328. Policy and system bottlenecks influencing the management of pre-eclampsia in five countries

Abstract

Introduction While training and mentoring programs have focused on primary healthcare (PHC) level providers to identify, stabilize and refer women with pre-eclampsia, policy and procurement bottlenecks are barriers to provision of care. Objective To describe health system factors that affect timely management of preeclampsia at all levels in Bangladesh, Ethiopia, Kenya, Nigeria and Pakistan. Methods Qualitative data were collected through in-depth interviews with policy makers and health managers across five countries on the knowledge of existing policies and procurement plans. Assessment of data used NVivo (Version 10) to derive codes for themes. Results Most countries have maternal health policies and guidelines covering management and treatment of pre-eclampsia however it is less clear within the different health system levels on specific task shifting to PHC level. Bangladesh, Ethiopia and Nigeria have task-shifting policies allowing PHC providers to administer a loading dose of magnesium sulphate (MgSO4) and referral, but is less clear on prescription of anti-hypertensives to control blood pressure. MgSO4 is on each country’s essential medicines list, however, procurement of MgSO4 (and other MH drugs) continues to be haphazard. The commodity is either not budgeted for, or the budget line is not being implemented, due to over-reliance on donor procurement or poor forecasting, tracking and accountability (Kenya, Pakistan). Widespread practice of patients and their families expected to procure drugs themselves continues; many stakeholders are concerned about quality of these drugs. Discussion Procurement of essential maternal health drugs and commodities for effective management of HDPs, have not been prioritized across all countries. Even tertiary hospitals fail to procure essential drugs and keep at point of use. Challenges remain in formalizing task shifting policies to manage pre-eclampsia effectively across the health system. Recommendations include lobbying ministries of finance and health to collaborate and prioritise maternal health care.