The Kenya Constitution states that every person has the right to the highest attainable standard of health, including reproductive health. To realize this right, every person must have access to high-quality, life-saving medicines.
Recently, the government achieved great strides toward making this right to health a reality for its citizens. For the first time, the Kenya Essential Medicines List 2016 (KEML) included misoprostol in the oxytocics section, indicating its use for the prevention and treatment of postpartum hemorrhage (PPH), excessive bleeding after childbirth and a leading cause of maternal death. Misoprostol is stable at room temperature, available in pill form, and inexpensive. Because of these advantages and the drug’s wide availability, misoprostol may be a woman’s only chance for surviving PPH in settings with limited infrastructure and a shortage of skilled birth attendants–like many parts of Kenya.
“It is unfathomable that the availability of life-saving medicines in our facilities is not guaranteed. It is heartbreaking to audit and review the deaths of mothers due to heavy bleeding after delivery because of the unavailability of oxytocin.” Dr. Wangui Muthigani, Manager in charge of Maternal, Newborn Health, Ministry of Health
The KEML identifies the essential medicines that meet the priority healthcare needs of the population and guides the government’s purchasing and distribution decisions for public health facilities. According to the KEML 2016, the lowest level providers in the health service delivery system–community clinics, dispensaries and community midwives–are authorized to distribute misoprostol for PPH. Kenya is now among the growing number of countries countries that have approved misoprostol for PPH, thanks to the advocacy of the FCI Program of Management Sciences for Health and a task force comprising members from the National Maternal and Newborn Health Technical Working Group, which is led by the Ministry of Health. Our advocacy included the following key actions:
- Bring the right people to the table. The Task Force–comprising government officials, researchers, health professionals, clinicians, faith leaders, respectful maternity care champions, and representatives from non-governmental organizations–brought together their expertise and connections to develop an evidence-based, targeted advocacy strategy to support the inclusion of misoprostol for PPH on the KEML.
- Advocate at just the right time! In advocacy, timing is key. Following the World Health Organization’s (WHO) release of its updated Model List of Essential Medicines in 2015, the government began updating its own EML. As such, we used this as an opportune time to influence the inclusion of misoprostol for PPH on the KEML.
- Point to the evidence. We gathered the findings from operations research conducted in Kenya and in similar settings to illustrate the feasibility of introducing misoprostol to prevent and treat PPH. We also reviewed locally available guidelines on misoprostol’s use for PPH and aligned them to WHO’s guidelines. We then developed recommendations specifying the appropriate health service delivery level and the cadre of providers able to administer misoprostol.
- Advocate strategically. We constructed appropriate messages for our target audiences, the Ministry of Health and the National Medicines and Therapeutics Committee (NMTC), which are responsible for updates to the EML. We drafted a letter to the NMTC, calling for the addition of misoprostol to the KEML for PPH prevention and treatment at all levels of the health system. The committee considered this letter, and our recommendations were included in the updated KEML. We regularly followed up with the NMTC on the status of our advocacy ‘Ask’.
While the inclusion of misoprostol in the KEML is a critical step for ensuring its availability at every level of Kenya’s health care system, continued advocacy is needed to ensure that high-quality misoprostol is actually available to women when they need it most and that it is administered correctly. We need to support national procurement authorities to acquire the right dosage and formulation, ensure that the government has adequate funds allocated to stocking misoprostol in public health centers, and update standard treatment guidelines and pre- and in-service health training curricula. We are proud of this advocacy win to include misoprostol as a maternal health medicine on the KEML, a necessary step to expand access to this life-saving medicine; now we must ensure that the government can make this promise a reality for all women–no matter where they give birth.
For more information and tools for effective advocacy:
Scaling up Misoprostol for Postpartum Hemorrhage: Moving from Evidence to Action
Advocacy, Approval, Access: Misoprostol for Postpartum Hemorrhage A Guide for Effective Advocacy
Updating National Essential Medicines List: A Step-by-Step Advocacy Guide
This blog post provides an update to an earlier post and originally appeared on Rights & Realities, a blog by the FCI program at MSH.