Knowledge Summary 5: Provide essential commodities
Access to good quality, affordable medicines and supplies would enable health workers to provide better care to girls, women, newborns and children. Currently, access is hampered by inefficient procurement and supply systems, poor partner collaboration, and the lack of crucial reproductive, maternal, newborn and child health (RMNCH) commodities on national essential medicines lists. There is evidence on how to ensure commodity security, particularly in relation to vaccines and contraceptives. Applying these lessons across the RMNCH continuum of care would help ensure that women and children have access to the essential interventions they need, when and where they need them.
There are several reasons why drugs, equipment and other commodities for RMNCH are in short supply. National procurement and supply systems are often weak and result in poor storage conditions, such as overstocking in central medical stores and stock-outs in remote areas. Inefficient national procurement systems lead to the development of parallel mechanisms to procure drugs and devices, thereby further reducing efficiency. Another challenge is the lack of coordinated implementation and information exchange between the private and public sectors, across countries, and between local, national and global levels.
What works?Stable and long-term funding
An integrated RMNCH commodities financing strategy is feasible even in the poorest countries. Some countries receive sector-wide or pooled funding from donors, and are also increasingly allocating their own funds. Such financing can be used to facilitate procurement of drugs and to subsidize medicines. For instance, in Lao PDR, one course of magnesium sulphate to treat pre-eclampsia currently costs up to US$24. Here, public financing is being used to help reduce the charge to the patient. Innovative financing strategies that used multiple sources to fill funding gaps have helped to maintain continuous supplies in, for example, Burkina Faso.
In some countries, such as Mexico, decentralized health spending has helped to increase funding for reproductive health supplies. However, decentralization does not work in all cases, with large amounts of pooled funding remaining unspent and delivery systems fragmented.Essential medicines lists
The World Health Organization’s (WHO) Model Lists of Essential Medicines and Devices can guide countries in planning for RMNCH supplies. Inclusion of the right commodities in the national essential medicines lists is crucial to improving women’s and children’s health. In Mongolia, for example, ergometrine - an important drug for the management of heavy bleeding during/after childbirth, is not on the essential medicines list.8 Although in the Philippines this drug is included in the national essential medicines list, the composition used is not optimal for the prevention and treatment of heavy bleeding.Integrated systems, better training and coordination
Requirements for each commodity are often different, for example, in terms of shelf life or sufficient suppliers, and so vertical supply chains are common. In countries where these chains have been integrated, duplication has been reduced and supply logistics made more efficient. For example, Uganda’s efforts to strengthen its health system included integrating procurement and supply systems.
Moreover, the effectiveness of medicines and supplies also depends on the abilities of both health workers and logistics staff. In post-conflict countries like Liberia, improvements were made by training service providers in logistics management systems, and by integrating the training into national health education.
Coordination among partners is also key to improving delivery of commodities in countries. For example, joint forecasting and planning by partners and subsequent negotiation with manufacturers has been undertaken successfully by The Reproductive Health Supplies Coalition (RHSC) (See Box 2). In some countries, such as Nicaragua, Tanzania, Ghana, Uganda and Bangladesh, contraceptive coordination committees (which have representatives from the government, donor agencies and NGO service providers) have also been able to improve delivery of supplies. However, shortages at primary and district health facility levels still need to be addressed.Advocacy delivers results
International advocacy has helped greatly to highlight the issue of shortages in supplies (see Box 3). Advocacy strategies at national level have also advanced the agenda for reproductive health supplies. Civil society organizations in Uganda, for instance, have highlighted gapsin reproductive health supplies, and lobbied for a range of commodities to be included in the essential medicines list for the country.13 In Tanzania, district contraceptive security committees now monitor supplies and ensure they are adequate.Partnerships support commodity security
The involvement of external service providers at the level of delivery has helped to improve public-sector services in many areas. For example, a third-party partnership enabled timely and effective procurement and delivery of commodities in the Democratic Republic of Congo, while an innovative delivery system had a similar effect in Zimbabwe (see Box 4). International partnerships, such as the Global Alliance for Vaccines and Immunisation, have played an important role in improving immunization coverage in developing countries by increasing supplies and strengthening delivery systems. Joint programming between the African, Caribbean and Pacific states, UNFPA and the European Commission has helped to maintain supplies in conflict and post-conflict countries.
The global RMNCH community must come together to advocate and support the implementation of more informed and collaborative procurement strategies and systems – not only to provide regular supplies of commodities already known to be essential, but also to develop and roll-out new and improved products.