Those who work in reproductive health (RH) know that RH supplies are vital to the wellbeing — and even survival — of women and girls.

Contraceptives, maternal health medicines, menstrual health products, and safe abortion supplies are not nice-to-have items on a wish list. They make the difference between independence and fear. Safety and insecurity. And yes, life and mortality.

But RH supplies cannot save lives on their own.

Today, on World Health Day, global attention turns to the promise of health — including reproductive health — for all. But behind that promise lies a system that is under threat.

Fuel shortages and price spikes linked to geopolitical conflict are directly disrupting medical supply delivery. Transport costs for delivering health supplies have risen with longer routes and delays. The pharmaceutical supply chain is under risk.[i]

Funding is less predictable, with declines in contributions from key donors. Stockouts loom, and programs have closed.

The critical role of data: why visibility matters more than ever

In this environment, supply chains are only as strong as the data that guides them. Accurate, timely data is essential to forecast demand, align procurement with need, prevent stockouts and overstocks, and coordinate across fragmented funding streams.

Collaborative data networks like RHSC’s Global Family Planning Visibility and Analytics Network (VAN) play a critical role in this regard not least because its data feeds into RHViz, a public-facing suite of dashboards integrating and aggregating shipment data from the Global FP VAN to give the RH community unprecedented visibility into the quantities and types of family planning products flowing into country programs around the globe.

The VAN itself has grown in use and relevance: our newly released 2025 VAN Scorecard Report shows that average monthly logins in 2025 reached 1,343 — up 14% since September 2023.

The VAN is grounded in the principle that country governments drive the decisions about product flow into their countries. And despite the challenges faced in 2025, more country governments started to pay for their own subscriptions to the VAN.

The Scorecard shares overwhelmingly positive examples and user perspectives about time saved, crises averted, and access increased. I urge you to take a look. And to join us in safeguarding supplies — and lives — into the future.

[i] https://thehill.com/policy/healthcare/5805149-iran-war-pharmaceutical-supply-chain/

Reproductive Health Supplies: Essential. Lifesaving. Under Threat. was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.

A 20-year journey in local health commodity manufacturing in Africa

Trained first as a physician, and later in public health and business management, Dr. Janet Byaruhanga has spent nearly two decades working within the African Union system. At AUDA-NEPAD she contributes to advancing the Pharmaceutical Manufacturing Plan for Africa (PMPA) and broader efforts to strengthen access to essential medical products and health technologies across the continent.

AUDA-NEPAD’s PMPA program sits at the intersection of public health, industrial policy, and economic development.

The origins of that journey stretch back to 2005, when African Union Heads of State met in Abuja as HIV, tuberculosis, and malaria were devastating communities across the continent. While lifesaving antiretroviral medicines had become available globally, Africa remained heavily dependent on imports.

That moment catalyzed the PMPA, an initiative designed to build long-term capacity for local pharmaceutical production.

However, early efforts quickly revealed a foundational challenge: fragmented, and often weak, regulatory systems across the continent.

“Regardless of our desire for self-reliance,” Dr. Byaruhanga explains, “we could not depend on products whose quality we could not assure.”

This realization led to the African Medicines Regulatory Harmonization initiative, which ultimately contributed to the establishment of the African Medicines Agency (AMA). The agency’s goal is a harmonized regulatory framework capable of ensuring safety, efficacy, and investor confidence, an increasingly important priority in a post-COVID world where global supply chains have proven fragile.

Beyond regulation: building an ecosystem

At AUDA-NEPAD, strengthening pharmaceutical manufacturing is seen not only as a health priority but also as part of Africa’s broader industrialization agenda. The vision is two-fold: to ensure reliable access to affordable, quality-assured medical products for African populations, while simultaneously strengthening economic resilience and regional value chains.

Small and medium-sized pharmaceutical manufacturers play an important role in the ecosystem.

AUDA-NEPAD works with partners to support manufacturers through technical assistance, market intelligence, and innovative financing approaches.

Access to affordable long-term capital remains a critical constraint for the sector. Pharmaceutical manufacturing is highly capital-intensive, yet financing available to African manufacturers is often short-term and costly, she explains. AUDA-NEPAD is therefore working with partners to map the financing landscape and explore development finance solutions better suited to long-term industrial growth.

Technology access, workforce development and research capacity are also part of the broader ecosystem needed to strengthen Africa’s pharmaceutical sector.

A strategic, prioritized approach

Recognizing the importance of prioritization, AUDA-NEPAD has advanced a continental strategy identifying 24 priority products for regional manufacturing in Africa, seeking to align public health priorities with industrial development by focusing investments where sustainable manufacturing capacity can realistically be built. Rather than encouraging every country to manufacture every medical product, the strategy promotes regional specialization and market integration, leveraging the African Continental Free Trade Area (AfCFTA), to support viable pharmaceutical production hubs across the continent.

A special focus on maternal health supplies

In parallel, AUDA-NEPAD is expanding its work on maternal health commodities, particularly those used to prevent and treat post-partum hemorrhage (PPH), one of the leading causes of maternal mortality in Africa. Among the key evidence sources informing the priority medicines list was the Manufacturing Landscape Assessment for Maternal Health Supplies in Sub-Saharan Africa, produced under RHSC’s Compass Initiative, a suite of strategies and tools designed to safeguard reproductive health access in the wake of COVID-19 and improve preparedness for future crises.

With key partners, AUDA-NEPAD is convening continental and regional policy dialogues with governments, regional economic communities, and development partners to strengthen coordination around key postpartum hemorrhageinterventions. This work focuses on improving policy alignment, financing frameworks, and market visibility for priority maternal health products, while also exploring opportunities to support sustainable production within Africa.

“Strengthening reproductive health supply security and building local manufacturing capacity are closely linked,” Dr Byaruhanga notes. “Ensuring reliable access to life-saving maternal health medicines requires both strong health systems and resilient regional production capacity”.

Coordination in a growing continental architecture

Africa’s health architecture has expanded significantly over the past decade, with newer institutions such as the Africa Centers for Disease Control and Prevention and the African Medicines Agency spearheading the continent’s health programs. Now more than ever, systemic coordination is key. “It is an ecosystem, and no single institution can do this alone,” Dr. Byaruhanga says.

“It is an ecosystem and no single institution can do this alone”

This philosophy also extends to global partnerships. AUDA-NEPAD continues to engage with international partners, development finance institutions, and networks such as RHSC to strengthen knowledge sharing, coordination and advocacy around reproductive health supply security.

By working through collaborative platforms, AUDA-NEPAD aims to ensure that new initiatives build on existing efforts rather than duplicating them.

“This is not just about producing medicines. “It is about sovereignty, resilience and ensuring that African populations have reliable access to the health products they need.”

A long journey — with growing momentum

The work ahead remains complex and often highly technical. But for Dr. Byaruhanga, the stakes are clear.

“This is not just about producing medicines,” she says. “It is about sovereignty, resilience and ensuring that African populations have reliable access to the health products they need”.

Nearly 20 years after first joining the African Union system, she continues to work with partners across the continent — and the world — to advance that vision.

Strengthening Africa’s Health Security was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.

In four refugee-hosting districts in Uganda, the National Midwife Association of Uganda is leading a quiet shift in maternity care, helping health workers optimize prevention of and respond faster and more effectively to one of childbirth’s deadliest complications: severe bleeding after delivery, commonly known as postpartum hemorrhage, PPH.

Uganda hosts a large population of refugees from neighboring countries, primarily due to ongoing conflicts in the region. These settlement areas are often extremely overcrowded, and the health facilities within them experience high caseloads and patient volumes. Refugees generally cannot choose to leave the settlement to seek care elsewhere; they must rely on the facilities assigned to the settlement. This places significant pressure on the health centers serving these populations.

Efforts to strengthen response to PPH

Postpartum hemorrhage (PPH) accounts for about 38 percent of maternal deaths in Uganda each year, according to government and UN estimates. A year-long initiative, led by NMAU and supported by RHSC and CHAI through a small grants mechanism*, is expanding access to heat-stable carbetocin (HSC) and tranexamic acid (TXA) for the prevention and treatment of PPH. Additionally, frontline teams have been trained to manage obstetric emergencies with greater speed and precision.

Why heat-stable carbetocin?

Many regions in Uganda are hot, dry, and have harsh weather conditions, making temperature‑sensitive commodities difficult to store and transport safely. Unlike oxytocin, which must be refrigerated at 2–8°C, HSC remains effective for several years when stored below 30°C. While oxytocin remains an essential medicine for treating postpartum hemorrhage, the introduction of heat‑stable carbetocin removed the need for a reliable cold chain.

The project focused on 26 health facilities across Yumbe, Terego, Madi-Okollo, and Isingiro — districts serving large refugee populations where health systems are often stretched. NMAU combined hands-on training, mentorship, and standardized emergency protocols to strengthen PPH prevention and treatment.

Mentorship took place on-site and was grounded in providers’ real working conditions, allowing for context-specific problem solving, peer learning, and continuity through local trainers, unlike off-site models that require travel and are less directly relevant.

The team approach

Fifteen facility-based champions were first trained as master trainers using Ministry of Health–approved emergency obstetric and newborn care modules. In turn, they trained 493 maternity care providers, including midwives, clinicians, theatre staff, district pharmacists, and records officers. Effective PPH management relies on a coordinated team approach, and the project emphasized that every staff member has a role to play — even those not directly providing clinical care.

Training sessions focused on the proper administration of HSC for the prevention of PPH and TXA as part of the WHO-recommended E-MOTIVE treatment bundle, which replaces the traditional reliance on visual estimation of blood loss — which is often inaccurate — with objective measurement and a rapid clinical response that can be initiated as soon as excessive bleeding is detected. Rather than one-off workshops, the program used a “low-dose, high-frequency” model — shorter, repeated, simulation-based sessions held on site and reinforced through practice. Facilities received job aids, posters, and digital reference tools, and WhatsApp communities of practice connected providers with mentors for real-time clinical advice.

This was truly a midwife‑led project because midwives are on the frontline of PPH. PPH is a nightmare for any midwife, and our ears are always tuned to listen for solutions — anything that can help us avoid facing another PPH case. So, when we midwives heard about this new drug, HSC, now commonly called the “magic bullet” in Uganda, everyone was eager to learn more. — Annette Evelyn Kanyunyuzi (Nurse-midwife & President National Midwives Association of Uganda)

Early shortages of HSC threatened to slow the rollout, but NMAU worked closely with Uganda’s Ministry of Health, UNFPA, district pharmacists, and other district leaders to resolve logistical bottlenecks. In the meantime, unused HSC stock was redistributed from facilities that had already completed their training to those still conducting sessions. This allowed training and mentorship activities to continue uninterrupted while new supplies were being arranged.

Mentors conducted on-site follow-ups, reviewing case records, checking dosing accuracy, and helping teams close treatment gaps. The approach improved confidence and consistency in using both medicines. As confidence grew, so did demand. Health workers began requesting additional doses through sub‑national coordination mechanisms such as Local Maternity and Neonatal Systems, established by Uganda’s MOH to strengthen maternal and newborn care at regional level. Providers who had already used HSC shared positive experiences, prompting facilities that had not yet received the product to inquire about it.

Overcoming hesitancy with open exchange, problem-solving

Following training, some initial hesitancy to use HSC was expected, reflecting normal behavior‑change patterns. While early adopters quickly embraced the new medicine, some midwives — particularly those in lower‑level facilities — were cautious due to concerns about managing potential PPH cases if the drug did not work as expected. This hesitancy decreased rapidly thanks to the reliability of the drug even in settings without cold‑chain infrastructure and strong peer support and active engagement within the Community of Practice. Providers shared positive experiences using HSC without complications, and the group collaboratively reviewed cases where side effects were suspected. This open exchange, reassurance, and collective problem‑solving built confidence and significantly reduced fears around adopting HSC.

When NMAU first began expanding the use of TXA, they also noted instances where providers were confusing it with another medicine called bupivacaine, which is used for spinal or epidural anesthesia.

TXA and bupivacaine can be mixed up in busy labor wards not because the medicines themselves are similar — they are very different — but because of packaging and workflow factors. Both medicines come in small, clear glass ampoules of similar size and shape, and both are commonly used in obstetric settings. In fast‑paced or emergency situations, especially when medicines are stored close together, this increases the risk of picking up the wrong ampoule.

To address this, they brought the Association of Anaesthetic Officers into the training and involved both the anaesthetic officers and the anesthesiologists to strengthen safe and proper use of TXA.

Looking forward

NMAU has also begun working with midwifery, medical, and nursing schools, recognizing that integrating HSC and TXA clinical guidance into pre‑service training could be transformative for the next generation of health workers.

The initiative also helped drive national momentum. With Ministry of Health backing and partner advocacy, procurement has surged: UNFPA plans to purchase 200,000 HSC doses in 2026, while UNICEF has committed one million more, positioning Uganda to scale up lifesaving PPH care nationwide.

Demand for HSC is exceptionally high across NMAU’s midwives’ network. The front-line health workers regularly ask about the drug and when their facilities will receive it, and how to include it in their procurement requests. While it is encouraging that HSC is becoming available, the next challenge is ensuring that the “magic bullet” medicine is used correctly and consistently so that women receive its full benefit. Midwives repeatedly emphasize that preventing PPH cannot rely on PPH medicines alone. High‑quality care throughout labor and delivery remains essential.

*The small grants mechanism, or the Catalytic Opportunity Fund for Introduction and Scale-Up of New and Lesser-Used Postpartum Hemorrhage Medicines (NLUM-PPH COF), is managed by RHSC and the Clinton Health Access Initiative and funded by MSD for Mothers and the UK’s Reproductive Health Supplies Programme. MSD for Mothers is an initiative of Merck & Co., Inc., Rahway, NJ, USA.

New Training and Medicines Help Ugandan Health Workers Tackle Leading Cause of Maternal Death was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.

What inspired you to enter healthcare supply chain work?

I was studying to become a pharmacist, and I realized that stockouts of critical reproductive health supplies have long-term impacts on the lives of women and girls. I could see clearly that reproductive health is a right that should be guaranteed by efficient public management. It is equally important to ensure quality medical supplies on the one hand and access to public health services on the other. One cannot work without the other, so a comprehensive approach to public health is crucial.

What do you do today?

I’m a pharmacist by profession and I have specialized in Public Health and now in Supply Chain Management. Currently, I am the Executive Director of the Medicines, Supplies and Drugs Department and the Head of the Health Surveillance Control Office at the Integrated Healthcare Networks Division (DIRIS) of Southern Lima, which includes 148 healthcare centers and 2 hospitals in 13 districts of Peru’s capital.

In my current position, I lead health supply chain management and oversee the monitoring and regulation of medical supplies and devices, with dedicated oversight of sexual and reproductive health supplies, to ensure quality, availability, and safety for public health users.

I lead monitoring and oversee actions by inspecting public and private pharmaceutical establishments, ensuring compliance with national regulations on Good Storage Practices and Good Pharmaceutical Practices. I coordinate with the inspection team to respond immediately to health alerts issued by the General Directorate of Medicines, Supplies and Drugs (Digemid) of the Ministry of Health regarding observed products. Working with my team of inspectors, we cover 1,810 public and private establishments.

What supply challenges does Peru face?

Peru still faces significant gaps in access to supplies, particularly in regions outside the capital, and these gaps are exacerbated by limited access to services and information.

I have worked not only in Lima, but also in other regions such as Ucayali, Huanuco and Loreto, each with its own challenges. When I applied for a LAPTOP scholarship I was Director of the Medicines, Supplies and Drugs Department in Ucayali, a vast region in the heart of the Amazon rainforest, with muddy terrain, periods of extreme heat, and obstacles such as fallen logs, ravines and roads that sometimes disappear into rivers. To get to Atalaya, it takes approximately three days by boat or an hour and a half in a small plane. I needed to implement a good logistics system that complied with good storage and transportation practices. Staff had to be well trained in these practices and have clear protocols to follow.

We also focused on getting products and services to vulnerable populations. Ucayali is home to several indigenous peoples and in order to reach them we had to work in partnership with indigenous leaders, communities and civil society organizations with field experience. When you want to enter an indigenous community, you cannot do it on your own. It is necessary to have the permission and support of the Apu (leader) and provide information that is culturally appropriate for each indigenous community and in their own language.

I believe deeply in getting directly involved. You have to step away from your desk and go out there and walk with the people. I visited several indigenous communities, raising awareness with a clear message. Those were long days, but I liked being out there more than behind a desk. This experience has allowed me to learn first-hand the reality of people, how they live, and what it means to lack access to key supplies.

How did the RHSC Laptop Scholarship help your career?

This course has allowed me to technically structure the knowledge I had gained from experience. Before I applied what I knew in a fragmented way. Then, I gained a comprehensive approach to supply chain management. I learned how to plan supply, manage inventories strategically, monitor the performance of key indicators, apply financial logistics, risk management in supply chains, inverse logistics, etc. Now, I can analyze supply chains as a comprehensive system, from supply planning to user distribution.

Thanks to this course I was able to strengthen my technical leadership. Today, I make decisions based on data and indicators, which makes my team more confident. I am able to coordinate better and implement a preventive approach to supply chain management instead of reactive one. For example, I use supply planning to prevent stockouts, making a better analysis of real needs.

What is your hope for the future?

I dream of the day that every woman and girl can exercise her reproductive rights — not just in our country but the world over. I want to contribute my knowledge because a well-managed supply chain saves lives.

From my role and wherever I am, I will keep contributing by raising awareness and giving technical advice to strengthen public health, especially for vulnerable populations such as indigenous peoples. They have the right to information and to have timely access to quality supplies.

Toward the day when every woman and girl can exercise their reproductive rights was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.

By Martyn Smith: Director, Reproductive Health Supplies Coalition

We have reached the conclusion of our serialized Freight Expectations blog series, which spun off from eight stories presented at ICFP 2025 in Bogotá in November 2025. It was my privilege to draw out the most intriguing and inspiring stories from partners I respect from around the world, and then to design and moderate this unique session.

Urgent need

If there is one thing our storytellers prioritized in common, it was the urgent need to future-proof our supply chains because complacency or inaction will cost lives. Mukul Taparia reminded us that even a 30-year relationship is not a guarantee of safety — that things can go from perfect to a nightmare in one instant. Nelly Munyasia’s shared raw shock — you can prepare for one setback, but be caught off-guard by a completely different obstacle. Many programs are just one politically biased decision away from shutting down completely.

Resilience, reinvention, revival

But our storytellers also reminded us that our community is one of resilience, innovation, and solutions. We heard how supply chains are reinvented, reshaped, and revived to make them more human-centered, putting women in a place of priority. Private spaces in community pharmacies, clear messaging on social media, midwives’ homes turned into consultation rooms during the pandemic — our community has innovated so that women and girls can get the lifesaving products they need.

The importance of data

Nora Quesada remembered the transformative power of data visibility — even the so-called ‘primitive’ Excel spreadsheets sent through dial-up modems in her story from the 90s reduced expiration wastage by 40% in Mexico. And Cletus Adohinzin pointed to the Family Planning Visibility and Analytics Network — or the VAN — as the central mechanism for sharing data and ensuring coordination, helping Niger share its excess stocks of 40,000 copper IUDs with Nigeria.

The power of good data came across loud and clear, reminding me of an incident in my own career when I called on data to save access to reproductive health supplies for an entire country.

In 2008, when I was working in Sierra Leone, my organization was expanding rapidly, and we needed to know exactly what was flowing into the country. It was a conversation with RHSC’s CARHs group — a forerunner to today’s Consensus Planning Group managed by the VAN — that helped my team see this clearly, and ensure there was product to meet the program.

Yes, data was certainly under the spotlight in Freight Expectations, but one element emerged as equally important — if not more so.

Trust fuels everything — it is our collective currency.

If data is the new oil…

Most of you here might have heard the saying ‘Data is the new oil’, popular for years now. But today, you’re more likely to hear: ‘If data is the new oil, then trust is the new currency’. Data powers modern supply chains, but trust allows data to be exchanged and used effectively. Trust fuels everything — it is our collective currency. Yasmin Chandani reminded us that while inSupplyHealth’s AI solutions proved phenomenally successful, acceptance and transition were gradual, and called on building … yes, trust.

Trust, flexibility …

Another element has fueled supply chains in times of crisis. What helped Yasmin’s community pharmacists in Kenya learn to administer injections, and branch out into a new service? What helped Mukul’s outfit break down pallets, make them up again, and repackage the same supplies seven times? In Mario Flores Alvarez’s story, what helped DKT bridge that private-public sector gap, spring into action, and deploy its cold‑chain infrastructure and network of 120 trained distributors to move millions of long-acting contraceptive doses within weeks?

What helped Peru’s female pharmacists in Nadia Olson’s story put their meager salaries into building a system the ministry would not invest in? In Mexico, what helped the doctors and nurses in Nora’s story step out of their comfort zones to learn about stock situations and inventory?

Yes, I’m referring to flexibility. Nora told us to “think like water” — adapting and working around obstacles. But flexibility is often fueled by something we have all reached within ourselves to find in this time of brutal adversity.

… and courage

I am talking, of course, about the courage to pick ourselves up and keep dreaming and building. We cannot afford to discard that courage, because along with it, we would be trashing the future of millions of women and girls who want to prosper and thrive. This is moral courage. We are here because we believe in what we do, and we believe in a future where health equity is not a pipe dream. It can be achieved.

Three things

As we bring our Freight Expectations supply chain stories to an end, I call upon you to do three things.

1. The first: if you’ve missed any of the eight blogs, catch up here for stories of faith and bravery.
2. The second: Keep your courage in good supply. The RHSC has been building and nurturing trust-based relationships for more than 20 years. We are here to support you, make crucial connections, and offer you the alchemy of collective action.
3. The third thing I ask: keep telling your stories. They are formidable agents of change that blast doubters out of the water. I thank my wonderful storytellers for their honest, unflinching, and powerful stories.

Not the End was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.

by Nadia Olson, Public Health Systems and Supply Chain Expert

“Women transform health care systems against all odds, and ultimately, they helped sustain me through my own crisis.”

I’ve worked in reproductive health and family planning for more than 20 years. Working with countries and communities to help expand innovative health programs globally, I’ve witnessed extraordinary stories of women in leadership. These stories emerged not in boardrooms or conferences, but in quiet moments of trust and collaboration — over lunch conversations, or long truck rides along rugged and dusty roads, or on the floor counting medicines in hot inventory rooms, or treks into far away communities. I’ve two of the most beautiful stories to share here to show that women transform health care systems against all odds, and ultimately, how they helped sustain me through my own crisis.

My first story is about The Pharmacists’ Revolution in Peru

In the corridors of Peru’s Ministry of Health, I worked with a team of female pharmacists who held positions of authority and expertise that I respected, but it was only after we had built deep trust over years of collaboration that they revealed their incredible backstory to me.

Years earlier, they had worked as low-level logistics functionaries with minimal authority, overshadowed by the male doctors who controlled the institution. Despite their expertise, these women had little voice in decision-making. But they saw what their superiors missed: the ministry desperately needed a management information system to effectively manage their health commodities.

With determination born from frustration, they had organized themselves and made an extraordinary decision. Each month, they pooled money from their own pockets — from their already meager salaries — a significant sacrifice for women earning so little. With these funds, they worked with student developers to build the pharmaceutical management information system the ministry needed but wouldn’t invest in.

Their grassroots innovation became the backbone of the Ministry of Health’s supply chain management system, saving money and dramatically improving supply chain efficiency. Through this strategic investment in technology, these women didn’t just solve a problem, they transformed their own positions. The system they created gave them the authority, expertise, and influence they now held. Over time, they rose through the ranks, eventually becoming ministry leaders. In the ultimate vindication of their vision, one of these former low-level pharmacists became the Minister of Health herself.

While Peru’s pharmacists worked within existing systems to create change, halfway around the world in Yemen, women were building health care from the ground up in places where formal systems had collapsed entirely.

My second of three stories is about frontline care in crisis, and Yemen’s community midwives

In Yemen’s remote areas, where conflict has devastated health care infrastructure, community midwives often stand as the only health providers available: no doctors, no nurses, just these dedicated women serving their communities. Their story is one of persistent presence through repeated abandonment.

These midwives have weathered cycles of support and withdrawal long before the current crises. Even before the latest war and budget cuts, they experienced interruptions in support that left them to serve their communities alone. When war erupted, support disappeared entirely, only to eventually return little by little.

Their clinics became beacons of hope in areas forgotten by formal health systems.

Over time, my colleagues on the Yemen team and I came up with the innovative idea of home-based clinics. The community midwives received equipment, commodities, and training to establish these clinics, transforming their homes into lifelines for their communities. These female leaders provided essential care at the grassroots level, serving populations that would otherwise have no health care access at all. Their clinics became beacons of hope in areas forgotten by formal health systems.

One of my team members, Suaad, who had been there through all these iterations and all the interruptions, eventually achieved the remarkable feat of becoming Director of USAID’s very large — and only — development project in Yemen. This took enormous effort. Seeing a woman in this role was the highlight of my career, which had never happened before for such a large project.

When the Trump administration cut funding in 2025, it was a familiar blow. These vital services faced extinction once again. But the midwives continue providing care on their own, charging nominal fees when possible, driven by commitment rather than compensation. Suaad is still there. Like me, she has two sons who are so proud of their mother’s beauty and strength and insistence on staying home to weather this latest storm together with the midwives. We will all work together in Yemen again. In the meantime, we will sustain our sisterhood.

And now, my own story, about myself.

After losing my position in that same wave of terminations, it was not easy to find a pathway forward. Throughout my struggle, I kept these women in mind — the pharmacists in Peru, the midwives in Yemen, Suaad, and other leaders in so many countries throughout the world. Their stories gave me courage and helped me understand that the work is not attached to any single institution. It belongs to all of us who have been working together all this time.

Throughout these months, my two sons, Mateo, sixteen, and Xavier, twelve, have been cheering me on. They’ve tightened their belts with me and have shown genuine interest in what I am doing to find a way forward. My father Carl has held my hand through this difficult time. My mentor David, who had also been my boss during the early days of this work, came looking for me so we could create something new together. This network of male support alongside all these stories of resilient women has helped give me the foundation to flourish.

Like so many of us, this wasn’t my original project for 2025, but sometimes life pushes you to do what you’ve been imagining.

I finally landed consultancy work through several new mechanisms I’m building, one of which I’m building with David called Vital Supply Chain. This new organization will bring health supply chain expertise closer to the people who need it, equipping the experts of the past with technological tools and AI know-how to directly support people on the ground to develop those skills themselves. The other my own consultancy, aptly named Crossroads Consulting that helps us navigate today’s complex global health challenges. Like so many of us, this wasn’t my original project for 2025, but sometimes life pushes you to do what you’ve been imagining.

Finding this path forward has been deeply meaningful, not just professionally, but personally, in the midst of all of the grief and turmoil. The most beautiful moment came from my big boy Mateo. He told me he never doubted that I would find a way forward — just like the women in these stories. Stories he had heard many times before. And here’s a little secret: throughout all those months, many times I overheard him whispering this to his little brother Xavier, which lifted me along my way, before he eventually told it to me, “Don’t worry Xavier, Mama will find a way through, it’s Mama. She is great and, she has so many people that want to help her, like grandma and grandpa.”

These stories illuminate that whether we’re transforming institutions from within, building healthcare from the ground up in places where formal systems have collapsed, or rebuilding our own lives after loss, the same principles apply: presence, innovation, community, and the unwavering belief that meaningful work, creativity, and love among us transcends any single job title or setback (no matter how enormous).​​​​​​​​​​​​​​​​ It won’t fix the wrongs and the losses, especially in the poorest, most fragile places; but we won’t be torn apart as long as we live and have minds and hearts to weave together to help every single one of us to find our footing again.

Faith can transcend the most threatening setbacks was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.

What inspired him to enter healthcare supply chain work

When I was a child, I watched my father go on his sales rounds to remote communities in rural Rwanda, selling medicines. I saw the power medicines had to save lives, and I saw how eager people were to get their drug of choice for their health conditions. It started me on my life’s journey of working with healthcare supplies.

What he does today

A pharmacist by profession, I now work at Partners in Health. My work involves procurement and inventory management for anti-cancer drugs, nutritional products, and cancer-detecting equipment, as well as reproductive health supplies.

How it started

My early interest in biology, chemistry, and mathematics at school led to my pharmacy degree in which I scored a first class, and then to an internship, where I encountered many stockouts of lifesaving medications. I became interested in how to prevent stockouts — they lead to complications of disease, long hospital stays, and complications. I learned that a well-functioning supply chain is key.

Resilience

With the current global funding crisis which is negatively affecting many countries, some of our mitigation strategies had to be thoughtful and creative. We ran out of funds for in-person training, so we made do with online training, mentorship programs, virtual check-ins, and one-to-one in-person meetings to avoid the expenses that venue hire and other logistics would entail.

In the long run, LMICs should be collaborating on pooled procurement and developing manufacturing facilities in their regions and countries to minimize import costs.

How his RHSC Laptop Scholarship has helped his career

My Master of Science in Global Health Procurement and Supply Chain Management from the Empower School of Health, in collaboration with the United Nations Institute for Training and Research, has really changed the way I approach my daily work. It has helped me understand quantification, forecasting, and strategic planning better. What I learned supports me in evidence-based decision making, and to improve coordination and contribute to planning. In my daily inventory management work, I can better assess stock levels so that our data is more accurate. In fact, our stockout rate — a key indicator for measuring health commodity availability — has fallen from 8 (out of 10) to 2 since I acquired my new skills and I do credit my enhanced knowledge and training.

Where he sees himself in 5 years’ time

Rwanda has many examples of best practice in healthcare, and we have attracted much foreign investment in our decentralized healthcare systems and Rwanda-based vaccine-manufacturing plant. As my supply chain expertise develops, I see myself contributing to regional and global supply chain operations.

Motivation to keep learning

Learning is a continual, lifelong process. Our world is changing with AI playing a bigger and bigger role. We need to learn about how AI works, and what it can do. People are afraid that AI will take their jobs. So we have to stay one step ahead. How can we develop the skills and strengths human beings have that AI cannot replicate? At the weekends, I go for two-hour runs to keep my body healthy, and I watch motivational videos and look for different courses to keep my mind sharp. My primary aim is to grow my knowledge. There is too much at stake in medical access and we owe it to our communities to keep healthcare supply chain efficient and safe.

On the eve of International Education Day, we hear from LAPTOP Scholar Jean Claude Niyibizi on… was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.

by Mario Flores Alvarez, CEO of DKT LATAM North

People working in reproductive health often reference the private sector, but what does the term “private sector” mean for family planning? Many of us immediately think of for‑profit drug manufacturers, but it not just that. The private sector is a broader ecosystem of actors operating outside direct government control, and delivering health‑related goods and services for a fee. Actors include:

• Social marketing organizations
• Private sector clinics and pharmacies.
• Logistic firms and distributors that move commodities from manufacturers to the point of care
• Media and demand generation agencies

Together, they form a market oriented network responding quickly to shifts in demand, scaling distribution, and innovating on pricing, packaging, and service delivery. I want to tell you two stories to illustrate the power of the private sector.

My first story comes from Ghana.

When COVID-19 struck Ghana in early 2020, the Ghana Health Service faced a paradox: women were afraid of unintended pregnancy during economic uncertainty, so demanded more contraception. At the same time, supply chain was seriously compromised by travel bans, closed borders, donor funding cuts, and staff changes.

DKT International was the only private sector actor in Ghana with enough stock of both long- and short-term contraceptives, a robust national distribution network, and expertise in promoting commodities to consumers.

For the first time ever, a private social marketing organization (SMO) was acting as a public‑sector supplier!

In April 2020, the Ghana Health Service granted DKT a temporary permit to distribute short term methods directly to pharmacies and to supply long term contraceptives to maternity homes and clinics that were still operating during a national lockdown.

For the first time ever, a private social marketing organization (SMO) was acting as a public‑sector supplier! DKT called on its cold‑chain infrastructure and its network of 120 trained distributors to move millions of doses within weeks.

A DKT campaign emphasized that contraceptive use does not increase COVID‑19 risk, debunking social media rumors.

Private maternity homes faced stockouts, so DKT bought commodities from the public sector at reduced rates and redistributed them to these clinics, so women could get long-acting products without traveling to distant public hospitals.

DKT also supplied manual vacuum aspiration kits, combi-packs, and training to public sector facilities helping reduce maternal mortality during and after the pandemic. By helping keep reproductive health services functioning, DKT helped reduce unintended pregnancies and maternal mortality during a time when health system capacity was stretched thin.

What lessons did we learn?

1. Speed matters: A private sector partner with pre positioned stock and distribution network can fill gaps faster than a public procurement cycle
2. Flexibility is crucial: Temporary permissions allowed DKT to act as a public and private sector supplier
3. Synergy, not competition: By purchasing commodities from the public sector and redistributing them to private clinics

My second story is about private sector partnerships in Latin America and the Caribbean — or the LAC region.

In Mexico and our eight other LAC countries, the contraceptive market is split into two parts — public and private. While public clinics offer long term contraceptives for free, private clinics also sell these methods, but their prices are much higher. Women with low and even middle incomes cannot afford private clinics prices although they may prefer them.

DKT’s strategy in the region:

• We procure implants, IUS and IUDs at negotiated bulk rates and sell them at a margin that keeps prices competitive.
• We distribute commodities in partnership with private sector distributors to ensure efficiency and coverage
• We conduct hands-on workshops for clinicians, emphasizing technical proficiency and also client centered counseling. Empathy drives satisfaction, which in turn increases word of mouth referrals.
• We use social media, influencer partnerships, and traditional media, to create a pipeline of informed clients who are then referred to our private partner clinics.

I have referred in the next story to a special, invisible quality fueling success. That quality is empathy — an ability to understand and share what the client wants in her and his healthcare, and then to design a supply chain informed by that understanding.

A story about a young woman from Mexico

María from Guadalajara wanted an IUS but could not afford the price at a large private hospital. She was referred to a DKT partnered clinic after contacting our team on Facebook when she saw a social media post highlighting “affordable, high quality IUS — now within reach.” After a brief consultation, María received the service for 50% less than the market price.

That single interaction illustrates how these four aligned incentives — affordable commodities from DKT, motivated distributors, empathetic quality service from the clinic, and targeted demand generation — can convert a potential consumer into a satisfied user. Multiply that across thousands of women, and the market share for private sector LARCs expands dramatically, creating a sustainable financing loop that does not rely solely on donor subsidies.

Because this model operates outside the constraints of public budgeting, it ensures continuous availability of LARCs and other reproductive graph services, even when donor funding fluctuates

What does the future hold? DKT’s private sector portfolio is expanding to male focused services, recognizing that reproductive autonomy involves both partners.

In Mexico, DKT piloted a social media driven campaign that educates men about vasectomy, offers free counseling, and connects them with accredited private clinics. The model projects over 3,000 vasectomies by 2026 in one small DKT clinic.

The key ingredients for private sector success are:

• Firstly, aligning incentives: DKT, distributors, private sector clinics, donors, and governments.
• Secondly, prioritizing collaboration over competition
• Thirdly, prioritizing health outcomes, not just sales, can harness donor funding to lower prices without sacrificing sustainability.
• And lastly, innovation like digital demand campaigns for vasectomy shows that the private sector is agile enough to respond to emerging needs, whether a pandemic or a shifting cultural landscape.

As a result, all actors are collectively creating a market where reproductive health is not a luxury but readily available health services that can withstand pandemics and other crises.

I have referred in this story to a special, invisible quality fueling success. That quality is empathy — an ability to understand and share what the client wants in her and his healthcare, and then to design a supply chain informed by that understanding.

Where there is empathy, there is hope.

The unique benefits the private sector offers reproductive health supply access was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.

Supply chains — the heartbeat of our programs, the threads in our fabric

by Yasmin Chandani, CEO and Founder, inSupplyHealth Ltd.

Good partnerships are the foundation for strong supply chain systems. I’d like us to think about supply chains beyond the trucks and warehouses and spreadsheets that might immediately come to mind.

To me, supply chains are the heartbeat of family planning and reproductive health programs. When they work well, they are steady and rhythmic, they deliver products, gather information, and they save lives. At the same time, supply chains are also the threads of a fabric (or a program), weaving together people, products, processes, data, technology, funding and promises — connecting a woman in a community pharmacy to a distributor in a capital city, a regional manufacturer, a Ministry policy maker and a government treasury decision maker.

But when a heartbeat falters, the whole body feels the impact. And when a single thread snaps, the whole fabric becomes weaker. When COVID-19 struck, our collective heartbeat skipped — and, for a time, even stopped. Cargo routes froze. Borders closed. In Kenya and across East Africa, supply chains that had taken decades to build began to unravel. Our teen pregnancy rates shot through the roof, and we lost valuable progress in many health indicators.

We saw where the threads were weakest — we were (1) too centralized, (2) too donor-dependent, (3) too far from where women needed care.

“What if pharmacies could become a legitimate, trusted part of the national family planning and self-care fabric?”

But one place where that pulse stayed the strongest was in community pharmacies — especially neighborhood chemists. Community pharmacies became the threads that quietly held the fabric together when everything else was fraying.

A community pharmacy is where most Kenyans go when we have health issues. My neighborhood pharmacy is on speed dial when my kids are sick — the pharmacists know me, greet me and I’m in and out in a couple of minutes. During Covid, pharmacies were embedded in the fabric of communities, adapting rapidly, adding home-delivery methods and adopting telehealth methods.

Post Covid, the Kenyan Health Ministry wondered — “What if pharmacies could become a legitimate, trusted part of the national family planning and self-care fabric?” Through support from the Gates Foundation, and partnership with government partners and stakeholders, we started to weave pharmacies into the family planning total market approach.

It is not easy to shift the mindset that the public sector is not the only place you can get quality family planning. We had to align regulations and policies, train pharmacy providers in counselling and choice, in how to inject, and help them build trust and client confidence. We had to connect digital and reporting systems and build value chains so pharmacies could offer choice and consistent supplies.

We learned two important lessons: firstly, we needed multiple partners to buy into this shared vision. And secondly, to innovate within governments, we needed to build trust and work together across multiple arms of the ministry and not with just one program or contact.

To support commercializing the supply of self-injectables, we worked with the ministry and professional associations to train almost 500 pharmacies and digitize the curriculum to enable rapid scale up of this pharmacy model. Pharmacists learned to start talking to women about contraception when they came in for other items. They offered women a safe, private space for contraceptive counselling. We checked in with them every month to help problem-solve and supported some of them to adopt social media marketing, which proved to be effective. Women told their friends and as demand grew, pharmacies took ownership of their supply chains. Within months, more women were coming in for contraceptive injectables in our partner pharmacies, and most importantly, pharmacy owners and operators started to understand how important offering quality family planning services could be for business.

Fast forward to 2025, with global funding cuts causing a significant gap in family planning financing. Our heartbeat took a shocking blow.

Fortunately, in Kenya we have a little hope. We can now explore multiple initiatives: scaling up family planning through pharmacies; exploring how our new social health insurance fund can reduce out-of-pocket payments; and investing in domestic financing for contraceptives. Thinking outside the box after the pandemic has shown us that as a country, we can be resilient, responsive, and resourceful.

I can see a future where pharmacies, clinics, and ministries are all part of the same fabric

At inSupply Health, we are doing our part to explore how to help ministries maximize their resources. In the last two years, we have co-created AI-enabled forecasting tools in Kenya and Tanzania with our ministry partners — with excellent results. Data extraction and cleaning takes 15 minutes compared to 2-and-a-half days previously. We can use more data, more robust methods and we have high accuracy rates for stable methods that have good data. But again, this transition was gradual and called on building trust. Users had to compare the processes side-by-side, validate cleaned data, and accept the innovation slowly. But it has been a success, and we are handing the tools to the ministries.

I can see a future where pharmacies, clinics, and ministries are all part of the same fabric and where governments don’t just manage donor pipelines but finance, monitor, and optimize their own resilient supply chains. And where women are at the center and can afford their family planning method of choice AND access it conveniently, without bureaucracy or bias standing in the way.

We are at an inflection point in our industry — like never before. It’s time to: (1) act decisively and boldly, (2) invest in tools for efficiency so we can do more with less, (3) galvanize a domestic financing agenda to reduce dependency, and (4) accelerate strategies that help our systems continue to serve women and their families. It’s time to invest in our collective heartbeat, to strengthen our supply chain fabric.

Supply chains — the heartbeat of our programs, the threads in our fabric was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.

By Dr Clétus Adohinzin: head of reproductive health and HIV prevention projects, West African Health Organisation (WAHO)

In the world of healthcare supply chains, sharing medicines between countries takes a lot of coordination, trust, attention, partnership and willingness to make this sharing possible.

Why can sharing be so difficult?

• National rules on drug registration can vary from country to country.
• The process of importing medicines varies depending on the type, its use and the country, although common steps include obtaining authorisation from the competent authority, customs declaration, quality controls and compliance with transport and documentation standards. All of this can lead to delays that may compromise sensitive medicines.
• Some medicines require a cold chain, mainly heat-sensitive products. Their efficacy and safety depend on strict adherence to controlled temperatures. Transporting this type of medicine without a guaranteed cold chain may render them unusable.
• Countries may have strict procurement and budget rules, and accepting external surpluses could conflict with procurement rules or distort markets.
• Labels may be written in a foreign language or indicate different dosage units, creating clinical risk and legal liability.
• The donor country may send what it has available, but not necessarily what its neighbour needs, leading to waste.

WAHO was created in 1984 precisely to facilitate all this. Our vision was to achieve the highest possible level of health for the populations of this sub-region, and to realise this dream, we worked to harmonise Member States’ policies, pool resources and promote cooperation between them.

The strength of our regional collaboration and solidarity (one of the fundamental principles of ECOWAS) was put to the test during the COVID-19 pandemic and its imminent impact on supply chains in our region.

During the pandemic, WAHO played a key role in coordinating procurement, logistics and regional policy measures that enabled the cross-border movement of essential medical supplies in ECOWAS countries. It procured and distributed personal protective equipment (PPE), diagnostic kits and oxygen therapy equipment with the support of the Nigerian Air Force, enabling rapid delivery to our Member States when commercial routes were blocked.¹ ²

WAHO also developed regional guidelines and standard operating procedures for the cross-border movement of essential goods with ECOWAS’s departments of trade, customs and free movement, and transport, and co-financed air transport from Beijing to Abuja to speed up distribution.³

Finally, by using regional logistics centres, WAHO reduced customs duplication and accelerated cross-border supply flows.⁴

Collectively, these actions consolidated fragmented national responses into a coordinated regional supply system.

In addition, WAHO’s membership in the Global Family Planning Visibility and Analysis Network (VAN) has strengthened our regional coordination by providing greater understanding and power. Under our institution’s leadership, VAN has been integrated into the region’s early warning system and is used by all our member states to provide regional visibility on contraceptive security in order to inform about funding gaps and transfers to help neighbouring countries in need.

This integration has opened up new possibilities for contraceptive transfers in the region.

In December 2023, Nigeria faced a central stockout of IUDs. It formally requested assistance from WAHO to transfer IUDs. The Ministry of Health of Niger had identified a surplus of the same product and reported it through the VAN Consensus Planning Group (CPG). The VAN served as the central mechanism for sharing data and ensuring coordination between governments, VAN analysts, donors, and national teams. WAHO provided funding and supported the translation of transfer documents (from French to English) to facilitate the transfer.

Thanks to this coordination, 40,000 copper IUDs were successfully transferred to Nigeria in 2023, filling a critical funding gap and providing protection equivalent to approximately 185,000 couple-years. The transfer was able to take place before the situation worsened, rather than waiting for the crisis to erupt. And waste was reduced, as the expiry of unused stocks in Niger was avoided.

The transfer of products from Niger to Nigeria was the result of coordination between WAHO, UNFPA, key government officials and the large VAN team.

In recent years, WAHO has carried out more than 15 transfers in response to requests from countries.

But today, West Africa is facing a similar crisis. Now, more than nine months after the reduction in US government funding, health officials are reporting severe tensions in drug stocks. Although some countries have attempted to fill the funding gap by allocating a larger portion of their budgets to healthcare, officials fear that this may not be enough.⁵

This is putting a damper on the momentum for solidarity. Countries are now hesitant to donate their surpluses. This situation requires us, as stakeholders, to take action. This means that we must make even better use of the resources that are still available. We will:

We must unite and collaborate as a region, rather than resorting to isolationism in the face of the unknown. This trust and commitment to coordination will continue to make our region more resilient for the future.

• Invest in improving regional and national capacities to make the most of VAN data to make informed decisions and minimise risks such as stockouts and expiries.
• Accelerate the implementation of the ECOWAS regional common procurement system, which can ensure access to affordable, quality, safe and effective products.
• Improve ECOWAS joint registration processes for medicines and vaccines.

We know we have the means to achieve this. We have strong, proven partnerships, we have the infrastructure, and we have the will. To move forward, we must now look to the past to draw inspiration and momentum from our past successes. And now more than ever, we must mobilise to put our collective vision and power to work for the future of women and girls in our region.

1. https://airforce.mil.ng/news/covid-19%3A-naf-commences-airlift-of-essential-medical-materials-procured-by-waho-to-13-ecowas-countries1022941178
2. https://fmino.gov.ng/dr-olorunnimbe-mamora-flags-off-air-logistics-support-for-covid-19-medical-equipment-from-nigeria-to-ecowas-waho
3. https://www.gn-sec.net/news/ecowas-covid-19-ministerial-coordinating-committee-health-held-their-first-meeting
4. https://fmino.gov.ng/dr-olorunnimbe-mamora-flags-off-air-logistics-support-for-covid-19-medical-equipment-from-nigeria-to-ecowas-waho
5. https://www.washingtonpost.com/world/2025/10/09/usaid-cuts-africa-health-crisis/

Looking Back to Move Forward: Drawing Motivation from the Successes We Achieved in West Africa was originally published in It’s about supplies on Medium, where people are continuing the conversation by highlighting and responding to this story.