Early Data, Strong Signals
Access to Medicines Initiative's Cost-Effectiveness and Lives Saved at the One Year Mark
Hello again! Thank you for your interest in our work to improve public contraceptive supply chains in Nigeria. There have been some exciting developments in the past few months and we are eager to share them with you!
If this is your first time hearing about our program (or you would like to learn more), you can check out our first newsletter, which gives an overview of our mission and our ongoing pilot project.
We are currently running a pilot in around 140 public health facilities across Katsina and Sokoto state, Nigeria. Our goals are to:
Identify the specific problems with the contraceptive supply chain,
Understand the impact of these problems on contraceptive usage, and
Test the most cost-effective solutions that we can transform into policy.
Program Updates and Preliminary Pilot Results
As part of our pilot, we are supplying additional contraceptives to selected facilities in our pilot to measure how much consumption changes with increased availability. This helps us estimate the cost-effectiveness of our program and assess which solutions are most impactful.
Since our last newsletter, we completed our first delivery to 20 public health facilities in Sokoto state, and our second round of deliveries is currently underway in Katsina state. A total of 37 public health facilities across three Local Government Areas (LGAs) in Katsina will receive various contraceptive commodities and/or consumables.
As mentioned in our first newsletter, our first Katsina delivery supplied contraceptives to 23 participating health facilities. After comparing consumption data before and after the delivery, we are excited to share the results. While consumption remained roughly unchanged in other regions, in LGAs that received additional contraceptives,
Pill consumption increased 50%,
Injectable consumption increased 40%,
Condom consumption increased 240%, and
Implant consumption increased 20%.
From this delivery alone, we estimate that we generated around 224 additional Couple Years of Protection (CYP) - equivalent to protecting 224 women for one year each. This averted approximately 110 unintended pregnancies. Based on our current model, we believe our delivery averted around 50 DALYs and saved 1–2 lives1.
Notably, we sought to provide more contraceptives than what they would need over the typical two-month resupply period. However, many facilities showed a much higher demand than anticipated, with some running out of stock within just a few weeks. In response, we increased the quantities for our second delivery to Katsina, and we anticipate the impact could be even greater. We are also looking forward to analyzing data from our Sokoto delivery as soon as it becomes available.
Unfortunately, since our last newsletter, there has also been a significant negative shift in the broader family planning space. Until recently, USAID provided significant support to the public health supply chain, but this support has now been indefinitely stopped. While supply chain issues were prevalent before, we anticipate that they will severely worsen over the next few years.
Our own data already shows rapid deterioration within the supply chain - the gaps in facility availability have widened even quicker than we had expected, and state and local medical stores have been depleting their safety stocks. All of this will continue unless USAID funding is reinstated - or unless systemic improvements and increased investment create a more resilient and self-sustaining supply chain.
Cost-Effectiveness Analysis
While the problems in the supply chain are great, we believe there is strong potential for improvement. We have refined our impact model based on our pilot results, which we use to estimate the costs of procurement for each state and consumption increases as a result of our work. We then use the efficacy of each method we provided to estimate how many unintended pregnancies are averted. Reducing unintended pregnancies not only saves women’s lives by reducing maternal mortality, but it also reduces under five mortality by improving birth spacing. You can explore our model in more depth here.
Based on this model, we expect a cost of $7 for each additional Couple Year of Protection, and a cost of $18 for each unintended pregnancy averted. As a result, we expect that the cost per life save will be $1300, or $3100 if you only include maternal benefits.2 We also estimate the cost per DALY to be $37, or $82 if you only include maternal benefits.
For context, one popular charity evaluator, GiveWell, lists its top charities as having a cost effectiveness in the range of $3500 - $5500 per life saved. Our current model suggests that we may be on track to surpass this threshold in our second year! We are encouraged by the potential of our approach and remain focused on monitoring and refining our program to ensure the greatest possible impact and cost-effectiveness.
Current Plans for Year 2
In Year 2, our work will shift from primarily understanding the causes of contraceptive stockouts to actively implementing solutions.
A central focus will be on advocacy for the domestication of procurement at the state level. Adopting the National Guidelines for State-Funded Procurement of Family Planning Commodities into state law would enable states to better align supply with local demand, increase procurement budgets, and collaborate more flexibly with relevant partners. We believe this shift will strengthen supply chains, improve service delivery, and offer greater resilience to disruptions in the federal supply, such as shifts in international aid priorities.
This particular policy focus has been a high priority for us since the beginning of our work at AMI, in part because one of our co-founders, Miri, was directly involved in domesticating this policy in another Nigerian state in 2023. Having had the opportunity to help shape its details to fit the needs and peculiarities of that state, she observed firsthand the significant potential for impact and tractability of this approach. Recent USAID contract terminations and shifts in aid budgets across Europe have only made this course of action more urgent and relevant.
In parallel, we plan to study the impact of increased contraceptive stock at a large scale over a longer period of time. This study will center on Implanon, a long-acting contraceptive with over 99% efficacy, which our current supplier offers for under $2 per dose. When accounting for implant removal rates, each dose of Implanon provides 2.5 Couple Years of Protection, making this one of the most cost-effective contraceptive methods. Beyond the direct impact of this work, a key goal for this project will be to refine our monitoring and evaluations system, improving the accuracy of our measurements and minimizing costs as we scale.
While Implanon seems to be one of the most cost-effective options, this is our main focus only in the short term, as a robust and equitable supply chain must offer a full range of methods to meet diverse user needs. Our goal is not just to fill supply gaps ourselves, but to help strengthen the entire system to ensure long-term access to a full mix of contraceptive options. By working alongside government partners, we aim to make procurement more sustainable, responsive to demand, and well-funded at scale. This systems-level approach allows us to achieve far greater impact than we could alone, driving durable improvements across the supply chain.
Get Involved
At Access to Medicines Initiative, we are not committed to a specific program, but to an outcome - increasing access to contraceptive commodities for all women who want them, regardless of their socioeconomic status or location. We focus our work on generating the most reliable evidence we can, and following the data to the most cost-effective way to achieve our goal.
In the next post, we will go into more depth about our Year 2 plans, which will be informed by additional pilot results. If you have any feedback - positive or negative - or thoughts about our work you would like us to consider, this is an unusually good time of year to influence our thinking. Please email either Miri (miri@accessmedicines.org) or Evan (evan@accessmedicines.org), or book a call with Miri here.
We are currently raising funds for our year 2 budget. If you would like to donate to support our work, please click the button below to donate. If you are considering a large contribution or if you have questions before donating, please email Evan (evan@accessmedicines.org) or book a call with them here.
Previously, we referenced an alternative model of economic benefits that diverges significantly from GiveWell’s recent analysis on the value of contraception. Although this was never a central part of our analysis, we have removed it for now and will revisit it once we’ve had time to investigate the differences more thoroughly, to ensure all claims we share are aligned with the latest evidence and reasoning standards.
We separate maternal benefits from child benefits because while there is strong evidence that family planning improves neonatal outcomes, the magnitude of this effect has more uncertainty than that of averting maternal mortality. We believe that the evidence for our intervention is strong even excluding this effect.
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