Monica Milando, a community nurse in Kisumu, Kenya’s third-largest city, is a brave woman. To make sure that women visiting her health center would be able to get the contraceptives they needed, she used to handwrite inventory reports and then ride her own bicycle—the only transportation she could afford—to go pick up the contraceptives herself at the district government office.


Not only was it a tiring trip for this 58-year- old woman, but she also often travelled all the way to the district office just to find that the contraceptives were not available. As a result, the health center experienced regular stock-outs.


“Last year, four women came several times for the [Depo-Provera®] shot, but we did not have it,” says Monica. “I tried to offer pills, but their husbands would notice the pills, so they didn’t use any contraceptives and became pregnant.”


Many women in Kenya have to hide their contraceptive use from their husbands, who believe that women should not have access to family planning. They choose injectable contraceptives because they can get the injections without their husbands noticing— unlike pills, which they would have to hide or implants, which their husbands might detect under their skin. So for many of the women at Monica’s clinic, a stock-out of Depo-Provera® means no contraception at all.


But the inventory problem is being solved with technology. In 2012, UNFPA partnered with Pharm Access Africa Limited (PAAL) to implement an SMS-based system of commodity stock reporting. Instead of handwriting inventory reports, now Monica sends text messages by mobile phone to a central system. The text messages are formatted with numerical codes to indicate how much of each contraceptive commodity—injectables, implants, pills, condoms, IUDs—the health center has in stock, and how much is needed. The contraceptives are then delivered directly to the center.


This simple technology has made a huge contribution to ending stock-outs, at Monica’s clinic and at others using the system. Since all the clinics report through PAAL’s central system, it is easy to see which clinics have an excess of commodities and which have a shortage, so that commodities can be transferred between health centers. If, for example, Monica has more IUDs than she can use, but a neighboring health center has none, PAAL will send couriers to pick up the IUDs from Monica’s clinic and deliver them to the clinic that is short on stock. The program is still in its infancy, but Monica and her clients have already seen a difference. Beatrice Anyango, 29, relies on Monica’s clinic for her contraceptive supply. “Recently, there haven’t been any complications,” she says. “The Depo is in stock, and everything is okay.”


Having a constant supply of contraceptives also allows Monica and other nurses to increase their outreach to neighboring communities. “For outreach, when we go, we know now that we have all the products,” Monica says. “It has lessened our workload but also made it so that we can really serve these women, and we are able to get the women the contraceptives they so desperately need.” UNFPA has rolled out the PAAL system to 117 health facilities in Kenya, and at more than 80% of them stock-outs have been completely eliminated. A scale-up of the system to other districts in the country is now being planned.


Photo by Liz Gilbert © Bill & Melinda Gates Foundation


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