Improving Maternal Health: Strengthening Procurement Systems at the Subnational Level

Beth Yeager and Sheena Patel

Expanding access to essential maternal medicines saves mothers’ lives. But access to life-saving maternal medicines requires an effective supply chain that delivers the right medicines to the right people at the right times. In many countries, weak pharmaceutical management systems are unable to meet the challenges of providing access to these essential medicines. While efforts to date have been focused on providing support to strengthen national level programs and procurement practices, there is growing evidence that suggests local procurement (at the district or hospital level) of these essential medicines is common in many countries.

The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program developed a methodology and a set of tools to assess local procurement of maternal health medicines. Procurement is the step in the supply chain where forecasts and supply plans are used to  purchase products that are delivered to the point of entry. Unless procurement practices are efficient and effective, acquiring pharmaceuticals may be costly and disorganized, with the potential for stock-outs and the risk of procuring poor quality products.

SIAPS tested the assessment methodology and tools in Bangladesh, where it is working with the Ministry of Health and Family Welfare to strengthen procurement management systems. The assessment was performed to understand how local procurement practices affect access to quality maternal health medicines at the district level to stimulate a broader discussion about strategies to improve access to these medicines.

Specifically, the assessment (1) measured the availability of key maternal health medicines (oxytocin, misoprostol, and magnesium sulfate) at selected storage and health care; (2) evaluated local procurement practices at the district level for essential maternal medicines; and 3) compared local procurement practices against national and international standards and guidelines. The assessment also looked at maternal mortality rates, service delivery, and supply chain functionality.

The assessment in Bangladesh found that local procurement accounts for a substantial amount of maternal health medicines acquired at the district level. Further, the findings showed that local procurement of maternal health medicines:

  • Lacked coordination and information sharing between the national and subnational levels
  • Had no district-level guidance for qualification or local procurement of medicines
  • Provided insufficient training for the procurement committee members about quantification or procurement
  • Did not use standard evidence-based method for forecasting maternal health medicines at the district level
  • Resulted in higher cost for medicines at the district level compared to the national level

Additionally, there were problems with quality assurance such as tender documents lacking product specifications for cold chain storage of oxytocin and for double-sided aluminum packaging of misoprotol.

What can we do about strengthening local procurement practices to ensure better access to life-saving maternal medicines? Improving the coordination between the national level procurement system and the subnational level is essential. A key component in decision making is a robust pharmaceutical information system that provides accurate, useful, and current data. The system can only perform better when the supply chain staff are trained and supported. Quality assurance and control systems need to be refined. Last, there needs to be a holistic procurement strategy at both the national and subnational level that ensures access to life-saving maternal medicines.

Better access to maternal medicines will result in lower mortality rates for mothers. Investing in women’s health is not only the right thing do but brings incomparable dividends to the household, the community, and the nation.