Tackling two of the leading causes of maternal mortality in Zimbabwe by introducing misoprostol at all facility levels

Zimbabwe's maternal mortality ratio (MMR) of 960 is currently 50% higher than the average MMR in sub-Saharan Africa. The Zimbabwe Ministry of Health and Child Welfare (ZMoHCW) is committed to strengthening its health system by creating access to misoprostol, a uterotonic drug that can be used to manage postpartum hemorrhage (PPH) as well as to treat incomplete abortion and miscarriage. As PPH and unsafe abortion are two of the top five causes of maternal mortality in Zimbabwe, the ZMoHCW has formed a multi-pronged strategy for introducing misoprostol into the Zimbabwean health system. The strategy consists of: 1) policy change (e.g., introducing misoprostol on the Essential Drugs List of Zimbabwe as well as into the country's Postabortion Care Guidelines); 2) conducting operations research testing the feasibility of introducing misoprostol at all facility levels; and 3) working to revise the registration of a misoprostol product in the country to include obstetric indications. Despite the challenges of operating within an under-resourced health system, preliminary data from the operations research demonstrates that misoprostol is already being successfully used to manage PPH and treat incomplete abortion and miscarriage at all facility levels. The introduction of misoprostol to address two of the primary causes of maternal deaths has been identified by the ZMoHCW as a global best practice for scaling up facility-based maternal health services in low-income countries and a replicable model for strengthening health systems globally.