Guidance on Elements to Consider when Planning for the Integration of Oxytocin into the EPI Cold Chain

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Post-partum hemorrhage (PPH) remains one of the major causes of maternal mortality and accounts for 35% of all maternal deaths.1 The World Health Organization (WHO) has recommended oxytocin as the most effective medicine for the prevention and treatment of PPH, particularly for facility-based births.2 In line with this recommendation, most countries list oxytocin as the medicine of choice for the prevention and treatment of PPH.

Despite this positive policy framework for oxytocin use, supply chain barriers that limit access to the medicine persist. Studies from many countries have shown that continuous availability of oxytocin at service delivery points is an issue, and more recent studies in individual countries have demonstrated that lack of availability is a major challenge.3,4,5,6 Inadequate forecasting of requirements, weak information systems, and poor distribution systems contribute to this challenge. Another major issue in ensuring access to quality oxytocin is maintaining cold storage of the product throughout the supply chain. Oxytocin must be stored between 2°C and 8°C, with possible excursions to room temperature for brief periods. In many countries, the distribution systems in place for essential medicines do not allow for cold storage. Likewise, in many settings, warehouses at lower levels of the system and service delivery points do not have the infrastructure or equipment to maintain cold storage. A recent systematic review of the literature showed the widespread availability of oxytocin of questionable quality in both the private and public sectors in many countries.7

In most countries, Expanded Program on Immunizations (EPI) cold chains are highly effective in reaching even the lowest levels of the system. However, they are managed vertically and separately from other essential commodities. One barrier to integrating other products into the EPI cold chain is the perception at the country level that this is not permitted. To address this perception, the Maternal Health Technical Resource Team of the UN Commission on Life-Saving Commodities, in close collaboration with WHO and the United Nations Children’s Fund (UNICEF), developed a joint statement declaring that countries may choose to integrate other products, specifically oxytocin, into the EPI cold chain to ensure access to quality products.8 Integration is an option to consider, but operationalization within the country context is also needed.