Content uploaded by Ambreen Khan
Author content
All content in this area was uploaded by Ambreen Khan on Feb 02, 2023
Content may be subject to copyright.
Content uploaded by Ambreen Khan
Author content
All content in this area was uploaded by Ambreen Khan on Nov 25, 2021
Content may be subject to copyright.
Content uploaded by Muhammad Tariq
Author content
All content in this area was uploaded by Muhammad Tariq on Aug 24, 2021
Content may be subject to copyright.
672
Research article EMHJ – Vol. 27 No. 7 – 2021
Leveraging technology and supply chain to improve family planning
logistics in Pakistan
Muhammad Tariq,1 Ambreen Khan1 and Kayhan Motla1
1USAID Global Health Supply Chain Program, Procurement and Supply Management, National Science and Technology Park, Islamabad, Pakistan
(Correspondence to: Muhammad Tariq: mtariq@chemonics.com).
Abstract
Background: Pakistan and USAID have invested in improving the contraceptive supply chain data and commodity se-
curity. In 2011, the first digital contraceptive logistics management information system (cLMIS) was launched, enabling
supply chain data visibility from the federal level to health facilities. The system has built-in modules on forecasting and
supply planning, inventory management, consumption reporting, business intelligence tools, automatic email and SMS
alerts. Using these features, policy-makers and health managers annually forecast needs, and procure contraceptives ac-
cordingly.
Aims: The objective of this research was to understand the existing technological platforms for family planning (FP) sup-
ply chain data visibility and the potential impact on contraceptive commodity security.
Methods: The authors reviewed available published and grey literature papers on contraceptives and supplies in Paki-
stan. We extracted data from the cLMIS, evaluated indicators including reporting compliance, reported stock-out rates,
and contraceptive performance. The analysis was validated by reviewing supply chain and FP indicators, such as average
monthly consumption, months of stock, and couple years of protection.
Results: The cLMIS has resulted in improved distribution, early warning and accountability at the lowest tiers in the FP
supply chain in the public sector. At the facility level, FP commodity availability increased from 40% in 2009 to 84% in 2018.
Conclusion: Contraceptive supply chain has seen significant growth over the past decade to meet expanding reproduc-
tive health evidence to inform strategic decisions; cLMIS is a prime contributor to improvements registered in FP stock
availability at public sector facilities.
Keywords: logistics management information system, family planning commodities, data visibility, stock availability
Citation: Tariq M; Khan A; Motla K. Leveraging technology and supply chain to improve family planning logistics in Pakistan. East Mediterr Health J.
2021;27(7):672–678. https://doi.org/10.26719/2021.27.7.672
Received: 27/10/20, accepted: 14/01/21
Copyright © World Health Organization (WHO) 2021. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license
(https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Introduction
Through enabling people to determine the number and
spacing of their children, contraception offers a range of
potential benefits, including contributing to economic
development, improved maternal and child health, and
being a source of women’s empowerment (1).
Despite increases in contraceptive use, an estimated
214 million women of reproductive age had an unmet need
for contraception in low- and middle-income countries in
2017 (2). Reducing unmet need for modern contraception
by increasing the access to and supply of contraceptives
has been a critical area of interest in reproductive health
for decades (2). It is key to meeting the family planning
(FP) 2020 goal of enabling an additional 120 million
women and girls in the world’s poorest countries to be
using modern methods of family planning by 2020 (3).
Thus, the objective of this research was to understand
the existing technological platforms for FP supply chain
data visibility and the potential impact on contraceptive
commodity security.
Although there has been a national FP programme
since the 1960s, there has been limited progress in
Pakistan. The country faces rapid population growth,
with projections that by 2050 the population will surpass
310 million from 207.7 million currently (4). A signatory
to the global FP2020 pledge (5), Pakistan is committed
to reducing its population growth rate by increasing
the contraceptive prevalence rate from 34.2% in 2017–18
to 50% by 2020; however, modern contraceptive use by
married women has remained stagnant over the past 5
years, with 26% of women using a modern method in
2012–13 (6) and 25% in 2017–18 (7). Among the modern
method mix, there was negligible difference in the use of
all methods over time.
Even with substantial efforts, Pakistan’s health
and population departments struggle to steward
dynamic FP programmes. The primary hindrance in
successfully implementing FP programmes remains a
lack of coordination among government run health and
population welfare departments, planning and finance
divisions, and public and private stakeholders (8).
In 2010, provincial departments of population welfare
were moved to the administrative control of the provinces
and became administratively independent from the
Ministry of Population and Welfare. This administrative
673
Research article EMHJ – Vol. 27 No. 7 – 2021
change did not create significant improvement in
health systems (9); even with support from donors and
nongovernmental organizations, supply chain systems
remained ad hoc and fragile. A 2014 qualitative study
showed frequent stock-outs and interrupted supplies
decreasing access to FP (6). Requisitioning contraceptives
from different departments/stakeholders, poor
supply mechanisms, lack of transportation financing,
inadequate planning, procurement delays and the lack of
a monitoring and supervision framework compounded
the challenges (6). Before 2011, the system was inadequate
owing to the lack of a standardized logistics management
information system (LMIS) for FP products (10).
Lack of access and lack of availability caused by
supply chain failures are among the principal reasons for
contraceptive non-use and contraceptive discontinuation
(11). Supply chain management comprises the steps
involved in moving a product from the supplier to the
customer (12). Research has identified distribution
system inefficiencies and lack of institutionalized LMISs
as critical barriers to effective contraception supply
chains in low- and middle-income countries (13). For
example, Morocco’s highly complex “pull-based” supply
chain system involved excessive steps and relied on the
accuracy of 900 minimally-trained midwives at service
delivery points to make contraception forecasts (14). The
system required facilities to pick up supplies from the
warehouse at their own expense, and many facilities kept
poor inventory records. In Senegal, Daff et al. contend
that inefficiencies in the public health supply chain
system contributed to a lack of accurate and timely data
hindering the existence of a well-functioning supply
chain system (15). These examples illustrate that the
absence of robust public health supply chains systems
leads to unreliable data and inaccurate forecasts and
procurements, which can impact the product availability
at the last mile.
Prior to the implementation of the contraceptive
logistics management information system (cLMIS) in
Pakistan, the reported clients, via service delivery point
data and observed by surveys, showed major differences.
The contraceptive performance reports published by the
Pakistan Bureau of Statistics depended on the collation of
the manual records available in the warehouse, and even
then showed some inconsistencies (Tables 1,2).
Recognizing these issues, the Government of Pakistan
looked at options available to resolve the discrepancies
and streamline the system. In Pakistan, prior to 2008,
contraceptives were supplied via the Central Warehouse’s
manual record keeping system, leading to errors and
delays. In response to a request from the health ministry
in 2008, this manual record keeping system was replaced
by an online system, the cLMIS. It was developed as a
result of cooperation between the Ministry of National
Health Services, Regulations and Coordination, the
provincial departments of health and the population
welfare departments with support from the United States
Agency for International Development (USAID) (16).
In July 2011, during the first phase of implementation,
19 districts (out of 143 total) across Pakistan were equipped
with the system. Staff were trained, and pilot testing
carried out to verify that the new system would improve
data visibility, enabling effective stock monitoring.
By 2012, it had been scaled up nationally and was used
in all 143 districts. With USAID support, around 1000
government staff in provincial health and population
welfare departments received training on how to use the
cLMIS (17).
This cLMIS collects, organizes and reports data,
and generates analytics to facilitate improved policy
decisions. The system enables supply chain data
visibility of all contraceptive health commodities for the
public sector and nongovernmental organizations. With
the introduction of the web-based cLMIS, managers,
logisticians and donors have better visibility into the
supply chain and can thus improve their management
to ensure products reach consumers through Pakistan’s
health care delivery system. The cLMIS allows
authorized users at various locations to enter logistical
data and access cLMIS reports through a web browser.
Reports include stock status, months of stock and other
information critical to supply chain functioning. By
improving the timeliness and quality of logistics data and
reducing the time needed to access the data, the cLMIS
effectively enables evidence-informed decision-making
for supply chain management (17).
Table 1 Trends in commodity/service supply, Pakistan, 2011–2018 (million persons served)
Type Year Difference
2011–2018
(%)
2011–12 2012–13 2013–14 2014–15 2015–16 2016-17 2017–18
Condoms 1.49 1.88 1.93 2.58 2.73 2.74 2.71 1.22 (44.9)
Oral pills 0.48 0.50 0.52 1.15 1.15 1.47 1.30 0.82 (63.1)
Intra-uterine device (insertions) 1.32 1.23 1.67 1.79 1.82 1.89 1.83 0.51(28.1)
Injectable (vials) 0.54 0.58 0.56 1.46 1.31 1.85 1.63 1.09 (66.9)
Contraceptive surgery (sterilization) 0.12 0.10 0.11 0.22 0.19 0.17 0.17 0.05 (31.2)
Total 3.95 4.29 4.80 7.20 7.19 8.12 7.64 3.69 (48.3)
Source: Pakistan Bureau of Statistics. Annual contraceptive performance reports from the years 2011–12 to 2017–18.
674
Research article EMHJ – Vol. 27 No. 7 – 2021
Methods
The authors reviewed papers on contraceptive use and
logistics, both published and grey literature, relating to
Pakistan as well as the contraceptives performance re-
ports compiled by the Pakistan Bureau of Statistics and
the Pakistan Demographic and Health Surveys (6,8,18). In
addition, data was extracted from the cLMIS, focusing on
such indicators as reporting rate and stock availability ra-
tios. The data extracted from cLMIS included indicators
on data reporting compliance, reported stock-out trends
and contraceptive performance (Figure 1).
Stock availability and reporting rates from 2015–2018
were compared. The study was conducted considering
one stakeholder, the population welfare departments, in
all 4 provinces. The population welfare department is the
main stakeholder in contraceptive service delivery for the
public sector and the not-for-profit private sector.
Results
Systems reporting compliance improved over the years,
showing increased contraceptive performance and im-
proved stock availability at the service delivery points.
Quantitative data obtained from cLMIS were used for
time series analysis of reporting rates as well as data use
and stock availability. Stock availability and reporting
rates over 4 years (2015–2018) were compared (Figure
2). The graph shows the stock availability of 4 products,
condoms, pills, intrauterine contraceptive devices and
injectables, for 2015–2018. The data usage indicator was
developed to ascertain that supply decisions were in line
with stock availability at service delivery points. The re-
porting rate and data use increased from 71% to 99% and
stock availability increased from 86% to 91%. The analy-
sis confirms that, with improved data visibility through
the LMIS, decision-makers were able to take decisions
on allocation of funds for contraceptive procurement,
leading to improved stock availability. The availability of
supplies in the public sector has led to an increase in the
share of services provided for condoms, intrauterine con-
traceptive devices and injectables.
Discussion
The main purpose of an improved supply chain is to en-
sure commodity availability (19). The cLMIS reduced pa-
per-based reporting and optimized health systems data
reconciliation at the health facility level. Timely report-
ing at the district and union council level (lowest admin-
istrative tier of the government) is essential to ensuring
superior stock monitoring from procurement to “last-
mile”.
Web-based end-to-end dashboards made the cLMIS
data for the entire supply chain visible to government
decision-makers, including but not limited to the health
secretariat and federal and provincial health ministries.
These powerful analytics inform the relevant authorities
to take timely actions for stock replenishments at district
and health facility levels. One key example would be the
FP executive dashboard, which informs the decision-
makers at the provincial and district levels where service
delivery point stocks have gone below the agreed-
upon levels, posing a risk of stock-out. The system also
automatically generates stockout emails and SMS alerts,
enabling relevant officials to take timely decisions.
The FP executive dashboard was developed to provide
an overview of stock sufficiency for FP commodities in
Table 2 Service delivery vs uptake for 2011–18 (million
persons served)
Type Service
delivereda
Service
uptakeb
Difference
Condoms 2.71 9.20 –6.49
Oral pills 1.30 1.70 –0.40
Intra-uterine device
(insertions)
1.83 2.10 –0.27
Injectable (vials) 1.63 2.50 –0.87
Contraceptive surgery
(sterilization)
0.17 8.90 –8.73
Total 7.64 24.40 –16.76
aFrom the Contraceptive Performance Report 2017–18.
bFrom the Pakistan Demographic and Health Survey 2017–18 (sterilization includes 8.8 for
women and 0.1 for men).
Figure 1 The framework demonstrating the Pakistan contraceptive logistics management information system (LMIS)-driven data
visibility
Data visibility through Pakistan LMIS-Framework
Improved LMIS data visibility Impact
Data reporting Informed decisions
Financing
Improved stock availability
Data use
Contraceptive LMIS
675
Research article EMHJ – Vol. 27 No. 7 – 2021
all 4 provinces, relevant districts and service delivery
points/health facilities. In each province, the health and
population welfare departments are the main consumers
of FP commodities, and in some provinces, such as Sindh,
both departments are procuring jointly with storage at
the Central Warehouse and Supplies in Karachi. Thus, the
dashboard not only provides a real-time stock situation at
the Central Warehouse & Supplies but also the pipeline
for each product, enabling users to observe the stock
situation for a particular commodity at the service
delivery point level (20).
It is worth noting that data reporting in the districts
and health facilities is compiled on a monthly basis.
Consequently, the stock data for districts and health
facilities will be displayed in the upcoming month, i.e.
data related to March will be displayed in April after data
entry has been completed. By requiring that data for a
given month be reported before the 10th of the upcoming
month, data visibility is greatly improved. This monthly
reporting also accurately calculates reordering dates such
that stock sufficiency levels are maintained, minimizing
the possibility of future stock-outs.
The stock-out rate is defined as the number of service
delivery points that, at any point, in a defined period
(e.g. the past 3, 6 or 12 months), experience a stock-out
of a specific FP tracer product that the service delivery
point is expected to provide. The web-based end-to-end
dashboards display the months of stock for each product
using different colours to identify the level of severity
with respect to replenishing the stock. This provides users
with intelligence for when and how much a particular
product needs to be ordered in the future to maintain the
desired maximum stock levels.
Increased data visibility through cLMIS enabled
policy-makers and managers to take evidence-informed
and timely decisions, particularly in terms of replenishing
stock. This was supported by the system’s ability to
generate automatic email and SMS alerts to policy-
makers and managers. For example, based on district
consumption trends generated from LMIS data, all 4
provinces (Balochistan, Khyber Pakhtunkhwa, Punjab,
Sindh) and other regional governments committed more
than $US 130 million during 2014–2020 for FP commodity
procurement, with an average of $US 20 million per year
compared with $US 5 million per year before (2001–2009)
(32). Technology improved the data visibility for cLMIS
helping policy-makers make timely and better decisions.
Nationally speaking, there are a total of 20 503 active
service delivery points in Pakistan; 5030 fall under the
purview of the population welfare department, 12 940
under the provincial departments of health, and 2533
under the People’s Primary Healthcare Initiative. Based
on cLMIS data and improved reporting compliance, the
contraceptive method mix shifted towards long-term
methods, including intrauterine devices and implants.
The national consumption of intrauterine contraceptive
devices increased from 0.96 m in 2015 to 1.05 m in 2018,
and implants from 0.033 m in 2015 to 0.075 m in 2018
(www.lmis.gov.pk). The stock-out trend analysis showed
that the increase in supply data was accompanied by an
increase in stock availability, i.e. an increase of stocks
present at the service delivery point.
The trend escalated further after automatic stock
alerts were generated to managers/policy-makers through
email and SMS, which was first introduced in 2018. The
stock availability rate reported in 2018 was 91% (Figure
2). This was mainly due to resource mobilization by the
provincial governments for contraceptive procurement
along with timely initiation of procurements contingent
upon LMIS based quantification. Around 5000 alerts
generated in 2018–19 enabled policy-makers to take
timely actions to avert stock-outs; however, the use of
data and alerts is an incremental journey (23).
The paper-based reporting system was automated,
leading to better maintained and more accurate records
and the removal of duplication of efforts. Political
ownership and support by senior leadership for cLMIS
helped to achieve timely data reporting and ensure data
quality, leading to effective decision-making (24). The
provincial authorities issued notifications to the districts
for reporting compliance, which enabled timely visibility
of data (25).
Figure 2 Comparison of data use and stock availability for condoms, pills, intrauterine contraceptive devices and injectables in
Pakistan, 2015–2018
100
95
90
85
80
75
70
%
Data usage Stock availabilty
Year
2015 2016 2017 2018
676
Research article EMHJ – Vol. 27 No. 7 – 2021
The stock-out rate decreased from 14% to 9% (Figure
2) due to improved access to accurate, timely and reliable
inventory information. Data were used to support
improved forecasting, which was formerly based on
manually compiled consumption data, usually one-year-
old data. Accurately estimating forecasted need is key to
ensuring that the correct quantities of contraceptives are
procured to provide a regular, uninterrupted supply of
commodities (26). This in turn supported clear costing of
the FP commodity needs. These demand and financing
requirements were calculated based on data obtained
from cLMIS that led to better financial management
and timely procurement of FP commodities. The
LMIS reporting enabled measurement of the modern
contraceptive prevalence rate based on a couple of years’
protection generated, which was impossible previously
(22).
Despite improving the reporting rates and stock
availability, Pakistan’s cLMIS, as is the case in many other
low- and middle-income countries, still faces challenges,
including a lack of integration. The cLMIS needs to be
linked with the district health information system or
the national health management information system
(6); integration would enable better coordination and
delivery of services and supplies of FP (27).
Another challenge is sustainability. There is still no
health information and communication policy which
could serve as a guideline for digitizing the health sector,
avoiding duplication of efforts and leveraging technology
for evidence-informed decision-making (28). There
also remains a lack of trained human resources (29).
Management issues like calibrating stock (to avoid stock-
outs or overstocking) as well as lack of communication
and interdepartmental coordination also complicate
efforts (19,30). Other issues include inconsistencies in
reporting meaning the system is unable to identify
exact demand (6). Finally, there are challenges around
financing for delivering FP products from the district
warehouses to the health facilities. Strengthening
supply chains to meet the growing demand for FP will
require systems diagnostics, supply chain redesign or
adjustment, strategically located storage and distribution
systems, adequate staffing and training, and better
information about inventory and financing (31). To help
address these challenges, there is a need to bring all
stakeholders together to have and use a single platform
for an integrated health information system where
services, surveillance, demographic and logistic data
streams intersect in addition to health information and
communication policy.
Conclusion
With USAID support, the Pakistan FP supply chain has
expanded over the past decade from $5m to around $20m
spending per year (21). This growth has been accelerated
by providing decision-makers with the evidence needed
to make timely strategic decisions. However, the system
is still experiencing challenges such as frequent stock-
outs and a lack of contraceptives, which has a negative
impact on programme effectiveness and quality of care,
resulting in a loss of trust in the overall health system
(32). Technology-driven data visibility alone is insuffi-
cient; for real change to happen, data must be analysed
and used for routine and strategic decisions and for con-
tinuous quality improvement. Against this backdrop,
cLMIS indisputably stands out by improving FP stock
availability at the last mile.
Funding: None.
Competing interests: None declared.
Mettre à profit la technologie et la chaîne d'approvisionnement pour améliorer la
logistique de la planification familiale au Pakistan
Résumé
Contexte : Le Pakistan et l'USAID ont investi dans l'amélioration des données de la chaîne d'approvisionnement en
contraceptifs et de la sécurité des produits. En , le premier système numérique d'information pour la gestion
de la logistique des contraceptifs a été lancé, permettant la visibilité des données de la chaîne d'approvisionnement
depuis le niveau fédéral jusqu'aux établissements de santé. Le système comprend des modules intégrés de prévision
et de planification de l'approvisionnement, de gestion des stocks, de rapports de consommation, d'outils de veille
stratégique, d'alertes automatiques par courriel et par SMS. En utilisant ces options, les responsables de l'élaboration
des politiques et les responsables de la santé peuvent prévoir les besoins chaque année et en conséquence se procurer
des contraceptifs.
Objectifs : L'objectif de la présente recherche était de comprendre les plateformes technologiques existantes pour
la visibilité des données de la chaîne d'approvisionnement pour la planification familiale et l'impact potentiel sur la
sécurité des produits contraceptifs.
Méthodes : Nous avons passé en revue les articles disponibles publiés et la littérature grise sur les contraceptifs
et les fournitures au Pakistan. Nous avons extrait les données du système numérique d'information pour la
gestion de la logistique des contraceptifs, évalué les indicateurs, notamment la conformité des rapports, les taux
de rupture de stock rapportés et la performance des contraceptifs. L'analyse a été validée par l'examen de la chaîne
d'approvisionnement et des indicateurs de planification familiale, tels que la consommation mensuelle moyenne, les
mois de stock et le coupleannées de protection.
677
Research article EMHJ – Vol. 27 No. 7 – 2021
References
1. Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012;380:149–56. doi:10.1016/S0140-
6736(12)60609-6
2. Family planning/contraception methods. Geneva: World health Organization; 2020 (https://www.who.int/news-room/fact-
sheets/detail/family-planning-contraception, accessed 21 February 2021).
3. Alkema L, Kantorova V, Menozzi C, Biddlecom A. National, regional, and global rates and trends in contraceptive prevalence
and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis. Lancet. 2013;381:1642–52.
doi:10.1016/S0140-6736(12)62204-1
4. World population prospects 2019: highlights. New York: UN Department of Economic and Social Affairs; 2019 (https://popula-
tion.un.org/wpp/Publications/Files/WPP2019_Highlights.pdf, accessed 21 February 2021).
5. Commitment makers. Family planning 2020. Washington, DC: United Nations Foundation; 2017 (http://www.familyplan-
ning2020.org/commitment-makers, accessed 1 March 2021).
6. Pakistan demographic and health survey 2012–2013. Islamabad: National Institute of Population Studies and Measure DHS ICF
International; 2013 (http://www.nips.org.pk/abstract_files/PDHS Final Report as of Jan 22-2014.pdf, accessed 21 February 2021).
7. London summit on family planning (July 2012). Summaries of commitments. London: Department for International Develop-
ment; 2013 (http://www.familyplanning2020.org/sites/default/files/London_Summit_Commitments_12-2-2013_0.pdf, accessed 21
February 2021).
Résultats : Le système numérique d'information pour la gestion de la logistique contraceptive a amélioré la
distribution, l'alerte précoce et la responsabilisation aux niveaux les plus bas de la chaîne d'approvisionnement
en planification familiale dans le secteur public. Au niveau des établissements, la disponibilité des produits de
planification familiale est passée de en à en .
Conclusion : La chaîne d'approvisionnement en contraceptifs a connu une croissance significative au cours de
la dernière décennie pour répondre à l'augmentation des bases factuelles en matière de santé reproductive afin
d'informer les décisions stratégiques. Le système numérique d'information pour la gestion de la logistique des
contraceptifs joue un rôle important dans les améliorations de la disponibilité des stocks de planification familiale
dans les établissements du secteur public.
2011
201884200940
678
Research article EMHJ – Vol. 27 No. 7 – 2021
8. Pakistan demographic and health survey 2017–2018. Key indicators report. Islamabad: National Institute of Population Studies,
and DHS Program ICF; 2018 (https://www.nips.org.pk/abstract_files/PDHS%20-%202017-18%20Key%20indicator%20Report%20
Aug%202018.pdf, accessed 21 February 2021).
9. Zaman A, Subhan F, Mumtaz A, Khan AQ. 18th amendment & provincial autonomy: challenges for political parties. Bi-Annual
Res J, Balochistan Study Centre, University of Balochistan; 2018.
10. Wazir MS, Shaikh BT, Ahmed A. National program for family planning and primary health care Pakistan: a SWOT analysis.
Reprod Health. 2013;10:60. doi:10.1186/1742-4755-10-60
11. Nishtar S, Amjad S, Sheikh S, Ahmad M. Synergizing health and population in Pakistan. J Pak Med Assoc. 2009;59(9 Suppl.
3):S3–23. PMID: 20088459
12. Zafar S, Shaikh BT. ‘Only systems thinking can improve family planning program in Pakistan’: a descriptive qualitative study.
Int J Health Policy Manag. 2014 Nov 17;3(7):393–8. doi:10.15171/ijhpm.2014.119
13. Jacoby D. Guide to supply chain management: how getting it right boosts corporate performance. Hoboken, New Jersey: John
Wiley & Sons; 2009.
14. Chandani Y, Breton G: Contraceptive security, information flow, and local adaptations: family planning Morocco. Afr Health Sci.
2002;1:73–82. PMID: 12789120
15. Daff BM, Seck C, Belkhayat H, Sutton P: Informed push distribution of contraceptives in Senegal reduces stockouts and im-
proves quality of family planning services. Glob Health Sci Pract. 2014 May 13;2(2):245–52. doi:10.9745/GHSP-D-13-00171
16. Sedgh G, Hussain R: Reasons for contraceptive nonuse among women having unmet need for contraception in developing
countries. Stud Fam Plann. 2014;45:151–69. doi:10.1111/j.1728-4465.2014.00382.x
17. DELIVER project. Pakistan: New logistics management information system incorporates sustainability and cost savings. Ar-
lington: US Agency for International Development; 2012 (https://publications.jsi.com/JSIInternet/Inc/Common/_download_pub.
cfm?id=15745&lid=3, accessed 21 February 2021).
18. Annual contraceptive performance report 2018–19. Islamabad: Pakistan Bureau of Statistics; 2020 (https://www.pbs.gov.pk/
content/annual-contraceptive-performance-report-2018-19, accessed 21 February 2021).
19. Qureshi SA, Hamid S, Bajwa MS: The role of contraceptive logistics management information system in provision of family
planning services in the province of Sindh, Pakistan. Diversity Equality Health Care. 2017;14:34–9.
20. Family planning executive dashboard user’s guide. Peshawar: Government of Khyber Pakhtunkhwa, Population Welfare De-
partment and Department of Health; 2018 (http://lmis.gov.pk/docs/ExecutiveDashbaordGuide/ExecutiveDashboardUsersManu-
al.pdf, accessed 21 February 2021).
21. USAID Global Health Supply Chain Program. situation analysis: contraceptive manufacturing in Pakistan. 2020 [http://lmis.gov.
pk/docs/SituationAnalysisReportIndigenousProductionofContraceptives/situation_analysis_contraceptive_manufacturing_in_
pak_sep082020.pdf, accessed 21 February 2021).
22. Pakistan Logistics Management Information System. (http://www.lmis.gov.pk/index.php, accessed 21 February 2021).
23. Supply chain management: investing in contraceptive security and strengthening health systems. Baltimore: Johns Hopkins
University, HIP Family Planning High Impact Practices; 2020 (http://www.fphighimpactpractices.org/briefs/supply-chain-man-
agement/, accessed 21 February 2021).
24. SEED Assessment Guide for Family Planning Programming. New York: Engender Health; 2011 (https://www.engenderhealth.
org/files/pubs/family-planning/seed-model/seed-assessment-guide-for-family-planning-programming-english.pdf, accessed 21
February 2021).
25. Deliver project. Final country report: Pakistan. Arlington: US Agency for International Development; 2016 (https://deliver.jsi.
com/wp-content/uploads/2017/01/FinaCounRepo_PK.pdf, accessed 21 February 2021).
26. Recent success stories in reproductive health commodity security. New York: United Nations Population Fund; 2010 (https://
www.unfpa.org/sites/default/files/pub-pdf/success_rhcs.pdf, accessed 21 February 2021).
27. Ten good practices in essential supplies for family planning and maternal health. New York: United Nations Population Fund,
Global Programme to Enhance Reproductive Health Commodity Security; 2012 (https://www.unfpa.org/sites/default/files/pub-
pdf/Ten%20Good%20Practices%20Essential%20Supplies_GPRHCS_web.pdf, accessed 21 February 2021).
28. SDG 3. Ensure healthy lives and promote well-being for all at all ages. New York: United Nations Department of Economic and
Social Affairs; 2015 (https://sustainabledevelopment.un.org/sdg3, accessed 21 February 2021).
29. Key initiatives. Lahore: Population Welfare Department, Government of the Punjab; 2017 (https://pwd.punjab.gov.pk/system/
files/Initiatives_0.pdf, accessed 21 February 2021).
30. Basharat R. Public health supply chain systems to be digitised: SAPM health. The Nation. 19 January 2020 (https://nation.com.
pk/19-Jan-2020/public-health-supply-chain-system-to-be-digitised-sapm-health, accessed 21 February 2021).
31. Mukasa B, Ali M, Farron M, Van de Weerdt R: Contraception supply chain challenges: a review of evidence from low- and mid-
dle-income countries. Eur J Contracept Reprod Health Care. 2017 Oct;22(5):384–90. doi:10.1080/13625187.2017.1394453
32. d’Arcangues CM, Ba-Thike K, Say L: Expanding contraceptive choice in the developing world: lessons from the Lao People’s
Democratic Republic and the Republic of Zambia. Eur J Contracept Reprod Health Care. 2013;18:421–34. doi:10.3109/13625187.2013
.826796
