Improving Maternal Health: Strengthening Procurement Systems at the Subnational Level: Bangladesh

Improving Maternal Health: Strengthening Procurement Systems at the Subnational Level: Bangladesh

 {Photo credit: SIAPS Program/MSH.}Workshop participants discuss how local procurement practices affect access to quality maternal health medicines at the district level in Bangladesh.Photo credit: SIAPS Program/MSH.

Expanding access to essential maternal health medicines saves mothers’ lives. Access to life-saving maternal medicines requires an effective supply chain that delivers the right medicines to the right people at the right times. In many countries, weak pharmaceutical management systems are unable to meet the challenges of providing access to these essential medicines. While efforts to date have been focused on providing support to strengthen national level programs and procurement practices, there is growing evidence that suggests that local procurement (at the district, or hospital level) of these essential medicines is common in many countries.

US Agency for International Development (USAID)-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program developed a methodology and a set of tools to assess local procurement practices of maternal health medicines. Procurement is the step in the supply chain where forecasts and supply plans are turned into purchased products that are delivered to the point of entry. Unless procurement practices are efficient and effective, acquiring pharmaceuticals may be costly and disorganized, with the potential for stock-outs and the risk of procuring poor quality products.

SIAPS tested the assessment methodology and tools in Bangladesh, where it is working with the Ministry of Health and Family Welfare to strengthen procurement management systems. The purpose of the assessment was to understand how local procurement practices affect access to quality maternal health medicines at the district level in order to stimulate a broader discussion about strategies to improve access to these medicines.

Specifically, the assessment: 1) measured the availability of key maternal health medicines (oxytocin, misoprostol and magnesium sulfate) at selected storage and health care facilities to determine the medicines’ source; 2) evaluated local procurement practices at the district level for essential maternal medicines; and 3) compared local procurement practices against national and international standards and guidelines. The assessment looked at maternal mortality rates, service delivery and supply chain functionality.

The assessment in Bangladesh found that local procurement accounts for a substantial amount of maternal health medicines acquired at the district level. Further, the findings showed that local procurement of maternal health medicines:

  • Lacked coordination and information-sharing between the national and subnational level
  • Had no district-level guidance for qualification or local procurement of medicines
  • Provided insufficient training of the procurement committee members about quantification or procurement
  • Used no standard evidence-based method for forecasting maternal health medicines at the district level
  • Resulted in higher cost for medicines at the district level than national level

Additionally, there were problems with quality assurance in the form of tender documents lacking product specifications for cold chain storage of oxytocin and for double-sided aluminum packaging of misoprostol.

What can we do about strengthening local procurement practices to ensure better access to life-saving maternal medicines? It is important to improve the coordination between the national level procurement system and the subnational level. A key component in decision making is a robust pharmaceutical information system. The system can only perform better when the human resource capacity is developed. Quality assurance and control systems need to be refined. Last, there needs to be a holistic strategy at both the national and subnational level that ensures access to life-saving maternal medicines.

Better access to maternal medicines will result in lower mortality rates for mothers. Investing in women’s health is not only the right thing do but brings incomparable dividends to the household, the community and the nation.

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