Each year, 289,000 women die from childbirth- or pregnancy-related causes, and 5.9 million children die from largely preventable causes such as pneumonia and malaria. To end preventable child and maternal deaths, medicines and supplies must be available when and where they are needed without causing financial hardship. This requires a strong pharmaceutical system that ensures the availability of both appropriate medicines and service providers at service delivery points. The Millennium Development Goals (MDGs), which included a focus on decreasing maternal and child mortality, were generally successful. Globally, maternal mortality fell below 45%, and child mortality decreased by 53%. However, only 6 of the 75 project countries were on track to meet the goal of reducing maternal mortality, and 25 were on track to meet the required child mortality reductions.
As the MDGs concluded in 2015, countries, donors, and partners launched the Sustainable Development Goals. These goals are more ambitious and comprehensive than the MDGs and require more focused, systems strengthening efforts. Maternal, newborn, and child health (MNCH) is part of the goal to ensure healthy lives, including “quality essential health care services and medicines and vaccines for all” by 2030.
The SIAPS Approach
The Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program and its partners worked to improve women’s and children’s access to and use of life-saving medicines. Through a systems strengthening approach, SIAPS went beyond addressing supply chain challenges to incorporate interventions that benefit the whole system, including strengthening pharmaceutical legislation and policies and supporting community case management (CCM) and patient-centered care.
At the global level, SIAPS raised awareness of the barriers to essential maternal and child health commodities by participating on various technical reference teams (TRTs) for the United Nations Commission on Life-Saving Commodities for Women and Children (UNCoLSC), the Reproductive Health Supplies Coalition, and the Community Case Management Task Force, among others. At the country level, SIAPS worked to implement customizable tools and job aids, develop standard treatment guidelines, and streamline pharmaceutical management information systems for evidence-based decision making.
Beginning in 2012, SIAPS supported UNCoLSC with TRTs. The supply chain TRT and SIAPS worked with other partners to develop quantification guidance on UNCoLSC’s 13 life-saving reproductive, maternal, newborn, and child health commodities and program briefs on supply chain management best practices. SIAPS also supported the maternal health TRT to produce an inventory of tools to increase access to and improve the use of maternal health supplies and to conduct an options analysis and develop a case study on integrating oxytocin in the vaccine cold chain in Mali, as well as a guidance document for program managers. Through its support of the pneumonia and diarrhea working group, SIAPS validated job aids and dispensing envelopes in DRC and conducted a landscape analysis for treating sepsis in newborns.
In addition, SIAPS developed innovative tools and resources to assist countries in ensuring access to MNCH commodities. These included methods to estimate the need for maternal health medicines to assist in quantification and procurement; guidance for planning the introduction of new RMNCH medicine and supplies; tools to assess the subnational procurement of MNCH in Bangladesh and in Kenya medicines; and a district-level guide to developing interventions that will improve the availability and use of medicines for childhood illness. A major barrier to access to RMNCH commodities is sufficient financing. SIAPS conducted a mapping of the financial flows and bottlenecks for MNCH commodities in four countries.
As chair of the supply chain management subgroup of the CCM task force, SIAPS coordinated activities to raise awareness of management of pharmaceuticals for iCCM and to provide resources, including a series of webinars and other documents such as resupply tools. As part of the iCCM financing task team, SIAPS led work on developing procurement supply management guidance documents for countries navigating mobilization of Global Fund resources for iCCM implementation.
To assist countries in ending preventable child and maternal deaths, SIAPS supported a systems strengthening approach to addressing barriers to access. For example, SIAPS assisted the Ministries of Health in Guinea and Burundi to improve access to treatment for children under 5 years of age through CCM and in DRC to increase access to life-saving commodities for women and children. In Burundi, SIAPS focused on maintaining the supply chain for community health workers and the quality of care provided; contributed to protocols, job aids, and other tools; and conducted an evaluation of CCM of malaria that included a costing study component.
Support to the Global Financing Facility (GFF)
SIAPS seconded a staff member to the GFF for the first five months of a 12-month consultancy committed by USAID to the GFF secretariat. The objective of this one-year technical assistance is to provide support and overarching guidance on RMNCAH commodity financing and supply chain management approaches to the GFF secretariat and the now 26 participating countries through a combination of in-person technical support, the development of global guidance, and the identification of technical partnerships to ensure scalability. Among other activities, the 10 new GFF countries were oriented on commodity management by the SIAPS consultant as part of an orientation workshop in Ghana in February 2018 and were encouraged to consider commodity management among their priorities in the investment case. Under the GFF ongoing knowledge management and learning agenda, SIAPS hosted a webinar for country teams from the 16 existing GFF countries on commodity management, highlighting the importance of strengthening pharmaceutical systems using GFF investment cases rather than just focusing on logistical challenges, reflecting the SIAPS approach.
- Guidance on Elements to Consider When Planning for the Integration of Oxytocin into the EPI Cold Chain
- Guidance for Planning the Introduction of New Reproductive, Maternal, Newborn, and Child Health Medicines and Supplies
- Inventory of Tools for Maternal Health Supplies
- Promising Practices in Supply Chain Management
- Quantification of Health Commodities: RMNCH Supplement (available in English and French)
- Facilitating Adherence to Amoxicillin Dispersible Tablets for the Treatment of Childhood Pneumonia
- Estimation of Unmet Medical Need for Essential Maternal Health Medicines (available in English and French)
- Improving Medicines Access and Use for Child Health: A Guide to Developing Interventions
- SIAPS has showcased the importance of a systems approach in several global forums including: APHA and Mini-U.