"This is not just about getting quantities of drugs out, this is about saving women's lives with really simple products that work," said Julia Bunting, team leader of AIDS and reproductive health at the United Kingdom Department for International Development and coalition chair of the Reproductive Health Supplies Coalition, at the ninth meeting of the 2009-2010 Advancing Policy Dialogue on Maternal Health series. Joined by panelists Melodie Holden, president of Venture Strategies Innovations (VSI), and Elizabeth Leahy Madsen, senior research associate at Population Action International (PAI), the panel discussed the challenges and strategies for expanding access to maternal health commodities.
Integrating Maternal Health and Family Planning Supply Chains
"It is often said that the family planning and the maternal health communities have very different views of supplies… but actually [both communities] recognize that we need to explore the continuum," said Bunting, addressing the need to integrate maternal health commodities into existing reproductive health supply chains. "I really think the stars are aligned right now for advancing this agenda," added Bunting.
"Many of the commodities that we talk about in terms of reproductive and maternal health cost tiny amounts to deliver, but actually save lives and are some of the most cost-effective interventions we have both in public health and in broader development," said Bunting.
No Product, No Program
"Supplies are a key element in programs to improve maternal health and they are also a tangible and visible hook to increase awareness and commitment," said Madsen. "Policymakers whose eyes glaze over when they hear the term ‘health systems strengthening' can grasp… much better when they learn that supply shelves in clinics are bare and that women are making great efforts to reach facilities, only to leave empty- handed," said Madsen.
1. Oxytocin: used to treat and prevent post-partum hemorrhage
2. Misoprostol: used to treat and prevent post-partum hemorrhage
3. Magnesium Sulfate: used to treat pre-eclampsia
4. Manual Vacuum Aspirators: used for treatment of early and incomplete abortion
By focusing on supplies that target the three leading causes of maternal mortality, Madsen and her colleagues identified factors that inhibit access to these commodities and developed recommendations for strengthening maternal health supply chains.
Madsen identified several strategies to strengthen supply chains for maternal health commodities including forecasting and preparing for growing demand, advocating for government and donor support, encouraging scaling-up of community-based approaches, promoting family planning, and focusing on human resource training.
"In maternal health, if a supply to prevent or treat a life-threatening complication is in stock, there must also be a way for a woman to reach it in time… and in most cases a provider who knows how to administer it," said Madsen.
"This research is intended to lay the groundwork for future advocacy and policy initiatives by providing an evidence base that is informed by local expertise," said Madsen. "We hope that this information will inform program implementation, funding decisions, and awareness raising."
Getting the Product to People: The Case of Misoprostol
"The story of Misoprostol is still being written. The goal is to invest in creating access to interventions that are low-cost and relatively simple to use," said Holden. By sharing lessons learned, Holden described VSI's experience registering and procuring Misoprostol and demonstrated how community mobilization is imperative to overcoming major challenges for large-scale implementation.
"Making products available is not without challenges," said Holden. To increase access to Misoprostol in rural communities, maternal health experts must work to "engage communities, educate and mobilize women, train providers at all levels of the health care system, and provide support to distributors to jump start sales," said Holden. "By looking holistically across entire health systems, bringing in great interventions, addressing the components of supply and demand, and working with local partners, we can have lasting impact."
While the price of Misoprostol has decreased significantly, Holden stressed the need to identify creative ways along the supply chain that reduce costs to the end user. Additionally, "establishing policies around this new intervention not only establishes its reach, but also makes its use institutionalized, which means it will be part of the system even if governments or individuals change," said Holden.
"If there is a gap between what could be achieved with Misoprostol and what is being achieved, we need to go back to the model and figure out what pieces aren't working," concluded Holden. "The work is complex and takes time, but it's worth it."
Drafted by Ramona Godbole, and edited by Geoff Dabelko.