Assessing and Monitoring Maternal Health Commodity Security Increasing Access to Lifesaving Commodities for Women and Children Ellie Bahirai, John Snow, Inc. Tabassum Firoz, PRE-EMPT/University of British Columbia On behalf of the UNCoLSC Maternal Health TRT Assessing and Monitoring Maternal Health Commodity Security

Provide background to Life Saving Maternal Health Commodities Define Commodity Security (CS) and explain why it is important Describe the Maternal Health Commodity Security (MHCS) framework Apply the framework to a country case study Webinar Objectives

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Life-Saving Commodities – Maternal Health Oxytocin (prevention and treatment of postpartum hemorrhage) Misoprostol (prevention and treatment of postpartum hemorrhage) Magnesium sulfate (prevention and treatment of eclampsia) Together, these conditions account for almost half of maternal deaths. If these three medicines were available to every woman giving birth, 1.4 million women could be saved over ten years. The UN Commission on Life-Saving Commodities singled out three overlooked maternal health commodities that can treat and address the leading causes of death during pregnancy and childbirth:

Defining Commodity Security Commodity security (CS) is broadly defined as the ability to choose, obtain, and use quality health commodities when and where they are needed. MH CS focuses on MH commodities and the unique characteristics of these specific maternal health commodities. MH category‐specific CS allows policymakers and implementers to better understand, evaluate, and design solutions based on the unique characteristics of MH commodities.

Guiding principles of the MHCS framework Commodities must be accessible, available, and affordable throughout the continuum of care: (antepartum, intrapartum, and postpartum periods) Women’s and their healthcare providers’ equitable access to and rational use of quality MH commodities are enabled by intersectoral collaboration and integrated service delivery. Support rational use of the three key MH commodities (as defined by the UNCoLSC), so they are prescribed, dispensed, or sold appropriately and patients use them correctly (WHO 2012). Note: Conceptualization of MHCS framework is simplified and does not address many other commodities required for safe motherhood (work of the MHTRT focused on the three MH commodities identified as key). While these three commodities are necessary to improve MH outcomes, they are not sufficient to manage all causes of poor MH and mortality.

Q.1 Do you have experience working with Misoprostol, Magnesium Sulphate, and Oxytocin in MH programs? Select YES or NO

Q. 2 Have you been involved in a supply coordination committee, and if so, for which kind of products? Select one

MHCS Framework

Macro Level

Meso (Intermediate) Level 

Micro Level

Community/User Level

MHCS Framework

Maternal Mortality Ratio (MMR): Fragiland Case Study Location: Sub-Saharan Africa Maternal Mortality Ratio (MMR): 380 Main Causes of Death: Pre-eclampsia/ eclampsia and postpartum hemorrhage MOH has determined that most of these maternal deaths are preventable. Maternal deaths could be prevented by increased access to quality services, medicines, and other health commodities.

Fragiland Case Study In order to work towards the 2030 Agenda for Sustainable Development's target 3.1, the MOH is focusing on three specific commodities: magnesium sulphate oxytocin misoprostol. The MOH has decided to use the maternal health commodity security (MHCS) framework to conduct a baseline assessment of Fragiland’s situation for MHCS. Target 3.1: Reducing maternal deaths to 70 out of 100,000 live births

Macro Level Funding landscape Health system and policy Fragiland has a weakened health system The MOH has developed a National Strategic Plan for Maternal and Perinatal Mortality Reduction The plan includes access to emergency obstetric care, child spacing and other reproductive health services. Funding landscape Significant parallel and project-based funding for maternal health commodities 72 organisations engaged in advocacy at national and sub-national levels Many of these organisations focus on the implementation of interventions or on service provision. Most organisations are concentrated at the central level

Health Supplies, Diagnostics and Devices Monitoring & Evaluation Meso Level Health Supplies, Diagnostics and Devices Health supplies including diagnostics and devices are lacking Quality Assurance 3 MH commodities are registered but not available in the specific dosages Drug testing laboratories have limited manpower and logistics capacity Service Delivery Poor service provision Supply Chain MH supplies is co-mingled with other medicines Stock outs and shortages of supplies Human Resources Migration of health workers Inadequate training and education Monitoring & Evaluation No M&E plan in place

Community leaders and religious leaders are also very influential. Micro level In Fragiland: There are low rates of facility delivery and skilled attendance at birth. Community leaders and religious leaders are also very influential. Decision making about pregnancy and delivery lies with the family rather than the woman alone.

Q.3 Is your country context similar to Fragiland? Select YES or NO

Q.4 Would the MHCS framework be useful in your country? Select YES or NO

Additional Resources

Links to additional resources Maternal Health Commodity Security Brief http://www.lifesavingcommodities.org/wp-content/uploads/2016/05/A- Commodity-Security-Framework-for-Maternal-Health.pdf.pdf A Commodity Security Framework for Maternal Health – White Paper http://www.lifesavingcommodities.org/wp- content/uploads/2015/01/CommSecuFramMateHeal.pdf

For more information, visit: lifesavingcommodities.org Thank you! For more information, visit: lifesavingcommodities.org Send us feedback on the framework at: ebahirai@jsi.com & tfiroz@cfri.ca