Updating a list can help ensure access to life-saving medicines

Related program: Advocacy and policy

Example: Kenya Essential Medicines List, 2016

Changing indicators and expanding drug use in Kenya’s national Essential Medicines List allows for increased government expenditure for postpartum hemorrhage treatment methods.

The need

Postpartum hemorrhage (PPH)—excessive blood loss after a mother gives birth—is one of the leading causes of maternal mortality in Kenya. A strong body of evidence demonstrates that both oxytocin and misoprostol are highly effective, low-cost methods of preventing and managing PPH in low-resource settings. Unlike oxytocin, which requires constant refrigeration, misoprostol can be transported and stored at room temperature. This makes it an excellent alternative in situations or circumstances where oxytocin is not available or cannot be administered. However, prior to 2016, Kenya’s Essential Medicines List (EML), which guides government priorities and expenditures for heath products, did not list misoprostol for use for PPH management.

The policy solution

An effective way to ensure availability of essential health products is for policy makers to mandate their inclusion into the national EML. EMLs give priority status to medicines that address a country’s most pressing public health problems, making them a vital tool for improving and maintaining a country’s health.

Kenya’s EML, modeled after the World Health Organization’s Model Essential Medicines List, guides national drug policy, details safe and cost-effective medicines that should be widely available, and helps the Ministry of Health (MOH) prioritize funding and support for those commodities.

Previously, misoprostol was indicated for induction of labor and was administered by specialist health care workers at higher levels of the health care system. Advocates identified the upcoming EML update as an opportunity to expand its use, thereby reaching women where oxytocin could not. They also saw it as an opportunity to increase the cadre of health workers allowed to administer misoprostol, particularly at lower levels of the health system where the majority of Kenyan women give birth.

PATH, Family Care International, the Kenya Obstetrical and Gynecological Society, and the United Nations Population Fund (UNFPA) partnered to advocate for the MOH to re-establish a task force to review the evidence on the use of misoprostol for PPH. At the same time, internal champions within the MOH were cultivated, specifically the focal officer for maternal and newborn health. Ministry champions were armed with evidence, treatment guidance, and job aids, which equipped them with the information needed to influence the therapeutics committee responsible for reviewing Kenya’s EML. Ultimately, this multi-pronged approach led to a major policy breakthrough for pregnant women: the EML was updated to include misoprostol for the treatment of PPH, allowing for its use at lower-level health facilities by nurses, nurse midwives, midwives, and clinical officers. The EML also allowed for use of misoprotol by midwives working at community level under the community midwifery program.

The impact

This policy change increases the number of tools available to treat PPH and expands access of the drug to women who could previously not afford or access health care specialists. Additionally, with misoprostol, PPH can be addressed at the lower levels of the health care system, thereby reducing the delays faced when getting referrals to specialists or referral hospitals. Quick action is a key component in successfully managing PPH and this update to the EML responds to this challenge. Ultimately, this change will help save the lives of thousands of Kenyan women and newborns by preventing deadly blood loss during childbirth.

The listing of a medicine in a national list such as the EML is only the first step—but an extremely important one—to ensuring the expected benefits and substantial health impact of a medicine are realized.

Considerations for application

Advocates looking to influence EML updates can use this example as a model, recognizing that the process for updating EMLs is different in different countries. Some countries also have standard lists for Essential Medical Supplies as well.

In 2018, WHO released its first ever Essential Diagnostics List (EDL). Most countries have not developed their own EDLs. Advocates can weigh in diagnostic-related health priorities by pushing for the development, and then regular updates, of this list in their own county.

Policy text

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