Let’s reward the use of maternal health supplies

By Milka Dinev, LAC Forum Regional Advisor, Reproductive Health Supplies Coalition 

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

During a donor visit to Peru in the year 2000, a maternal health supporter and friend saw that rural women in Peru were suffering and dying because they lacked access to safe maternal health services during the critical hours of childbirth. This young donor had recently had her children, so she decided to reward the unsung heroes who made extraordinary efforts to save the lives of women during childbirth. It would be the “Oscar” of maternal health and survival.

The Sarah Faith Award was created to promote and reward the extraordinary efforts made by health providers and communities to save the lives of mothers and their children. For ten years, this award provided funding and technical assistance to the health teams and communities that had demonstrated teamwork and solidarity. Most cases were heroic efforts – transporting a mother to a rural health facility on the shoulders of four or five men using a stretcher made of wood and blankets (or in a boat along the Amazon River) or a doctor/nurse giving his or her own blood for a much-needed transfusion. The award honored deserving teams with US$25,000 to improve their health facilities or their community services. This award was an extraordinary tool to improve morale among health providers and health promoters. Each winning team received a beautiful statue that they prominently displayed in their facility.

Yet, it is worthwhile to observe that an important selection criterion for the Sarah Faith Award is how applicants improved access to maternal health services. So what happens to women who do not have access to such heroes as the ones the Sarah Faith prize rewards? I do believe this is where supplies come into play, carrying out a crucial, lifesaving role. How many lives could be saved if pregnant women had free access to misoprostol in order to prevent postpartum hemorrhage during their home delivery, or if the nurse in the health facility could administer magnesium sulfate to women with pre-eclampsia to control their blood pressure? How many lives could be saved if oxytocin supplies were adequately refrigerated?

Arguably, services — with their immediate human element — make for better story-telling a lot of the time. And good storytelling is a mainstay of the marketing and publicity that surround award mechanisms. And by comparison, supplies often carry rather sterile connotations of warehouses, supply chains, and transportation.

Working at the Reproductive Health Supplies Coalition, I am often struck by the challenge of even finding a photo that adequately tells the supplies story. And yes, there is a supplies story however, there is no “supplies award”. There is very little we do in promoting morale and engagement among those that work to make supplies available, accessible and  affordable within a framework of quality and equity!

As far as maternal health supplies go, it is easy for groups to forget the role of the three key life-saving commodities and therefore fail to prioritize their presence in health facilities 100% of the time. Much of the assistance provided through the Sarah Faith Award was directed to the direct provision of these commodities: a good fridge for the oxytocin (and vaccines of course) and a training package to update providers on the use, dosage and storage of these supplies.

The Family Planning Community has this saying “no product no program”. It is time to start using a similar phrase that includes maternal health supplies as part of a holistic approach to safe motherhood.

 

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 CaucusFamily Care International and the USAID-Accelovate program at Jhpiego 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.

 

 

The myth of the meager maternal health market

By Deepti Tanuku, Program Director, USAID-Accelovate

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

pakistan mother maternal health quality care facility smile woman pakistani
Mother in Sindh, Pakistan receiving quality care. Photo: Jhpiego.

When I first entered this line of work, I often heard one thing: the maternal health market is way too small to be sustainable, much less lucrative. Naturally, one can only expect market failure for maternal health drugs and, by extension, a chronic situation of limited access to lifesaving medicines among those most in need.

However, I disagree.

The maternal health market is, of course, comparatively small when looking at the parallel markets for reproductive health, HIV, TB, malaria and even child health.

Take malaria for example. Prepared technical guidance provided by the President’s Malaria Initiative states that the unit cost for delivery of long-lasting insecticidal nets (LLINs) provided free of charge through antenatal clinics in four countries ranged from US $1.61 to $2.35 – which is roughly equivalent to the unit cost of US $1.50 for a delivery package of the three essential maternal health medicines: oxytocin, misoprostol and magnesium sulfate. However, in 2014 an estimated 214 million long-lasting insecticidal nets were delivered to malaria-endemic countries in Africa, while only 36 million women gave birth in the same region that same year. As any business school student can tell you, applying the formula of Price x Quantity = Revenue means that the maternal health market simply doesn’t compare in size.

This is the origin of the myth. For those of us committed to the goal of improved maternal health, we cannot confuse a small market with an unhealthy market – small can still mean healthy. Small can and should still mean a consistent and sustainable supply of high-quality and affordable maternal health drugs to all mothers in all settings.

There is a catch. The maternal health community cannot wait for market realities to drift toward our favor – we must actively and purposefully shape them. This begins with strong political will at both global and national levels. The creation of the UN Commission on Lifesaving Commodities for Women and Children is an excellent start, as is the inclusion of maternal health within the Reproductive Health Supplies Coalition (RHSC) agenda. These actions complement the ongoing efforts of other groups in this space, including the Maternal Health Task Force, itself.

The good news is that in the context of strong political will, there is plenty of research to shape evidence-based next steps. Together, we have built a clear understanding of market access barriers and we even know ways to incentivize around them. We also have market shaping strategies from other priority health areas, such as family planning, that serve as blueprints that we can adapt for our own purposes. As the maternal health community, it is up to us to use these tools to advocate for and help ourselves.

Finally, it’s good to revisit why this issue is critically important. Several studies and reports have demonstrated time and time again that healthy mothers strengthen families, societies and a nation’s economic development, which, in turn, strengthen a nation’s markets. Let’s say that again: Healthy mothers strengthen markets. It’s time markets returned the favor.

Resources used in the writing of this post:

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 CaucusFamily Care International and the USAID-Accelovate program at Jhpiego 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.

Improving Access to Maternal Health Commodities through a Systems Approach: Where are we now?

 

By Beth Yeager, Principal Technical Advisor, Management Sciences for Health & Chair, Maternal Health Supplies Caucus, Reproductive Health Supplies Coalition. This post 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 CaucusFamily Care International and the USAID-Accelovate program at Jhpiego 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.

Nearly three years ago, I blogged about a systems approach to improving access for a Maternal Health Task Force (MHTF) series on maternal health commodities:

Increasing access to essential medicines and supplies for maternal health requires a systems approach that includes: improving governance of pharmaceutical systems, strengthening supply chain management, increasing the availability of information for decision-making, developing appropriate financing strategies and promoting rational use of medicines and supplies.

It was an exciting year for maternal health. The UN Commission on Life-Saving Commodities for Women and Children (UNCoLSC) had just released its report with 10 recommendations for improving access to 13 priority commodities that included 3 for maternal health: oxytocin, misoprostol and magnesium sulfate.  The UNCoLSC report also reflected the idea that a systems approach was necessary and included recommendations related to both upstream and downstream supply chain bottlenecks, information, financing and appropriate use. That same year, the Maternal Health Supplies Caucus of the Reproductive Health Supplies Coalition held its first membership meeting in October for the purpose of joining the maternal health and family planning communities to “draw on existing approaches to address the bottlenecks undermining commodity security across health systems.”

Since then, great progress has been made in identifying the bottlenecks to access, raising awareness of the complexity of addressing these challenges and increasing global commitment to ending preventable maternal deaths as part of the post-2015 development agenda.

Improving governance

With respect to governance, through the efforts of the UNCoLSC to promote coordinated national strategies for Reproductive, Maternal, Newborn and Child Health (RMNCH), the need for coordinated planning among all stakeholders, including measures of accountability, has come to the forefront.

Reviewing national policies — such as the essential medicines lists and standard treatment guidelines — and advocating for the inclusion of the three priority maternal health medicines in these policies has raised awareness of both the need to harmonize policies at the national level and the challenges to implementing these policies.

Recognition of the importance of the regulatory role governments play in ensuring the quality of products in circulation in the public and private sectors has also grown. In a recent study conducted by the USAID-funded Systems for Improved Access to Pharmaceuticals and Services program (SIAPS) in Bangladesh, we found that over 40% of the oxytocin in circulation at the district level was procured from local wholesalers.

Strengthening supply chain management

In terms of supply chain challenges, resources are now available to assist countries in more accurate forecasting for maternal health medicines. The Estimation of Unmet Medical Need for Essential Maternal Health Medicines developed by SIAPS (a project led by Management Sciences for Health with partners) presents an approach that allows national program managers and other key stakeholders to assess a country’s theoretical need for the three maternal health commodities and compare this with actual procurement data from past years in an effort to make more evidence-based decisions. The RMNCH quantification guidance developed by the Supply Chain Technical Resource Team of the UNCoLSC also includes the three maternal health medicines.

Information for decision making

Over the past three years, we have also learned how little information is readily available about these commodities and the conditions they are meant to treat at the country level. In many cases, logistic management information systems do not capture these three products (and many others necessary for maternal health). Likewise, health information systems do not necessarily capture the number of women who develop post-partum hemorrhage and are successfully treated. Efforts are currently underway in a number of countries to address this problem.

The global community has learned a lot these past three years and made great progress in further revealing the actions required to increase access to quality medicines and supplies for maternal health. With the current proposed target of ending preventable maternal deaths by 2030, global and national stakeholders need to continue their coordinated efforts to build stronger, more responsive systems.

Beth Yeager, MHS, is Principal Technical Advisor, SIAPS program, at Management Sciences for Health (MSH), Chair Maternal Health Supplies Caucus, Reproductive Health Supplies Coalition

Making connections: Ensuring access to reproductive and maternal health supplies

Shafia Rashid is Senior Program Officer for Global Advocacy at Family Care International. This post 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 CaucusFamily Care International and the USAID-Accelovate program at Jhpiego 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.

The past ten years have witnessed impressive gains in the availability and use of reproductive health supplies like condoms and oral contraceptives that allow men and women to safely and effectively prevent or space pregnancies. As a result of concerted efforts by many partners, contraceptive prevalence rates have risen over 60% in countries around the world.

These dramatic successes in improving access to reproductive health supplies can shed important lessons and guidance for those working to ensure that life-saving maternal health medicines — including, oxytocin, misoprostol and magnesium sulfate — are available to all women, when they need them and wherever they give birth. These medicines — which can save lives by preventing or treating the leading causes of maternal death — remain out of reach for many women, particularly for poor, rural, indigenous and other vulnerable women. Many countries lack clear, supportive policies and adequate budgets to make essential maternal health medicines widely available, or have weak supply chains and logistical systems. Inadequate regulatory capacity, poor quality of medicines and lack of information and guidance on correct use are other barriers to access.

In order to summarize lessons learned and provide concrete tools to improve access to maternal health supplies, the Reproductive Health Supplies Coalition tasked Family Care International to create seven policy briefs that show policy makers and program managers real-world examples of successful interventions. Importantly, there is a brief dedicated to each of the three most critical maternal health supplies: oxytocin, misoprostol and magnesium sulfate. Other briefs cover the cross-cutting issues of policy and financing, supply and demand generation.

Lessons learned from successful efforts to improve access to family planning commodities can help to effectively address the challenges related to maternal health medicines. Family planning advocates have, for example, tracked government expenditures on reproductive health supplies: in Indonesia, budget analysis and concerted advocacy led the mayors of five districts to increase their family planning budgets by as much as 80%. Similarly, many countries — including Bolivia, the Dominican Republic, El Salvador, Honduras, Nicaragua and Paraguay — have established contraceptive security committees that bring together multiple supply chain stakeholders to support coordination, address long-term product availability issues and reduce duplication and inefficiencies. These committees have advocated for increased financial support for contraceptives, improved inventory management, developed standard operating procedures, published reports and provided technical assistance. These efforts to increase budgets and ensure commodity security for contraceptives can be effectively adapted and expanded to improve financing and security for maternal health supplies as well.

A wide range of tools and resources can support countries in strengthening their forecasting, procurement and other supply chain functions. Tools originally developed with a sole focus on reproductive health supplies now include or can be adapted to apply to maternal health supplies as well and can be used by country managers working to improve the supply of maternal health medicines.

Finally, many countries are moving toward integrating their supply chains to include family planning commodities and other essential medicines, including medicines for maternal health. In Ethiopia, for instance, the government (with the support of in-country partners) integrated their supply chain to include all health commodities and to connect all levels of the supply chain with accurate and timely data for decision-making. In Nicaragua, where the supply chain was separated vertically by health issue and type of commodity until 2005, the health ministry has integrated the essential medicines system with the contraceptives’ supply chain and has now fully automated the system and expanded it to include all essential medicines.

There are many parallels and potential synergies between reproductive and maternal health supply chains and processes. The reproductive and maternal health communities must take the following actions to address the interrelated barriers that prevent access to and use of life-saving commodities:

  • Advocate for development and implementation of supportive policies at the national and sub-national levels,
  • Advocate for dedicated budget lines to enable monitoring and evaluation of policy implementation
  • Improve government systems and procedures for procuring high-quality medicines and maintaining their quality throughout the supply chain
  • Invest in a streamlined, coordinated supply chain across sectors and levels, reducing inefficiency and duplicative efforts
  • Strengthen the knowledge and skills of health providers so that they are aware of evidence-based policies and guidelines and can effectively administer these essential medicines

More information can be found in Essential Medicines for Maternal Health: Ensuring Equitable Access for All, a set of briefs that highlight challenges and strategies for increasing the availability of these maternal health medicines and identify linkages with reproductive health supplies. You can download the Essential Medicines for Maternal Health policy briefs in English, French and Spanish.

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/

Maternal health supplies ARE reproductive health supplies

Shafia Rashid is senior program officer for global advocacy at Family Care International.

In late October, the Reproductive Health Supplies Coalition (RHSC) held its annual membership meeting in Mexico City. Representatives from governments, international organizations, pharmaceutical companies, and civil society came together to press for greater and more equitable access to reproductive health supplies. The RHSC’s focus includes family planning commodities, such as condoms, oral contraceptives, and other methods that allow men and women to safely and effectively prevent or space pregnancies.

MH supplies briefs coverThis was my first time attending the annual RHSC meeting. I was there because the Coalition has expanded its mandate to explicitly address maternal health supplies. Earlier this year, it commissioned FCI to develop a series of seven policy briefs, Essential Medicines for Maternal Health: Ensuring Equitable Access for All, which were launched at the Mexico City meeting. These briefs highlight challenges and strategies for increasing the availability of three maternal health medicines – oxytocin, misoprostol, and magnesium sulfate – and:

  • Make the case for increasing priority and investment in these medicines
  • Provide examples of successful strategies from around the world
  • Highlight linkages with reproductive health supplies

A special plenary session addressed this crucial question: How are maternal health supplies reproductive health supplies? This sparked a wide-ranging, engaging, and very interesting discussion. Here are some of the key points that emerged:

  • Many countries can already see clear value in linking reproductive and maternal health supplies, and are moving toward integrating their supply chains to include family planning commodities and essential medicines, including medicines for maternal health. In Ethiopia, for instance, the government (with the support of in-country partners) integrated their supply chain to include all health commodities and to connect all levels of the supply chain with accurate and timely data for decision-making. In Nicaragua, where the supply chain was vertical until 2005, the health ministry has integrated the essential medicines system with the contraceptives’ supply chain, which has now been automated and expanded to include all essential medicines.
  • The RHSC and other partners have developed a wide range of tools and resources to support countries in strengthening their forecasting, procurement, and other supply chain functions. Tools originally developed with a sole focus on reproductive health supplies now include or can be adapted to apply to maternal health supplies as well, so they can now be used by country managers working to improve the supply of maternal health medicines.
  • Lessons learned from successes in improving access to family planning commodities can help us to effectively address the challenges related to maternal health medicines. Family planning advocates have, for example, tracked government expenditures on reproductive health supplies: in Indonesia, budget analysis and concerted advocacy led the mayors of five districts to increase their family planning budgets by as much as 80%. Similarly, many countries — including Bolivia, the Dominican Republic, El Salvador, Honduras, Nicaragua, and Paraguay – have established contraceptive security committees that bring together multiple supply chain stakeholders to support coordination, address long-term product availability issues, and reduce duplication and inefficiencies. These committees have advocated for increased financial support for contraceptives, improved inventory management, developed standard operating procedures, published reports, and provided technical assistance. These efforts to increase budgets and ensure commodity security for contraceptives can effectively adapted and expanded to improve financing and security for maternal health supplies as well.

Many parallels and potential synergies exist between maternal and reproductive health supplies, and the reproductive and maternal health communities must take action to address the interrelated barriers that prevent access to and use of life-saving commodities. These actions include:

  • Advocating for development and implementation of supportive policies at the national and sub-national levels, and for dedicated budget lines to enable monitoring and evaluation of policy implementation
  • Improving government systems and procedures for procuring high-quality medicines and maintaining their quality throughout the supply chain
  • Investing in a streamlined, coordinated supply chain across sectors and levels, reducing inefficiency and duplicative efforts
  • Strengthening the knowledge and skills of health providers so that they are aware of evidence-based policies and guidelines and can effectively administer these essential medicines

→ For more information, you can download the Essential Medicines for Maternal Health policy briefs here.

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Panelists at the plenary session, RHSC annual meeting, October 2014 Photo: RHSC

“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.