What if you went to the pharmacy and the person dispensing your medication was not the pharmacist, but an electrician? No, this is not a practical joke. It is the unsettling reality uncovered by Lloyd Matowe, the director of Pharmaceutical Systems Africa (PSA), when he visited a rural Ugandan health facility—the facility women in the community depend on to get their reproductive health supplies.

Why was an electrician dispensing medication? The only dispenser at the 47-bed facility was ill. In his absence, no one except this compassionate and enterprising electrician was available to step in.

Shocking? Yes. Atypical? No.

I am here at the 10^th meeting of the Reproductive Health Supplies Coalition (RHSC) in Mexico City. Over the past decade, PAI has worked in partnership with the RHSC to document the realities of women in the developing world and the challenges they face in getting contraception and other reproductive health supplies. Often, these women must travel far from their communities to reach a health facility, only to return home empty-handed due to shortages and stock-outs. The reasons for stock-outs vary, but one of the most vexing is lack of trained personnel to manage reproductive health supply chains.

Why does this matter? Part of making sure that women can access the supplies they need is correctly estimating demand for those supplies. Staff at health facilities should have the knowledge and skills to make sure that the supplies most in demand are in stock—and those least in demand are not overstocked. Unfortunately, in too many countries, staff members often lack these fundamental skills.

Matowe points out that in Liberia, for example, most supply chains are managed by people who are untrained. Some have as little as three years of formal education. The problem is exacerbated by Liberia’s weak educational system. Not only are there no standardized curricula for supply chain managers, educational standards at all levels are absent. It is not surprising then that in July, just before the Ebola outbreak, 64 percent of public healthcare facilities had no Depo-Provera; 90 percent had no ergometrine ( a combination drug used to prevent post-partum bleeding); and 71 percent had no male condoms—even though these supplies were in stock at the national level. Clients who depend on these supplies are left in the lurch, with potentially tragic results.

Liberia now faces a double challenge. An already weak health system is being pushed to the brink by the Ebola epidemic. Reproductive health, never the highest on policymakers’ lists, is not even an afterthought as all resources are channeled toward fighting Ebola. The United Nations Population Fund (UNFPA) recently highlighted the risks now faced by pregnant women in Ebola-effected countries and called for action to help prevent rising maternal deaths as women are forced to deliver without the help of a skilled attendant. We know that in this context, access to contraception—which helps to reduce maternal deaths by preventing unintended pregnancies—is also out of reach.

These challenges make the work of PSA even more urgent. With support of an Innovation Fund grant from the RHSC, PSA is greeting the supply management personnel challenge head on. Working with a broad coalition, including the Supply Chain Management Unit in the Ministry of Health and Social Welfare, the School of Pharmacy in the University of Liberia, the Pharmaceutical Association of Liberia, the Nursing Council of Liberia, the Pharmacy Board of Liberia and People that Deliver, PSA hopes to:

• Map supply chain management training activities in Liberia
• Assess training curricula
• Develop a supply chain management training roadmap for the country
• Adapt the training roadmap into policy

It will no doubt be challenging. But if successful, Lloyd and his colleagues would fix a missing link in Liberia’s health supply chain—critical to getting contraceptives and drugs where they are most needed, and ultimately saving women’s lives.