NATIONAL PROGRAMS TO

PREVENT AND MANAGE

PPH
2012 STATUS REPORT

Jeffrey M. Smith
Maternal Health Team Leader

Sheena Currie
Julia Perri
Julia Bluestone
Tirza Cannon

2012
MCHIP
Program Profile
 USAID’s flagship
maternal, newborn and
child health program Maternal Health
 Period: October 2008 to
September 2013
 Approx $100 million / year
 Led by Jhpiego, with
partners JSI, Save the PPH
Children, PSI, others
 Support program
implementation
 Global MNH focus

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Tracking Maternal Health Progress:
A Situation of Limited Data
MDG Indicators:
 % SBA
 % ANC 4
 Contact, not content
Unfortunately, not:
 Frequent
 Specific
 Precise
 Accurate
 Comprehensive
2012 Global Status Report
Purpose and Objectives

 Address the need for better qualitative and

overarching quantitative data on maternal
health programs
 Track and compare progress and setbacks
by year
 Provide some broad global and national
trends on MH program priorities
 Identify areas of focus for future programming

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Methods
 37 Countries
 January – March 2012
 Self reporting from national
stakeholders
 Data collection
 44 item questionnaire
 Scale up maps: PPH & PE/E
 English, French, Spanish
 SDGs and EMLs collected
 MCHIP team communicated with
countries on gaps and completed
analysis

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2012 Questionnaire on PPH

PPH Core Components:  Collaboration from other

 Policy partners: MSH and VSI
 Training
 Logistics  2011 and 2012
 M&E questionnaires same
 Programming except for few questions.
 Scale Up / Expansion  Results comparable but
more precise.

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 Results
Responses from 37
countries:
 Nearly all responses
complete
 7 new countries included:
 Cambodia, East
Timor, Ecuador, El
Salvador, Pakistan,
Philippines, Yemen
 One country unable to
participate this year
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Presentation of Results
Findings in 8 themes
1: Availability of medicines: Uterotonics
3: AMTSL
4: Misoprostol
5: Midwife/SBA scope of practice
6: Education / Training in PPH and PE/E
7: National Reporting on Selected MH Indicators
8: Potential for Scale-Up and bottlenecks

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Theme 1A: Availability of Uterotonics

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 Theme 1A: Availability of Uterotonics

Oxytocin regularly available at facility, 2011 versus 2012

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Theme 1A: Availability of Uterotonics
Misoprostol regularly A complicated picture
available in facilities, 2012 emerges of miso availability:
Illustrative quotes
 “Misoprostol is not on [the]
National EML of [our country],
so whenever it is required, it is
purchased.”
 “The doctors prescribe it for the
family of the patient, and the
family buys it from the private
pharmacy.”
 Depends on…whether there is
sharing of supplies between
higher- and lower-level facilities
in the same area.”
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Oxytocin regularly available in
facilities in 2011 and 2012, by region

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Oxytocin regularly available in
facilities in 2011 and 2012, by region

AFRICA: Uterotonics

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Theme 3: AMTSL

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Theme 3: AMTSL
Percentage of SDGs Correctly Containing Components of AMTSL (n=21*)

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Theme 4: Misoprostol

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 Theme 4: Misoprostol for
home birth, 2012
Home birth versus facility birth?
Illustrative quotes:
 “MOH supports primarily institutional
births. In 2007, [a donor] proposed
several efforts to MOH. No progress
has been seen due to the fear
among MOH officials that the use of
misoprostol will encourage illegal
abortion.”
 “Pilot is ongoing, led by the
University Department of Obstetrics
and Gynecology. However, current
policy does not support home births;
mothers are supposed to deliver at
health facilities.”
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Theme 5: Midwifery/SBA scope of
practice

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The progress we see

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Mixed Progress
 Increased availability of oxytocin (by report)
 2011: 74% of countries (23 of 31)
 2012: 89% of countries (33 of 37)

 Mixed picture of misoprostol on national EML

 2011: 61% of countries (19 of 31)
 2012: 57% of countries (21 of 37)
 (2011 misoprostol added to WHO EML for prevention PPH)

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What we don’t have
 Coverage data
 Not commonly in HMIS
 Hospital/facility-based, not population-based
 Unable to track coverage over time
 MCHIP + WHO + US-CDC
 Global MNH benchmark indicators
• Use of a uterotonic immediately after birth
• Cesarean section rate
• Assisted vaginal deliveries rate
• Fresh stillbirth rate
• Stock out of MgSO4

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 (Country name) PATHWAY TO IMPLEMENTATION OF
POSTPARTUM HEMORRHAGE (PPH) PREVENTION AND MANAGEMENT AT SCALE

National Strategic Program Implementation Sustainability/

Choices Institutionalization
Introduction Early Mature
Key

Health system Partnership USAID-supported activity

governance: development: Activity from other donors/partners
NGOs, professional
National advocacy:
Proactive health services National advocacy: Intersectoral Addressed previously, not active
financing; Elimination of associations, local
Leadership by partnerships; Regular No activity
policy barriers to maternal governments, university;
Identification of MOH focal champions; PPH in additional funding
health services partners’ agendas; from partners;
person/champions
Additional funding Budget line item
PPH policy: mobilized from partners
Community awareness:
Use of uterotonics; Clear IEC/BCC; Awareness of Training programs:
job descriptions for skilled SBA role; Awareness of
Program expansion: Government-budgeted
birth attendant cadres dangers of PPH Dissemination of training programs on
managing PPH; Service technical tools; PPH; PPH REDUCTION
delivery guidelines for PPH Expansion to new competencies in pre-
PPH Programs: OF PPH AND
regions/districts service and in-service
Operations research on IMPROVED
curricula MATERNAL
Drugs & equipment: initial implementation of
Health worker
Oxytocin/misoprostol misoprostol and/or AMTSL HEALTH
for all SBA cadres training system:
procurement, logistics, Clinical coverage: STATUS
Qualified
distribution High coverage of
trainers/master
Technical components: trainers; Training uterotonic use; Public
Clinical standards capacity and private
Service delivery capacity implementation
development;
at sites: Clinical training;
Reliable infrastructure, Programmatic
Supervision
personnel and systems to growth: Drug & equipment
deliver services MOH increasing availability:
Pharmaceutical ownership by analyzing Drugs and supplies in
systems: data, making decisions government routine
Health workers training Uterotonics on Essential and supervising procurement
systems: Medicines List and in mechanisms
For PPH prevention and Medicine Registration;
management Supply chain management Coverage of uterotonic in the third stage of labor

0% 25% 50% 75% 100%

Initial program
M&E Readiness assessment Survey data Indicators in HMIS Routine monitoring
experience data

INTRODUCING INNOVATION MOVING TOWARD SUSTAINABLE IMPACT AT SCALE

Maps on
National
Program for
Postpartum
Hemorrhage
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Limitations

 Self-reporting of data
 Limited ability to cross check things like
availability of medicines
 Changes in national stakeholder teams from
2011 to 2012
 Possibility of translation nuances/error
 Scale-up maps are open to interpretation, are
complicated to fill out, and are difficult to
compare from year-to-year
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Conclusions
 Increased availability of
oxytocin
 Mixed picture of misoprostol
on national EML
 Less progress with access
to misoprostol
 Some movement in initial
programs on use of
misoprostol
 Although policy and
program efforts for PPH and
PE/E are being prioritized,
internal inconsistencies of
national guidelines and
other documents are
notable

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Thank you
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www.mchip.net/globalstatusreport

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