Maternal Health Suppliesin Bangladesh and Uganda

Reproductive Health Supplies Coalition28 May 2010

Elizabeth Leahy MadsenJennifer Bergeson-LockwoodJessica Bernstein

Population Action International

Maternal Health Context

• Three delays: Deciding to seek care, reaching facility, receiving care

• Maternal mortality would have to decline 5.5% annually to achieve MDG5

• Supplies is one of the associated factors in improving maternal health outcomes

• Link between supplies and health system capacity

Maternal Health Supplies

• Four “tracer” supplies for maternal health

o Oxytocin for postpartum hemorrhage

o Misoprostol for postpartum hemorrhage

o Magnesium sulfate for pre-eclampsia and eclampsia

o Manual vacuum aspirators (MVA) for early and incomplete abortion

Magnesium sulfate, Uganda

Policy Environment

• Government support and political commitment

• National maternal health strategies and road maps reference supplies

• Some supplies on Essential Drugs Lists

• Strong policies do not translate into financial commitment or effective implementation

• Lack of quantified targets to measure improved access to supplies

Health System Structure

• Low rates of facility-based deliverieso 15% Bangladesh,

41% Uganda

• Expectation that supplies may be out of stock in facilities

• Varying levels of community-based care

• Major role of private sector: Perceived reliability for supplies and quality of care

Private sector hospital, Bangladesh

Financing of Maternal Health Supplies

• Little dedicated donor funding for maternal health supplies, unlike contraceptives and condoms

• Maternal health supplies aggregated with other costs and difficult to track

• Significant underspending of budget allocations despite frequent supply shortages

• Widespread unofficial user fees

Forecasting, Procurement and Logistics

• Lower likelihood of annual forecasting relative to family planning

• Importation challenges if no local manufacturing

• Limited procurement cycles

• Mismatch between quantification of orders and delivery

• Recent introduction of misoprostol

Joint Medical Store, Kampala

Civil Society and Development Partners

• NGO service providers expanding service provision of maternal health supplies

• Civil society provides technical guidance and a strong voice for advocacy

• Donor support through sector or budget frameworks

• Many large donor-funded projects focused on maternal health

Continuum of Care

• Integrated reproductive, maternal, newborn and child health care

• Increasing focus on integration of newborn health at policy level

• Facility capacity limited by human resource and shortages of supplies and equipment

• Need to maintain quality and coverage of interventions through scale-up

Advocacy Entry Points

• Implement and fund policies already in place

• Raise awareness and scale up community-based approaches

• Prioritize family planning

• Enhance the supply chain

• Monitor the national budget for maternal health

Moulvi Bazar, Bangladesh