Global Leaders in Maternal Newborn Health: Maria Fernandez Elorriaga (Mexico)

By Kayla McGowan, Project Coordinator, Women and Health Initiative, Harvard T.H. Chan School of Public Health

This article originally appeared on the Maternal Health Task Force blog.

In July 2016, global leaders gathered for the second annual Safe Mothers and Newborns Leadership Workshop (SMNLW) hosted by the Maternal Health Task Force (MHTF) in partnership with the Barcelona Institute for Global Health (ISGlobal) and The Aga Kahn University and sponsored by the Bill & Melinda Gates Foundation. The participants represented 26 countries from five continents.

Maria Fernandez Elorriaga (Mexico)SMNLW participant Maria Fernandez Elorriaga is the principal investigator and technical coordinator of a study investigating the use of the World Health Organization (WHO) Safe Childbirth Checklist to improve the quality of institutional delivery in Mexico. Maria is also co-investigator on two more studies of implementation science in maternal and perinatal care. In addition, Maria has worked as a primary and community care nurse in Spain, as a regional nutrition coordinator in Malawi and as child health and nutrition coordinator in the Sahrawi refugee camps in Tindouf, Algeria. Continue reading “Global Leaders in Maternal Newborn Health: Maria Fernandez Elorriaga (Mexico)”

Three barriers to delivering maternal health supplies and the solution

By Katharine McCarthy and Saumya RamaRao

Katharine McCarthy is Research Coordinator and Saumya RamaRao is Senior Associate at Population Council. This article originally appeared on the Maternal Health Task Force blog.

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:

  1. Market failures leading to an insufficient supply of quality drugs
  2. A weak regulatory environment leading to variability in drug formulation and quality
  3. 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:

Call for posts: How to increase access to maternal and reproductive health supplies

By Milka Dinev, Beth Yeager, and Katie Millar

Milka Dinev is the Latin America and Caribbean Forum Regional Advisor for the Reproductive Health Supplies Coalition. Beth Yeager is the principal technical advisor for maternal, newborn and child health for Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, led by Management Sciences for Health (MSH). Katie Millar is a technical writer for the Maternal Health Task Force (MHTF), where this article originally appeared

The Maternal Health Task Force (MHTF), the Reproductive Health Supplies Coalition (RHSC)/Maternal Health Supplies Caucus (MHS) and Family Care International (FCI) share the goal of increasing awareness of the key role that reliable access to quality maternal and reproductive health supplies plays in reducing maternal mortality. To this end, we’d like to invite you to contribute a post to our blog series, Increasing access to maternal and reproductive health supplies: Leveraging lessons learned in preventing maternal mortality.

women-mobile-clinicOur goal for this blog series is to create a platform for sharing innovative interventions, lessons-learned and opportunities for collaboration across various organizations and communities in terms of what can be done to ensure availability of quality maternal health supplies. The new global target of fewer than 70 maternal deaths per 100,000 births by 2030 makes timely access to quality maternal and reproductive health medicines and supplies for women even more critical.

Two of the major causes of maternal deaths are post-partum hemorrhage (PPH) and pre-eclampsia/eclampsia. Both conditions can be successfully managed with proven interventions that include administration of oxytocin and misoprostol in the case of PPH, and magnesium sulfate for pre-eclampsia and eclampsia.

Unfortunately, many health systems face challenges that limit access to these life-saving commodities. For example, in some cases there is insufficient funding for these medicines in national budgets, driving increased out-of-pocket spending. Likewise, regulatory agencies are sometimes unable to assure the quality of products circulating in the market due to funding and human resource constraints. Storage conditions remain inadequate for medicines with special storage requirements, like maintaining the cold chain. Lack of information systems that provide up-to-date, reliable data on supply availability further complicates the issue as managers are unable to make evidence-based decisions regarding supplies. Finally, demand side barriers exist as providers often lack appropriate guidance on the use of these life-saving supplies.

These challenges are not insurmountable. Indeed, many of these challenges have been successfully addressed in ensuring access to reproductive health commodities. The reproductive health community has worked for more than three decades to improve the quality of their supplies, strengthen the supply chains that deliver these supplies (mainly contraceptives) and create information systems that help managers make decisions regarding these supplies. Many of these lessons could well apply to increase accessibility and availability of quality maternal health supplies.

Questions and topics for potential guest posts:

  1. What are the barriers you face in ensuring mothers get the supplies they need? How has your work addressed the complicated interplay between contributing factors that attribute to a mother not receiving the life-saving medicine she needs?
  2. Are governments assuming responsibility for and taking the necessary actions to address maternal health supplies issues? What strategies have been successful to increase involvement of government in ensuring maternal health supplies?
  3. What have been successful strategies to reduce financial barriers to access maternal health supplies?
  4. What are lessons learned regarding supply chains for maternal health and information systems for their monitoring?
  5. How can we best prepare health providers to both use maternal health supplies correctly and advocate for their use?
  6. What strategies can be used to raise awareness of the importance of quality assurance among governments, health providers and women?
  7. How can we use the lessons learned by the reproductive health community to advance the maternal health supplies issues?

If your work involves other factors related to supplies, please feel free to propose an original topic.

General guidelines for guest blog posts:

  • Please include the author name, title, and photo
  • Goal: Guest posts should raise questions, discuss lessons learned, analyze programs, describe research, offer recommendations, share resources, or offer critical insight
  • Audience: The audience for this series is health and development professionals working in maternal and newborn health around the world, primarily in resource-constrained settings
  • Tone: Conversational. Does not need to meet professional publication standards
  • Feel free to choose your own style or approach. Q/A and lists (e.g. top ten lessons) can often be effective ways of organizing a blog post
  • Length: 400-600 words
  • No institutional promotion
  • Please include links to sources such as websites and/or publications
  • May also include photos and videos, please include a caption and a credit for the photo

To contribute a post to this series, please contact, Katie Millar, at kmillar@hsph.harvard.edu.

Submissions to this series will be reviewed and accepted on a rolling basis, but preference will be given to posts received by March 30th, 2014.

Posts in this series will be shared on the MHTF blog and may be cross-posted on other leading global health and development blogs.

Thank you for considering contributing to our series. We look forward to hearing from you soon!

Photo credit: Mobile Clinic Medical Day in Azbat Jarrad © 2010 Physicians for Human Rights – Israel, used under a Creative Commons Attribution license: https://creativecommons.org/licenses/by/2.0/

“Improving Access, Saving Lives: Essential Maternal Health Medicines” Twitter Expert Hour

Every two minutes, a woman in a developing country dies from pregnancy and childbirth complications. Postpartum hemorrhage (PPH) and pre-eclampsia/eclampsia (PE/E) are the leading causes of maternal death. Although these conditions are preventable, too often life-saving medicines do not reach women in developing countries.

On September 26th, Family Care International, USAID’s Maternal and Child Health Integrated Program (MCHIP), PATH, and Jhpiego hosted a Twitter expert hour to discuss how increasing access to simple, affordable maternal health commodities — misoprostol, oxytocin, and magnesium sulfate — has the potential to save millions of women’s lives.

MCHIP Maternal Health Team staff Sheena Currie and Jeff Smith led the Twitter conversation on misoprostol; PATH’s Maternal, Newborn, and Child Health Program Leader Catharine Taylor discussed oxytocin; and Jhpiego and Jeff Smith tweeted about magnesium sulfate. The Twitter chat stimulated an exchange of compelling information and evidence and generated provocative questions from the community. You can check out the discussion in the Storify below and continue the conversation by visiting Twitter and including #supplylife in your tweets.