Global Availabilty of Uterotonics:

Oxytocin Availability Improving, and Misoprostol Progressing Slowly

Figure 1: Global Summary of Uterotonics, Selected Countries, 2012
Survey Responses from 37 Countries: Drug Availability - Uterotonics

Survey Response No Yes

Afghanistan Angola Bangladesh Bolivia Cambodia DRC East Timor Ecuador El Salvador Eq. Guinea Ethiopia Ghana Guatemala Guinea Honduras India Indonesia Kenya Liberia Madagascar Malawi Mali Mozambique Nepal Nicaragua Nigeria Pakistan Paraguay Philippines Rwanda Senegal South Sudan Tanzania Uganda Yemen Zanzibar Zimbabwe

Survey Questions
Oxytocin regularly available in facilities Oxytocin free of charge to patients at public facilities Oxytocin currently available at the MOH medical store Misoprostol regularly available in facilities Misoprostol on the EML USAID-Supported Countries Surveyed January to March 2012

The USAID / MCHIP global survey of national programs to address postpartum hemorrhage and preeclampsia has been conducted in two subsequent years: 2011 and 2012. The 2012 survey results show that access and availability of oxytocin has improved globallyincreasing from regular availability in 74% of countries (23 of 31) in 2011 to 89% of countries (33 of 37) responding in 2012. Eighty-nine percent of countries surveyed report regular availability of oxytocin and 92% report oxytocin availability in the MOH medical store. Seventy percent of countries report that oxytocin is free of charge, and only four countries report that oxytocin is not available more than half the time. Smaller gains, however, have been made regarding the availability of misoprostol. While 21 countries (only two more than the 19 positive responses from 2011) show misoprostol on the Essential Medicines List (EML) in 2012, it is currently regularly available (more than half the time) in only 10 of those countries.

Mixed progress has been made regarding the availability of oxytocin in Asia. While India and Nepal now report that oxytocin is regularly available, Bangladesh considers it to be less available in 2012 than in 2011. The survey shows that misoprostol has yet to be added to the EML in Afghanistan and Indonesia. Progress has been made in LAC in the availability of oxytocin. In 2011, of the five countries surveyed, only Guatemala reported irregular availability of oxytocin. In 2012, all countries surveyed from LAC report that it is now regularly available. The inclusion of misoprostol on the EML, however, remains uneven, with Guatemala and Nicaragua continuing to report the absence of misoprostol from the EML and Paraguay clarifying its response from 2011 to 2012 and now indicating that misoprostol is not on the EML. Several African countries report improvements in oxytocin availability. Of the five countries that reported oxytocin as not regularly available in 2011, only South Sudan still reports oxytocin is not regularly available. There have been some gains and losses in the availability of misoprostol in African countries when data from 2011 and 2012 are compared. Of the 11 African countries that did not report having misoprostol on the EML in 2011, three have added it to the EML since 2011. Three others, however, now indicate that it is not on the EML. Although this discrepancy may be due to clarification of previous responses, this finding deserves a closer look. Figure 2: Availability of Oxytocin in Health Facilities, 2011 and 2012
2011 (n=31) 2012 (n=37)

Oxytocin regularly available in facilities

Oxytocin regularly available in facilities

0%

26%

11%

35%

54%

74%

Yes

No

Regularly Less than half the time

More than half the time Never

Figure 3: Availability of Misoprostol in Maternity Centers in 37 Countries, 2012 Misoprostol regularly available in facilities
Illustrative examples: Country 1 and Country 2 stated that misoprostol was never available in public maternity centers, while Country 3 said that it is available more than half the time. They qualified their answers with the following: Country 1: "Misoprostol is not on National EML of [our country], so whenever it is required, it is purchased." Country 2: "The doctors prescribe it for the family of the patient, and the family buys it from the private pharmacy." Country 3: "Depends on the workload at that facility and whether there is sharing of supplies between higher- and lower-level facilities in the same area."

19% 38% 8%

Regularly More than half the time Less than half the time Never

35%

Figure 4: Misoprostol Inclusion on EML, 2011 and 2012

2011 (n=31) 2012 (n=37)

Misoprostol on the EML

Misoprostol on the EML

39%
61%

43% 57%

No

Yes

Yes

No

Figure 5: Oxytocin Cost to Patients in 37 countries, 2012 Oxytocin free of charge to patients at public facilities
Illustrative examples: two of the countries stated that oxytocin was free of charge to patients in public health facilities qualified their answers with the following: Country 1: "It is free of cost, whenever available. Most of the time it is not available and patients have to buy it or it is provided through charity/donation, but not refrigerated." Country 2: "If the Medical Supply at the Ministry distributes it, it will be free. But most of the time, it may not be there, as the amount distributed to health facilities is not sufficient. If it is not available, the family may buy it from the private pharmacy."

30%

Yes
No
70%

Figure 6: Presence of Oxytocin in the MOH Medical Oxytocin currently available at the MOH medical store Store
8%

in 37 countries, 2012

Yes
No
92%

Figure 7: Frequency of Oxytocin Stock-Outs, 2012 Frequency of oxytocin stock-outs at central/regional levels 3%
14%

Frequently Sometimes
3
30%

Methodology: A country-level landscape analysis was conducted from January to March 2012 in 37 countries across Africa, Asia and Latin America, including USAID priority countries that face the highest disease burden for maternal health. The purpose of this analysis was to document progress in national scale-up of programs to reduce PPH and PE/E, as compared to the 2011 findings. Data were collected through national meetings of key stakeholders who together completed a 46-item questionnaire that addressed six core components of programming: policy, training, drug distribution and logistics, monitoring and evaluation, programming and opportunities for scale-up. The questionnaire incorporated both quantitative and qualitative responses, which were checked for completeness and gaps, and analyzed by the MCHIP maternal health team.

54%

Rarely No answer

Figure 8: Changes in Uterotonics in 30 countries, 2011 to 2012

Oxytocin regularly available in facilities 2011 yes
Afghanistan Angola Bangladesh Bolivia DRC Ethiopia Eq. Guinea Ghana Guatemala Guinea Honduras India Indonesia Kenya Liberia Madagascar Malawi Mali Mozambique Nepal Nicaragua Nigeria Paraguay Rwanda Senegal South Sudan Tanzania Uganda Zanzibar Zimbabwe

Misoprostol on the EML 2011 2012 no yes no

2012 no yes no yes