Tackling Waste in Family Planning Supply Chains:
A Behavioral and Political Economy Approach in Sub-Saharan Africa
Country: Sub-Saharan Africa | Year: 2025
Approach: Behavioral Science, Political Economy Analysis
& Systems Thinking
Overview
Mismanagement in Sub-Saharan Africa’s health sector limits the delivery of essential services, including family planning. Resources meant for health services are often lost to theft, bribery, and inefficiencies, and people are forced to pay for services that should be free or not receiving services at all. This systemic issue is driven by a culture of impunity, lack of leadership prioritization, and fragmented policies that fail to address the problem’s interconnected nature.
To address this, sistemaFutura and Busara used a combined approach of Behavioral Science and Political Economy Analysis (PEA) to understand and tackle corruption in the family planning supply chain. We used systems thinking to map stakeholder interactions and outcomes, and identified key leverage points for change. This approach helped us design behaviorally-informed interventions to disrupt cycles of waste and improve the effectiveness of family planning services.
Health Sector Corruption:
Significant financial resources intended for health services are lost due to bribery, theft, and other forms of corruption. This undermines the effectiveness of the health system, particularly in the delivery of family planning services.
Complex Challenges
Inefficient Supply Chains:
Commodities that are meant to be free often end being sold on informal markets or simply being unavailable due to theft, bribery, and favoritism.
Structural Barriers to Change:
Cultural and structural barriers, including a culture of impunity, prevent many stakeholders from taking action to address corruption.
Fragmented Policies:
Existing policies to combat corruption in the family planning supply chain are fragmented and fail to address the interconnectedness of these issues.
Our Approach
The team applied a combination of behavioral science, political economy analysis, and systems thinking: addressing the weakness of each approach with the strengths of the others. For example, behavioral science is effective at shaping human behavior but often overlooks political context. PEA addresses political dynamics but struggles with practical implementation, and systems thinking helps integrate interconnections among factors and stakeholders in development. Together, we:
Identified the relevant actors involved, such as government bodies and other stakeholders in the specific area of interest (e.g., family planning commodity supply chain in Sub-Saharan Africa).
Created and implemented a tool that captures stakeholder perspectives, incentives, micro-behaviors, and the specific context of the problem through interviews, observations, and data collection.
Mapped multi-level interactions among stakeholders, their specific decisions and behaviors, and how they interact with each other. Then identified leverage points and constraints within the system that perpetuate the problem and resist change.
Drafted behaviorally-informed interventions based on insights that allow for actionable opportunities for change.
Behavioral Systems Map
We identified four main areas in which waste (premeditated and semi-intentional) directly or indirectly affects the provision of free family planning supplies in the country. Each area is shaped by the broader context of the supply chain and the society in the region, and thus we have examined both the acts of waste themselves, and the broader system that enables and reinforces it.
The four routes by which waste directly or indirectly affects the family planning supply chain are: Stock outs, as supplies are not available to patients; Negative patient experiences, as they are asked for bribes or fees for otherwise free products; Upstream obfuscation, which makes it difficult to identify large-scale waste; Downstream discouragement, which leads patients simply to give up, and stop seeking free family planning supplies or going without altogether. These are displayed in Figure 1.
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The Impact
Across each of the four effects of corruption, we find common drivers:
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An expectation from family and friends to support them, and that the person’s role in the supply chain should benefit them.
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A pervasiveness and normality of corruption; a culture of denial and group protection.
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A lack of information that makes it difficult to discern actual corruption from structural problems with similar outcomes.
Some opportunities for change identified in this project included:​
Creating Transparency in Key Processes.
Creating Accountability Mechanisms for Delivery Issues.
Emphasising Model Behavior.