THE UN COMMISSION ON LIFE-SAVING COMMODITIES FOR WOMEN AND CHILDREN

Too often, affordable, effective medicines and simple health supplies do not reach the women and children who need them

The UN Commission on Life-Saving Commodities for Women and Children…

• President Goodluck Jonathan of Nigeria (co-Chair) • PM Jens Stoltenberg of Norway (co-Chair) • UNICEF and UNFPA (Vice-Chairs) • Commissioners included leaders from public,

private and research/academic entities

Delivered to the UNSG in September 2012 a comprehensive report with a set of 10 recommendations across 13 commodities

Mission

Leadership

Results

Advocate at the highest levels to build consensus around priority actions for increasing availability, affordability, accessibility and rational use of essential commodities

1. Shaping global market 2. Shaping delivery markets 3. Innovative Financing 4. Quality strengthening 5. Regulation efficiency 6. Supply and awareness 7. Demand and awareness 8. Reaching women and children 9. Performance and accountability 10. Product innovation

Reproductive health

Female Condoms Implants Emergency Contraception

Maternal Health

Oxytocin Misoprostol Magnesium sulfate

Newborn Health

Injectable antibiotics Antenatal Corticosteroid (ANCS) Chlorhexidine Resuscitation Equip.

Child Health Amoxicillin Oral Rehydration Salts Zinc

Accelerate achievement

of MDGs 4 & 5

The Commission’s recommendations support clear objectives for under-utilized life-saving commodities across the RMNCH Continuum of care

Intervention area: Family planning/Contraception

– Female condoms

– Contraceptive implants • Levonorgestrel 75mg/rod x 2 rods Implant • Etonogestrel 68mg /rod x 1 rod implant

– Emergency contraception

• Levonorgestrel 1.5 mg Tablet • Levonorgestrel 0.75 mg Tablet • Ulipristal acetate 30mg Tablet • Mifepristone 200mg Tablet

Life Saving Commodities for Women and Children: Reproductive Health

Intervention area: Post-Partum Haemorrhage (PPH)

– Oxytocin Injection 10IU, 1ml – Misoprostol 200µg Tablet

Intervention area: Eclampsia and severe pre-eclampsia

– Magnesium sulfate Injection 500mg/ml, 2ml and 10ml ampoules – ± Calcium gluconate injection 100 mg/ml in 10-ml ampoule (for

treatment of magnesium toxicity)

Life Saving Commodities for Women and Children: Maternal Health

Intervention area: Newborn sepsis

• Injectable antibiotics – Gentamycin Injection 40mg/ml in 1ml ampoules or 2ml ampoules

(80mg/2ml). – Gentamycin Injection 20mg/ml in 1ml ampoules. – Gentamycin Injection 10mg/ml in 2ml ampoules (20mg/2ml). – Procaine penicillin Injection 1g in a vial (1g is equivalent to 1000000 IU;

water suspensions or powder for suspension) – Ceftriaxone Injection 250mg, 500mg or 1g in a vial – Ampicillin Injection 250mg, 500mg or 1g in a vial

Intervention area: Newborn cord care

– Chlorhexidine 4% gel or solution

Life Saving Commodities for Women and Children: Newborn Health (1)

Intervention area: Preterm respiratory distress syndrome

– Antenatal corticosteroids (ANCs) • Betamethasone Injection 4mg/ml in 1ml or 8mg in 2 ml ampoules (as

betamethasone phosphate disodium salt) • Betamethasone Injection 6mg/ml (3mg/ml betamethasone sodium

phosphate + 3mg/ml betamethasone acetate) in an aqueous vehicle • Dexamethasone Injection 4mg/ml in 1ml ampoules (as dexamethasone

phosphate disodium salt)

Intervention area: Newborn asphyxia

– Resuscitation devices • Resuscitator manual, Neonatal with mask, bag and valve • Electric suction pump less than 100mm Hg, 1 bottle.

Life Saving Commodities for Women and Children: Newborn Health (2)

Intervention area: Pneumonia

– Amoxicillin 250mg or 500mg Dispersible tablets

Intervention area: Diarrhoea

– Oral rehydration salts (ORS) – Zinc sulfate

• 10mg or 20mg Dispersible Tablets • 10mg/5ml syrup

Life Saving Commodities for Women and Children: Child Health

Efforts are now under-way to implement the Commission’s recommendations…

An initial group of 8 ‘Pathfinder’ Countries* prepared plans to scale-up access to life-saving commodities and services • Within context of sharpening national RMNCH plans • Drawing from the Commission’s recommendation,

they address priority bottlenecks and gaps Global Working Groups have been set-up for each of the recommendations and commodities • Lead by a Convening and Co-Convening agency • Self-selected group members based on areas of

expertise and experience • Each Working Group is funded to carry out specific

activities, e.g. addressing global or regional bottlenecks and opportunities; carrying out market analyses; synthesizing knowledge for guidelines, toolkits, etc. that will support country implementation

• Facilitated by an RMNCH Trust Fund, housed by UNFPA

• Supported by a small ‘secretariat’ called the RMNCH Strategy and Coordination Team, housed by UNICEF

* DRC, Ethiopia, Malawi, Nigeria, Senegal, Sierra Leone, Tanzania, Uganda

Eight pathfinder countries: Diverse submissions with common elements

• Evidence based – Wide RMNCH perspective – Systems-oriented

• Bottleneck identification

• Resource mapping – Domestic and partner contributions (though at

high-level only) – Few conducted full RMNCH needs assessment

• Main objectives and activities – 6/8 comprehensive RMNCH – Some gap filling (Ethiopia); others ‘planning-

oriented’ (DRC)

Pathfinder country profiles and summary of proposal

Manufacture Coverage

National

Commodity Specific

Landscape Synthesis assisted with bottleneck identification

Key bottlenecks identified

• Upstream issues re: alignment and harmonization – WHO – National EML – treatment guidelines – training materials – Lack of registered commodities that were on the EML

• Almost all commodities imported

• Poor/absent post-market surveillance

• Frequent stock outs nearly universal – Quantification, budgeting – Parallel vertical supply chains: Malawi – Integrated LMIS with good downstream monitoring: Tanzania

• Health worker capacity re: new guidelines – Provider-related barriers – Need to task shift and decentralize

• Poor demand/utilization of some services (FP)

• Financial access barriers (DRC, Senegal)

Most resources support cross-cutting RMNCH activities

Country Total Nigeria $10,265,649 Senegal $5,513,964 Sierra Leone $5,320,040 Malawi $3,955,255 Uganda $3,877,359 DRC $3,496,404 Tanzania-Mainland $3,292,390 Tanzania-Zanzibar $750,070 Ethiopia $1,990,775 Grand Total $ 38,461,906

Reproductive

Maternal

Newborn

Child

RMNCH Mix

Budgets split by RMNCH Continuum of care Total country budgets (US$)

Interventions will be implemented more or less equally between the government, UN agencies and NGOs

CHAI JSI Marie-Stopes

NGOs receiving > $800k

BBCMA PSI University of Ibadan Centre for Population and Reproductive Health Management Sciences for Health MHEN USP Planned Parenthood of Nigeria

NGOs receiving > $300k

Tanzania, Zanzibar, Ethiopia

Bulk of funds through govt

Main budget activities focus on training, advocacy, and supply chain management, with commodities only accounting for 10%

Budget split by cost category (100% = US$38.5m)

Infrastructure & equpt 3%

Operational research 5%

Policy & guidelines update 9%

Commodities 10%

Coordination and Mgt 10%

Supply chain mgt 12%

Clear focus on health worker performance, regulatory alignment, demand generation & supply chain strengthening

Budget split by UNCoLS ‘recommendation’ area (100% = US$38.5m)

Local markets 2%

Innovative financing 2% Quality 1%

Regulation 7%

Regional or supra-national approaches would be beneficial

• Regulatory efficiency – Joint approaches to EML updating – Regional agreements on new product registration – WHO pre-qualification

• Reduced market barriers (market shaping and supply chain)

– Price data/pooled procurement – Local Manufacturing/GMP certification

• Quality control and post-market surveillance

• Accountability/Metrics

• Quantification and forecasting models

• Cooperation across LMIS initiatives and monitoring activities

• Updated job-aids, checklists, training materials