TCIHC Successfully Advocates for Supply Chain Management Tool in Uttar Pradesh Cities
Meeting the family planning needs of those living in Uttar Pradesh (UP) – one of the most populous states in India with over 200 million residents – remains a struggle, especially during health crises such as the ongoing COVID-19 pandemic. One particular challenge that has been overcome with the help of The Challenge Initiative for Healthy Cities (TCIHC) was the need for robust and systematic supply chain management in UP’s urban areas.
The Ministry of Health and Family Welfare (MoHFW) rolled out a dedicated Family Planning Logistic Management Information System (FPLMIS) in 2017 to help improve access to and increase use of modern contraceptive methods, but only for rural areas with plans to eventually use it in urban areas. The FPLMIS is an easy-to-use SMS-based application that enables users to monitor and order family planning commodity stocks to minimize interrupted supplies and unavailable contraceptives.
At the same time FPMLIS was rolled out for rural use only, TCIHC began supporting UP city governments to implement its high-impact approach fixed-day static /family planning day (FDS) for urban primary health centers (UPHCs), which ensures quality family planning services with a choice of reversible spacing methods at a time and place known to the community. TCIHC also helped them activate outreach camps (ORC) and urban health nutrition days (UHNDs) as functional family planning service delivery points by integrating family planning into their agendas. Availability of family planning commodities at all three of these service delivery points was essential for success, so TCIHC looked for ways to streamline supply chain management to prepare for scaling up these approaches throughout UP and beyond.
TCIHC met with the state family planning division in December 2018 to make the case for advancing the rollout of the FPLMIS in urban areas, explaining how this would strengthen the supply chain at the UPHC as well as the last mile via urban ASHAs, a relatively new cadre of frontline health workers in the urban health delivery system. This would mean potential family planning clients would not be turned away without a method from an ORC or UHND, and no ASHA would have to refuse a method to an eligible family planning client during her household visits due to lack of family planning commodities, specifically oral contraceptive pills (OCP) and condoms. Moreover, this would save time expended by ASHAs, Auxiliary Nurse Midwives (ANMs), pharmacists and medical officers-in-charge in compiling requests for supplies. The state family planning division was convinced by these arguments and approved rolling out the FPLMIS to TCIHC-supported cities.
This decision allowed TCIHC to support the creation of unique identification codes for each cadre and a complete database of service delivery points as well as ASHAs, ANMs and other human resources essential to inform supply and demand of commodities for urban areas and facilities. TCIHC supported district teams in coaching ASHAs and ANMs on how to place orders (indenting process) and UPHC staff on inventory management and distribution of supplies. By May 2019, the FPLMIS was ready to process orders and issue supplies to urban areas through UPHCs, ORCs, UHNDs and urban ASHAs.
Now the FPLMIS tracks critical supply chain management indicators in the 20 TCIHC-supported cities of UP, including procurement status, stock-in and stock-out situations and near expiration status. The updated FPLMIS is helping government officials make quick decisions to address supply chain issues as they can easily track stock availability at all points of service delivery. Dr. Alpana Sharma, the General Manager of Family Planning of UP at the National Health Mission (NHM), explains the significance of this change:
As we have now introduced FPLMIS in urban areas, we see that it has strengthened the monitoring system of family planning commodities, improved logistic and supply chain management and ensured timely availability of contraceptives from state to UPHCs and ASHA/ANM level. This has enabled urban ASHAs to indent [process orders for] required family planning commodities through FPLMIS portal and the system is able to respond in a timely manner. Overall, eligible couples are receiving timely family planning supplies and are able to attain their desired family size. We can clearly see the advantages of FPLMIS over a manual supply chain management as we now have accurate forecasting, timely distribution and less/minimal supply imbalances. We appreciate the support of TCIHC in preparation of complete database of UPHCs, urban ASHA/ ANM and other service providers required for FPLMIS portal.”
Results from the 20 TCIHC-supported cities inspired the state to rollout FPLMIS in the remaining 55 districts of UP. Linking UPHCs with FPLMIS has clearly put UPHCs in the drivers’ seat as they can control supply chain operations, reduce the imbalance of contraceptive stock and ensure availability to clients in UP’s urban areas.
Neeraj, an ASHA at the UPHC Laxmi Nagar in Mathura noted what this change means for her and other ASHAs:
FPLMIS has simplified the indenting and issue of supplies and commodities such as OCP, condoms, pregnancy kit, etc. We just need to send one SMS with details of our requirements and we get these supplies upon our next visit to the UPHC. As a result, now we always have sufficient quantity of family planning commodities and are able to provide to people who desire and need them.”