Establishing Sustainable Access to Quality Uterotonics in Kano, Lagos and Niger States-A Supply Chain Perspective.

Background: The quality of oxytocin and misoprostol, the most widely used uterotonics for postpartum haemorrhage (PPH) management, suffer supply chain challenges and climactic susceptibilities.

Aim: To describe a supply chain strengthening programme for introducing heat-stable Carbetocin (HSC), to health facilities in Kano, Lagos and Niger states.

Method: Human-centred design (HCD) was employed to uncover uterotonics supply chain challenges and to identify priority interventions across a market-shaping value chain to facilitate the rollout of HSC. Through a mixed-methods approach and interviews with 203 stakeholders, challenges in the uterotonics supply chain and potential solutions were identified. A market-shaping value chain was employed to map HSC introduction and rollout, focusing on key interventions. Before the project initiation, we established clear objectives including identifying barriers, introduction and rollout journey mapping of HSC.

Results: Using HCD, HSC was successfully rolled out to over 87 health facilities. Employing the market-shaping value chain, pivotal interventions were executed. These included policy updates (inclusion of HSC in the National and States Essential Medicines List), regulatory actions (registering Carbetocin with NAFDAC), financing strategies (co-developing state roadmaps for sustainable procurements), supply management (reducing stock-outs) and healthcare provider training on supply chain management practices. These efforts facilitated seamless integration of HSC into the states' supply chains.

Conclusion: HCD and market-shaping value chain approach were employed to introduce HSC in Nigeria. This study shows that integrating these approaches can enhance the availability and accessibility of essential medicines, offering potential replicability in similar health systems.