Translating Global Policies into Country Action: Magnesium Sulfate Country Case Studies

Session: Clinical Interventions for Maternal Health: From Policy to Practice

Presenter: Deepti Tanuku, Accelovate Program, Jhpiego
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Background: The procurement, supply chain, and use of magnesium sulfate is complicated by multiple product formulations that require different dilution processes to be administered effectively. As a result, this effective and affordable drug that treats the second leading cause of maternal mortality in low and middle income countries remains under-utilized and is often subject to stock-outs. This situation has been addressed at the global level – via suggested changes to the WHO EML that lists only one priority formulation. However, this global level policy change still required country-level action. Accelovate collected data in several countries to determine the pathway for change for country level EMLs, so that they may reflect global level policies.

Methodology: Accelovate compared clinical practices relative to procurement policy, clinical practice, and available magnesium sulfate formulations. Through key informant interviews, survey questionnaires targeting 8 classifications of health professionals, literature reviews and site visits, data for 36 countries was collected. Specific questions were asked on (1) common MgSO4 presentations available in medical facilities, (2) MgSO4 presentations considered most practical, (3) common MgSO4 presentations registered and procured at country level, and (4) listed MgSO4 presentations in clinical guidelines and country based essential medicines lists.

Results: Accelovate found that providers cite preferred magnesium sulfate presentations that are neither available in nor commonly procured by their facility – indicating a mismatch between supply and demand. In some cases, this tempted providers to substitute magnesium sulfate with diazepam, a more straightforward but less effective anticonvulsant. In addition, there was some differences between country-based EML and the globally recommended priority formulation.

Conclusion: Promoting magnesium sulfate use requires the promotion of a priority formulation and ensuring available product presentations reflect the standardized formulation. The necessary steps for this will be outlined and discussed, along with three country case studies for Malawi, Zambia and Zimbabwe.