A Nurse tending to a Mother and Child
In 2010, the UN Secretary-General’s Global Strategy for Women’s and Children’s Health highlighted the suffering of women and children around the world caused by lack of access to life saving commodities. Life in the developing world is filled with stories like that of the woman who, just after child birth, dies from excessive bleeding because the health centre is stocked-out of the medicine to save her life; the child with a simple case of pneumonia who cannot be treated because the needed antibiotic is not registered for use; and the 45-year old woman who finds out she is pregnant for the seventh time, after almost dying the last time she gave birth because she does not have access to modern methods of family planning.
The overarching health system and financial impediments for governments and end-users to access life-saving commodities is made worse by the lack of awareness of how, why and when to use them, preventing women and children from accessing and using appropriate commodities. Other system barriers to these commodities include the severely under-resourced regulatory agencies in low-income countries, which lead to delayed registration of commodities, lack of oversight of product quality and general inefficiencies; market failures, where return on investment is too low to encourage manufacturers to enter the market or produce sufficient quantities; and user supply and demand challenges such as limited demand for the product by end-users, local delivery problems and incorrect prescription and use.
The UN Secretary-General’s Global Strategy called on the global community to work together to save 16 million lives by 2015 through increasing access to essential medicines, medical devices and health supplies that effectively address leading avoidable causes of death during pregnancy, childbirth and childhood. This challenge has been taken up by the UN Commission on Life-Saving Commodities for Women and Children, with a focus on the world’s 49 poorest countries.
The Commission recognises that if the needs for modern contraceptive methods were fully met in these countries, an estimated 53 million unintended pregnancies would be avoided, about 90,000 women’s lives would be saved and an estimated 590,000 newborn deaths would be averted. In addition, many of the over 800,000 deaths of children each year from diarrhoea could be prevented with oral rehydration solution and zinc that cost less than US$0.50 per treatment.
The Commission has identified 13 overlooked life saving commodities that, if more widely accessed and used, could save the lives of more than 6 million women and children. These are; Maternal health commodities such as Oxytocin and Misoprostol (to prevent and treat post-partum haemorrhage) and Magnesium sulphate (to prevent and treat eclampsia and severe pre- eclampsia); Newborn health commodities such as injectable antibiotics (to treat newborn sepsis), Antenatal corticosteroids (to prevent respiratory distress in preterm babies), Chlorhexidine (for newborn cord care) and resuscitation devices (to treat newborn asphyxia); Child health commodities amoxicillin (to treat pneumonia) and Oral rehydration salts and Zinc (to treat diarrhoea); and Reproductive health commodities such as Female condoms, Contraceptive implants and Emergency contraception.
To deliver on the promise of saving the lives of millions of women and children, the Commission recommends actions which focus on the need for improved global and local markets for life-saving commodities, innovative financing, quality strengthening and regulatory efficiency, improved national delivery of commodities and better integration of private sector and consumer needs. The scaling up of access to and use of these 13 commodities is not only a moral obligation, but one of the most effective ways of getting more health for the money invested.
It would make a significant contribution to put maternal and child health in a trajectory to end these preventable and tragic deaths. The Commission estimates that the scale up will cost less than USD 2.5 billion over five years and save over 6 million lives. These estimated costs per lives saved are low and represent excellent global development investments.
The Commission has also developed a detailed plan for implementation with cross-cutting and commodity-specific actions and clearly stated national, regional and global activities and associated costs. Recognising that many commodity-related obstacles are linked to financial barriers and rooted in broader health system challenges – such as poor governance, inadequate human resources, ineffective local supply chains and insufficient information systems – the Commission calls for further links between the identified solutions and priority actions and other global and national initiatives for strengthening health systems
The Commission believes that it is possible to overcome seemingly entrenched barriers when partners work together. The success in substantially reducing the price of antiretroviral drugs for HIV is testimony to the effect of partnerships, with 6.6 million people in developing countries receiving these drugs at the end of 2010.
Initiatives such as aggregating orders, and improving the forecasting, financing and manufacturing capacity of insecticide-treated nets in sub-Saharan Africa increased their supply from 5.6 million in 2004 to 145 million in 2010, leading to substantial reductions in deaths due to malaria.
When auto-disable syringes for immunization were introduced in 1992 to prevent infections from re-use in developing countries, the cost was over six times that of normal syringes. The price difference is now near equal and use near universal due to sustained increased demand following initial GAVI Alliance support for their use.
These previous achievements give us the confidence to call on local communities, National authorities and the global community to once again rally around an initiative that will save millions of lives in the poorest countries of the world, this time by improving the availability, affordability and accessibility of these 13 proven life-saving commodities.