Access to oxytocin and misoprostol for management of postpartum haemorrhage in Kenya, Uganda and Zambia: a cross-sectional assessment of availability, prices and affordability

Abstract

ObjectiveTo assess access (availability and affordability) to oxytocin and misoprostol at health facilities in Kenya, Uganda and Zambia to improve prevention and management of postpartum haemorrhage (PPH).DesignThe assessment was undertaken using data from Health Action International (HAI) research on sexual and reproductive health commodities based on a cross-sectional design adapted from the standardised WHO/HAI methodology.SettingData were collected from 376 health facilities in in Kenya, Uganda and Zambia in July and August 2017.Outcome measuresAvailability was calculated as mean percentage of sampled medicine outlets where medicine was found on the day of data collection. Medicine prices were compared with international reference prices (IRP) and expressed as median price ratios. Affordability was calculated using number of days required to pay for a standard treatment based on the daily income of the lowest paid government worker.ResultsAvailability of either oxytocin or misoprostol at health facilities was high; 81% in Kenya, 82% in Uganda and 76% in Zambia. Oxytocin was more available than misoprostol, and it was most available in the public sector in the three countries. Availability of misoprostol was highest in the public sector in Uganda (88%). Oxytocin and misoprostol were purchased by patients at prices above IRP, but both medicines cost less than a day’s wages and were therefore affordable. Availability of misoprostol was poor in rural settings where it would be more preferred due to lack of trained personnel and cold storage facilities required for oxytocin.ConclusionAvailability and affordability of either oxytocin or misoprostol at health facilities met the WHO benchmark of 80%. However, countries with limited resources should explore mechanisms to optimise management of PPH by improving access to misoprostol especially in rural areas.

Quality of care for postpartum hemorrhage: A direct observation study in referral hospitals in Kenya

“…These policies have led to significant increases in the rate of facility-based delivery [13,14], despite several challenges in implementation that affected access for some potential beneficiaries [15]. There have also been significant efforts to scale up effective interventions for PPH prevention and treatment in health facilities in Kenya including training health care providers on Active Management of the Third Stage of Labor and increasing the coverage of effective uterotonic medicatoins [16,17]. However, mortality from PPH remains high despite these efforts and a recent review of maternal mortality in Kenya identified quality of care as a key challenge [18].…”