interventions that were appropriate
within the context of the country or program. In both Uganda and Kenya, assessments were followed by a
full-scale logistics system design and implementation, including the creation of logistics SOPs and
country-wide training curricula, as well as the execution of system roll-out activities.
Additionally, in Uganda, Kenya, and Zambia, a full quantification of laboratory supplies was also
conducted. However, to complete the quantification exercise and to keep the number of commodities
required in laboratories to a manageable 250 to 300 products, countries had to standardize the test menus,
test techniques, testing equipment, and SOPs. DELIVER facilitated this work by managing a
collaborative standardization process among relevant country stakeholders; taking a holistic approach to
the strengthening and management of laboratory services.

Finally, as a result of the collaborative field work undertaken during the course of the project, DELIVER
institutionalized the knowledge gained from these activities by producing extensive, strategic technical
documents, including Guidelines for Managing the Laboratory Supply Chain (Felling et at. 2006),
Lessons Learned in Managing Laboratory Supplies (DELIVER 2006), Guide for Quantifying Laboratory
Supplies (Diallo 2006), and the Assessment Tool for Laboratory Services (Diallo 2006) , and by
producing numerous posters and presentations for industry meetings and conferences, sharing the
project’s knowledge and experience in a global forum.
WORK IN FRAGILE STATES

USAID elaborated its Fragile States Strategy in 2005. While DELIVER was awarded in 2000 and was not
given an explicit focus, the project did work in a number of on fragile states (Nigeria, Rwanda,
Zimbabwe, and the DRC). The fourth USAID Strategic Priority in the Fragile States Strategy is to
“Develop the capacity of institutions that are fundamental to lasting recovery…” (USAID 2005) e.g.,
health care. DELIVER, by focusing on building logistics management capacity to ensure the effective
provision of health services, contributed to this strategy. DELIVER also supported this strategy both in
post-conflict settings like the DRC and Nigeria and in a country currently in crisis, Zimbabwe.
Since 2001, the DRC has been struggling to emerge from a post-conflict state. The end of the twentieth
century was extremely chaotic in the DRC (then Zaire). “After thirty-two years of dictatorial rule under
Mobutu Sese Seko, a war brought Laurent Desire Kabila to power in early 1997. …a second war pitting
President Kabila against his former key allies, Rwanda and Uganda, [began] in mid-1998. Despite a peace
agreement signed in Lusaka during the second half of 1999, instability, large-scale human rights abuses,
and multiple humanitarian emergencies continued into 2001…The assassination of Laurent Kabila and his
replacement by his son, Joseph, in early 2001 ushered in a more hopeful period of increased movement
towards peace, greater stability, and improved economic management.” (USAID 2002) However, Eastern
Congo continued to experience humanitarian emergencies. Challenges working in the DRC in this period
included disruption of in-country transportation, open conflict, and the risk of emergency evacuation.
DRC activity came late in the DELIVER project cycle. The project received funding in 2004 to support a
reproductive health logistics initiative managed by a local NGO, SANRU, which has piloted family
planning interventions in 22 zones. Initial training in reproductive health logistics was so well received
that it led to additional resources being made available by USAID and, by CARE in 2005, for system
assessment, logistics system design activities, and the implementation of capacity-building strategies that
included training of supervisors and trainers, all of which have contributed to improved contraceptive
availability in the target zones, as well as increased enthusiasm by project implementers.
Nigeria’s short-lived civilian rule was crushed in 1993 when General Sani Abacha took power in a
military coup. Abacha employed violence on a wide scale to suppress civil unrest and was considered by
both Nigerians and foreign observers to be extremely corrupt. In response, USAID decertified the
government of Nigeria for development assistance in 1994. While humanitarian assistance continued,
USAID ended its support to the Federal MOH family planning program. Abacha’s death in 1998 and
Federal elections in 1999 created an opportunity for a return to civilian rule and a resumption of broader
USAID development assistance to the public sector. Challenges working with the government in 2001
included travel restrictions due to civil unrest; poorly defined implementation responsibilities across a
huge, multi-tiered administrative bureaucracy; and a strained relationship between the Government of
Nigeria and the largely pessimistic donor agencies.
In 2001, DELIVER conducted its first assessment of the Federal MOH family planning program. Over
the next five years, the project engaged with the government of Nigeria (GON), as well as other national
and international stakeholders, in a broad program designed to strengthen both reproductive health policy
and to build logistics management capacity to ensure the availability of contraceptives in all 36 states. By
2003, DELIVER had trained more than 2,000 health service personnel from 12 states on the National

contraceptive logistics management system (CLMS). By 2004, through the combined efforts of the GON,
UNFPA, USAID, and its contractors, more than 10,000 ministry staff had been trained on the CLMS. A
mid-term evaluation in 2005 indicated that contraceptive availability increased between 2002 and 2005;
storage practices and the availability of stockcards also improved during this time. In 2004, largely
because of the perceived success with contraceptive logistics, DELIVER was asked to begin working
with the National AIDS and STI Control Program; by 2006, the project had helped them build and
implement logistics systems for HIV/AIDS commodities.
In contrast to the DRC and Nigeria, Zimbabwe is currently in crisis. “Political and economic policies have
resulted in hyperinflation, high unemployment, shortages of food and fuel, and widespread hunger and
disease. The country’s once excellent public health system is declining, and quality health services are
sparse. Many international donors have discontinued their development programs, leaving national health
interventions underfunded.” Political instability has also exacerbated a brain drain in all sectors, and as
highly qualified personnel find employment in other countries, critical services are often understaffed.
Another challenge for DELIVER, as indeed for all USAID projects operating in Zimbawe, is to support
social sector service delivery without associating too closely with the unpopular policies of the current
regime. However, in Zimbawe, the government of Zimbabwe provides a large percentage of health
services (e.g., over 75 percent of family planning services according to the 1999 DHS). In 2003,
DELIVER worked with the Zimbawean National Family Planning Council to establish the highly
innovative Delivery Truck Topping Up (DTTU) system for condoms. The DELIVER strategy was to
work with local stakeholders to implement programs that sought to demonstrate measurable short-term
impact by reducing frequency and duration of stockouts of contraceptives and, later, HIV/AIDS program
commodities. These activities operated to support the broader goal of health systems strengthening within
the MOHCW (see table 3).
Table 3. Specific DELIVER Interventions, 2002–2006
Strategic
DRC Nigeria Zimbabwe
Intervention
Assist the government to • LMIS, inventory control • LMIS and Inventory • Procure and distribute
ensure the provision of system design Control System USG funded ARV
basic public health • Supervisors’ training redesign drugs for selected
services. and training of trainers (streamlining) phase I sites.
• System Assessment • Service providers • Provide technical
• Forecasting training. trained on CLMS assistance and
• TOT for master strengthen public
trainers sector capacity in
Build technical capacity • Training on supply chain
for logistics management forecasting and management of
within institutions PipeLine software HIV/AIDS
responsible for • Training on health commodities in the
healthcare. commodity supply national program.
chain management • Strengthen sites’
• Supervisor training for ability to manage ARV
state and LGA FP medicines.
coordinators
Emphasize displaced Work focused on South N/A In the current state of

persons or other Maniema,a conflict- crisis, the entire
vulnerable groups. affected region. population may be
vulnerable, particularly
PLWHA.

Table 3. Specific DELIVER Interventions, 2002–2006 (continued)
Strategic
DRC Nigeria Zimbabwe
Intervention
Develop close DELIVER worked in close • SPARHCS Support to the National
partnerships with other collaboration with CARE assessment HIV Care and Treatment
donors and international and SANRU. • Joint action plans Partnership Forum and
organizations to enhance • CPT and various technical working
coordination. quantification groups and
exercises subcommittees.
Strengthen or reform While not a major • CLMS cost recovery Support for policies,
policies within institutions objective of the project, strategy including the
responsible for DELIVER worked with • National RHCS policy establishment of a
healthcare. other stakeholders to logistics section in the
identify policy issues MOHCW and support for
during an LSAT exercise decentralization of
in 2006. HIV/AIDS services to
rural health centers.
The timeframe for the DELIVER interventions in these countries was relatively short (2–4 years).
However, according to the 2005 USAID Fragile States Strategy, “Because those living in fragile states
cope with instability and uncertainty by focusing on the near term, short-term measures are critical to
meeting their immediate needs and promoting an environment of security. At the same time, the urgent
need for short-term measures should also be considered in the context of longer-term efforts required to
advance stability, reform, and institutional capacity” (USAID 2005). The DELIVER emphasis on
capacity building in this environment conformed unintentionally to this strategy (see table 4).
Table 4. DELIVER Achievements
Strategic
Intervention DRC Nigeria Zimbabwe
Assist the • Logistics system in • System designs, SOPs • DTTU system distributes
government to place in South and training curricula for [contraceptives] to 99% of
ensure the provision Maniema. contraceptives, ARVs, and all health facilities every
of basic public • Stockouts avoided in HIV test kits. trimester; has achieved
health services South Maniema. • Over 2,000 service stockout rates of less
• USAID Mission and providers, 99 supervisors, than 5%.
their partners trained in and 40 trainers trained on • ARVs provided in full
different methods for the CLMS. supply for 500+ patients at
forecasting. • % of public-sector facilities the phase I sites.
• A 2006 study of CARE- with condoms in stock on • The phase I ART sites
supported SDPs the day of visit increased have SOPs and are
indicated: from 4% in 2002 to 94% in correctly following national
– products available at 2005. guidelines.
warehouses and HC • % of storage facilities • Phase I sites can manage
– no stockouts on the adhering to good storage ARVs using project
day of visit practices increased designed forms and
– fewer stockouts between 2002 and 2005. procedures.
during the last 6 • % of public-sector facilities
months compared to with combined oral
2004 contraceptives, injectables,
and condoms in stock on
day of visit was 56% in
2005 compared to 0
in 2002.

In Nigeria, the percentage of public-sector facilities with condoms in stock on the day of visit increased
from 4 percent in 2002 to 94 percent in 2005.
By working to develop broad stakeholder support for concrete, measurable objectives, DELIVER
accomplish much in the context of fragile states. In Nigeria, the percentage of public-sector facilities with
condoms in stock on the day of visit increased from 4 percent in 2002 to 94 percent in 2005. In the DRC,
contraceptive stockouts were reduced to zero in the CARE-supported sites; in Zimbabwe, a full supply of
ARVs was established for over 500 patients, supported by USAID. In Zimbabwe, DELIVER was also
able to work with an NGO to establish a highly innovative and effective distribution system—the
DTTU—which ensured the availability of contraceptives nationally. Condom stockout rates in Zimbabwe
are less than 5 percent in 99 percent of health facilities nationally. “The lesson learned in DTTU is that,
even in a fragile state environment with a collapsing economy, commodity security can be achieved with
willing donors, accurate product forecasting, and a well-designed and implemented distribution system.
Key to the success of the system has been placing control of financial and other resources for the system
in the hands of the donors’ contractors, rather than with government agencies.”
RESULTS
DELIVER’s largest input in any country arena was for technical assistance; the intermediate outputs
included LMIS system designs or training materials; the main outputs were improved logistics operations
of various types. However, the contract is clear that, in terms of impact, the intended result is improved
availability of commodities, particularly contraceptives, without setting up many systems or training
many MOH staff.
In reality, caution is required when attributing causality for improvements or deteriorations in product
availability. For example, a marked improvement in availability of oral contraceptives in a sample of sites
following the implementation of an LMIS could be primarily attributable to the recent arrival of a major
shipment from a donor and not to improved information flow. Or, a slight decline in product availability
following implementation of a stock accounting system could represent a good showing in the context of
a generally deteriorating environment at the MOH rather than a poor performance of a new system.
Considering these caveats, the evolution of product availability can be assessed in five ways:
By far, DELIVER has amassed the greatest amount of information for contraceptives. For this product
category the project considers three approaches:
• comparing baseline and endline measures
• analyzing consumption data from CPTs
• parallels of LSAT, LIAT, and CPR
• financial inputs compared with project outputs.
Because HIV/AIDS and laboratory support were introduced as new challenges for public health logistics,
an attempt is made to assess some of the impact of the project’s work on product availability. This we do
by—
• Review of project outputs in HIV/AIDS product management.
COMPARING BASELINE AND ENDLINE MEASURES FOR CONTRACEPTIVE AVAILABILITY

The clearest way to assess product availability is to compare measures taken early in the project with
measures taken later in the project. As noted above, DELIVER developed the LIAT tool to take simple
quantitative measures of selected logistics indicators, among which are product availability and stockout

frequency. As noted, altogether the project took 36 LIAT measures in 19 countries. Although the tool has
worked well for problem identification, system design, and performance monitoring, it has been much
less useful for evaluation because, during the course of the project, changes were made in LIAT’s design
and in sampling methods, causing a situation where many of the early and late measures could not be
usefully compared. In the end, it was possible to develop useful comparisons for only seven countries 5 In
preparing this report the project evaluated these data, but for such a small sample of countries no trends
emerged.
ANALYZING CONSUMPTION DATA FROM CONTRACEPTIVE PROCUREMENT TABLES

Fortunately DELIVER has more than one option for evaluating product availability. Table 5 shows the
trend in the quantity of annual consumption of public-sector contraceptives from 2000 to 2006 for
selected countries. The quantity of contraceptive consumption is expressed in terms of thousands of
couple-years of protection (CYP). The information is obtained from the CPTs archived in NEWVERN.
Although CPTs contain historical consumption data for two years prior to the CPT year, only the
consumption data from the year prior to the CPT year is used for this analysis. Blank cells indicate that
the CPT for the corresponding reference period is not available.
Only the countries with sufficient data to observe meaningful trends are included in the analysis. The
contraceptive consumption information is limited to the public sector because the public sector family
planning programs are the major clients for DELIVER’s technical assistance activities. Therefore, the
change in public sector contraceptive consumption in a country can be partly attributable to the impact of
DELIVER.
The analysis shows that in countries where DELIVER provided technical assistance (and where data are
available), there is an increase in quantity of public-sector contraceptive consumption. 6 This, in turn,
suggests improved product availability on a national basis.
Table 5. Trend in Annual Consumption of Public Sector Contraceptives (in 1,000s of CYP) in
Selected Countries, 2000 to 2006
2000 2001 2002 2003 2004 2005 2006

Asia
Jordan 140.5 151.1 159.8 170.4 178.3
Africa
Ghana 279.6 377.0 330.6 385.6 424.2 403.0 433.0
Madagascar 239.0 273.1 265.1 303.1
Malawi 361.5 350.7 415.1 503.0 466.6 608.5
Mali 58.6 90.0 64.1 67.7 128.6
Mozambique 347.8 587.3 331.7 418.8 383.1
Rwanda 40.7 64.9 93.5 155.4
Tanzania 1,242.3 937.5 925.4 1,145.0 978.4 1,311.8 1,573.0
Uganda 531.7 391.6 678.4 250.3 702.9 211.8 919.0
Zimbabwe 1,106.5 1,143.9 1,331.5 1,386.4 1,235.4 1,302.9
5
Nigeria, Malawi, Rwanda, Mali, Uganda, Ghana, and Bangladesh
6
The major drawback of this analysis is that some of the historical consumption data reported in the CPTs are actually issues data from central
warehouses or, in a few cases, demographic or service statistic estimates, which, as we know, are prone to errors. Nevertheless, when issues data
are used to proxy consumption, the logistics advisors take the effort to adjust the final estimates based on best judgment and other programmatic
information to reduce the errors.

Table 5. Trend in Annual Consumption of Public Sector Contraceptives (in 1,000s of CYP) in
Selected Countries, 2000 to 2006 (continued)
2000 2001 2002 2003 2004 2005 2006

Latin America
El Salvador 81.7 121.2 147.5 167.6 172.0 181.9
Guatemala 127.1 148.9 200.7 228.1 224.5 230.5
Nicaragua 198.9 226.9 220.2 159.0 255.1 299.6
Paraguay 88.0 138.9 154.8
Source: 2001 to 2007 CPTs obtained from NEWVERN in May 2007
Because the quantity of contraceptive consumption in many cases are estimates from issues data, the
annual consumption reported for a given year may include quantities of contraceptives that are still in the
pipeline but were actually consumed the following year. Therefore, to observe valid change in
contraceptive consumption over time it is more appropriate to compare the average annual consumption
(averaged over two to three years) rather than comparing the reported annual consumption. Accordingly,
to correctly interpret the trend in the annual consumption of contraceptives in table 5, the reported
consumption figures for each of the countries are illustrated in graphs and changes in contraceptive
consumption over time expressed in changes in the average annual consumption and described in the text
below. See appendix 6 for copies of the graphs.
CORRELATIONS OF LSAT, LIAT, AND CONTRACEPTIVE PREVALENCE RATES

Another way to assess trends in product availability, albeit indirect, is to examine correlations between
product availability measures, perceived logistics system performance, and CPR. An ongoing study of
data from nine countries (Malawi, Mali, Ghana, Rwanda, Nigeria, Honduras, El Salvador, Nicaragua, and
Bangladesh) does that.
Figure 4 shows a strong positive correlation between perceived system performance (as scored by a
LSAT) and improvements in product availability (as measured by a LIAT). The data support the
following observations.
• There is a strong relationship between the availability of three contraceptive methods (condoms,
pills, and injectables) and the overall system performance (i.e., LSAT) score.
• As logistics performance improves, the availability of a mix of contraceptive methods
also improves.
• With a strengthened logistics system, pills, condoms, and injectables are more available in
health facilities.

Figure 4. Correlation between Product Availability and LSAT Score
This study also finds that there are strong correlations between availability of the same three
contraceptive methods and CPR and between perceived improvements in logistics operations and CPR.
See figures 5 and 6. These data suggest the following.
• There are strong relationship between the availability of three contraceptive methods (condoms, pills,
and injectables) and the CPR for the public sector.
• As product availability of a mix of contraceptive methods improves, the CPR for the public sector
increases.
• When there is a choice of temporary contraceptive methods (pills, condoms, and injectables) available
in health facilities, more women use contraception.
• There is a strong relationship between the overall LSAT score and the CPR for the public sector.
• As the overall LSAT score increases, the CPR for the public sector increases.
• When logistics systems are strengthened, more women use contraception.

Figure 5. Correlation between Contraceptive Prevalence Rate and Product Availability
Figure 6. Correlation between LSAT Score and Contraceptive Prevalence Rate

While these correlations do not establish a causal relationship between DELIVER’s inputs and improved
product availability, they do demonstrate strong associations between logistics systems improvements
undertaken by DELIVER, increased product availability, and improved CPR.
As noted, this study is ongoing, and it will continue under the USAID | DELIVER PROJECT. See
appendix 5 for a summary of results to date, including a brief explanation of the study methodology.
COMPARING FINANCIAL INPUTS WITH PROJECT OUTPUTS FOR CONTRACEPTIVE

MANAGEMENT
For a sample of the 17 countries with the largest programs, the project attempted to tabulate financial
inputs and project outputs. For outputs, we focused on the project elements for logistics systems
improvement and contraceptive security. The sample includes Rwanda, Tanzania, Uganda, Zimbabwe,
West Africa Regional Program, Ghana, Mali, Nigeria, El Salvadort, Honduras, Nicaragua, and Paraguay.
These projects have the largest technical assistance budgets, ranging from $9.4 million in Uganda to
$732,000 in Paraguay. See appendix 7 for a table summarizing the data reviewed. For at least four
reasons, this exercise has very limited analytical options.
• In any country arena, USAID inputs through DELIVER are only one among several funding streams;
it is rarely possible to associate specific outcomes uniquely with one set of inputs.
• For some indicators, product availability for example, both baseline and endline measures are not
always available; therefore, seemingly positive results cannot always be validated as trends.
• The composition of country programs vary greatly, making it difficult to make useful cross-country
comparisons.
• Within countries it is not possible to attribute specific sums to specific activities within multipart
programs.
What we can do for this sample, however, is to note the types of activities that seem to be in greatest
demand.
• Nine of the programs had major LMIS design and implementation activities. Of these, five have had
integration of logistics systems as the major focus. Since 1986, first FPLM and then DELIVER have
been working to improve the LMIS. Demand for work in this area seems to be evolving toward
greater sophistication as countries decide to integrate diverse logistics systems. No doubt, this is
stimulated in most cases by HSR programs.
Twelve of the countries in the sample had definable contraceptive security programs. In most cases,
DELIVER allocated resources for such general activities as supporting contraceptive security committees
and developing national plans. Five country programs had phaseout of donor assistance as a focus. This
brings along work on related activities, such as forecasting, donor coordination, procurement, and funding
diversification. Even countries that do not use the term phaseout request assistance in these areas, as they
tend to emerge as the most concrete issues to work on when contraceptive security is taken seriously.
REVIEW OF PROJECT OUTPUTS FOR HIV/AIDS PRODUCTS

DELIVER designed and implemented logistics systems for HIV tests and ARV drugs in seven of the nine
countries in which DELIVER had a country office. The project had the resources and mandate to
strengthen HIV/AIDS supply chains. Previously, no standardized systems had been designed for these
commodities in any of the countries; the establishment of functional supply chains greatly facilitated each
country’s ability to rapidly scale-up availability of HIV testing services and access to ART.

Examples include—
• The Government of Uganda had no patients on ARTs in the public sector in 2003. By October 2006,
the country enrolled and maintained 52,000 ART patients using the MOH ARV drug supply chain,
which was designed and supported by DELIVER with the MOH and NMS partners
• Between 2002–2004, the Government of Kenya distributed more than 4 million rapid HIV test kits
through the public sector supply chain for HIV tests to facilitate rapid scale-up of VCT and PMTCT
services around the country. The supply chain was designed, implemented, and operated for the MOH
with DELIVER assistance and support.
• In a number of countries—including Ghana, Kenya, Nigeria, Tanzania, and Uganda—the existence
and successful operation of these supply chains enabled the countries to leverage multiple sources of
funding for commodity procurement, including PEPFAR, the Global Fund, and World Bank grants.
See appendix 8 for the range of supply chain interventions for HIV/AIDS products in the nine countries
where DELIVER assisted.
Unlike contraceptives, good options are not available for making quantitative measures of HIV/AIDS
product availability as an indicator of system performance. The primary reason is because when
DELIVER was first awarded in 2000, HIV testing and ART service provision were not feasible options
for most national programs. Thus, many of the LIATs conducted at the start of the project gathered
baseline data that did not include either of these commodity categories, which means that improvements
over time cannot be measured.
We can, however, provide information on the values for the products purchased by DELIVER. Prior to
the establishment of PEPFAR’s Supply Chain Management System (SCMS) project, DELIVER was
asked to undertake procurement of HIV tests, laboratory supplies, and ARV drugs in six countries for an
overall total of $22.2 million from 2004 to 2006. Most of the procurement was to support ART provision
by national programs. Table 6 displays expenditures by country.
Table 6. Total Value ($U.S.) of HIV Tests, Laboratory Supplies, and

ARV Drugs Procured by DELIVER PEPFAR Funds, 2004–2006
Total Value Procured

ARV Drugs ($) HIV Tests and
Laboratory Supplies ($)
Mozambique 1,606,647.12
Tanzania 7,817,425.64
Zambia 9,252,768.22 723,893.01
Zimbabwe 1,143,166.87 137,009.40
Angola 87,442.94
Kenya 1,434,376.32
$19,820,007.85 $2,382,721.67

ADOPTION OF ADVANCES IN
LOGISTICS
As with contraceptive security and human capacity development, adoption of advances in logistics is a
potentially inclusive topic. Under a broad definition, novel approaches in technical assistance, such as
SPARHCS or process mapping, might qualify because they stand for better methods that ultimately
contribute to improved logistics service. However, other sections of the report already document the roles
played by these approaches and comparable tools. In this section, we emphasize innovations that are
intended to be applied by system participants within the context of routine work place operations. The
examples describe new technologies that DELIVER helped counterparts to introduce.
SUPPORTING FORECASTING AND PROCUREMENT

Over the past two decades, DELIVER has developed techniques and software tools that can be used by
central-level logistics planners and technical assistance providers to improve the forecasting of health
commodities and to monitor the procurement pipeline of these items. The PipeLine and ProQ software
packages developed by FPLM and DELIVER are the result of many years of experience by technical
advisors, central-level planners, and supply chain technicians.
As far back as the early-1990’s, JSI realized the need for an off-the-shelf software product to assist in
forecasting demand and monitoring procurement of contraceptives. FPLM developed PipeLine to help
program managers monitor whether they were receiving contraceptives in the right quantity and to assist
in making good procurement decisions. DELIVER inherited a software program from FPLM that was set
up for contraceptives only. Following a number of upgrades, PipeLine is now adapted to process data for
all categories of public health products, including essential drugs, vaccines, and expendable medical
supplies. It is available in English, Spanish, French, and Arabic.
PipeLine was used in more than 25 different countries with generally positive results. To give just two
examples, in Uganda it was used to continually monitor 126 different products; while in Zimbabwe, it
was used successfully to identify which ARVs were understocked and overstocked.
PipeLine is probably best used to identify potential understocks and overstocks and scheduling future
shipments to ensure appropriate stock levels. It also has some ability to estimate annual costs of
shipments (i.e., commodity cost and freight charges). On the other hand, DELIVER identified
improvements that can be made to PipeLine in the future if resources permit. PipeLine has only limited
forecasting capacity and would benefit from additional functionality in that area. Some users have
reported that it can be difficult to set-up and maintain, therefore, some enhancements to the installation
and data entry interfaces may be warranted.
In response to the growing demand for more reliable forecasts for HIV test kits in today’s environment of
rapid expansion of HIV testing, DELIVER in 2003 introduced a new software program called ProQ. The
software was designed to help health program managers determine the quantities of HIV tests they needed
across all HIV testing programs, namely for voluntary counseling and testing, preventing mother-to-child
transmission, blood safety, and sentinel surveillance. This function was particularly important because if
health programs are to meet their goals of treating and preventing increasing numbers of AIDS patients, a
much larger number of people must determine their HIV status, and the number of HIV tests to be
managed greatly increases. ProQ evaluates expected demand, service capacity, budget availability, and

pipeline considerations particular to each component of these HIV testing programs, and it provides
managers with the overall quantities of HIV test kits to order.
ProQ has proved especially useful as an advocacy tool for facilitating policy decisions. The software uses
data on supply chain capacity, demographics, morbidity, service capacity, and testing goals to forecast the
quantity of HIV tests needed; compare demand with service capacity; adjust amounts needed to balance
the supply pipeline; and estimate quantities to purchase to match budget allocation.
ProQ requires the use of specially designed questionnaires to assist with data collection for each specific
purpose of HIV testing. These questionnaires guide users through the data collection and/or assumption
building process (in the absence of data), and in doing so clearly identify gaps or contradictions in
policies surrounding HIV testing that may lead to poor supply outcomes. In several countries, including
Kenya, Uganda, and Zambia, using ProQ enabled program managers to enhance the efficiency of the HIV
test supply chain by harmonizing testing algorithms for VCT and PMTCT, improving product selection
decisions within each program, and identifying gaps in funding across programs.
ProQ requires users to have an in-depth knowledge of the national HIV testing guidelines and how HIV
testing services are conducted on the ground, understand the different HIV testing technologies, be
familiar with supply chain constraints, and have access to procurement and budgeting information. The
lack of information in one or more of these areas can make it difficult to use ProQ. Future enhancements
to ProQ might facilitate its usage in circumstances where data are incomplete.
DELIVER advisors have used ProQ in Tanzania, Uganda, Kenya, Ghana, and Zambia. While, in some
cases, the advisors have teamed with local counterparts to estimate and enter data, it must be
acknowledged that at this point the program is not institutionalized to a great degree. Additional work is
required to make it perform robustly in the typically data-poor country environments. Nonetheless,
because ProQ is available through the Web, feedback indicates that ProQ has been used and found to be
extremely helpful by users in a variety of settings, without any input from DELIVER. An example is its
use by Medecins Sans Frontieres in Rwanda for quantifying HIV test needs for their program.
SUPPORTING WAREHOUSING AND INVENTORY

MANAGEMENT SYSTEMS
Warehouse management systems (WMS) software are technologies that integrate software, bar coding
equipment and, sometimes, radio frequency communications to provide computerized process
management and inventory control within the walls of a storage and distribution facility. A WMS
normally supports the tasks routinely performed within a warehouse: receiving, put-away, replenishment,
picking/packing, shipping, cycle counting, and inventory control. When implemented correctly, a WMS
can bring specific and measurable advances in efficiency, such as reducing lead times, increasing storage
capacity, and improving warehouse labor productivity.
In resource-poor settings, the complexity of a WMS can vary greatly. In many cases, WMSs are used for
little more than maintaining a log of transactions and reporting on stock balances. In some cases, the
WMS also provides rudimentary put-away and picking functions. In a few cases, the WMS supports the
complete range of tasks normally associated with warehousing. In even fewer cases, the WMS supports
bar coding.
DELIVER’s experiences in implementing a WMS covered this entire range of possibilities. Three
examples illustrate the applicability and challenges of a WMS in specific settings.
• In October 2000, DELIVER assisted the MOH of Cambodia to design a transaction monitoring and
inventory management system for use in district storerooms. The Reproductive and Child Health
Alliance (RACHA) of Cambodia implemented the system (called ODDID) for the ministry between
2001 and 2004. During this time, ODDID was modified to meet the changing needs of its users.

An assessment of the implementation of ODDID conducted by DELIVER in October 2005 suggested
that these efforts had been very successful. RACHA’s strategy of starting with a core of basic
functions and then adding new functions not only ensured that the system met the changing needs of
users but also won approval from skeptical MOH managers. Another key ingredient in the success of
ODDID was the establishment of a user’s hotline. District storekeepers were encouraged to contact
RACHA whenever they encountered a problem. This helped them feel more secure and valued. User
training was also integrated into the ongoing RACHA training program supported by the MOH.
• In September 2003, DELIVER assisted in an implementation of the Intellitrack WMS at the
headquarters of Côte d’Ivoire–based Retro-CI HIV/AIDS research project. This WMS was
configured to track storage and distribution of stocks managed by the virology, biology, and
pharmacy departments at project headquarters. Intellitrack reported on stock and supported most of
the tasks normally associated with warehousing. It also contained bar coding and radio frequency
components, although neither were implemented in this case.
Intellitrack was designed so that distribution tracking began with stock-on-hand data from a central
storage facility. In Côte d’Ivoire, delays in the gathering stock-on-hand data halted the use of the
WMS in one department. This limitation of the software could not be easily remedied and thus
severely hindered the usefulness of the WMS. The lack of a local source of technical support made it
impossible to adapt the software to support Retro-CI’s unique warehousing operations.
• In 2003, DELIVER staff, working through JSI Logistics Services helped implement the WMS
manufactured by Broadline at the MOH’s central warehouse in East Timor, as part of a World Bank–
funded project. In its original form, the WMS was centered on the concept of the purchase order.
Thus, any warehouse receipt had to be associated with a corresponding purchase order. In addition,
the warehouse locator system required that all incoming and outgoing stock be recorded by volume.
The implementation process quickly revealed that the design on which the Broadline WMS was based
did not apply to the East Timor situation. A significant percentage of incoming stock was either
donated or returned from sites and thus not associated with any purchase order (a requirement of the
software). In addition, human resource constraints at the warehouse prohibited staff from recording
receipts/issues by their respective volumetric measurements (another requirement of the software).
Significant customization was required to uncouple the concept of a purchase order from warehouse
receipts and to eliminate the requirement that all receipts/issues be entered in volumetric
measurements. Additional customization was required to amend numerous reports and to incorporate
coding systems unique to East Timor.
In short, Broadline’s WMS could not function as advertised in the East Timor context. The
customization to produce a workable version of the WMS required the on-site presence of a Broadline
software engineer for nearly six months. Successful implementation was also aggravated by the lack
of a local partner for Broadline that could provide ongoing technical support. Attempts were made to
educate technicians from the leading network installer in East Timor to support the WMS, but it had
only limited success. Software problems encountered after system commissioning often led to lengthy
system downtimes and a tendency for warehousing staff to revert back to the paper-based system.
SUPPORTING SUPPLY CHAIN MANAGEMENT

DELIVER spent considerable time developing software to improve distribution planning and
monitor/report on logistics transactions throughout the supply chain, which could be used either by
central logistics planners or decentralized technicians. As far back as FPLM I, JSI developed the
contraceptive commodities management information system (CCMIS). In its original form, CCMIS
allowed central-level planners to monitor the stock status of contraceptives at different levels of the
system. Over the years, CCMIS evolved into what is now known as Supply Chain Manager (SCM). SCM

and another package, also developed by DELIVER, called Distribution Resource Planning (DRP), were
combined to provide a powerful set of tools for managing the supply chain:
• SCM, a software tool written in Microsoft Access, provides logistics management information to
managers of distribution systems. By using SCM to gather and process a program’s logistics data,
managers are better able to ensure an effective and secure supply of commodities to clients. Its main
module provides information about supply status and distribution of stocks at each service delivery
point or storage facility, quantities of products dispensed to users, and trends in consumption.
SCM has been implemented in many countries with mostly positive results. Although originally
written to be deployed at the central level, in 2004 the software was customized and implemented in
Malawi in 11 of 26 districts. The software markedly improved the accuracy of reorders sent to the
Central Medical Store. It also improved the collection of historical logistics data that is now easily
aggregated and processed at the central level for forecasting and other decision making. It was
scheduled to be rolled-out in the remaining 15 districts in late 2006.
SCM does have some limitations in its current form. It is best used with systems that use fixed order
interval/variable order quantity inventory control strategies and that have relatively high reporting
rates. It also is predicated on tracking data where there is one source for the item, for example, service
delivery points being supplied from a single warehouse. These and other limitations can or already
have been overcome through country-specific adaptations.
• DRP is designed to maximize transport routing efficiency and vehicle capacity, thereby helping to
eliminate stockouts and prevent shortages. First used with great success in Kenya in the 1990’s, DRP
uses stock level and consumption data to estimate when and how much stock is needed at lower-level
facilities. Based on this information, DRP enables distribution managers to choose between available
vehicles to make deliveries. DRP can automatically propose a vehicle routing system for the most
effective distribution.
A generic version of DRP in Microsoft Access is available through DELIVER as a module of the
SCM software package. With some technical assistance, DRP can be adapted for country-specific
use. Though successful in Kenya, it is noted that DRP was applied there in the context of a well-
funded and staffed FPLM/DELIVER country program.
WORKING WITH ENTERPRISE RESOURCE PLANNING SYSTEMS

An enterprise resource planning (ERP) system is a fully integrated collection of information systems that
span most basic business functions required by an organization. In the context of an LMIS, these systems
normally include accounting, sales/procurement, inventory management, and distribution planning. The
implementation and integration of an ERP can represent the single largest information system project ever
undertaken by an organization. Depending on the sophistication, such systems can cost anywhere from
several hundreds of thousands of dollars to several million dollars and require an army of managers,
users, analysts, programmers, and other consultants to implement. Because of the cost and complexity of
implementing an ERP, they are seldom used in resource-poor settings.
DELIVER’s experience with ERPs was limited but still instructive, including two experiences:
• In 2003 and 2004, DELIVER attempted to integrate bar coding into the existing NAVISION software
used by the Ugandan National Medical Stores. NAVISION, an ERP, contains modules for sales,
accounting, personnel, and inventory control. Efforts to connect existing bar code scanners with the
version of NAVISION owned by the National Medical Stores proved unsuccessful. Though both
NAVISION and the manufacturers of the scanners claimed that the products could interact, a certain
amount of engineering is required to bring this about. The technical expertise to provide routine

ongoing support to an installation was either not available in Uganda or, if it was, did not present
itself. Very recently, however, the National Medical Stores upgraded NAVISION to a newer version
purported to more easily support most off-the-shelf scanners.
• In Mozambique, DELIVER supported the development of the Sistema Integrado De Gestao De
Medicamentos (SIGM). This represented an effort to implement an ERP for a specific client
according to its particular business and environment. SIGM is an ERP that is designed to integrate
planning, procurement, warehousing, and distribution functions for all medications and related
consumable items between the central and provincial levels of the supply chain (17 sites in all). It is
designed to help improve timely access to logistics data for improved decision making. The system
will be able to be used for monitoring, management decision, and evaluation. It is also web-based,
thus allowing daily data downloads/uploads from provincial sites.
The development of the SIGM was beset with difficulties since its inception, including changing staff
at the MOH, a changing political environment in Mozambique, difficulties in getting consensus on
requirements, and variable responsiveness on the part of both the client and the contractor. As a
result, the project has been delayed 12 to 18 months. Such a large, long-term project runs the risk of
staff turnover within the client implementing agency and subcontractor levels; this poses a danger for
successful implementation and sustainability because a new generation of leadership within the
government may not be as supportive.
WORKING WITH TWO OTHER “CUTTING EDGE” SOLUTIONS

DELIVER also experimented with more sophisticated hardware/software to solve logistics problems.
Some of these cutting-edge tools resulted in tangible improvements in the logistics systems of resource-
poor countries, while others have met with what could be called mixed results.
• In Yemen and, and more recently, Mozambique, DELIVER used powerful Automated Computer
Aided Design (AutoCAD) software to develop designs for new warehouses. In both cases, AutoCAD
significantly increased the time required to produce layout/designs for both the site and store areas of
proposed warehouses. It also allowed stakeholders to easily experiment with different scenarios until
a mutually acceptable design could be found.
AutoCAD software can work well in resource-poor settings if it is free of problems. The fact that it is
not dependent on interaction with other software and can run on any personal computer supporting
Windows makes it very useful for warehouse design.
• In South Africa, first JSI Logistics Services, and subsequently DELIVER, experimented with a
unique way of tracking patients on ARTs. In place of the traditional patient cards often used at
hospitals in resource-poor settings, magnetized smartcards were issued to ART patients. They are
similar in size to the ATM cards used worldwide. The smartcards required a fingerprint to activate
them, thus preventing misuse. They were updated by service providers whenever the patient received
a service or drug prescription and then returned to the patient. Whenever the card was updated,
information on services and prescriptions was also stored on a reader that was later uploaded to a
central-level computer where the data were used to facilitate decision making.
The smartcards could be used anywhere that smartcard readers were available; because the readers
were portable, they could be used both at health facilities and during home visits. The data were also
encrypted, ensuring patient confidentiality and data security.
Pilot testing of the smartcards began in mid-2005 at a few sites. By all accounts, the system
functioned as designed and produced the information intended. Expansion will be funded through the
SCMS project.

MAKE OR BUY?
DELIVER achieved the broadest coverage with the new logistics technologies project developed,
specifically the PipeLine and Supply Chain Manager software. These programs represent a form of
appropriate technology, that is, they were relatively simple applications designed to improve specific
segments of the overall logistics process. They have been extensively implemented in suboptimal
situations and are known to be relatively robust in variable levels of productivity and high staffing
turnover rates. It has proven repeatedly that system maintenance can be delegated to in-country software
firms. Nevertheless, these programs do not support some important functions: they have had significant
development costs, and they require considerable ongoing technical assistance inputs for adaptation,
installation, and training.
As awareness of the importance of logistics increased among countries and donors and, as MOHs took on
increasing responsibility for managing commodity procurements, there was a natural tendency to look to
commercial off-the-shelf software (COTS), such as the WMSs and ERPs described earlier. The COTS
had the potential to support such sophisticated applications as bar coding or accounting that DELIVER’s
in-house software did not support. Because they are bought ready-made, they can be applied immediately,
significantly shortening implementation times. In some cases, but not all, they require no on-going
maintenance. In DELIVER’s experience, however, they have some important potential disadvantages,
including relatively high acquisition costs, high costs for adaptation, absence of in-country support
capacity, and failure to perform as advertised.

ESTIMATION OF USAID’S
CONTRACEPTIVE NEEDS
This section describes the work carried out by DELIVER in support of USAID’s Central Contraceptive
Procurement (CCP) system, with an emphasis on estimating USAID’s contraceptive needs. The closely
related topic of NEWVERN, the Central Contraceptive Management Information System (CCMIS), is
covered in the following section.
The Contraceptive Procurement Table (CPT) is the key tool for estimating contraceptive requirements,
and it connects global procurement activities with work at the country level. Between FY 2001 and FY
2006, 1,548 CPTs were received, reviewed for quality, analyzed, and entered into NEWVERN. These
CPTs represented 37 countries, 66 recipients, and 53 products. Table 7 displays the number of CPTs by
fiscal year, country, recipient, and product.
Table 7. CPTs by Year
FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006

Number of countries 23 28 26 22 21 20
Number of recipients 39 47 45 32 27 23
Number of products 31 33 38 28 25 33
While CPT data were maintained in NEWVERN, DELIVER also maintained an archive of all CPTs
received. Copies of CPTs were stored on-site for the current year and the past two years. All CPTs, three
years and older, were stored at an off-site location.
DELIVER annually produced the USAID Contraceptive Procurement Guide and Product Catalog as a
guide to missions, programs, CAs, and CSL and DELIVER staff on CPT preparation and USAID
ordering procedures. In FY 2002, DELIVER successfully implemented the CPT skills assessment training
course as another opportunity to improve the quality and reliability of CPTs. Over the course of
DELIVER, seven training sessions were held for 99 participants.
As noted earlier, PipeLine is a software tool that helps program managers gather critical forecasting
information, ensure that products arrive on time, maintain consistent stock levels at the program or
national level, and prevent stockouts. To improve the quality and reliability of CPTs, DELIVER enhanced
PipeLine to generate procurement tables using USAID’s CPT planning requirements and format. This
was released as version 2.0 in 2000.
At the end of DELIVER, the USAID | DELIVER PROJECT collaborated with the Supply Chain
Management System (SCMS) project to implement critical enhancements to PipeLine to increase its
functionality for a full range of health commodities and to facilitate the transfer of data between PipeLine
and the SCMS management information system.
To measure the reliability of CPTs, DELIVER conducted statistical analyses of forecasting accuracy.
Most recently, the Accurately Forecasting Contraceptive Needs: Levels, Trends and Determinants
assessed the accuracy of annual contraceptive forecasts in CPTs prepared between 1994 and 2002

compared to actual demand contained in CPTs prepared between 1996 and 2004. The comparison
consisted of 1,050 CPTs covering 50 programs in 19 countries.
The study reviewed the factors that influence forecast accuracy and defined forecast accuracy as “the
absolute percentage difference between projected and actual quantities of a contraceptive distributed in a
specific year for a given program.” The study revealed the following:
• Forecast accuracy improved between 1995 and 2004.
• Expected forecast error was about 25 percent (considered good in commercial circles).
• Forecasts were more likely to overestimate rather than underestimate actual consumption.
• Improvement in forecast accuracy were associated with improvements in the LMIS and with the use
of PipeLine software.
Finally, as noted in DELIVER’s report NEWVERN Performance Monitoring: Results 2000-2004,
countries submitting CPTs had longer order lead times (three months or more) than those countries not
submitting CPTs. This contributed to more effective central procurement planning. Countries that did not
submit CPTs were more likely to order shipments with a shorter lead time (less than three months),
placing added stress on the CCP system to respond to those shipment requests. The study also showed
that the CPT review period has decreased since 2002, indicating improved efficiency for central-level
operations and improved responsiveness to the field.

OPERATION OF USAID’S CCMIS
DELIVER maintained and managed NEWVERN, the automated order processing and financial tracking
system, also known as CCMIS. NEWVERN assisted DELIVER in supporting CSL to purchase and ship
family planning and reproductive health commodities to USAID-supported countries throughout the
world. NEWVERN was the primary repository of information relating to CSL’s contraceptive production,
warehousing, and shipping activities. It also contained information on CPTs; production contracts;
warehouse stocks by lot, field orders, shipments in process; and funds received and expended.
NEWVERN was available via the Internet to USAID staff, recipient programs, and other partners
involved in the procurement and shipping process. In FY 2005, DELIVER introduced a redesigned
NEWVERN website with many new user-friendly features and greater security options. Improvements
included the ability for users to view shipment information, account statements, and publications, as well
as updating pertinent shipping information for customers and recipients.
During the course of the DELIVER contract, the system underwent five major version updates with 12
minor upgrades, including 47 functionality additions/modifications, 23 report additions/modifications, 14
interface modifications, and 4 website updates.
The major upgrades included—
• adding the ability to track funds by account type
• handling multiple case sizes for a product
• adding the ability to transfer data electronically to the Reproductive Health Interchange
• allowing multiple shippers and both metric and English units of measure, and
• adding the PEPFAR account type.
Over the six years, there were about five instances when CSL users experienced interruptions with the
availability of NEWVERN through the T-1 line connection. In each instance, DELIVER worked closely
with USAID to quickly identify the source and resolve the problem. The NEWVERN website provided an
alternative for access to key NEWVERN information to CSL on those rare occasions.
In addition to the maintenance of NEWVERN, DELIVER operated the system by ensuring that—
• orders were accurately entered
• contract information was accurately maintained
• funding information was appropriately entered, monitored, and tracked by type
• recipient and customer data were maintained and kept current
• production and warehouse memos were issued in a timely manner
• shipping instructions were issued in a timely manner
• shipper activity was monitored
• receiving reports were issued and collected

• manufacturer and shipper invoices were reviewed and processed
• regularly scheduled reports were executed and distributed
• warehouse stock levels were monitored and reconciled
• on-time shipments were monitored.
DELIVER also maintained documentation that included a procedures manual for all operations, a
NEWVERN reference guide (a user’s manual), and a programmer’s manual (technical documentation).
These were updated regularly and were current as of September 2006.
There were certain key tasks for which DELIVER quantified NEWVERNS’ performance.
• Orders verified and entered into NEWVERN by DELIVER staff. An Authorization for Contraceptive
Shipment (ACS) was an implementation instruction to DELIVER from CSL; it was the official
documentation required to edit, enter, delete, or otherwise change NEWVERN shipments and/or
customer or recipient information. Each ACS form had a unique tracking number and specific
instructions were attached to it. Upon receiving an ACS from CSL, DELIVER staff members
reviewed and completed an ACS checklist to ensure completeness of information and as a quality
check for the correct implementation of the ACS instructions. DELIVER processed more than 860
ACS requests with near 100 percent accuracy. DELIVER was also responsible for scheduling
deliveries and issuing shipping instructions.
• Production Memos were production orders sent to contraceptive manufacturers. These orders were
usually for a fixed monthly delivery amount established in the manufacturer’s contract with USAID
and were due to manufacturers approximately 90 days prior to the end of a given production month.
Of the 509 Production Memos issued by DELIVER, 148 or 29 percent were issued late (less than 90
days). DELIVER also issued 447 amendments to these Production Memos, for a total of 956 memos
during the six years of DELIVER.
While the number of late Production Memos appears high at first glance, 132 (89 percent) of the 148
late Production Memos occurred as a result of unavoidable factors, such as the timing of a new
contract, contract modifications, waiting to obtain waivers and approvals, manufacturer production
delays or schedules, late orders, funding delays, and product transfer to a new freight forwarder.
Sixteen (11 percent of the late Production Memos, 3 percent of all Production Memos) were issued
late due to DELIVER staff error. In a few of these cases the Production Memos were misplaced by
DELIVER staff—subsequently, a new tracking process was implemented and, subsequently, no
Production Memos were misplaced. Table 8 displays the number of Production Memos and
amendments issued by fiscal year.
Table 8. Number of Production Memos and Amendments Issued by Fiscal Year
FY FY FY FY FY FY Total
2001 2002 2003 2004 2005 2006
Number of on time 72 69 42 53 60 65 361
Number of late 13 1 34 32 40 28 148
Total number 85 70 76 85 100 93 509
% of late 15% 1% 45% 38% 40% 30% 29%
Number of amendments 61 45 101 86 87 67 447

• Warehouse Memos are detailed instructions issued to the shipper to send product from the warehouse
to the field. Warehouse shipments were ordered individually, one shipment per memo. Because a
Warehouse Memo specified the number of cartons to pick by manufacturing lot, no Warehouse
Memo could be issued until the product to be shipped was in the warehouse. Warehouse Memos were
generally issued several times a month and over the course of DELIVER, JSI issued 2,758 memos
and 64 amendments, averaging 470 memos per year or 39 memos per month.
All of the aforementioned CCP activities contributed to the overall on time shipments rate, a critical
element to ensure contraceptive security. In FY 2006, DELIVER presented the results of a study,
Assessing Optimum Stock Level and Other Factors Influencing On-Time Shipments, which indicated the
percentage of on-time shipments showed an increasing trend over the life of DELIVER. Additionally,
DELIVER implemented a process to review on-time shipments more frequently—and the causes for late
shipments—to provide another tool for CSL and DELIVER to closely monitor the performance of the
CCP system and to address any concerns before they became major problems.
In addition to the day-to-day operations of the CCP system and other support to CCP, DELIVER received
and fulfilled 242 special requests for data and/or analysis from USAID and various CAs. The project also
provide related services to field programs through its advisors. As examples, the project published the
monthly CPT Status Report related to short-term contraceptive supply; queried advisors about implant use
to help USAID determine their post-Norplant strategy; surveyed advisors to find a likely acceptor
program for Megestron; and disseminated information to the field about product issues. Occasionally, the
project assisted CSL in facilitating the transfer of products between countries to be cost effective or to
avoid stockouts, overages, or potential product destruction. Examples included shipping replacement
Duofem to Zambia from DR Congo and transferring vaginal foaming tablets from Mali to Senegal.
DELIVER staff members also played a key role in supporting the overall contract management by CSL.
The project enjoyed favorable relationships with FHI (the quality assurance service provider for CCP),
Matrix International Logistics (CCP’s freight forwarder), and manufacturers, taking an active role in
management meetings and providing reports and other information for decision making. Surveys of CSL
staff showed a high level of satisfaction with our overall performance and responsiveness.

LEADERSHIP: DELIVER WAS
MORE THAN THE SUM OF THE
PARTS
International public health has always been characterized by evolution in challenges, technologies, and
priorities. Contemplating such recent developments as HSR, the advent of global funds or the onslaught
of HIV/AIDS—to name just three—it sometimes seems as if the pace of evolution is accelerating. In
these conditions, a project the size of DELIVER must be prepared to do more than distribute this product
or solve that problem. It was also our significant responsibility to provide, for clients and other
stakeholders, leadership that prepares us to respond effectively to existing and emerging challenges. The
quantity, quality, and diversity of achievements described in the first seven sections of this report makes
clear that DELIVER lived up to this responsibility. The following examples substantiate this claim to
leadership. In response to a request from USAID, we revised this text.
• Ways are being found to make progress in contraceptive security. Many organizations and individuals
are responsible for the progress made to date and DELIVER is prominent among them. Tools such as
SPARHCS and the Contraceptive Security Index have been widely disseminated. Countries and even
whole regions are changing their policies and practices in response to strategic inputs by DELIVER.
Some initiatives, such as improved procurement practices and diversification of funding, are already
showing measurable financial results. Others, such as policy formation and total market approaches,
will take more time to develop before they can achieve comparable outcomes. In either case,
however, DELIVER provided practical solutions that will provide increasing benefits if we can help
countries stay focused on implementing them.
• Improved logistics enhances HSR. In 2000, FPLM III presented the results of a study on the effects of
HSR initiatives, such as integration and decentralization, on contraceptive logistics systems. A major
finding was that HSR planners did not understand the role of logistics in public health management,
nor did they understand how carelessly designed reforms could cause deteriorations in logistics
services. The most common response was, “We’ve got to be at the table next time.” DELIVER did, in
fact, make it to the table in a number of countries, including Ghana, Uganda, Ethiopia, Malawi,
Indonesia, and Bolivia. In these cases, with the support of MOHs and other stakeholders, DELIVER
helped to build consensus on the importance of logistics and to coordinate system design and
implementation activities so that logistics services were a beneficiary and not a victim of HSR.
• HIV/AIDS logistics is complicated, but progress is being made. USAID had the foresight to expand
DELIVER’s mandate beyond contraceptives. The Jeffery Sachs call to action that launched the ARV
movement took place at the beginning of the project, and this was followed shortly by significant
global funding initiatives, including GFATM and PEPFAR. Previous USAID HIV/AIDS-focused
projects had done some work with logistics, but in retrospect it was minimal. The decision to treat
HIV/AIDS brought urgent new problems—surges in volume; management of short-lived high-value
commodities; and the need for many new products—as the simultaneous availability of ARV, OI
drugs, and laboratory supplies became a program requirement. With its pre-existing expertise in
forecasting, procurement, information management, and distribution, DELIVER was able to gear up
quickly to support ministries as they learned to handle big, short-lead-time financing, and commodity
inputs. While not all clients’ problems were solved, the ability to cope was greatly improved.

• Introducing advanced technologies is difficult, but efforts must continue. Public-sector logistics
systems became more sophisticated, and population increases and new health programs placed ever
heavier burdens on them. While this was happening, financial constraints were limiting the options
for providing effective service. The overall logic of this situation called for improved logistics system
efficiency—the use of appropriate techknowledgy.
Programs, PipeLine and ProQ, still seemed to work best in most countries, though they do not solve all
problems. Throughout the life of the project, DELIVER experimented with adapting private-sector
methods and products. The results were mixed. Commercial-off-the-shelf software and cutting-edge
innovations such as bar coding did not work as well as hoped. It is possible, however, as we learn more
about the set-up and support requirements of these products, some will be identified that can improve
efficiency and be replicated economically. Certainly efforts should continue. One technology that worked
well was the use of electronic smart cards to track ART dispensing to HIV/AIDS patients.

REFERENCES
DELIVER and Task Order 1 of the USAID | Health Policy Initiative. 2006. Contraceptive Security Index
2006: A Tool for Priority Setting and Planning. Arlington, Va.: DELIVER, for the U.S. Agency for
International Development.
DELIVER. 2005. USAID Contraceptive Procurement Guide and Product Catalog 2006. Arlington, Va.:
DELIVER, for the U.S. Agency for International Development.
DELIVER. 2006. Guidelines for Managing the HIV/AIDS Supply Chain. Arlington, Va.: DELIVER, for
the U.S. Agency for International Development.
DELIVER. 2006. Lessons Learned in Managing Laboratory Supplies. Arlington, Va.: DELIVER, for the
U.S. Agency for International Development.
Diallo, Abdourahmane, Claudia Allers, Yasmin Chandani, Wendy Nicodemus, Colleen McLaughlin, Lea
Teclemariam, and Ronald Brown. 2006. Guide for Quantifying Laboratory Supplies. Arlington, Va.:
Diallo, Abdourahmane, Lea Teclemariam, Barbara Felling, Erika Ronnow, Carolyn Hart, Wendy
Nicodemus, and Lisa Hare. 2006. Assessment Tool for Laboratory Services (ATLAS) 2006. Arlington,
Va.: DELIVER, for the U.S. Agency for International Development.
Felling, Barbara, Wendy Nicodemus, Ronald Brown, Abdourahmane Diallo, Meba Kagone, Paula
Nersesian, and Lea Teclemariam. 2006. Guidelines for Managing the Laboratory Supply Chain.
Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
John Snow Inc./DELIVER, 2004. The Logistics Handbook: A Practical Guide for Supply Chain
Managers in Family Planning and Health Programs. Arlington, Va.: John Snow Inc./DELIVER, for
the U.S. Agency for International Development (USAID).
John Snow, Inc./DELIVER and Futures Group/POLICY Project. 2003. Contraceptive Security Index
2003: A Tool for Priority Setting and Planning. Arlington, Va.: John Snow, Inc./DELIVER.
Karim, Ali. Forthcoming. Accurately Forecasting Contraceptive Needs: Levels, Trends and Determinant.
USAID | DELIVER PROJECT, Task Order 1.
Ross, John, and Randy Bulato. 2001. Contraceptive Projections and Donor Gap. Arlington, Va.: Family
Planning Logistics Management/ John Snow, Inc, and The Futures Group International.
Sarley, David, Raja Rao, Carolyn Hart, Leslie Patykewich, Paul Dowling, Wendy Abramson, Chris
Wright, Nadia Olson, and Marie Tien. October 2006. Contraceptive Security: Practical Experience in
Improving Global, Regional, National, and Local Product Availability. Arlington, Va.: DELIVER,
for the U.S. Agency for International Development.
U.S. Agency for International Development (USAID). December 2002. USAID Democratic Republic of
the Congo Integrated Strategic Plan FY 2004–FY 2008 (concept paper). Washington, D.C.: USAID.
U.S. Agency for International Development (USAID). January 2005. Fragile States Strategy. PD-ACA-
999. Washington, D.C.: USAID.

APPENDIX 1
COUNTRIES WHERE DELIVER

WORKED AND COUNTRY FACT
SHEETS
Angola Krygyzstan
Armenia Liberia
Azerbaijan Madagascar
Bangladesh Malawi
Benin Mali
Bolivia Mozambique
Brazil Nepal
Burkina Faso Nicaragua
Cameroon Niger
Chile Nigeria
Colombia Pakistan
Costa Rica Paraguay
Côte d’Ivoire Peru
Democratic Republic of the Congo Philippines
Dominican Republic Romania
Ecuador Russia
Egypt Rwanda
El Salvador Senegal
Ethiopia Sierra Leone
Ghana South Africa
Guatemala Tanzania
Guyana Togo
Haiti Uganda
Honduras Ukraine
India Uzbekistan
Indonesia Yemen
Jordan Zambia
Kazakhstan Zimbabwe
Kenya
Countries where DELIVER worked in
2006
Azerbaijan Mali
Bangladesh Mozambique
Benin Nepal
Bolivia Nicaragua
Democratic Republic of the Congo Nigeria
Dominican Republic Pakistan
El Salvador Paraguay
Ethiopia Peru
Ghana Philippines
Guatemala Rwanda
Guyana Sierra Leone
Honduras South Africa
Jordan Tanzania
Kazakhstan Uganda
Kenya Yemen
Krygyzstan Zambia
Liberia Zimbabwe
Madagascar West Africa
Malawi
COUNTRY FACT SHEET
Country: BANGLADESH Total Funding: $10,747,286
DELIVER Field Office No. of local staff: 27 Presence established on: 2000 (DELIVER)
Technical Focus Family Planning X TB Donor Coordination X
Areas
Integrated Systems X Contraceptive Security X Market Segmentation X
Information Systems X EPI Financing
HIV/AIDS Essential Drugs X
Principal Client Ministry of Health and Family Welfare (MOHFW),
Organizations Directorate General of Family Planning (DGFP)
Central Medical Stores, Directorate General of Health Services
PHN, USAID/Bangladesh
World Bank, stakeholders
DELIVER’s The key objective of DELIVER in Bangladesh is to provide technical assistance to the
Objectives MOHFW’s health logistics activities towards making contraceptives and essential health
commodities available at service delivery sites.
• Collaborate with MOHFW to formulate policies for achieving contraceptive security (CS)
• Support timely procurement of contraceptives and RH commodities under HNPSP
• Improve supply chain management of family planning and health commodities
• Collaborate with public and private sector for strengthening commitment in CS
• Support functioning of coordination mechanism with GOB, DPs, NIPHP partners and private
sector for achieving CS
Major Interventions/ • Updated market segmentation analysis (MSA) report based on BDHS 2003-04 results
Primary Results • Prepared policy brief incorporating changes as suggested in MSA
• Worked with MOHFW/Drug Administration Unit to ease regulatory barriers for private sector
participation in CS
• Assisted DGFP in pre-qualification of bidders for procurement of contraceptives
• Maintained a procurement database by source of funds and contacts
• Continued to provide TA support to MOHFW, DGHS, and DGFP for accomplishing procurement
of Health and FP packages planned under HNPSP
• Maintained procurement tracking of DGFP and DGHS (CMSD) packages
• Conducted procurement training for 30 DGFP and DGHS procurement personnel
• Provided TA to DGFP for developing a coordinated procurement plan for contraceptives and
other commodities
• Revised procurement manual/tools per PPR 2003 and WB guidelines 2004
• Provided TA to do pre-shipment inspection of condoms
• Assisted DGFP in implementing procedures on disposal of used needles and syringes
• Assisted in production of MSR kits using the packaging unit at CWH
• Monitored use of commercial vehicles in transportation of FPMCH commodities resulting in 50%
coverage by commercial transport
• Provided need-based TA support for hardware/software maintenance of WIMS and LMIS
• Conducted a pilot testing of web-based LMIS reporting in warehouses
• Devised and implemented an effective computer backup system in selected warehouses
• Assisted DGFP to ensure availability of commodities at GOB and NGO sites through field
monitoring visits
• Tracked pipeline and procurement status and work with MOHFW/DGFP/DPs to avert stock out
• Assisted DGFP in operationalizing a Logistics Monitoring Cell for carrying out supervision and
monitoring of logistics activities
MARCH 2007
This publication was produced for review by the United States Agency for
International Development. It was prepared by the DELIVER project.
• Conducted LMT for 100 pharmacists posted as Storekeepers
• Assisted DGFP to produce month Pipeline and LMIS reports, and prepared a consolidated GOB
and SMC Pipeline Report
• Published three issues of CS newsletter
• Published periodic DELIVER reports (monthly, quarterly, yearly)
• Conducted M&E exercise for national FP logistics systems and disseminated results
• Updated DELIVER page on the Central DELIVER website
• Facilitated participation of 1 GOB official for overseas training
• Provided need-based OJT to GOB and NGO logistics personnel during monitoring visits
• Provided technical assistance to DGFP for conducting national physical inventory
• Provided support to operationalize 10 newly GOB constructed upazila stores
• Conducted assessment to introduce bar coding technology in the central warehouse
• Assisted DGFP in testing of contraceptives available in the supply chain
• Assisted DGFP to hold regular meetings of CS IEC forum to implement CS BCC strategies
• Undertook CS advocacy through journalists and other electronic media
• Provided TA to SMC to design a central warehouse
• Initiated TA to SMC to design and implement an effective LMIS
• Provided TOT to 50 NSDP and NGO headquarters officials on logistics management
• Supported Department of Population Sciences, Dhaka University to incorporate CS into its
curriculum
• Continued on-going collaboration with NIPHP partners to review and promote CS activities
• Organized quarterly meeting with NSDP to review supply of contraceptives to NSDP NGO sites
• Organized quarterly donor coordination meeting to review stock and pipeline status of
contraceptives and selected RH commodities
• Organized regular meetings with MOH officials to review procurement packages
• Assisted MOH to organize quarterly meetings of Logistics Coordination Forum
• Organized NIPHP working group meeting to review progress of DELIVER and SMC workplan
activities
The authors’ views expressed in this publication do not necessarily reflect the views of the
United States Agency for International Development or the United States Government.
DELIVER
John Snow, Inc.
1616 North Fort Myer Drive, 11th Floor
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: BOLIVIA Total Funding: $ 1,802,000
DELIVER Field Office No. of local staff: 6 Presence established: 2001
Technical Focus Contraceptive Security x Essential Medicines x Training of personnel x
Areas within the public health
sector
Integrated Systems for x University-level training x Advocacy with national x
Medicines and Supplies of logistics and local authorities
professionals
Implementation of x
Municipal Institutional
Pharmacies (FIM)
Principal Client Ministry of Health and Sports (MSD), National Directorate for Medicines and Technology (DINAMED),
Organizations Directorate for Health Services Development (DDSS), Universal Mother and Child Health Insurance
Program (SUMI), Center for Supply Management of Health Commodities (CEASS), Departmental
Health Services (SEDES); Local Health Services (DILOS); Municipal Governments; public and private
universities through the Nursing, Pharmacy, Biochemistry, and Pharmaceutical Chemistry programs;
coordination with international cooperating agencies, including UNFPA, UNICEF, WHO/PAHO, JICA,
DFID, and CIDA; coordination with NGOs, including PROSALUD, PROCOSI, CIES, CSRA, and CARE.
DELIVER’s • Improve the availability of medicines and contraceptives for the benefit of consumers.
Objectives • Promote and facilitate public policies that support the improving the availability of medicines and
commodities.
• Create effective public health logistics systems.
• Support mobilization of financial resources for the procurement of contraceptives.
• Train health personnel to increase the quality of health services rendered.
Major Interventions • Development and implementation of the standardized Contraceptive Logistics Management
System for the public and private sectors, which incorporates NGOs and the Ministry of Health
and Sports at the national level, and Municipal Governments at the local level.
• Training of health personnel responsible for managing contraceptive commodities, as well as
personnel within the Municipal Institutional Pharmacies (FIM) of the MSD, of the SEDES, and of
the Municipal Governments.
• Development of skills and abilities in logistics management for regional trainers in the nine
departments of Bolivia, including the personnel from the following groups: Sexual and
Reproductive Health Program; the SUMI; pharmacies and laboratories; CEASS; municipal
officials; experts from universities and technical health schools; and regional coordinators from
the different cooperating agencies and NGOs.
• Advocacy with national authorities to incorporate the Logistics Management System as part of
the national health policy and guidelines.
• Promote the sustainability of the Logistics Management System for Medicines and Supplies
through incorporating logistics into the curriculum for programs on Nursing, Pharmacy,
Biochemistry, and Pharmaceutical Chemistry in the public and private universities, as well as in
the Technical Health Schools for the program for Nursing Assistants.
• Technical assistance to the Municipal Governments and the public health sector in
implementation of the Municipal Institutional Pharmacies (FIM).
• Coordination and technical assistance with the Ministry of Health and Sports and the Municipal
Governments for the control and on-going support of the LMIS for FIM.
MARCH 2007
This publication was produced for review by the United States Agency for International
Development. It was prepared by the DELIVER project.
• Coordination with NGOs for the implementation of the Logistics Management subsystem for
PROSALUD, PROCOSI, CIES, CSRA, and CARE.
• Inter-institutional coordination with other international agencies, including UNFPA, UNICEF,
WHO/PAHO, JICA, DFID, and CIDA.
• Development and implementation of a computerized system designed for support of the LMIS,
an integral component of the National Supply System SNUS.
• Development of training and self-teaching manuals on logistics.
• Promotion for the formation of the inter-institutional committee for achieving contraceptive
security.
• Consolidation of the contraceptive needs forecasts at the national level, using the PipeLine
software tool, for beneficiary agencies of USAID and for the Ministry of Health and Sports.
• Introduction of logistics indicators to the Information Analysis Committees (CAI) in some regions
of the country, with the goal of promoting analysis that would allow continuous evaluation and
implementation of corrective measures.
• Analysis of market segmentation for contraceptives.
Primary Results • Policy achievement of introducing the Logistics Management System for Medicines and Supplies
(SALMI) as part of the regulations of the National Supply System (SNUS) that was finalized by
Supreme Decree Nº 26873 and Ministerial Resolution Nº 0735 of the National Health System of
December 2002.
• Sustainability of the Logistics Management System, after introducing it as part of the curriculum
for the programs of Nursing, Pharmacy, Biochemistry, and Pharmaceutical Chemistry in public
and private universities, as well as in the Technical Health Schools for the program for Nursing
Assistants (42 instructors trained at the national level).
• 3,997 personnel trained in logistics directly by DELIVER, with more than 378 people trained in
their place of work at the time of implementing and/or reorganizing the FIM.
• 342 Municipal Institutional Pharmacies implemented with the technical support and training from
DELIVER/JSI Bolivia.
• Development of 11 documents to support the logistics management system, including training
manuals, guides, case studies, and others.
• Donation of the computerized SALMI-LMIS system to the Ministry of Health and Sport, the
Departmental Health Services, and to the Municipal Governments.
• Sustainability of the logistics management system through sharing the training methodology with
the Ministry of Health and Sports and with NGOs, who will give continuity to the implementation
of the SNUS.
• Establishment of the inter-institutional committee for achieving contraceptive security.
• Expansion of the SUMI to cover women from 5 to 60 years of age.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: Democratic Republic of Congo Total Funding: $290,000
DELIVER Field Office No. of local staff: 0 Presence established on: No Field Office
Technical Focus Family Planning x TB Donor Coordination
Areas
Integrated Systems Contraceptive Security Market Segmentation
Financing EPI
HIV/AIDS Essential Drugs
Principal Client SANRU, CARE, and USAID
Organizations
DELIVER’s • Strengthen SANRU’s reproductive health (RH) logistics system.
Objectives • Design a reproductive health logistics system with CARE and train CARE staff in implementation.
• Increase the forecasting/logistics capacity of the USAID Mission in DRC.
Major Interventions • Train supervisors from all 22 zones where SANRU is providing family planning services in basic
logistics management.
• Conduct a rapid assessment of CARE’s existing logistics system.
• Conduct a design workshop with CARE to design an RH logistics system, including a logistics
management information system and an inventory control system.
• Facilitate a training of trainers to increase the competency and capacity of personnel in health
logistics management.
• Serve as an on-going resource for CARE in RH logistics.
• Assess CARE’s new system and make necessary changes to strengthen system.
• Conduct an impact assessment of CARE’s system (LSAT and LIAT).
• Facilitate workshop on forecasting for USAID Mission staff and their partners.
• Debrief USAID Mission, CARE International and Ministry of Health on Sud Maniema’s logistics
system.
Primary Results • Logistics system in place in Sud Maniema.
• Stockouts avoided in Sud Maniema.
• USAID Mission and their partners trained in different methods for forecasting.
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: EL SALVADOR Total Funding: $1,020,000
DELIVER Country No. of local staff: 3 Presence established in: February 2006
Office (2 consultants, and 1 admin. staff for 8 months)
Areas of technical Family Planning x TB Donor Coordination x
emphasis
Integrated Systems Contraceptive Security x Market Segmentation x
Financing x EPI
Main Organizations Ministry of Health, Contraceptive Security (CS) Committee, ADS (IPPF affíliate), UNFPA, USAID
DELIVER • To improve the contraceptive logistics system, by improving product availability indicators.
Objectives • Foster CS activities through the CS committee, and at the national level.
• Work with the MOH to allocate funds for contraceptive procurement, on an annual basis
• Coordinate the signing of an MOU between UNFPA and the GOES.
• Establish indicators to ensure sustainability of CS activities and the institutionalization of logistics
system.
• Transfer skills in forecasting and contraceptive needs estimation to MOH staff.
Main Areas of • Contributed to the design of the USAID phase-out plan for the MOH.
Intervention • Worked closely with the UNFPA regional office to develop the MOU between UNFPA and the
Government of El Salvador (GOES).
• Participated in the negotiations between UNFPA and GOES, on behalf of USAID.
• Facilitated the meetings between UNFPA and GOES, until the MOU was signed.
• Advocacy work with the Finance Unit and the Planning Unit of the MOH to allocate funds for
contraceptive procurement on an annual basis.
• Implemented the LIAT tool to evaluate the logistics system, and calculate core logistics
indicators.
• Provided on-the-job training to MOH regional and service delivery point staff.
• Implemented a supervisión and monitoring system for the Regions (SILAIS) and SDPs, to
ensure proper functioning of the logistics system, and timely data reporting.
• Transferred skills to MOH and ADS staff in forecasting and contraceptive needs estimation.
• Provided input to the CS strategic plan.
• Procured computers, and other equipment for the FP program, to improve the processing of key
logistics data.
Primary Results • Phase-out plan between USAID and MOH in place.
• Logistics system improved, by increasing product availability at SDPs.
• MOU between UNFPA and GOES signed.
• MOH procuring nearly 80% of their contraceptive needs with government funds.
• MOH preparing its own contraceptive procurement tables (CPTs), with no external assístance.
• Logistics indicators established and measured.cCS committee formed, and discussing the
inclusion of a line item in the national budget for contraceptive procurement.
MARCH 2007
Internaitonal Development. It was prepared by the DELIVER project.
The author’s views expressed in this publication do not necessarily reflect the views of the
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: ETHIOPIA Total Funding: $5,684,000
DELIVER Field Office No. of local staff: 20 Presence established on: September 1, 2003
Technical Focus Family Planning x TB x Donor Coordination x
Areas
Integrated Systems x Contraceptive Security x Market Segmentation
Financing x EPI
HIV/AIDS Essential Drugs x
Principal Client Ministry of Health/Family Health Department (MOH/FHD); Pharmaceutical Administration and Supply
Organizations Service (PASS); Other Federal Level Program Departments; Regional Health Bureaus; Coordination
with UNFPA, UNICEF, JSI/ESHE, Pathfinder International, DKT, and others.
DELIVER’s • Improve the public sector’s Commodity Logistics System (CLS) with an initial focus on
Objectives contraceptives.
• Strengthen public sector logistics capacity.
• Enhance contraceptive and commodity security.
Major Interventions • Scale-up of the Ethiopian Contraceptive Logistics System (ECLS) in Amhara, Oromia, SNNP,
and Tigray Regions in 16 new Zones with more than 3,000 trainees (following pilot phase in
these Regions and Addis Ababa).
• Implement the ECLS in six outer regions and cities: Somali, Afar, Dire Dawa, Harar,
Beneshangul Gumuz, and Gambella.
• Continue to produce quarterly Contraceptive Stock Status Report for MOH and key partners.
• Implement a training program for MOH supervisors at various levels, including a monitoring and
supervision system for the contraceptive logistics system.
• Partner with MOH and UNICEF in development of a Master Plan for the Health Commodity
Supply System.
• Provide support to Federal level (PASS) for distribution, inventory management, and warehouse
planning.
• Provide resources and organizational skills to a major “dejunking” effort at the Federal MOH
warehouses.
• Provide support to the Tigray, Amhara, Oromia, and SNNP Regions for distribution, warehousing
and basic logistics training.
• Provide annual national contraceptive forecast (March 2006) and assist with preparations for a
National Contraceptive Security Workshop (April 2006).
Primary Results • Improvement in CS Indices.
• Warehouse Improvement and inventory management information.
• Trained over 6,000 regional and woreda-level health workers on ECLS (as of June 2006).
• Approval and integration of Master Plan for the Health Commodity Supply System.
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: GHANA Total Funding: $3,841,000
DELIVER Field No. of local staff: 3 Presence established on: 2002
Office
Technical Focus Family Planning x TB Donor Coordination x
Areas
Integrated Systems x Contraceptive x Market Segmentation x
Security
Financing x EPI
HIV/AIDS x Essential Drugs x
Principal Client Ministry of Health/ Procurement and Supplies Division (MOH/P&S); Ghana Health Service/ Stores,
Organizations Supplies and Drug Management Division(GHS/ SSDM);Public Health Division (GHS/PHD),
Reproductive and Child Health Unit (GHS/ RCHU), National AIDS/ STI Control Program (NACP);
Central Medical Stores (CMS), Public Health Reference Laboratory (PHRL), Ghana Social Marketing
Foundation; coordination with UNFPA, UNICEF, DfID, JICA, Royal Netherlands Embassy (RNE),
WHO and USAID/Ghana/HPN SO7 partners such as Academy for Educational Development (AED),
Population Council, Quality Health Partners-EngenderHealth (QHP), Family Health International
(FHI), ICC/CS members, and others
DELIVER’s • Strengthen contraceptive security.
Objectives • Strengthen the National HIV/AIDS Program.
Major Interventions • Improve reliability of health commodity distribution by supporting the implementation of the
integrated supply chain (essential medicines, contraceptives, non-drug consumables) based on
the scheduled delivery system.
• Build capacity to estimate and monitor commodity requirements.
• Improve capacity for financing health commodities including HIV/AIDS commodity.
• Improve capacity to procure contraceptives at the international market.
• Assess and improve logistics management capacity at national level, ART and testing sites for
ARVs, HIV test kits and lab commodities.
• Improve capacity to monitor and evaluate logistics performance.
Primary Results • Integrated supply chain implemented in 5 regions with scheduled delivery functional in 3 of the 5
regions: contraceptives, essential drugs and non-drug consumables.
• SOPs for managing the integrated supply chain developed and produced for all the facilities in
the public sector.
• Combined Requisition, Issue and Receipt voucher with the pre-printed list of the commodities in
full supply has been provided and are being used to manage the integrated supply chain.
• 1055 staff managing the health commodities trough the integrated supply chain (including 33
regional and central trainers) have been trained in logistics management (SOPs).
• The 2006 LIAT showed that during the day of visit, on average, 21% and 26% of health facilities
were out of stock for respectively contraceptives and essential medicines. 17% of testing sites
were out of stock.
• 34% and 38% of the facilities experienced stockout during the last 6 months for respectively
contraceptives and essential medicines.
• 33% of the testing sites experienced stockout of test kits during the last three months.
MARCH 2007
• Local capacity built and available to do forecasting, quantification, and procurement of
contraceptives, essential drugs and HIV/ AIDS commodities with minimal assistance.
• Contraceptive security strategy developed, approved and implemented.
• ICC/CS in place, led by the Director of Public Health, Ghana Health Service and meeting
regularly.
• Enough resources mobilized through ICC/CS advocacy for contraceptives procurement: from
2003 to 2006, there was no funding gap for contraceptives for all the programs in Ghana.
• Strong government commitment to finance contraceptive: MOH provided $1.5 million in 2003,
$1.8 million in 2005 and $1.0 million in 2006 for contraceptives procurement.
• Formulated policies to strengthen contraceptive security such as a financial sustainability plan
for contraceptive procurement.
• ARVs and test kits LMIS designed, implemented, and functioning well.
• Staff from all the ART sites and the testing sites have been trained in LMIS: in total, 95 staff from
the 21 currently functional ART sites and 171 labs. Technicians have trained in LMIS.
• HIV/ AIDS commodity security strategy plan has been developed and approved.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: GUYANA Total Funding: $448,000
Areas
Financing EPI
Principal Client USAID/Guyana; Centers for Disease Control; Ministry of Health/Materials Management Unit; Ministry
Organizations of Health/Maternal and Child Health Office; Supply Chain Management Support Project; Guyana
HIV/AIDS Reduction Project; Family Health International; Management Sciences for Health; Guyana
Responsible Parenthood Association; Family Planning Association of Guyana
DELIVER’s • Improve the public sector’s commodity logistics system.
Objectives • Strengthen public sector logistics capacity, especially in the MMU/MOH.
• Coordinate with SCMS to improve commodity logistics system and commodity forecasting.
• Enhance contraceptive security.
Major Interventions • Assisted with identification of strategies for MOH that could be implemented to improve commodity
security without significant increases in funding or human resources.
• Specified systems and guidelines for commodity management at facility, regional and national
levels.
• Developed order processing information system for use within MMU.
• Initiated organizational development program at MMU.
• Assisted USAID, CDC and GHARP and SCMS projects in planning, organizing and opening new
Annex warehouse for HIV/AIDS commodities.
• Developed standard operating procedures for the new Annex warehouse.
• Worked with SCMS to develop work plan for improving commodity management over next five
years, and planned orderly transition of activities to SCMS.
• Conducted assessment of MOH contraceptive supply system and provided a national
contraceptive forecast and contraceptive security assessment report with recommendations.
Primary Results • Development of procedures for MOH commodity management (2002).

• Development of automated order processing and information system for stock management at
MMU (2004).
• Cooperation with FHI, MSH, SCMS project to establish new annex warehouse (2005-2006).
• Cooperation with SCMS to develop work plan to improve commodity management system over
next five years.
• Prepared contraceptive security assessment report and National Contraceptive Forecast for 2006-
2008 for USAID and MCH office, MOH.
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: Honduras Total Funding: $1,065,000
DELIVER Field Office No. of local staff: 2 Presence established: February 2005
Areas
Integrated Systems Contraceptive Security x Market Segmentation
Financing EPI
Principal Client Health Secretariat/Department of Comprehensive Family Health, Honduran Association for Family
Organizations Planning (ASHONPLAFA); coordination with UNFPA, UNICEF, PAHO and others.
DELIVER’s • Strengthen the supply chain (financing, warehousing/storage, procurement, and distribution) of
Objectives the Honduran Health Secretariat.
• Assist the Government of Honduras and ASHONPLAFA with the process of procuring
contraceptives through the preparation of Contraceptive Procurement Tables (CPTs).
• Increase contraceptive and commodity security through the development and implementation of
a National Contraceptive Security (CS) Strategy that includes the Inter-institutional CS
Committee and allocation of funds in the national budget for purchasing contraceptives.
Major Interventions • Organize and assist with managing the Inter-Institutional CS committee.
• Develop and promote the National CS Strategy.
• Assist the Health Secretariat with the process of guaranteeing funding in the national budget for
the purchase of contraceptives.
• Develop and standardize the use of an automated inventory control program in the central and
regional warehouses and in health centers (Unidades de Salud).
• Assist the Health Secretariat in adapting and applying the “Methodological Strategy for Family
Planning” at the national level.
• Assist the Health Secretariat and ASHONPLAFA in conducting routine physical inventories
required for preparation of the CPTs.
Primary Results • Conducted physical inventory of contraceptives every 6 months starting in June 2004, in order to
prepare the CPTs.
• Prepared semi-annual CPTs beginning in 2001, which serve to inform the procurement process
for USAID and the Health Secretariat.
• Training of personnel at the central level and from Health Region No. 3 in the use of the
Logistics System Assessment Tool (LSAT) for contraceptives.
• Strengthening of the inter-institutional Contraceptive Security Committee, which was able to
meet on a monthly basis except during the change in government.
• Finalization of the Founding Document for the Inter-Institutional Contraceptive Security
Committee, required for its legal recognition by Ministerial Resolution.
• Development of the National CS Strategy, along with its legal recognition by Ministerial
Resolution and its adoption by all the member institutions and organizations comprising the CS
Committee.
• Adaptation of the National Strategy for Programming, Monitoring, and Evaluation of Family
Planning Activities, which is now more functional and easy to apply.
• Training of personnel from all levels of the Honduran Health Secretariat on the application of the
Methodological Strategy for Family Planning.
MARCH 2007
• Development of the automated inventory control program currently used in the 20 regional
warehouses and the central warehouse.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: India Total Funding: $1,523,000
DELIVER Field Office No. of local staff: 3 (plus 2 short- Presence established on: 1997
term consultants)
Areas
Financing EPI
Principal Client Ministry of Health and Family Welfare (MHFW); Uttaranchal (state) Government, Dehradun
Organizations
DELIVER’s • Assist the MOHFW/Uttaranchal to streamline and strengthen the logistics system and
Objectives specifically to develop the procurement policy and procedure manual.
• Set-up logistics management information system (LMIS) in initially selected pilot districts and
train staff.
Major Interventions • Design and set-up logistics information system
o Develop a comprehensive, automated, statewide LMIS
o Train staff in LMIS operations
o Develop a uniform inventory control system
o Develop a statewide logistics Supply Procedures Manual
• Training and performance improvement
o Develop a statewide training strategy
o Establish a Logistics Management Training Resource Center in identified training agency
• Strengthen Logistics Management Cell’s (LMC) capacity to manage and monitor logistics
management improvement activities
• Organize logistics observational tours for policy and implementation level officials
• Operationalize warehouses
o Equip warehouses with storage and LMIS equipment
o Ensure staffing; provide training and orientation
o Develop storage guidelines and storekeeper’s manual
o Introduce automated inventory control system and storekeeping practices
Primary Results • Logistics Management Cell established and formalized within the MOH with staff trained in
logistics supervision and monitoring in UP.
• LMIS unit set-up and formalized with trained staff in Uttaranchal.
• Several key logistics materials defining standard procedures and practices produced including
the Supply Procedure Manual, Trainers Manual, and Storekeepers’ Manual.
• Forty-five field-based trainers from MOHFW trained in logistics management.
• Four new regional warehouses operationalized with inventory control systems, guidelines and
staff in place.
• LMIS developed, implemented or field-tested in 10 districts (7 in UP and 3 in Uttaranchal).
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: JORDAN Total Funding: $404,000
DELIVER Field Office No. of local staff: O Presence established on: no local field office
Areas
Integrated Systems Contraceptive Security X Market Segmentation X
Financing EPI
Principal Client Government of Jordan Reproductive Health program/ Ministry of Health MCH Directorate/ MOPH,
Organizations POLICY Project
DELIVER’s • Improve performance and build Jordanian capacity in contraceptive procurement, quantification,
Objectives and LMIS management
Major Interventions • Support Contractive Security through

- Updating of logistics standard operating procedures and curricula
- Training to build local capacity in quantification, procurement, and maintenance of the
JCLS
- Technical support to national staff with quantification and procurement
- Enhancement of contraceptive logistics software tools
- Targeted assessments (market segmentation, logistics)
• Develop a phase out plan for USAID contraceptive donations
• Support Government of Jordan efforts to plan contraceptive procurement by assisting the
contraceptive procurement committee to
- Draft standard operating procedures for procurement of contraceptive commodities
- Develop specifications for 2006 condom procurement
Primary Results • Government of Jordan public sector now manages contraceptive quantification with local capacity
and has begun to fund procurement of all Depo-Provera and condom requirements for their
program.
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: MADAGASCAR Total Funding: $281,708
DELIVER Field Office No. of local staff: NA Presence established on: NA
Areas
Financing EPI
Principal Client Ministry of Health/Family Planning and PSI
Organizations
DELIVER’s • Strengthening of reproductive health commodity security in Madagascar
Objectives
Major Interventions • Evaluate the reproductive health commodity security
• Elaborate an action plan for commodity security
• Develop the national strategic plan to strengthen the contraceptive distribution channel
• Develop a logistics plan leading to the integration of family planning commodities into essential
drugs distribution channel
• Review of the national strategic plan
• Build national capacity in forecasting and procurement planning
• Stock status survey
Primary Results • National strategic plan available

• Logistics committee team members trained in forecasting and procurement planning
• Functional logistics committee team in place
• Mobilization of financial resources through donors and the Malagasy government
• Integrated supply chain in place and functional
• Constant monitoring of stock level
• Review of minimum and maximum levels
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: MALAWI Total Funding: $4,028,385
DELIVER Field Office No. of local staff: 6 Presence established on: 2000
Areas
Financing EPI
Principal Client Ministry of Health and Population
Organizations
DELIVER’s • Behavior change enabled
Objectives • Access to services increased
• Health sector capacity strengthened
• MOH service delivery systems strengthened
• NGO, CBO, and FBO service delivery systems strengthened
Major Interventions • Strengthen awareness of Community Drug Committee responsibilities.
• Provide training and TA to health facilities to facilitate accurate stock records, timely stock status
reporting, and proper stock storage at health centers.
• Conduct supportive visits to districts to facilitate proper usage of SCM Software in data entry, data
management, compilation of stock status reports and processing of requisitions for drugs and
medical supplies.
• Conduct commodity availability survey (LIAT) and logistics system assessment (LSAT).
• Conduct essential drug and contraceptive procurement forecast.
• Undertake commodity security strategic planning.
• Hold quarterly logistics meetings with stakeholders and other key partners.
• Hold Annual Logistics Coordinating meeting.
• Support MOH staff attendance at JSI/DELIVER Supply Chain Management training course.
• Conduct tailor made DELIVER Supply Chain Management Logistics course.
• Conduct refresher courses for pharmacy technicians and health workers.
• Facilitate linkages between Warehouse Management System software (SIGMED) and Supply
Chain Manager.
• Support NGOs in accessing contraceptives, condoms and STI products.
• Commission the National Stock Status Database.
Primary Results • Provision of computers and software to 17 district pharmacies; 3 computers already committed for
central hospitals.
• Fully functional computerized processing of MOH logistics data using Supply Chain Manager
software from 400+ service delivery points (SDPs) by 26 districts for purposes of electronic
ordering of contraceptives, STI products, essential health package drugs, and other products from
RMS.
• HTSS with an achievable plan to introduce National Stock Status Database (NSSD) having
capability of computerized monitoring of consumption, order fill rates, and stock imbalances.
• HTSS and CMS engaged in collaborative decision making to perform accurate quantification and
forecasting of future needs.
MARCH 2007
• CMS capability to receive orders in timely fashion to facilitate rapid packing and dispatch of filled
orders to service delivery points.
• Enhanced accountability of logistics supply system through computerized product tracking
capability and transparency at the district level.
• Empowerment of drug committees through provision of IEC materials to facilitate their proper
functioning.
• Creation of the Logistics Unit at the Ministry of Health, in the Health Technical Support Services
department to facilitate smooth functioning of the MHCLMS to support the implementation of the
EHP, following the success of the RHLMIS at RHU
• Improved the availability of contraceptives and other essential drugs at the SDPs.
• 8 MOH key level staff attended the DELIVER Supply Chain Logistics course.
• Facilitated Supply Chain Logistics course in Malawi for RMS staff, District Pharmacy Technicians &
other supervisory level staff from various programs including some NGO’S where a total of 19
were trained.
• Conducted LMIS TOT where 10 officers were accredited with the training of trainers for the
MHCLMS and LMIS training for SDP staff where a total of 362 health workers were trained.
• Conducted Refresher LMIS training for district and SDP staff and a total of 77 ministry of health
and CHAM staff were trained.
• Conducted Supply Chain Manager Software trainings to facilitate utilization of the software at the
district level—a total of 60 pharmacy technicians trained so far.
• Completed the rollout of the RHLMIS and later integrated to create MHCLMS.
• Developed the 2006—2010 National CS Strategic Plan.
• Improved short- and medium-term contraceptives forecast and identify the financial resources to
meet those requirements.
• Improved the MOH’s ability to collect, compile, and analyze dispensed to users data for
contraceptives and other vital health products.
• Streamlined supply management and reporting procedures at the district and health facility level.
• Improved access and distribution of contraceptives to the NGO, particularly non-health oriented
organizations.
• Raised visibility of logistics within the MOH through creation of the Logistics Unit and placement of
staff who were directly supported by the project in technical terms.
• Provided Quality Assurance, Monitoring and Management through conducting commodity
availability surveys.
• Conducted a process mapping exercise to eliminate non-value adding activities at the various
levels in the supply chain. This resulted into one level being taken out and the eventual
implementation of the direct delivery system.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: MALI Total Funding: $3,066,697
DELIVER Field Office No. of local staff: 2 Presence established on: August 1, 2002
Areas
Integrated Systems x Contraceptive Security x Market Segmentation x
Financing x EPI
Principal Client Ministry of Health/ (MOH/DPM; Direction de la Pharmacie et du Médicament); Centrale d’Achat des
Organizations Génériques (CAG), Pharmacie Populaire du Mali (PPM), Keneya CIWARA Project; AMPPF, SAVE
the Children, regional health bureaus; coordination with UNFPA, and others
DELIVER’s • Improve the health commodity logistics system performance.
Objectives • Improve human capacity in logistics.
• Strengthen reproductive health commodity security in Mali.
Major Interventions • Improving the health commodity logistics system performance by—
- redesigning the integrated logistics system (max-min levels and review period),
- establishing mechanisms to collect and report reliable dispensed-to-user data at the central
level,
- assisting in the automation of the collection and analysis of data to facilitate its use in the
decision making process, and
- estimating country requirement for reproductive health commodities based on data collected
and reported from SDPs.
• Improving human capacity in logistics through—

- skill building among staff members from the recipient organizations to manage their stock,
as well as to interpret and put to use the data collected through their logistics systems for
forecasting and decision making;
- supervision and OJT, and
- pre-service training in health schools.
• Strengthening reproductive health commodity security in Mali by—

- assisting the MOH in implementing the Contraceptive Security Strategic Plan,
- coordinating donors interventions,
- assisting the MOH in conducting studies covering fields such as pricing policy, market
segmentation, and others, as proposed by the Mali MOH; and
following up on the milestones of DELIVER’s assistance within the Mali CSEP.
Primary Results • Logistics system Improvement:

- Development of new LMIS Forms to enhance reliable data collection and reporting. The newly
designed RIV will allow capturing dispensed-to user data at SDP level.
- National Physical Inventory. Conducted yearly. In 2005, the following sites were visited: 100% of
DRCs, 100% of DVC, 75% of CSComs. In total, 85% of the national consumption volume has
been capture through this activity.
- CPTs: The National Forecasting Committee is now self-sustainable, conducting CPTs with
minimal external technical assistance.
MARCH 2007
- CYP jumped 18% between 2004 and 2005 which is a great performance because of the MOH
large scale FP campaign and pipeline streamlining.
• Logistics performance improvement: Training and OJT conducted through the system as follows:
o Central: 100% program managers are trained in LM
o Régional: 100% of Regional Pharmacists and their assistants are trained
o DRC: 100% of District Warehouse managers are trained in LM
o DVC: 85% of District Warehouse keepers are trained in LM
o CSCOM: 12% of CSCom warehouse keepers are trained in LM
o Relais N/A—CBD Workers
• Contraceptive Security:
- Resource Mobilization: Increased contribution of UNFPA in CS activity funding over the course
of the last four years.
- Commodity Procurement: USAID still committed to secure commodities. KfW to take over Social
marketing commodities starting in December 2006.
- CS Advocacy effort with congressmen, journalists, and community leaders. They are new
partners and CS champions in their respective areas.
- Synergy among CAs who actually funded some of DELIVER planned activities, like training
collaboration and commodity availability in the field.
- CS Steering Committee is functional.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: MOZAMBIQUE Total Funding: $4,857,000.00
DELIVER Field Office No. of local staff: 8 Presence established on: July 2004
Technical Focus Family Planning TB Donor Coordination
Areas
Financing EPI
Principal Client Ministry of Health
Organizations (CMAM) Central de Medicamentos e Artigos Medicos
DELIVER’s The goal of DELIVER activities was to build the capacity within CMAM and the MOH to strengthen
Objectives the forecasting, procurement, storage, and distribution of essential drugs, contraceptives and
HIV/AIDS commodities in Mozambique.
Major Interventions • Improve access to quality logistics management information through SIGM (Sistema Integrado de
Gestão de Medicamentos).
• Procure Antiretroviral medicines.
• Conduct requirements analysis for the construction of a central warehouse to serve the northern
part of the country in Nacala.
Primary Results • Managed from conception the development and implementation of a complex integrated drug
management software system customized for Mozambique’s public health sector (the Sistema
Integrado de Gestão de Medicamentos, or SIGM), including: Definition of specifications and scope
of work based on client needs; competitive bidding and awarding of a contract; management of
subcontractors; review, analysis, and verification of progress on the scope of work; training of
users; capacity building for CMAM technical staff and leadership; and post-implementation
monitoring and support.
• By the end of DELIVER, SIGM was successfully implemented at the three central warehouses
managed by Medimoc, Medimoc headquarters, and CMAM headquarters, and had been used by
CMAM and the central warehouses for conducting the second and third quarterly requisition
cycles, as well as monthly distribution of ARVs.
• DELIVER procured 10 different antiretroviral drugs from six suppliers, valued at $1,606,647, for
donation to CMAM on behalf of USAID.
• Coordinated with CMAM, other Mozambican government entities, international donors,
multilaterals, and other CAs and organizations on improved health services delivery, product
quality, and commodity security. Related DELIVER activities included preparing Contraceptive
Procurement Tables (CPTs) and arranging to test condoms warehoused by Medimoc.
• Provided technical support to CMAM´s Information Technology department, including hardware,
software, troubleshooting, and training.
• DELIVER provided two warehousing experts and a local architect to conduct a requirements
analysis for the construction of a warehouse for storing medicines and consumable medical
supplies in the port city of Nacala. The final report of this technical assistance presents the
volumetric analysis, storage and materials handling specifications, architectural warehouse
specifications, a proposed layout and a cost estimate for a new warehouse.
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: NEPAL Total Funding: $1,240,000 (approximate)
DELIVER Field Office No. of local staff: 9-11 Presence established on: 2000 (DELIVER)
Technical Focus Family Planning x TB Donor x
Areas Coordination
Integrated Systems x Contraceptive Security x Market
Segmentation
Information Systems x EPI x Financing
Principal Client Ministry of Health and Population (MOHP)/Department of Health Services, Logistics
Organizations Management Division, Family Health Division, Child Health Division, NCASC, NHTC, USAID,
Nepal Family Health Program (NFHP), KfW, DFID, World Bank, UNFPA, UNICEF, JICA, etc.
DELIVER’s The objective of DELIVER in Nepal was to provide technical assistance in the
Objectives MOHP’s health logistics activities towards making contraceptives and essential
health commodities available at service delivery sites.
• Strengthen contraceptive and other essential health commodity security efforts
• Strengthen the logistics management information system (LMIS)
• Streamline distribution.
• Improve and strengthen human resource in health logistics.
• Strengthen and implement pull system of essential drugs in districts.
Store management (e. g., dejunking, auctioning of unusable commodities, and
reorganization of stores).
• Logistics system design for Nepal’s HIV/AIDS and STD program.
• Capacity building at the district and sub-district levels.
Major Interventions • Ilaka-level logistics intervention (Developing commodity management guidance for the
community level (sub-district level)
• Monitoring and evaluation of district health office effectiveness based on logistics data
• Overseeing construction and operationalization of district stores built with funding from
other donors (e.g., KfW, DFID)
• Improving both design and functioning of the Ministry’s logistics management information
system (LMIS) and inventory system for regional medical stores
• Warehouse modernization and renovation
• Capacity building of the health personnel at the center, region, districts and at service
delivery sites
• System assessment for HIV/AIDS commodities
• System design workshop for logistics for HIV/AIDS and STD program
• Three-year forecast for HIV tests, ARVs, STI, and OI drugs
Primary Results • Increased availability of contraceptives and other key essential commodities in health
1
facilities (increased year round availability of 7 key health commodities at service delivery
sites - 27 percent in 2001/02 to 71 percent in 2005/2006)
• Strengthened LMIS reporting (maintained at 90% per quarter); improved and strengthened
inventory management system at regional medical stores
• Strengthened warehousing at national, regional, zonal, district, and sub-district level
• Improved HRH capacity (total of 2,363 government personnel were trained in different
types of health logistics training from 2003 with DELIVER support)
• Improved adoption of advances in logistics (system design and implementation for
HIV/AIDS logistics)
1
condoms, injectables, pills, oral rehydration salts, vitamin a, cotrimoxizole, and iron tablets
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: NICARAGUA Total Funding: $1,031,000
DELIVER Field Office No. of local staff: 2 Presence established: January 2003
Areas
Integrated Systems x Contraceptive Security x Market Segmentation x
Financing x EPI x
HIV/AIDS Essential Medicines x
Principal Client Ministry of Health, MINSA (Department of Standardization of Medical Commodities, Department of
Organizations Quality Assurance). PROFAMILIA, Nicaraguan Social Security Institute (INSS), Medical Insurance
Companies (EMPs), Nicaraguan Chamber of Health, and CANSALUD.
Coordination with: UNFPA, PAHO, MSH-PRONICASS, QAP, PASMO, Federación NicaSalud, and
Georgetown University.
DELIVER’s • Improve the quality of information about contraceptive commodities.
Objectives • Periodic monitoring of logistics indicators.
• Integration of the logistics system for medical and contraceptive commodities.
• Contraceptive security (CS).
• Increase coverage and improve quality of contraceptive methods offered through PROFAMILIA.
• Increase in family planning services available through the Medical Insurance Companies
affiliated with the INSS.
• Creation of reproductive health partnerships with other partners within USAID/Nicaragua.
Major Interventions • Development of a contraceptive logistics information system in 100% of the health centers
(Unidades de Salud) of MINSA.
• Implementation of the Medical Commodity Logistics Management Information System (SIGLIM)
in 5 regions of the country in collaboration with MSH-PRONICASS.
• Completion of qualitative and quantitative evaluations of logistics indicators.
• Development of a contraceptive security plan for Nicaragua.
• Establishment of a post-obstetric contraceptive strategy in 22 maternal and child health hospitals
in the country.
• Development of an efficient contraceptive logistics system for the 17 PROFAMILIA health clinics.
• Assessment of the contraceptive logistics system in the 17 PROFAMILIA health clinics.
• Assessment of the contraceptive logistics system and family planning service delivery in the
Medical Insurance Companies contracted by the INSS.
• Training on warehousing and inventory control for 28 Medical Insurance Companies.
• Development of a communications strategy for the promotion of FP services in the Medical
Insurance Companies.
• Implementation of forecasting of contraceptive needs using PipeLine software in the 17
PROFAMILIA health clinics.
• Semiannual updates of contraceptive forecasts for MINSA and PROFAMILIA.
• Coordination with UNFPA on the process of procuring contraceptives to be donated by MINSA.
• Monitoring and supportive supervision visits to MINSA health facilities, PROFAMILIA health
clinics, and the Medical Insurance Companies affiliated with the INSS.
• Coordination with QAP, UNFPA, UNICEF, OPS, NicaSalud, IRH, Banking of Health, and other
MARCH 2007
USAID partners for the purpose of strengthening FP services.
• Support the process of forecasting commodity needs for PASMO and NicaSalud.
• Develop a local FP monitoring strategy for 9 regions in the country.
Primary Results • The skills of MINSA personnel in guaranteeing sufficient supplies of contraceptives have
improved by 100%, and supplies are determined according to consumer demand at the different
levels of service.
• Development has begun on an integrated information system for all medical commodities offered
by MINSA.
• PROFAMILIA is able to produce reliable forecasts that allow the organization to provide a wide
variety of contraceptives.
• An understanding of the situation of family planning services in the EMPs of the INSS and the
development of an improvement plan for the delivery of these services.
• Development of activities at the institutional and interagency levels geared toward guaranteeing
contraceptive security in the country.
• Procurement of contraceptives donated by USAID to MINSA and PROFAMILIA has been timely
and efficient, and the required quantities are based on historical consumption.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: Nigeria Total Funding: $5,603,0000
DELIVER Field Office No. of local staff: 6 Presence established on: October 31, 2005
Technical Focus Family Planning x TB Donor Coordination X
Areas
Integrated Systems Contraceptive Security X Market Segmentation
Financing EPI
HIV/AIDS x Essential Drugs
Principal Client Government of Nigeria Federal Ministry of Health (FMOH)
Organizations
DELIVER’s From 2002 to 2006, DELIVER worked to improve the availability of contraceptives and selected
Objectives HIV/AIDS program commodities by:
• Improving logistics system performance.
• Improving human capacity in logistics management.
• Improving resource mobilization to ensure long-term reproductive health commodity security.
Major Interventions • Support Contractive Security through—
- Support for Strategic Pathway for Reproductive Health Commodity Security
assessments and workshops (joint with FMOH, UNFPA, and POLICY Project)
- Develop logistics standard operating procedures for the national Contraceptive
Logistics Management System (CLMS)
- CLMS curricula for SDP, State/LGA, and federal levels
- TOT for master trainers
- Training of over 2,400 service providers and supervisors
- Coordination with other programs (UNFPA, Packard Foundation USAID VISION
Project, and COMPASS) to ensure national coverage of CLMS training
- Storage and transportation studies
- Integration feasibility assessment reviewing five vertical programs
- “Informed buying” assessment
- Comprehensive baseline and midterm logistics information assessments
- Monitoring and evaluation plans, support for monitoring and supervision
- Forecasting and procurement planning technical assistance and training.
• Support HIV/AIDS commodity security through—
- Antiretroviral therapy (ART) Stages of Readiness Assessment in 65 sites (14 public/51
private) rapid assessment
- Logistics management system design and SOPs for ARVs and HIV test kits
- Training curricula for logistics management of ARVs and HIV test kits
- Logistics management training for over 200 national and facility personnel covering all
ART centers in the federal system
- Forecasting, pipeline monitoring, and procurement planning TA and training
- National level quantifications and stock status surveys
- Monitoring and evaluation plans, support for monitoring and supervision
- Successfully advocated for the establishment of a Logistics Unit in the National AIDS
and STI Control Program
- Provided leadership in developing the logistics harmonization policy of the National
HIV/AIDS Program
March 2007
Primary Results • RHCS policy developed and adopted, joint implementation plans developed and implemented
• CLMS implemented, training curricula developed and training cadres trained
• Over 2,400 SDP staff from 12 states received training with DELIVER support with national roll out
supported by coordinated stakeholder effort
• CLMS re-evaluated, streamlined system piloted in three states
• Monitoring and supervision planned and implemented
• Measurable improvement in contraceptive storage and inventory management at all levels over
LOP
• Measurable improvement in contraceptive availability in the public sector attributed to the
distribution of seed stock
• Logistics systems designed for ARV drugs and HIV test kits
• All Government of Nigeria ART sites trained on LMIS.
DELIVER
John Snow, Inc.
1616 North Ft. Myer Drive, 11th Floor
Tel: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: PARAGUAY Total Funding: $732,455
DELIVER Field Office No. of local staff: 2 Presence established: October 2005
Areas
Integrated Systems Contraceptive Security x Market Segmentation x
Financing x EPI
HIV/AIDS Essential Medicines
Principal Client Ministry of Health (MSPBS), Paraguayan Social Security Institute (IPS), coordination with the
Organizations Contraceptive Security (CS) Committee, and UNFPA.
DELIVER’s • Improve the contraceptive logistics system.
Objectives • Improve contraceptive security.
• Establish indicators to measure program impact.
Major Interventions • Qualitative and quantitative evaluations to measure changes in logistics system performance.
• Revision and validation of the LMIS, printing, and dissemination.
• Training of trainers on logistics, counseling, and contraceptive technologies.
• Implementation of regional logistics training courses.
• Capacity building/skills transfer in contraceptive forecasting for the MSPBS.
• Develop the National Strategic Plan for Contraceptive Security.
• Develop the plan for phase-out of contraceptive donations.
• Facilitation of the approval process to procure contraceptives through UNFPA, by signing a
Memorandum of Understanding (MOU).
• Monitoring contraceptive shipment delivery schedules at the central level.
• Donation of computer equipment to the country’s 19 regions.
• Donation of air conditioning units to 16 regional warehouses and to the central warehouse.
• Donation of room dividing walls to six regional warehouses.
• Negotiation for the relocation of the central warehouse.
Primary Results • Law enacted for protection of funding for procurement of contraceptives and birthing kits.
• Approval of the National Contraceptive Security Plan.
• Appointment of central level Logistics Director.
• MOU signed between UNFPA and the MSPBS for the procurement of contraceptives.
• Baseline logistics indicators established.
• 230 people trained in logistics.
• 19 regional managers empowered and conducting logistics training courses.
• Regional warehouses with adequate space and temperature conditions.
• 19 regions received computer equipment for monitoring of the logistics system.
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: Rwanda Total Funding: $1,766,193
DELIVER Field Office No. of local staff: 3 Presence established on: February 2002
Areas
Financing EPI
Principal Client Ministry of Health and Population
Organizations
DELIVER’s • Ensure sustainability of contraceptive logistics system (CLS).
Objectives • Strengthen public sector logistics capacity.
• Frame and enhance contraceptive security.
Major Interventions • Design of the contraceptive logistics system
• Develop and review of the national strategic plan to strengthen the contraceptive distribution
channel
• Create the logistics committee
• Implement the design workshop recommendations
• Develop the standard operating procedures and job aids
• Train MOH and MOD health personnel
• Draft the supervision reference tool
• Monitor the distribution channel
• Ensure constant availability of contraceptives at all levels
• Forecast contraceptive need requirements
• Mobilize resources to purchase contraceptives
• Stock status survey
• Sensitize local stakeholders on contraceptive security
• Develop the 2006–2010 strategic plan
Primary Results • Increase in CPR from 4% to 10.3%

• Functional logistics system in place
• Stockouts reduced to less than 10%
• 546 health personnel trained
• Storage conditions improved (almost all facilities meet more than 75% of storage conditions)
• System does not produce expiries
• National strategic plan available
• Logistics committee team in place and functioning improving
• Mobilization of financial resources through donors
• Constant monitoring of stock level
• Review of minimum and maximum levels
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: SOUTH AFRICA Total Funding: $3,666,000
DELIVER Field Office No. of local staff: 12 Presence established on:
Areas
Integrated Systems Contraceptive Security Market Segmentation
Financing EPI
Principal Client South African National Department of Health
Organizations
DELIVER’s • Strengthen condom logistics.
Objectives • Support for a balanced ABC prevention campaign.
• Develop an ARV logistics system.
Major Interventions • DELIVER has focused its condom logistics interventions in four strategic areas: developing
systems, implementing an LMIS, ensuring quality, and providing training to build capacity for
managing condom supplies.
• DELIVER worked collaboratively with the Khomanani campaign to launch a new public sector
condom and to expand IEC efforts at the community level. Initial work on the new public sector
condom was linked to the quality improvement activities already described. In addition,
TASC/DELIVER worked with the AIDS Communication Team in the NDOH that manages the
Khomanani campaign to develop a trade marked brand and develop a marketing strategy that was
closely linked to key Khomanani strategies and messaging. (TASC is an earlier project.)
• DELIVER was charged by the Chief Director of HIV/AIDS and TB to research local (South African)
information technology solutions in the private sector that could be used to assist in the roll out of
ARV drugs from a logistics perspective—knowing that drug security presents a major challenge.
Primary Results Improved Logistics System
• Condom stockouts have plummeted to only 1 percent nationwide at the 186 male condom primary
distribution sites throughout the country and 203 female condom sites that receive public sector
condoms.
• NGOs and private sector companies are now part of the national logistics system, which is
managed through an automated LMIS that is updated from paper-based monthly reports submitted
from primary distribution sites.
• Public confidence in government-provided condoms has improved with the introduction and
marketing of the high quality choice male condom.
• 364 million choice condoms were procured and distributed in 2005, nearly double the number
consumed in 2000.
• Access to female condoms in particular has expanded from 29 research sites to over 200 public
and NGO sites.
• Quality assurance is now a standard component of the condom procurement and distribution
system.
MARCH 2007
Improved Human Capacity in Logistics
• Trained more than 2,800 individuals in logistics functions, including national and provincial
program managers, warehouse and supply staff, and providers, as well as staff from NGOs and
private companies that distribute public sector condoms.
• Assisted the NDOH human resources department to establish and recruit and train staff for four
NDOH posts within the STI and HIV/AIDS Prevention Unit, to capacitate the unit to handle the
contract management, quality assurance, warehousing, distribution and tracking for over 1 million
condoms per day.
• Produced an LMIS training manual and related materials for distribution to the provinces to assist
in integrated, district level cascading training efforts.
• Produced an LMIS operator manual to assist in the transfer of technical skills to newly recruited
NDOH staff.
• Produced a comprehensive technical specifications manual for the LMIS for use by IT
programmers in developing further enhancements to the LMIS over time.
Designed and Field Testing of STAT Secure Technology Advancing Treatment
Developed under TASC and field tested under DELIVER, the STAT system is a pioneering approach
to managing ARV drugs while eliminating theft or diversion of these expensive commodities in the
supply chain, particularly at the service delivery site. It involves the adaptation of innovative smart
card and biometric technology that is available in banking and other private sector businesses and
applying it to a public health setting.
STAT offers the following features:

• Positive and reliable identification of patients is enabled through fingerprint scan.
• Confidentiality is assured\ through fingerprint scan.
• Patient’s smart card contains vital information so that a patient may receive treatment at any facility
with smart card equipment.
• Provider’s card stores information on the day’s patient encounters.
• Patient encounter data can be uploaded at the end of the day to a central database, eliminating the
need for a continuous on-line link.
• Card readers are powered by rechargeable batteries and can be used in home visiting programs.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: TANZANIA Total Funding: $15,658,280
DELIVER Field Office No. of local staff: 7 Presence established on: September 2002
Areas
Financing EPI
Principal Client Ministry of Health and Social Welfare- Pharmaceutical Supply Unit, Ministry of Health and Social
Organizations Welfare Reproductive and Child Health Section; National AIDS Control Program; Ministry of Health-
Department of Hospital Services; USAID & CDC (PEPFAR), AED/T-MARC, Medical Stores
Department, and Japan International Cooperating Agency
DELIVER’s Goal
Objectives • Ensure availability of essential health commodities at all levels of the public sector health care
delivery system through an integrated supply chain.
Objectives
• Improve essential health commodity management at all levels of the public sector health care
delivery system by designing and implementing a fully operational logistics system and logistics
MIS that can manage increased categories and volumes of commodities.
• Build individual and organizational capacity and capabilities for logistics system management
and use of logistics MIS data at all levels of the Tanzanian public health sector.
Major Interventions Conducted a stock status assessment in February 2003.
Developed, pilot-tested, and expanded an Integrated logistic system:

• Facilitated the Training of Trainers for ILS roll-out and rolled-out ILS to Dodoma, Iringa, Mbeye,
Ruvuma and Rukwa regions; worked with Ministry officials to facilitate Ministry roll-out of ILS in
Coast and Dar es Salaam regions.
• Provided hardware/software for MSD and recruit data entry personnel.
• Developed, revised and printed ILS manuals, forms, and supplies.
STI/PMTCT/ART Logistics System Development and Implementation:

• Quantified STI/PMTCT products and provided logistics support to selected STI/PMTCT and ART
sites, PMTCT Secretariat, TACAIDS/GFATM, C&TU, and CDC as solicited.
Logistics Technical Assistance to Family Planning Services:

• Prepared CPTs; assisted with maintenance of RCHS contraceptive distribution database; and
provide logistics and financial support for LMIS refresher training for District MCH and DACC.
Commodity Security (CS):

• Prepared long-term contraceptive and condom forecast; developed CS framework; conducted
CS stakeholder meeting; assisted RCHS with organization of monthly contraceptive security
meetings; and enhanced PSU data analysis capacity (hardware, software, training. etc.).
ARV Procurement:
• Procured just over $7.8 million worth of ARV drugs for Tanzania
MARCH 2007
• Completed quantifications and procurement plans and issued two task orders to Crown Agents
to complete the procurement; and updated/refined the quantification spreadsheets as necessary.
Logistics Management Capacity Building

• Developed management tools and process map of clearing procedures for the MOH and MSD.
• Sponsored Chief Pharmacists offshore logistics training in Nairobi.
Routine Systems Monitoring

• Assisted with coordinating donor inputs and program managers with routine system performance
reports; provided ongoing logistics support to facilities.
Monitoring and Evaluation

• Conducted a Stock Status Survey (Feb 2003) and LIAT of the pilot ILS (Sept 2005); Conducted
a qualitative logistics assessment prior to the ILS pilot.
Other
• Acted as the funding mechanism for USAID’s President’s Malaria Initiative and additional child
health work with Rene Salgado.
Primary Results • Seven of the 21 regions in Tanzania now covered by the ILS, accounting for a total of 33.51
percent of the population.
• Twenty trainers and approximately 2,300 staff involved in logistics activities at health centers,
dispensaries, and hospitals trained in the ILS.
• Pharmaceutical Supplies Unit (PSU) strengthened and clearly designated as owner and
implementer of the ILS.
• ILS subsystem designed for STI drugs, laboratory supplies, and HIV test kits and introduced in
indent and kit system regions.
• LMIS and reordering system designed for ARVs and incorporated into ART training module.
• Condoms included in ILS—managed through MCH coordinators in kit and indent regions—
included in annual CPTs, and stock status tracked during monthly contraceptive security
meetings.
• Contraceptive security improved through coordination of the annual CPT exercise, MTEF
submissions, and annual stakeholders’ consultative meetings as well as monthly contraceptive
security meetings.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: UGANDA Total Funding: $9,402,434
DELIVER Field Office No. of local staff: 23 Presence established on: 2001
Areas
Financing x EPI x
Principal Client Ministry of Health, National Medical Stores, Joint Medical Stores, Joint Clinical Research Council,
Organizations and health sector NGOs
DELIVER’s • Establish effective logistics systems for expanded distribution of HIV/AIDS commodities.
Objectives • Establish effective logistics system for distribution of HIV tests, lab reagents and consumables.
• Establish effective logistics system for distribution of TB drugs.
• Establish effective logistics system for vaccines and related EPI commodities.
• Improve logistics system for essential drugs and contraceptives.
• Improve warehouse management and distribution in NMS.
• Improve use of information technology to support management of logistics information.
• Improve capacity in MOH to monitor and manage health logistics system.
• Assist MOH to increase drug financing and drug availability.
Major Interventions • Policy inputs in logistics to change essential drug system to a “pull” demand system and to create
working logistics systems for ARVs, HIV test kits, TB drugs, and laboratory supplies.
• Assisted MOH in quantification and in successful financial support proposals for ARVs, HIV test
kits, vaccines, contraceptives, TB drugs, and laboratory reagents and consumables.
• Designed, tested and introduced to the MOH system the logistics forms for ARVs, test kits,
essential drugs, TB drugs, vaccines, contraceptives, condoms, and lab supplies and set up
computer programs to support these systems.
• Trained all ARV providers and produced logistics management procedure manual for ARVs,
Nevirapine and HIV tests.
• Established lab supply credit line through NMS and trained lab staff in labs on new lab logistics
supply system.
• Trained 3,500 health workers in all MOH and NGO facilities in logistics system for essential drugs
and contraceptives.
• Trained TB program staff in 44 districts on new logistics system for TB drugs, established central
logistics management information system processing logistics data from 1,917 SDPs.
• Assisted national level warehouses to improve efficiency and distribution systems.
Primary Results • Successful change to “pull” demand system for essential drugs and contraceptives allowed greater
local control of product choices and increased product access.
• Value of drug supply through MOH system increased by 4.5 times.
• National Medical Stores made the transition from a “pass-through” warehouse to a unit packing
individual orders for over 1,900 MOH facilities every two months.
• Logistics considerations now part of MOH program planning process, based on logistics data.
• MOH free ARV drugs now reaching over 30,000 patients monthly at 220 sites.
• HIV tests went from 30,000 in 2001 to over 1 million in 2006 at more than 460 sites.
MARCH 2007
• National system providing laboratory supplies and reagents to all MOH and NGO labs.
• TB drug logistics system totally re-designed to use logistics data to track and distribute TB drugs.
• UNEPI vaccine systems improved and national warehouse made more efficient.
• Contraceptives integrated into essential drugs logistics system and distributed every 2 months.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: UKRAINE Total Funding: $310,000
Areas
Financing EPI
Principal Client USAID/Ukraine, Belarus, and Moldova; Ministry of Health/National AIDS Center; Ministry of
Organizations Health/Maternal and Child Health Office; Ukraine Reproductive Health Network (URHN);
UkrmedPostach; International HIV/AIDS Alliance; UNICEF; WHO; World Bank (AIDS Epidemic
Control Project); GTZ (Knowledge Hub for Care and Treatment); Medecins Sans Frontieres (MSF);
POLICY Project
DELIVER’s Reproductive Health/Contraceptive Security: To conduct an assessment of contraceptive
Objectives availability and related RH and FP issues, and provide recommendations for future USAID
reproductive health activities aimed at improving contraceptive security in Ukraine.
HIV/AIDS: To better inform USAID/Ukraine about the current logistics systems, procurement and
information systems, and financing mechanisms of the Government and partners for HIV/AIDS drugs
and other commodities - as part of USAID/Ukraine’s HIV/AIDS 2003-2008 strategy.
Major Interventions RH/Contraceptive Security (2004):
Assessment completed to determine:
• Availability of contraceptives through the public and private sectors
• Relative availability in urban and rural areas
• Recommendations for reducing barriers to access
• Current movement of contraceptives from initial procurement to end users (clients) in the public
sector
• The potential for adding contraceptives to the distribution systems of other essential drugs and
commodities
• Options for public/private approaches to contraceptive supply, government procurement,
targeting, and donations from various donors
• An estimation of the future need for contraceptives
• Potential questions for inclusion in a rider survey for an upcoming DHS survey.
HIV/AIDS (2005):
Assessment and follow-up trip completed to determine:
• Capacity of the logistics system to support rapid expansion of the HIV/AIDS Control program,
including inventory control, logistics management information systems, and distribution (transport
and storage)
• Capacity of the logistics system to support provision of PMTCT commodities supplied through
various funding sources, including international tendering and/or local purchase
• Capacity of the MOH to procure ARV drugs within an expanded program
• ARV drug pricing and tax issues
• International HIV/AIDS Alliance (IHAA) roles and responsibilities as the Global Fund to Fight
AIDS, Tuberculosis and Malaria (GFATM)’s Principal Recipient
• Key transition strategies for scaling up the ART role of the MOH and scaling down the ART role
of the IHAA
• Policy and human resources issues in support of the HIV/AIDS Control program
• Preparation of an action plan to support and expand the HIV/AIDS Control program.
MARCH 2007
Primary Results • Provided specific recommendations to USAID, the MOH, and IHAA regarding the
national HIV/AIDS program in the areas of policy, procurement, and supply chain
management.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: West Africa/WAI Total Funding: $2,822,000
DELIVER Field Office No. of local staff: N/A Presence established on: January 2003
Technical Focus Family Planning x x Donor Coordination x
Areas
x Contraceptive Security x x
Financing x x
Principal Client • Ministries of Health in Cameroon, Burkina Faso, Togo, and Sierra Leone
Organizations • Regional Institutions: WAHO, IRSP, CESAG
• Global Fund countries in West and Central Africa
DELIVER’s • To provide technical assistance to Burkina Faso, Cameroon, and Togo to estimate their
Objectives contraceptive needs and to develop their strategic plans for contraceptives.
• To provide technical assistance in contraceptive security to other countries at the request of
USAID/West Africa.
• To provide technical assistance to the West African Health Organization (WAHO) to sensitize
ECOWAS health ministers in reproductive health commodity security and develop a sub-regional
reproductive health commodity security strategic plan.
Major Interventions • Estimate commodities requirements for USAID and other donors.
• Develop commodity security strategic plans for individual countries.
• Assist WAHO to develop an RH commodity security strategy.
• Train in country and regional institutions staff in commodity security and logistics.
• Advocate for contraceptive security with high level decision and policy makers both at the
regional and country levels.
• Carry out logistics assessments.
• Carry out commodity security assessments.
Primary Results • Country strategic plans developed in Burkina, Cameroon,Togo, and Sierra Leone.
• Sub-regional strategic plan developed for ECOWAS under WAHO leadership.
• Contraceptive products available in countries as a result of an estimation of requirements in
Cameroon, Togo, Sierra Leone, and Burkina Fasp.
MARCH 2007
International Development It was prepared by the DELIVER project
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: YEMEN Total Funding: $350,000
DELIVER Field Office No. of local staff: 0 Presence established on: No field office
Focus Governorates: Al Jawf, Amjran, Marib, Sa’ada, Shabwa
Areas
Financing EPI
Principal Client Ministry of Public Health & Population (MOPHP); Ministry of Health/ Reproductive Health Directorate
Organizations (MOH/DRH); Reproductive Health commodity security committee; coordination with UNFPA, GTZ,
PHR+ Catalyst, and others
DELIVER’s • Improve planning and management capabilities at governorate level and below.
Objectives • Ensure that essential commodities are available in health care facilities at pilot sites.
• Strengthen the skills of MOPHP personnel in managing the supply of essential commodities.
Major Interventions • Improve the performance of the RH Directorate at central level by—
- Introducing procedures and software to routinely update forecasts and monitor
procurement and pipeline status.
- Examining central level storage facility and proposing improved layout and storage
protocols.
- Modifying and printing new storage and distribution guidelines.
- Producing an Arabic-enabled version of the DELIVER pipeline monitoring and
procurement planning (PipeLine) software.
• Improve the performance of the Governorate and lower levels through—
- In-depth assessment of MOPHP commodity management system.
- Partnering with key counterparts to ensure that assessment tools and intervention
strategies are aligned across all Governorates.
- Reporting on strengths and challenges identified in current system.
- Proposing strategies for addressing deficiencies.
• Support contraceptive security:
- Updating PipeLine database to inform near-term procurement effort.
- Supporting donor coordination.
• Investigate Contraceptive quality concerns:
- Researching conceptive quality reports and suggest strategies for addressing concerns
Primary Results • Clarified vision of current logistical system that is aligned with partner activities nationwide,
including key strengths and challenges.
• Proposed warehouse design for improved commodity storage at central level.
• Arabic-enabled software tool that enables improved procurement management by local program
managers.
• Short-term procurement needs calculated to prevent supply imbalances.
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: ZAMBIA Total Funding: $15,729,988
Technical Focus Family Planning TB Donor Coordination x
Areas
Integrated Systems x Contraceptive Security Market Segmentation
Financing EPI Procurement x
Principal Client Ministry of Health, Medical Supplies Limited, Center for Infectious Disease Research in Zambia,
Organizations Church Health Association of Zambia, Catholic Relief Services/ AIDS Relief, and USAID
DELIVER’s • Required ARVs and HIV tests quantified and procured in a manner consistent with resources and
Objectives policies for scaling up.
• Forecasting and procurement planning mechanisms for ARVs and HIV tests in place at the central
level.
• Inventory control procedures, a logistics management information system (LMIS) and storage and
distribution policies and procedures established for all levels for ARVs and for HIV tests.
• Logistics policies and procedures for managing ARVs and HIV tests documented and
disseminated.
• Appropriate personnel in the MOH trained in the logistics policies and procedures for ARVs and
HIV Tests in order to implement the new supply chains.
• Appropriate short and long term mechanisms in place to monitor the supply chains for ARVs and
HIV tests and adjustments made, as needed.
Major Interventions • Carried out continuous technical assistance in the area of quantification and forecasting.
• Gathered data for, managed, and taught key client organizations how to use the PipeLine
database in order to have continuous input for the analysis of the National ARV and HIV Test
supply situations.
• Managed the procurement and receipt of USAID-funded ARVs and HIV tests.
• Sought and obtained buy-in for the development of a clearly outlined, documented, and GRZ-
approved logistics system for ARVs and for HIV tests.
• Held stakeholders’ meetings for information and collaboration purposes.
• Carried out system design workshops for ARVs and then for HIV tests.
• Developed detailed standard operating procedures for the two systems.
• Designed detailed curricula and materials to implement the two systems.
• Trained trainers.
• Carried out both national and pilot training programs.
Primary Results • Strengthened logistics systems for the management of ARVs and HIV tests were implemented.
• A logistics management unit (LMU) was established at the Medical Stores Limited warehouse.
• An automated national inventory control system and logistics management information system
were established within the LMU.
• Key procurement organizations were coordinated to provide input to national procurement
planning.
MARCH 2007
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
COUNTRY FACT SHEET
Country: ZIMBABWE Total Funding: US $7,437,000
Areas
Financing EPI
Principal Client Zimbabwe National Family Planning Council (ZNFPC), Ministry of Health and Child Welfare
Organizations (MOHCW), United States Agency for International Development, Centers for Disease Control
DELIVER’s • Improve availability of HIV/AIDS condoms in public sector health facilities.
Objectives • Procure and distribute USG funded ARV drugs for selected Phase I sites.
• Provide TA and strengthen public sector capacity in supply chain management of HIV/AIDS
commodities in the national program.
• Strengthen Phase I sites clinical readiness to implement ART.
• Support and monitor Phase 1 sites during start-up of ART.
• Strengthen sites’ ability to manage ARV medicines.
Major Interventions Improve the availability of condoms:
• Produced public sector procurement tables (CPTs).
• Coordinated USAID male condom shipments.
• Coordinated DTTU system implementation.
• Designed and implemented DTTU system automated LMIS.
• Reviewed social marketing CPTs.
Improve the availability of ART and ARVs:
• Procured ARV drugs and facilitate customs clearance, storage; distribution and ARV
registration.
• Conducted ART site assessments.
• Designed and implemented an interim ARV distribution system.
• Conducted LIAT for HIV/AIDS commodities.
• Conducted ART program review.
• Developed a concept paper for the provincial ART expansion model and tool to assess
provincial suitability to pilot the model
• Conducted clinical ART quality assessments.
• Facilitated HIV/AIDS training for local clinicians.
Primary Results • DTTU system distributed to 99% of all health facilities every trimester and has achieved stock
out rates of less than 5%.
• Delivered nine different ARV formulations to support the ART program in Zimbabwe at a
cumulative value of USD $1,130,523; ARV drugs are provided in full supply for 500+ patients at
the Phase I sites
• The national program has an interim ordering and distribution subsystem for HIV&AIDS
March 2007
commodities and is forming a special unit to mange these commodities.
• The Phase I ART sites have standard operating procedures and are correctly following national
guidelines.
• All five sites monitored and are now decentralizing stable patients to lower level facilities; 170
providers have been trained in OI/ART management.
• Phase I sites are able to manage ARVs using project designed forms and procedures.
• Computer equipment, reference material and other resources have been provided to selected
sites to improve quality of care.
DELIVER
John Snow, Inc.
1616 North Ft. Myer Drive, 11th Floor
Tel: 703-528-7474
Fax: 703-528-7480
www.deliver.jsi.com
APPENDIX 2
FINAL PUBLICATIONS LIST
I. COUNTRY-RELATED DOCUMENTS
Bangladesh
Assessment of USAID/Bangladesh Component of DELIVER Project: A Success to Build On
Bornbusch, Alan, J. Timothy Johnson, and Sharmila Raj. 2006. Assessment of USAID/Bangladesh
Component of DELIVER Project: A Success to Build On. (Prepared for the USAID Mission, Bangladesh,
Office of Population, Health and Nutrition.) Arlington, Va.: DELIVER, for the U.S. Agency for
Bangladesh Behavior Change Communication Communications Strategy for Contraceptive

Security
Wright, Christopher. 2003. Bangladesh Behavior Change Communication Communications Strategy for
Contraceptive Security. John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
Bangladesh Bidder’s Guide

Woodle, Dian, Todd Dickens, and Jennifer Fox. 2003. Bangladesh Bidder’s Guide. Prepared by PATH.
Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
Bangladesh Contraceptive Market Segmentation Analysis

Chowla, Deepika, David Sarley, Susan Scribner, Ruth Berg, and Asma Balal. 2003. Bangladesh
Contraceptive Market Segmentation Analysis. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S.
Agency for International Development.
Bangladesh: Final Country Report

DELIVER. 2007. Bangladesh: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
A Consequence of Success: The Issue of Contraceptive Security in Bangladesh

Ministry of Health and Family Welfare, Government of the People’s Republic of Bangladesh. 2004. A
Consequence of Success: The Issue of Contraceptive Security in Bangladesh. Dhaka: John Snow,
Inc./DELIVER, for the U.S. Agency for International Development.
Contraceptive Requirements, Bangladesh: 2006–2010

Hudgins, Anthony A. 2005. Contraceptive Requirements, Bangladesh: 2006–2010. Dhaka: John Snow,
Facilitator Guide for NGO Contraceptive Security and Logistics (Including Complete Participant
Guide for Group Training)
DELIVER. 2006. Facilitator Guide for NGO Contraceptive Security and Logistics (Including Complete
Participant Guide for Group Training). Dhaka: DELIVER, for the U.S. Agency for International
Development.
Logistics Line (DELIVER Newsletter), Issue 1
John Snow, Inc./DELIVER. 2005. Logistics Line (DELIVER Newsletter), Issue 1. Dhaka: John Snow,
Logistics Line (DELIVER Newsletter), Issue 2

DELIVER. 2006. Logistics Line (DELIVER Newsletter), Issue 2. Dhaka: DELIVER, for the U.S. Agency
for International Development.
Manual on FWA Register

Hossain, Muhd. Anwar. 2005. Manual on FWA Register. Dhaka, Bangladesh: John Snow,
Procurement Primer for Health and Family Planning Program in Bangladesh

Woodle, Dian, Todd Dickens, and Jennifer Fox. 2003. Procurement Primer for Health and Family
Planning Program in Bangladesh. (Prepared by PATH for John Snow, Inc./DELIVER.) Arlington, Va.:
John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
Projected Contraceptive Commodity Requirements 2000–2015

Islam, M. Ataharul, and Nitai Chakraborty. 2001. Projected Contraceptive Commodity Requirements
2000–2015. Dhaka: John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
Public and Private Sector Collaboration in Providing Contraceptive Security

Kabir, Md. Jahangir. 2004. Public and Private Sector Collaboration in Providing Contraceptive Security.
Dhaka: John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
On Track: Developing a Strategy for Contraceptive Security in Bangladesh (also in Spanish)

John Snow, Inc./DELIVER. 2002. On Track: Developing a Strategy for Contraceptive Security in
Bangladesh. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
On Track: New Procurement Manuals Guide Long-Term Contraceptive Procurement in

Bangladesh
John Snow, Inc./DELIVER. 2003. On Track: New Procurement Manuals Guide Long-Term
Contraceptive Procurement in Bangladesh. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S.
Report on Study on Availability of Contraceptives at Service Delivery Point

Centre for Development Services (CDS). 2005. Report on Study on Availability of Contraceptives at
Service Delivery Point (SDP) Level.(Prepared for John Snow, Inc./DELIVER.) Dhaka: John Snow,
Benin
On Track: Building Support for Contraceptive Security in Benin
John Snow, Inc./DELIVER. 2002. On Track: Building Support for Contraceptive Security in Benin.
Bolivia
Bolivia: Análisis de Segmentación del Mercado
DELIVER. 2005. Bolivia: Análisis de Segmentación del Mercado. La Paz, Bolivia: John Snow,
Inc./DELIVER, para la Agencia de los Estados Unidos para el Desarrollo.
Bolivia: Final Country Report: Executive Summary
DELIVER. 2007. Bolivia: Final Country Report: Executive Summary. Arlington, Va.: DELIVER, for the
Bolivia: Informe Final del País

DELIVER. 2007. Bolivia: Informe Final del País. Arlington, Va.: DELIVER, for the U.S. Agency for
Contraceptive Security in Bolivia: Assessing Strengths and Weaknesses (also in Spanish)

Taylor, Patricia, Nora Quesada, Patricia Saenz, Karina Garcia, Cynthia Salamanca, Patricia Mostajo, and
Varuni Dayaratna. 2003. Contraceptive Security in Bolivia: Assessing Strengths and Weaknesses.
Arlington, Va.: John Snow, Inc./DELIVER, and Washington, DC: Futures Group/POLICY II, for the
On Track: Preservice Logistics Training in Bolivia

John Snow, Inc./DELIVER. 2004. On Track: Preservice Logistics Training in Bolivia.
Políticas, Prácticas y Opciones sobre la Adquisición de Insumos Anticonceptivos: Bolivia

Quesada, Nora, Wendy Abramson, Verónica Siman Betancourt, Varuni Dayaratna, Jay Gribble, David
Sarley, Carlos Lamadrid, Nadia Olson, y Juan Agudelo. 2006. Políticas, Prácticas y Opciones sobre la
Adquisición de Insumos Anticonceptivos: Bolivia. Arlington, Va.: DELIVER, y Washington, D.C.:
USAID | Iniciativa de Políticas en Salud OT1 para la Agencia de los Estados Unidos para el Desarrollo
Internacional.
State of the Practice Brief: Bolivia: Meeting the Millennium Challenge: Women and Their Families
Can Survive and Thrive Through Expanded Access to Family Planning
DELIVER. 2006. State of the Practice Brief: Bolivia: Meeting the Millennium Challenge: Women and
Their Families Can Survive and Thrive Through Expanded Access to Family Planning. Arlington, Va.:
Brazil
Contraceptive Procurement Policies, Practices, and Lessons Learned: Brazil
Studart, Cecilia, Blanka Homolova, Miguel Fontes, Rodrigo Laro, and Nadia Olson. 2006.
Contraceptive Procurement Policies, Practices, and Lessons Learned: Brazil. Arlington, Va.:
Burkina Faso
Burkina Faso: Evaluation of the Logistics System for Antiretroviral Drugs
Roche, Gregory, Abdourahmane Diallo, Paul Dowling, and Suzanne Church. 2004. Burkina Faso:
Evaluation of the Logistics System for Antiretroviral Drugs. John Snow, Inc./DELIVER, for the U.S.
Colombia
Políticas, Prácticas y Lecciones Aprendidas en la Adquisición de Métodos Anticonceptivos:
Colombia
Agudelo, Juan, Nora Quesada. 2006. Políticas, prácticas y lecciones aprendidas en la adquisición
de métodos anticonceptivos: Colombia. Bogotá, Colombia: DELIVER, para la Agencia de los
Estados Unidos para el Desarrollo Internacional.
Democratic Republic of the Congo
Evaluation du Système de Gestion Logistique des Contraceptifs au Sud Maniema en République
Démocratique du Congo
Ouédraogo, Youssouf, Motomoke Eomba, Jennifer Antilla, 2006. Evaluation du Système de
Gestion Logistique des Contraceptifs au Sud Maniema en République Démocratique du Congo.
Arlington, Va.: DELIVER, pour l’Agence des États-Unis pour le Développement International.
Domincan Republic
República Dominicana: Diagnóstico Sobre La Disponibilidad Asegurada De Insumos Anticonceptivos (DAIA)
Agudelo, Juan, Erin Hasselberg, Ramón Orlando Jiménez, Eleodoro Pérez Sierra, Viriato Acosta. Marzo
2005. República Dominicana: Diagnóstico Sobre La Disponibilidad Asegurada De Insumos
Anticonceptivos (DAIA). Arlington, Va: DELIVER, para la Agencia de los Estados Unidos para el
Desarrollo Internacional.
Políticas, Prácticas, y Opciones para la Adquisición de Insumos Anticonceptivos: República

Dominicana
Agudelo, Juan, Varuni Dayaratna, Cristian Morales, Nora Quesada, David Sarley, Wendy Abramson,
Jay Gribble, Carlos Lamadrid, Nadia Olson, y Verónica Siman Betancourt. 2006. Políticas, Prácticas, y
Opciones para la Adquisición de Insumos Anticonceptivos: República Dominicana. Arlington, Va.:
DELIVER, y Washington, D.C.: USAID | Iniciativa de Políticas en Salud Orden de Trabajo 1, para la
Agencia de los Estados Unidos para el Desarrollo Internacional.
State of the Practice Brief: Dominican Republic: Guaranteeing Universal Access to Family
Planning
DELIVER. 2006. State of the Practice Brief: Dominican Republic: Guaranteeing Universal Access to
Family Planning. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Ecuador
Ecuador: Diagnóstico Sobre La Disponibilidad Asegurada De Insumos Anticonceptivos (DAIA)
Uribe, Bernardo, Nora Quesada, Sharon Soper, Juan Agudelo, Lino Martinez. Julio 2005. Ecuador:
Diagnóstico Sobre La Disponibilidad Asegurada De Insumos Anticonceptivos (DAIA). Arlington, Va:
John Snow, Inc./DELIVER, para la Agencia de los Estados Unidos para el Desarrollo Internacional.
Políticas, Prácticas y Opciones para la Adquisición de Insumos Anticonceptivos: Ecuador

Quesada, Nora, Verónica Siman Betancourt, Wendy Abramson, Varuni Dayaratna, Jay Gribble, David
Sarley, Carlos Lamadrid, Nadia Olson y Juan Agudelo. 2006. Políticas, Prácticas y Opciones para la
Adquisición de Insumos Anticonceptivos: Ecuador. Arlington, Va.: DELIVER y Washington, DC:
USAID | Iniciativa de Políticas en Salud, para la Agencia de los Estados Unidos para el Desarrollo
Internacional.
State of the Practice Brief: Ecuador: Constructing a Secure Safety Net for Mothers and Children
through Guaranteed Access to Basic Health Care
DELIVER. 2006. State of the Practice Brief: Ecuador: Constructing a Secure Safety Net for Mothers and
Children through Guaranteed Access to Basic Health Care. Arlington, Va.: DELIVER, for the U.S.
El Salvador
On Track: Achieving Contraceptive Security in El Salvador (also in Spanish)
John Snow, Inc./DELIVER. 2004. On Track: Achieving Contraceptive Security in El Salvador. Arlington,
Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
Políticas, Prácticas y Opciones para la Adquisición de Insumos Anticonceptivos: El Salvador

Siman Betancourt, Verónica, Nora Quesada, Wendy Abramson, David Sarley, Varuni Dayaratna, Jay
Gribble, Carlos Lamadrid y Nadia Olson. 2006. Políticas, Prácticas y Opciones para la Adquisición de
Insumos Anticonceptivos: El Salvador. Arlington, Va.: DELIVER y Washington, DC: USAID |
Iniciativa de Políticas en Salud, para la Agencia de los Estados Unidos para el Desarrollo Internacional.
State of the Practice Brief: El Salvador: Securing Essential Contraceptive Supplies for All Who
Need Them
DELIVER. 2006. State of the Practice Brief: El Salvador: Securing Essential Contraceptive Supplies for
All Who Need Them. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Ethiopia
Contraceptive Inventory and Logistics System Survey: July 2001
Alt, David, Bernardo Uribe, and Lea Teclemariam. 2001. Contraceptive Inventory and Logistics System
Survey: July 2001. Addis Ababa: Federal Democratic Republic of Ethiopia Ministry of Health.
Contraceptive Inventory and Logistics System Survey

Family Health Department, Ministry of Health, Federal Democratic Government of Ethiopia: 2006.
Contraceptive Inventory and Logistics System Survey: January 2006. Addis Ababa: Federal Democratic
Republic of Ethiopia Ministry of Health.
Ethiopia: Final Country Report

DELIVER. 2007. Ethiopia: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Ghana
Assessment of the Ghana Laboratory Logistics System and Services
Addo, Nii Akwei, Rowland Adukpo, Veronica Bekoe, Samuel Boateng, Ronald Brown, Egbert Bruce,
Aoua Diarra, Parfait Edah, Wendy Nicodemus, and Festus Sroda. 2006. Assessment of the Ghana
Laboratory Logistics System and Services. Arlington, Va.: DELIVER, for the U.S. Agency for
DELIVER Ghana Transportation Study

Crown Agents Consultancy. 2002. DELIVER Ghana Transportation Study, Report. Arlington, Va.:
Crown Agents Procurement and Consultancy Services.
Ghana: Decentralization and the Health Logistics Systems

Bossert, Thomas, Diana Bowser, Johnnie Amenyah, and Rebecca Copeland. 2004. Ghana:
Decentralization and the Health Logistics Systems. Arlington, Va.: John Snow, Inc./DELIVER, for the
Ghana: Final Country Report

DELIVER. 2007. Ghana: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency
Ghana HIV/AIDS Commodity Security: A National Strategy 2006-2010
Ministry of Health (MOH), Ghana. 2006. Ghana HIV/AIDS Commodity Security: A National Strategy
2006-2010. Ghana: MOH.
Ghana: Pharmaceutical Pricing Study, Policy Analysis and Recommendations

Sarley, David, Hany Abdallah, Raja Rao, Peter Gyimah, Joycelyn Azeez, and Bertha Garshong. 2003.
Ghana: Pharmaceutical Pricing Study, Policy Analysis and Recommendations. Arlington, Va.: John
Snow, Inc./DELIVER, for the U.S. Agency for International Development.
Ghana: Preparing for the Management of Antiretroviral Drugs—Findings and Recommendations

for the ARV Assessment Team
Felling, Barbara, Johnnie Amenyah, Amos Sam-Abbenyi, Kwasi Torpey, Phyllis Ocran, Adwoa Agyei,
Maj. Regina Akai-Nettey (Ret.), and Felix Yellu. 2003. Ghana: Preparing for the Management of
Antiretroviral Drugs—Findings and Recommendations for the ARV Assessment Team. Arlington, Va.:
Ghana: Process Mapping. First Step to Reengineering the Health Supply Chain of the Public Sector
System
Brumburgh, Scott, and Sangeeta Raja. 2001. Ghana: Process Mapping. First Step to Reengineering the
Health Supply Chain of the Public Sector System. Arlington, Va.: John Snow, Inc./DELIVER, for the
Ghana: Quantitative and Qualitative Logistics System Assessment (LIAT and LSAT) Report 2006
McLaughlin, Colleen, Erika Ronnow, Erin Shea, Parfait Edah, and Egbert Bruce. 2006. Ghana:
Quantitative and Qualitative Logistics System Assessment (LIAT and LSAT) Report 2006. Arlington, Va.:
Meeting the Commodity Challenge: The Ghana National Contraceptive Security Strategy
Ministry of Health (MOH), Ghana. 2004. Meeting the Commodity Challenge: The Ghana National
Contraceptive Security Strategy 2004–2010. Ghana: MOH.
On Track: Developing a Strategy for Contraceptive Security in Ghana

John Snow, Inc./DELIVER. 2002. On Track: Developing a Strategy for Contraceptive Security in Ghana.
On Track: How to Cut 100 Steps from Your Contraceptive Supply Chain
DELIVER. 2003. How to Cut 100 Steps from Your Contraceptive Supply Chain. Arlington, Va.: John
Technical Report of the January 2006 ARV Quantification Review and HIV Test Kits
Quantification
Addo, Nii A., S. Boateng, P. Ocran, J. Azeez, V. Bekoe, N. Frempong, E. Bruce, P. Dowling, P. Edah,
and E. Takang. 2006. Technical Report of the January 2006 ARV Quantification Review and HIV Test
Kits Quantification. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Guatemala
Diagnóstico de la Disponibilidad Asegurada de Insumos Anticonceptivos en Guatemala: Fortalezas
y Retos de los Servicios de Planificación Familiar en Guatemala
Abramson, Wendy, Anabella Sánchez, y Nadia Olson. 2006. Diagnóstico de la Disponibilidad Asegurada
de Insumos Anticonceptivos en Guatemala: Fortalezas y Retos de los Servicios de Planificación Familiar
en Guatemala. Guatemala: DELIVER, para la Agencia de los Estados Unidos para el Desarrollo
Internacional.
Guatemala: Decentralization and Integration in the Health Logistics System (also in Spanish)
Bossert, Thomas, Diana Bowser, Johnnie Amenyah, and Becky Copeland. 2003. Guatemala:
Decentralization and Integration in the Health Logistics System. Arlington, Va.: John Snow,
Políticas, Prácticas, y Opciones para la Adquisición de Insumos Anticonceptivos: Guatemala

Sánchez, Anabella, Verónica Siman Betancourt, Nora Quesada, Wendy Abramson, Nadia Olson, Jay
Gribble, David Sarley y Carlos Lamadrid. 2006. Políticas, Prácticas, y Opciones para la Adquisición de
Insumos Anticonceptivos: Guatemala. Arlington, Va.: DELIVER y Washington, DC: USAID | Iniciativa
de Políticas en Salud, para la Agencia de los Estados Unidos para el Desarrollo Internacional.
State of the Practice Brief: Guatemala: Ensuring a Voice and a Choice for Women
DELIVER. 2006. State of the Practice Brief: Guatemala: Ensuring a Voice and a Choice for Women.
Honduras
Contraceptive Security in Honduras: Assessing Strengths and Weaknesses (also in Spanish)
Quesada, Nora, Patricia Mostajo, Cynthia Salamanca, Cindi Cisek, Leslie Patykewich, and Ali Karim.
2004. Honduras: Contraceptive Security Assessment, April 26–May 7, 2004. Arlington, Va.: John Snow,
Inc./DELIVER, and Washington, DC: Futures Group/POLICY II, for the U.S. Agency for International
Development.
Estrategia Metodológica de los Servicios de Planificación Familiar (Methodological Strategy for

Family Planning Services)
Ministry of Health (MOH), Honduras. 2006. Estrategia Metodológica de los Servicios de Planificación
Familiar (Methodological Strategy for Family Planning Services). Tegucigalpa, Honduras: MOH.
Estrategia Nacional para la Disponibilidad Asegurada de Insumos Anticonceptivos (National

Contraceptive Security Strategy)
Ministry of Health (MOH), Honduras. 2005. Estrategia Nacional para la Disponibilidad Asegurada de
Insumos Anticonceptivos (National Contraceptive Security Strategy). Tegucigalpa, Honduras: MOH.
Evaluación Cuantitativa de Indicadores Logísticos Honduras, 2006

Chimnani, Jaya, Kim Peacock, José Ochoa, Jane Feinberg, and Sandra Sánchez. 2006. Evaluación
Cuantitativa de Indicadores Logísticos Honduras, 2006. Honduras: DELIVER, for the U.S. Agency for
Honduras: Final Country Report

DELIVER. 2007. Honduras: Final Country Report. Arlington, Va.: DELIVER, for the United
States Agency for International Development.
Políticas, Prácticas y Opciones para la Adquisición de Insumos Anticonceptivos: Honduras
Gribble, Jay, Nora Quesada, Varuni Dayaratna, Wendy Abramson, David Sarley, Carlos Lamadrid, Nadia
Olson, y Verónica Siman Betancourt. 2006. Políticas, Prácticas y Opciones para la Adquisición de
Insumos Anticonceptivos: Honduras. Arlington, Va.: DELIVER, y Washington, DC: USAID | Iniciativa
de Políticas en Salud, para la Agencia de los Estados Unidos para el Desarrollo Internacional.
State of the Practice Brief: Honduras: Moving Contraceptive Security Forward with Political
Commitment and Financial Capital
DELIVER. 2006. State of the Practice Brief: Honduras: Moving Contraceptive Security Forward with
Political Commitment and Financial Capital. Arlington, Va.: DELIVER, for the U.S. Agency for
India
A Brochure on the Logistics Resource Center at IIM
Lama, Shyam. 2004. A Brochure on the Logistics Resource Center at IIM. Uttar Pradesh, India: Indian
Institute of Management, Lucknow.
Field monitoring checklist

Ministry of Health and Family Welfare, Lucknow. 2003. Field monitoring checklist. Uttar Pradesh, India:
Government of Uttar Pradesh.
India: Final Country Report

DELIVER. 2007. India: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Logistics Strategic Plan, 2005-07

Ministry of Health and Family Welfare, Lucknow. 2003. Logistics Strategic Plan, 2005-07. Uttar
Pradesh, India: Government of Uttar Pradesh.
Procurement Policy and Procedure Manual

Ministry of Health and Family Welfare, Lucknow. 2003. Procurement Policy and Procedure Manual.
Uttar Pradesh, India: Government of Uttar Pradesh.
Trainers Manual
Ministry of Health and Family Welfare, Lucknow. 2003. Trainers Manual. Uttar Pradesh, India:
Government of Uttar Pradesh.
Jordan
On Track: Jordan Takes Control of Its Logistics System: Update
John Snow, Inc./DELIVER. 2003. On Track: Jordan Takes Control of Its Logistics System: Update.
Kenya
Condoms for HIV/AIDS Prevention Logistics System Assessment Report
Ronnow, Erika, and Youssouf Ouedraogo. 2005. Condoms for HIV/AIDS Prevention Logistics System
Assessment Report. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Focus on Results: Kenya
DELIVER. 2007. Focus on Results: Kenya. Arlington, Va.: DELIVER, for the U.S. Agency for
Improving Health Logistic systems in Eastern South Region of Kenya Ministry of Health 2005–
2006
Bahati, Augustine. 2006. Improving Health Logistic Systems in Eastern South Region of Kenya Ministry
of Health: Grouped Systems Roll out Report 2005–2006. Nairobi, Kenya: DELIVER, for the U.S. Agency
Integrated Logistics System Procedures Manual
John Snow, Inc./DELIVER. 2005. Integrated Logistics System Procedures Manual. Arlington, Va.: John
Kenya: Assessment of the Health Commodity Supply Chains and the Role of KEMSA
Aronovich, Dana, and Steve Kinzett. 2001. Kenya: Assessment of the Health Commodity Supply Chains
and the Role of KEMSA. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
Kenya: Final Country Report

DELIVER. 2007. Kenya: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Kenya: HIV Test Kits Logistics System Procedures Manual

John Snow, Inc./DELIVER. 2005. Kenya: HIV Test Kits Logistics System Procedures Manual. Arlington,
Kenya Laboratory Supplies—Logistics System Assessment Report

Ronnow, Erika, and Youssouf Ouedraogo. 2005. Kenya Laboratory Supplies—Logistics System
Development.
Kenya: Stock Status and Logistics System Assessment Report 2006

Bunde, Elizabeth, Erika Ronnow, and Gerald Kimondo. 2006. Kenya: Stock Status and Logistics System
Assessment Report 2006. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Kenya Tuberculosis Supplies—Logistics System Assessment Report

Ronnow, Erika, and Youssouf Ouedraogo. 2005. Kenya Tuberculosis Supplies—Logistics System
Development.
Logistics Management Information System (LMIS) Data Management Procedures

Ministry of Health (MOH), Kenya. 2005. Logistics Management Information System (LMIS) Data
Management Procedures. Nairobi, Kenya: MOH.
Logistics Management of Laboratory Supplies Standard Operating Procedures Manual

DELIVER. 2006. Logistics Management of Laboratory Supplies Standard Operating Procedures
Manual. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Logistics Management of Laboratory Supplies Trainers Manual

DELIVER. 2006. Logistics Management of Laboratory Supplies Trainers Manual. Arlington, Va.:
On Track: In Kenya, Logistics Project Helps to Extend the Coverage of STI Drugs: Update
John Snow, Inc./DELIVER. 2003. On Track: In Kenya, Logistics Project Helps to Extend the Coverage
of STI Drugs: Update. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Latin America and the Caribbean

Decentralizing and Integrating Contraceptive Logistics Systems in Latin America and the
Caribbean: Considerations for Informed Decision Making throughout the Health Reform Process
(also in Spanish)
Sánchez, Anabella, Wendy Abramson, Nadia Olson, and Nora Quesada. 2006. Decentralizing and
Integrating Contraceptive Logistics Systems in Latin America and the Caribbean: Considerations for
Informed Decision Making throughout the Health Reform Process. Arlington, Va.: DELIVER, for the
Decentralizing and Integrating Contraceptive Logistics Systems in Latin America and the
Caribbean, With Lessons Learned from Asia and Africa
Beith, Alix, Nora Quesada, Wendy Abramson, Anabella Sánchez, and Nadia Olson. 2006. Decentralizing
and Integrating Contraceptive Logistics Systems in Latin America and the Caribbean, with Lessons
Learned from Asia and Africa. Arlington, Va.: DELIVER, for the U.S. Agency for International
Development.
Descentralización e integración de los sistemas logísticos de anticonceptivos en Latinoamérica y el

Caribe: consideraciones para la toma de decisiones informadas a través del proceso de reforma de
la salud
Sánchez, Anabella, Wendy Abramson, Nadia Olson, and Nora Quesada. 2006. Descentralización e
integración de los sistemas logísticos de anticonceptivos en Latinoamérica y el Caribe: consideraciones
para la toma de decisiones informadas a través del proceso de reforma de la salud. Arlington, Va.:
DELIVER, para la Agencia de los Estados Unidos para el Desarrollo Internacional.
Opciones para la Adquisición de Anticonceptivos: Lecciones Aprendidas en Latinoamérica y el

Caribe
Sarley, David, Varuni Dayaratna, Wendy Abramson, Jay Gribble, Nora Quesada, Nadia Olson, y
Verónica Siman Betancourt. 2006. Opciones para la Adquisición de Anticonceptivos: Lecciones
Aprendidas en Latinoamérica y el Caribe. Arlington, Va.: DELIVER, y Washington, DC: USAID |
Iniciativa de Políticas en Salud, para la Agencia de los Estados Unidos para el Desarrollo Internacional.
Options for Contraceptive Procurement: Lessons Learned from Latin America and the Caribbean
(also in Spanish)
Sarley, David, Varuni Dayaratna, Wendy Abramson, Jay Gribble, Nora Quesada, Nadia Olson, and
Verónica Siman Betancourt. 2006. Options for Contraceptive Procurement: Lessons Learned from Latin
America and the Caribbean. Arlington, Va.: DELIVER, and Washington, DC: USAID | Health Policy
Initiative, for the U.S. Agency for International Development.
Regional Contraceptive Security Report: Latin America and the Caribbean

Reproductive Health Commodity Security Strategy for the West Africa Subregion (also in Spanish)
DELIVER. 2006. Reproductive Health Commodity Security Strategy for the West Africa Subregion.
Arlington, Va.: DELIVER, for the United States Agency for International Development.
Malawi
Focus on Results: Malawi
DELIVER. 2007. Focus on Results: Malawi. Arlington, Va.: DELIVER, for the U.S. Agency for
Malawi: Final Country Report

DELIVER. 2007. Malawi: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Malawi: Health Commodities Logistics Management System Procedures Manual
DELIVER. 2003. Malawi: Health Commodities Logistics Management System Procedures Manual.
Malawi: Health Commodities Logistics Management System Standard Operating Procedures

DELIVER. 2006. Malawi: Health Commodities Logistics Management System Standard Operating
Procedures. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Malawi Logistics System Assessment and Stock Status Report: Comparison of 2004 and 2006
Assessment Results
Chimnani, Jaya, Veronica Chirwa, and Erika Ronnow. 2006. Malawi Logistics System Assessment and
Stock Status Report: Comparison of 2004 and 2006 Assessment Results. Arlington, Va.: DELIVER, for
Malawi Supply Chain Manager Annex: Malawi Health Commodities Logistics Management
System Standard Operating Procedures Manual
Zingeni, Jon. 2006. Malawi Supply Chain Manager Annex: Malawi Health Commodities Logistics
Management System Standard Operating Procedures Manual. Arlington, Va.: DELIVER, for the U.S.
Mali
Focus on Results: Mali
DELIVER. 2007. Focus on Results: Mali. Arlington, Va.: DELIVER, for the U.S. Agency for
Mali: Contraceptive Market Segmentation and Pricing Analysis

Dowling, Paul, and David Sarley. 2004. Mali: Contraceptive Market Segmentation and Pricing Analysis.
Mali: Evaluation des Indicateurs et du Système de Gestion Logistique des Contraceptifs et des
Médicaments de Traitements des IST du Mali
Ouedraogo, Youssouf, Briton Bieze, Ibnou Diallo, and Dana Aronovich. 2006. Mali: Evaluation des
Indicateurs et du Système de Gestion Logistique des Contraceptifs et des Médicaments de Traitements des
IST du Mali. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Mali: Evaluation of the Logistics Management System for Contraceptives and Drugs to Treat
Sexually Transmitted Diseases: Executive Summary
Ouedraogo, Youssouf, Briton Bieze, Ibnou Diallo, and Dana Aronovich. 2006. Mali: Evaluation of the
Logistics Management System for Contraceptives and Drugs to Treat Sexually Transmitted Diseases:
Executive Summary. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Mali: Final Country Report
DELIVER. 2007. Mali: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Mozambique
Condom Quality Testing Results, Mozambique, July 2006
Noguera, Marilyn. 2006. Condom Quality Testing Results, Mozambique, July 2006. Arlington, Va.:
Mozambique: Final Country Report
DELIVER. 2007. Mozambique: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency
Requirements Analysis and Cost Estimation for the Construction of a Warehouse in Nacala,
Mozambique for the Ministry of Health
Ayob, Mahomed, Tim O´Hearn, and Jim Eberle. 2006. Requirements Analysis and Cost Estimation for
the Construction of a Warehouse in Nacala, Mozambique for the Ministry of Health. Arlington, Va.:
Nepal
Nepal: Contraceptive Security: Issues, Findings, and Recommendations
Rao, Raja, and Tanvi Pandit. 2004. Nepal: Contraceptive Security: Issues, Findings, and
Recommendations. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Nepal: Final Country Report

DELIVER. 2007. Nepal: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Nepal: Reproductive Health Commodity Pricing Survey: Understanding Equity, Access and
Affordability of Essential Reproductive Health Commodities
Rao, Raja, and Dhruba Thapa. 2006. Nepal: Reproductive Health Commodity Pricing Survey:
Understanding Equity, Access and Affordability of Essential Reproductive Health Commodities.
Nepal: Support for HIV/AIDS Commodity Security

Allain, Linda, Ruslan Malyuta, and Eric Takang. 2006. Nepal: Support for HIV/AIDS Commodity
Security. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
On Track: How Do You Build a Storage Facility?

John Snow, Inc./DELIVER. 2003. On Track: How Do You Build a Storage Facility? Arlington, Va.: John
On Track: Nepal Braves Integration, and Comes Out Ahead: Update

John Snow, Inc./DELIVER. 2003. On Track: Nepal Braves Integration, and Comes Out Ahead: Update.
Nicaragua
Contraceptive Security in Nicaragua: Assessing Strengths and Weaknesses (also in Spanish)
Taylor, Patricia A., Carolina Arauz, Gracia Subiria, Cindi Cisek, José Antonio Medrano, Diony Fuentes,
David Sarley, Leslie Patykewich, and Ali Karim. 2004. Contraceptive Security in Nicaragua: Assessing
Strengths and Weaknesses. Arlington, Va.: John Snow, Inc./DELIVER, and Washington, DC: Futures
Group Inc./POLICY II, for the U.S. Agency for International Development.
Evaluacion Sobre el Impacto de la Capacitacion y Diagnostico del Systema Logistico

Basurto, Carmen, and Bernardo Uribe. 2001. Evaluacion Sobre el Impacto de la Capacitacion y
Diagnostico del Systema Logistico. Nicaragua: John Snow, Inc./DELIVER and the Ministry of Health.
Evaluaciones anuales de indicadores logísticos MINSA 2004

Beteta, Wilber, Carolina Arauz, and Carmen Basurto. 2004. Evaluaciones anuales de indicadores
logísticos MINSA 2004. Nicaragua: John Snow, Inc./DELIVER and the Ministry of Health.
Nicaragua: Análisis de Segmentación del Mercado

Abramson, Wendy, Sharon Soper, Leslie Patykewich, Ali Karim, and David Sarley. 2005. Nicaragua:
Análisis de Segmentación del Mercado. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency
Nicaragua: Final Country Report: Executive Summary

DELIVER. 2007. Nicaragua: Final Country Report: Executive Summary. Arlington, Va.: DELIVER, for
the U.S. Agency for International Development
Nicaragua: Informe Final del País

DELIVER. 2007. Nicaragua: Informe Final del País. Arlington, Va.: DELIVER, para la Agencia de los
On Track: Sustaining Family Planning Successes in Nicaragua

John Snow, Inc./DELIVER. 2005. On Track: Nepal Braves Integration, and Comes Out Ahead: Update.
Políticas, Prácticas, y Opciones para la Adquisición de Insumos Anticonceptivos: Nicaragua

Agudelo, Juan, Cristian Morales, Nora Quesada, David Sarley, Wendy Abramson, Jay Gribble, Carlos
Lamadrid, Nadia Olson, Varuni Dayaratna, and Verónica Siman Betancourt. 2006. Contraceptive
Procurement Policies, Practices, and Options: Nicaragua. Arlington, Va.: DELIVER y Washington,
DC: USAID | Iniciativa de Políticas en Salud, para la Agencia de los Estados Unidos para el Desarrollo
Internacional
State of the Practice Brief: Nicaragua: Increasing Families’ Access to Improved and Expanded
Family Planning Services through Political Commitment
DELIVER. 2006. State of the Practice Brief: Nicaragua: Increasing Families’ Access to Improved and
Expanded Family Planning Services through Political Commitment. Arlington, Va.: DELIVER, for the
Nigeria
A Baseline Assessment of the Contraceptive Logistics System in Nigeria
Teclemariam, Lea, Tim Williams, and Rebecca Copeland. 2002. A Baseline Assessment of the
Contraceptive Logistics System in Nigeria. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S.
Focus on Results: Nigeria
DELIVER. 2007. Focus on Results: Nigeria. Arlington, Va.: DELIVER, for the U.S. Agency for
Nigeria: Assessment of the Transportation System and Distribution Costs for Family Planning
Commodities
O’Hearn, Tim, and Mike Healy. 2003. Nigeria: Assessment of the Transportation System and Distribution
Costs for Family Planning Commodities. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency
Nigeria: Final Country Report

DELIVER. 2007. Nigeria: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Nigeria: Midterm Evaluation of the Contraceptive Logistics System

Bieze, Briton, Lea Teclemariam, and Timothy O’Hearn. 2005. Nigeria: Midterm Evaluation of the
Contraceptive Logistics System. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
Nigeria: Rapid Assessment of HIV/AIDS Care in the Public and Private Sectors
Durgavich, John, Tim O’Hearn, Lea Teclemariam, David Galaty, Gilbert Kombe, Ali Onoja, Godwin
Asuquo, and Cesar Nuñez. 2004. Nigeria: Rapid Assessment of HIV/AIDS Care in the Public and Private
Sectors. Arlington, Va.: John Snow, Inc./DELIVER, The Partners for Health ReformPlus Project, and
POLICY Project.
On Track: Assessments Lay the Groundwork for Improved Logistics Systems in Nigeria
John Snow, Inc./DELIVER. 2003. On Track: Assessments Lay the Groundwork for Improved Logistics
Systems in Nigeria. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Paraguay
Contraceptive Security in Paraguay: Assessing Strengths and Weaknesses (also in Spanish)
Quesada, Nora, Cynthia Salamanca, Juan Agudelo, Patricia Mostajo, Varuni Dayaratna, Leslie
Patykewich, and Ali Karim. 2004. Contraceptive Security in Paraguay: Assessing Strengths and
Weaknesses. Arlington, Va.: John Snow, Inc./DELIVER, and Washington, DC: Futures Group/POLICY
II, for the U.S. Agency for International Development
Evaluación Cuantitativa de Indicadores Logísticos

Uribe, Bernardo, Carolina Vera, Juan Agudelo, Sandra Sanchez, Ministry of Health, and Carmen Basurto.
2006. Evaluación Cuantitativa de Indicadores Logísticos (Quantitative Assessment of Logistic
Indicators). Asunción, Paraguay: DELIVER, for the U.S. Agency for International Development.
Paraguay: Final Country Report: Executive Summary

DELIVER. 2007. Paraguay: Final Country Report: Executive Summary. Arlington, Va.: DELIVER, for
Paraguay: Informe Final del País

DELIVER. 2007. Paraguay: Informe Final del País. Arlington, Va.: DELIVER, para la Agencia de los
Políticas, Prácticas, y Opciones para la Adquisición de Insumos Anticonceptivos: Paraguay
Quesada, Nora, Varuni Dayaratna, Wendy Abramson, Jay Gribble, Verónica Siman Betancourt,
David Sarley, Carlos Lamadrid, Nadia Olson, y Juan Agudelo. 2006. Políticas, Prácticas, y
Opciones para la Adquisición de Insumos Anticonceptivos: Paraguay. Arlington, Va.: DELIVER y
Washington, DC: USAID | Health Policy Initiative, para la Agencia de los Estados Unidos para el
Desarrollo Internacional.
State of the Practice Brief: Paraguay: Guaranteeing Widespread Access to a Broad Choice of
Contraceptives
DELIVER. 2006. State of the Practice Brief: Paraguay: Guaranteeing Widespread Access to a Broad
Choice of Contraceptives. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Peru
Contraceptive Security in Peru: Assessing Strengths and Weaknesses (also in Spanish)
Taylor, Patricia A., Gracia Subiria, Cindi Cisek, Carmen Basurto Corvera, and Patricia Mostajo. 2004.
Contraceptive Security in Peru: Assessing Strengths and Weaknesses. Arlington, Va.: John Snow,
Inc./DELIVER, and Washington, DC: Futures Group/POLICY II, for the U.S. Agency for International
Development.
Políticas, Prácticas, y Opciones para la Adquisición de Insumos Anticonceptivos: Perú.

Dayaratna, Varuni, Nora Quesada, Jay Gribble, Wendy Abramson, David Sarley, Carlos Lamadrid, Nadia
Olson, y Verónica Siman Betancourt. 2006. Políticas, Prácticas, y Opciones para la Adquisición de
Insumos Anticonceptivos:Perú. Arlington, Va.: DELIVER y Washington, DC: USAID | Iniciativa de
Políticas en Salud, para la Agencia de los Estados Unidos para el Desarrollo Internacional.
State of the Practice Brief: Peru: Meeting the Contraceptive Needs of Families through Strong
Central-Level Capacity and Active Public Participation
DELIVER. 2006. State of the Practice Brief: Peru: Meeting the Contraceptive Needs of Families through
Strong Central-Level Capacity and Active Public Participation. Arlington, Va.: DELIVER, for the U.S.
Philippines
Philippines: Final Country Report
DELIVER. 2007. Philippines: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Romania
Romania: Scaling Up Integrated Family Planning Services: A Case Study
Gasco, Merce, Christopher Wright, Magdalena Pătruleasa, and Diane Hedgecock. 2006. Romania:
Scaling Up Integrated Family Planning Services: A Case Study. Arlington, Va.: DELIVER, for the U.S.
Russia
Russia: Integrating Family Planning into the Health System
Cappa, Laurie, Natalia Vartapetova, Tatyana Makarova, and Polina Flahive. 2007. Russia:
Integrating Family Planning into the Health System. A Case Study of the Maternal and Child
Health Initiative. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Rwanda
Evaluation du Système de Gestion Logistique des Contraceptifs du Rwanda
Ouédraogo, Youssouf, Armand Utshudi, Norbert-Aimé Péhé, Jovith Ndahinyuka, Gregory Roche. 2006.
Evaluation du Système de Gestion Logistique des Contraceptifs du Rwanda. Arlington, Va.: DELIVER,
Focus on Results: Rwanda

DELIVER. 2007. Focus on Results: Rwanda. Arlington, Va.: DELIVER, for the U.S. Agency for
On Track: Assessing a New Logistics System: Lessons from Rwanda
John Snow, Inc./DELIVER. 2004. On Track: Assessing a New Logistics System: Lessons from Rwanda.
Rwanda: Assessing the Logistics Management System for Contraceptives: Executive Summary
Ouedraogo, Youssouf, Armand Utshudi, Norbert Pehe, Jovith Ndahinyuka, and Gregory Roche. 2006.
Rwanda: Assessing the Logistics Management System for Contraceptives: Executive Summary. Arlington,
Rwanda Contraceptive Logistics System Assessment

John Snow, Inc./DELIVER. 2002. Rwanda Contraceptive Logistics System Assessment. Arlington, Va.:
Rwanda: Final Country Report

DELIVER. 2007. Rwanda: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Senegal
On Track: Innovative Training Materials Help Senegal's Family Planning Efforts
John Snow, Inc./DELIVER. 2004. On Track: Innovative Training Materials Help Senegal's Family
Planning Efforts. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
South Africa
South Africa: Final Country Report
DELIVER. 2007. South Africa: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency
Tanzania
The Integrated Logistics System (ILS) Launch Workshop Participant Workbook
Ministry of Health (MOH), Tanzania. 2004. The Integrated Logistics System (ILS) Launch Workshop
Participant Workbook. Tanzania: MOH.
Tanzania: Final Country Report

DELIVER. 2007. Tanzania: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Tanzania: Integrated Logistics System Pilot-Test Evaluation: Using the Logistics Indicator
Assessment Tool
Amenyah, Johnnie, Barry Chovitz, Erin Hasselberg, Ali Karim, Daniel Mmari, Ssanyu Nyinondi, and
Timothy Rosche. 2005. Tanzania: Integrated Logistics System Pilot-Test Evaluation: Using the Logistics
Indicator Assessment Tool. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
Tanzania: Integrated Logistics System Procedures Manual Roll-Out Version

Chovitz, Barry, Johnnie Amenyah, Barbara Felling, Gregory Roche, and Tim Rosche. 2006. Tanzania:
Integrated Logistics System Procedures Manual Roll-Out Version. Arlington, Va.: DELIVER, for the
Tanzania: Integration of Contraceptive Products into the Medical Stores Department's

Distribution System, June 1997–July 2000
Mmari, Daniel, Ben Mkasa, Kim Peacock, Dr. Catherine Sanga, and Steve Wilbur. 2001. Tanzania:
Integration of Contraceptive Products into the Medical Stores Department's Distribution System, June
1997–July 2000. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Tanzania: Logistics System Capacity and Site Readiness to Expand PMTCT and Initiate ART—
Findings and Recommendations of the PMTCT and ART Assessment Team
Allers, Claudia, Marilyn Noguera, Barry Chovitz, Abdourahamane Diallo, Christopher Shaw, Tanvi
Pandit, Sultan Mlandula, Gerald Massuki, Paul Senge, and Michael Burke. 2003. Tanzania: Logistics
System Capacity and Site Readiness to Expand PMTCT and Initiate ART—Findings and
Recommendations of the PMTCT and ART Assessment Team. Arlington, Va.: John Snow, Inc./DELIVER,
Tanzania: Quantification of Drugs for STI Program and HIV Test Kit Requirements 2004–2005
Chovitz, Barry, and Johnnie Amenyah. 2004. Tanzania: Quantification of Drugs for STI Program and
HIV Test Kit Requirements 2004–2005. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency
Chovitz, Barry, Peter Mellon, and Tim Rosche. 2005. Tanzania: Quantification of Drugs for STI Program
and HIV Test Kit Requirements 2005–2006. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S.
Amenyah, J., S. Nyinondi, and E. Hasselberg. 2006. Tanzania: Quantification of Drugs for STI Program
and HIV Test Kit Requirements 2006–2008. Arlington, Va.: DELIVER, for the U.S. Agency for
Tanzania Situational Assessment of Logistics Systems for Public Health Commodities

at Selected Districts and SDPs
Ministry of Health (MOH), Tanzania, Reproductive and Child Health Section. 2000. Tanzania Situational
Assessment of Logistics Systems for Public Health Commodities
at Selected Districts and SDPs. Tanzania: MOH.
Tanzania Stock Status Survey: Commodity Availability for Selected Health Products: Baseline
Survey for Integrated Logistics System
The United Republic of Tanzania, Ministry of Health and Social Welfare. 2003. Tanzania Stock Status
Survey: Commodity Availability for Selected Health Products: Baseline Survey for Integrated Logistics
System, 2003. Dar es Salaam, Tanzania: Ministry of Health.
Uganda
Condom Distribution Guidelines
Ministry of Health (MOH), Uganda, STD/AIDS Control Program. 2006. Condom Distribution
Guidelines. Uganda: MOH.
Focus on Results: Uganda

DELIVER. 2007. Focus on Results: Uganda. Arlington, Va.: DELIVER, for the U.S. Agency for
National Laboratory Assessment Survey 2004

Ministry of Health, Uganda, Centers for Disease Control and Prevention (CDC), John Snow,
Inc/DELIVER. 2004. National Laboratory Assessment Survey 2004. Atlanta, Ga.: CDC, and Arlington,
Va.: John Snow, Inc./DELIVER, and Uganda: MOH.
On Track: Analyzing Transportation Costs

John Snow, Inc./DELIVER. 2003. Uganda: Analyzing Transportation Costs. Arlington, Va.: John Snow,
On Track: Evaluating Products and Services at the Same Time

John Snow, Inc./DELIVER. 2004. On Track: Evaluating Products and Services at the Same Time.
Standard Operating Procedures for Laboratory Reagent Preparation

Ministry of Health (MOH), Uganda. 2005. Standard Operating Procedures for Laboratory Reagent
Preparation. Uganda: MOH.
Uganda: Assessing the Costs of Distribution to Health Sub-Districts, A Case Study in Financial
Analysis
Vian, Taryn. 2003. Uganda: Assessing the Costs of Distribution to Health Sub-Districts, A Case Study in
Financial Analysis. Arlington, Va.: John Snow, Inc./DELIVER and Boston, Mass.: Boston University.
Uganda: Estimation of Commodity Requirements for 2002–2003, Drugs to Treat Malaria

Eberle, Jim,and Yasmin Chandani. 2002. Uganda: Estimation of Commodity Requirements for 2002–
2003, Drugs to Treat Malaria. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
Uganda: Estimation of Commodity Requirements Needs for 2002–2003, Drugs to Treat

Tuberculosis
Eberle, Jim, and Yasmin Chandani. 2002. Uganda: Estimation of Commodity Requirements Needs for
2002–2003, Drugs to Treat Tuberculosis. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S.
Uganda: Estimation of Commodity Requirements for 2002–2004, Drugs to Treat Sexually
Transmitted Infection
Chandani, Yasmin. 2002. Uganda: Estimation of Commodity Requirements for 2002–2004, Drugs to
Treat Sexually Transmitted Infection. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
Uganda: Estimation of Commodity Requirements for 2003, Drugs to Treat Opportunistic

Infections
Chandani, Yasmin, Moses Muwonge, and Fred Sebisubi. 2003. Uganda: Estimation of Commodity
Requirements for 2003, Drugs to Treat Opportunistic Infections. Arlington, Va.: John Snow,
Uganda: Final Country Report

DELIVER. 2007. Uganda: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Uganda Health Facilities Survey 2002

Ministry of Health (Uganda), ORC Macro, and John Snow, Inc./DELIVER. 2002. Uganda Health
Facilities Survey 2002. Arlington, Va.: John Snow, Inc./DELIVER, and Calverton, Md.: ORC Macro.
Uganda Health Facilities Survey 2006: Performance of HIV/AIDS and Family Planning
Commodity Logistics Systems, Comparison of 2002 and 2006 National Survey Results
Copeland, Rebecca, Cecilia Sewagudde, and Briton Bieze. 2006. Uganda Health Facilities Survey 2006:
Performance of HIV/AIDS and Family Planning Commodity Logistics Systems, Comparison of 2002 and
2006 National Survey Results. Arlington, Va.: DELIVER, for the U.S. Agency for International
Development.
Uganda: Highlights from a Pilot Assessment of the Introduction of Auto-Disable Syringes for Use
with Depo-Provera
Williams, Tim. 2001. Uganda: Highlights from a Pilot Assessment of the Introduction of Auto-Disable
Syringes for Use with Depo-Provera. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
Uganda: Logistics and Procurement Decisions and Issues for Consideration for Initiating and
Expanding Access to ARV Drugs
Ministry of Health (MOH), Uganda and Logistics Subcommittee of the ARV Task Force. 2003. Uganda:
Logistics and Procurement Decisions and Issues for Consideration for Initiating and Expanding Access
to ARV Drugs. Uganda: MOH.
Uganda: Procurement Case Studies Report

John Snow, Inc./DELIVER. 2003. Uganda: Procurement Case Studies Report. Arlington, Va.: John
Uganda: Summary of Findings of the Uganda Health Facilities Survey 2002

Ministry of Health (Uganda), ORC Macro, and John Snow, Inc./DELIVER. 2003. Uganda: Summary of
Findings of the Uganda Health Facilities Survey 2002. Arlington, Va.: John Snow, Inc./DELIVER, and
Calverton, Md.: ORC Macro.
Ukraine
Ukraine: Contraceptive Availability Assessment
Hudgins, Tony, and Chris Wright. 2004. Ukraine Contraceptive Availability Assessment. Arlington,
West Africa
On Track: Improving Contraceptive Security in West Africa
John Snow, Inc./DELIVER. 2004. Improving Contraceptive Security in West Africa. Arlington, Va.: John
West Africa: Final Regional Report

DELIVER. 2007. West Africa: Final Regional Report. Arlington, Va.: DELIVER, for the U.S. Agency
West Africa Reproductive Health Commodity Security Sub-Regional Strategy: A Concept Paper
(also in French)
John Snow, Inc./DELIVER. 2005. West Africa Reproductive Health Commodity Security Sub-Regional
Strategy: A Concept Paper. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
West Africa Reproductive Health Commodity Security: Country Assessment Report: Burkina Faso
Kagone, Meba, Eric Takang, Antoine Ndiaye, Olga Sankara, and Ernest Ouedraogo. 2005. West Africa
Reproductive Health Commodity Security: Country Assessment Report: Burkina Faso. Arlington, Va.:
West Africa Reproductive Health Commodity Security: Economic Community of West African
States Trade and Economic Integration
Sarley, David. 2002. West Africa Reproductive Health Commodity Security: Economic Community of
West African States Trade and Economic Integration. Arlington, Va.: John Snow, Inc./DELIVER, for the
West Africa Reproductive Health Commodity Security: Encouraging Greater Private Sector
Participation
Dowling, Paul. 2006. West Africa Reproductive Health Commodity Security: Encouraging Greater
Private Sector Participation. Arlington, Va.: DELIVER, for the U.S. Agency for International
Development.
West Africa Reproductive Health Commodity Security: Ghana RHCS Country Assessment
Amenyah, Johnnie, Raja Rao, Erin Shea, Mohammed Oubnichou, Alex Nazzar, and Gifty Addico. 2005.
West Africa Reproductive Health Commodity Security: Ghana RHCS Country Assessment. Arlington,
West Africa Reproductive Health Commodity Security: Local Manufacturing

Dowling, Paul. 2005. West Africa Reproductive Health Commodity Security: Local Manufacturing.
West Africa Reproductive Health Commodity Security: Logistics System Capacity in West Africa
Diarra, Aoua. 2005. West Africa Reproductive Health Commodity Security: Logistics System Capacity in
West Africa. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
West Africa Reproductive Health Commodity Security: Regional Financing Gap

John Snow, Inc./DELIVER. 2005. West Africa Reproductive Health Commodity Security: Regional
Financing Gap. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
West Africa Reproductive Health Commodity Security: Regional Reproductive Health Policy
Kagone, Meba. 2005. West Africa Reproductive Health Commodity Security: Regional Reproductive
Health Policy. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
West Africa Reproductive Health Commodity Security: Review of Pooled Procurement

Abdallah, Hany. 2005. West Africa Reproductive Health Commodity Security: Review of Pooled
Procurement. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
West Africa Reproductive Health Commodity Security: RH Commodity Pricing: Potential Benefits
Rao, Raja. 2005. West Africa Reproductive Health Commodity Security: RH Commodity Pricing:
Potential Benefits. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Yemen
Yemen: Goals of Deliver Assistance
DELIVER. 2006. Yemen: Goals of Deliver Assistance. Arlington, Va.: DELIVER, for the U.S. Agency
Yemen Situation Analysis: Assessment of the Contraceptive Logistics System in 5 Governorates

DELIVER. 2006. Yemen Situation Analysis: Assessment of the Contraceptive Logistics System in 5
Governorates. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Zambia
Zambia: DELIVER Brochure
DELIVER. 2006. Zambia: DELIVER Brochure. Arlington, Va.: DELIVER, for the U.S. Agency for
Zambia: Final Country Report

DELIVER. 2007. Zambia: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Zimbabwe
The HIV Care and Treatment Program in Zimbabwe: Current State and Recommendations for
USAID Support
Field-Nguer, Mary Lyn, Mukashilima Chikuba, David Alt, and Tendesayi Kufa. 2005. The HIV Care and
Treatment Program in Zimbabwe: Current State and Recommendations for USAID Support. Arlington,
Management of HIV & AIDS Commodities in Zimbabwe: A Capacity Assessment of NatPharm
and Ministry of Health and Child Welfare
Takang, Eric, DraganaVeskov, Celestine Kumire, and Jabulani Nyenwa. 2006. Management of HIV &
AIDS Commodities in Zimbabwe: A Capacity Assessment of NatPharm and Ministry of Health and Child
Welfare. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Zimbabwe Antiretroviral Therapy Program: Issues and Opportunities for Initiation and Expansion
Alt, David, Marilyn Noguera, Lisa Hirschorn, Chiedza Maponga, Patrick Osewe, and Amos Sam-
Abbenyi. 2003. Zimbabwe Antiretroviral Therapy Program: Issues and Opportunities for Initiation and
Expansion. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Zimbabwe: Assessing the Cost of Transporting HIV/AIDS Commodities, a Case Study in Financial
Analysis 2003
Vian, Taryn. 2003. Zimbabwe: Assessing the Cost of Transporting HIV/AIDS Commodities, a Case Study
in Financial Analysis 2003. Arlington, Va.: John Snow, Inc./DELIVER and Boston, Ma.: Boston
University.
Zimbabwe: Final Country Report

DELIVER. 2007. Zimbabwe: Final Country Report. Arlington, Va.: DELIVER, for the U.S. Agency for
Zimbabwe: HIV/AIDS Commodities Transport Assessment

Alt, David, and Marilyn Noguera. 2002. Zimbabwe: HIV/AIDS Commodities Transport Assessment.
Zimbabwe HIV & AIDS Logistics System Assessment

Nyenwa, Jabulani, David Alt, Ali Karim, Tendesayi Kufa, Jennifer Mboyane, Youssouf Ouedraogo, and
Tendai Simoyi. 2006. Zimbabwe HIV & AIDS Logistics System Assessment. Arlington, Va.: DELIVER,
II. FACT SHEETS
Case for Increasing Availability of HIV/AIDS Products through Improved Supply Chain
Management
John Snow, Inc./DELIVER. 2001. Case for Increasing Availability of HIV/AIDS Products through
Improved Supply Chain Management. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency
Contraceptive Fact Sheets (also in Spanish and French)

DELIVER. 2007. Contraceptive Fact Sheets. Arlington, Va.: DELIVER, for the U.S. Agency for
Contraceptive Security Index 2003: A Tool for Priority Setting and Planning (also in French)
John Snow, Inc./DELIVER and Futures Group/POLICY Project. 2003. Contraceptive Security Index 2003: A Tool
for Priority Setting and Planning. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Contraceptive Security Index 2003: Technical Manual

John Snow, Inc./DELIVER and Futures Group/POLICY Project. 2004. Contraceptive Security Index 2003:
Technical Manual. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
Contraceptive Security Index 2006: A Tool for Priority Setting and Planning
DELIVER and Task Order 1 of the USAID | Health Policy Initiative. 2006. Contraceptive Security Index
2006: A Tool for Priority Setting and Planning. Arlington, Va.: DELIVER, for the U.S. Agency for
Contraceptive Security Index User’s Guide

DELIVER. 2007. Contraceptive Security Index User’s Guide. Arlington, Va.: DELIVER, for the U.S.
Frequently Asked Questions: Logistics and Supply Chain Management of HIV

John Snow, Inc./DELIVER. 2001. Frequently Asked Questions: Logistics and Supply Chain Management
of HIV. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
HIV Test Kit Selection: Operational Considerations for VCT and PMTCT Services
John Snow, Inc./DELIVER. 2004. HIV Test Kit Selection: Operational Considerations for VCT and
PMTCT Services. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Importance of Logistics in HIV/AIDS Programs: Central Information Systems (also in Spanish)

John Snow, Inc./DELIVER. 2004. Importance of Logistics in HIV/AIDS Programs: Central Information
Systems. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
Importance of Logistics in HIV/AIDS Programs: Financing and Procurement (also in Spanish)

John Snow, Inc./DELIVER. 2004. Importance of Logistics in HIV/AIDS Programs: Financing and
Procurement. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Importance of Logistics in HIV/AIDS Programs: Human Capacity for Logistics (also in Spanish)
John Snow, Inc./DELIVER. 2004. Importance of Logistics in HIV/AIDS Programs: Human Capacity for
Logistics. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Importance of Logistics in HIV/AIDS Programs: Logistics Management Information Systems (also

in Spanish)
John Snow, Inc./DELIVER. 2004. Importance of Logistics in HIV/AIDS Programs: Logistics
Management Information Systems. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
Importance of Logistics in HIV/AIDS Programs: No Product? No Program (Overview) (also in

Spanish)
John Snow, Inc./DELIVER. 2004. Importance of Logistics in HIV/AIDS Programs: No Product? No
Program (Overview). Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Importance of Logistics in HIV/AIDS Programs: Warehousing and Consolidated Shipping (also in

Spanish)
John Snow, Inc./DELIVER. 2004. Importance of Logistics in HIV/AIDS Programs: Warehousing and
Consolidated Shipping. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Importance of Logistics in HIV/AIDS Programs: Warehousing and Distribution (also in Spanish)
John Snow, Inc./DELIVER. 2004. Importance of Logistics in HIV/AIDS Programs: Warehousing and
Distribution. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Logistics Fact Sheets: ARV Drugs (complete set)

DELIVER. 2006. Logistics Fact Sheets: ARV Drugs. Arlington, Va.: DELIVER, for the U.S. Agency for
Logistics Fact Sheets: GPHF-Minilab® and CD4 Machines (FACSCount™ and Guava Easy
CD4™)
DELIVER. 2006. GPHF-Minilab® and CD4 Machines (FACSCount™ and Guava Easy CD4™).
Logistics Fact Sheets: HIV Test Kits (complete set)

DELIVER. 2006. Logistics Fact Sheets: HIV Test Kits. Arlington, Va.: DELIVER, for the U.S. Agency
Photo Glossary: Consumable and Durable Laboratory Supplies

DELIVER. 2006. Photo Glossary: Consumable and Durable Laboratory Supplies.
ProQ: Software for Estimating HIV Test Needs for VCT & PMTCT Programs (also in Spanish)
John Snow, Inc./DELIVER. 2003. ProQ: Software for Estimating HIV Test Needs for VCT & PMTCT
Programs. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Protecting Stored Contraceptive Commodities from Pest Damage

John Snow, Inc./DELIVER. 2005. Protecting Stored Contraceptive Commodities from Pest Damage.
Strategic Decentralization: Centralizing Logistics

John Snow, Inc./DELIVER. 2001. Strategic Decentralization: Centralizing Logistics. Arlington, Va.:
Strategic Pathway to Reproductive Health Commodity Security Fact Sheet

DELIVER. 2005. Strategic Pathway to Reproductive Health Commodity Security Fact Sheet. Arlington,
Technical Terms and Definitions for Laboratory Logistics

DELIVER. 2006. Technical Terms and Definitions for Laboratory Logistics.
What Is DELIVER? (also in Spanish and French)

DELIVER. 2007. What Is DELIVER? Arlington, Va.: DELIVER, for the U.S. Agency for International
Development.
III. Guidelines, Handbooks, and Manuals
Assessing Supply Chains for HIV/AIDS Commodities
Aronovich, Dana, Briton Bieze, Barbara Felling, and Yasmin Chandani. 2006. Assessing Supply Chains
for HIV/AIDS Commodities. Arlington, Va.: DELIVER, for the U.S. Agency for International
Development.
Assessment Tool for Laboratory Services (ATLAS) 2006

Diallo, Abdourahmane, Lea Teclemariam, Barbara Felling, Erika Ronnow, Carolyn Hart, Wendy
Nicodemus, and Lisa Hare. 2006. Assessment Tool for Laboratory Services (ATLAS) 2006. Arlington,
Building Blocks for Inventory Management of HIV Tests and ARV Drugs: Inventory Control
Systems, Logistics Management Information Systems, and Storage and Distribution
DELIVER. 2006. Building Blocks for Inventory Management of HIV Tests and ARV Drugs: Inventory
Control Systems, Logistics Management Information Systems, and Storage and Distribution. Arlington,
Concepts of Logistics System Design

Owens, Richard C., Jr., and Timothy Warner. 2003. Concepts of Logistics System Design. Arlington,
Contraceptive Security Index 2003: Technical Manual

2003: Technical Manual. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
Description of Indicators
DELIVER. 2002. Description of Indicators. Arlington, Va.: DELIVER/John Snow, Inc., for the U.S.
Guide for Quantifying ARV Drugs

Allers, Claudia, and Yasmin Chandani. 2006. Guide for Quantifying ARV Drugs. Arlington, Va.:
Guide for Quanitfying HIV Tests

Chandani, Yasmin, Leah Teclemariam, David Alt, Claudia Allers, and Laurie Lyons. 2006. Guide for
Quanitfying HIV Tests. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Guide for Quantifying Laboratory Supplies

Diallo, Abdourahmane, Claudia Allers, Yasmin Chandani, Wendy Nicodemus, Colleen McLaughlin, Lea
Teclemariam, and Ronald Brown. 2006. Guide for Quantifying Laboratory Supplies. Arlington, Va.:
Guidelines for Assessing Costs in a Logistics System: An Example of Transport Cost Analysis
Abdallah, Hany. 2004. Guidelines for Assessing Costs in a Logistics System: An Example of Transport
Cost Analysis. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Guidelines for Implementing Computerized Logistics Management Information Systems (LMIS)
DELIVER. 2006. Guidelines for Implementing Computerized Logistics Management Information Systems
(LMIS). Second Edition. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Guidelines for Managing the HIV/AIDS Supply Chain

DELIVER. 2006. Guidelines for Managing the HIV/AIDS Supply Chain. Arlington, Va.: DELIVER, for
Guidelines for Managing the Laboratory Supply Chain

Felling, Barbara, Wendy Nicodemus, Ronald Brown, Abdourahmane Diallo, Meba Kagone, Paula
Nersesian, and Lea Teclemariam. 2006. Guidelines for Managing the Laboratory Supply Chain.
Guidelines for the Proper Storage of Health Commodities (8.5x11 size) & (wall chart) (also in
Spanish and French)
John Snow, Inc./DELIVER. 2002. Guidelines for the Proper Storage of Health Commodities.
Guidelines for the Storage of Essential Medicines and Other Health Commodities (also in
Arabic, Russian, French, and Chinese)
John Snow, Inc./DELIVER in collaboration with the World Health Organization. Guidelines for the
Storage of Essential Medicines and Other Health Commodities. 2003. Arlington, Va.: John Snow,
Guidelines for Warehousing Health Commodities

DELIVER. 2005. Guidelines for Warehousing Health Commodities. Arlington, Va.: DELIVER, for
HIV/AIDS Commodity Security: A Framework for Strategic Planning

Dowling, Paul, Lisa Hare, Yasmin Chandani, and Alexandra Zuber. 2006. HIV/AIDS Commodity
Security: A Framework for Strategic Planning. Arlington, Va.: DELIVER, for the U.S. Agency for
HIV/AIDS Service Delivery Programs: Overview and Insights for Supply Chain Managers
Field-Nguer, Mary Lyn, Lisa Hirschhorn, Dragana Veskov, Jennifer Mboyane, and Yasmin Chandani.
2006. HIV/AIDS Service Delivery Programs: Overview and Insights for Supply Chain Managers.
The Logistics Handbook: A Practical Guide for Supply Chain Managers in Family Planning and
Health Programs (also in Spanish)
John Snow Inc./DELIVER, 2004. The Logistics Handbook: A Practical Guide for Supply Chain
Managers in Family Planning and Health Programs. Arlington, Va.: John Snow Inc./DELIVER, for the
U.S. Agency for International Development (USAID).
Logistics Indicators Assessment Tool (LIAT) (also in Spanish and French)

DELIVER. 2005. Logistics Indicators Assessment Tool (LIAT). Arlington, Va.: John Snow
Logistics System Assessment Tool (LSAT) (also in Spanish and French)
John Snow, Inc./DELIVER. 2004. Logistics System Assessment Tool (LSAT). Arlington, Va.: John Snow,
Logistics Workbook: A Companion to the Logistics Handbook

John Snow, Inc./DELIVER. 2000. Logistics Workbook: A Companion to the Logistics Handbook.
Monitoring and Evaluation Indicators for Assessing Logistics Systems Performance

DELIVER. 2006. Monitoring and Evaluation Indicators for Assessing Logistics Systems Performance.
Procuring HIV/AIDS Commodities Using U.S. Government Funds: Lessons & Approaches
Hasselberg, Erin, Miguel Jaureguizar, Yasmin Chandani, Carmit Keddem, Carolyn Hairston, and
Corynne Harvey. 2006. Procuring HIV/AIDS Commodities Using U.S. Government Funds: Lessons &
Approaches. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Safe Injection and Waste Management: A Reference for Logistics Advisors

Nersesian, Paula V., Vanessa Cesarz, Allison Cochran, Jennifer Mboyane, and Katie Schmidt. 2004
Safe Injection and Waste Management: A Reference for Logistics Advisors. Arlington, Va.: John Snow,
Supply Chain Management of Anitretroviral Drugs: Considerations for Initiating and Expanding
National Supply Chains
Chandani, Yasmin, Barbara Felling, Claudia Allers, David Alt, Marilyn Noguera, and Alexandra Zuber.
2006. Supply Chain Management of Anitretroviral Drugs: Considerations for Initiating and Expanding
National Supply Chains. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Tool to Assess Site Readiness for Initiating Antiretroviral Therapy (ART), Version 1.2 (also in
Spanish)
Hirschhorn, Lisa, Andrew Fullem, Christopher Shaw, Wendy Prosser, and Marilyn Noguera. 2004.
Tool to Assess Site Readiness for Initiating Antiretroviral Therapy (ART), Version 1.2. Boston: John
Snow, Inc., for the U.S. Agency for International Development.
Training Curriculum in Laboratory Logistics: Part I

DELIVER. 2006. Training Curriculum in Laboratory Logistics: Part I. Arlington, Va.: DELIVER, for
Training Curriculum in Laboratory Logistics: Part II (Draft)

DELIVER. 2006. Training Curriculum in Laboratory Logistics: Part II (Draft). Arlington, Va.:
USAID Contraceptive Procurement Guide and Product Catalog 2006

DELIVER. 2005. USAID Contraceptive Procurement Guide and Product Catalog 2006. Arlington, Va.:
IV. LOGISTICS BRIEFS AND SUCCESS STORIES
On Track: Auto-Disable Syringes: A Health Solution and a Logistics Challenge (also in Spanish)
John Snow, Inc./DELIVER. 2003. On Track: Auto-Disable Syringes: A Health Solution and a Logistics
Challenge. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Delivering HIV/AIDS Commodities to Customers: Lessons Learned in Supply Chain Management

DELIVER. 2006. Delivering HIV/AIDS Commodities to Customers: Lessons Learned in Supply Chain
Management. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
On Track: Implementing Logistics Systems in Areas Affected by Conflict

John Snow, Inc./DELIVER. 2004. On Track: Implementing Logistics Systems in Areas Affected by
Conflict. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
On Track: Importance of Choice

John Snow, Inc./DELIVER. 2003. On Track: Importance of Choice. Arlington, Va.: John Snow,
On Track: Importance of Logistics: No Product? No Program (also in Spanish)

John Snow, Inc./DELIVER. 2002. On Track: Importance of Logistics: No Product? No Program.
Lessons Learned in Managing Laboratory Supplies

DELIVER. 2006. Lessons Learned in Managing Laboratory Supplies. Arlington, Va.: DELIVER, for the
On Track: Influence of Logistics on Contraceptive Use

John Snow Inc./DELIVER. 2005. On Track: Influence of Logistics on Contraceptive Use. Arlington, Va.:
John Snow Inc./DELIVER, for the U.S. Agency for International Development.
On Track: ProQ: Software for Estimating HIV Test Needs for VCT & PMTCT Programs
John Snow, Inc./DELIVER. 2003. On Track: ProQ: Software for Estimating HIV Test Needs for VCT &
PMTCT Programs. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Segmenting Markets To Maximize Contraceptive Security

John Snow, Inc./DELIVER. 2002. Segmenting Markets to Maximize Contraceptive Security. Arlington,
Success Story: Market Segmentation: Helping Target the Right Programs to the Right Clients
DELIVER. 2006. Success Story: Market Segmentation: Helping Target the Right Programs to the Right
Clients. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
On Track: Web Sharing Tool Is Key to Supply Initiative's Collaborative Strategy

John Snow, Inc./DELIVER. 2003. On Track: Web Sharing Tool Is Key to Supply Initiative's
Collaborative Strategy. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
V. POLICY PAPERS
Contraceptive Forecasting Accuracy: Trends and Determinants
Karim, Ali Mehryar, Karen Ampeh, and Lois Todhunter. 2004. Contraceptive Forecasting Accuracy:
Trends and Determinants. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
Contraceptive Security: Practical Experience in Improving Global, Regional, National, and Local
Product Availability
Wright, Nadia Olson, and Marie Tien. October 2006. Contraceptive Security: Practical Experience in
Improving Global, Regional, National, and Local Product Availability. Arlington, Va.: DELIVER, for the
Equity of Family Planning in Developing Countries

Karim, Ali, David Sarley, David O’Brien, Dana Aronovich, Leslie Patykewich, Nora Quesada, and
Patricia Taylor. 2004. Equity of Family Planning in Developing Countries.
HIV/AIDS Commodity Security: Supply Chain Management Implications for HIV/AIDS

Policymakers and Program Managers
John Snow, Inc./DELIVER. 2004. HIV/AIDS Commodity Security: Supply Chain Management
Implications for HIV/AIDS Policymakers and Program Managers. Arlington, Va.: John Snow,
Influence of Family Planning Logistics Systems on Contraceptive Use (A Working Paper)

Karim, Ali. 2005. Influence of Family Planning Logistics Systems on Contraceptive Use (A Working
Paper). Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development.
Logistical Challenge: Ensuring Access to ARVs for Kids

DELIVER. 2005. Logistical Challenge: Ensuring Access to ARVs for Kids.
Process Mapping for Improved Health Logistics System Performance

DELIVER. 2005. Process Mapping for Improved Health Logistics System Performance. Arlington, Va.:
Procurement Strategies for Health Commodities: An Examination of Options and Mechanisms

within the Commodity Security Context
Rao, Raja, Peter Mellon, David Sarley. 2006. Procurement Strategies for Health Commodities: An
Examination of Options and Mechanisms within the Commodity Security Context. Arlington, Va.:
Promoting Contraceptive Security through Innovative Health System Interventions

John Snow, Inc./DELIVER. 2005. Promoting Contraceptive Security Through Innovative Health System
Interventions Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Reproductive Health Commodity Security for Improved Maternal and Child Health (also in French)
Kagone, Meba. Lisa Hare, David O'Brien, Dana Aronovich, Aoua Diarra. 2003. Reproductive Health
Commodity Security for Improved Maternal and Child Health. Arlington, Va.: John Snow,
VI. SOFTWARE MANUALS

PipeLine Brochure (also in French and Spanish)
John Snow, Inc./DELIVER. 2004. PipeLine Brochure. Arlington, Va.: John Snow, Inc./DELIVER, for
PipeLine 3.0 User's Guide (also in French, Spanish, and Arabic)

John Snow, Inc./DELIVER. 2004. PipeLine User’s Guide. Arlington, Va.: John Snow, Inc./DELIVER,
ProQ User's Manual

John Snow, Inc./DELIVER. 2003. ProQ User's Manual. Arlington, Va.: John Snow, Inc./DELIVER, for
Supply Chain Manager User’s Manual

DELIVER. 2006. Supply Chain Manager User’s Manual. Arlington, Va.: DELIVER, for the U.S. Agency
APPENDIX 3
CONTRACEPTIVE SECURITY
INDEX
ContraCeptive SeCurity
index 2006
a tool for priority Setting and planning
December 2006
ContraCeptive SeCurity
index 2006
a tool for priority Setting and planning
The authors’ views expressed in this publication do not necessarily reflect the views of the United States
DELIVER
DELIVER, a six-year worldwide technical assistance support contract, is funded by the U.S. Agency
for International Development (USAID).
Implemented by John Snow, Inc. (JSI) (contract no. HRN-C-00-00-00010-00) and subcontractors
(Manoff Group, Program for Appropriate Technology in Health [PATH], and Crown Agents Consultancy,
Inc.), DELIVER strengthens the supply chains of health and family planning programs in developing
countries to ensure the availability of critical health products for customers. DELIVER also provides
technical management of USAID’s central contraceptive management information system.
DELIVER and Task Order 1 of the USAID | Health Policy Initiative. 2006. Contraceptive Security
Index 2006: A Tool for Priority Setting and Planning. Arlington, Va.: DELIVER, for the U.S. Agency
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
a
primary goal of reproductive health and family planning programs is to ensure that people
can choose, obtain, and use a wide range of high-quality, affordable contraceptive methods
and condoms for STI/HIV prevention. Referred to as contraceptive security, this goal requires
sustainable strategies that will ensure and maintain access to and availability of supplies.
As global demand for family planning continues to rise, contraceptive security (CS) will become
more challenging to achieve. Financing for reproductive health (RH) and family planning (FP)
programs is not keeping pace with demand and donor resources are more constrained than ever.
Countries are being encouraged to contribute to the procurement of RH and FP commodities from
their national and local budgets. Despite investments in service delivery and logistics systems, these
systems remain inadequate in many countries. At the same time, increased demand—coupled with
the impact of the HIV/AIDS pandemic, health sector reforms, limited national and international
funding, and the brain drain—leaves countries unable to meet all of their populations’ RH needs.
It remains critical that stakeholders and program managers focus attention on long-term CS. Programs
cannot meet their clients’ RH and FP needs without the reliable availability of high-quality contraceptive
supplies and services. Attaining the poverty reduction and health goals adopted by many countries will
be slowed unless improvements are made in CS. Ensuring contraceptive supply and service availability
to clients requires a multi-sectoral approach. The public and private sectors must cooperate to ensure
a supportive policy environment, appropriate forecasting and procurement of commodities, efficient
supply chains, well-trained providers, effective service delivery systems, an accepting social environment,
and adequate financing. To plan effective interventions to reach this goal, policymakers, program managers,
and international donor agencies need to know if and how their programs are progressing toward CS.
This wall chart presents a set of indicators that can be used to measure a country’s level of CS and to
monitor global progress toward reaching this goal, over time. The indicators are aggregated to establish
a composite index. The Contraceptive Security Index 2006 was first calculated and presented in 2003;
the Contraceptive Security Index 2006 presents an update of those findings.
uSeS
The Contraceptive Security Index 2006 is a powerful tool for raising awareness about contraceptive security
(CS) and the interrelationships between program components, different sectors, and program outcomes.
At the national and international levels, the index can be used to set priorities; and to plan and advocate
to support policies and other interventions that promote progress toward CS. At the country level,
it can help identify areas of relative strength and weakness to help stakeholders target their resources
more effectively and appropriately. However, because the CS Index presents a broad picture of CS in
a country, in-depth assessments of specific components are required to identify issues that need to be
addressed in national CS strategic plans.
The CS Index is also a useful guide for helping global donors and lenders determine the countries
most in need of assistance and to determine what kind of assistance they need. The index can help
country governments, donors, and lenders improve resource allocation by giving them a way to track
where countries are on a continuum of CS.
With repeated measures taken over time, the index can provide a measure of progress toward the
goal of CS. By drawing attention to the importance of CS, this tool can help donors and governments
focus on meeting the growing contraceptive needs into the future.
ContraCeptive SeCurity index 2006

Methodological Considerations
This index represents a country’s CS situation at a point in time, although the actual data was collected
over a period of years. It is unavoidable that indicators will be updated for different countries at different
intervals. Ideally, to use the results to monitor progress toward the goal of CS over time, the index
will be updated periodically (e.g., every two to three years).
Comparisons can be drawn over time between the 2003 and 2006 findings at the aggregate level
(i.e., by region, component, and total score), as presented in the Results section. However, because of
a change in the data collection methodology for some of the supply chain indicators (see the Methodology,
Definitions, Supply Chain section), comparisons across time from 2003 to 2006 at the country level
and at the individual supply chain indicator level are not advisable at this time. Nonetheless, although
time trends need to be considered with caution in this update, the index’s applicability for the other
purposes mentioned above remains valid.
reSultS
A total of 63 countries are represented in the 2006 index, including the 57 countries from the 2003
index plus six additional countries new to the index.
Table 1 shows the raw data for the 17 indicators, grouped into the five components that were used to
construct the CS Index: supply chain, finance, health and social environment, access, and utilization.
This represents the most current data available. However, where new values were not available in
2006, raw scores from the 2003 index are included in this index as the most current data available.
Table 2 shows the weighted scores by component and total. Figure 1 shows the total weighted scores
for the 63 countries presented in the index. The range of possible scores on the weighted CS Index
is 0 to 100, although actual scores in 2006 range from 35.5 to 73.2. In 2003, the range was 28.1 to
68.1. Using a paired t-test, the 2006 total scores, averaged across all countries included in both the
2003 and 2006 indices, represent a statistically significant increase from 2003, which indicates aggre
gate improvement. Figure 2 compares total index scores averaged by region. The observed increases
in the total index score are significant only in Asia and the Pacific, the Middle East and North Africa,
and sub-Saharan Africa. The global averages for the five components show a significant improvement
in every component from 2003 to 2006 (see figure 3). In most cases, averages for the component
scores by region also showed improvement, although these improvements were only significant in the
following cases:
Supply Chain: sub-Saharan Africa
Finance: Asia and the Pacific, Eastern Europe and Central Asia, and Middle East and North Africa
Health and Social Environment: Latin America and the Caribbean and sub-Saharan Africa
Access: Eastern Europe and Central Asia and sub-Saharan Africa
Utilization: Asia and the Pacific and Latin America and the Caribbean
2 ContraCeptive SeCurity index 2006

Table 1. Contraceptive Security Index Indicators, Raw Data

Table 2.Weighted Component Scores

Figure 1.Total Weighted Scores: 63 Countries

Figure 2.Total Scores Averaged by Region
Figure 3.Total Scores Averaged by Region
Component scores for an individual country can be compared within a year (maximum weighted
score of 20 for each component), enabling users to identify components that need attention and
further assessment. Countries can score similarly overall, but have strengths or weaknesses in different
components. This highlights the need for the indicators to be reviewed within the broader context
of a country, including aspects not captured in the CS Index because of data limitations. Finally, it
is important to note that movement in rank up or down by a few places at the country level may not
represent significant differences or changes in the level of contraceptive security.
BaCkground
The Contraceptive Security Index 2006 presents an update of the findings from the Contraceptive
Security Index 2003. To be consistent with the current global definition of contraceptive security, the
framework at the core of the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS)
was used as a conceptual guide in developing the CS Index. It defines the program and program en
vironment components that are required to achieve RH commodity security, whether for contracep
tives or for other RH commodities (see figure 4).
The CS Index and other efforts that promote and advance contraceptive security have drawn much
needed attention to these issues, and have led to a global movement around contraceptive security.

Methodology
The Contraceptive Security
Index 2003 was developed Figure 4. SPARHCS Framework for Reproductive Health
by a team of CS experts from Commodity Security
USAID, the DELIVER project
of John Snow, Inc. (JSI), the
POLICY Project of Futures
Group, and Commercial
Market Strategies (CMS). Us
ing the same methodology as
the 2003 index, the CS Index
2006 was updated by a team
from USAID, DELIVER, and
Task Order 1 of the USAID
| Health Policy Initiative of
Constella Futures. The same
indicators and data sources
were maintained for the 2006
index using the latest version
of all reference documents.
(Refer to notes by indicator
below.) If new indicator values were not available since the publication of the 2003 index, the 2003
data are preserved as the most current data available.
The process of constructing the CS Index was planned to minimize data collection costs (using only
secondary data), and to maximize data reliability, validity, and replicability. The selected indicators are a
mix of inputs and outputs, and programmatic and macro-level issues. Together, they paint a picture
of CS and promote a cross-sectoral approach to addressing CS. Although some indicators are highly
correlated, each represents an important aspect of CS. The 17 indicators are arrayed across the five
CS components described below; the components are aggregated to create the index. For detailed
information about how missing data were filled in to calculate the index, how indicators were weight
ed, and other technical issues, please refer to the Contraceptive Security Index 2003: Technical Manual
(JSI/DELIVER and Futures Group/POLICY Project 2004).1
definitions
Component I: Supply Chain—Each of the five indicators of logistics management represents a key
function in the supply chain for contraceptive supplies. An effective supply chain ensures the contin
uous supply of sufficient quantities of high-quality contraceptives needed to achieve security. More
effective management of supplies is associated with better prospects for contraceptive security.
When the CS Index 2003 was calculated, the largest database available with the first four indicators listed
below was from the application of the Family Planning Logistics Management (FPLM) project’s Com
posite Indicators for Contraceptive Logistics Management (JSI/FPLM and EVALUATION Project 1999).2
This tool was updated and improved under the DELIVER project and became the Logistics System
Assessment Tool (JSI/DELIVER 2004),3 which is the source of the updated data for the first four in
dicators for the CS Index 2006. The two tools are comparable because the LSAT was directly derived

from the Composite Indicators, however the maximum possible score for each indicator changed in
the new tool. Due to the change in the data collection tool and methodology, comparisons over time
at the country level are discouraged at this time.
• Storage and distribution—This indicator assesses storage capacity and conditions,

standards for maintaining product quality, inventory control, stockouts, how system
losses are tracked, and distribution and transportation systems.
• LMIS (Logistics Management Information Systems)—This indicator assesses

reporting systems, validation of data, and information management and use in decisionmaking.
• Forecasting—This indicator assesses how forecasts of consumption are prepared, up

dated, validated, and incorporated into cost analysis and budgetary planning.
• Procurement—This indicator assesses how forecasts are used to determine short-term

procurement plans and the degree to which correct amounts of contraceptives are obtained
in an appropriate time frame.
The fifth supply-related indicator is drawn from the results of the Family Planning Effort (FPE) survey
(Ross, Stover, and Adelaja 2006).4
• Contraceptive policy—Under some circumstances, locally manufactured contraceptives

can provide an affordable and sustainable option for clients. In many countries, it will be
more effective to have policies and regulations that facilitate open markets and the impor
tation of competitively priced, high-quality products. This indicator measures the extent
to which import laws and legal regulations facilitate the importation of contraceptive supplies
that are not manufactured locally, or the extent to which contraceptives are manufactured
within the country.
Component II: Finance—Sustainable and adequate financing for the procurement of contraceptives,
service delivery, and other program components from international donors and lenders, national or
local governments, households, and third parties is critical for ensuring contraceptive security. Without
a commitment of financing, program quality and access will suffer and CS will not be sustainable.
Data are not widely or readily available to obtain an adequate country-level picture of contraceptive
financing by donors/lenders, third parties (e.g., insurers, employers), or the private sector. Three indi
cators are used to capture the prospects for government and household financing of family planning
services and contraceptives in a country. The World Bank’s World Development Indicators (WDI)
were the source for these indicators (IBRD/World Bank 2006).
• Government health expenditures as a percentage of total government
spending—A national government’s commitment to public health, specifically to repro
ductive health and family planning, is critical for CS. The poorest segments of a population
depend on free or subsidized health services, often provided by the government for essential
preventive and curative health services. This indicator is a measure of political commitment to
public health spending as a proxy for government commitment to family planning programs.
Greater commitment to health spending means more potential resources for family planning
programs as part of overall government health programs. This indicator is derived from
two indicators in the WDI: public expenditures on health as a percentage of gross domestic
product (GDP), divided by total government expenditures as a percentage of GDP:
(gov exp on health/gdp) ÷ (total gov exp/gdp) = (gov exp on health/total gov exp)

• Per capita GNI—A greater ability to pay for contraceptives at the household level is
associated with better prospects for CS. To allow for a better comparison across countries,
this indicator represents the average consumer’s potential ability to pay for family planning
services and contraceptives expressed in purchasing power parity (PPP), which corrects for
the differences in the market price of goods in each country.
• Poverty level—While per capita income measures the average consumer’s ability to pay,
there are always inequalities in the distribution of income. High poverty rates can threaten
CS if provisions are not made to ensure access to services and commodities for the poor.
Higher poverty rates can indicate a greater reliance of the population on the public sector,
adding stress to already overburdened systems. Because higher poverty rates are associated
with lower household incomes and poorer access to health care, higher poverty rates are
also associated with poorer prospects for contraceptive security. This indicator is expressed
as the percentage of the national population living below the nationally defined poverty line.
Component III: Health and Social Environment—The health and social environment component
comprise three indicators; this component is included because it is widely recognized that other factors
in the broader health and social environment can affect prospects for contraceptive security at both
the country and individual levels, as described below.
• Governance—A healthier political environment improves prospects for contraceptive
security. An accountable, stable, effective, and transparent government is more likely
to be committed to the health and well-being of its population and to use its resources
appropriately for the public good. International donors are also more likely to provide
financial and material support to such a government. The private sector is more likely to
invest in creating new or expanding existing markets for contraceptives. This indicator
is a composite measure of governance that includes six dimensions of governance: voice
and accountability, political stability, government effectiveness, regulatory quality, rule of
law, and control of corruption. It is derived from the World Bank’s Governance Matters
(Kaufmann, Kraay, and Mastruzzi 2005).
• Women’s education—Women’s educational attainment is one of the best predictors
of contraceptive use. Women who are educated beyond primary school are more likely to
use a contraceptive method. In addition, in countries where women’s status is good, edu
cated women are more likely to advocate for the protection of family planning programs.
This indicator is expressed as the percentage of females enrolled in secondary school,
which is defined as the ratio of the number of students enrolled in secondary school to the
population in the applicable age group (gross enrollment ratio). Secondary school enrollment
rates were obtained from the Population Reference Bureau’s online DataFinder database
(2005 Women of Our World and The World’s Youth 2006 Data Sheet).
• Adult HIV prevalence— It is increasingly recognized that a higher burden of HIV in a

population can erode prospects for contraceptive security. HIV/AIDS contributes to higher
levels of poverty and the pandemic has put new, competing demands on health financing.
This indicator is expressed as the percentage of adults aged 15–495 who were infected with the
HIV virus at the end of 2003. Adult HIV prevalence rates were obtained from the UNAIDS
Report on the Global HIV/AIDS Epidemic 2005.

Component IV: Access—The three access indicators measure aspects of availability and access to mod
ern methods of contraception—the degree to which clients can choose and obtain their method of
choice. Family planning and reproductive health programs should strive to offer a variety of methods
to meet the needs of all clients.
• Access to modern family planning methods—Ready and easy access by clients to

a wide range of contraceptive methods is associated with better prospects for contraceptive
security. When family planning services are widely available, it is very difficult to reverse
progress in access and availability of these services and supplies. This indicator from the
FPE survey measures the percentage of a country’s population that has ready and easy
access to male and female sterilization, pills, injectables, condoms, spermicides, and IUDs
(Ross, Stover, and Adelaja 2006).6
• Public sector targeting—Public sector family planning programs that offer heavily
subsidized (and sometimes free) services and commodities are designed to meet the needs of
the poor and near-poor segments of a population. This public sector funding is limited in
virtually every country. The degree to which the poorest people benefit from these subsi
dized services, while wealthier clients who can afford to pay for services and commodities
have and use other options, reflects upon the long-term CS in a country. This indicator
measures the proportion of a country’s contraceptives distributed through public sector
channels that go to poor and near poor family planning clients. Poor and near poor are
clients who are in the lowest 40 percent of the population as defined by a standard of liv
ing index (SLI). Data from Demographic and Health Surveys (DHS) and Reproductive
Health Surveys (RHS) are used both to compute the SLI and the distribution of public
sector FP users across SLI categories.7
• Spread of access to modern family planning methods—Access to a wide range

of family planning methods represents a choice for clients. Access to a range of methods
can also mean that if one method becomes unavailable, other methods are available to
clients in the interim. This concept of choice is key to contraceptive security, regardless of
what methods clients choose (reflected in Component V). This indicator is related to the
access indicator above and it uses the same data from the FPE survey. It measures whether
clients have ready and easy access to a broad range of at least three contraceptive methods
by selecting the highest-scored method, minus the third-highest scored method, divided
by the sum of access scores for all methods (Ross, Stover, and Adelaja 2006).
Component V: Utilization—This component comprises three indicators that measure clients’ behavior
in terms of contraceptive use within the country program context.
• Method mix—While the access indicators (see Component IV) measure the extent to which
consumers have ready and easy access to methods, this indicator measures the degree to
which consumers use a range of methods. The broader the range of methods used, the
better the prospects for contraceptive security, because it demonstrates that women have
a choice and are choosing from a range of methods. This indicator was measured as the
difference in prevalence rates between the most prevalent modern method in a country and
the third-most prevalent method, divided by the total modern method prevalence. A higher
value indicates a higher concentration of use on a limited number of methods, which is
interpreted as being not conducive to contraceptive security. This indicator was derived
from the most recently available DHS or RHS data set for each country.

• Unmet need for family planning—Unmet need is indicative of barriers to accessing
and using family planning. The higher the percentage of women with unmet need for
contraception, the poorer the prospects for contraceptive security because unmet need
represents clients who express a need to use family planning but cannot or do not. This in
dicator measures the percentage of women who express a desire to space or limit their next
pregnancy, or who would have preferred to avoid or delay their current pregnancy, but
are not using a contraceptive method. This indicator was derived from the most recently
available DHS or RHS data set for each country.
• Contraceptive prevalence rate (CPR)—This indicator is the most obvious outcome

of contraceptive security—women actually using contraception. Higher contraceptive use
is indicative of better access and availability of contraceptives for the population. Increased
contraceptive use will also encourage the improved availability in both the public and private
sectors through political pressures and market forces. This indicator measures the percentage
of married women of reproductive age currently using a modern method of family planning.
This data is from the Population Reference Bureau’s 2006 World Population Data Sheet.
referenCeS
Hare, L., Hart, C., Scribner, S., Shepherd, C., Pandit, T. (ed.), and Bornbusch, A. (ed.). 2004. SPAR
HCS: Strategic Pathway to Reproductive Health Commodity Security. A Tool for Assessment, Planning,
and Implementation. Baltimore, Md.: Information and Knowledge for Optimal Health (INFO)
Project/Center for Communications Programs, Johns Hopkins Bloomberg School of Public Health.
International Bank for Reconstruction and Development (IBRD)/World Bank. 2006. World Devel
opment Indicators 2006. (http://devdata.worldbank.org/wdi2006/contents/index2.htm)
John Snow, Inc./DELIVER. 2004. Logistics System Assessment Tool (LSAT). Arlington, Va.: John
2003: Technical Manual. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for
John Snow, Inc./Family Planning Logistics Management (JSI/FPLM) and the EVALUATION
Project. April 1999. Composite Indicators for Contraceptive Logistics Management. Arlington, Va.:
JSI/FPLM, for the U.S. Agency for International Development.
Kaufmann, Daniel, Aart Kraay, and Massimo Mastruzzi. May 2005. Governance Matters IV: Gover
nance Indicators for 1996–2004. (http:/www.worldbank.org/wbi/governance/govdata/)
Population Reference Bureau. March 2005. 2005 Women of Our World. Washington, D.C.: Popula
tion Reference Bureau. (www.prb.org)
Population Reference Bureau. August 2006. 2006 World Population Data Sheet. Washington, DC:
Population Reference Bureau. (www.prb.org)
Population Reference Bureau. February 2006. TheWorld’s Youth 2006 Data Sheet. Washington, DC:
Population Reference Bureau. (www.prb.org)
Ross, John, John Stover, and Demi Adelaja. March 2006. Family Planning Programs in 2004: Efforts,
Justifications, Influences, and Special Populations of Interest. Working Paper. Chapel Hill: MEA
SURE/Evaluation Project of the Carolina Population Center.
UNAIDS. 2005. Report on the Global HIV/AIDS Epidemic 2005. Geneva: UNAIDS.

additional reSourCeS
Ashford, L. 2002. Securing Future Supplies for Family Planning and HIV/AIDS Prevention. Washing
ton, D.C.: MEASURE Communication/Population Reference Bureau. (http://www.prb.org/pdf/
SecFutureSupplies_Eng.pdf)
Druce, Nel. March 2006. Reproductive Health Commodity Security (RHCS) Country Case Studies Synthesis:
Cambodia, Nigeria, Uganda and Zambia. London: DFID Health Resource Centre.
Family Planning Logistics Management (FPLM)/John Snow, Inc. (JSI). 2000. Programs That Deliver:
Logistics’ Contributions to Better Health in Developing Countries. Arlington, Va.: FPLM/JSI.
(http://deliver.jsi.com/2002/Pubs/Pubs_Policy/Programs_That_Deliver/index.cfm)
Finkle, C. 2003. Ensuring Contraceptive Supply Security. Outlook vol 2, no 3. Seattle: PATH. (http://
www.path.org/files/eol20_3.pdf)
Finkle, Clea T., Jane Hutchings, and Janet Vail. 2001.Contraceptive Security: Toward a Framework
for a Global Assessment. Seattle: Program for Appropriate Technology in Health (PATH).
Quijada, Caroline, Tania Dmytraczenko, and Beaura Mensah. July 2004. Ensuring Contraceptive
Security within New Development Assistance Mechanisms. Bethesda, Md.: The Partners for Health
Reformplus Project, Abt Associates, Inc.
Rao, Raja, Peter Mellon, and David Sarley. 2006. Procurement Strategies for Health Commodities: An
Examination of Options and Mechanisms within the Commodity Security Context. Arlington, Va.:
Wright, Nadia Olson, and Marie Tien. 2006.
Contraceptive Security: Practical Experience in Improving Global, Regional, National, and Local
Product Availability. Arlington, Va.: DELIVER, for the U.S. Agency for International Development.
Sine, J., and S. Sharma, 2002. Policy Aspects of Achieving Contraceptive Security. Policy Issues in Planning
and Finance No 1. Washington, DC: POLICY Project/ Futures Group International. (http://www.
policyproject.com/pubs/policyissues/PI_Eng.pdf)
Taylor, Patricia A., Nora Quesada, Wendy Abramson, Varuni Dayaratna, and Leslie Patykewich.
2004. Regional Report: Contraceptive Security in Latin America and the Caribbean. Results and
Recommendations. Arlington, Va.: John Snow, Inc./DELIVER and Washington, DC: Futures
Group/POLICY Project, for the U.S. Agency for International Development.
United Nations Population Fund (UNFPA). 2002. Reproductive Health Essentials: Securing the Supply.
New York: UNFPA.
(http://www.unfpa.org/upload/lib_pub_file/39_filename_securingsupply_eng.pdf)
U.S. Agency for International Development (USAID). 2004. Contraceptive Security: Ready Lessons.
Baltimore, Md.: INFO Project/Center for Communication Programs, Johns Hopkins Bloomberg
School of Public Health, for the U.S. Agency for International Development. (http://www.dec.
org, search under “contraceptive security”).

Additional contraceptive security resources are available at the following web sites:
DELIVER project: (www.deliver.jsi.com)

Health Policy Initiative (HPI): (www.healthpolicyinitiative.com)
Maximizing Access and Quality (MAQ) Initiative: (www.maqweb.org)
Partners for Health Reformplus Project: (www.phrplus.org)
POLICY Project: (www.policyproject.com)
Population Action International: (www.populationaction.org)
PSP-One Project (formerly Commercial Market Strategies Project): (www.psp-one.com)
The Supply Initiative: www.rhsupplies.org)
UNFPA: (www.unfpa.org)
USAID: (www.usaid.gov)
The USAID Contraceptive Security Team works to advance and support planning and implementation
for contraceptive security in countries. The team provides technical assistance to USAID missions,
country partners, donors, and international partners. The team can be contacted c/o Mark Rilling or
Alan Bornbusch, Commodities Security and Logistics Division, Office of Population and Reproductive
Health, Bureau for Global Health, mrilling@usaid.gov or abornbusch@usaid.gov.
The Reproductive Health Supplies Coalition is a 21-member coalition of donors, multilateral organizations,
private foundations, nongovernmental organizations, low- and middle-income country governments,
and others dedicated to improving global health and the quality of life by ensuring access to high-quality
reproductive health (RH) supplies. The coalition works to synthesize and share information, knowledge,
and experience; improve coordination and harmonization of programs; and develop new tools and
approaches to address the challenges of inadequate and unreliable financing for RH supplies, inefficiencies
in supply systems; and inequities in access to RH supplies. More information can be found at
(www.rhsupplies.org.)
aCknowledgMentS
Development of the CS Index 2006 was carried out by staff from the USAID Contraceptive Security Team, the
DELIVER project of John Snow, Inc. (JSI), and the POLICY Project and Task Order 1 of the USAID | Health
Policy Initiative of Constella Futures.
Funding for the development and publication of the CS Index 2006 was provided by the U.S. Agency for
International Development (USAID) under the DELIVER project (HRN-C-00-00-00010-00) implemented
by John Snow, Inc. In addition, the POLICY Project contributed to the development of this wallchart under
USAID contract no. HRN-C-00-00-00006-00. This work continued under Task Order 1 of the USAID
| Health Policy Initiative under contract no. GPO-I-01-05-00040-00. Task Order 1 is implemented by
Constella Futures in collaboration with the Center for Development and Population Activities, the White
Ribbon Alliance, and the World Conference of Religions for Peace.
The authors’ views expressed in this publication do not necessarily reflect the views of the United States
Cover photographs courtesy of DELIVER.

For more information, please visit
http://www.deliver.jsi.com.
The authors' views expressed in this publication do not necessarily reflect the views of
the United States Agency for International Development or the United States Government.
DELIVER
John Snow, Inc.
Phone: 703-528-7474
Fax: 703-528-7480
Contraceptive
Security Index 2003
A Tool for Priority Setting and Planning
A primary goal of reproductive health and family planning

programs is to ensure that people can choose, obtain, and use
a wide range of high-quality, affordable contraceptive methods and
condoms for STI/HIV prevention. Referred to as contraceptive
security, this goal requires sustainable strategies to ensure and
maintain access to and availability of supplies.
A
s demand for family planning continues to rise in developing countries and countries in
transition, compounded by significant population growth, contraceptive security (CS) will
be more challenging to achieve. Financing for reproductive health (RH) and family planning
(FP) programs has not kept pace with demand and donor resources are more constrained than
ever. These pressures have placed an increasing burden on national programs, with logistics and
service delivery systems stretched to their limits. Not only has higher demand for supplies driven
up funding requirements, but the fight against HIV/AIDS has also multiplied the need for
additional resources and increased competition for existing resources. Now, more than ever,
it is critical that programs focus attention on long-term contraceptive security.
Programs cannot meet their clients' reproductive health and family planning needs without
the reliable availability of quality contraceptive supplies and services. Further, attaining the
poverty reduction and health goals adopted by many countries-most notably in HIV reduction,
and maternal and child health-will be slowed without improvements in contraceptive security.
Ensuring contraceptive supplies and services are available to clients requires a multi-sectoral
approach. The public and private sectors must cooperate to ensure a supportive policy envi
ronment, appropriate forecasting and procurement of commodities, efficient supply chains,
well-trained providers, effective service delivery systems, a supportive social environment, and
adequate financing. Policy makers, program managers, and international donor agencies need
to know if and how their programs are progressing toward contraceptive security in order to
plan effective interventions to reach this goal.
This document presents a tool developed to measure a country's level of contraceptive security
and to monitor it over time. The tool uses a set of indicators covering the primary components of
contraceptive security to measure the level of contraceptive security in countries. These indicators
can be used separately to monitor progress in each component. They are also aggregated to
establish a composite index, which can be used to compare countries at a point in time or to
monitor progress over time within a country.
The Contraceptive Security Index can also be used for priority setting, planning, and advocacy
at the national and international levels to support policies and other interventions that promote
contraceptive security. The index can help country governments, donors, and lenders improve
resource allocation by providing them with a way to track where countries are on a continuum
of contraceptive security. With repeated measures over time, the index is meant to provide a
measure of progress toward the goal of contraceptive security.
Uses
These results are a powerful tool for raising awareness about CS and the inter-relationships between
program components, different sectors, and program outcomes. The CS Index can be useful
for cross-country comparisons, comparing inputs, and program outputs. At the country level,
it can identify areas of relative strengths and weaknesses to help stakeholders target their resources
more effectively and appropriately. However, in-depth assessment is required at the country
level to identify issues that need to be addressed through the development of a strategic plan
designed to move countries toward contraceptive security.
The CS Index can be used to set priorities and to advocate for national and international support
for promoting progress toward contraceptive security. It is also a useful guide for advocating
among global donors and lenders to determine the countries most in need of assistance and
to determine what kind of assistance they need. The results can be used to monitor progress
2
toward the goal of contraceptive security over time. By drawing attention to the importance of
contraceptive security, this tool can help donors and governments focus on meeting the growing
contraceptive needs into the future.
Finally, the CS Index should be updated periodically, as new data become available (ideally,
every two to three years).
Results
Table 1 shows the 17 indicators, grouped into the five components used to construct the CS
Index. Figure 1 shows the scores for the 57 countries included in the index. The range of possible
scores on the weighted CS Index is 0 to 100, although actual scores range from 28.1 to 68.1.
It is important to note that movement in rank up or down by a few places may not represent
significant differences in levels of contraceptive security. The index represents a country's CS
situation at a point in time, although the actual data was collected over a period of years. It is
unavoidable that indicators will be updated for different countries at different intervals.
Individual countries can be compared on their weighted component scores (maximum score of
20 for each component), allowing users to identify components that need attention and further
assessment (see table 2). Countries can score similarly overall, but have strengths or weaknesses
in different components. Figures 2 and 3 show the weighted component scores for the five highest
scoring and five lowest scoring countries in the series. Of the five highest scoring countries—Brazil,
Mexico, Peru, Colombia, and Jordan—the total scores are very similar. However, Jordan is stronger
in supply chain management and the health and social environment component than the other
countries, but has weaker scores for access and utilization. Colombia's scores show the opposite
situation—the public sector supply chain scores are relatively weak, but utilization is high. This
highlights that the indicators need to be reviewed within the broader context of a country, including
aspects not captured in the CS Index due to data limitations. In Colombia, for example, the
private sector is a major provider of family planning services and supplies.
Background
The CS Index builds on the recent work of other public health organizations. Staff at the Program
for Appropriate Technology in Health (PATH) authored Contraceptive Security: Toward a Framework
for a Global Assessment (Finkle, Hutchings, and Vail 2001), which was presented at a 2001 international
conference for reproductive health commodity security.1 This paper laid the groundwork for
the development of a methodology to measure and monitor contraceptive security.
In a separate effort, more than twenty organizations collaborated in the development of the
Strategic Pathway to Reproductive Health Commodity Security (SPARHCS), a tool for assessing
and planning for reproductive health commodity security. The framework at the core of SPARHCS
was used as a guide in developing the CS Index. It defines the program and program environment
components that are required to achieve RH commodity security, whether for contraceptives
or for other RH commodities. See figure 4.
Both efforts have drawn much needed attention to the issues around contraceptive security
and have generated interest in refining a methodology to measure CS. The CS Index takes
additional indicators into account, organizes them around a conceptual framework vetted by
a wide range of family planning experts, and allows additional countries to be scored in the
index for cross-country comparisons and in-country analysis.
3
Table 1. CS INDEX INDICATORS
SUPPLY CHAIN FINANCE HEALTH & SOCIAL ENVIRONMENT ACCESS UTILIZATION
Storage and LMIS Forecasting Procurement Contraceptive Gov. Health Per Capita Poverty Level Governance Women's Adult HIV Access to Public Sector Spread Method Mix Unmet Need CPR
Distribution Policy Expenditure GNP, PPP Education Prevalence FP Methods Targeting of Access
to FP Methods
max=60 max=24 max=16 max=16 max= 4 max=30 max=US$20,000 max=100 max=30 max=100 max=50 max= 4 max=10 max=1 max=1 max=50 max=100
Asia &
the Pacific
Bangladesh 43 19 10 10 4.0 11 1600 50 12.3 13 0.1 3.3 1.5 0.00 0.38 15.3 43
Cambodia - - - - 4.0 - 1790 36 14.6 17 2.7 1.4 0.6 0.40 0.25 29.7 19
India 45 18 12 16 3.3 5 2820 29 15.1 39 0.8 3.1 0.9 0.00 0.75 15.8 43
Indonesia 38 15 8 9 4.0 3 2830 27 10.2 48 0.1 3.3 1.3 0.00 0.24 9.2 55
Nepal 40 13 14 16 3.6 - 1360 42 12.3 33 0.5 2.2 0.6 0.10 0.25 27.8 35
Philippines 40 17 12 10 2.0 8 4070 37 14.6 78 0.1 3.0 1.2 0.10 0.23 18.8 35
Vietnam 49 20 13 11 3.4 6 2070 51 12.0 46 0.3 3.0 1.0 0.10 0.58 6.9 65
Eastern Europe
& Central Asia
Azerbaijan 35 12 8 8 - 3 2890 50 10.7 81 0.1 - - - 0.41 12.0 12
Kazakhstan - - - - 2.0 19 6150 35 12.0 91 0.1 1.7 1.0 0.20 0.67 8.7 53
Kyrgyz Rep. - - - - 1.0 12 2630 64 11.3 83 0.1 2.3 0.9 0.10 0.74 11.6 49
Turkey 45 18 12 12 3.4 9 5830 - 13.0 48 0.1 2.9 1.1 0.00 0.41 10.1 38
Turkmenistan - - - - 3.3 - 4240 - 8.6 - 0.1 2.5 0.8 0.20 0.70 19.0 53
Uzbekistan - - - - 4.0 - 2410 28 9.3 88 0.1 2.1 1.0 0.20 0.86 13.7 63
Latin America
& the Carribean
Bolivia 24 13 5 9 3.2 20 2240 63 13.7 34 0.1 2.6 0.5 0.00 0.29 26.1 25
Brazil 45 18 16 16 2.0 13 7070 17 15.6 54 0.7 4.0 1.3 0.00 0.51 7.3 70
Colombia 47 14 10 9 1.6 28 6790 64 11.7 69 0.4 3.7 1.5 0.00 0.24 6.2 64
Dominican Rep. 45 16 9 10 2.8 11 6650 29 16.1 61 2.5 2.8 1.4 0.00 0.63 11.9 66
Ecuador 42 13 9 9 2.0 - 2960 35 11.4 50 0.3 2.4 1.0 0.00 0.24 21.2 50
El Salvador 40 9 5 10 4.0 22 5160 48 15.5 39 0.6 2.2 0.8 0.10 0.45 8.9 54
Guatemala 31 15 8 8 4.0 - 4380 56 11.7 25 1.0 2.4 0.3 0.10 0.41 23.1 34
Guyana 34 8 10 12 2.0 - 4690 35 15.0 76 2.7 2.3 - 0.20 - - 36
Haiti 47 9 9 12 4.0 23 1870 - 8.9 20 6.1 2.0 1.0 0.20 0.40 39.8 22
Honduras 44 14 11 9 2.0 - 2760 53 12.8 37 1.6 2.2 1.2 0.10 0.17 11.2 51
Jamaica - - - - 4.0 7 3490 19 15.8 67 1.2 2.3 2.1 0.20 0.14 18.9 63
Mexico 53 18 12 14 3.1 16 8240 - 15.3 64 0.3 3.9 - 0.00 - 19.0 59
Nicaragua 49 12 8 8 3.0 6 2450 48 12.8 62 0.2 2.6 1.2 0.00 0.30 14.7 66
Paraguay 39 5 4 7 4.0 16 5180 22 10.0 48 - 3.1 2.3 0.00 0.11 19.9 48
Peru 52 19 12 14 3.4 15 4470 49 14.4 67 0.4 3.3 0.9 0.10 0.11 10.2 50
Middle East
& North Africa
Egypt 45 12 8 8 3.0 3 3560 17 15.0 73 0.1 2.2 1.2 0.10 0.55 10.7 54
Jordan 56 23 12 16 2.5 14 3880 12 17.1 89 0.1 1.9 1.3 0.00 0.50 14.2 39
Morocco 52 21 14 16 2.3 4 3500 19 16.5 34 0.1 2.6 0.9 0.00 0.71 19.7 49
Yemen 53 15 10 10 4.0 8 730 42 10.4 14 0.1 1.1 0.1 0.10 0.25 38.6 10
Sub-Saharan
Africa
Benin 36 14 6 7 2.4 - 970 33 13.6 11 3.6 1.3 0.3 0.10 0.11 27.2 7
Burkina Faso 29 10 7 1 3.0 3 1120 45 12.5 6 6.5 1.5 0.3 0.20 0.15 25.8 5
Cameroon 22 3 6 7 0.0 7 1580 40 11.6 22 11.8 0.4 0.2 0.00 0.09 19.7 8
Côte d’Ivoire 9 1 1 0 2.0 6 1400 - 10.5 16 9.7 0.9 0.2 0.70 0.29 27.7 7
Eritrea 39 15 9 7 - - 1030 53 11.2 17 2.8 - 0.1 - 0.39 27.0 7
Ethiopia 36 12 8 9 2.7 7 800 44 11.2 10 6.4 1.2 0.3 0.40 0.44 35.8 6
Gabon - - - - 1.3 - 5190 - 12.6 42 - 1.7 0.7 0.20 0.26 28.0 12
Ghana 35 12 5 4 4.0 3 2170 40 14.7 28 3.0 2.5 0.7 0.10 0.09 23.0 13
Guinea - - - - 2.9 9 1900 40 13.1 7 - 2.0 0.7 0.30 0.36 24.2 4
Kenya 48 16 12 12 3.3 7 970 52 10.2 22 15.0 2.8 0.5 0.10 0.18 23.9 32
Madagascar 34 9 8 9 1.0 15 820 71 12.9 16 0.3 0.7 0.2 0.20 0.38 25.6 10
Malawi 59 17 11 14 3.0 - 560 65 14.1 12 15.0 1.1 0.6 0.30 0.53 29.7 26
Mali 41 14 10 10 3.0 - 770 64 12.9 8 1.7 1.5 0.2 0.30 0.23 28.5 6
Mauritania - - - - 4.0 - 1940 46 10.8 11 - 1.2 0.0 0.10 0.35 31.6 5
Mozambique 38 12 9 10 3.0 - 1050 69 14.4 5 13.0 1.9 0.1 0.20 0.31 22.5 5
Namibia - - - - 4.0 12 7410 - 18.4 67 22.5 3.2 0.4 0.10 0.24 21.9 26
Nigeria 31 5 5 5 2.0 3 790 34 9.6 30 5.8 1.7 0.2 0.20 0.05 17.4 9
Rwanda 27 10 4 9 4.0 - 1240 51 10.2 9 8.9 2.1 0.3 0.20 0.60 35.6 4
Senegal 47 16 12 14 2.0 13 1480 33 13.7 12 0.5 2.2 0.1 0.20 0.21 34.8 8
South Africa - - - - 3.0 13 10910 - 16.9 92 20.1 2.7 0.8 0.10 0.23 15.0 55
Tanzania 44 15 15 14 4.0 - 520 36 13.4 5 7.8 0.9 0.4 0.30 0.21 21.8 17
Togo 42 13 7 7 4.0 - 1620 32 9.7 14 6.0 2.0 0.5 0.10 0.13 32.3 7
Uganda 22 3 8 7 2.5 7 1460 44 10.8 9 5.0 1.5 0.3 0.30 0.18 34.6 18
Zambia 36 17 15 6 2.0 3 750 73 12.9 21 21.5 1.7 0.3 0.10 0.36 26.5 23
Zimbabwe 34 16 8 9 3.2 3 2220 35 8.1 45 33.7 2.2 0.9 0.20 0.65 12.9 50
4
Table 2. WEIGHTED COMPONENT SCORES
Supply Chain Finance Health & Social Access Utilization Total
(20 pts) (20 pts) Environment (20 pts) (20 pts) (max=100 pts)
(20 pts)
Asia &
the Pacific
Bangladesh 15.0 6.3 10.3 13.2 11.6 56.4
Cambodia 15.2 7.3 10.7 6.7 9.0 48.9
India 16.3 6.9 12.5 12.4 9.1 57.2
Indonesia 13.3 6.5 12.1 13.0 14.2 59.1
Nepal 15.9 7.3 11.5 10.1 10.3 55.1
Philippines 13.0 7.3 15.1 11.8 11.6 58.9
Vietnam 16.0 5.2 12.4 11.7 12.9 58.1
Average 15.0 6.7 12.1 11.3 11.2 56.2
Eastern Europe
& Central Asia
Azerbaijan 9.3 5.0 14.4 7.5 9.8 46.0
Kazakhstan 13.3 10.6 15.4 8.8 11.2 59.4
Kyrgyz Rep. 13.7 5.9 14.7 10.4 10.1 54.9
Turkey 15.4 8.1 12.7 12.2 11.8 60.2
Turkmenistan 11.2 8.4 12.4 10.0 9.7 51.6
Uzbekistan 14.5 5.7 14.6 9.5 10.0 54.3
Average 12.9 7.3 14.0 9.8 10.4 54.4
Latin America
& the Carribean
Bolivia 10.5 7.8 12.0 11.3 9.6 51.1
Brazil 16.0 10.7 13.6 14.2 13.6 68.1
Colombia 11.8 10.9 13.8 13.8 15.2 65.5
Dominican Rep. 13.2 9.4 14.0 12.3 11.9 60.8
Ecuador 11.5 7.4 12.5 11.3 12.2 55.0
El Salvador 11.9 10.1 12.6 10.2 12.7 57.6
Guatemala 12.6 8.1 10.8 10.2 9.8 51.4
Guyana 11.1 8.8 14.7 9.7 12.0 56.3
Haiti 13.9 9.0 9.2 9.3 6.8 48.3
Honduras 12.3 6.8 11.8 10.5 14.1 55.4
Jamaica 13.4 8.1 14.5 10.6 14.1 60.6
Mexico 16.1 10.7 14.3 14.1 11.6 66.8
Nicaragua 12.3 5.7 13.6 11.8 13.8 57.1
Paraguay 10.2 10.4 11.3 13.4 13.1 58.4
Peru 16.5 8.2 14.3 12.1 14.6 65.6
Average 12.9 8.8 12.9 11.7 12.3 58.5
Middle East
& North Africa
Egypt 12.0 7.4 14.9 10.5 11.8 56.5
Jordan 17.1 10.2 16.4 10.7 10.7 65.0
Morocco 16.8 7.5 12.6 11.6 9.2 57.7
Yemen 15.0 5.9 9.9 7.9 7.2 45.9
Average 15.2 7.7 13.4 10.2 9.7 56.3
Sub-Saharan
Africa
Benin 10.4 5.7 9.9 8.4 9.4 43.8
Burkina Faso 8.6 4.7 9.0 8.0 9.2 39.5
Cameroon 5.2 6.0 9.1 7.5 10.6 38.5
Côte d'Ivoire 3.0 4.5 8.8 3.6 8.2 28.1
Eritrea 12.1 5.0 9.9 8.1 7.6 42.8
Ethiopia 11.4 5.5 9.0 6.2 6.0 38.0
Gabon 7.4 8.8 11.3 8.6 8.7 44.8
Ghana 10.6 5.4 11.4 10.6 10.5 48.6
Guinea 11.6 6.7 9.5 8.5 8.0 44.2
Kenya 15.2 5.1 8.4 11.0 11.1 50.7
Madagascar 9.0 5.5 10.6 6.6 8.1 39.7
Malawi 16.0 6.2 8.6 6.9 7.6 45.3
Mali 13.1 5.6 9.8 7.3 8.4 44.2
Mauritania 10.2 7.7 9.0 8.0 7.1 42.1
Mozambique 12.3 4.5 8.5 8.6 8.6 42.4
Namibia 18.2 10.3 12.2 11.6 10.5 62.8
Nigeria 7.4 5.3 10.0 8.3 11.3 42.3
Rwanda 10.7 6.5 8.3 9.0 4.9 39.4
Senegal 14.3 7.7 10.4 9.1 7.8 49.4
South Africa 13.9 11.4 13.9 11.0 13.5 63.7
Tanzania 16.7 5.2 8.9 6.4 10.2 47.5
Togo 12.5 6.1 9.0 9.7 8.6 45.8
Uganda 8.2 5.8 9.0 7.4 8.7 39.1
Zambia 12.5 2.7 8.1 9.0 8.9 41.2
Zimbabwe 12.4 5.7 7.0 9.6 10.6 45.3
Average 11.3 6.1 9.6 8.4 9.0 44.4
Overall Average 12.6 7.1 11.5 9.9 10.3 51.4
5
Figure 1. Total Weighted Scores
Côte d'Ivoire
Ethiopia
Cameroon
Uganda
Rwanda
Burkina Faso
Madagascar
Zambia
Mauritania
Nigeria
Mozambique
Eritrea
Benin
Mali
Guinea
Gabon
Zimbabwe
Malawi
Togo
Yemen
Azerbaijan
Tanzania
Haiti
Ghana
Cambodia
Senegal
Kenya
Bolivia
Guatemala
Turkmenistan
Uzbekistan
Kyrgyz Rep.
Ecuador
Nepal
Honduras
Guyana
Bangladesh
Egypt
Nicaragua
India
El Salvador
Morocco
Vietnam
Paraguay
Philippines
Indonesia
Kazakhstan
Turkey
Jamaica
Dominican Rep.
Namibia
S. Africa
Jordan
Colombia
Peru
Mexico
Brazil
0 10 20 30 40 50 60 70
6
Figure 2.
Top 5 Countries by CS Index Component Score
70
60 Utilization
50 Access
40
Health & Social
Environment
30
Finance
20
Supply Chain
10
0
Brazil Mexico Peru Colombia Jordan
Figure 3.
Bottom 5 Countries by CS Index Component Score
70
60
Utilization
50
Access
40
Health & Social
30 Environment
20 Finance
10 Supply Chain
0
Rwanda Uganda Cameroon Ethiopia Côte
d'Ivoire
Refer to table 2 for component and total scores
7
Figure 4. SPARHCS Framework for RH Commodity Security
8
Methodology
The work noted above was a starting point for a working group convened to conceptualize the CS Index.
The group consisted of CS experts from USAID, John Snow, Inc./DELIVER, Futures Group
International/POLICY, and Commercial Market Strategies (CMS). The process of constructing
the CS Index was designed to minimize data collection costs (using only secondary data), and
to maximize data reliability, validity, and replicability. Seventeen indicators were chosen to meet
these criteria. They address a mix of inputs and outputs, and programmatic and macro-level issues.
Together, they paint a picture of CS and promote a cross-sectoral approach to addressing CS.
Although some indicators are highly correlated, each represents an important aspect of CS.
During development, the working group experimented with different indicators and weighting
schemes and recognized that they all had limitations. In the end, 17 indicators are arrayed across
the five CS components described below; the components are aggregated to create the index.
For detailed information regarding how missing data were filled in to calculate the index, how
indicators were weighted, and other technical issues, please refer to the Contraceptive Security
Index Technical Manual2.
Definitions
Component I: Supply Chain—Each of the five indicators of logistics management represents a key
function in the supply chain for contraceptive supplies. An effective supply chain ensures the
continuous supply of sufficient quantities of high-quality contraceptives needed to achieve security.
More effective management of supplies is associated with better prospects for contraceptive security.
The first four indicators were obtained from John Snow, Inc.'s (JSI) Family Planning Logistics
Management (FPLM) project's Composite Indicators for Contraceptive Logistics Management
database (JSI/FPLM 1999)3.
● Storage and distribution—This indicator assesses storage capacity and conditions,
standards for maintaining product quality, inventory control, stockouts, tracking
system losses, and distribution and transportation systems.
● LMIS (Logistics Management Information Systems)—This indicator assesses reporting
systems, validation of data, and information management and use in decision-making.
● Forecasting—This indicator assesses how forecasts of consumption are prepared,
updated, validated, and incorporated into cost analysis and budgetary planning.
● Procurement—This indicator assesses how forecasts are used to determine short-term
procurement plans and the degree to which correct amounts of contraceptives are obtained
in an appropriate time frame.
The fifth supply-related indicator is drawn from the results of Futures Group’s (Futures)
Family Planning Effort (FPE) survey (Ross and Stover May 2000)4.
● Contraceptive policy—Under some circumstances, locally manufactured contraceptives
can provide an affordable and sustainable option for clients. In many countries, it will
be more effective to have policies and regulations that facilitate open markets and the
importation of competitively priced, quality products. This indicator measures the extent
to which import laws and legal regulations facilitate the importation of contraceptive
supplies that are not manufactured locally, or the extent to which contraceptives are
manufactured within the country.
9
Component II: Finance—Sustainable and adequate financing for the procurement of contraceptives,
service delivery, and other program components from international donors and lenders, national
or local governments, households, and third-parties is critical for ensuring contraceptive security.
Without a commitment of financing, program quality and access will suffer and CS will not be
sustainable. Data are not widely or readily available to obtain an adequate country-level picture
of contraceptive financing by donors/lenders, third parties (e.g., insurers, employers), or the
private sector. Three indicators are used to capture the prospects for government and house
hold financing of family planning services and contraceptives in a country. The World Bank's
World Development Indicators (WDI) were the source for these indicators5.
● Government health expenditures as a percentage of total government spending—A national
government's commitment to public health, specifically to reproductive health and family
planning, is critical for CS. The poorest segments of a population depend on free or
subsidized health services often provided by the government for essential preventive and
curative health services. This indicator is a measure of political commitment to public
health spending as a proxy for government commitment to family planning programs.
Greater commitment to health spending means more potential resources for family planning
programs as part of overall government health programs. This indicator is derived from
two indicators in the WDI: public expenditures on health as a percentage of gross domestic
product (GDP) divided by total government expenditures as a percentage of GDP:
(Gov Exp on Health/GDP) ÷ (Total Gov Exp/GDP) = (Gov Exp on Health/Total Gov Exp)
● Per capita GNP—A greater ability to pay for contraceptives at the household level is
associated with better prospects for contraceptive security. This indicator represents the
average consumer's potential ability to pay for family planning services and contraceptives
expressed in purchasing power parity (PPP), which corrects for differences in market
prices of goods in each country to allow for a better comparison across countries.
● Poverty level—While per capita income measures average consumer ability to pay,
there are always inequalities in the distribution of income. High poverty rates can
threaten CS if provisions are not made to ensure access to services and commodities
for the poor. Higher poverty rates can indicate a greater reliance of the population
on the public sector, adding stress to already overburdened systems. Because higher
poverty rates are associated with lower household incomes and poorer access to
health care, higher poverty rates are also associated with poorer prospects for contra
ceptive security. This indicator is expressed as the percentage of the national popula
tion living below the nationally defined poverty line.
Component III: Health and social environment—The health and social environment component,
composed of three indicators, is included because it is recognized that other factors in the
broader health and social environment can affect prospects for contraceptive security at both
the country and individual levels, as described below.
● Governance—A healthier political environment improves prospects for contraceptive
security. An accountable, stable, effective, and transparent government is more likely
to be committed to the health and well-being of its population and to use its resources
appropriately for the public good. International donors are also more likely to provide
financial and material support to such a government. The private sector is more likely
to invest in creating new or expanding existing markets for contraceptives. This indicator
is a composite measure of governance composed of six dimensions of governance: voice
10
and accountability, political stability, government effectiveness, regulatory quality, rule
of law, and control of corruption. It is derived from the World Bank's "Governance
Matters" index (Kaufman, Kraay, and Zoido-Lobaton January 2002).
● Women's education—Women's educational attainment is one of the best predictors of
contraceptive use. Women who are educated beyond primary school are more likely to use
a contraceptive method. In addition, in countries where women's status is good, educated
women are more likely to advocate for the protection of family planning programs. This
indicator is expressed as the percentage of females enrolled in secondary school defined
as the ratio of the number of students enrolled in secondary school to the population in
the applicable age group (gross enrollment ratio). Secondary school enrollment rates were
obtained from the Population Reference Bureau's 2002 Women of the World publication,
with the exception of Jordan (Roudi-Fahimi, Farzaneh, and Moghadam October 2003)6.
● Adult HIV prevalence—It is increasingly recognized that a higher burden of HIV in a
population can erode prospects for contraceptive security. HIV/AIDS contributes to higher
levels of poverty and the pandemic has put new, competing demands on health financing.
This indicator is expressed as the percentage of adults aged 15-497 who were infected with
the HIV virus at the end of 2001. Adult HIV prevalence rates were obtained from the
UNAIDS Report on the Global HIV/AIDS Epidemic 2002.
Component IV: Access—The three access indicators measure aspects of availability and access to
modern methods of contraception—the degree to which clients can choose and obtain their method
of choice. Family planning and reproductive health programs should strive to offer a variety of
methods to meet the needs of all clients.
● Access to modern family planning methods—Ready and easy access by clients to a wide range
of contraceptive methods is associated with better prospects for contraceptive security.
When family planning services are widely available, it is very difficult to reverse progress
in access and availability of these services and supplies. This indicator measures the
percentage of a country's population that have ready and easy access to male and
female sterilization, pills, injectables, condoms, spermicides, and IUDs. It is also taken
from Futures' Family Planning Effort survey (Ross and Stover May 2000).8
● Public sector targeting—Public sector family planning programs that offer heavily
subsidized (and sometimes free) services and commodities are designed to meet the
needs of the poor and near-poor segments of a population. This public sector funding
is limited in virtually every country. The degree to which the poorest people benefit
from these subsidized services, while wealthier clients who can afford to pay for services
and commodities have and use other options, ref lects upon the long-term CS in a country.
This indicator measures the proportion of a country's contraceptives distributed through
public sector channels that go to poor and near poor family planning clients. "Poor and
near poor" is defined as clients who are in the lowest 40 percent of the population as
defined by a standard of living index (SLI). Data from Demographic and Health
Surveys (DHS) and Reproductive Health Surveys (RHS) are used both to compute the
SLI and the distribution of public sector FP users across SLI categories.9
● Spread of access to modern family planning methods—Spread of access to modern family
planning methods-Access to a wide range of family planning methods represents a choice
for clients. Access to a range of methods can also mean that if one method becomes
unavailable, other methods are available to clients in the interim. This concept of choice
11
is key to contraceptive security, regardless of what methods clients choose (ref lected in
Component V). This indicator is related to the access indicator above and it uses the same
data. It measures whether clients have "ready and easy access" to a broad range of at
least three contraceptive methods by taking the highest-scored method, minus the third-
highest scored method, divided by the sum of access scores for all methods. This data
is also taken from Futures' Family Planning Effort survey (Ross and Stover May 2000).
Component V: Utilization—This component is composed of three indicators that measure
clients' behaviors in terms of contraceptive use within the country program context.
● Method mix—While the access indicators (see Component IV) measure the extent to which
consumers have ready and easy access to methods, this indicator measures the degree to which
consumers' use a range of methods. The broader the range of methods used, the better the
prospects for contraceptive security, because it demonstrates that women have a choice
and are choosing from a range of methods. This indicator was measured as the differ
ence in prevalence rates between the most prevalent modern method in a country and
the third-most prevalent method, divided by the total modern method prevalence. A
higher value indicates a higher concentration of use on a limited number of methods,
which is interpreted as being not conducive to contraceptive security. This indicator
was derived from the most recently available DHS or RHS data set for each country.
● Unmet need—Unmet need is indicative of barriers to accessing and using family planning.
The higher the percentage of women with unmet need for contraception, the poorer the
prospects for contraceptive security because unmet need represents clients who express a need
to use family planning but cannot or do not. This indicator measures the percentage of women
who express a desire to space or limit their next pregnancy, or who would have preferred to
avoid or delay their current pregnancy, but are not using a contraceptive method. This
indicator was derived from the most recently available DHS or RHS data set for each country.
● Contraceptive prevalence rate (CPR)—This indicator is the most obvious outcome of
contraceptive security-women actually using contraception. Higher contraceptive use
is indicative of better access and availability of contraceptives for the population.
Increased contraceptive use will also encourage the improved availability in both the
public and private sectors through political pressures and market forces. This indicator
measures the percentage of married women of reproductive age currently using a
modern method of family planning. This data is from the Population Reference
Bureau's 2003 World Population Data Sheet.
1
Held in Istanbul in May 2001. "Meeting the Reproductive Health Challenge: Securing Contraceptives and Condoms for HIV/AIDS Prevention" was
organized by the Interim Working Group on Reproductive Health Supplies (IWG). This was a collaborative effort by John Snow, Inc., Population
Action International, the Program for Appropriate Technology in Health, and the Wallace Global Fund to address the looming crisis represented
by the shortfall in contraceptives around the world.
2
The CS Index Technical Manual is available on-line at www.deliver.jsi.com or www.tfgi.com.
3
Staff from FPLM and Ministry of Health counterparts scored these indicators for public sector logistics systems through a participatory focus group
discussion held in each country.
4
The FPE is conducted periodically around the world by administering a questionnaire to expert respondents from each country.
5
World Development Indicators website: http://www.worldbank.org/data/onlinedbs/onlinedbases.htm
6
Female secondary school enrollment rate for Jordan.
7
HIV prevalence among adults of reproductive age (15-49) is used as the indicator for the CS Index, because this population is most likely to use
contraceptives and avail themselves of services from FP programs, making it the most relevant population for contraceptive security. It is also the most
widely available data.
8
This indicator uses the mean access score for these contraceptive methods.
9
DHS are generally conducted with oversight from a USAID centrally funded project. In some countries, RHS, similar to a DHS but overseen by the
Centers for Disease Control and Prevention, have been used where a recent DHS data set was not available.
12
References
Finkle, Clea T., Jane Hutchings, and Janet Vail. 2001.Contraceptive Security: Toward a Framework
for a Global Assessment. Seattle: Program for Appropriate Technology in Health (PATH).
John Snow, Inc./Family Planning Logistics Management and the EVALUATION Project. April
1999. Composite Indicators for Contraceptive Logistics Management. Arlington, Va.: John Snow, Inc./
Family Planning Logistics Management, for USAID.
Kaufman, Daniel, Aart Kraay, and Pablo Zoido-Lobaton. January 2002. Governance Matters, II:
Updated Indicators for 2001-02. (http:/www.worldbank.org/wbi/governance/govdata2001).
Population Reference Bureau. 2002. 2002 Women of the World. Washington, D.C.: Population
Reference Bureau. www.prb.org.
Population Reference Bureau. 2003. 2003 World Population Data Sheet. Washington, DC: Popu
lation Reference Bureau. www.prb.org.
Ross, John, and John Stover. May 2000. Effort Indices for National Family Planning Programs,
1999 Cycle. Washington, D.C.: Futures Group International for MEASURE/Evaluation.
Roudi-Fahimi, Farzaneh, and Valentine M. Moghadam. October 2003. "Empowering Women,
Developing Society: Female Education in the Middle East and North Africa." Population
Reference Bureau Policy Brief. Washington, D.C.: Population Reference Bureau.
UNAIDS. July 2002. Report on the Global HIV/AIDS Epidemic 2002. Geneva: UNAIDS.
Further Resources
Ashford, L. 2002. Securing Future Supplies for Family Planning and HIV/AIDS Prevention.
Washington, D.C.: MEASURE Communication/Population Reference Bureau.
(http://www.prb.org/pdf/SecFutureSupplies_Eng.pdf).
Family Planning Logistics Management (FPLM)/John Snow, Inc. 2000. Programs that Deliver: Logistics'
Contributions to Better Health in Developing Countries. Arlington, VA.: FPLM/John Snow, Inc.
(http://deliver.jsi.com/2002/Pubs/Pubs_Policy/Programs_That_Deliver/index.cfm).
Finkle, C. 2003. Ensuring Contraceptive Supply Security. Outlook Vol 2, No 3. Seattle, WA.: PATH.
(http://www.path.org/files/eol20_3.pdf).
Hare, L., C. Hart, S. Scribner, C. Shepherd, T. Pandit (ed.), and A. Bornbusch (ed.). 2004. SPARHCS:
Strategic Pathway to Reproductive Health Commodity Security. A Tool for Assessment, Planning, and Imple
mentation. Baltimore, Md.: Information and Knowledge for Optimal Health (INFO) Project/
Center for Communications Programs, Johns Hopkins Bloomberg School of Public Health.
Sine, J., and S. Sharma. 2002. Policy Aspects of Achieving Contraceptive Security. Policy Issues in
Planning and Finance No 1. Washington, D.C.: Policy Project/Futures Group International.
(http://www.policyproject.com/pubs/policyissues/PI_Eng.pdf).
United Nations Population Fund (UNFPA). 2002. Reproductive Health Essentials: Securing the Supply.
New York, N.Y.: UNFPA. (http://www.unfpa.org/upload/lib_pub_file/
39_filename_securingsupply_eng.pdf).
U.S. Agency for International Development (USAID). 2004. Contraceptive Security: Ready Lessons.
Baltimore, Md.: INFO Project/Center for Communication Programs, Johns Hopkins
Bloomberg School of Public Health, for USAID.
(http://www.dec.org, search under "contraceptive security").
13
Additional contraceptive security resources are available at the following web sites:
DELIVER Project: www.deliver.jsi.com
POLICY Project: www.policyproject.com
Commercial Market Strategies Project: www.cmsproject.com
Partners for Health Reformplus Project: www.phrplus.org
Population Action International: www.populationaction.org
The Supply Initiative: www.rhsupplies.org
USAID: www.usaid.gov
UNFPA: www.unfpa.org
The USAID Contraceptive Security Team works to advance and support planning and imple
mentation for contraceptive security in countries. The team provides technical assistance to USAID
Missions, their country partners, and other donors and international partners. The team can
be contacted c/o Mark Rilling or Alan Bornbusch, Commodities Security and Logistics
Division, Office of Population and Reproductive Health, Bureau for Global Health,
mrilling@usaid.gov or abornbusch@usaid.gov.
Acknowledgements
Development of the CS Index was led by Dana Aronovich of John Snow, Inc. (JSI)/DELIVER project and
Jeffrey Sine of the POLICY Project at Futures Group (Futures).
We thank Alan Bornbusch (USAID), Carolyn Hart (JSI/DELIVER), and Carol Shepherd (Futures/POLICY) for their
leadership and guidance, as well as Mark Rilling, Steve Hawkins, and Tanvi Pandit of USAID; Ali Karim,
David O'Brien, Gus Osorio, David Sarley, Pat Shawkey, and Tim Williams of JSI/DELIVER; Karen Foreit,
John Ross, and Bill Winfrey of Futures; and Asma Balal and Susan Scribner of the Commercial Market
Strategies Project for their input during the development of the index and wallchart. We also thank
reviewers of the first draft of the CS Index who provided many useful suggestions and constructive
input, including Margaret Neuse, Tim Clary, Rose McCullough, Elizabeth Schoenecker, Susan Wright,
USAID/Madagascar, Jagdish Upadhyay, Tim Johnson, and Jane Hutchings.
Funding for the development and publication of the CS Index was provided by the U.S. Agency for
International Development (USAID) under the DELIVER project (HRN-C-00-00-00010-00), POLICY II Project
(HRN-C-00-00-00006-00), and Commercial Market Strategies Project (HRN-C-00-98-00039-00).
This document does not necessarily represent the views or opinions of USAID. It may be reproduced
if credit is given to John Snow, Inc./DELIVER, POLICY Project at Futures Group, and the Commercial
Market Strategies Project.
Cover photograph, Third from left: © CCP, Courtesy of Photoshare. Remaining photos courtesy of
John Snow, Inc./DELIVER.
John Snow, Inc./DELIVER and Futures Group/POLICY Project. 2003. Contraceptive Security Index 2003:
A Tool for Priority Setting and Planning. Arlington, Va.: John Snow, Inc./DELIVER.
14
APPENDIX 4
CASE STUDY
QUESTION 1.
The Uganda example cited by the offeror (p. 13) demonstrates their knowledge of the complexities of in-
country systems. The offeror, though, does not follow-up with a discussion of concrete solutions to the
kinds of problems identified in this example.
Using an illustrative country case study, not to exceed four pages, please describe how the proposed
technical approaches for supply chain strengthening, commodity security, and procurement would be
implemented across different technical areas such as malaria, HIV/AIDS, and family planning. Describe how
the offeror would implement specific solutions to the following tasks, and propose innovative solutions
and new technologies and approaches, where appropriate.
• Procurement, consignment and distribution of malaria commodities under the President’s Malaria
Initiative, including rapid diagnostic tests, artemether lumefantrine, and long-lasting insecticide
treated nets.
• Development of an integrated commodity security plan for key malaria and HIV/AIDS commodities.
• Technical assistance to the Ministry of Health in strengthening integrated supply chain and logistics
systems to manage large volumes of family planning, malaria, and HIV/AIDS commodities, including
strengthening warehousing, storage, inventory management, and distribution systems across this
range of commodities. Include how to strengthen distribution to the most remote areas of the country.
We have done our best to provide a case study in just four pages covering health supply chain
strengthening, commodity security, and procurement in Uganda. Clearly, though, each of those topics is
worthy of several dozen pages. What follows
must be considered only the briefest overview,
albeit one in which we have tried to lay out specific,
viable strategies and plans, technologies, and
approaches to solve complex problems.
In 2001 public health logistics in Uganda was
characterized by a multiplicity of vertical
systems – at least 14 – that separately managed
such product categories as contraceptives, essential
medicines, vaccines, and anti-TB drugs.
Problems, including insufficient financing,
substandard procurement, storage, and
distribution practices, and absence of
information on consumption and balances
conspired to make stockouts the norm at all
JSI is strengthening the supply chain of HIV and AIDS drugs in
levels. Since then assistance programs funded over 30 countries, including Uganda, pictured here.
by USAID and other donors have directed
considerable resources to logistics system improvement and these inputs have produced positive results. The
most important is the integration of contraceptives, condoms, essential drugs, STI and OI drugs, laboratory
supplies, test kits, and malaria drugs into one national distribution system. PipeLine software is used to
monitor 95 products managed through this supply chain, and the LMIS for HIV tests and ARV drugs is
computerized at the central level using Supply Chain Manager.
The National Medical Stores (NMS), a semi-autonomous body, receives and stores health commodities, and packs
orders for 1,970 health facilities on a bi-monthly basis based on a pull system credit line. Orders are
delivered to the district where they are picked up by facilities. ARVs are stored at NMS, but a separate
system has been established currently reaching 35,000 patients at 220 accredited sites. The 960 laboratories
are supplied by NMS through a newly created credit line. The Government of Uganda (GOU) has also
established relationships with faith-based organizations, NGO, and non-MOH logistics supply chains to
facilitate distribution of the increased volume of commodities available through the PEPFAR- and President’s
Malaria Initiative (PMI)-funded programs. Some MOH-procured products are distributed through the Joint
Medical Stores (JMS) supply chain, which serves faith-based health facilities on a cash and carry basis,
reaching 25-35% of the Uganda population. Under this system, faith-based facilities pick up their
commodities from the JMS warehouse.
Despite the gains made over the past five years, the increasing demands on the system mean that Uganda
still requires significant technical assistance. For example, the GOU expects to supply ARVs to over 300
sites serving 56,000 patients by the year 2008. HIV Voluntary Counseling and Testing is being replaced with
Routine Counseling and Testing, considerably increasing the requirement for HIV tests. As an example of
how services will expand, HIV testing will take place at TB sites and TB testing and treatment will take
place at ART sites. Malaria programs are bringing in large quantities of products, and services are
increasingly being integrated with HIV/AIDS services. From 2001 to 2006, volume inputs from donors
and other third party suppliers increased 8.5 times, and are expected to increase still further. Magnitudes
of increase vary by commodity, with TB drugs approximately doubling, and essential drugs and vaccines
increasing 8-fold. These increases in volume are accompanied by dramatic increases in cold chain
requirements and the variety of commodities to be managed, challenges that must be planned for
explicitly. For all these reasons, Uganda needs robust but agile health supply chains to continue supplying
existing programs and to accommodate growth. LCS’s key role, in collaboration with SCMS and their supply
chain responsibilities for HIV/AIDS commodities, will be to work with the MOH to harmonize the
logistics management for these health products, ensuring standardization of logistics functions and
strategic collaboration among key players.
Procurement, Consignment, and Distribution of Malaria Commodities. The PMI Country Action
Plan for Uganda proposes the procurement of artemether-lumefantrine (AL), long lasting insecticidal nets
(LLIN) and rapid diagnostic tests (RDT), in addition to supporting other activities. This initiative will
require close coordination with the GFATM malaria program to reach the most people in an efficient
manner. LLINs are currently procured and distributed through a social marketing agency, and the numbers are
still small, but will grow over the next five years. AL and other artemesinin-based combined therapy
(ACT) will be distributed through the essential drugs system.
Quantification of these products will take place in country. The skills that DELIVER has developed over
the years for quantifying ARV, anti-malarial, OI, STI and TB drug, and HIV test requirements can be
easily transferred and adapted for the quantification of AL, LLINs, and RDTs. Since RDT sensitivity can
be compromised by many factors, WHO recommends quality control measures throughout the system,
including testing upon receipt at the national level (the National Drug Authority [NDA] already carries
out routine post-shipment testing on certain commodities, including RDT), and surveillance, sampling,
and testing from the district and the SDP levels. This will be taken into account during the quantification
exercise. Like ARVs, the rapidly growing demand for AL could place a huge burden on manufacturers.
One LCS partner has entered into an agreement with Novartis, allowing direct procurement of Coartem®
(AL), bypassing the WHO procurement process, and allowing better planning for greater and consistent
product availability. The PMI procurement plan will be established based on targets and factoring in what
others (government and/or donors) have in the pipeline, and will abide by all USAID/USG rules and
regulations as well as registration, customs clearance waivers, and post-shipment testing by NDA.
JSI currently plays a key role in supporting the MOH to coordinate supply chain and commodity inputs
and interventions by partners working in HIV/AIDS and malaria. JSI has chaired the National ARV
Procurement and Logistics Subcommittee since its creation in 2002 and serves as the Secretariat of a new
MOH committee headed by WHO, to coordinate malaria commodity shipments coming from the different
donors. LCS could take on this crucial role in the future. LCS could facilitate clearance and transport of
the product to the NMS by contracting with a private firm, guaranteeing quick clearance as well as secure,
rapid delivery. Calculation of space requirement at the NMS for AL (which is bulkier than most drugs due
to blister packaging for product integrity) and RDT needs to take place. AL will flow through the
essential drugs system while RDTs will be delivered directly to the 960 MOH and NGO labs covered by
the MOH system. Most RDTs are sensitive to heat and humidity, and require cool chain handling.
JSI recently worked with the MOH and WHO on the quantification and procurement of GFATM-funded
LLINs ($14 million) as well as the design of the distribution network, including storage, transport,
distribution options, and LMIS. Because of the specific nature (bulky and treated with insecticide) of nets,
they and other insecticidal products for re-treatment of nets or for indoor residual spraying were/are not
integrated into the health commodity system. Instead, they are managed vertically. The procurement and
consignment processes for LLINs will be similar to the ones described for AL and RDTs, but once the
nets have been cleared, they will be transported directly to the district level, using third party transport,
where they will be stored. The target populations for nets are children under 5, pregnant women, PLWA
and IDPs in camps in the north. One of the most successful ways to reach these target populations is to
leverage immunization campaigns. UNEPI has agreed with this approach. Again, using third party
transport, nets will be shipped to immunization sites. Those target populations who cannot benefit from
this distribution will be identified at the sub-county level and nets will be distributed by social marketing
groups. Some LLINs will be stored at ANC clinics for distribution to pregnant women who cannot attend
immunization campaigns. Local and international organizations working with PLWA and in the IDP
camps will distribute to these target populations.
The JSI-developed PipeLine software currently used to track 95 commodities will also be used to monitor
procurement plans for AL, RDTs, and LLINs. NMS and JMS distribution records will be used for product
tracking and donor reporting for AL and RDT, but a different tracking system will be established for nets
and sprays. Because of increasing quantities and distributions, an LLIN distribution system will have to
be systematized, including the development of an LMIS. For AL and RDTs, the current LMIS in use at
NMS needs to be modified to include these products.
Integrated Commodity Security Planning for Malaria and HIV/AIDS Products. Demand for both
anti-malarial and HIV/AIDS treatment and prevention commodities will exceed supply in the short and
medium term. The MOH/GFATM provides only 25% of the estimated ACT needs, the demand for free
LLINs will grow for the foreseeable future, and ARV funding is sufficient for covering only a portion of
present and future demand. Although 120,000 patients have met the eligibility criteria for starting ART, to
date only 35,000 receive ARVs. The target for 2008 is 56,000 patients on ART, while 80,000 reach
eligibility each year.
The imminent influx of large amounts of product for malaria and HIV/AIDS programs suggests that the
initial commodity security priorities, at least for the first two years, should be harmonization and
coordination of donor financing, procurement, logistics reporting, and distribution. This is especially
important in light of the special characteristics and distribution requirements of some products e.g., the
value of pharmaceuticals, the short shelf lives for drugs and test kits, the bulk of nets, the hazards of
pesticides. JSI has worked successfully with counterparts to develop commodity security (CS) plans for
HIV/AIDS products and for contraceptives and MCH commodities in over 25 countries. Long term financial
sustainability is of major interest and thus receives the most attention as planners use the total market
approach to apportion future costs among donors, government budgets, social marketing programs, and
commercial sector options; other factors also come into play, e.g., coordination and procurement capacity.
While long term financial sustainability is important for Uganda it is not necessarily an immediate
priority.
LCS can play an important role in matching funding by product category with scale up, storage, and
distribution plans year by year. LCS can also take the lead in projecting medium and long term needs to
inform immediate and strategic procurement plans, long term financing, and logistics system
development. For commodity security we emphasize strengthening the capacity of MOH staff to manage
international competitive bids and to work efficiently with GFATM and World Bank resources. As these
most urgent CS issues come under control, LCS and GOU can begin to work with all stakeholders to
bring emphasis to a total market approach, incorporating the future roles of household spending and the
commercial sector.
Strengthening MOH Integrated Supply Chains. Use of the term supply chains (plural) is deliberate. It
is true that some functions, e.g. storage, can be largely integrated for most different product categories, but in
specific cases it may be best to coordinate separately managed functions. Two such cases were discussed
above: RDTs and some HIV tests, requiring cold chains, and pesticides/related products, which are
unusually bulky and environmentally sensitive.
The MOH in Uganda currently manages large volumes of commodities. As with CS planning, it is best to
think in terms of at least two phases for SCM strengthening. During the first, more urgent one (first two
years of LCS), priority is given to those problems occasioned by surges in volume of contraceptive,
malaria, and HIV/AIDS products. LCS could emphasize adapting technologies that have brought
efficiency to commercial sector logistics operations, e.g., the use of bar coding to track products. The
second phase involves a whole market approach to assess long term product financing and the long term
role, structure, and financial aspects of public sector distribution.
Despite considerable improvement over the last five years, the MOH system is still characterized by stockouts,
delays in deliveries, and incorrect orders. These are common in many supply chains, but when the stockouts
are of life saving commodities, it becomes a matter of urgency. The causes of these problems are not
always obvious. LCS will work with the MOH and NMS to carry out a logistics process analysis to
identify root causes, using standard measures such as order accuracy, accuracy of order processing, on-
time delivery, putaway accuracy, accurate order picking, and packaging accuracy. Once root causes are
understood (and we may expect them to have local variations), a plan to resolve the issues will be
devised, to include human capacity development activities. Some phase-one issues and solutions are:
Develop an emergency response capability. The NMS currently works to capacity and struggles to
respond to emergency orders from the field. Establishing an “Emergency Order Team” of NMS staff to
deal with emergency orders of life-saving products (ARVs, AL) would temporarily provide a solution
until longer-term system-wide interventions make emergencies extremely rare.
Emphasize human capacity development. High turnover within the MOH (30% last year) and the
introduction of new products warrant training and re-training of staff in logistics management,
emphasizing supervision and OJT for greater sustainability. The lack of customs clearance knowledge and
expertise at the NMS causes delays in product availability. An expert seconded to NMS would be able to
transfer skills and help establish custom clearance procedures and planning.
Improve workflows at NDA. Testing procedures need to be made more efficient. NDA is legally
required to locally test anti-malarials, ARVs, condoms, LLINs, and TB drugs, sometimes causing delays
in clearance and distribution. NDA currently registers all products by hand; computerization could raise
productivity and speed registration.
Improve IT. An integrated MIS for all products should be developed for overall improvement of
commodity management.
Improve communications. Simply placing an MOH staff person at the NMS would ensure sharing of
information coming from the various partners on procurement plans.
Improve last mile delivery. The problem of distribution to remote areas is a special concern. A
DELIVER study on drug distribution demonstrated that a vehicle is required only 4 to 5 days every 2
months, which means it is not financially efficient to solve the problem through purchase of additional
vehicles. Delivery Truck Topping Up systems have brought good results (e.g., South Africa, Zimbabwe)
and could be used in Uganda. Creating district-level transport budgets to allow local management of
distribution to hard to reach sites is another intervention that has brought good results (e.g., Tanzania).
Develop a long-term health logistics strategy. Strategic or CS planning should involve projecting the
optimum role for public sector logistics in health supply chains. To understand the long term role of the public
sector distribution system, a method extensively employed in the private sector called Logistics Master
Planning (LMP) can be used. Beginning with profiles of the central variables such as client needs and
product handling requirements, LMP designs the processes for inventory planning and management,
supply, transport, and distribution including warehousing. At this point significant reforms such as
reduction of in-country pipelines, outsourcing of procurement, storage, and distribution services, and cost
recovery for appropriate categories of products can be addressed.
APPENDIX 5
TRENDS IN CONSUMPTION
DATA FROM CONTRACEPTIVE
PROCUREMENT TABLES
Trend in public sector contraceptive consumption (in 1000s of CYP), Jordan
200.0
178
180.0 170
160
160.0 151
140
140.0
CYP in 1000s
120.0
100.0
80.0
60.0
40.0
20.0
0.0
2000 2001 2002 2003 2004
In Jordan, between 2000 and 2004, the average public sector contraceptive consumption increased at a
rate of about 9.5 thousands CYP per year from 140 thousand CYP in 2000 to 178 thousand CYP in 2004.
Trend in public sector contraceptive consumption (in 1000s of CYP), Ghana

500.0
450.0 424 433
403
377 386
400.0
350.0
331
CYP in 1000s
300.0 280
250.0
200.0
150.0
100.0
50.0
0.0
2000 2001 2002 2003 2004 2005 2006
The public sector contraceptive consumption in Ghana increased by 28 percent from an average of about
329 thousand CYP per year during 2000–2002 to an average of about 420 thousand CYP per year during
2004–2006.
Trend in public sector contraceptive consumption (in 1000s of CYP), Madagascar
350.0
303
300.0 273 265
239
250.0
CYP in 1000s
200.0
150.0
100.0
50.0
0.0
2001 2002 2003 2004 2005
The average public sector contraceptive consumption in Madagascar increased from about 256 thousand
CYP per year during 2001–2002 to about 284 thousand CYP per year during 2004–2005.
Trend in public sector contraceptive consumption (in 1000s of CYP), Malaw i

700.0
608
600.0
503
500.0 467
415
CYP in 1000s
400.0 361 351
300.0
200.0
100.0
0.0
2000 2001 2002 2003 2004 2005
The average public sector contraceptive consumption in Malawi increased by 40 percent from about 376
thousand CYP per year during 2000–2002 to about 526 thousand CYP per year during 2004–2005.
Trend in public sector contraceptive consumption (in 1000s of CYP), Mali
140.0 129
120.0
100.0 90
CYP in 1000s
80.0 68
64
59
60.0
40.0
20.0
0.0
2001 2002 2003 2004 2005 2006
The average annual public sector contraceptive consumption in Mali increased by 32 percent from about
74 thousand CYP per year during 2001–2002 to about 98 thousand CYP per year during 2005–2006.
Trend in public sector contraceptive consumption (in 1000s of CYP), Mozambique

700.0
587
600.0
500.0
419
CYP in 1000s
383
400.0 348 332
300.0
200.0
100.0
0.0
2001 2002 2003 2004 2005 2006
The average annual contraceptive consumption in the public sector in Mozambique decreased by 5
percent from about 422 thousand CYP per year during 2001–2003 to about 401 thousand CYP per year
during 2005–2006. However, the decreasing trend in the contraceptive consumption in the country is
observed due to the unusually high consumption reported during 2002 (which is mainly contributed by
condoms). The outlier year for contraceptive consumption is probably reflecting the quantity of
contraceptive distributed rather than the actual quantity of contraceptive used by the end users.
Trend in public sector contraceptive consumption (in 1000s of CYP), Rw anda
180.0
155
160.0
140.0
120.0
CYP in 1000s
100.0 93
80.0 65
60.0
41
40.0
20.0
0.0
2002 2003 2004 2005 2006
In Rwanda, the consumption of the public sector contraceptives increased radically by 2.4 times from an
average of about 53 thousand CYP per year in 2002 and 2004 to an average of about 124 thousand CYP
per year in 2005–2006.
Trend in public sector contraceptive consumption (in 1000s of CYP), Tanzania

1,800.0
1,573
1,600.0
1,400.0 1,312
1,242
1,145
1,200.0
CYP in 1000s
937 925 978

1,000.0
800.0
600.0
400.0
200.0
0.0
2000 2001 2002 2003 2004 2005 2006
The average public sector contraceptive consumption in Tanzania increased by 24 percent from about
1.04 million CYP per year during 2000–2002 to about 1.29 million CYP per year during 2004–2006.
Trend in public sector contraceptive consumption (in 1000s of CYP), Uganda
1,000.0 919
900.0
800.0
678 703
700.0
CYP in 1000s
600.0 532
500.0
392
400.0
300.0 250
212
200.0
100.0
0.0
2000 2001 2002 2003 2004 2005 2006
The average public sector contraceptive consumption in Uganda increased by 14 percent from about 534
thousand CYP per year during 2000–2002 to about 611 thousand CYP per year during 2004–2006.
Trend in public sector contraceptive consumption (in 1000s of CYP), Zimbabw e

1,600.0
1,386
1,400.0 1,332 1,303
1,235
1,200.0 1,107 1,144
CYP in 1000s
1,000.0
800.0
600.0
400.0
200.0
0.0
2000 2001 2002 2003 2004 2005 2006
The average annual consumption of public sector contraceptives in Zimbabwe increased from about 1.13
million CYP per year during 2000–2001 to about 1.36 million CYP per year during 2002–2003 then
decreased to about 1.27 million CYP per year during 2005–2006. Nevertheless, the average annual
contraceptive consumption in 2005–2006 was 13 percent higher than what it was during 2000–2001.
Trend in public sector contraceptive consumption (in 1000s of CYP), El Salvador
200.0 182
180.0 168 172
160.0 147
140.0
121
CYP in 1000s
120.0
100.0 82
80.0
60.0
40.0
20.0
0.0
2001 2002 2003 2004 2005 2006
The average public sector contraceptive consumption in El Salvador increased by nearly 50 percent from
about 117 thousand CYP per year during 2000–2002 to about 174 thousand CYP per year during 2004–
2006.
Trend in public sector contraceptive consumption (in 1000s of CYP), Guatemala

250.0 228 231
224
201
200.0
149
CYP in 1000s
150.0
127
100.0
50.0
0.0
2000 2001 2002 2003 2004 2005
The average public sector contraceptive consumption in Guatemala increased by 43 percent from about
Trend in public sector contraceptive consumption (in 1000s of CYP), Nicaragua
350.0
300
300.0
255
250.0 227 220
CYP in 1000s
199
200.0
159
150.0
100.0
50.0
0.0
2000 2001 2002 2003 2004 2005
The average public sector contraceptive consumption in Nicaragua increased by 10 percent from about
Trend in public sector contraceptive consumption (in 1000s of CYP), Paraguay

180.0
155
160.0
139
140.0
120.0
CYP in 1000s
100.0 88
80.0
60.0
40.0
20.0
0.0
2003 2004 2005 2006
In Paraguay, the quantity of contraceptive consumption in the public sector increased by 29 percent from
an average of about 113 thousand CYP per year in 2003 and 2005 to about 147 thousand CYP per year in
2005–2006.
APPENDIX 6
CORRELATIONS OF LSAT, LIAT,
AND CPR
The DELIVER project’s mandate is supported by the theory that the use of modern contraception will
increase when health logistics systems are strengthened and a choice of several contraceptive methods is
readily available in health facilities. Although this has intuitively been assumed in the past, analysis of
DELIVER assessment data for 11 countries provides evidence confirming this hypothesis: a strong
quantitative relationship exists between product availability, logistics system performance, and CPR. The
analysis shows that as the performance of the health logistics system (i.e., LSAT) improves, product
availability (i.e., LIAT) improves, and family planning use (i.e., CPR) increases.
Correlation between product availability and LSAT score
• Strong relationship between the availability of three contraceptive methods (condoms, pills, and
injectables) and the overall system performance (i.e., LSAT) score
• As logistics performance improves, the availability of a mix of contraceptive methods also improves
• With a strengthened logistics system, pills, condoms and injectables are more available in health
facilities.
Correlation between stockout for pills and LSAT score
• Strong relationship between the stockout rate of pills and the overall system performance, i.e., LSAT
score
• As logistics performance improves, stockout rates of pills declines
• With a strengthened logistics system, stockouts of pills in health facilities decline.
Correlation between mean duration of stockout and LSAT score
• Strong relationship between the mean duration of stockout of pills and the overall LSAT score
• As logistics performance improves, the average duration of stockout of pills over a six month period
declines
• With a strengthened logistics system, stockouts of pills in health facilities decline.
Correlation between condom stockout and LSAT score
• Strong relationship between the mean duration of stockout of condoms and the overall LSAT score
• As logistics performance improves, the average duration of stockout of condoms over a six month
period declines
• With a strengthened logistics system, stockouts of condoms in health facilities decline.
Correlation between contraceptive prevalence rate (CPR) and product availability
• Strong relationship between the availability of three contraceptive methods (condoms, pills, and
injectables) and the CPR for the public sector
• As product availability of a mix of contraceptive methods improves, the CPR for the public sector
increases
• When there is a choice of temporary contraceptive methods (pills, condoms, and injectables) available
in health facilities, more women use contraception.
Correlation between LSAT score and CPR
• Strong relationship between the overall LSAT score and the CPR for the public sector
• As the overall LSAT score increases, the CPR for the public sector increases
• When logistics systems are strengthened, more women use contraception.
METHODOLOGICAL NOTE
Product availability is measured using results from the Logistics Indicators Assessment Tool (LIAT). The
indicators used from the LIAT are stockout on day of visit based on physical inventory, the duration of
stockouts over the six months preceding the assessment, and the availability of a mix of methods (pills,
condoms, and injectables) on the day of visit based on physical inventory.
Logistics performance is measured using scores from the Logistics System Assessment Tool (LSAT). The
LSAT has 11 components, 8 of which were consistently measured in the countries analyzed. The scores
from these 8 components were averaged to produce an overall LSAT score.
CPR is taken from the most recent Demographic Health Surveys (DHS). The graphs above show only the
CPR for the public sector, since most of the LIAT and LSAT data is from the public sector. CPR for the
public sector is defined as the percentage of women of reproductive age who are currently using
contraception from public sector sources.
Analysis was conducted on 11 DELIVER countries for which both LSAT and LIAT data was available.
Seven of these countries had LSAT and LIAT data from two points in time, allowing for a comparative
analysis that suggested that improvements in logistics systems were associated with improvements in
product availability.
APPENDIX 7
COUNTRY PERFORMANCE/ACHIEVEMENT
NOTES, DELIVER
Country & Logistics Systems Performance/ Contraceptive
Product Availability Commodity Security
$ spent Systems Design/Strengthening Consumption
Bangladesh • The stockout for FP • One hundred percent of warehouses • Contraceptive security strategy • The number of
commodities in the SDPs and 70 percent of Upazila stores had developed. married women in
$10,747,286 remaining less than 5 percent stock cards, and up-to-date bin cards • Equity in modern method reproductive age
during that period while the were available in 100 percent of contraceptive use between who are using
number of contraceptive users warehouses and 60 percent of Upazila rich and poor and between contracep-tives
increased substantially. For stores (2006). The percent of rural and urban areas from public sector
condoms, pills, and injectables, warehouses and Upazila stores with improved. sources increased
and IUDs, product availability at accurate stock cards was 95 and 90 from 7.4 million in
the Upazila level was 95.5 percent respectively (2006), and 99 • The effectiveness of the 2000 to 8.0 million
percent in 2006. percent of facilities sent in LMIS public-private partnership in in 2004
forms (2006). the contraceptive market of
Bangladesh is improving;
• In the application of a LSAT in 2002 public sector clients who were
and 2004, overall scores increased in the richest quintile are
from 79 percent to 93 percent, with gradually shifting to the private
improvements due mainly to sector, while the public sector
improvements in the LMIS, is continuing to expand its
forecasting, inventory control, and services among the poor.
transport scores.
• Designed procurement manual for
contraceptives and trained MOH officers
that led to improved procurement
capacity for contraceptives for the public
sector programs.
Philippines • Although CPR for all methods • Develop a phase-down allocation • The public sector health
increased by only two schedule for each province based on system continues to be the
$1,332,000 percentage points between poverty incidence, LGU capacity/ major provider of family
1998 and 2003, use of modern readiness to adopt a reduction in planning methods, with 67.2
methods increased from 28 contraceptive donations, CPR, and percent of the share of CPR,
percent to 33 percent during the unmet need. compared to 29.3 percent from
same period, showing a • Modify the CDLMIS software at the the private sector, including
significant improvement in Department of Health/Central Office 17.2 percent covered by
contraceptive use, probably due (DOH CO), to help DOH manage the pharmacies. Since 1970, the
to the availability of these reduced allocations of donated U.S. Government has been a
supplies throughout the contraceptives to provinces based on major donor by providing
government facilities LGU classification (by wealth), and to assistance to the family
allow LGUs to monitor locally planning program of the
procured supplies. Philippines, and for the last 12
years, USAID contraceptive
• Train LGU, DOH/Centers for Health donations (pills, injectables,
Development, and Population intrauterine devices [IUDs],
Commission (POPCOM) staff to and condoms) accounted for
address the contraceptive phaseout 80 percent of the country’s
issues described under the CSR total requirements. However,
strategy, and the development and in 2003 USAID began phasing
implementation of Policy Guidelines out its donations as part of a
Formulation workshops for DOH, broader effort to encourage
provincial, and LGU staff. local ownership of the family
planning program.
Ethiopia • The supply of contraceptives in • A significant milestone was reached • In July 2003, DELIVER,
Ethiopia, while still vulnerable, has when the Ministry of Health formally together with the POLICY
$5,684,000 improved considerably in launched the new HCSS in October Project, planned and facilitated
2006/2007. The 2006 LIAT survey 2006. a Reproductive Health
found that less than a quarter of • 87% reported contraceptive Commodity Security.
facilities sampled were stocked dispensed-to-user data (quantities • In July 2006, with DELIVER’s
out of high demand products – used), 76% reported on stock-on- guidance, this committee
DepoProvera (24%) and hand, and 80% of all facilities organized a second national
Microgynon (15%), while only reported one of these elements within CS workshop. Key topics
12% of facilities reported being the last month of the survey. The high included reconciling targets
stocked-out of condoms. Stock- rate of reporting on these logistics with shortfalls in supply and
outs were common during 2004 essential data elements was developing regional forecasts.
and 2005, particularly for satisfying given the lack of a system The Family Planning Technical
injectables, the preferred method. in 2003. Committee meets monthly.
Since 2005, several of the
regions, led by SNNPR, have
allocated funds for the
procurement of contraceptives,
and the FMOH also allocated a
small amount in this year’s
budget.
Kenya • The 2006 Stock Status • There were marked improvements in
Assessment found that more logistics system performance in the
$20,493,830 then 95 percent of facilities had DELIVER pilot region in the areas of
(TA) all tracer commodities in stock reporting rates, LMIS, inventory
$1,473,170 on the day of the visit with the control, supervision and the presence
(Com) exception of Diflucan and of trained personnel.
Nevirapine suspension. For • Other: In addition to the logistics system
family planning, 80 percent of all for family planning commodities, which
facilities and district stores had was developed under FPLM III and the
five methods in stock 9pills, first year of DELIVER, systems for TB,
injectables, IUDs, emergency STI drugs, ARVs and blood safety
contracptive pills and male reagents and tests were developed. By
condoms. Rapid HIV tests the end of DELIVER partial systems were
(Determine and Bioline) were developed for laboratory supplies and
found in 90 percent of health malaria commodities.
facilities and 80 percent of the
district stores. • Changes to the LMIS system (Clarion-
based to Oracle-based) resulted in better
• Fewer contraceptive stockouts reports and a consumption-based
were found in 2006 in the system for determining resupplies of
Eastern South DELIVER pilot contraceptives to health facilities. This
province than in the rest of the system handles approximately 400
country commodities from RH, TB,
HIV/AIDS,STI, malaria and laboratory
programs. It uniquely combines an
inventory control system, a logistics data
information system and a distribution
information system in one package for
more than 4,000 health facilities.
Malawi • Compared to the 2004 baseline, • The reproductive health logistics • There has been a
the frequency and duration of system has been strengthened by rapid growth in
$4,028,385 stockouts had declined by 2006. establishing a Logistics Unit in the CPR with
With only a few exceptions, STI MOH to facilitate the design of the temporary
drugs were stocked at Malawi Health Commodities Logistics methods
appropriate levels at health Management System (MHCLMS), (injectables,
facilities throughout the country. nationwide roll-out of the redesigned condoms and pills)
MHCLMS in 2003-04, development of making up 78% of
new CLMS forms and handbooks the method mix.
with and nationwide training of logistics The average public
staff. sector
• The use of stock cards in facilities contraceptive
improved between 2004 and 2006. In consumption
addition, logistics system increased by 40
performance as measured by LSAT percent from about
improved in DELIVER focus areas of 376 thousand CYP
LMIS, forecasting and inventory per year during
control procedures. Following 2000–2002 to
recommendations from DELIVER the about 526
regional medical stores, who are thousand CYP per
responsible for delivery of year during 2004–
commodities to health facilities, 2005.
secured vehicles sufficient to
complete these activities.
Rwanda • The Rwanda 2005 DHS results • DELIVER Assisted the GOR for the • The consumption
show an increase of the CPR development of standard operating of the public sector
$1,766,193 from 4% in 2000 to 10.3% in procedures, the capacity building of contraceptives
2005. While this point to an stock managers. The project trained increased radically
increased level of service all stock managers at central, by 2.4 times from
provision overall, it would not be regional and district level. Even tough an average of
possible without a parallel the country faces a turn over of about 53 thousand
increase in the availability of the trained staff, 60% of visited facilities CYP per year in
commodities needed to provide have trained personnel for warehouse 2002 and 2004 to
those services. and facilities stock management. At an average of
the end of the project and the about 124
reduction of stockouts at all levels are thousand CYP per
effective. year in 2005–
• Improved storage conditions: The 2006.
LIAT reported that 100% of SDP and
warehouses are meeting more than
75% of storage conditions in 2006
compare to less than 62 % in 2002
and 92 % in 2004; the study also
report more than 90% reporting rate,
therefore ensuring the availability of
the 3 essential data for decision
making.
Tanzania • Stockout on the day of the visit • Designed and implemented ILS to • Contraceptive security forum • The average public
for family planning commodities replace indent, vertical, and kit established. In June 2005 the sector
$7,834,330 was higher (22%) in the ILS pilot system in seven regions of Tanzania contraceptive security forum contraceptive
(TA) regions in 2005 compared to the covering 34 percent of the population. identified imminent stockout consumption
$7,823,950 national average (9%) estimated The evaluation of the pilot ILS for contraceptives due to increased by 24
(Com) two years earlier; nevertheless indicates that about 72% of the staff delays in funding which was percent from about
stock-outs for essential drugs in the ILS pilot regions felt confident responded by USAID, a 1.04 million CYP
and HIV test kits on the day of in their ability to implement ILS; and, member of the forum, by per year during
visit was lower (7% and 8%, almost all (99%) of the staff preferred providing emergency funds. 2000–2002 to
respectively) in the ILS regions the ILS to the previous vertical about 1.29 million
compared to the national systems. CYP per year
averages (15% and 13% for • The logistics system performance as during 2004–2006.
essential drugs and HIV test measured by LSAT improved in the
kits, respectively) ILS regions. The average LSAT score
for essential drugs in the ILS regions
in 2004 was higher (31%) compared to
the national average (25%) in 2002;
the improvement in the supply chain
functionality for essential drugs in the
ILS regions as determined by the
LSAT scores is associated with the
improvement in product availability for
those commodities in those regions
observed from the facility surveys. The
average LSAT score for STI
commodities in the ILS regions was
also higher (53%) compared to the
national average (16%) three years
earlier. The LSAT scores for family
planning commodities was 77% in
2004 for the ILS regions
Uganda • 2006 survey showed increase in • System Strengthening: Trained over • Public sector expenditures on • The average public
product availability in every 8,600 health personnel. Over 70% of health commodities increased sector
$9,402,434 product category. facilities are adhering to storage from US$.90/capita to contraceptive
• Increased ARV-supplied sites guidelines (’06) US$4.60/capita. consumption
nearly ten-fold, from 24 (’04) to • System Design: Increased the increased by 14
222 (’06). throughput of the supply chain five- percent from about
fold (based on value). 534 thousand CYP
• MOH facilities providing TB per year during
drugs increased 75%. ; PMTCT • Implemented new supply chains for 2000–2002 to
services by 300%.; EPI lab supplies, TB drugs, HIV/AIDS about 611
coverage increased from 63% to products. thousand CYP per
89%. year during 2004–
2006.
Zimbabwe • Stockout rates have been • In 2002, an assessment revealed that • The average
maintained below 5 percent for critical HIV/AIDS condoms and annual
$6,508,000 male condoms, Depo-Provera, contraceptives were not reaching consumption of
(TA) Lo-Femenal, and Ovrette in both service delivery points and in public sector
$929,000 2005 and 2006. There was 98 response, the Delivery Team contraceptives
(Com) percent distribution coverage in Topping-Up (DTTU) system was increased from
2006 and 100 percent reporting designed, delivering these about 1.13 million
nationwide in 2006 as well. commodities directly from the central CYP per year
level to all service delivery points during 2000–2001
nationwide. The DTTU system was to about 1.36
piloted in 2003 and implemented million CYP per
nationwide in 2004. year during 2002–
• An automated logistics management 2003 then
information system is maintained at the decreased to
central level. In 2006, new TOP UP about 1.27 million
software was designed and installed in CYP per year
early 2007 to improve system quality during 2005–2006.
and reporting. Summary delivery Nevertheless, the
Reports are produced after each average annual
trimester delivery and disseminated contraceptive
through the system to key stakeholders. consumption in
2005–2006 was 13
• LSAT assessments conducted in percent higher
2004 and 2007 indicate than what it was
improvements in almost all of the during 2000–2001.
components, with LMIS, product The decline in
selection, obtaining supplies and contraceptive
procurement, transport and consumption
distribution, and product use between 2002-
achieving a score of 100 percent 2003 and 2005-
each. 2006 could be
reflecting decrease
in losses and
adjustments due to
improved inventory
system rather than
decrease in actual
consumption of
contraceptives.
West Africa • Activities carried out included
Initiative forecasts of contraceptive
requirements in Burkina,
$950,000 Cameroon, Togo, and Sierra
Leone. The forecasts are
conducted in response to
USAID needs to purchase the
WARP required supplies for the
countries being assisted.
$1,872,000 Contraceptive procurement
tables are produced to inform
UNFPA, MOH and other
provider procurement plans.
DELIVER, in collaboration with
the AWARE-RH and POLICY
II projects, has assisted
country MOH’s to develop
contraceptive security strategic
plans in Burkina, Cameroon,
Togo and Sierra Leone. On
the basis of these strategic
plans, the countries are
mobilizing necessary
resources to ensure CS.
• DELIVER conducted workshops
to build capacity of institutions
and individual professionals on
CS and HIV /AIDS logistics. The
paramount regional activity
remains DELIVER technical
assistance to WAHO, As a result
of this support, and other forms
of technical assistance provided
by DELIVER, WAHO was able to
develop a strategic plan for
reproductive health commodity
security (RHCS) and begin work
on a CIB system in the sub-
region. The CIB receives funding
and technical support from
USAID. The sub regional
strategic plan is supported by a
number of funding agencies
including USAID and UNFPA.
Ghana • The 2006 Logistics Indicator • A major development of DELIVER’s • DELIVER, together with the • The use of modern
Assessment Tool results show intervention is the new integrated various stakeholders in methods of
$3,841,000 that, on average, 21 percent and supply chain system operationalized reproductive health contraception
26 percent of facilities were out of in 2002 to augment the previous commodity distribution, reached 19 percent
stock during the day of the visit, vertical chains for contraceptives, annually prepares forecasts of in 2003, compared
respectively, for contraceptives medical consumables, and essential the various commodities with 13 percent in
and essential medicines (EM). drugs. Standard operating required in the country and 1998; The public
During the last six months, 38 procedures (SOPs) and a logistics corresponding procurement sector contraceptive
percent of health facilities (hospital management information system plans (contraceptive consumption
and health centers) had (LMIS) system were developed to procurement tables) for these increased by 28
experienced a stockout of at least facilitate implementation of the new commodities. DELIVER and percent from an
one of the sample list of 12 tracer system and by July 2006 1,055 the stakeholders, through the average of about
medicines. Thirty-four percent of people had been trained nationwide, Inter-Agency Coordination 329 thousand CYP
health facilities (hospitals and including 33 trainers. The SOPs Committee/Contraceptive per year during
health centers) had experienced a describe key activities in the stores Security (ICC/CS), present 2000–2002 to an
stockout of at least one of the and supply operations, with the results to the partners to average of about
three popular contraceptives in responsibilities for personnel at the obtain their financial 420 thousand CYP
Ghana (Lo-Femenal, Depo- regional and service delivery point commitments. per year during
Provera, male condom) during the levels. 2004–2006.
past six months. For EM and • There are policies, guidelines, and
contraceptives, stockouts structures to ensure proper inventory
normally occurred once, control, and training programs are
irrespective of the product or frequently conducted by the Stores,
institution. These data now serve Supplies, and Drug Management
as a baseline for further work. (SSDM) and Pharmacy Units of the
• In April/May of 2006 Lo- GHS to ensure their use. All of the
Femenal was available in 81 warehouses have been reorganized
percent of facilities (hospitals and equipped to support the
and health centers) on the day integrated supply and scheduled
of the visit, Depo-Provera was delivery systems (which were put in
available in 76 percent of the place with DELIVER’s assistance),
facilities and male condoms and there are policies, guidelines,
were available in 79 percent of and coordinating bodies in place for
the facilities. financing and donor coordination.
• In general, the availability of
contraceptives was is better
than that of essential medicines
at the facilities. An average of
21 percent of the health
facilities were out of stock for
contraceptives during the day
of the visit, while 26 percent of
health facilities were out of
stock for essential medicines
and 17 percent of testing sites
were stocked out of test kits.
Mali • Most contraceptive products were • DELIVER assisted Mali MOH to • The average annual
also showing availability in over design and implement a national public sector
$3,066,697 80 percent of facilities in 2005. integrated logistics management contraceptive
For example, condom availability system for health commodities. The consumption
at health facilities on the day of project helped to standardized increased by 32
visit increased two-fold in 2005 to procedures and forms at central, percent from about
approximately 82% regional, districts and SDP levels. 74 thousand CYP
• To make it functional an per year during
organizational strengthening 2001–2002 to about
approach were implemented. All key 98 thousand CYP
staff from central and regional level per year during
has been trained to complete LMIS 2005–2006.
forms correctly and submit them,
according to schedule. In 2005, over
70 percent of facilities reported
sending their logistics management
reports within the previous two
months, and approximately 66
percent of facilities were using the
reports to manage contraceptives and
STI treatment drugs.
• In addition to the LMIS data, twice a
year, the project conducted a
nationwide stock status evaluation to
gather accurate and reliable logistics
essential data for forecasting,
procurement planning, securing
stakeholder commitment to the
procurement plan, and submitting
timely and accurate CPTs annually.
Nigeria • Compared to the 2002 baseline • The reproductive health logistics • An assessment of Nigeria’s
assessment, product availability system has been strengthened CS situation was conducted in
$5,603,000 in 2005 for Noristerat, Exluton, through a redesign of the 2002 using the Strategic
Depo-Provera, and male contraceptive logistics management Pathway to reproductive
condoms significantly increased system (CLMS), nationwide roll-out of Health Commodity Security
31 percent, 57 percent, 19 the redesigned CLMS in 2003-04, (SPARHCS) tool and the
percent, and 68 percent development of new CLMS forms and results have been instrumental
respectively. In addition, there handbooks with and nationwide in advancing CS in Nigeria
were modest increases in Lo- training of logistics staff. since. Results include the
Femenal (6 percent) and • Stock card availability improved for all establishment of a national
Microgynon (15 percent) during contraceptive commodities between committee and working group
the same time period. 2002 and 2005, with increases of 17 for reproductive health CS and
percent for Lo-Femenal and the development of a National
Microgynon; 18 percent for Noristerat Strategic Plan for
and Depo-Provera; 30 percent for Reproductive Health
Exluton; and 54 percent for male Commodity Security.
condoms. The percentage of facilities
with updated stock cards also improved
for all commodities between 2002 and
2005, increasing 38 percent for Lo-
Femenal; 23 percent for Microgynon;
44 percent for Noristerat; 50 percent for
Exluton, Male condoms, and IUCD; and
57 percent for Depo-Provera.
• Storage conditions improved for twelve
storage condition markers, with the most
significant improvements in maintaining
the storeroom in good condition
(increase of 11 percent), storing
products separately from insecticides
and chemicals (increase of 9 percent),
and separating damaged or expired
products (increase of 8 percent).
El Salvador • 84% of facilities had resupply • LMIS is now automated at district • There is an active • The average public
methods available continuously level as well as central contraceptive security sector
$1,020,000 over 6 month period sampled • >80% of facilities’ record-keeping is committee and there is a contraceptive
(’06) compared to 58% in ‘05 accurate (’06). annual funding for consumption
contraceptive procurement. increased by
• With USAID assistance, the nearly 50 percent
MOH has set up an agreement from about 117
with UNFPA to serve as a thousand CYP per
contraceptive procurement year during 2000–
agent for El Salvador, thereby 2002 to about 174
gaining access to economies thousand CYP per
of scale and high-quality year during 2004–
contraceptives. 2006.
• Funding: In 2005, the MOH
financed nearly 80 percent of its
total contraceptive needs through
UNFPA; it spent U.S.$1 million
and saved almost U.S.$2.5
million over local prices. While
the lack of a specific government
budget line item for
contraceptives and the
announcement of the
government’s austerity budget in
2006 lead the MOH to only have
funds to procure 53 percent of its
annual contraceptive needs, it
intends to absorb responsibility
for 100 percent of its
contraceptive needs by 2010.
Total budget for contraceptive
procurement is $1 million per
year.
Honduras • 80% of facilities had all methods • Personnel responsible for • In 2000, the Honduran
available on the day of visit. management of contraceptive Congress passed Legislative
$1,065,000 supplies in the regional and central Decree 34-2000, the Equal
warehouses were trained in the Opportunities for Women Law,
automated inventory control program. which requires the government
• The SOH has increased public sector to guarantee every woman the
coverage in recent years, from 35 right to exercise her
reproductive rights and freely
percent in 1996 to 41 percent in decide the number and birth
2001. This increase in coverage has spacing of her children. The
mostly served women in the lowest law also focuses on preventing
socioeconomic segments of the adolescent pregnancies
population. through enhanced sexual and
• System Design: The LMIS has been reproductive health IEC
automated at the central and regional programs and provision of FP
levels. counseling services.
• In 2002, the National Institute
of Women (INAM), a
governmental institution,
developed an unprecedented
policy titled The National
Policy for Women, which
includes the First National
Plan for Equal Opportunities,
2002−2007. This is the first
public policy ever approved
that requires the government
to expand and strengthen FP
services and counseling in
order to guarantee that men
and women can fully exercise
their reproductive rights. This
policy and plan, made official
by the president through
Executive Decree 15-2002,
requires the government to
reduce maternal and child
mortality rates as well as
transmission of HIV. Moreover,
in June 2006, INAM signed a
cooperative agreement with
the SOH to implement health
actions described in the
National Policy for Women.
• There is an active
contraceptive security
committee that is supported by
Ministerial Decree.
• Funding: By 2002, both the
Secretariat of Health and
ASHONPLAFA, the national
IPPF affiliate, had covered 38
percent of their contraceptive
needs. In 2004, the SOH
procured approximately
$300,000 worth of injectables,
and financed and procured
more contraceptives in 2005.
In 2006, the SOH budgeted
U.S.$1 million, which covers
nearly 100 percent of its
estimated contraceptive
needs, and are planning to
procure 100 percent of all
needs in 2007.
Other (e.g., organizational strengthening, local organizations, etc.): Within the NGO sector, the Honduran Family Planning Association
(ASHONPLAFA) is the main provider of FP services—covering a substantial 29 percent of all FP users. This NGO operates 24 clinics and has a
well-developed, successful community outreach program with 1,631 community service distribution points. ASHONPLAFA also provides social
marketing services and distributes contraceptives to hundreds of traditional commercial outlets. Through well-established social marketing
programs, ASHONPLAFA and another major NGO player, the Pan American Social Marketing Organization (PASMO), have been vital in
allowing access to affordable contraceptives in pharmacies and other traditional outlets.
Nicaragua • Product availability increased • System Strengthening: 100% of • The Nicaraguan Constitution • The average public
from 8% to 94% from ’01 to ’05. facilities received their requested explicitly guarantees the right sector
$1,031,000 quantity in ’05 (up from 79%). 100% to reproductive health and contraceptive
of the 17 regional levels accurately universal access to basic consumption
aggregate logistics data. health services. The National increased by 10
• System Design: A well functioning Health Plan (2004–2015) calls percent from about
supply chain for contraceptives exists for reducing unmet need for 215 thousand CYP
in Nicaragua. In 2005, contraceptives FP and includes unmet need per year during
and essential drugs became part of as a performance indicator. 2000–2002 to
an integrated supply chain. The new National Sexual and about 238
Reproductive Health Program thousand CYP per
document will serve as a guide year during 2003–
for the future delivery of quality 2005.
RH services. This document is
being published during a
period of health sector reform;
it can help protect FP
resources and priorities in the
face of expected structural
changes throughout the MOH.
In addition, the Maternal
Mortality Commission and the
Contraceptive Security (CS)
Committee actively address
CS issues.
• USAID and UNFPA are the
main donors of contraceptives
to the country and to the MOH.
In 2006, for the first time, the
MOH agreed to purchase
U.S.$9,000 worth of condoms,
which will be bid and procured
locally; USAID and UNFPA will
provide 69 percent and 31
percent of the remaining
contraceptive needs,
respectively. These
organizations are planning to
donate contraceptives to cover
demand through at least the
first quarter of 2008 (UNFPA)
and possibly through the end
of 2008 (USAID).
• Using a draft phase-down plan
which will be completed
shortly, the MOH will begin to
procure contraceptives—2
percent in 2006, 16 percent in
both 2007, 19 percent in 2008,
and 20 percent in 2009—
depending on the total USAID
contributions per year. The
phase-down plan will help
prepare the country for the
decline in donations and for
sustained contraceptive
availability after 2008.
Other (e.g., organizational strengthening, local organizations, etc.): The Nicaraguan Social Security Institute (SSI), which is one of the most
innovative social security schemes in the Latin American and Caribbean region, covers 10 percent of all primary health care needs through its
provision of health services to its beneficiaries, most of whom live in urban areas. SSI contracts with private medical providers known as
provisional medical companies (EMPs). The EMPs function as private businesses and are located in both private and public health facilities that
provide maternal and child health care to beneficiaries who receive FP during their reproductive years.
Paraguay • Availability of all resupply • As of 2006, 92 percent of SDP’s were • Established budget
methods at least 94% from ’01 utilizing stock cards for record line item for
$732,455 to ’05. keeping. Recordkeeping accuracy contraceptives.
increased from 9% (’05) to 48% (’06). • The Contraceptive
• In May 2006, the MOH signed an Security Strategy
agreement with UNFPA that set up a and Implementation
procurement mechanism for Plan (2006– 2010),
contraceptives with Government of which was approved
Paraguay (GOP) funds. Another by the National
memorandum of understanding will Council for
also be signed shortly between the Reproductive Health
GOP, USAID, and UNFPA that in May 2006. This
commits the GOP to gradually plan includes
assume full financial responsibility for various indicators
contraceptive procurement by 2009. that will help monitor
and evaluate
progress toward
achieving sustained
CS in Paraguay.
• Funding: In May
2006 Paraguay’s
Congress
sanctioned a new
law entitled Funding
of Reproductive
Health Commodities
and Safe Birth Kits,
which directly
earmarks funds to
procure reproductive
health commodities,
including
contraceptives. This
groundbreaking law
guarantees full
funding for all MOH
reproductive health
and FP supplies on
the basis of
projections of future
needs; this goes
further than most
other countries in
the LAC region
toward sustaining
contraceptive
availability by
ensuring funding
even when the
demand for
contraceptives
continues to grow.
Other (e.g., organizational strengthening, local organizations, etc.): The 2004 Reproductive Health Survey revealed that the private sector plays
a predominant role in Paraguay’s contraceptive market. Private-sector provision accounted for 61 percent of the market in 2004, with
pharmacies serving 50 percent of contraceptive users. Paraguay's pharmacies offer commercial and social marketing brands spanning a wide
price range, making them affordable for most consumers. The presence of social marketing brands has been possible in part through USAID‘s
support to PROMESA, an NGO working in FP, and more recently, PSI/Paraguay, which provides a wide range of contraceptives in private
pharmacies.
APPENDIX 8
SUMMARY OF HIV/AIDS SUPPLY CHAIN
INTERVENTIONS IN NINE SUB-SAHARAN
AFRICAN COUNTRIES
Summary of Supply Chain Interventions for HIV/AIDS Commodities in Nine Sub-Saharan African Countries
Country Assessments / Product Forecasting Procurement Warehouse Logistics Policy & Performance
M&E Selection Quantification Mgmt System CS Improvement
Design, LMIS
& ICS Imple-
mentation
Site Readiness HIV tests HIV tests HIV tests Manage HIV HIV tests ART National SOP development
Kenya for ART Lab ARV drugs Lab tests, STI/TB ARV drugs Policy and TOTs for HIV
LSAT supplies Lab supplies supplies drugs TB drugs test, ARV and TB
LIAT STI/OI/TB Support for OI drugs drug systems
drugs ARV/OI drugs rollouts
Site Readiness HIV tests HIV tests
Nigeria for ART ARV drugs ARV drugs
LSAT
Site Readiness HIV tests HIV tests Support for all HIV tests TOTs for Integrated
Tanzania for PMTCT and ARV drugs ARV drugs HIV/AIDS ARV drugs Logistics system
ART STI drugs commodities TB, OI, STI rollout in pilot
LSAT drugs provinces
LIAT through ILS
Site Readiness HIV tests HIV tests Support for all HIV tests National HIV Development of
Uganda for ART ARV drugs ARV drugs HIV/AIDS ARV drugs Testing & SOPs for HIV tests
LSAT Lab Lab supplies commodities TB drugs Counseling and ARVs and
supplies STI/OI/TB Policy support for system
drugs rollout
Country Assessments / Product Forecasting Procurement Warehouse Logistics Policy & Performance
M&E Selection Quantification Mgmt System CS Improvement
Design, LMIS
& ICS Imple-
mentation
Mini-LIAT HIV tests HIV tests HIV tests Support for all HIV tests SOP development
Zambia ARV drugs ARV drugs ARV drugs HIV/AIDS ARV drugs and TOTs for HIV
Lab Lab supplies commodities test, ARV drug
supplies system rollouts
Site Readiness HIV tests ARV drugs Outsource and HIV tests Suppport for
Zimbabwe for ART ARV drugs support HIV ARV drugs training on pilot
LSAT tests and ARV OI drugs system rollout for
LIAT drugs HIV tests and ARV
drugs
Site Readiness HIV tests HIV tests SOP development
Ghana for ART ARV drugs ARV drugs and TOTs for HIV
test, ARV drug
systems rollouts
LIAT HIV tests SOP development
Malawi and TOTs for HIV
test system rollouts
ARV drugs ARV drugs Support for
Mozambique ARVs
For more information, please visit deliver.jsi.com.
DELIVER
John Snow, Inc.
1616 Fort Myer Drive, 11th Floor
Phone: 703-528-7474
Fax: 703-528-7480
deliver.jsi.com

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DELIVER: FINAL PROJECT REPORT

DELIVER: Final Project Report iii

iv DELIVER: Final Project Report

DELIVER: Final Project Report v

vi DELIVER: Final Project Report

DELIVER: Final Project Report vii

DELIVER: Final Project Report ix

Resource Mobilization for Contraceptive Security

Human Capacity Building and Logistics System Improvement

x DELIVER: Final Project Report

Adopting Logistics Advances

Estimating USAID’s Contraceptive Needs

DELIVER: Final Project Report xi

Leadership for Logistics Solutions

xii DELIVER: Final Project Report

DELIVER: Final Project Report xiii

STRUCTURE AND OPERATIONS

DELIVER: Final Project Report 1

2 DELIVER: Final Project Report

ORGANIZATION OF THIS REPORT

DELIVER: Final Project Report 3

4 DELIVER: Final Project Report

Figure 2. Projected Gap in Donor-Provided Contraceptive Funding

REQUIREMENTS FOR CONTRACEPTIVE SECURITY

DELIVER: Final Project Report 5

NEW WORKING GROUPS

6 DELIVER: Final Project Report

DELIVER: Final Project Report 7

8 DELIVER: Final Project Report

Country 2003 Total Score 2006 Total Score Percentage

STRATEGIC PATHWAY TO REPRODUCTIVE HEALTH COMMODITY SECURITY

DELIVER: Final Project Report 9

10 DELIVER: Final Project Report

DELIVER: Final Project Report 11

Maternal Deaths per 100,000 Live Births

COUNTRY CONTRACEPTIVE SECURITY PROGRAMS

12 DELIVER: Final Project Report

DELIVER: Final Project Report 13

14 DELIVER: Final Project Report

DELIVER: Final Project Report 15

B: Still donor dependent Less dependency Being Limited but Larger

C: Less donor and Some donations Being Some funding Significant

D: More balanced public None or limited No Yes Varied

E: Private-sector and Phased-out or no No Limited local Very high

16 DELIVER: Final Project Report

DELIVER: Final Project Report 17

18 DELIVER: Final Project Report

DELIVER: Final Project Report 19

EXAMPLES OF COUNTRY WORK IN SUPPLY CHAIN IMPROVEMENT

20 DELIVER: Final Project Report

DELIVER: Final Project Report 21

22 DELIVER: Final Project Report

DELIVER: Final Project Report 23

24 DELIVER: Final Project Report

DELIVER: Final Project Report 25

26 DELIVER: Final Project Report

WORK IN FRAGILE STATES

DELIVER: Final Project Report 27

Table 3. Specific DELIVER Interventions, 2002–2006