1. Maternal Health Supplies in Bangladesh and Uganda Reproductive Health Supplies Coalition 28 May 2010 Elizabeth Leahy Madsen Jennifer Bergeson-Lockwood Jessica Bernstein Population Action International

2. Maternal Health Context Three delays: Deciding to seek care, reaching facility, receiving care Maternal mortality would have to decline 5.5% annually to achieve MDG5 Supplies is one of the associated factors in improving maternal health outcomes Link between supplies and health system capacity

3. Maternal Health Supplies Four “tracer” supplies for maternal health o Oxytocin for postpartum hemorrhage o Misoprostol for postpartum hemorrhage o Magnesium sulfate for pre-eclampsia and eclampsia o Manual vacuum aspirators (MVA) for early and incomplete abortion Magnesium sulfate, Uganda

4. Policy Environment Government support and political commitment National maternal health strategies and road maps reference supplies Some supplies on Essential Drugs Lists Strong policies do not translate into financial commitment or effective implementation Lack of quantified targets to measure improved access to supplies

5. Health System Structure Low rates of facility-based deliveries o 15% Bangladesh, 41% Uganda Expectation that supplies may be out of stock in facilities Varying levels of community- based care Major role of private sector: Perceived reliability for supplies and quality of care Private sector hospital, Bangladesh

6. Financing of Maternal Health Supplies Little dedicated donor funding for maternal health supplies, unlike contraceptives and condoms Maternal health supplies aggregated with other costs and difficult to track Significant underspending of budget allocations despite frequent supply shortages Widespread unofficial user fees

7. Forecasting, Procurement and Logistics Lower likelihood of annual forecasting relative to family planning Importation challenges if no local manufacturing Limited procurement cycles Mismatch between quantification of orders and delivery Recent introduction of misoprostol Joint Medical Store, Kampala

8. Civil Society and Development Partners NGO service providers expanding service provision of maternal health supplies Civil society provides technical guidance and a strong voice for advocacy Donor support through sector or budget frameworks Many large donor-funded projects focused on maternal health

9. Continuum of Care Integrated reproductive, maternal, newborn and child health care Increasing focus on integration of newborn health at policy level Facility capacity limited by human resource and shortages of supplies and equipment Need to maintain quality and coverage of interventions through scale-up

10. Advocacy Entry Points Implement and fund policies already in place Raise awareness and scale up community- based approaches Prioritize family planning Enhance the supply chain Monitor the national budget for maternal health Moulvi Bazar, Bangladesh