http://www.rhsupplies.org/fileadmin/user_upload/CoLSC/Meeting_Documents/Dakar_2-5_July_2013/second_part/Global_conveners_brief_Misoprostol_Final.pd

Reproductive Health Supplies Coalition

Ibis Reproductive Health

  S A F E G U A R D I N G  W O M E N  A N D  C H I L D R E N  W I T H  E S S E N T I A L  C O M M O D I T I E S  
 
 
 
 Technical Reference Team 
Commodity: Misoprostol 
Misoprostol is used to prevent and treat post-partum hemorrhage, the leading 
cause of maternal deaths worldwide. Appropriate packaging is important to 
ensure the integrity of the product. 
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Background  
The UN Commission on Life-Saving Commodities for 
Women and Children (the Commission) was formed in 
2012 by the UN Secretary-General as part of the global 
Every Woman, Every Child (EWEC) movement. EWEC 
challenges the global community to increase access to 
and appropriate use of essential medicines, medical 
devices, and health supplies that effectively address 
the leading preventable causes of death during 
pregnancy, childbirth, and childhood.  
 
Led by a wide range of high-level leaders from around 
the world, the Commission developed a framework for 
action on Reproductive, Maternal, Newborn, and Child 
Health (RMNCH) products that can be applied 
nationally and utilized in global RMNCH initiatives. The 
framework outlines a priority list of 13 commodities, 
key barriers to access and use, and 10 cross-cutting 
recommendations to rapidly increase both access and 
use. By increasing access to and use of these 13 
commodities, it is estimated that 6 million women and 
children can be saved by 2017. 
 
Moving forward 
To help carry forward the Commission’s 
recommendations at the global and national levels, 
Global Technical Reference Teams (TRT) were 
established. One group was formed for each of the 13 
commodities and 10 recommendations, and an 
advocacy working group is dedicated to advancing 
cross-cutting goals. The groups carry out their work 
through a variety of mechanisms, including guidance 
documents and tools to support countries in their 
efforts to implement recommendations and address 
global and regional bottlenecks. The TRTs are 
coordinated by a Strategy and Coordination Team 
hosted by the United Nations Children’s Fund (UNICEF).  
 
Spotlight on Misoprostol 
Postpartum hemorrhage (PPH) or excessive bleeding 
after childbirth is the leading cause of maternal death.  
 
 
 
 
 
 
 
 
 
PPH is preventable and treatable, yet one out of four 
maternal deaths is caused by this complication 
occurring after birth. Misoprostol is one uterotonic 
medicine that can prevent and treat PPH by stimulating 
strong contractions of the uterus. The World Health 
Organization (WHO) recommends using misoprostol 
for preventing and treating PPH when oxytocin, 
another uterotonic, is unavailable or cannot be 
administered safely. Misoprostol pills are administered 
orally and are particularly useful for home deliveries, 
especially in remote areas where access to health 
services is not readily available.   
 
The Maternal Health Technical Reference Team (MH 
TRT) works to increase the appropriate use of quality 
oxytocin, misoprostol and magnesium sulfate, as well 
as to improve access and use by reducing key barriers 
in EWEC countries. The MH TRT’s objectives are to: 
 
• Improve forecasting and quantification; 
• Achieve an adequate supply of quality 
commodities available where needed; 
• Improve and adopt practices and policies for safe 
use; and  
• Advance innovations such as simplified packaging 
and presentation, as well as heat-stable 
formulations and easier to use modalities.  
  S A F E G U A R D I N G  W O M E N  A N D  C H I L D R E N  W I T H  E S S E N T I A L  C O M M O D I T I E S  
 
 
 
 
 
The MH TRT’s seven subgroups offer expertise to 
advance specific work streams related to one of the 
three maternal health commodities or cross-cutting 
issues. 
 
Group membership  
The lead conveners of the MH TRT are the US Agency 
for International Development (USAID) and the United 
Nations Population Fund (UNFPA). The subgroup 
conveners include: Tools-Systems for Improved Access 
to Pharmaceuticals and Services program led by 
Management Sciences for Health; Mapping of 
manufacturers-Concept Foundation; Increasing use of 
magnesium sulfate-Accelovate and MCHIP/Jhpiego; 
Oxytocin in the cold chain-USAID; Improved uptake and 
use of WHO guidelines and recommendations-PATH; 
Misoprostol on Essential Medicines Lists (EML)- 
Venture Strategies Innovation; and Commodity 
Security- John Snow, Inc. 
 
Progress to date                                                   
The MH TRT has developed several key tools and 
resources that can be used to address issues relating to 
the three commodities. These include fact sheets on 
quantification, forecasting, product use, demand, and 
quality tools. The fact sheets describe key 
characteristics of each tool and include the purpose, 
expected outcome, type, and format of the tool. The 
fact sheets also outline the resources required to use 
the tools and the tools’ available languages.  
 
The group has also conducted work specific to 
misoprostol, including:  
 
• An extensive  list of generic misoprostol 
manufacturers worldwide, including the status of 
and potential for WHO prequalification 
submissions; 
• Landscape analysis and record review of national 
EMLs in Africa and Asia; and 
• List of priority countries to undergo revisions of 
EMLs based upon the need, timing of internal 
revision cycle in country, and the presence of 
organizations and misoprostol programming to 
support policy revision. 
 
Upcoming activities  
During the next two years, the MH TRT will:  
 
• Develop a knowledge translation methodology that 
will be used in three pathfinder countries to 
increase the safe and appropriate use of 
magnesium sulfate, misoprostol, and oxytocin;   
• Develop a searchable web-based compendium of 
tools used for quantification and forecasting, as 
well as evaluating use, demand, and quality; and 
• Develop a blueprint for the adaption of the 
Strategic Pathway to Reproductive Health 
Commodity Security framework for maternal 
health supplies and a supplies-specific commodity 
security framework for countries to implement.   
 
Available resources 
The MH TRT will offer technical assistance to 
pathfinder countries to: 
 
• Include misoprostol on Democratic Republic of 
Congo and Sierra Leone’s EMLs ;   
• Adapt tools to assist with quantification and 
forecasting, as well as evaluating use, demand, and 
quality of maternal health commodities; 
• Assess the market for misoprostol; 
• Identify barriers and facilitators to implement 
WHO guidelines and assist countries to develop 
implementation plans that address issues 
highlighted by evaluation efforts; and 
• Establish commodity security committees related 
to reproductive, maternal, newborn and child 
health. 
 
Contact us 
For more information or to request tools and technical 
assistance, please contact Deborah Armbruster, USAID 
(darmbruster@usaid.gov), or Jagdish Upadhyay, 
UNFPA (upadhyay@unfpa.org).   


Technical Reference Team
Commodity: Misoprostol

http://clacaidigital.info/bitstream/handle/123456789/491/Global%20conveners%20brief%20Misoprostol%20Final.pdf?sequence=5&isAllowed=y

Technical Reference Team Commodity: Misoprostol

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