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NATIONAL PROGRAMS TO PREVENT AND MANAGE PPH AND PE/E

2012 MULTI COUNTRY ANALYSIS USAID-SUPPORTED COUNTRIES

Jeffrey M. Smith Sheena Currie Tirza Cannon Julia Perri 6 May 2012

Purpose and Objectives


Address the need for better qualitative and overarching quantitative data on maternal health programs Provide some broad global and national trends on program priorities in maternal health Identify areas of focus for future programming
Both at national and global level

Methodology
41 Countries January March 2012 National level Self reporting of national stakeholder group Data collection
44 item questionnaire Scale up maps: PPH & PE/E English, French, Spanish

2012 Questionnaire on PPH and PE/E


PPH and PE/E 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.

Results
Responses from 37 countries:
All responses complete
7 new countries included:
Cambodia, East Timor, Ecuador, El Salvador, Pakistan, Philippines, Yemen

One country unable to participate this year

Presentation of Results
Findings in 8 themes 1A: Availability of medicines: Uterotonics 1B: Availability of medicines for PE/E MgSO4 and antihypertensives 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: Monitoring and evaluation 8: Scale up and bottlenecks
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Presentation of Results
Findings in 8 themes
Global status of 2012 Comparisons of questions between 2011 and

2012 Changes by country from 2011 to 2012

Qualitative review of certain data Full responses to questionnaires Scale up maps

THEME 1A: Availability of Uterotonics

THEME 1A: Availability of Uterotonics


2011
Oxytocin regularly available at facility

2012
Oxytocin regularly available in facilities
0% 11%

26%

Availability of Uterotonics in Health Facilities, 2011 and 2012


n = 31
Yes No

35% 74%

54%

Regularly Less than half the time

More than half the time Never

n = 37

2012

Message: Oxytocin availability increasing ; misoprostol availability needs to be watched closely


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Misoprostol regularly available in facilities

19% 38% 8%

35%

Regularly Less than half the time

More than half the time Never

n = 37

THEME 1A: Availability of Uterotonics

2011
Misoprostol on the EML for prevention of PPH

2012
Misoprostol on the EML for prevention of PPH

Misoprostol inclusion on EML, 2011 and 2012

39% 61%

43%
57%

n = 31
Yes No Yes No

n = 37

10 Message: Misoprostol inclusion on EML is lagging

Progress in Countries, 2011 2012


Oxytocin regularly available in facilities 2011 yes
Afghanistan Angola Bangladesh Bolivia DRC Ethiopia Eq. Guinea Ghana Guatemala Guinea Honduras India Indonesia Kenya Liberia Madagascar Malawi
Mali Mozambique Nepal Nicaragua Nigeria Paraguay Rwanda Senegal South Sudan Tanzania Uganda Zanzibar Zimbabwe

Misoprostol on the EML 2011 2012 no yes no yes

2012 no yes no

THEME 1B: Approval and Availability of MgSO4

THEME 1B: Approval and Availability of MgSO4

Availability of MgSO4 in Health Facilities, 2011 and 2012 2011


MgSO4 regularly available in facility

2012
MgS04 regularly available in facilities
0%

24% 48%

52%

49%

27%

2012
Yes No

n = 31

Regularly Less than half the time

More than half the time Never

n = 37

Message: Magnesium availability increasing


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THEME 1B: Approval and availability of MgSO4


Change in the Availability of MgSO4, by Region, 2011 and 2012

THEME 2: Medicines Approved at the National Level, data 2012, n = 37

First line anticonvulsants for severe PE/E

Anti-hypertensives approved on national EML for use in severe PE

THEME 3: Use of Active Management to prevent PPH, 2012 (n=37)

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THEME 4: Programs to prevent PPH at homebirth using misoprostol

Preventing PPH with misoprostol: Program piloting and scale up, 2012 data, n = 37
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What progress have we seen

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

Increased availability of MgSO4


2011: 48% of countries (15 of 31) 2012: 76% of countries (28 of 37)

Mixed picture of misoprostol on national EML Recall that in 2011 misoprostol added to WHO EML
2011: 61% of countries (19 of 31)

2012: 57% of countries (21 of 37)


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Conclusions
Some drugs are more available We lack coverage data for use of these drugs Variety in approval of different antihypertensives Mixed picture of misoprostol on national EML Some movement in initial programs on use of misoprostol PPH Programs more robust than PE/E Programs

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Thank you
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