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Implementing best practices postpartum hemorrhage_Crow and Hovland_10.14.11

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  • MANDY
  • MANDYProgram Analysis- we are talking about high impact interventions in the prevention and management of PPH and PE/E You will notice that we talk here about the administration of the uterotonic Misoprostol for the prevention and management of PPH And the administration of the anti-convulsant Magnesium Sulfate for the management of severe pre eclampsia
  • CARMEN
  • CARMEN
  • CARMENResponses from 31 Countries: Complete: 27 countries (Tanzania and Zimbabwe separate) Partial: 4 countries (BG, Guatemala, Honduras, Nicaragua)Unable: 4 countries (Pakistan, Philippines, Peru, Cambodia)Results presented 4 waysMain issues expressed horizontally, across countries: Dichotomous bar graphs - Global picture Summary tables Responses to questionnaires (pages 18 – 96)Scale – up maps (pages 97 – 123)
  • CARMEN
  • CARMEN
  • MANDY
  • MANDYHighlight the strengths first
  • CARMEN
  • CARMEN
  • MANDY
  • MANDY
  • MANDY
  • MANDYWe only have regional data We can learn a great deal from child survival – identify the breakdown of these causes
  • CARMEN
  • CARMEN
  • CARMEN
  • CARMEN
  • CARMEN
  • MANDY
  • MANDY
  • MANDYLed by MOH
  • MANDY
  • CARMEN
  • MANDYIn this process, we engaged countries- data quality is important and we hope to improve it but this exercise was especially important for countries to be able to take a look at where they are in a structured way and identify where they need to go
  • Transcript

    • 1. Multi country Analysis of Prevention of PPH and PE/E in USAID Program- Supported Countries
      Carmen Crow & Mandy Hovland
      Jeffrey M. Smith
      Angie Fujioka
      14 October 2011
    • 2. Overview
      Broad Program Goal:
      Accelerate the scale up of high impact interventions;
      Achieve high coverage
      Monitor catalytic role of USAID in program expansion
      Need for both horizontal and vertical program status analysis
      Map USAID’s investment and country achievement over time
      2
    • 3. 3
      4th Dimension
      Program analysis:
      Horizontally – globally across countries
      Vertically – specifically, within country
      Depth – of program penetration in country
      Time – evolution or progress of programs with a country
    • 4. Methodology
      35 Countries
      January – March 2011
      National level
      46 item questionnaire
      Group consensus and self reporting
      English, French, Spanish
      4
    • 5. Questionnaire on PPH and PE/E
      Postpartum Hemorrhage
      Policy
      Training
      Misoprostol
      Logistics
      M&E
      Programming
      Scale Up / Expansion
      Pre-Eclampsia/Eclampsia
      Policy
      Training
      Logistics
      M&E
      Programming
      Scale Up / Expansion
      5
    • 6. Results
      Responses from 31 Countries:
      Complete: 27 countries
      Partial: 4 countries
      Unable: 4 countries
      Results presented 4 ways
      Main issues expressed horizontally, across countries:
      Dichotomous bar graphs - Global picture
      Summary tables
      Responses to questionnaires
      Scale – up maps
      6
    • 7. Results
      7
      Results
      Results
    • 8. 8
    • 9. 9
      THEME 2: Education and Training in AMTSL
      Figure 4: Survey responses from 31 countries: Education and training in AMTSL (Active Management Third Stage Labor)
    • 10. 10
    • 11. 11
    • 12. 12
      THEME 5: Education and Training on PE/E Management Principles
      Figure 7: Survey responses from 31 countries: Education and training on PE/E management principles
    • 13. 13
      What we don’t have…
      What we don’t have…
      What we don’t have…
    • 14. What we don’t have…
      Lack of coverage data
      Not commonly in HMIS
      Hospital/facility-based, not population-based
      Unable to track coverage over time
      MCHIP + WHO + CDC
      Global MNH benchmark indicators
      Use of a uterotonic immediately after birth
      Use of MgSO4 for diagnosis of severe PE or E
      Use of partograph for labor management
      Others
      14
    • 15. Child Mortality: 4 countries in Africa
      15
      Chad
      Ethiopia
      Zambia
      Kenya
    • 16. Maternal Mortality: 4 countries in Africa
      16
      Chad
      Ethiopia
      Zambia
      Kenya
    • 17. PATHWAY TO IMPLEMENTATION OF
      POSTPARTUM HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE
      Health system governance: Proactive financing of maternal health services
      Community mobilization:
      Awareness raising of PPH;
      Birth preparedness
      MCHIP/USAID active programs
      Other partners active programs
      Addressed previously, not active
      Training programs:
      Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula
      No programs
      National advocacy: Expansion of national program and highlight work of champions
      PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadresmanaging PPH; PPH service delivery guidelines
      Global advocacy and partnerships: Global action to support work on reduction of PPH
      Pilot programs:
      Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres
      REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS
      Clinical coverage:
      High coverage use of a uterotonic; Public and private implementation
      Standardization: Quality of care approaches;
      Government led training expansion
      Program initiatives in obstetric and postpartum management:
      Quality of care;
      Clinical training;
      Supervision
      Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services
      Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated
      Programmatic growth:
      Adding districts, partners, financing
      Drug & equipment availability:
      Drugsand supplies in government routine procurement mechanisms
      Health workers training systems:
      For PPH prevention and management
      Pharmaceutical systems: Uterotonics on Essential Drug Listand in Drug Registration;Supply chain management
      Drugs & equipment:Oxytocin/ misoprostol procurement, logistics, distribution
      Coverage of uterotonic in third stage of labour
      0% 25% 50% 75% 100%
    • 18. Maps on Postpartum Hemorrhage
    • 19. ANGOLA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
      Health system governance: Proactive financing of maternal health services
      Community mobilization:
      Awareness raising of PPH;
      Birth preparedness
      Training programs:
      Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula
      National advocacy: Expansion of national program and highlight work of champions
      PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadresmanaging PPH; PPH service delivery guidelines
      Global advocacy and partnerships: Global action to support work on reduction of PPH
      Pilot programs:
      Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres
      REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS
      Clinical coverage:
      High coverage use of a uterotonic; Public and private implementation
      Standardization: Quality of care approaches;
      Government led training expansion
      Program initiatives in obstetric and postpartum management:
      Quality of care;
      Clinical training;
      Supervision
      Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services
      Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated
      Programmatic growth:
      Adding districts, partners, financing
      Drug & equipment availability:
      Drugsand supplies in government routine procurement mechanisms
      Health workers training systems:
      For PPH prevention and management
      Pharmaceutical systems: Uterotonics on Essential Drug Listand in Drug Registration;Supply chain management
      Drugs & equipment:Oxytocin/ misoprostol procurement, logistics, distribution
      Coverage of uterotonic in third stage of labour
      0% 25% 50% 75% 100%
    • 20. MOZAMBIQUE - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
      Health system governance: Proactive financing of maternal health services
      Community mobilization:
      Awareness raising of PPH;
      Birth preparedness
      Training programs:
      Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula
      National advocacy: Expansion of national program and highlight work of champions
      PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadresmanaging PPH; PPH service delivery guidelines
      Global advocacy and partnerships: Global action to support work on reduction of PPH
      Pilot programs:
      Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres
      REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS
      Clinical coverage:
      High coverage use of a uterotonic; Public and private implementation
      Standardization: Quality of care approaches;
      Government led training expansion
      Program initiatives in obstetric and postpartum management:
      Quality of care;
      Clinical training;
      Supervision
      Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services
      Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated
      Programmatic growth:
      Adding districts, partners, financing
      Drug & equipment availability:
      Drugsand supplies in government routine procurement mechanisms
      Health workers training systems:
      For PPH prevention and management
      Pharmaceutical systems: Uterotonics on Essential Drug Listand in Drug Registration;Supply chain management
      Drugs & equipment:Oxytocin/ misoprostol procurement, logistics, distribution
      Coverage of uterotonic in third stage of labour
      0% 25% 50% 75% 100%
    • 21. GHANA- PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
      Health system governance: Proactive financing of maternal health services
      GHS and partners active programing
      Community mobilization:
      Awareness raising of PPH;
      Birth preparedness
      Other partners, with GHS support
      Addressed previously, not active
      Training programs:
      Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula
      No programs
      National advocacy: Expansion of national program and highlight work of champions
      PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadresmanaging PPH; PPH service delivery guidelines
      Global advocacy and partnerships: Global action to support work on reduction of PPH
      Pilot programs:
      Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres
      REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS
      Clinical coverage:
      High coverage use of a uterotonic; Public and private implementation
      Standardization: Quality of care approaches;
      Government led training expansion
      Program initiatives in obstetric and postpartum management:
      Quality of care;
      Clinical training;
      Supervision
      Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services
      Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated
      Programmatic growth:
      Adding districts, partners, financing
      Drug & equipment availability:
      Drugsand supplies in government routine procurement mechanisms
      Health workers training systems:
      For PPH prevention and management
      Pharmaceutical systems: Uterotonics on Essential Drug Listand in Drug Registration;Supply chain management
      Drugs & equipment:Oxytocin/ misoprostol procurement, logistics, distribution
      Coverage of uterotonic in third stage of labour
      0% 25% 50% 75% 100%
    • 22. SOUTH SUDAN - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
      Health system governance: Proactive financing of maternal health services
      Community mobilization:
      Awareness raising of PPH;
      Birth preparedness
      Training programs:
      Government budgeted training programs on PPH; PPH competencies in pre-service and in-service curricula
      National advocacy: Expansion of national program and highlight work of champions
      PPH policy: AMTSL/misoprostol use; Expanded job descriptions for skilled birth attendant cadres managing PPH; PPH service delivery guidelines
      Global advocacy and partnerships: Global action to support work on reduction of PPH
      Pilot programs:
      Phase 1 implementation of misoprostol and/or AMTSL for all skilled birth attendant cadres
      REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS
      Clinical coverage:
      High coverage use of a uterotonic; Public and private implementation
      Standardization: Quality of care approaches;
      Government led training expansion
      Program initiatives in obstetric and postpartum management:
      Quality of care;
      Clinical training;
      Supervision
      Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services
      Global clinical and program approaches: Evidence-based interventions for prevention and management of PPH demonstrated
      Programmatic growth:
      Adding districts, partners, financing
      Drug & equipment availability:
      Drugs and supplies in government routine procurement mechanisms
      Health workers training systems:
      For PPH prevention and management
      Pharmaceutical systems: Uterotonics on Essential Drug List and in Drug Registration; Supply chain management
      Drugs & equipment:Oxytocin/ misoprostol procurement, logistics, distribution
      Coverage of uterotonic in third stage of labour
      0% 25% 50% 75% 100%
    • 23. Maps on Pre-Eclampsia and Eclampsia
    • 24. ANGOLA: PATHWAY TO IMPLEMENTATION OF PE/E MANAGEMENT AT SCALE
      Health system governance: Proactive financing of maternal health services
      Community mobilization:
      Awareness raising of PE/E;
      Birth preparedness
      Training programs: Government budgeted training programs on PE/E; PE/E competencies in pre-service and in-service curricula
      National advocacy: Expansion of national program and highlight work of champions
      Global advocacy and partnerships:
      Global action to support work on prevention, early detection, and management of PE/E
      PE/E policy:
      Calcium supplementation; Screening in ANC; MgSO4 for clinically diagnosed severe PE/E cases; PE/E service delivery guidelines
      IMPROVED
      MANAGEMENT OF PE/E CASES AND REDUCED MATERNAL & PERINATAL MORTALITY
      Pilot programs:
      Phase 1 implementation of MgSO4 and other interventions for severe PE/E
      Clinical coverage:
      High coverage use of MgSO4; High coverage calcium supplementation; Public and private implementation
      Standardization:
      Quality of Care approaches;
      Government led training expansion
      Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services
      Program initiatives in ANC & obstetric management:
      Quality of care;
      Clinical training;
      Supervision
      Global clinical and program approaches: Evidence-based interventions for prevention, early detection, and management of PE/E demonstrated
      Programmatic growth:
      Adding districts, partners, financing
      Drug & equipment availability:
      Drugs, supplies, and diagnostic tools in government routine procurement mechanisms
      Health worker training systems:
      For PE/E prevention and management
      Pharmaceutical systems:
      Drug registration; Essential Drug List; Supply chain management
      Drugs & equipment:
      Procurement, logistics, distribution
      Coverage of MgS04 for severe PE/E
      0% 25% 50% 75% 100%
    • 25. MALAWI - PATHWAY TO IMPLEMENTATION OF PE/E MANAGEMENT AT SCALE
      Health system governance: Proactive financing of maternal health services
      Community mobilization:
      Awareness raising of PE/E;
      Birth preparedness
      Training programs: Government budgeted training programs on PE/E; PE/E competencies in pre-service and in-service curricula
      National advocacy: Expansion of national program and highlight work of champions
      Global advocacy and partnerships:
      Global action to support work on prevention, early detection, and management of PE/E
      PE/E policy:
      Calcium supplementation; Screening in ANC; MgSO4 for clinically diagnosed severe PE/E cases; PE/E service delivery guidelines
      IMPROVED
      MANAGEMENT OF PE/E CASES AND REDUCED MATERNAL & PERINATAL MORTALITY
      Pilot programs:
      Phase 1 implementation of MgSO4 and other interventions for severe PE/E
      Clinical coverage:
      High coverage use of MgSO4; High coverage calcium supplementation; Public and private implementation
      Standardization:
      Quality of Care approaches;
      Government led training expansion
      Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services
      Program initiatives in ANC & obstetric management:
      Quality of care;
      Clinical training;
      Supervision
      Global clinical and program approaches: Evidence-based interventions for prevention, early detection, and management of PE/E demonstrated
      Programmatic growth:
      Adding districts, partners, financing
      Drug & equipment availability:
      Drugs, supplies, and diagnostic tools in government routine procurement mechanisms
      Health worker training systems:
      For PE/E prevention and management
      Pharmaceutical systems:
      Drug registration; Essential Drug List; Supply chain management
      Drugs & equipment:
      Procurement, logistics, distribution
      Coverage of MgS04 for severe PE/E
      0% 25% 50% 75% 100%
    • 26.
    • 27. RWANDA- PATHWAY TO IMPLEMENTATION OF PE/E MANAGEMENT AT SCALE
      Health system governance: Proactive financing of maternal health services
      Community mobilization:
      Awareness raising of PE/E;
      Birth preparedness
      Training programs: Government budgeted training programs on PE/E; PE/E competencies in pre-service and in-service curricula
      National advocacy: Expansion of national program and highlight work of champions
      Global advocacy and partnerships:
      Global action to support work on prevention, early detection, and management of PE/E
      PE/E policy:
      Calcium supplementation; Screening in ANC; MgSO4 for clinically diagnosed severe PE/E cases; PE/E service delivery guidelines
      IMPROVED
      MANAGEMENT OF PE/E CASES AND REDUCED MATERNAL & PERINATAL MORTALITY
      Pilot programs:
      Phase 1 implementation of MgSO4 and other interventions for severe PE/E
      Clinical coverage:
      High coverage use of MgSO4; High coverage calcium supplementation; Public and private implementation
      Standardization:
      Quality of Care approaches;
      Government led training expansion
      Service delivery capacity at sites: Reliable infrastructure, personnel, and systems to deliver services
      Program initiatives in ANC & obstetric management:
      Quality of care;
      Clinical training;
      Supervision
      Global clinical and program approaches: Evidence-based interventions for prevention, early detection, and management of PE/E demonstrated
      Programmatic growth:
      Adding districts, partners, financing
      Drug & equipment availability:
      Drugs, supplies, and diagnostic tools in government routine procurement mechanisms
      Health worker training systems:
      For PE/E prevention and management
      Pharmaceutical systems:
      Drug registration; Essential Drug List; Supply chain management
      Drugs & equipment:
      Procurement, logistics, distribution
      Coverage of MgS04 for severe PE/E
      0% 25% 50% 75% 100%
    • 28. Conclusions
      Policy is further ahead of practice –
      Oxytocin/AMTSL and MgS are authorized, but not always completely practiced
      Key principles of PPH prevention and PE/E management are generally in training and education (content not analyzed)
      Implementation of PPH Prevention at Homebirth with misoprostol programs are patchy
      Oxytocin and MgSO4are not routinely available at health facilities
      28
    • 29. Actions to be Taken
      Use the data for addressing global issues and improving country programs
      Conversations with MCHIP country offices
      Other bilaterals and partners
      Repeat on annual basis
      Improve the quality of the data
      Engage more countries
      29
    • 30. Thank you
      30

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