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Access to essential

medicines for Maternal


and Newborn Health

Dr Rita Kabra
Making Pregnancy Safer
WHO/EDM Technical Briefing Seminar
Salle G, WHO/HQ

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27 September 1 October 2004
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Outline of the presentation

current situation: maternal and newborn


health
Making pregnancy safer, Integrated
management of pregnancy and childbirth
Examples of two medicines
The way ahead

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Current scenario

Every minute a woman dies from


complications of pregnancy or childbirth

All but 1% of these deaths occur in


developing countries

Most deaths occur due to poor service


provision, lack of access to and use of
these services

Most of these deaths could be avoided only


if appropriate care was available throughout

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pregnancy, childbirth and the post-natal
period.

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Causes of maternal death
529,000 : 99 % in developing countries

Severe bleeding Infection


24% 15%

Eclampsia
12%

Indirect causes Obstructed


20% Labour
8%

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Other direct Unsafe abortion
causes 13%
8%

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Making Pregnancy
Safer
WHOs contribution to the
Safe Motherhood initiative

Health sector strategy aimed to


assist countries to identify and
implement affordable strategies
to address maternal and newborn
health.

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World Health
Organization 9/2004 Rita Kabra_/5
The central objective of the
Making Pregnancy Safer

To ensure safe pregnancy and


childbirth through the availability,
access and use of quality skilled care
for all women and their newborns

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World Health Organization
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Essential component of skilled care

A skilled attendant/skilled
professionals supported by an
appropriate environment with access
to basic supplies, essential medicines
and relevant emergency services

Skilled care should be provided within


a continuum of care at all levels of
the health system

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What is the continuum of care?

FAMILY and COMMUNITY

FIRST LEVEL CARE

REFERRAL LEVEL CARE

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Evidence-based practice guidelines for maternal and
newborn health care: according to level of care

(Arabic)
(Portuguese)
English
French
Spanish
Russian
Laotian
Vietnamese
Indonesian
Chinese
Farsi

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Essential medicines are selected on basis
of evidence on efficacy and safety

Integrated Management of Pregnancy and


Childbirth
(IMPAC)

Pregnancy, Childbirth, Postpartum and Newborn


Care:
A guide for essential practice
(PCPNC)

ADAPTATION GUIDE
A guide to identify necessary adaptations of
clinical policies and guidelines

A. The Adaptation Process


December 2003
Working Draft: for Limited Distribution Only

World Health Organization


Department of Reproductive Health and Research

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Making
Pregnancy Safer Using Human Rights
Planning Guide to improve Maternal
and Neonatal Health
2004

The midwifery modules

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Beyond the numbers
Reviewing maternal deaths
and complications to
make pregnancy safer

World Health Organization


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Essential medicines for maternal and
newborn health
Postpartum haemorrhage Oxytocin injectable/
uniject
IV fluids

Eclampsia/Pre-eclampsia Magnesium sulphate


Calcium gluconate
Hydralazine

Sepsis/Infection Ampicillin
Gentamicin
Metronidazole
Tetanus toxid vaccine

HIV Nevirapine or
Zidovudine

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Anaemia Iron/folic acid
Blood

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Access to essential medicines is a pre requisite
to improved maternal and newborn health

Essential medicines are those that satisfy


the priority health care needs of the
population. (report to WHO Executive
Board, January 2002)

Selection criteria: Essential medicines are


selected with due regard to disease
prevalence, evidence on efficacy and
safety, and comparative cost effectiveness

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Oxytocin for preventing and treating
postpartum hemorrhage (PPH)
150,000 maternal deaths per year
Active management of third stage of labour
reduces the risk of PPH by about 60%
reduces the need for extra oxytocic by
70%, reduces the risk of postpartum
anaemia
Management of PPH:
oxytocin
prostaglandins : misoprostol
Ergometrine

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blood transfusion
surgery
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Table 3 Cost estimates for using oxytocin for
prevention of post-partum hemorrhage in Uganda
Population 1,094,000
Pregnancies 64,863
Incidence of PPH 10%
Potential cases 6486
Interventions effectiveness 50% (3243 fewer cases)

Scenario 2: with
Scenario 1: no preventive
preventive
intervention
intervention

Unit cost of treatment for PPH $56


Cost of treatment for cases of $56
$182,006
PPH $364,011
$182,006
Savings
$1,800,000
Total programme cost
10%
Potential savings

Rounded to nearest whole numbers.

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Figures taken from two Districts Iganga and Mbarara.
*Actual savings depend on factoring, such as additional costs, savings from all
types of complications averted, etc.

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Magnesium sulphate for preventing
and treating eclampsia
50,000 maternal deaths women per
year

The Collaborative Eclampsia trial:


lowers risk of recurrent convulsions by
67%, lower risk for ventilation,
pneumonia, and need for intensive care

The Magpie trial : Lowers risk of


eclampsia by 58% for women with pre

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eclampsia.

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Access to magnesium sulphate:
a long way to go

10 Inclusion of magnesium sulphate in 45 of 112 national lists


8 Added to the
WHO EML
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Challenges
Availability: Every pregnancy faces risk, essential
medicines should always be available at every health
centre

Accessibility: geographical distribution of medicines, and


at loer level facilities

Quality and safety : Storage, stability, avoid overuse


and misuse

Policy: Regulations on who can prescribe, training of


health workers, rational selection, evidence based
guideline

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Political will

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Key points for policy makers

Most maternal deaths are avoidable

Most maternal health problems can be treated


with a few essential medicines

Access to essential medicine is a prerequisite


to improve maternal and newborn health

Procurement, reimbursement, training and


donations of drugs should be based on proper
use of these few medicines

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The future is promising
International commitment :The Millennium
Development Goals
reduce maternal mortality by three quarters
reduce under-five mortality by two thirds

WHO s commitment :Making Pregnancy Safer


Department for country implementation

MPS commitment: strengthening of integrated


health systems. A co-ordinated response to
essential maternal and perinatal health care.
malaria, HIV programme.

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Close collaboration with EDM on reproductive
health/ maternal health medicines.
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.women are not dying
because of diseases
we cannot treat.
They are dying
because societies
have yet to make the
decision that their
lives are worth
saving.

Dr. M. Fathalla

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Web site:
www.who.int/reproductivehealth
Documentation centre:
lambertsue@who.int

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