Hope on a Dirt Road: Meeting people where they are with family planning services

"But now, with the last-mile delivery commodities are always available. They get their preferred choice." – Judith Kavi

AtBukunor, a farming community in the Yilo Krobo Municipality of the Eastern region of Ghana, nurse Judith Kavi leaves home at dawn to reach her clients before they start their day.

On her calendar this day: Victoria Tettey, a mother of five, is due for her dose of an injectable contraceptive, Depo Provera, her preferred option to prevent pregnancy. She cannot miss a dose because she doesn’t want any more children.

“I opted for family planning because I have had enough children, and I don’t want to give birth again,” she said.

She wonders if Judith will make it on time to her home today.

Farming is life in this rural village. Leaving their fields to go to the community health center is not an option for these villagers, so they depend on Judith’s monthly home visits for routine health care.

Judith often arrives at her clients’ homes covered in mud and laden with boxes of medicines.

What her clients don’t know is what it takes for Judith to get these medicines to them.

In the past, Judith, and many other health workers in Ghana, embarked on arduous journeys to district stores to pick up health products. They typically paid their own way to reach the district store, which could be several kilometers away. Sometimes, after enduring this strenuous journey, they would find that the medications they sought were out of stock, and were forced to return empty-handed to their communities.

The distance between the health center in Bukunor and the district pharmacy in Somanya is about 30 kilometers (about 18 miles). This journey should take about an hour, but given the nature of the roads, it can take an entire day.

“It is stressful!” says Judith, “If you are the only one at the facility, you have to close the facility and stand by the roadside for almost 30 minutes before you get a car.”

“After going through all that, when you get there [district office], you will be told the commodities are not available, and they are now going to request from the regional medical stores.”

To further strengthen last-mile delivery and increase coordination between health facility staff like Judith and regional warehouses who process the orders, USAID’s Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project undertook an initiative to bring health products closer to the people who need them.

GHSC-PSM forged partnerships with the private sector, collaborating with third-party logistics companies to transport these products from government warehouses to local hospitals and community health centers. The project also harnessed the power of the popular social communication platform WhatsApp.

Judith checking and inventorying contraceptives received.
Photo by 5Fifty Productions.

Almost 90% of Ghana’s population uses WhatsApp as of 2021. For Daniel Kwaku Apawu, a warehouse manager at one of Ghana’s regional medical stores, WhatsApp revolutionized two-way communication and coordination with stakeholders, which is essential for ensuring timely supply of contraceptives, and nurturing trust in the system.

“With 29 districts in three regions, you need to coordinate very, very well for efficient work processes. So, at the beginning of each year, we draw a timetable for the entire year that is shared through the WhatsApp platform. We share product availability, what we have in stock. People can just drop in questions to the WhatsApp group,” Daniel said.

“If there are challenges — for instance the car can get stuck in some mud — this WhatsApp group, we use it to inform [the health facilities]. We give reasons why at this specific time the commodities cannot get to them because of the problem, and at times they empathize with us,” he continued.

This reliable supply of family planning commodities has been a huge source of relief for Judith. While the arduous task of picking up family planning commodities was a burden she was willing to shoulder, the cost to her clients was a far bigger cause of unease.

“When the client comes, [and] they do not get their preferred method, they refuse to do family planning. By the time you get the commodity, they have either lost interest or become pregnant. But now, with the last-mile delivery commodities are always available. They get their preferred choice,” said Judith.

From 2017 to October 2022, GHSC-PSM procured and distributed 45.3 million family-planning products to more than 5,000 USAID-supported health facilities and organizations in Ghana. When combined with proper counseling and correct use, that is enough contraceptives to help prevent an estimated:

  • 1.9 million unintended pregnancies
  • 4,000 maternal deaths
  • 22,000 child deaths

At the Bukunor Health Center, Judith’s cell phone pings. The WhatsApp message says to be ready in an hour; the truck just completed its last delivery and is on its way. Victoria is first on her list of appointments this month. She’ll see her soon.