UN Commission on Life-saving Commodities: Executive Summary of Commissioners' Report (Sept 2012)

Publication date: 2012

UN Commission recommends innovative actions to save women’s and children’s lives “Each year, millions of women and children die from preventable causes. These are not mere statistics. They are people with names and faces.” – United Nations Secretary-General Ban Ki-moon A new mother bleeds to death because the health centre has run out of the medicine needed to save her life; a child dies of pneumonia because there is no registered child-friendly form and dose of the antibiotic he needs; a woman with no knowledge of modern family planning methods is in despair at finding she is pregnant for the seventh time, after almost dying the last time she gave birth – sadly all these scenarios are everyday realities, but they don’t have to be. In the case of family planning, for example, if all women who wanted to prevent or delay pregnancy were using modern contraceptive methods, an estimated 53 million unintended pregnancies would be avoided, about 90,000 women’s lives saved and some 590,000 newborn deaths averted. And 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. 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. The Global Strategy called on the global community to work together to save 16 million lives by 2015 through increasing access to and appropriate use of essential medicines, medical devices and health supplies that effectively address leading avoidable causes of death during pregnancy, childbirth and childhood. This challenge was taken up by the UN Commission on Life-Saving Commodities for Women and Children (the Commission), which is a part of the Every Woman, Every Child movement and has the overall goal to increase access to these commodities in the world’s poorest countries. Commissioners – led by Co-Chairs President Goodluck Jonathan of Nigeria and Prime Minister Jens Stoltenberg of Norway and Vice Chairs UNICEF and UNFPA – defined a list of 13 overlooked life-saving commodities for women and children; identified key barriers preventing access to and use of these commodities; and recommended innovative action to rapidly increase both access and use. Following is a snapshot of avoidable causes of death, identified commodities that address them, barriers to their use and the potential impact of innovative action: Cause of death Commodity Examples of key barriers Potential 5-year impact Post-partum haemorrhage (excessive bleeding following delivery) Oxytocin Often poor quality 15,000 maternal lives saved Post-partum haemorrhage Misoprostol Not included in national lists of essential medicines Severe pre-eclampsia (pregnancy complications including high blood pressure) and eclampsia (convulsions) Magnesium sulfate Lack of demand by health workers 55,000 maternal lives saved Newborn sepsis (blood infection) Injectable antibiotics Poor compliance by health workers 1.22 million neonatal lives saved Preterm respiratory distress syndrome (breathing difficulties) Antenatal corticosteroids Low awareness of product and impact 466,000 neonatal lives saved Newborn cord care Chlorhexidine Limited awareness and demand 422,000 neonatal lives saved Newborn asphyxia (shortage of oxygen) Resuscitation devices Requires trained health workers 336,000 neonatal lives saved Pneumonia Amoxicillin Limited availability of child-friendly product 1.56 million under-five lives saved Diarrhoea Oral rehydration solution Poor understanding of products by mothers/ caregivers 1.89 million under-five lives saved Diarrhoea Zinc Family planning/ contraception Female condoms Low awareness among women and health workers Almost 230,000 maternal deaths averted Family planning/ contraception Contraceptive implants Requires trained health workers Family planning/ contraception Emergency contraception Low awareness among women www.everywomaneverychild.org The three main barriers identified by the Commission are: ineffective regulation, within sufficient resources leading to delays, poor quality oversight and general inefficiencies; limited supplies of high-quality products because manufacturers have no incentive to sell their products in particular countries or fail to produce sufficient quantities; and user supply and demand challenges such as low demand by end-users, local delivery and distribution breakdowns and incorrect prescription and use. The good news is that recent experiences have shown it is possible, if partners work together, to overcome even persistent barriers to access and use. One example is the substantial reduction in deaths from malaria achieved by combining orders, improving forecasting, sustaining financing and extending manufacturing capacity in Africa for insecticide-treated nets (ITNs), which increased the supply of ITNs in sub-Saharan Africa from 5.6 million in 2004 to 145 million in 2010. In addition, mHealth – the use of mobile technologies such as cellular phones – has improved forecasting and reporting on stocks and increased demand and care-seeking through texting of health information and appointment reminders. The Commission has therefore recommended the following 10 actions to deliver on the promise of saving the lives of millions of women and children: 1. Shaping global markets 2. Shaping local delivery markets 3. Putting in place innovative financing 4. Strengthening quality 5. Making regulation more efficient 6. Increasing supply and awareness 7. Increasing demand and utilization 8. Reaching the poorest women and children 9. Improving performance and accountability 10. Prioritizing and funding product innovation These recommendations will be accompanied by a detailed implementation plan that includes cross-cutting and commodity-specific actions, clearly stated national, regional and global activities and associated costs. In addition, since many of the barriers are connected to financial and broader health system challenges, the Commission has linked the identified solutions and priority actions with other global and national initiatives for strengthening health systems. The Commissioners believe that implementing these 10 recommendations will transform the supply, demand and use of quality life-saving commodities for women and children, and they will advocate at the highest levels for bold, concrete action. The UN Secretary-General noted in defining the Commission’s work: “Together we want to help the world see and believe in a better future. Mothers and children are at the heart of this future, and the Commission’s recommendations provide the tools needed to get there.”

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