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Multi country Analysis of Prevention of PPH and PE/E in USAID Program- Supported Countries <br />Carmen Crow & Mandy Hovla...
Overview<br />Broad Program Goal: <br />Accelerate the scale up of high impact interventions; <br />Achieve high coverage ...
3<br />4th Dimension<br />Program analysis: <br />Horizontally – globally across countries<br />Vertically – specifically,...
Methodology<br />35 Countries <br />January – March 2011<br />National level <br />46 item questionnaire<br />Group consen...
Questionnaire on PPH and PE/E<br />Postpartum Hemorrhage <br />Policy<br />Training <br />Misoprostol <br />Logistics<br /...
Results<br />Responses from 31 Countries: <br />Complete: 27 countries<br />Partial: 4 countries<br />Unable: 4 countries<...
Results<br />7<br />Results<br />Results<br />
8<br />
9<br />THEME 2: Education and Training in AMTSL<br />Figure 4: Survey responses from 31 countries: Education and training ...
10<br />
11<br />
12<br />THEME 5: Education and Training on PE/E Management Principles<br />Figure 7: Survey responses from 31 countries: E...
13<br />What we don’t have…<br />What we don’t have…<br />What we don’t have…<br />
What we don’t have…<br />Lack of coverage data <br />Not commonly in HMIS<br />Hospital/facility-based, not population-bas...
Child Mortality: 4 countries in Africa<br />15<br />Chad<br />Ethiopia<br />Zambia <br />Kenya<br />
Maternal Mortality: 4 countries in Africa<br />16<br />Chad<br />Ethiopia<br />Zambia <br />Kenya<br />
PATHWAY TO IMPLEMENTATION OF <br />POSTPARTUM HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE<br />Health system governance:...
Maps on Postpartum Hemorrhage<br />
ANGOLA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE<br />Health system governance: Proactive finan...
MOZAMBIQUE - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE<br />Health system governance: Proactive ...
GHANA- PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE<br />Health system governance: Proactive financ...
SOUTH SUDAN - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE<br />Health system governance: Proactive...
Maps on Pre-Eclampsia and Eclampsia<br />
ANGOLA: PATHWAY TO IMPLEMENTATION OF PE/E MANAGEMENT AT SCALE<br />Health system governance: Proactive financing of matern...
MALAWI - PATHWAY TO IMPLEMENTATION OF PE/E MANAGEMENT AT SCALE<br />Health system governance: Proactive financing of mater...
RWANDA- PATHWAY TO IMPLEMENTATION OF PE/E MANAGEMENT AT SCALE<br />Health system governance: Proactive financing of matern...
Conclusions<br />Policy is further ahead of practice – <br />Oxytocin/AMTSL and MgS are authorized, but not always complet...
Actions to be Taken<br />Use the data for addressing global issues and improving country programs <br />Conversations with...
Thank you<br />30<br />
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Implementing best practices postpartum hemorrhage_Crow and Hovland_10.14.11

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Implementing best practices postpartum hemorrhage_Crow and Hovland_10.14.11

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

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