By Katharine McCarthy and Saumya RamaRao
This post is part of the blog series “Increasing access to maternal and reproductive health supplies: Leveraging lessons learned in preventing maternal mortality,” hosted by the Maternal Health Task Force, Reproductive Health Supplies Coalition/Maternal Health Supplies Caucus and Family Care International, which discusses the importance and methods of reaching women with lifesaving reproductive and maternal health supplies in the context of the proposed new global target of fewer than 70 maternal deaths per 100,000 births by 2030. To contribute a post, contact Katie Millar.
How can we use the lessons learned by the reproductive health community to advance the maternal health supplies issues?
Each year more than 180,000 women die during pregnancy or childbirth from hemorrhage or pre-eclampsia/eclampsia. Many of these deaths can be prevented with appropriate access to oxytocin, misoprostol and magnesium sulfate. A delivery package containing these medicines is estimated to cost less than US $1.50 per person, and is predicted to save 1.4 million lives over ten years, if available to all women. Current barriers in markets for maternal health drugs, however, cause these drugs to remain largely inaccessible for many women. As the maternal health field refocuses priorities for the SDGs, the importance of building healthy markets for essential medicines is evident.
What are the Major Barriers in Accessing Maternal Health Drugs?
In 2012 the UN Commission on Life Saving Commodities for Women and Children identified key barriers that limit access to lifesaving maternal health drugs:
- Market failures leading to an insufficient supply of quality drugs
- A weak regulatory environment leading to variability in drug formulation and quality
- Lack of provider and consumer awareness of drugs and/or their appropriate use
The interrelated nature of supply and demand challenges makes addressing them difficult. But, there may be a solution. As seen in other health commodity markets, market shaping strategies involving the “total market” may best address these challenges by capitalizing on the potential of all market players to achieve a coordinated approach.
The Solution: What is Market Shaping?
Like many markets, the maternal health drug market is made up of actors from different sectors, including the public (e.g., government), private commercial (e.g., manufacturers, distributors, midwives and oby-gyns), and private non-profit sectors (e.g., faith-based health care providers). Two main reasons for inefficiencies in markets are (1) lack of information and (2) an unbalanced sharing of risk.
Incomplete information or gaps in information flows can be a barrier to market entry. For example, manufacturers and suppliers of drugs may lack information on many aspects of the market such as volume of demand, timing of demand, prices and profitability. Such information gaps can be addressed by high quality demand forecasts, a schedule of when orders are likely to be place, and data on stock-outs, prices, and drug quality. With wider availability of information, new manufacturers and suppliers can be encouraged to enter the market, expanding the supply of available drugs.
To address unbalanced market risk, another strategy is volume guarantees. Unbalanced risk can occur in uncertain markets when a manufacturer or distributor bears the majority of upfront costs with an unforeseeable future profit. A volume guarantee, or an agreement by buyers to purchase of a certain quantity of a product, can offset the risk to suppliers and encourage drug production. Volume guarantees can also aid in negotiations to strengthen the quality and reduce the cost of drugs by achieving purchasing power not previously possible in fragmented developing country markets. Such leverage can also aid in identifying opportunities for innovations in product improvement and financing, further encouraging product purchase and use.
What Else Will it Take?
While capitalizing on market opportunities can facilitate access to drugs and save lives, these strategies alone are likely not sufficient. Complementary programmatic investments are needed to strengthen the supply chain and service delivery, as well as to generate demand by raising awareness on the need and appropriate use of maternal health drugs, and to advocate for the importance of women’s lives. As maternal health researchers, policy planners, advocates and program leaders, we all have our role to play in ensuring women have access to resources for a safe and healthy delivery. We must now turn to moving what we know can work to those in most need.
To learn more about how market shaping lessons from the HIV and reproductive health commodity markets can be applied to scale-up access to maternal health drugs, please see a recent commentary by McCarthy et al., published in Maternal and Child Health Journal.
Resources used in the writing of this post:
- UN Commission on Life-Saving Commodities for Women and Children. Commissioner’s Report: 2012
- Key Data and Findings: Medicines for Maternal Health. Prepared for the United Nations Commission on Life-Saving Commodities for Women and Children
- Market Shaping for Family Planning: An analysis of current activities and future opportunities to improve the effectiveness of family planning markets