Tag Archives | B Yeager

Guidance on Elements to Consider when Planning for the Integration of Oxytocin into the EPI Cold Chain

The purpose of this document is to provide guidance to national program managers who are considering integrating oxytocin into the EPI cold chain. It is intended for representatives from relevant offices of the Ministry of Health (MoH), such as Pharmacy, Central Medical Stores, and Maternal and Child Health, as well as other policy makers, stakeholders, and implementing partners.

This guidance document introduces the pharmaceutical management elements that must be considered to successfully integrate oxytocin into the EPI cold chain and outlines the steps that will help national program managers plan the integration processes and strategies. Integrating oxytocin into the EPI cold chain may affect several elements within the pharmaceutical management cycle, from distribution systems, inventory management, and logistics management information systems and reporting procedures to roles and responsibilities, health facility infrastructure, and monitoring and evaluation. Some elements of the pharmaceutical system are afterthoughts that are only considered when challenges arise during implementation. Taking into account all elements that will be impacted by integrating oxytocin into a supply chain will not only help identify issues but also address needed changes in standard operating procedures and at the various stages of the supply chain. It is important to consider each element and address it in the strategy and implementation plan to ensure that oxytocin integration into the EPI cold chain is successful.

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Guidance for Planning the Introduction of New Reproductive, Maternal, Newborn, and Child Health Medicines and Supplies

The purpose of this document is to provide guidance to program managers in ministries of health at national and sub-national levels as well as personnel in other interested organizations on actions to take and factors to consider when expanding access to essential RMNCH commodities. While this document focuses on RMNCH medicines and supplies, it may be used as a guiding document and planning tool for other essential medicines and supplies. This guide addresses several pharmaceutical management issues (pharmaceutical policies, effective medicine management, strengthening regulatory systems, information needs, and product quality and safety practices) that are often overlooked when considering the introduction of new products. The systems strengthening approach described in this document focuses on governance, human resources, information systems, financing, and service delivery, with the provision of medical products cutting across these sub-systems. The goal of this guidance document is to assist managers to systematically plan for the successful introduction of new medicines and supplies by harmonizing and aligning efforts among all stakeholders involved in the process.

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Building Systems for Access and Appropriate Use of iCCM Medicines

Briggs J, Yeager B, Diarra S. Building Systems for Access and Appropriate Use of iCCM Medicines. This seminar was presented as part of the 2016 USAID Global Health Mini-University. For more information on the Mini-University, visit www.mini-university.com.

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Options Analysis for Integration of Oxytocin in the EPI Cold Chain in Mali

The Maternal Health Technical Resource Team (MHTRT) of the UN Commission on Life-Saving Commodities for Women and Children has been exploring strategies to increase access to quality oxytocin, including advocating for the integration of oxytocin in the existing cold chain for the Expanded Programme on Immunization (EPI).

Some countries, such as Mali and Ghana, have attempted integration in some areas of the country already and have experiences that can help answer that question. PATH and the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program recently prepared case studies on these countries that describe the extent to which integration was achieved. In neither case was integration systematic; it occurred spontaneously and out of necessity at points along the distribution chain.

The purpose of this activity is to work with national stakeholders to identify and analyze feasible and acceptable options for the integration of oxytocin in the EPI cold chain at key points along the distribution chain and to develop guidance on the operationalization of such integration.

A team composed of an international consultant, a national consultant, two representatives from the Directorate of Pharmacy and Medicines (DPM) and the SIAPS-Mali team worked together in the preparation and organization of workshops.

During the preparatory phase of the two working meetings, the team developed the terms of reference, the letter of invitation, and the agenda of the working meetings and presentations and agreed on the profile of the participants for the working meetings.

The methodological approach was the same for both working meetings, namely presentations followed by discussion and group work, summarized in a plenary session.

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Ensuring Access to and Appropriate Use of Medicines for iCCM: It takes a system

Briggs J, Joshi MP, Yeager B, Diarra S. Ensuring access to and appropriate use of medicines for iCCM: It takes a system. Oral presentation at the 143rd American Public Health Association (APHA) Annual Meeting and Expo, Chicago, IL, USA. November 3, 2015.

 

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Integration of Oxytocin into the Cold Chain of the Expanded Programme on Immunization: Case of Mali

Postpartum hemorrhage (PPH) still remains one of the major causes of maternal mortality, accounting for 35% of all maternal deaths. The World Health Organization (WHO) has recommended oxytocin as the most effective medicine for the prevention and treatment of PPH, particularly for facility-based births. Most countries include oxytocin on their essential medicines lists (EML) as the medicine of choice for prevention and treatment of PPH. In most countries, everal oxytocin products are registered. Despite this positive policy framework for oxytocin use, supply chain barriers that limit access to the medicine still persist in many countries. Inadequate forecasting of requirements, weak information systems, and poor distribution practices, and inability to maintain proper storage conditions—temperatures between 2 and 8 °C—throughout the supply chain are all factors contributing to this lack of availability.

In practice, in countries where the average temperature is above 30 °C and where adequate infrastructure for cold chain management is often lacking, maintaining the required storage conditions for oxytocin is a challenge. As a result, oxytocin is often provided by service delivery points outside of a temperature-controlled cold chain, compromising its effectiveness and shelf life. In most countries, EPI cold chains are highly effective in reaching even the lowest levels of the health system.  However, they are managed vertically, separately from other essential commodities. One of the barriers to integrating other products into the EPI cold chain is the perception at the country level that this is not permitted. However, some countries, such as Mali, have already attempted integration in some areas of the country and have experiences that may be useful.

The main objective of this activity was to document how oxytocin is currently distributed in Mali so that the experience may be used as a case study to inform how the integration of oxytocin into the EPI cold chain may be achieved.

 

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Subnational Procurement of Maternal Health Medicines: Results from an Assessment in Bangladesh

SIAPS has developed a methodology and a set of tools to assess the effect of local procurement on the availability of maternal health medicines. SIAPS validated these assessment tools in Bangladesh to allow a broader discussion about potential strategies to improve access to maternal health medicines and to understand how local procurement practices affect access to quality maternal health medicines at the district level.

Specifically, the assessment (1) measured the availability of maternal health medicines at selected storage and health care facilities to determine the medicines’ source, (2) evaluated local procurement practices being used at the district levels for essential maternal health commodities, and (3) compared those practices with national and international standards and guidelines. The results further identified options for strengthening local procurement practices and overall procurement strategies.

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Estimation of Unmet Medical Need for Essential Maternal Health Medicines

An alarming number of countries are not on target to meet Millennium Development Goal to reduce maternal mortality despite efforts and investments made at both the global and national levels. Increasing access to and use of essential commodities for maternal health have recently gained attention as key concerns of several international initiatives. The United Nations (UN) Commission on Life-Saving Commodities for Women and Children acknowledges supply and demand challenges as among the main barriers to access and use of these life-saving commodities.

A basic step in improving access to these commodities is making sure they are available where and when women need them. This requires proper supply planning which, for various reasons, has been a challenge in procuring essential maternal medicines.

The purpose of this document is to present an approach that will allow national program managers and other key stakeholders to assess a country’s theoretical need for the three overlooked life-saving maternal health commodities–oxytocin, magnesium sulfate, and misoprostol–and compare this with actual procurement data.

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