Table 3 Recommendations for overcoming the barriers identified

1. National treatment guidelines need to be up-dated to include MgSO4 for the treatment of severe pre-eclampsia, and the National Essential Medicine List and National Formulary need to be disseminated to all health facilities providing antenatal and delivery care, and to pharmacists working in the government stores and health facility pharmacies.

2. Magnesium sulphate needs to be registered with the PRA in order to ensure its safety, efficacy and quality.

3. Magnesium sulphate needs to be stocked at the Central Medical Store so that it can be made available to district hospitals and health centre

4. The market demand for MgSO4 needs to be determined, probably including a prospective study of the incidence of eclampsia and pre eclampsia.

5. In-service training for midwives and pharmacists needs to be co-ordinated with the availability of magnesium sulphate at the Central Medical Store, to avoid long periods between the training and using the product, and reinforcing the need for supply.