How to assure access of essential RMNCH medicines by looking at policy and systems factors: an analysis of countdown to 2015 countries

Abstract

BackgroundIn 2000, the Millennium Development Goals set targets for social achievements by 2015 including goals related to maternal and child health, with mixed success. Several initiatives supported these goals including assuring availability of appropriate medicines and commodities to meet health service targets. To reach the new Sustainable Development Goals by 2030, information is needed to address policy and systems factors to improve access to lifesaving commodities.MethodsWe compiled indicator data on 15 commodities related to reproductive, maternal, newborn, and child health (RMNCH) and analyzed them across 75 Countdown to 2015 countries from eight regions to identify problems with specific commodities and determinants of access. The determinants related to policy, regulatory environment, financing, pharmaceutical procurement and supply chain, and information systems. We mapped commodity information from four datasets from the World Health Organization and the United Nation’s Commission on Life Saving Commodities creating a stoplight dashboard to illustrate countries’ environment to assure access. We also developed a dashboard for policy and systems indicators for select countries.ResultsThe commodities we identified as having the fewest barriers to access had been in use longer, including oral rehydration solution and oxytocin injection. Looking across the different systems and policy determinants of access, only Zimbabwe had all 15 commodities on both its essential medicines list and in its standard treatment guidelines, and only Cameroon and Zambia had at least one product registered for each commodity. Senegal alone procured all tracer commodities centrally in the previous year, and 70% of responding countries had costed plans for maternal, newborn, and child health. No country reported recent stock-outs of all the 15 commodities at the central level—countries always had some of the 15 commodities available; however, products with frequent stock-outs included misoprostol, calcium gluconate, penicillin injections, ceftriaxone, and amoxicillin dispersible tablets.ConclusionsThis analysis highlights country deficiencies in policies and systems, such as incoherent policy guidelines, problems in product registration, lack of logistics data, and central-level stock-outs that may affect access to essential RMNCH commodities. To tackle these deficiencies, countries need to integrate commodity-related indicators into other health monitoring activities to improve service quality.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3766-6) contains supplementary material, which is available to authorized users.

Availability, Management and Use of Priority Life-Saving Medicines for Under-Five Children in Two Health Districts in Senegal: A Cross-Sectional Study

“…Similarly, quality information is important not only to estimate drug needs but also to know the state of stocks at all levels of the health system [39]. This information is provided in part by the stock card which is the basic element of drug management [40].…”

Commodity security frameworks for health planning

“…Finally, and based on surveys from 75 LMICs, Briggs et al 26 report that unreliable supplies of commodities for reproductive, maternal, new born and child health (RMNCH) are due to deficiencies in “policies” (for e.g., a mismatch between essential medicines lists and standard treatment guidelines due to time lags in updating these reference manuals) and deficiencies in “systems”. Deficiencies in “systems” refer to, for e.g., essential RMNCH medicines not registered in some LMICs or non-renewal of registration licenses.…”

“…Other system deficiencies had to do with existing health financing arrangements. Briggs et al 26 report that in some LMICs exemptions from out-of-pocket payments existed for commodities that were only used in RMNCH (for e.g. oxytocin) whilst RMNCH commodities that had other clinical uses (for e.g.…”

Exploring wealth-related inequalities in maternal and child health coverage in Latin America and the Caribbean

“…Finally, we use population attributable risk (PAR) to show the possible improvement if the general population hypothetically had the same coverage level as the wealthiest quintile (CCI-Q5). We estimated the PAR percentage (PAR%) to show the proportion of improvement in national coverage if socioeconomic inequality would have been eliminated (PAR / CCI * 100) [19]. We used Pearson correlation to measure the degree of relationship between the CCI and the PAR%.…”