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Tanzanian NGOs and Government Open Door to Improve Contraceptive Supply System
For many Tanzanians seeking family planning services, long travel and lengthy waiting times are often accompanied by shelves empty of needed medicines—the result of an inefficient contraceptives supply system . Contraceptive stock-outs can lead to unintended pregnancy, exposing women to health risks and potentially limiting their education and future prosperity. In response, a new initiative, driven by a collective advocacy effort and endorsed by the Ministry of Health and Social Welfare (MoHSW), will open the door for contraceptives to reach communities more easily, quickly, and regularly.
On October 24, 2012, the MoHSW authorized new accountability guidelines allowing non-governmental organizations (NGOs) to access contraceptive commodities directly from the Medical Stores Department (MSD),Tanzania’s government-run medicines supply entity. NGO-supported health facilities provide more than one-third (34%) of all contraceptives in mainland Tanzania .
Previously, NGO facilities needed the approval of District Medical Officers (DMOs) to receive contraceptive supplies for outreach activities. Within this system, NGOs routinely received fewer supplies than were actually needed. With the new initiative, NGOs can now communicate contraceptive needs directly to the MSD, meaning that needed commodities are more likely to be procured and NGO-supported facilities are more likely to meet demand and less likely to have stock outs.
The collaborative advocacy effort behind the new guidelines included the National Contraceptive Security Committee and NGO partners including Advance Family Planning (AFP) Tanzania; Partners in Population and Development, Africa Regional Office (PPD ARO); and Health Promotion Tanzania (HDT). The partners analyzed barriers, built a rationale, and facilitated technical meetings with government officials to formulate the guidelines for MoHSW approval.
Strategic Partnerships Create Momentum
AFP first began working with NGOs in May 2012 to develop an advocacy plan to address difficulties in accessing contraceptives at the district level. With PPD ARO and Health Promotion Tanzania, AFP engaged two consultants to conduct a rapid assessment of barriers to accessing MSD supplies. One key barrier identified was the lack of an accountability mechanism, making it difficult for MSD to monitor the quantity of contraceptives NGOs needed, provided and dispensed to clients. Using the assessment’s findings, new accountability guidelines were developed to allow the MSD to track distribution of the supplies and incorporate NGO forecasts.
To build consensus on the guidelines, AFP Tanzania then consulted the National Family Planning Working Group, a coalition of national and international NGOs chaired by the Ministry of Health’s Reproductive and Child Health Section. The Working Group flagged the accountability issue as an important source of inefficiency and inequity in delivery of family planning services. They recommended that the guidelines be brought to the National Contraceptive Security Committee of the Working Group for resolution in July 2012 .
To facilitate the committee’s consideration of the guidelines, an AFP-supported logistics consultant worked with a focal person from Pharmaceutical Supply Unit of the MoHSW to develop accountability forms. From July through October, the committee conducted review meetings to ensure that the draft guidelines and accountability forms were complementary to other Ministry documents, particularly the Report and Request (R&R) forms—the MSD paperwork used to track and fill NGO orders. The modified documents were reviewed by senior officials of the Reproductive and Child Health Section, and Procurement Supplies Section of the MoHSW.
Advocacy Wins Decisionmakers’ Support
On October 24, 2012 the Ministry presented the new guidelines at the Contraceptive Security Meeting for finalization and approval. With the guidelines in place, the MSD will fully include NGO forecasts, requirements, and consumption in the national annual calculation of contraceptives to be procured. NGOs will submit, among other things, their annual outreach plans for ease of supervision and monitoring by relevant authorities. As a next step, the MoHSW’s Reproductive and Child Health Section and the Contraceptive Security Committee agreed to incorporate issues pertaining to NGOs’ access to contraceptives in the National Family Planning Guidelines and Standards.
The strategic partnership between PPD ARO, AFP Tanzania, and Health Promotion Tanzania was instrumental in identifying key decisionmakers within the National Contraceptive Security Committee and MoHSW as well as assessing core concerns and ways to address them. The partnership also benefited from lessons learned from a similar advocacy effort in Uganda. Uganda’s NGO family planning providers likewise experienced difficulty in accessing contraceptives through the National Medical Stores (NMS). Advocacy activities spearheaded by AFP Uganda through PPD ARO and the Ugandan government proved crucial in identifying ways to address a similar issue in Tanzania.
Next Steps: Using Data to Improve Availability
AFP Tanzania will continue to work with partners and the government to mobilize resources to meet quantification needs and use data on inventory levels to improve availability. Once the NGOs start receiving family planning commodities from MSD, AFP will continue working with the MoHSW through the Reproductive and Child Health Section to monitor the flow of contraceptives.
1. Ministry of Health and Social Welfare, Tanzania Primary Health Services Development Programme (2007-2017). Downloaded from http://www.unfpa.org/sowmy/resources/docs/library/R222_MOHTanzania_2007_PHC_2007-2017.pdf.
2. Tanzania Private Health Sector Assessment Report (Strengthening Health Outcomes through the Private Sector) – USAID, January 2013.
3. National Contraceptive Security Working Group, Minutes of Meetings, Meeting of July 5th, 2012 and October 12th, 2012.
Photo by George Lamson, courtesy of Flickr Creative Commons.