The time for action is now. Federal authorities must institutionalise ILMD and Supply Visibility as core components of national primary health care and supply chain policy, supported by sustainable domestic financing. State governments and local authorities must scale proven models, use data for decision-making, and hold facilities and delivery systems accountable.
A Critical Pathway to Healthcare Access in Nigeria
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The Primary Health Care (PHC) system is the foundation of Universal Health Coverage (UHC) in Nigeria and its functionality depends on, amongst other inputs, the predictable availability of health products at service delivery points. Yet many PHCs continue to experience frequent stockouts, delayed deliveries, wastage of commodities, and weak accountability, all of which limit their ability to deliver essential health services. This long-standing challenge is now being addressed through the introduction of Strengthening Integrated Last Mile Delivery (SILMD) and Supply Visibility (SV), a critical intervention for building a more resilient, efficient, and trusted healthcare system.
In 2025, stakeholders across Nigeria’s health sector, including the Gates Foundation, reached a consensus that efforts and investments aimed at strengthening PHCs as the backbone of the health system cannot succeed without a reliable, responsive, and transparent supply chain. While policies and funding for family planning and essential medicines have improved over the years, persistent weaknesses in last-mile delivery and supply visibility continue to undermine service delivery at the community level. It is, therefore, safe to say that SILMD and Supply Visibility are not technical luxuries, but public health necessities.
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The introduction of SILMD and Supply Visibility has improved supply-side efficiencies and, in turn, generated measurable demand-side results. These improvements demonstrate the Gates Foundation’s investment in Integrated Last Mile Delivery (ILMD) as a scalable, high-impact approach to strengthening Family Planning (FP) and other essential commodity outcomes through a resilient and responsive supply system that effectively serves communities.
No doubt, SILMD and Supply Visibility can enhance healthcare reliability by providing real-time insight into stock levels, consumption rates, and impending expiries at the facility and community levels. With accurate visibility, supply chain managers can forecast FP needs more precisely, rebalance stock before shortages occur, and respond quickly to spikes in demand driven by outreach campaigns or community mobilisation. This reduces the mismatch between demand creation efforts and commodity availability, a common challenge in FP programming.
What Is Changing?
The last mile of health commodity distribution, from state or local government stores to service delivery points, has long been the weakest link in Nigeria’s health supply chain. This process is often challenged by time constraints, poor road networks and transportation difficulties, personnel integrity issues, and weak coordination. Stockouts of FP commodities, essential medicines, and other consumables at service delivery points are frequently not due to national supply shortages, but rather to breakdowns in coordination and accountability at the final stages.
For women seeking family planning services, a stockout is not a minor inconvenience, but can result in missed opportunities for contraception, unintended pregnancies, and a loss of trust in the health system. For frontline health workers, inconsistent deliveries disrupt service provision and can demoralise staff who are unable to meet community needs despite their best efforts.
With strengthened supply visibility through digital Logistics Management Information System (LMIS) tools, mobile reporting, and real-time dashboards, health managers are now better positioned to act before shelves run empty. Supply visibility shifts the system from reactive crisis management to proactive planning, ensuring continuity of care for clients who rely on PHCs.
For women seeking family planning services, a stockout is not a minor inconvenience, but can result in missed opportunities for contraception, unintended pregnancies, and a loss of trust in the health system. For frontline health workers, inconsistent deliveries disrupt service provision and can demoralise staff who are unable to meet community needs despite their best efforts. An integrated last-mile delivery system, one that aligns logistics providers, health authorities, facility staff, and data systems, has the potential to transform this reality. By coordinating transport schedules, consolidating deliveries, and clearly defining roles across federal, state, LGA, and ward levels, SILMD ensures that commodities actually reach the facilities where services are delivered on time and in good quality.
Why SILMD and Supply Visibility Are Non-Negotiable
From the community perspective, consistency builds trust. Family planning clients are very sensitive to service disruptions. When women repeatedly find their preferred method unavailable, they are more likely to discontinue use or discourage others from seeking services from the affected facility. SILMD and Supply Visibility reduce these negative experiences, helping to normalise family planning as a reliable service. Over time, this consistency transforms positive word-of-mouth into a powerful driver of increased demand within communities.
Before ILMD, family planning commodities were often stored within the Family Planning unit, resulting in weak accountability and reported losses. There was no single custodian responsible for these commodities, making losses difficult to trace and control. With ILMD, commodities are now centrally stored and managed through the pharmacy, significantly improving oversight and accountability. ILMD has also strengthened the availability of other essential health commodities, expanded family planning method mix, and improved the reliability of supplies across facilities.
This improved reliability has restored provider confidence and increased client turnout at service delivery points. Importantly, the shift away from open-market procurement represents a strategic effort to reduce exposure to counterfeit and substandard commodities, particularly injectables. Weak last-mile delivery disproportionately affects rural, hard-to-reach, and underserved communities, where PHCs are often the last to receive supplies and the first to experience prolonged stockouts. This reality undermines national goals for universal health coverage, reproductive health access, and reductions in maternal mortality.
If Nigeria is serious about strengthening PHCs and achieving its reproductive health and universal health coverage goals, ILMD and Supply Visibility must be treated not as pilot projects, but as core health system functions that are deliberately planned, adequately funded, and sustainably maintained.
Strengthening ILMD and Supply Visibility is therefore also an equity intervention. When deliveries are planned based on real consumption data rather than convenience or guess work, and when visibility extends to even the most remote facilities, no community is left invisible or underserved, regardless of location.
A Way Forward for Nigeria
The time for action is now. Federal authorities must institutionalise ILMD and Supply Visibility as core components of national primary health care and supply chain policy, supported by sustainable domestic financing. State governments and local authorities must scale proven models, use data for decision-making, and hold facilities and delivery systems accountable.
Development partners should align behind integrated, government-led solutions rather than parallel systems, while the private sector and implementing partners bring innovation and operational excellence to last-mile delivery. Civil society organisations, religious leaders, and community leaders must continue to demand transparency and the consistent availability of essential health commodities at PHCs within their communities.
Strengthening Integrated Last Mile Delivery and Supply Visibility is one of the most effective ways to ensure that every PHC is functional, every health worker is equipped, and every Nigerian has access to lifesaving care. This is not merely a supply chain reform, but a health system imperative.
If Nigeria is serious about strengthening PHCs and achieving its reproductive health and universal health coverage goals, ILMD and Supply Visibility must be treated not as pilot projects, but as core health system functions that are deliberately planned, adequately funded, and sustainably maintained.
Negedu Umoru is a health system strengthening specialist and head of programmes at C4SD..
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