Assessing the contraceptive supply environment in Kinshasa, DRC: trend data from PMA2020

Abstract

Performance Monitoring and Accountability 2020 (PMA2020) is a population-based and facility-based survey program conducted in 11 countries to track contraceptive use dynamics and the supply environment. Annual data collection provides trend data unavailable from any other source. Two-stage cluster sampling was used to select 58 enumeration areas in Kinshasa; data were collected in 2014, 2015 and 2016 from three to six service delivery points (SDPs) per EA. Of the 228–248 SDPs surveyed each year, only two-thirds reported to offer family planning (FP) services. Of those reporting to offer FP, one-fifth or more did not do so on the day of the survey. As of 2016, only one-half of SDPs offering FP had at least three methods available, a proxy for contraceptive choice; only one in five had at least five methods. Long-acting reversible contraceptives, including implants and IUDs, were less widely offered and more often stocked out than resupply methods, including condoms, pills and injectables. Contraceptive stockouts were rampant: in 2016, over a quarter of the SDPs experienced stockouts of all methods (except condoms) in the previous 3 months, and two of the three most widely used methods—implants and injectables—were also the most likely to be stocked out. The findings documented the inconsistency in pricing of methods across facilities; moreover, less than one quarter of SDPs posted prices. Patterns in the contraceptive supply environment remained relatively unchanged between 2014 and 2016. The PMA2020 SDP module provides timely, actionable information to the DRC government, FP implementing organizations and donors involved in FP service delivery in Kinshasa, DRC. Yet the value of this information will be determined by the ability of the local FP stakeholders to use it in bringing the needed improvements identified by this survey to the contraceptive supply environment.

DMPA-SC stock: Cross-site trends by facility type

“…Our study observed supply side trends that are consistent with increasing DMPA-SC prevalence across SSA [3] . Results are also consistent with previous research on other modern methods describing the wide variation in contraceptive stock availability across countries, methods, and sectors [16] , [17] , [18] , [19] . This variation may be due to varying supply chain models and their respective challenges in these different settings.…”

Modern contraceptive availability and stockouts: a multi-country analysis of trends in supply and consumption

“…Although a detailed examination of the relationship between contraceptive procurement, supply chain management and stockouts was beyond the scope of this research, our findings nonetheless have the potential to inform ongoing debates about the merits of different contraceptive distribution models vis-à-vis stockouts. For example, whereas Burkina Faso and DRC use a ‘pull system’ in which procurement is decentralized and multiple low-level actors place contraceptive orders from central hubs based on their forecasted needs ( PATH, 2017 ; Babazadeh et al , 2018 ), Nigeria uses a variation of the push system in which the central hubs are responsible for resupplying SDPs with contraceptives ( USAID | DELIVER PROJECT, 2014 ) with Kenya using a combination of the two systems ( Eliya Msiyaphazi Zulu et al , 2012 ). Yet, it was not entirely clear from our findings whether contraceptive stockouts vary based on the distribution model employed, considering the differences in contraceptive consumption across countries.…”

“…Stockouts likely play a role in this lack of access, though the relationship between contraceptive availability and use remains poorly understood. Existing evidence suggests that contraceptive stockouts and method availability range widely across countries and across methods ( Ali et al , 2018 ; Babazadeh et al , 2018 ; Zimmerman et al , 2019 ). Different countries may experience different contexts of varying supply chain challenges that ultimately impact method availability and stockouts differentially.…”

Evolution of a Large-Scale Community-Based Contraceptive Distribution Program in Kinshasa, DRC Based on Process Evaluation

“…The family planning supply environment in Kinshasa has been evolving rapidly since 2012 21 – 23 . Multiple national and international partners now overlap, and sometimes compete for, contraceptive delivery using diverse pricing strategies, intervention scales, and clinical or community service points.…”