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Lookup NU author(s): Dr Petra SevcikovaORCiD, Professor Allyson PollockORCiD
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© 2015 Elsevier Ltd.Misoprostol use for postpartum haemorrhage (PPH) has been promoted by Civil Society Organizations (CSOs) since the early 2000s. Yet, CSOs' role in improving access to misoprostol and shaping health policy at global and national levels is not well understood. We document the introduction of misoprostol in Uganda in 2008 from its registration, addition to treatment guidelines and national Essential Medicines List (EML), to its distribution and use. We then analyse the contribution of CSOs to this health policy change and service provision. Policy documents, procurement data and 82 key informant interviews with government officials, healthcare providers, and CSOs in four Ugandan districts of Kampala, Mbarara, Apac, Bundibugyo were collected between 2010 and 2013.Five key CSOs promoted and accelerated the rollout of misoprostol in Uganda. They supported the registration of misoprostol with the National Drug Authority, the development of clinical guidelines, and the piloting and training of health care providers. CSOs and National Medical Stores were procuring and distributing misoprostol country-wide to health centres two years before it was added to the clinical guidelines and EML of Uganda and in the absence of good evidence. The evidence suggests an increasing trend of misoprostol procurement and availability over the medicine of choice, oxytocin. This shift in national priorities has serious ramifications for maternal health care that need urgent evaluation. The absence of clinical guidelines in health centres and the lack of training preclude rational use of misoprostol. CSOs shifted their focus from the public to the private sector, where some of them continue to promote its use for off-label indications including induction of labour and abortion. There is an urgent need to build capacity to improve the robustness of the national and local institutions in assessing the safety and effectiveness of all medicines and their indications in Uganda.
Author(s): Atukunda EC, Brhlikova P, Agaba AG, Pollock AM
Publication type: Article
Publication status: Published
Journal: Social Science and Medicine
Year: 2015
Volume: 130
Pages: 242-249
Print publication date: 01/04/2015
Online publication date: 18/02/2015
Acceptance date: 01/01/1900
ISSN (print): 0277-9536
ISSN (electronic): 1873-5347
Publisher: Elsevier Ltd
URL: https://doi.org/10.1016/j.socscimed.2015.02.022
DOI: 10.1016/j.socscimed.2015.02.022
PubMed id: 25728484
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