NATIONAL PROGRAMS TO PREVENT AND MANAGE PE/E

2012 STATUS REPORT

Jeffrey M. Smith Maternal Health Team Leader Sheena Currie Julia Perri Julia Bluestone Tirza Cannon 2012

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

Maternal Health

PE/E

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 PE/E

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

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 1B: Availability of medicines: Magnesium Sulfate 2: Medicines approved at national level 5: Midwife/SBA scope of practice 6: Education / Training in PPH and PE/E

Theme 1B: Availability of Medicines: Magnesium Sulfate

Theme 1B: Availability of Medicines: Magnesium Sulfate

MgS04 availability increasing, from 2011 to 2012

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Frequency of Magnesium sulfate stockouts, 2012

Countries reveal a supply chain and distribution problem
Stockouts occur approximately 46% of the time MgS04 available in the MOH medical store 86% of the time MgS04 available in facilities only 76% of the time
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Magnesium sulfate availability 30 countries, 2011 & 2012

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Theme 2: Medicines Approved at the National Level

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Theme 2: Medicines Approved at the national level, 2012 (n = 37)

Anti-hypertensives approved on national EML for use in severe PE First line anticonvulsants for severe PE/E

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Medicines approved by region, 2011 & 2012

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Theme 5: Midwifery/SBA scope of practice

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Not much change in the midwifery/SBA scope of practice

2011 (n=31)

Midwives authorized to diagnose severe PE/E & administer MgS04

2012 (n=37)

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Theme 6: Education/Training in Key MNH Skills

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The progress we see

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Mixed Progress
Increased availability of MgSO4 (by report)
2011: 48% of countries (15 of 31) 2012: 76% of countries (28 of 37)

By comparison: Increased availability of oxytocin (by report)

2011: 74% of countries (23 of 31) 2012: 89% of countries (33 of 37)

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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 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 Choices Program Implementation Introduction
Partnership development:

Early

Mature

Sustainability/ Institutionalization
Key

Proactive health services financing; Elimination of policy barriers to maternal health services

Health system governance:

NGOs, professional associations, local governments, university; Identification of MOH focal person/champions

Use of uterotonics; Clear job descriptions for skilled birth attendant cadres managing PPH; Service delivery guidelines for PPH

PPH policy:

Community awareness:
IEC/BCC; Awareness of SBA role; Awareness of dangers of PPH

Leadership by champions; PPH in partners agendas; Additional funding mobilized from partners

National advocacy:

Intersectoral partnerships; Regular additional funding from partners; Budget line item

National advocacy:

USAID-supported activity Activity from other donors/partners Addressed previously, not active No activity

Program expansion:
Dissemination of technical tools; Expansion to new regions/districts

Oxytocin/misoprostol procurement, logistics, distribution

Drugs & equipment:

Operations research on initial implementation of misoprostol and/or AMTSL for all SBA cadres

PPH Programs:

Health worker training system:

Qualified trainers/master trainers; Training capacity

Government-budgeted training programs on PPH; PPH competencies in preservice and in-service curricula

Training programs:

Technical components: Service delivery capacity at sites:

Reliable infrastructure, personnel and systems to deliver services Clinical standards development; Clinical training; Supervision

High coverage of uterotonic use; Public and private implementation

Clinical coverage:

REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS

Health workers training systems:

For PPH prevention and management

Uterotonics on Essential Medicines List and in Medicine Registration; Supply chain management
0%

Pharmaceutical systems:

MOH increasing ownership by analyzing data, making decisions and supervising

Programmatic growth:

Drugs and supplies in government routine procurement mechanisms

Drug & equipment availability:

Coverage of uterotonic in the third stage of labor 25% 50% 75% 100%

M&E

Readiness assessment

Initial program experience data

Survey data

Indicators in HMIS

Routine monitoring

INTRODUCING INNOVATION

MOVING TOWARD SUSTAINABLE IMPACT AT SCALE

Maps on National Programs for Pre-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 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 MgSO4 Heterogeneity in choice of antihypertensives PPH Programs more robust than PE/E Programs Although policy and program efforts for PPH and PE/E are being prioritized, internal inconsistencies of national guidelines andother documents are notable More progress needed with provider competence and confidence with MgS04

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Thank you
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