Tracking Scale Up of
Maternal and Newborn
Health Interventions
Jeffrey M. Smith
MCHIP
Interventions for Impact in
Essential Obstetric and Newborn Care
Africa Regional Meeting, 21-25 February, 2011
Child Mortality: 4 countries in Africa
2
Chad
Ethiopia
Kenya
Zambia
Maternal Mortality: 4 countries in Africa
3
Chad
Ethiopia
Kenya
Zambia
Scale up of PPH and PE/E interventions
4
Where are we?
And how dowe know?
How far do wehave to go?
Awoonor-Williams, et al. HEALTHPOLICY AND PLANNING; 20(1):25–34
Conceptual Map for Scale Up
Phases of implementation
Sequential in logic, not linear in time
An attempt to graphically represent theelements of a scale up approach
Not exhaustive or able to capture all details
6
PATHWAY TO IMPLEMENTATION OF
POSTPARTUM HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions for skilledbirth attendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financing ofmaternal healthservices
Drugs & equipment:Oxytocin/ misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raising ofPPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for all skilledbirth attendantcadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competencies inpre-service and in-service curricula
Clinical coverage:
High coverage use ofa uterotonic; Publicand privateimplementation
Drug & equipmentavailability:
Drugs and supplies ingovernment routineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
MCHIP/USAID active programs
Other partners active programs
Addressed previously, not active
No programs
PATHWAY TO IMPLEMENTATION OF
POSTPARTUM HEMORRHAGE PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions for skilledbirth attendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financing ofmaternal healthservices
Drugs & equipment:Oxytocin/ misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raising ofPPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for all skilledbirth attendantcadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competencies inpre-service and in-service curricula
Clinical coverage:
High coverage use ofa uterotonic; Publicand privateimplementation
Drug & equipmentavailability:
Drugs and supplies ingovernment routineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
MCHIP/USAID active programs
Other partners active programs
Addressed previously, not active
No programs
Mapping Scale up Process atNational Level
Analysis of national/MOHsituation
Participants and localcounterparts
Consideration of USAIDsupported efforts or otherpartner/donor supportedefforts
Previous efforts that werefully addressed in thepast
9
ANGOLA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions for skilledbirth attendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financing ofmaternal healthservices
Drugs & equipment:Oxytocin/ misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raising ofPPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for all skilledbirth attendantcadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competencies inpre-service and in-service curricula
Clinical coverage:
High coverage use ofa uterotonic; Publicand privateimplementation
Drug & equipmentavailability:
Drugs and supplies ingovernment routineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
MOZAMBIQUE - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
Introducing innovation
Moving toward sustainable impact at scale
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
GHANA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
GHS and partners activeprograming
Other partners, with GHS support
Addressed previously, notactive
No programs
SOUTH SUDAN - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions for skilledbirth attendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financing ofmaternal healthservices
Drugs & equipment:Oxytocin/ misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raising ofPPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for all skilledbirth attendantcadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competencies inpre-service and in-service curricula
Clinical coverage:
High coverage use ofa uterotonic; Publicand privateimplementation
Drug & equipmentavailability:
Drugs and supplies ingovernment routineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
LIBERIA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
ETHIOPIA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
MADAGASCAR- PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
MALAWI - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
NIGERIA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
RWANDA - PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
SENEGAL: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/procurement, logistics,distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementationAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
MCHIP/USAID active programs
Other partners active programs
Addressed previously, not active
No programs
81%
UGANDA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
ZAMBIA: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
ZIMBABWE: PATHWAY TO IMPLEMENTATION OF PPH PREVENTION AND MANAGEMENT AT SCALE
Global Actions
National StrategicChoices
Program Implementation
Sustainability /Institutionalization
Introduction
Early
Mature
Global advocacyand partnerships:Global action tosupport work onreduction of PPH
Global clinical andprogramapproaches:Evidence-basedinterventions forprevention andmanagement of PPHdemonstrated
PPH policy:AMTSL/misoprostoluse; Expanded jobdescriptions forskilled birthattendant cadresmanaging PPH; PPHservice deliveryguidelines
Health systemgovernance:Proactive financingof maternal healthservices
Drugs & equipment:Oxytocin/misoprostolprocurement,logistics, distribution
Service deliverycapacity at sites:Reliableinfrastructure,personnel, andsystems to deliverservices
Health workerstraining systems:
For PPH preventionand management
Communitymobilization:
Awareness raisingof PPH;
Birth preparedness
Pilot programs:
Phase 1implementation ofmisoprostol and/orAMTSL for allskilled birthattendant cadres
Program initiativesin obstetric andpostpartummanagement:
Quality of care;
Clinical training;
Supervision
Pharmaceuticalsystems:Uterotonics onEssential Drug Listand in DrugRegistration; Supplychain management
National advocacy:Expansion ofnational programand highlight workof champions
Standardization:Quality of careapproaches;
Government ledtraining expansion
Programmaticgrowth:
Adding districts,partners, financing
Training programs:
Governmentbudgeted trainingprograms on PPH;PPH competenciesin pre-service andin-service curricula
Clinical coverage:
High coverage useof a uterotonic;Public and privateimplementation
Drug & equipmentavailability:
Drugs and suppliesin governmentroutineprocurementmechanisms
REDUCTIONOF PPHANDIMPROVEDMATERNALHEALTHSTATUS
M&E
Readinessassessment
Pilot projectdata
Survey data
Indicators inHMIS
Routine monitoring
INTRODUCING INNOVATION
MOVING TOWARDS SUSTAINABLE IMPACT AT SCALE
Coverage of uterotonic in third stage of labour
0% 25% 50% 75% 100%
National Maps of Scale up Process
Tracking progress overtime
Platform for national andinternational conversationabout progress
Identifying gaps andsecuring additionalsupport / resources.
Please view the postersin the corridor!!
24
Thank you!
wwww.mchip.net
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