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