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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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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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