National Programs to Prevent and Manage PE/E, JSmith, FIGO2012

7/31/2019 National Programs to Prevent and Manage PE/E, JSmith, FIGO2012

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NATIONAL PROGRAMSTOPREVENTAND MANAGEPE/E

2012 STATUS REPORT

Jeffrey M. Smith

Maternal Health Team Leader

Sheena Currie

Julia Perri

Julia Bluestone

Tirza Cannon

2012


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MCHIPProgram Profile

USAIDs flagship

maternal, newborn andchild health program

Period: October 2008 toSeptember 2013

Approx $100 million / year

Led by Jhpiego, withpartners JSI, Save theChildren, PSI, others

Support programimplementation

Global MNH focus

PE/E

Maternal Health


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Tracking Maternal Health Progress:A Situation of Limited Data

MDG Indicators: % SBA

% ANC 4

Contact, not content

Unfortunately, not: Frequent

Specific

Precise Accurate

Comprehensive


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2012 Global Status ReportPurpose and Objectives

Address the need for better qualitative andoverarching quantitative data on maternalhealth programs

Track and compare progress and setbacksby 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 nationalstakeholders

Data collection 44 item questionnaire

Scale up maps: PPH & PE/E

English, French, Spanish

SDGs and EMLs collected

MCHIP team communicated withcountries on gaps and completedanalysis

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2012 Questionnaire on PE/E

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PE/E CoreComponents:

Policy

Training

Logistics

M&E

Programming Scale Up / Expansion

2011 and 2012questionnaires sameexcept 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, EastTimor, Ecuador, ElSalvador, Pakistan,Philippines, Yemen

One country unable toparticipate this year

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Presentation of Results

Findings in 8 themes1B: 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

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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 asupply chain anddistribution problem

Stockouts occurapproximately 46% of thetime

MgS04 available in theMOH medical store 86% of

the time

MgS04 available in facilitiesonly 76% of the time

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Magnesium sulfate availability30 countries, 2011 & 2012

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Theme 2: Medicines Approved at theNational Level

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

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First lineanticonvulsants for

severe PE/EAnti-hypertensives

approved on national EMLfor use in severe PE


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Medicines approved by region,2011 & 2012

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Theme 5: Midwifery/SBA scope ofpractice

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Not much change in themidwifery/SBA scope of practice

Midwives authorizedto diagnose severePE/E & administer

MgS04

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2012 (n=37)2011 (n=31)


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Theme 6: Education/Training in KeyMNH 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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Use of uterotonics; Clear

job descriptions for skilled

birth attendant cadres

managing PPH; Service

delivery guidelines for PPH

Proactive health services

financing; Elimination of

policy barriers to maternal

health services

Oxytocin/misoprostol

procurement, logistics,

distribution

Reliable infrastructure,

personnel and systems to

deliver services

For PPH prevention and

management

REDUCTION

OF PPH AND

IMPROVED

MATERNAL

HEALTH

STATUS

INTRODUCING INNOVATION MOVING TOWARD SUSTAINABLE IMPACT AT SCALE

0% 25% 50% 75% 100%

Activity from other donors/partners

USAID-supported activity

Addressed previously, not active

No activity

National Strategic

Choices

Program Implementation Sustainability/

InstitutionalizationIntroduction Early Mature

M&E Readiness assessmentInitial program

experience dataSurvey data Indicators in HMIS Routine monitoring

Leadership by

champions; PPH in

partners agendas;

Additional funding

mobilized from partners

Qualified

trainers/master

trainers; Training

capacity

MOH increasing

ownership by analyzing

data, making decisions

and supervising

Dissemination of

technical tools;

Expansion to new

regions/districts

Government-budgeted

training programs on

PPH; PPH

competencies in pre-

service and in-servicecurricula

High coverage of

uterotonic use; Public

and private

implementation

Drugs and supplies in

government routine

procurement

mechanisms

Intersectoral

partnerships; Regular

additional funding

from partners;

Budget line item

NGOs, professional

associations, local

governments, university;

Identification of MOH focal

person/champions

Operations research on

initial implementation of

misoprostol and/or AMTSL

for all SBA cadres

Clinical standards

development;

Clinical training;

Supervision

Uterotonics on Essential

Medicines List and in

Medicine Registration;

Supply chain management

IEC/BCC; Awareness of

SBA role; Awareness of

dangers of PPH


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Maps on National

Programs forPre-Eclampsiaand Eclampsia


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Limitations

Self-reporting of data

Limited ability to cross check things likeavailability of medicines

Changes in national stakeholder teams from2011 to 2012

Possibility of translation nuances/error

Scale-up maps are open to interpretation, arecomplicated to fill out, and are difficult tocompare 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 nationalguidelines andother documents are notable

More progress needed with provider competence andconfidence with MgS04

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Thank you


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