Limited access to quality-assured essential medicines is a common problem across the globe. Quality assurance requires strong commitment to quality-assured manufacturers, wholesalers and ongoing quality testing. For relatively inexpensive maternal commodities, such as oxytocin, that are critically important—but not used in high volume—there is little financial incentive for private health sector involvement and more reliance on the public sector to manage procurement. For example, for every pregnancy in Kenya, there are 12 cases of diarrheal disease, and thus treatment with ORS will require more doses, and perhaps lead to greater profitability, than treatment with oxytocin. Thus, quality-assured oxytocin should be a key commodity in national procurements.
The inclusion of oxytocin in national procurements varies significantly; however, in a few sub-Saharan African countries the quantities of procured oxytocin came close to reaching (or exceeding) the estimated number of treatments that would be required in the country to meet need. The need was estimated by using the approach described in the UNCoLSC quantification guidance1.
|Country||Approximate number of doses (of 10 IU injectable oxytocin)||Estimated need for oxytocin|
|Ethiopia||2.5 million||1.24 million|
|Kenya||3.5 million||1.35 million|
|Tanzania||1.5 million||1.78 million|
|Uganda||1 million||1.3 million|
For the oxytocin nationally procured in these six countries, over 90% of the oxytocin was found in the recommended 10 IU dose. In a broader survey of 16 country programs in sub-Saharan Africa, approximately 75% of the oxytocin was found in the 10 IU dose (the remainder found in the 5 IU dose). Assessing the dosing of oxytocin is important since the 10 IU dose provides more efficiency in the distribution of oxytocin.
For countries that reach this level of national procurement of quality-assured oxytocin, other aspects of supply chain and demand creation can become the focus of programs working to achieve public sector availability. For example, key focus areas might include highly effective procurement with volume pricing and quality assurance, education of health care workers, in-country distribution networks and tracking systems.
After assessing the availability of oxytocin, there are additional questions we must ask:
- Is the use of oxytocin widely known by health providers and is it included in treatment guidelines?
- How widely is the oxytocin distributed to health facilities?
- How many of the health facilities, which could utilize oxytocin, are able to assure cold storage?
- What percentage of the oxytocin doses meet quality assurance guidelines?
The quantification methodology used here assumes that there is a 1:1 match between the need and the availability. Even with sophisticated distribution channels, we do not assume that every pharmaceutical dose will reach a patient in need. Most commodity supplies must exceed the doses required by patients to ensure that every facility has stock. Finally, these doses counted for this study did not include any measure of quality assurance, which may also influence the final utility of these medicines, particularly for a commodity that requires cold storage.
1The total need for oxytocin includes prevention of PPH for 100% of facility-based deliveries (10 I.U.), induction for 10% of patients (10 I.U.), augmentation for 20% of patients (10 I.U.), and PPH treatment for 2.85% of patients (4*10 I.U.) and for home-birth settings, oxytocin for PPH treatment for 6% of patients (4*10 I.U.).
This post is part of the blog series “Increasing access to maternal and reproductive health supplies: Leveraging lessons learned in preventing maternal mortality,” hosted by the Maternal Health Task Force, Reproductive Health Supplies Coalition/Maternal Health Supplies Caucus, Family Care International and the USAID-Accelovate program at Jhpiego which discusses the importance and methods of reaching women with lifesaving reproductive and maternal health supplies in the context of the proposed new global target of fewer than 70 maternal deaths per 100,000 births by 2030. To contribute a post, contact Katie Millar.