Shafia Rashid is Senior Technical Advisor at the FCI Program of Management Sciences for Health.
In June 2013, Imtiaz Kamal–a crusader for midwifery and women’s health–celebrated Pakistan’s official recognition of the essential maternal health medicine, misoprostol, which has proven easy to administer, safe and effective for preventing and treating excessive postpartum bleeding. “Given the high prevalence of home births,” Imtiaz explained, “we need to invest in solutions, such as misoprostol, that save lives now, until we can achieve the long-term goals of strengthening health systems and increasing rates of facility births.”
Every woman has the right to the highest attainable standard of health, and that includes access to high-quality, life-saving medicines, such as misoprostol and emergency contraception. National essential medicines lists (EMLs) indicate medicines that meet the priority health care needs of the population and often guide a government’s purchasing and distribution decisions for public health facilities. The World Health Organization (WHO) updates its Model List of Essential Medicines every two years, and governments often refer to it to develop and update their own EMLs.
In many national EMLs, however, essential reproductive and maternal health supplies are not included, so they are not available in public health facilities.* In addition, country-level EMLs are not always regularly updated with newer or lesser known technologies, even though these products have been included on the WHO Model EML.
Advocates and other national stakeholders can work together to ensure that national EMLs are updated and reflect the latest evidence base. The Reproductive Health Supplies Coalition, UN Commission on Life-Saving Commodities for Women and Children, the International Consortium for Emergency Contraception, and the FCI Program of Management Sciences for Health developed EML Search to support such advocacy efforts.
EML Search is a database that provides national stakeholders with information on 13 reproductive and maternal health commodities.** The database can be searched by country–to determine which of these commodities are included in any given country’s EML–and by commodity for a list of countries that include it on their EMLs. Both the country and commodity listings include specifics about the commodity listed, such as dosage or brand name. EML Search will be an important tool to help advocates focus their efforts.
The global health community must make a concerted effort to ensure that national EMLs are fully updated to reflect emerging health priorities and updates in the evidence. EML Search will be an important tool to help advocates focus their efforts. For instance, emergency contraception (EC) is not consistently included on national EMLs, so it is not always available when women need it. EML Search reveals that only about half of countries’ EMLs include EC, impacting the most vulnerable women, such as those seeking sexual assault treatment at public hospitals and health clinics. In these cases, public hospitals will be unable to provide EC to women desperate to prevent the traumatic consequences of pregnancy from rape.
According to EML Search, only 11 countries approve misoprostol for postpartum hemorrhage (PPH); one of those countries, Burkina Faso, updated its EML in February 2014, thanks to the advocacy of Family Care International and civil society partners. Available since the 1980s, misoprostol was initially marketed to prevent stomach ulcers, but health professionals discovered that it also stimulates contractions of the uterus, making it useful for treating and preventing PPH. A growing body of evidence has demonstrated that misoprostol is safe, effective and easy to administer. In settings with limited infrastructure and lack of skilled birth attendants, misoprostol may be a woman’s only chance for surviving PPH.
Updating the national EML is an important first step in ensuring access to essential maternal and reproductive health commodities. But advocates also need to hold the government accountable for actually providing a secure, high-quality supply of these medicines; advocates also need to ensure that work on EMLs links with other efforts, including sound supply chains, training, and on-going monitoring and evaluation.
To learn more about EML Search:
Visit EML Search.
Attend our webinar on EML Search June 8, 7 AM PDT/10 AM EDT/4 PM CET. Register here to attend.
Presenters and Topics
- Why EMLs Are Important for Ensuring Access – Shafia Rashid, FCI Program, Management Sciences for Health
- Demonstrating the EML Search database – Elizabeth Westley, ICEC
- Malawi’s Advocacy to Update the EML – Maziko Matemba, Health & Rights Education Programme (HREP Malawi)
- What’s Next? How EML Search can support advocacy – Sarah Rich, ICEC
**The 13 commodities included in the database include: contraceptive implants, cycle beads, diaphragm, emergency contraceptive pills, female condom, Levonorgestrel Intrauterine System, magnesium sulfate, manual vacuum aspiration, mifepristone and misoprostol for medical abortion, misoprostol, oxytocin, pregnancy tests for family planning, and progesterone vaginal ring.