Toward Advancing Women’s Health in Least Developed Countries: Evaluating Contraceptive Distribution Models in Senegal

Problem definition: Improving access to contraceptives is one of the most effective interventions to prevent unintended pregnancies and save the lives of women in least developed countries (LDCs), where the overwhelming majority of maternal deaths occur. However, access to reproductive health commodities is often limited in LDCs because of frequent stock-outs at last-mile health facilities. In this study, we evaluate and compare the effect of two distribution models on last-mile contraceptive availability and key public health outcomes (e.g., unintended pregnancies, maternal and newborn deaths). These distribution models are (i) the commonly used pull distribution model, in which health facilities are fully responsible for managing inventory, and (ii) an alternative model known as the informed push distribution model, which delegates inventory management tasks to external logistics providers. Methodology/results: We leverage the staggered transition from pull distribution to informed push distribution in Senegal, a country that redesigned its contraceptive distribution system. We conduct empirical analyses, including a triple differences estimation, on novel field data compiled from multiple sources to evaluate the effect of the transition. We find that the transition significantly reduces contraceptive stockouts, frontline health worker workload, unintended pregnancies, and maternal and newborn mortalities and also improves client satisfaction, especially in health facilities with less mature inventory management practices and less developed road infrastructure. A comprehensive cost–benefit analysis shows that the aforementioned benefits are achieved in a cost-efficient manner at these facilities, making them prime candidates for the transition. However, for facilities with less mature inventory management practices but more developed road infrastructure, upgrading the inventory management system is a substantially more cost-efficient alternative than transitioning to a new distribution model without compromising the benefits. Managerial implications: Given the resource constraints faced by the public health sector in LDCs, it is imperative to understand how the operational and public health benefits of the transition to the informed push model vary based on facility characteristics. Our findings offer actionable insights for resource allocation by identifying health facilities that benefit the most from the transition.