Elisa Wells | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

In 2014, the Foundation commissioned the Public Health Institute to evaluate the grants it had made to increase community-based access to misoprostol for postpartum hemorrhage prevention in Ethiopia, Ghana, and Nigeria. The Foundation was interested in documenting the models and approaches used and the progress toward scaling up the respective models in the three countries. Between June and November 2014, the evaluation team reviewed grantee reports, proposals, and the literature; interviewed key informants and global, national, and local stakeholders; conducted focus group discussions with local stakeholders; and made observations during site-visits in each country. From this the team produced a case study for each country and a synthesis report, highlighting the common findings, identifying differences, and interpreting the lessons learned for broader use and scale up of misoprostol at the community level in Africa and globally. All the models evaluated faced similar obstacles when scaling up access to misoprostol at the community level: reluctance of healthcare providers and policy makers to give misoprostol to women in advance of their delivery; and concerns about possible “misuse” of misoprostol—the belief that women or lay workers may use the drug for abortion or induction of labor rather than to prevent hemorrhage. All of the models also faced challenges related to the misoprostol product, including packaging, distribution, and product quality. These community-based efforts in Ethiopia, Ghana, and Nigeria provide examples of success and also point to the common challenges such projects face as governments attempt to integrate them into existing health systems and scale up implementation to a national level. There is evidence that community-based distribution can be done successfully. The challenge now is to do it on the national scale and ensure access to all women who could benefit from this simple yet effective technology.