Javed Rahman | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Sub-national procurement of essential medicines is common in many countries where weak centralized systems cannot ensure access to essential medicines at service delivery points. The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program conducted an assessment of sub-national procurement of maternal health medicines in Bangladesh. The assessment measured the availability of these medicines at selected storage and health care facilities and evaluated local procurement practices in three districts. The assessment found that, while misoprostol and magnesium sulfate are supplied exclusively by the central level, sub-national procurement accounts for 42% of all oxytocin obtained in the districts. Although sub-national procurement is meant to fill the deficit of what is not supplied by the national level, less than 40% of facilities had a continuous supply of each medicine. Stock-outs of oxytocin and magnesium sulfate were common, ranging from a month to a year, and sub-national procurement prices were often higher compared to the national level. Major challenges include: (1) Absence of logistics management information systems for maternal health medicines; (2) lack of district-level guidance for quantification or local procurement of medicines; (3) Inconsistent training for committee members about quantification or procurement. SIAPS has worked with the MoHFW to address these challenges. Specifically, electronic logistic management information systems are being updated or developed to track essential MNCH commodities and guidelines on quantification and procurement at the sub-national level have been developed and incorporated into the curriculum of a national program for procurement managers. Strengthening information systems to provide data for robust quantification and improving sub-national staffs’ capacity to manage procurement processes can ensure availability of life-saving medicines when and where women need them.