national programs to prevent and manage pph and pe/e

7/29/2019 National Programs to Prevent and Manage PPH and PE/E

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NATIONAL PROGRAMSTOPREVENTAND MANAGEPPH AND PE/E

2012 STATUS REPORTOF 37COUNTRIES

Sheena CurrieSenior Maternal Health Advisor

MCHIP

Acknowledgments Jeff Smith, Julia

Perri, Tirza Canon, Julia Bluestone


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MCHIPProgram Profile USAIDs flagship

maternal, newborn andchild health program

Period: October 2008 toSeptember 2014

Approx $100 million /year

Led by Jhpiego, withpartners JSI, Save the

Children, PSI, others Support program

implementation

Global MNH focus

PPH

PE/E

Maternal Health


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MDG Website: Data for MDG 5

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MDG Website: Data for MDG 4

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Tracking Maternal Health Progress:A Situation of Limited Data

MDG Indicators: % SBA % ANC 4 Contact, not contentUnfortunately, not: Frequent Specific Accurate Comprehensive


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2012 Global Status ReportPurpose and Objectives

Address the need for better qualitative andoverarching quantitative data on maternal

health programs

Track and compare progress and setbacksby year

Provide some broad global and nationaltrends on MH program priorities

Identify areas of focus for future programming6


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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 Standard Delivery Guidelines

and Essential Medicine Listsfrom 20 countries collected

MCHIP team communicated withcountries on gaps and completedanalysis

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2012 Questionnaire on PPH and PE/E

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PPH and PE/E CoreComponents:

Policy Training Logistics M&E Programming Scale Up / Expansion

2011 and 2012questionnaires same

except for few questions.

Results comparable butmore precise.

Collaboration from otherpartners: MSH and VSI


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Results

Responses from 37countries:

Nearly all responsescomplete

7 new countries included: Cambodia, East Timor,

Ecuador, El Salvador,Pakistan, Philippines,

Yemen

One country unable toparticipate

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Presentation of Results

Findings in 8 themes

1A: Availability of medicines: Uterotonics

1B: Availability of medicines: Magnesium Sulfate

2: Medicines approved at national level

3: AMTSL

4: Misoprostol

5: Midwife/SBA scope of practice

6: Education / Training in PPH and PE/E7: 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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Oxytocin regularly available at facility, 2011 versus 2012


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Oxytocin data, 2012


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Misoprostol regularlyavailable in facilities, 2012

A complicated pictureemerges of miso availability:

Illustrative quotes

Misoprostol is not on [the]National EML of [our country], so

whenever it is required, it ispurchased.

The doctors prescribe it for thefamily of the patient, and the

family buys it from the private

pharmacy. Depends onwhether there is

sharing of supplies between

higher- and lower-level facilities

in the same area.

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Theme 1B: Availability of Medicines:Magnesium Sulfate

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Theme 1B: Availability of Medicines:Magnesium Sulfate

MgS04 availability increasing, from 2011 to 2012

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Frequency of Magnesium sulfatestockouts, 2012

Countries reveal a

supply chain and

distribution problem Stockouts occurapproximately 46% of the

time

MgS04 available in theMOH medical store 86% of

the time

MgS04 available in facilitiesonly 76% of the time

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Theme 2: Medicines Approved at theNational Level

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Theme 3: AMTSL

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Theme 3: AMTSL

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


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Theme 4: Misoprostol

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Theme 4: Misoprostol forhome birth, 2012

Home birth versus facility birth?

Illustrative quotes:

MOH supports primarily institutionalbirths. In 2007, [a donor] proposed

several efforts to MOH. No progresshas been seen due to the fear

among MOH officials that the use of

misoprostol will encourage illegal

abortion.

Pilot is ongoing, led by theUniversity Department of Obstetrics

and Gynecology. However, current

policy does not support home births;

mothers are supposed to deliver at

health facilities.22


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Theme 5: Midwifery/SBA scope ofpractice

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What we dont 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 rateAssisted vaginal deliveries rate Fresh stillbirth rate Stock out of MgSO4

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Maps on

NationalProgram forPostpartumHemorrhage


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Maps on

NationalPrograms forPre-Eclampsia

and Eclampsia


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Limitations

Self-reporting of data Limited ability to cross check things like

availability of medicines

Changes in national stakeholder teams from2011 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 ofoxytocin

Increased availability ofMgSO4

Mixed picture of misoprostolon national EML Less progress with access

to misoprostol

Some movement in initialprograms on use of

misoprostol

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Actions to be Taken

Use the data for addressing global issuesand improving country programs

Conversations with national MOHs, MCHIPcountry offices, other programs and partners

Repeat later this year Improve the quality of the data Promote the use of quantitative indicators Engage more countries

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