In clinics scattered across Indonesia's archipelago, nurses and midwives face an exhausting dilemma: they are trained to heal patients, yet tasked with managing the shelves that supply their medicines. When that second job goes wrong—when contraceptives vanish, when antibiotics run out—the consequences ripple far beyond an empty shelf. More than 95% of all maternal and newborn deaths globally occur in low- and middle-income countries, many preventable if supplies were simply available when needed.
Amir Karimi, an assistant professor of operations and analytics at the University of Texas at San Antonio, spent years investigating this gap. His research team evaluated the MyChoice Project, a large-scale initiative that trained health workers across Indonesia in basic inventory management. The findings, recently accepted by Management Science, reveal something quietly powerful: frontline workers armed with simple training skills can save lives at a fraction of what organizations typically spend on health interventions.
The numbers tell a striking story. Onsite training delivered directly in clinics—where nurses and midwives actually work—reduced stock-outs (periods when essential products become unavailable) by up to 43%, compared to minimal improvement from traditional classroom-based training. That gap between delivery methods matters enormously, both for effectiveness and cost. Onsite training costs as little as $9.72 per facility, because trainers can visit multiple clinics on a single route. Classroom-based approaches require venue rentals, supplies, and covering travel costs for all attendees—a burden that strains already-stretched budgets in developing nations.
"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 stakes are concrete. In Indonesia alone, approximately 17,000 health facilities must be replenished bimonthly. Along the way, supplies encounter dozens of roadblocks: import complications, broken trucks, roads closed by flooding, or simply poor inventory practices on the shelves themselves. When these systems fail, the human cost is immediate. 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.
What makes this finding so significant is its simplicity and scalability. This isn't about building new infrastructure or importing expensive technology—it's about teaching existing health workers to do their jobs better, in the places where they already work. The intervention works because it recognizes a fundamental truth: frontline health workers aren't the problem. They're the solution, if given the right tools and support.
Karimi isn't stopping at contraceptives in Indonesia. He has already conducted similar research in Senegal and is now exploring remote training programs, including a potential app that could further lower costs and expand reach across regions. "My ultimate goal is uncovering actionable insights that public health organizations and governments can use to address inequities on a global stage," he said.
For thousands of health facilities struggling to keep life-saving medicines on their shelves, that insight—delivered at a desk in a clinic, cost-effective and grounded in real work—may prove to be exactly what saves lives.