Romania: Ensuring Contraceptive Availability- Establishing a Family Planning MIS/Logistics System

Prior to 1990, contraception was forbidden in Romania and women relied on illegal abortion as the primary method of fertility regulation. While contraceptives have been available in Romania since then, until recently, many living outside urban centers did not have access to contraceptives, and where they were available, supplies were inconsistent. The governmental system was organized to make contraceptives available only from family planning clinics, which were not easily accessible or affordable for rural and/or poor populations. Abortion often occurred in unsafe conditions, resulting in increased maternal mortality and morbidity rates.

Logistics Management Information Systems training in Romania helped the Ministry of Health and Family streamline its contraceptive procurement and distribution systems.

In fall 2001, for the first time, the Ministry of Health and Family (MOHF) allocated funds for contraceptives to be procured and distributed free to poor, uninsured women from remote under served areas, where access to health services and supplies is low/very limited. (The MOHF also receives contraceptive donations from the UN Population Fund [UNFPA] and the U.S. Agency for International Development [USAID]). Through a new MIS/Logistics System, designed by JSI Research and Training Institute, Inc. under the USAID-funded Romanian Family Health Initiative, the MOHF is now able to determine the need for contraceptives in all 42 districts in the country. The MIS/Logistics system ensures a chain of supply and eliminates stock outs so that when a woman in Romania goes to her family doctor, there are contraceptives available.

This is a landmark step in contraceptive procurement and distribution, reaching the entire country. The Logistics System provides concrete information to donors and the MOHF so that cost-efficient decisions can be made based on contraceptive demand. This is critical because of ever-present resource constraints of the MOHF. The Logistics System also ensures that once procured, contraceptives are available at family health and family planning clinics throughout the country.

The Logistics System is just one success of the Romanian Family Health Initiative (RFHI), a bilateral, USAID-funded, project implemented by JSI Research and Training Institute, Inc. The RFHI is designed to increase the availability and utilization of high quality client-oriented services at the primary health care level, and to assure sustainability of reproductive health services in Romania. In addition to family planning services being expanded, the project also focuses on implementing and strengthening cervical and breast cancer screening, HIV and AIDS and STI referral systems, and domestic violence at the primary health care level.

Read more about the RFHI Project.

MIS/Logistics training has also taken place throughout the country on how to document contraceptive distribution, orders, storage, and dispensing protocols. JSI, together with SECS (Society for Education on Contraception and Sexuality), conducted training for Family Health and Family Planning Physicians. Physicians learned the purpose and components of the Contraceptive Logistics System, their individual responsibility in the System, how to correctly complete monthly reports for distribution and orders, correct storage of contraceptives, recommended MOHF dispensing protocols, and the MOHF recipient categories for Free of Charge Contraceptives. To date, more than 2,000 doctors and 900 nurses from PHC centers and FP cabinets have been trained. More than 80% of them are providing services in rural areas.

Establishing the family planning MIS/Logistics system was made possible by the collaboration of the government, an NGO, and JSI. This collaboration was unique; as it was the first time the government and an NGO have worked in unison to implement the National Family Planning Program. The management of the Logistics System takes place at the District Public Health Authority, supporting the decentralization of the Romanian health care system. Furthermore, the free contraceptives targeting strategy does not interfere and actually protects the private market, which is also benefiting from the MoH program implementation. In fact, the marketers are calling this a "halo effect."

Now, when a woman visits her family doctor seeking oral contraceptive pills in a rural village anywhere in Romania, she can expect to find them. Not only is her family doctor trained and capable of offering high-quality family planning services, the MIS/Logistics System helps to ensure the supply chain.