Presentation at the Global Maternal Newborn Health Conference, October 19, 2015
Postpartum hemorrhage is the leading cause of maternal mortality in Nigeria accounting for a quarter of maternal deaths. In an effort to reduce this burden, the Nigerian government became, in 2006, the first country in Africa to register misoprostol for the prevention and treatment of postpartum hemorrhage. In 2009, a seminal study of community-based distribution of misoprostol in Zaria (Northern Nigeria) demonstrated that misoprostol can safely and effectively be used by women in their homes. To support these efforts, the MacArthur Foundation made a series of grants, providing support to both a public and private sector model of distribution of misoprostol. In the public sector, Ahmadu Bello University worked with the Ministry of Health and the Society of Gynecology and Obstetrics of Nigeria to scale-up the successful interventions that had been used in Zaria: community sensitization and engagement to gain support and create demand; distribution of misoprostol directly to the women in the communities through trained lay workers doing home outreach; and supplying the product locally through “drug keepers”. In the private sector, the Society for Family Health/PSI worked to raise awareness about misoprostol for postpartum hemorrhage, train health workers in its use, and ensure access to the drug. A process evaluation of these projects, carried out by the Public Health Institute in 2014, identified challenges to scale-up that both approaches faced: significant concerns about the use of trained lay workers to distribute misoprostol; concerns about the potential use of misoprostol for abortion; and, the many challenges inherent in ensuring that a quality misoprostol product is consistently available at a reasonable cost. Framing community-based distribution of misoprostol in a way that resonates with key constituents and integrating community-based distribution into existing structures are the challenges that now lay ahead in Nigeria.