Total Awarded: Approximately $3,745,000
Total Grants: 7
Duration: 2007 - Present
Geographic Focus: Nigeria
Pre-eclampsia/eclampsia is a serious condition that can develop during pregnancy, even in women with no risk factors. Although there is little understanding of what causes pre-eclampsia/eclampsia, there is an effective treatment for this condition which, if left untreated, can progress to coma and death. In 1994, the World Health Organization (WHO) recommended magnesium sulfate as the standard treatment for pre-eclampsia and eclampsia and within two years it was placed on WHO’s Essential Medicines List. Despite its known efficacy, this inexpensive drug is often underutilized, in part because the diffusion of innovation takes time but also because of the service delivery challenges inherent to the use of magnesium sulfate – it requires a strong and effective referral system, often a challenge in under-resourced health systems. The underutilization of magnesium sulfate has been a recognized problem in Nigeria for some time; prior to 2007 there was almost no magnesium sulfate in the country.
The significant contribution of pre-eclampsia/eclampsia to maternal mortality in Nigeria – along with the promise of magnesium sulfate as a solution – caught the attention of the Foundation in 2005 with a program officer overheard a conversation between two Nigeria doctors who were lamenting the failure of a piece of equipment in their hospital laboratory that was used for manufacturing magnesium sulfate. Without it, one was saying to the other, they would have no supply of the drug to treat pre-eclampsia/eclampsia and no way to save women’s lives. The Foundation decided to fund a series of grants to expand the use of magnesium sulfate for pre-eclampsia/eclampsia in Nigeria. Beginning in 2007, the MacArthur Foundation made a series of grants to both public and private organizations to integrate the use of magnesium sulfate into the Nigerian health system. The grantees worked synergistically and carried out concurrent activities that addressed product supply, tested and evaluated new protocols, expanded the model, and built capacity.
What We Evaluated
In 2014, MacArthur commissioned the Public Health Institute to conduct a process evaluation of the grants the Foundation had made to expand the use of magnesium sulfate as a treatment for pre-eclampsia/eclampsia in Nigeria. The purpose of the evaluation was to gain a deeper understanding of how these programs were implemented, where they were successful, and where they still face obstacles to scale up. A team of experts conducted a desk review of literature and grantee reports, interviewed global experts and local key information and stakeholders, and visited the program sites. In addition, available quantitative data was reviewed, with a focus on training records and hospital and health center service statistics gathered by grantees.
What We Learned
- The use of the drug was legitimized and integrated through the effective use of research and evaluation
- More operations research is needed to continue to scale up the program and overcome obstacles to full implementation, including the lack of adherence to quality control standards for the correct use of magnesium sulfate in clinical settings
- Stakeholders were engaged, support from and action by other organizations was galvanized, and a national constituency was built
- Tasks were shifted to include community health extension workers, though more investment is needed to improve the use of the referral system within primary healthcare facilities and among patients
- Financial resources were aligned and mobilized
- National guidelines and curricula were created and implemented
- Drug supply channels were strengthened and systems put in place to monitor the distribution system, though more work is needed to prevent the frequent stockouts of magnesium sulfate that occur throughout the country.