2012 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
MCHIP Program Profile USAID s 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 2
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 4
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 5
2012 Questionnaire on PE/E PE/E Core Components: Policy Training Logistics M&E Programming Scale Up / Expansion Collaboration from other partners: MSH and VSI 2011 and 2012 questionnaires same except for few questions. Results comparable but more precise. 6
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 7
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 8
Theme 1B: Availability of Medicines: Magnesium Sulfate 9
Theme 1B: Availability of Medicines: Magnesium Sulfate MgS04 availability increasing, from 2011 to 2012 10
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 11
Magnesium sulfate availability 30 countries, 2011 & 2012 12
Theme 2: Medicines Approved at the National Level 13
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 14
Medicines approved by region, 2011 & 2012 15
Theme 5: Midwifery/SBA scope of practice 16
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) 17
Theme 6: Education/Training in Key MNH Skills 18
The progress we see 19
Mixed Progress Increased availability of MgSO 4 (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) 20
What we don t 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 21
(Country name) PATHWAY TO IMPLEMENTATION OF POSTPARTUM HEMORRHAGE (PPH) PREVENTION AND MANAGEMENT AT SCALE National Strategic Choices Program Implementation Introduction Early Mature Sustainability/ Institutionalization Key Health system governance: Proactive health services financing; Elimination of policy barriers to maternal health services PPH policy: Use of uterotonics; Clear job descriptions for skilled birth attendant cadres managing PPH; Service delivery guidelines for PPH Drugs & equipment: Oxytocin/misoprostol procurement, logistics, distribution Service delivery capacity at sites: Reliable infrastructure, personnel and systems to deliver services Health workers training systems: For PPH prevention and management Partnership development: NGOs, professional associations, local governments, university; Identification of MOH focal person/champions Community awareness: IEC/BCC; Awareness of SBA role; Awareness of dangers of PPH PPH Programs: Operations research on initial implementation of misoprostol and/or AMTSL for all SBA cadres Technical components: Clinical standards development; Clinical training; Supervision Pharmaceutical systems: Uterotonics on Essential Medicines List and in Medicine Registration; Supply chain management National advocacy: Leadership by champions; PPH in partners agendas; Additional funding mobilized from partners Program expansion: Dissemination of technical tools; Expansion to new regions/districts Health worker training system: Qualified trainers/master trainers; Training capacity Programmatic growth: MOH increasing ownership by analyzing data, making decisions and supervising National advocacy: Intersectoral partnerships; Regular additional funding from partners; Budget line item Training programs: Government-budgeted training programs on PPH; PPH competencies in preservice and in-service curricula Clinical coverage: High coverage of uterotonic use; Public and private implementation Drug & equipment availability: Drugs and supplies in government routine procurement mechanisms Coverage of uterotonic in the third stage of labor USAID-supported activity Activity from other donors/partners Addressed previously, not active No activity REDUCTION OF PPH AND IMPROVED MATERNAL HEALTH STATUS 0% 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 30
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 31
Thank you 32
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