Global Leadership on Maternal Health Medicines: A Conversation with Beth Yeager
We spoke with Management Sciences for Health (MSH)’s Beth Yeager, MHS, Principal Technical Advisor, Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program, and Chair, Maternal Health Supplies Caucus, Reproductive Health Supplies Coalition, about MSH’s global technical leadership on improving access to maternal health medicines and commodities. MSH serves as an active member of the UN Commission on Life-Saving Commodities for Women and Children (UNCoLSC) and the Reproductive Health Supplies Coalition.
Congratulations on being selected Chair of the Maternal Health Caucus (Caucus) of the Reproductive Health Supplies Coalition (RHSC/Coalition)! What is most interesting about this opportunity?
Thank you! The RHSC has brought together very diverse groups that are united in a common goal: ensuring people are able to access and use, affordable, quality reproductive health supplies. Its over 300 members include governments, donors, international and national NGOs, and private sector business. The Caucus is interesting because it draws on the wealth of experience from these members to focus on maternal health supplies.
What is your role as Chair of the Caucus?
As chair, I lead the Caucus by keeping the group engaged, motivated, and moving forward on activities. Specifically, I facilitate our regular teleconferences, setting an agenda for the calls. I also work with RHSC staff to monitor the implementation of any sub awards issued or grants received by the MHS Caucus and participate in the review of any proposals submitted to the Caucus under the Innovation Fund. I also engage with representatives of other RHSC groups to identify opportunities for the inclusion of maternal health supplies in the initiatives of their groups.
What was MSH’s role with RHSC prior to this?
MSH is a long-time member of the Coalition. Since 2011, I have been representing MSH’s Center for Pharmaceutical Management at RHSC meetings. Fabio Castaño [MSH Global Technical Lead, Family Planning and Reproductive Health] and I are members of the Systems Strengthening Working Group [SSWG]. And Fabio was recently asked to head the Universal Health Coverage work stream for the SSWG.
Tell us more about MSH’s role with the UN Commission on Lifesaving Commodities for Women and Children (UNCoLSC/Commission).
One of MSH’s roles in this Commission is to propose strategies to enhance the in-country access to and use of the 13 lifesaving commodities, including the three essential medicines for maternal care: oxytocin, magnesium sulphate, and misoprostol.
Before the work of the Commissioners even began, technical working groups were formed to determine "what was known" regarding these three medicines – essentially background information ​​for the commissioners. SIAPS was asked to lead the preparation of this background material on maternal health​ medicines, in collaboration with PATH. The document included the review of over 60 documents, including articles, technical reports and other publications, and interviews with key stakeholders.
The SIAPS maternal and child health team -- Jane Briggs, Suzanne Diarra, Maheen Malik, Sheena Patel , and I -- were all part of this effort.
Out of this exercise it became clear that one major supply chain bottleneck for these medicines was inaccurate forecasting of need. Countries were basing procurement decisions on how much they had procured the previous year, because of lack of information. Most countries did not include these three medicines in their logistics management information systems, nor were the conditions they were meant to treat included in their health information systems. The absence of these data meant that countries were forecasting need of these medicines based on guesstimates.
This is where the idea to develop the Estimation of Unmet Medical Need for Maternal Health Medicines came in.
What does the methodology mean for procurement at the country levels?
The tool allows national program managers and other key stakeholders to assess a country’s theoretical medical need for these three life-saving maternal health commodities for a specific time frame and compare this with actual procurement data for the same time frame, thus providing an indication of the extent to which needs are met and highlight the gaps that require attention. It also allows stakeholders at the national level to work together to advocate for actions to increase access to these life-saving commodities.
Can you say more about MSH developing “Estimation of Unmet Medical Need for Essential Maternal Health Medicines”?
We developed forecasting algorithms for each of the three products based on data that appeared in published literature regarding incidence of post-partum hemorrhage and pre-eclampsia/eclampsia. Using national demographic data and these algorithms we calculated an estimated need for these medicines, which we then compared with national procurement data.
We conducted this exercise in Bangladesh and the Democratic Republic of the Congo (DRC), and met with stakeholders to present the results. The comparison between the amount of medicines needed to cover 100 percent of women, and what was actually procured, sparked a lively discussion about what assumptions had gone into those procurement decisions.
In both countries, the meetings resulted in an agreement to form a technical working group comprised of both technical program people and those responsible for procurement to conduct more evidence-based forecasting for future procurement.
How is the methodology being used?
These algorithms are now included in the RMNCH quantification guidance developed by the Supply Chain Technical Resource Team of the UNCoLSC. They have also served as the basis for other demand estimation exercises. For example, they were adapted for the development of business cases for the three medicines that were recently developed by Jhpiego on behalf of the Maternal Health Supplies Caucus of the UNCoLSC.
Hopefully, these two tools (the unmet need approach and the RMNCH quantification guidance) will help countries produce more robust forecasts for these medicines.
Helping countries get the numbers right, will increase access to these medicines, and thereby assist in reducing maternal mortality.
Are there other ways MSH is supporting global leadership on maternal health medicines and commodities?
Beyond the two tools described above, in collaboration with the Maternal Health Technical Resource Team of the UNCoLSC, we have also developed an Inventory of Tools for Maternal Health. The tools listed in the inventory include materials related to quantification and forecasting, use, and demand and availability.
We have also been working on studies to analyze the feasibility of integration of oxytocin in the cold chain used for vaccines.
With the new targets set for ending preventable maternal mortality by 2030, and new funding sources for MNCH, such as the Global Financing Facility, coming on line, it’s an interesting time for maternal health.
MSH’s Beth Yeager blogs on Improving Access to Maternal Health Commodities through a Systems Approach: Where Are We Now?