Cross posted on Maternal Health Taskforce’s blog as part of the Maternal Health Commodities Blog Series.
By Beth Yeager, SIAPS principal technical adviser for maternal and child health.
Despite a decade of significant progress reducing maternal mortality rates, very few countries are on target to meet Millennium Development Goal #5A of reducing the maternal mortality ratio by three-quarters by 2015.
What is most alarming is that a large proportion of maternal deaths could have been avoided if women had access to adequate health services, where the necessary quality medicines and supplies were available and skilled health providers were present. The preventative and curative measures for the major causes of maternal deaths are well-known, but access to them remains elusive for many in low and middle-income countries.
Weaknesses in the overall health system – particularly related to governance, supply chain management, health information, and financing – prevent access to these supplies.
Governance for Health
Most essential maternal health medicines and supplies are generic products that are currently widely available in both the public and private sectors. However, these commodities often appear in differing formulations, presentations and quality. Ensuring access and availability of quality medicines and supplies in-country requires improving pharmaceutical policy, enforcing compliance with policies and procedures especially in procurement, and addressing regulatory components of the health system. Likewise, several key maternal health products are often only authorized for administration by highly skilled providers — despite evidence that administration by less skilled providers is both feasible and effective. These types of policies limit access to these products at higher level health facilities, thus limiting their availability at the lower level health facilities, or in the community. Smart governance for health would help improve the health system and access to medicines and supplies.
Supply Chain Management
The availability of maternal health medicines and supplies, such as oxytocin, magnesium sulfate and misoprostol, is hindered by the weaknesses often present in public sector systems. Poor quantification of requirements, inadequate pharmaceutical procurement mechanisms, poor distribution systems, inadequate storage facilities, and limited inventory tracking systems are all factors that currently affect availability of these products in the public sector. In the private sector, the low profit margins of products resulting from the widespread availability of generic formulations, and the availability of higher priced alternatives, which may not always be appropriate, affect their availability.
Health Information
The scarcity of information for decision-making at all levels is also a barrier to access to maternal health commodities. The lack of reliable morbidity data for conditions such as post-partum hemorrhage and pre-eclampsia/eclampsia, and the lack of personnel skilled in analyzing and utilizing the data make it difficult to accurately estimate demand for procurement purposes and identify gaps in coverage. The inadequate pharmaceutical information systems in most countries also affect the ability to effectively track inventory and use of the products once in the supply chain.
Financing
Public sector procurements for maternal health medicines and supplies are currently funded through public sector health budgets, instead of global initiatives, making them reliant on perceived national priorities and limitations in the funding mechanisms. The money allocated for the purchase of pharmaceutical products is often insufficient to meet current demands. These allocated funds usually are supplemented by funds generated from cost-recovery mechanisms that rely on the sale of these same products. The prioritization of what to purchase, when and in what quantities has to be done at health facility level by personnel who usually have limited skills and resources to do so rationally and effectively. When health facilities do not have funds to purchase essential supplies, households are asked to purchase them, driving out-of-pocket expenses for healthcare higher among those with the lowest disposable incomes.
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.
