The USAID effort to slow world population growth from the start identified success with making contraceptives widely available in the developing world through clinical and non-clinical reproductive health programs. Earlier KAP studies had shown the unmet demand for access to fertility control methods. USAID took on the challenge of meeting those needs. The barriers to making contraceptives widely available were formidable: markets and products designed and priced for commercial sales; a USAID purchasing system not designed for continuous, large-scale purchases; and an absence of reliable management tools to measure needs and avoid wild swings between excesses and shortages.
USAID first won lower prices through large purchases in the 70s and built distribution programs to get them to users in the field. In the 80's, USAID teamed up with CDC to develop ways of measuring program needs and continued to work with manufacturers to lower prices and design contraceptives for public program distribution. Later, in the 90's, USAID fully centralized its handling of procurement operations and drew on logistics experts to build a worldwide distribution system and systematic logistics training for field staffs.
USAID's development of a dependable supply system was the indispensable condition for the achievement of higher prevalence and lower fertility. Whether the large volumes of USAID-funded contraceptives actually got to the populations for whom they were intended is another story, but without the development of an efficient USAID supply system, the larger purpose of making fertility control widely available to the poor would have remained an academic issue.
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I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.