Registration, procurement, distribution, and use of misoprostol in Uganda:
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Date
2013-10-20Author
Atukunda, Esther Cathyln
Brhlikova, Petra
Agaba, Amon Ganafa
Pollock, Allyson M
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Background Poor access to essential medicines remains a barrier to improvement of health in low-income countries.
The maternal mortality rate from post-partum haemorrhage (PPH) in Uganda is one of the highest in the world.
Uganda launched a misoprostol rollout programme for prevention of PPH in 2009, before WHO added it to the
Essential Medicines List. We assessed the rollout programme in Uganda.
Methods We reviewed relevant documents (WHO and Ministry of Health guidelines, registration dossier), interviewed
key informants, and assessed procurement data collected from the Accessing Medicines in Africa and South Asia
project (2010–13). We interviewed informants from purposively selected districts of Mbarara, Bundibugyo, Kampala,
and Apac (one for each Ugandan Ministry of Health performance rank). We interviewed key informants about the
introduction, registration, procurement, distribution, availability, and use of misoprostol, treatment guidelines, and
human resources.
Findings We interviewed 82 participants. Civil society organisations promote misoprostol rollout across Uganda as
part of a larger assemblage of groups working on maternal health and had a key role in misoprostol registration with
the National Drug Authority and development of clinical guidelines. Evidence-based requirements for registration,
guideline development, and addition to the Essential Medicines List of Uganda were scarce. Civil society and national
medical stores were procuring and distributing misoprostol to health centres 2 years before its inclusion in clinical
guidelines and Uganda’s Essential Medicines List, despite the contested evidence for its eff ectiveness. Promotion and
distribution of misoprostol is continued by local affi liates off ering incentives to private health-care providers
promoting their programmes.
Interpretation Civil society organisations accelerated misoprostol rollout in Uganda. Despite its introduction as a
second choice treatment, evidence suggests an increasing trend of misoprostol procurement and availability over the
medicine of choice—oxytocin. Absence of guidelines and lack of
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