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.
Highlights
In 2000, the Millennium Development Goals set targets for social achievements by 2015 including goals related to maternal and child health, with mixed success
We argue that products can be available on the market, and yet many women and children are still not benefiting from their lifesaving properties; for example, a country may have approved the use of Oral rehydration solution (ORS) and amoxicillin, but has no policy supporting community case management of diarrhea or pneumonia
Commodities with the fewest problems included ORS, oxytocin, and gentamicin and penicillin injections, and those associated with more policy and systems problems included amoxicillin dispersible tablets, emergency contraception, female condoms, and chlorhexidine
Summary
In 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. MDGs 4 and 5 set goals to reduce under-five child mortality by two-thirds and improve maternal health, including reducing maternal mortality by three-quarters, and achieving universal access to reproductive health. Later in 2012, the UN’s Commission on Life Saving Commodities (UNCoLSC) was initiated in support of Every Woman Every Child and focused on improving access to 13 neglected lifesaving commodities to treat major causes of maternal, newborn, and child deaths, such as postpartum hemorrhage, eclampsia, newborn sepsis, and childhood diarrhea and pneumonia [2]. By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births
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