Maternal Health

Maternal Health
Mothers listen to a health worker promote better and balanced nutrition for children and mothers at St. Pius Kidepo HC III in Moroto District, Uganda 2015. © UNICEF/Ose
The UN Commission on Life-Saving Commodities singled out three overlooked maternal health commodities that can treat and address the leading causes of death during pregnancy and childbirth:

  • Oxytocin and misoprostol to prevent and treat postpartum hemorrhage
  • Magnesium sulphate to treat severe pre-eclampsia and eclampsia — the dangerous elevation of blood pressure during pregnancy (hypertensive disorders of pregnancy) that can lead to seizures, kidney and liver damage, and death.

Together, these conditions account for almost half of maternal deaths. If these three medicines were available to every woman giving birth, 1.4 million women could be saved over ten years.

 

Pooling expertise on maternal health                                      

The Maternal Health Technical Resource Team, a group of health experts from 28 organizations, has been implementing the UN Commission’s recommendations  from 2012 to 2016 and worked to ensure that they are available in countries with a high burden of disease, put into the hands of skilled health workers and administered properly to save women and children. The expertise of the TRT members as well as the knowledge resources they have developed during this period are captured in the Life-Saving Commodities Practitioners’ Network.

The Maternal Health TRT, which has focused on increasing access to oxytocin, misoprostol and magnesium sulphate, now has joined forces with the Maternal Health Caucus of the Reproductive Health Supplies Coalition.   The merger heralds a new phase of work which promises to continue efforts to increase access to these three essential medicines, while also including new commodities critical for saving women, such as anti-hypertensives, blood pressure cuffs to address pre-eclampsia and eclampsia, among others. 

 

Progress to date

Oxytocin in the Cold Chain

  • The World Health Organization and UNICEF drafted a Joint Statement towards including oxytocin in the vaccine or EPI cold chain.  The Joint Statement, which the TRT helped developed, will soon be signed by both parties.  It encourages the safe, feasible, and cost-effective integration of health supply chains in support of the UN Commission on Life-Saving Commodities for Women and Children.
  • Additionally, MSH and PATH, two members of the TRTs, have completed work in Ghana and Mali that reviews the current practices regarding oxytocin in the cold chain and are beginning an “Options Analysis” to assist these countries in determining how best to include oxytocin in the cold chain.  The results will be shared globally to provide data for other countries to do the same.

Commodity Security for Maternal Health A maternal health commodity security framework and White Paper are now available for countries to identify weaknesses or gaps at various levels and functions of their health systems and develop strategies to overcome them. Once the framework is applied, countries can use it to monitor their progress toward attaining maternal health commodity security and to adapt or adopt the necessary changes for improvement. Ultimately, those tools should  help countries improve the availability of oxytocin, misoprostol, and magnesium sulfate.

Quality of maternal health drugs

Misoprostol

  • Concept Foundation is continuing to develop considerable evidence that several countries are either providing sub-standard misoprostol products through the public sector and/or have sub-standard products available in the private sector. Misoprostol degrades on exposure to humidity. The sub-standard products are a result of several factors: poor quality active pharmaceutical ingredients; poor control of the manufacturing environment and use of inappropriate blister packaging.

The only solution to this crisis is to ensure that all misoprostol products procured are products that have been approved by a stringent regulatory agency (SRA) or are WHO-prequalified.

  • Concept is working with UNFPA in three countries on the quality of misoprostol found in all distribution sectors in those countries. To date, there are two prequalified misoprostol products, while two other products which received technical assistance from Concept are currently under review by WHO-PQ and a third will be submitted by the end of 2015. By the end of 2015, there should be five misoprostol products prequalified, of which four will be affordable.

Oxytocin

Oxytocin is also a critical product, which is susceptible to heat and hence to degradation in the supply chain. Concept is currently working with UNFPA in three countries to ascertain the quality assurance issued related to oxytocin. As yet there are no products prequalified but both UNFPA and UNICEF are supplying SRA-approved products at an affordable price ($0.20-0.26/10IU ampoule). There are two oxytocin products under review by WHO-PQ. Concept Foundation is working towards getting three additional manufacturers prequalified in the coming year. There is also an issue of provision of the correct dosage of oxytocin. WHO recommends the use of 10IU products, however, in many countries it appears that the majority of products available are 5IU.

Magnesium sulphate     

Concept is presently talking to two companies about becoming pre-qualified for the production of magnesium sulphate, and will work with more in 2015.   Regarding the presentation of magnesium sulphate, the TRT is now working with the WHO to attempt a change of language and have the 5 gr in 10 ml = 50% w/v presentation to be included in the Essential Medicines List.

Improve the supply of maternal health commodities  The Maternal Health Technical Resource Team published an Inventory of Tools for Maternal Health Supplies. It compiles 52 tools to serve as a resource to countries looking to improve access to and use of maternal health medicines. The tools listed in the inventory include materials related to quantification and forecasting, inventory management, quality assurance, use, availability, procurement and supply planning and advocacy. The inventory is also published on the Reproductive health Supplies Coalition website.