Lessons Learned: Leveraging the role of national distributors to accelerate access to medical abortion combi-packs in sub-Saharan Africa

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Approximately 56 million abortions occur each year globally, and almost half of them are unsafe. The risk of dying from an unsafe abortion is highest in Africa. Medical abortion
(MA), using a combination of mifepristone and misoprostol, is a safe and effective method of pregnancy termination that can be managed by different levels of health care providers or self-managed by women. Mifepristone and misoprostol may be obtained in a co-packaged product (combi-pack), which contains one mifepristone 200mg tablet and four misoprostol 200mcg tablets. Combi-packs are not yet broadly accessible in many countries in sub-Saharan Africa (SSA). Where combi-packs are available in SSA, they are often accessed through the supply chains of social marketing organizations (SMOs), or, less frequently, through ministries of health (MOHs). Although local commercial distributors (private sector actors who procure, store, and re-sell pharmaceutical products) are important links within these supply chains, it is not very common for a major combi-pack manufacturer to contract directly long-term with a commercial distributor in SSA, without the collaboration of an SMO partner.


The Reproductive Health Supplies Coalition (RHSC) is the largest network of reproductive health organizations in the world, bringing together more than 525 member organizations from all sectors, including governments, commercial sector actors, technical agencies, and civil society organizations. More than a third of its membership is based in low- and middle-income countries. In mid-2018, RHSC began a three-year project, funded by the Children’s Investment Fund Foundation (CIFF) and an anonymous donor, “Leveraging the role of national distributors to accelerate access to medical abortion combi-packs in sub-Saharan Africa”. This project’s intent was to test the efficacy of innovative approaches with commercial distributors as a means of enabling them to play a more active role in increasing access to combi-packs in SSA.