Nepal's Initiative for Proper Storage of Oxytocin

Ms. Shishli Simkhada briefing assessment sampling and methodology during the dissemination workshop

Topics:

Logistics

Procurement

Quality Assurance

Maternal and Child Health

Projects:

Date

August 3, 2022

Nepal has made significant improvement in maternal health over the past two decades. The maternal mortality ratio decreased between 1996 and 2016 from 539 maternal deaths per 100,000 live births, to 239 deaths per 100,000 live births. Despite this, Nepal is still ranked 46th among countries with the highest maternal mortality ratios.

Postpartum Hemorrhage (PPH) – excessive bleeding during and after childbirth – is one of the leading causes of maternal death in Nepal, and worldwide. Oxytocin is used to treat and prevent PPH, and is critical for health workers to have on hand when labor starts. Nepal's national standard treatment protocol recommends oxytocin injection for prevention and treatment of PPH in births at facilities. As it is heat sensitive, oxytocin must be kept cold to maintain its potency (and thus efficacy) throughout the health supply chain. A joint statement released by WHO, UNFPA and UNICEF in 2019 recommends that oxytocin should be kept in the cold chain (between 2 and 8 °C) during transportation and storage. However, cold chain management is still a challenge in Nepal.

In collaboration with Nepal's Family Welfare and Management Divisions of the Department of Health Services, GHSC-PSM has supported the Government of Nepal (GoN) to improve oxytocin storage practices at all tiers of the supply chain in Nepal.

Assessment on storage and distribution practices of oxytocin and dissemination workshop

In order to ascertain the current storage and distribution practices for oxytocin, GHSC-PSM conducted a cross-sectional study at 70 birthing centers (53 health posts, five primary healthcare centers, one primary hospital, and 11 district hospitals) during August and September 2021. The study showed that only 21 percent of the birthing centers received oxytocin maintaining cold chain procedures, and about 40 percent stored oxytocin in the refrigerator/freezer. GHSC-PSM observed a substantial lack of resources for maintaining oxytocin in cold chain during storage and distribution; a lack of awareness regarding oxytocin sensitivity in storage; and improper labelling in packages of oxytocin brands available on the market.

The findings of the oxytocin assessment, along with other maternal, newborn and child health (MNCH) commodity issues, were shared with the GoN and supply chain stakeholders during a workshop held on April 29 and 30, 2022. GHSC-PSM presented finalized recommendations at the workshop, and with the GoN, committed to the improvement of supply chain management of oxytocin. GHSC-PSM continues to support in the following ways.

Storage of oxytocin injection boxes in the refrigerator at health office store in Surkhet

Storage of oxytocin injection boxes in the refrigerator at health office store, Surkhet

Regular advocacy at different fora: The project advocates and sensitizes authorities at all distribution and storage levels to leverage resources, particularly for refrigeration and vaccine boxes. It does this at supply chain management working group (SCMWG) meetings, supportive supervision visits to health offices, municipalities, and health facilities, and other fora.

Orientation to municipality and birthing centers staff from 10 districts and follow up: To create awareness, strengthen advocacy, and ensure appropriate storage and distribution of oxytocin at various supply chain tiers, a one-day orientation program was organized for health workers in all seven of Nepal’s provinces. A total of 499 health workers from 108 municipalities and 391 birthing centers in 10 districts received the orientation. The orientation was highly praised by GoN stakeholders and healthcare workers, brought forward current practices, and resolved misunderstandings regarding oxytocin storage and distribution. Participants committed to maintaining oxytocin at recommended temperatures during storage and distribution, and to advocating for resources for their health facilities. A follow up after orientation conducted in 269 birthing centers showed positive results.

Development of informational materials

GHSC-PSM and the National Health Education Information and Communication Center designed informational materials (posters and stickers) about proper storage of oxytocin. The poster was developed for warehouses and promotes the need to maintain the recommended temperature during storage and distribution of oxytocin. Similarly, a sticker was designed for raising awareness among health workers at birthing centers with the specific message to maintain 2–8°C temperature for oxytocin. The materials are being distributed to all supply chain levels including birthing centers across the country.

IEC Oxytocin Storage Poster

IEC Oxytocin Storage Sticker

Positive changes to date

All central and provincial stores are maintaining appropriate cold chain for storage and distribution of oxytocin. Similarly, 73 out of 77 districts are storing oxytocin in refrigerators.
Nepal's Ministry of Health committed to revise standard treatment protocols for basic health services to include guidance on the optimal storage of oxytocin, specifically stating that it should be stored at 2–8°C in a refrigerator.
The Ministry's Family Welfare Division included the procurement of an ice-lined refrigerator for storage of oxytocin in its annual activity implementation guidelines for local-level governments.
Among the 108 municipalities and 391 birthing centers provided with orientation on oxytocin, 73 municipalities and 300 birthing centers have started storing oxytocin in a refrigerator. Follow-up in the remaining municipalities and birthing centers is ongoing. Additionally, four municipalities and six birthing centers purchased refrigerators with their own resources.

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