NATIONAL PROGRAMS TO PREVENT AND MANAGE PPH AND PE/E

2012 STATUS REPORT OF 37

COUNTRIES
Sheena Currie Senior Maternal Health Advisor MCHIP Acknowledgments Jeff Smith, Julia Perri, Tirza Canon, Julia Bluestone

MCHIP
Program Profile
USAIDs flagship maternal, newborn and child health program Period: October 2008 to September 2014 Approx $100 million / year Led by Jhpiego, with partners JSI, Save the Children, PSI, others Support program implementation Global MNH focus

Maternal Health

PPH

PE/E

MDG Website: Data for MDG 5

MDG Website: Data for MDG 4

Tracking Maternal Health Progress:

A Situation of Limited Data MDG Indicators:
% SBA % ANC 4 Contact, not content

Unfortunately, not:
Frequent Specific 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 Standard Delivery Guidelines and Essential Medicine Lists from 20 countries collected MCHIP team communicated with countries on gaps and completed analysis

2012 Questionnaire on PPH and PE/E

PPH and 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
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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/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

Oxytocin data, 2012

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Theme 1A: Availability of Uterotonics

Misoprostol regularly available in facilities, 2012 A complicated picture 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 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 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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Theme 2: Medicines Approved at the National Level

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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 seeis mixed

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

Increased availability of MgSO4 (by report)

2011: 48% of countries (15 of 31) 2012: 76% of countries (28 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 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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Maps on National Program for Postpartum Hemorrhage

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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 oxytocin Increased availability of MgSO4 Mixed picture of misoprostol on national EML Less progress with access to misoprostol Some movement in initial programs on use of misoprostol

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Actions to be Taken
Use the data for addressing global issues and improving country programs
Conversations with national MOHs, MCHIP

country 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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