Low-cost training for frontline health workers can reduce medical supply shortages

A recent study from The University of Texas at San Antonio reveals that low-cost training for frontline health workers can significantly reduce medical supply shortages, potentially saving thousands of lives in developing nations.

Amir Karimi, an assistant professor of operations and analytics in the Carlos Alvarez College of Business, evaluated a large-scale initiative in Indonesia designed to keep contraceptives on pharmacy shelves. The study recently accepted by Management Science, found that training nurses and midwives in basic inventory management reduced "stock-outs" - periods when a product is unavailable - by approximately 30%.

We have the technology to manufacture these products, but when supply chains break, the consequences are just as devastating as if you couldn't produce these medications at all. People are not going to have access, and it leads to adverse outcomes like unintended pregnancies, psychological distress and even death."

Amir Karimi, assistant professor of operations and analytics, Carlos Alvarez College of Business

A dual responsibility dilemma

In many low- and middle-income countries, frontline health workers are forced to balance a "dual role." Though their focus is clinical care, such as administering medication or counseling patients, they are often tasked with managing inventory.

Because these workers are primarily trained for medical tasks, inventory management is often viewed as a secondary priority or handled ad hoc. This challenge is compounded by infrastructure issues such as poor roads and a lack of local manufacturing, which requires products to be imported and distributed across thousands of facilities

In Indonesia alone, approximately 17,000 health facilities must be replenished bimonthly. Along the way, medical supplies can encounter dozens of roadblocks, including complications in the import process, trucks breaking down, roads being closed due to flooding, or inventory being poorly managed on the shelves. When these systems fail, the results are stark: More than 95% of all maternal or newborn deaths globally occur in low- and middle-income countries.

On-the-job training yields high returns

Karimi's team evaluated the MyChoice Project, which provided inventory management training to health workers across Indonesia. The study compared two delivery methods: "offsite" training in a traditional classroom and "onsite" training delivered on-the-job at health clinics.

The results showed that onsite training was not only more effective but also drastically cheaper. On-the-job sessions reduced stock-outs by up to 43%, compared to a much smaller impact from classroom-based learning.

"If training is delivered in the same setting where the work happens, it becomes more embedded," Karimi explained. "It is experiential learning rather than a theoretical approach that is detached from their day-to-day tasks."

The cost difference was equally significant. On-site training costs as little as $9.72 per facility, This is because trainers can visit multiple clinics on a single route, whereas off-site training requires paying for venue rentals, supplies and travel costs for all attendees.

Karimi's analysis suggests that for every 100,000 women of reproductive age, this training prevents more than 800 unintended pregnancies and saves more than four maternal and newborn lives.

Expanding the reach

While the study focused on contraceptives in Indonesia, Karimi believes the model could be applied to other essential medicines and regions.

He has already conducted similar research in Senegal and is currently in discussions to design remote training programs. One of those includes a potential app that could further lower costs and expand the program's reach.

"My ultimate goal is uncovering actionable insights that public health organizations and governments can use to address inequities on a global stage," Karimi said.