Mrs. Zoukoulou arrived at the family planning clinic just as it was opening, having set out from her home two hours before. She had left her eldest daughter, who was 13, in charge of the other five children so that she could make the journey to come pick up a new supply of oral contraceptives. After waiting for half an hour, she was able to see a nurse.
"Good morning Nurse," said Mrs. Zoukoulou. "I have almost finished the contraceptive pills you gave me six months ago, and I have come to get some more." Nurse Nzere checked Mrs. Zoukoulou's blood pressure and asked her whether she had had any side effects. Satisfied that Mrs. Zoukoulou was not having any problems, the nurse went into the store room and brought back six cycles of pills.
"Those are not the right kind. This is the kind I use," Mrs. Zoukoulou said, pulling her last cycle from her bag.
"I'm sorry. We don't have that brand right now," said Nurse Nzere. "The shipment has not yet arrived. But this brand is the same."
"But I have had no problems with the kind you gave me. Some of my friends have had problems with other kinds, so I want to keep using this one," Mrs. Zoukoulou said. "When will you have more?"
"I'm not sure," said Nurse Nzere. "We have ordered more, but the shipment hasn't arrived yet. There is a truck coming next week, but we don't know for certain whether this brand will be in the shipment."
"What am I supposed to do?" asked Mrs. Zoukoulou. "It took me two hours to walk here and I can't come again soon. I will finish my pills in six days, and I don't want to get pregnant. We are only just able to take care of our six children as it is."
"I'm very sorry this happened," said Nurse Nzere. "I can assure you that even though these pills look different from the ones you had before, you won't notice any difference. They will work just as well. Why don't you take three months" worth? We will certainly have the brand you like by then."
Mrs. Zoukoulou sighed. "You had better give me pills for six months. It is very difficult for me to come here; I don't think I'll be able to come again in three months."
On her way home, Mrs Zoukoulou stopped at the market to buy some manioc flour. "You look like you've been walking a long way," said the vendor, a friend of Mrs. Zoukoulou's. "I have just come from the family planning clinic, and I'm a bit upset," said Mrs. Zoukoulou. "Six months ago I finally got my husband to agree to let me use birth control pills, but when I went to get more today, they didn't have my kind. I had to get a different kind, but I don't know if I really want to take them. You remember Mrs. Nde. She had terrible headaches with this kind, and I'm afraid I will too."
At the end of the day, Nurse Nzere went in to see Mrs. Molenge, the clinic manager. "Do you know when our next shipment of LoFemenal oral contraceptives will arrive?" she asked. "I have had five people this week asking for them and I have had to give them another brand instead. Many of the women seemed very concerned about having to use a different brand, and I'm afraid they may stop taking them altogether."
"Oh dear," said Mrs. Molenge, "Not another problem with our commodities system. I know that our clients get very upset when they can't get the kind of oral contraceptives they came for. We need to re- evaluate the whole commodities system, and tell the central-level managers that we must be supplied with the same brands. We must get our commodities system working effectively, because our clients must be able to get the contraceptives they want when they come to our clinic."