Overcoming Bottlenecks and Joining the Dots to Improve Access to Quality Magnesium Sulfate for Treatment of Pre-eclampsia and Eclampsia in Nigeria

Session: New Approaches for Persistent Problems: Improving Availability of Life-saving Commodities for Women and Babies

Presenter: Salisu Ishaku, Population Council
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Preeclampsia/eclampsia (PE/E) causes around 40% of maternal deaths in some Nigerian states. Although magnesium sulphate (MgSO4) has been available in Nigeria during the last ten years, bottlenecks continue to limit the uptake of MgSO4, including inadequate knowledge across the both the health system and community levels and fragmented efforts by different institutions. A mixed methods approach as part of a landscaping analysis toward understanding who, what, why, how and where the bottlenecks are to improving access to MgSO4 supply at health facilities; ranging from policy development and dissemination, commodity procurement and distribution; health provider knowledge and skills, community knowledge and health seeking behavior. Bottlenecks are being reduced by combined efforts of the FMoH, local and international NGOs, training institutions and regulatory bodies. Following successful introduction of MgSO4 at tertiary level, primary health care providers were trained to provide the loading dose to women presenting with PE/E and referred onwards – driving both the public and private demand for the commodity. This influenced policy change at federal and state level and listing of MgSO4 on state essential medicine lists.  Schools of nursing and midwifery were engaged to incorporate MgSO4 on their pre-service curricula. Engaging an international manufacturer (e.g. FIDSON) through a volume guarantee arrangement has also resulted in increasing the commodity supply in some northern states as well as involvement of the National Agency for Food, and Drugs Administration and Control (NAFDAC).    Supply and distribution of MgSO4 for treating PE/E has increased over the last 5-10 years in Nigeria. This is a result of involvement of multiple actors and agencies from the regulatory body, procurement, logistics and distribution, quality assurance, to the ministry of health. However, challenges remain especially in ensuring that good quality magnesium sulfate is available at all points of services where women seek PE/E care.