maternal health supplies in bangladesh and uganda reproductive health supplies coalition 28 may 2010...
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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
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