In 2003, following a request from three leading African obstetrician-gynecologists, Venture Strategies for Health and Development began a program to explore misoprostol availability for the prevention and treatment of postpartum hemorrhage (PPH). Despite evidence supporting misoprostol’s effectiveness for PPH management, there was limited evidence on how the drug (which was only registered for the prevention and treatment of gastric ulcers at the time) could be distributed and used at the community-level.

In 2006, following a series of meetings convened by VSHD with government stakeholders and policy makers, professional medical associations, NGOs and regulatory agencies, Nigeria became the first country to grant regulatory approval of misoprostol for PPH prevention and treatment. Tanzania followed suit in 2007, quickly followed by Bangladesh, Nepal, Zambia, and Ghana.

After these early successes, VSHD recognized that to ensure product availability, there was a need to move beyond simply facilitating regulatory approval of misoprostol. Developing policies for misoprostol use and generating evidence that documented how it could be successfully distributed and used were identified as key to ensuring that it could be integrated into health systems to enable its long-term availability and use.