A framework for assessing availability of maternal health commodities: The case of misoprostol in Tanzania

Informed by two well-known conceptual frameworks for access to health commodities, and aligned with a recent report from the United Nations' Commission on Life Saving Commodities for Women and Children, VSI developed a product availability framework structured around 5 key themes: 1) registration and quality assurance, (2) policy and financing, (3) procurement and distribution, (4) provider knowledge and (5) end user knowledge. Data on product availability was collected through a policy review; key informant interviews with stakeholders and pharmacists; a knowledge, attitudes and practices survey of end-users; a retail survey at pharmacies; a health provider survey; and an analysis of supply chain, distribution and sales data. Barriers to misoprostol access in Tanzania were identified. These include vulnerable drug supply, due to poor national and regional forecasting and the registration of only one misoprostol product in Tanzania. Demand for misoprostol is also weak, due to a lack of health provider and end-user knowledge of misoprostol, no policies and programs supporting community distribution of misoprostol for prevention of postpartum hemorrhage or use for postabortion care, and confusion among health providers and district pharmacies on policies and procedures for ordering misoprostol. Key recommendations to increase availability include expanding postabortion care services and community health programs to include misoprostol, inclusion of misoprostol in pre-service trainings for pharmacists, nurse-midwives, and OB/GYNs, and in-service education for district pharmacists and health providers on ordering procedures for uterotonic drugs.